Outcome of neonatal tetanus in hospitalized patients

To determine the outcome of neonatal tetanus in hospitalized patients. A hospital based cross sectional study. This study was conducted in Children Hospital Quetta from April 2011 to March 2012. A hospital based cross sectional study was conducted to determine the outcome of neonatal tetanus. 60 full term neonates from 0 to 28 days of age were included in the study after fulfilling the criteria of tetanus. Diagnosis was established exclusively on clinical grounds. Mean age of presentation was 7.5 days, male female ratio was 3:1. Most common presentation was generalized seizure in 51. 5% cases, 30.1% presented with lockjaw, 15.1% presented with opisthotonos and only 03. 3% presented with poor sucking. 92% mothers were illiterate, 85% belong to the low socio economic status, 78% were from rural area, 75% delivered at home, immune status was low in 70% mothers, cord was cut by non sterilized equipments in 65%, cord was tied with unclean thread in 60%, unhygienic material was applied to the cord in 54%, and 25% developed tetanus after circumcision done by non sterilized instruments at home. 25 out of 60 neonates died and the overall mortality rate was 40.1% out of 60 cases, 24 were put on ventilator and 9 of them [37.5%] died, while out of 36 unventilated cases 16 [44.4%] died. The findings of the study demonstrate that the high mortality rate of neonatal tetanus is due to lack of knowledge of risk factors. Lack of maternal education, low immune status of mothers against tetanus along with unsafe and unhygienic delivery practices are major risk factors responsible for the development of neonatal tetanus

Frequency of thrombocytopenia in children suffering from Malaria

To determine the frequency of thrombocytopenia in children suffering from malaria. Descriptive Study. This study was carried out in pediatric department of Bolan Medical College Quetta during 18 months from April to October 2011. A total of 140 malaria parasite positive on peripheral film children from 6 months to 7 years of age hospitalized due to febrile illness were included in the study. Hematological parameters were determined by using automated analyzer. Those with reduced platelets count were reevaluated by manual method. Thick and thin smear stained with Giemsa for malaria parasite was studied by hematologist. Mild thrombocytopenia was labeled with platelets count < 150,000 to > 50,000 /cumm, moderate with platelets count of < 50,000 to > 20,000/cumm and severe with platelets count < 20,000/cumm. Out of 140 malaria parasite positive children, 100 [71.4%] had thrombocytopenia while 40 [28.6%] had normal platelets count. Mild thrombocytopenia was common in p falciparum 40% as compared to 14% in p vivax. Moderate and severe thrombocytopenia was common in p vivax 28% and 4% against p falciparum 12% and 2% respectively. 94 [67.1%] were male and 46 [32.9%] female. Thrombocytopenia was found to be significant in children suffering from malaria. Mild thrombocytopenia was common in p falciparum but the moderate and severe thrombocytopenia was common in p vivax

Effect of prophylactic dose of vitamin K on occurrence of hemorrhagic disease in newborn

To determine the effect of prophylactic dose of Vitamin K on occurrence of hemorrhagic disease in newborn. Non randomized controlled study was conducted in Children Hospital Quetta during June to December 2009. Total 300 healthy full term neonates between 2[nd] to 7[th] days of life were included in the study. They are divided into 2 groups; group 1 consisted of 100 neonates who were given prophylactic dose of vit K in a dose of 1.0mg intramuscularly and group 2 consisted of 200 neonates who did not receive prophylactic dose of Vit K as their parents did not agree. They were followed up till 12 weeks of life, for development of bleeding from any site. There are 3 types of Hemorrhagic disease of newborn according to age of manifestation. In early onset bleeding occurred within 24 hours of life, in classical onset bleeding occurred from 2[nd] to 7[th] days of life and in late onset bleeding occurred during 2[nd] to 12[th] week of life. In group 1 only 2 neonates [2%], out of 100 presented with late onset of hemorrhagic disease of newborn, one [50%] with gastrointestinal tract bleeding and other [50%] with subcutaneous bleeding. In group 2, out of 200neonates 14[7%] developed bleeding, 9 [64.3%] presented with classical onset and 5 [35.7%] with late onset. Commonest clinical manifestation in group 2 was gastrointestinal tract bleeding [28.8%], 2nd common manifestation was haematuria [21.4%] and umbilical cord bleeding [21.4%], followed by prolonged bleeding after circumcision [14.2%] and subcutaneous [14.2%]. Male to female ratio was 1.3:1

