Relationship of Respiratory Symptoms and Signs with Hypoxemia in Infants Under 2 months of Age.

Introduction: Hypoxemia is the most serious manifestation of any acute illness in infants less than two months and has shown to be a risk factor for mortality. Hypoxia can be detected using a pulse oxymeter or arterial blood gas analysis. However this facility is not available in most centers of Nepal. This study has correlated different signs and symptoms to predict hypoxia. Methodology: This hospital based prospective cross sectional study included 160 infant < 2 months, presenting to OPD or Emergency department with any acute illness A complete history was taken and weight, temperature, respiratory rate, heart rate and oxygen saturation was recorded. Presence or absence of nasal flaring, cyanosis, chest indrawing, head nodding, grunting, wheezing and crepitations on auscultation was recorded subsequently. Clinical signs of hypoxemic and non hypoxemic infants were compared and then analyzed. Results: 160 infants, 95 (59.4%) were male and 65 (40.6%) were female. Of the total population, 56(35%) were hypoxic where as 104(65%) were non hypoxic. Infants who presented with more than 3 symptoms, were lethargic, tachypneic or had chest indrawing had higher sensitivity(92.8%, 75%, 75% and 89.3 % respectively) where as infants with nasal flaring, grunting, head nodding or central cyanosis had high specificity (91.3%, 87.5%, 98% and 100%) respectively. Conclusion: Infants presenting with ≥ 3 symptoms, lethargy, respiratory rate of ≥ 70/minute or chest indrawing can be used for screening purpose to detect hypoxia and infants showing signs like grunting, head nodding, nasal flaring or central cyanosis should be considered hypoxic and treated with supplemental oxygen.

Accuracy of 7-8-9 Rule for Endotracheal Tube Placement in Nepalese Neonates.

Introduction: Neonatal intubation is done for cardiopulmonary resuscitation, hypoxemia, and hypercapnia, for surfactant therapy or for airway protection. When correctly placed, endotracheal tube (ETT) tip should be at mid tracheal position which is half way between the clavicles and the carina to prevent complications of ventilation. Objective: To assess the accuracy of 7-8-9 Rule in neonates at Kanti Children’s hospital. Methodology: Prospective observational study was conducted in neonates who required oral intubations from July 2009 to December 2009 at NICU of Kanti Children’s Hospital. The initial ETT depth of insertion was determined using admission weight in the 7-8-9 Rule calculation. This depth was compared to the midtracheal depth to determine clinical accuracy of the 7-8-9 Rule. Results: Mean gestation age of the 69 infants was 36.01 weeks (26 to 42 weeks) and weight was 2411 g( 900 g to 3800 g ). 7 (10.1%) neonates weighed 1000 g or less, 19 (27.5%) weighed between 1001 to 2000 g, 31 ( 44.9%) weighed between 2001 to 3000 g, 12(17.4%) weighed between 3001 to 4000 g. The accuracy of 7-8-9 rule in clinical setting with auscultation and Chest x-ray resulted in ETT depth 0.11 cm above midtracheal position. (-1.5 to 1.5 cm). Using this rule ET tube was placed 0.11 cm above the mid tracheal position. Conclusions: The 7-8- 9 Rule appears to be an accurate clinical method for endotracheal tube placement in Nepalese neonates.

A Typical Case of Child Abuse: A Case Report.

Child abuse is common but still unnoticed, undiagnosed, neglected childhood problem in Nepal. Child abuse has diverse clinical manifestation ranging from minor injury to severe head trauma to simulating severe medical problem. The true incidence of intentional head injury in children remains uncertain in Nepal. We are reporting a case of child abuse with blunt head trauma with intracranial hemorrhage presenting as a loss of consciousness simulating as a diabetic ketoacidosis (DKA)

Clinico-Laboratory Profile and Immediate Outcomes of Hyperbilirubinemic Babies Admitted in Kanti Children Hospital.

Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis.

Children with first episode of fever with seizure: is lumbar puncture necessary?

Fever with seizure, a common presentation with which a child may present to the emergency is mainly due to febrile seizure, but it may also be due to meningitis. This study was done to find out the incidence of meningitis and to find out whether lumbar puncture is necessary in different age groups of children presenting with first episode of fever with seizure. A prospective study was conducted in the emergency department of Kanti Children's Hospital. Children who presented with first episode of fever and seizure in the age group of 6 months to 5 years were included. Meningitis was diagnosed on the basis of either cytological and biochemical criteria or if a bacterial pathogen was isolated. Of the 175 children included, 17% were diagnosed to have meningitis. Cerebrospinal fluid was positive for a bacterial pathogen in 4.5% of the cases. In the age group of 6 months to 12 months, 30% of the children had meningitis as compared to 20 % and 5% in other age groups of 12- 18 months and above 18 months respectively. All children with culture proven bacterial meningitis were in the age group of 6-12 months and had no evidence of meningeal irritation. Signs of meningeal irritation had high specificity in diagnosing meningitis. Organisms grown were Haemophilus influenza in three cases, Streptococcus pneumoniae in two cases and Staphylococcus aureus in three cases. In conclusion, incidence of meningitis was found to be high in children presenting with first episode of fever and seizure. Lumbar puncture to rule out meningitis should especially be considered in children in the younger age group even without evidence of meningeal irritation.