Hypocalcemia and nutritional rickets in children: common etiological factors

Hypocalcemia can be defined as a state when serum calcium level is less than 7 mg/dl in preterm neonates and less than 8 mg/dl in term neonates and less than 8.5 mg/dl in older children. Nutritional rickets is commonly associated with rickets in children. To determine the common etiological factors of hypocalcemia and nutritional rickets in children. Cross sectional analytical study. This study was conducted in the department of Pediatrics, King Edward Medical University/Mayo hospital Lahore from March 1998 to January 2001. 120 patients [2 months to 60 months] who presented with tetany, clinical and skeletal manifestations of rickets and seizures were included in the study. Biochemical profile [serum calcium, phosphate and alkaline phosphatase] and radiographs of wrist joint were done. Each child was accessed for age, sex, feeding pattern, exposure to sunlight, number of children in family, maternal age, educational sta tus of mothers, presenting features of the disease, total calcium, phosphate and alkaline phosphatase level in the serum and X-ray wrist. The study group comprised of 120 children [72 boys and 48 girls] ranging from 2 months to 3.5 years. 65% of the children had weight below 5th centile on National Center for Health Statistics charts. 32% of children got sunlight exposure for less than 30 minutes/week and 16% got it for 30-120 minutes/week. Out of total 120, 110 were below 2years among these 110, 9% were exclusive breast fed, 35% got diluted fresh milk, 1% got formula milk and 13% got both breast and bottle feeding. In 45% children weaning was not started. 47.5% couples had 2 or more children. 72% mothers were below 30 years of age, at the time of interview. 31% of the mothers were uneducated. 85% children had seizures at the time of presentation. Out of these 24.51% had upper respiratory tract infection and 51.96% had lower respiratory tract infection 79% had clinical signs of florid rickets. 67.5% of patients were had serum calcium between 6 and 7mg/dl, 69% were had serum phosphate level < 4 mg/dl and 76% had alkaline phosphatase level >1000IU/L. Hypocalcemia represents a major health problem in Pakistani children. Infants under 2 years of age are liable to have vitamin D deficiency rickets particularly if they are exclusively breastfed or received fresh milk with reduced exposure to sunlight. The higher the level of education of mothers, the less likely is the chance that their children become rachitic. Hypocalcemia can present with a wide variety of symptoms, the most important of which are seizures and recurrent chest infections. Rickets must be looked for as an underlying cause of these complaints

Prevalence of risk factors of primary 3rd degree malnutrition in children under 5 yars of age; admitted in services hospital, Lahore

To determine the prevalence of risk factors of primary 3rd degree malnutrition in children under 5 years of age. Hospital based descriptive study. Department of Pediatrics, SIMS/Services Hospital, Lahore, from July 2005 to December 2005. A total of 200 children were included in study, from 2 months to 5 years of age. All had 3rd degree malnutrition according to modified Gomez Classification. Risk factors included were; Fresh [Cow] milk feeding, mixed feeding, delayed weaning, more than 2 children under 5, large family size [>5 children], partial vaccination, no vaccination, working mother, un-employed factors, twin delivery. Risk factors identified were as follows: Mixed feeding 85.5% [n=171], more than 2 children under 5 was 84.5% [n=169], delayed weaning 74% [n=148], only fresh milk 70% [n=140], large family size [>5 children] 69% [n=138], partial vaccination 66.5% [n=133], working mother 24% [n=48], unemployed father 13.5% [n=27] and twin deliveries 3.5% [n=7]. Most of the risk factors are preventable just by counseling and motivation o f parents. Malnutrition can be avoided without causing financial burden on family

Outcome of babies admitted with hypoxic-ischemic encephalopathy in neonatal unit of services hospital, Lahor

To determine the outcome of newborns, admitted with different stages of HIE in Neonatal Unit, Services Hospital, Lahore. Descriptive Study. Neonatology Section, Pediatrics Department, Services Institute of Medical Sciences [SIMS] / Services Hospital, Lahore. Over a period of Six months, from 1st August 2005 to 31st January 2006. A total of 170 newborns having Apgar score less than 7 were included in the study. Babies with any congenital anomaly were excluded. 80% were males. 17.64% had weight less than 1.5 Kg, 37.06% weight between 1.5 Kg to 2.5 Kg and 45.29% had weight more than 2.5 Kg. 90.5% of our babies were delivered in Services Hospital, Lahore. 77.64% babies were full term. Babies were divided into three groups; Group-I had Apgar score 0-3, Group-II between 4 and 5 and Group-III had Apgar score 6-7. In Group-I, 65% babies died, whereas 100% had any one of the complications, in Group-II, there were 22% deaths and no baby died from Group-III. Despite advanced technology, a high number of babies have HIE and its complications. It is better to prevent babies from HIE, because once HIE occur, you cannot save babies completely from its complications

comparison of the effect of breast feeding, mixed feeding and top feeding on weights of infants and children

A retrospective analysis of 503 patients admitted to diarrhoea ward between June to August 2003 was done regarding their weight and feeding practices. Out of them 36 children were excluded as they did not full fill the required criteria. So a total of 467 patients were studied. The patients were divided into three groups depending upon whether they were breast fed, mixed i.e. both breast and top fed, or top fed respectively. All patients between the ages of birth and 24 months were included. The number of patients in breast fed, mixed fed and top fed were 134,135 and 198 respectively. Male to female ratio was 1.4:1,1.5:1,1.4:1,with mean age in breast fed group for females 6.9 +/- 4.7 months and males 10.3 +/- 7.63,in mixed fed group 8.3 +/- 5.97 months and 8.4 +/- 6.4 months and in top fed group 8.25 +/- 7.35 months and 7.65 +/- 5.72 months respectively. Mean weight in each group was 6.1 +/- 1.9, 5.7 +/- 2.1 and 4.9 +/- 2.0 kg. When weight of breast fed children was compared with those of mixed fed the difference was not statistically significant with p value of 0.236 while the comparison with top fed was highly significant with p value of 0.000. Similarly babies on mixed feeding had significantly better weight than that of top fed with p value of 0.004. Although it has been stressed upon and a lot of effort has been put in to encourage breast feeding but still top feeding and mixed feeding are on the top resulting in malnourished and wasted children. From our study it is obvious that top fed children are grossly malnourished, and exclusive breast feeding is low. We need to take more steps to encourage breast feeding