Risk factors for neonatal sepsis

To determine the risk factors for Neonatal Sepsis. This study was conducted in Children Hospital Quetta from January 2008 till December 2009. A hospital based cross sectional study was conducted to determine the risk factors of neonatal sepsis. 255 Neonates were included in the study who were clinically diagnosed as cases of sepsis. 116 neonates were confirmed to be septic on the basis of positive blood culture. 107 neonates developed sepsis during first 7 days of life [early onset of neonatal sepsis] and 9 neonates developed sepsis during 8[th] to 28[th] day of life [late onset of neonatal sepsis]. 55.4% cases of early onset of neonatal sepsis presented with respiratory distress, 23.2% with gastrointestinal tract infection, 13.2% with complaints of inactivity, lethargy and reluctance to feed, 4.6% presented with skin infection, 1.8% with convulsions and 1.8% with septic shock. Most of the neonates 44.4%, in late onset presented with gastrointestinal tract problems, 22.2% neonates has nonspecific signs e.g. inactivity, lethargy and reluctance to feed. Just 11.1% came with skin manifestations [pustules, rashes, petechai and cord infection], 11.1% with convulsions and 11.1% as arthritis. One of the most common risk factor of early onset neonatal sepsis was low birth weight [<2.5 kg] in 47 cases [44%] out of these 47 cases, 40 [85%] were preterm and 7 [15%] were IUGR. Second most common risk factor was prolonged rupture of membranes > 18 hours in 28% cases, 11% neonates developed sepsis after meconium aspiration and 8.5% had some form of invasive procedure like exchange transfusion, abscess at I/V injection site and mechanical ventilation. Only 4.8% had history of maternal fever >101 f at the time or 48 hours before delivery. Only 3.7% neonates had no risk factors other than instrumental deliveries[forcep or vaccum extraction[, Low birth weight was also one of the most common risk factors in late onset neonatal sepsis [345] cases but associated with prolonged hospitalization >10 days and I/V fluid. All of them were premature. Inadequate cord care and poor maternal hygiene were also found to be important risk factors [22%]. Only 11 neonates had some history of contact with infectious mothers and family members [suffering from diarrhea and cough], and bottle feeding was the risk factor in 11% of neonates. Overall mortality was 19%. The findings of this study demonstrate that low birth weight, PROM, meconium aspiration syndrome, maternal fever, instrumental deliveries, prolonged hospitalization, invasive procedures, inadequate cord care, poor maternal hygiene, contact with infectious mothers, and bottle feeding are the risk factors of neonatal sepsis

Association of iron deficiency anemia and worm infestation in school children [5-10 Yrs] in Quetta

To determine the association of iron deficiency anemia and worm infestation in school children [5-10 Years] in Quetta. This case control, randomy study was carried in 9 schools of Quetta from March till July 2009. A total of 600 children were examined, 200 each from private, Government and non formal schools [Madrassa] for anemia. Iron deficiency anemia was confirmed on CBC, retics count, peripheral smear, RBCs indices and serum ferritin level. Hb<11.5 gm/dl, CMV<25 fl, MCH<75 fl and farriten<20 nm were the cut of points. History of worm infestation was conformed by parents and children. Out of 600 children 70 were anemic, of which 30 were positive for anemia and worm infestation both, 40 were anemic without worm infestation and 87 had history of worm infestation without anemia Worm infestation in anemic children was 3.8 times greater as compared to non anemic children