Trends in Perinatal Mortality in Tribhuvan University Teaching Hospital: 13 Years Review.

Introduction: The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia.

Bubble-CPAP in Neonatal Unit of TUTH.

Introduction: Nasal Continuous Positive Airway Pressure (CPAP) in newborn babies with respiratory distress reduces requirement for mechanical ventilation thereby decreasing referral to higher centre. In our neonatal unit prior to the use of this intervention, morbidity and mortality associated with respiratory distress was significant which has decreased after we started CPAP in Kartik 2065 (October 2008) including a decrease in referrals to higher centre for ventilator support.The objective of this study was to evaluate the outcome of bubbling CPAP in newborn babies who had respiratory distress. Methods: Observational study done in neonatal unit of TUTH over a period of 3 months i.e from Kartik to Poush 2065 B.S (mid of October to mid of January,2008) Results: 127 neonates were admitted, of whom 15 babies with respiratory distress (11.8% of total admissions) received CPAP. 11 babies improved, while 4 babies died. Among those attending follow up (8 babies) none had any features of chronic lung disease. Conclusion: In resource poor settings where level II neonatal care is already exists; CPAP can be easily applied for newborn babies with respiratory distress with promising results and it helps to decrease neonatal morbidity and mortality.

Lennox Gastaut Syndrome: A Case Report.

Lennox-Gastaut syndrome (LGS) is a severe form of childhood epilepsy that is defined by generalized multiple type seizures, slowness of intellectual growth, and a specific EEG disturbance. Children affected might previously have infantile spasms or underlying brain disorder but etiology can be idiopathic. LGS seizures are often treatment resistant and the long term prognosis is poor.

Profile of Asphyxiated Babies at Tribhuvan University Teaching Hospital.

Objective: To assess risk factors and outcome in the early neonatal period of babies who were asphyxiated at birth. Methodology: This was a retrospective study conducted at Tribhuvan University Teaching Hospital (TUTH) over a period of one year from 15th Feb 2007 to 14th Feb 2008. All the term babies who had Apgar score of less than < 6 at 1 minute of birth were included. Detailed maternal risk factors during pregnancy and labor were analyzed. The newborn babies who required admission in neonatal unit were again analyzed for development of hypoxic ischemic encephalopathy (HIE) and their outcome. Results: During the study period, out of 3594 term babies, 327 babies (9%) were asphyxiated. Of the total asphyxiated babies, 85% and 15% had moderate and severe asphyxia, respectively, at 1 minute of birth. Out of these asphyxiated babies, 51% and 7% had intrapartum and maternal risk factors, respectively. Intrapartum risk factors like meconium stained liquor, non-vertex presentation, and fetal heart rate abnormalities accounted for 4 fold risk of asphyxia. Of these babies, 26% required admission in nursery and 29% developed hypoxic ischemic encephalopathy. Among the admitted babies 6%expired, 2% left against medical advice and rest were discharged. Conclusion: Early identification and close monitoring of high risk mothers studies with maintaining partograph during labor will help to reduce neonatal asphyxia.