Indications of admission and outcome in a newly established neonatal intensive care unit in a developing country (Nepal).

Establishing and running a neonatal intensive care unit in a resource poor country is a big challenge. Neonatal Intensive care units (NICU) and Paediatric Intensive care units (PICU) has been started in Patan Hospital from July 2009. The in-born neonates are admitted to NICU and the out-born neonates to PICU. A retrospective hospital based study looking at the common indications for admission and the outcome of the neonates in the intensive care unit was carried out from July 2009 to December 2010. Data was collected from the admission discharge registers at the units and from patient record files. Over the 18 month period there were total 289 neonatal admissions, 214 to NICU and 75 to PICU. More than half of the neonates (53%) admitted to NICU and PICU were preterm. The most common neonatal condition leading to Intensive care unit (ICU) admissions was respiratory distress which accounted for 42%. Of the total neonates admitted to ICUs one third (33.5 %) needed mechanical ventilation. The most common conditions needing mechanical ventilation were hyaline membrane disease (33%) and severe sepsis (24%). The overall mortality rate was 26.6% .The mortality was higher among neonates weighing less than 2.5kg (32%) compared to those weighing >2.5kg (15.5%) (P value - 0.001) and it was higher in babies born before 34 weeks of gestation (P value - 0.009). Neonatal intensive care facilities though is expensive and not readily accessible, establishing a unit can not only save some of the precious lives but also helps in managing critically sick neonates aiming for an intact survival.

Hysterectomy: an analysis of perioperative and post operative complication.

OBJECTIVE: To document peri operative and post operative complication observed after hysterectomy, regardless of route on the operator. MATERIAL AND METHODS: A hospital based prospective study was carried out in department of obstetrics and gynaecology, KMCTH Sinamangal for six months. The study was carried out in patients undergoing hysterectomy who were followed from the time of admission to the time of discharge and two weeks thereafter. And followings were noted--Indication; route of hysterectomy, intraoperative and postoperative morbidities during hospital stay and after two weeks of discharge was noted. RESULT: Total number of hysterectomy carried out was 50. 31 (62%) were Total abdominal hysterectomy, and 19 (38%) were vaginal hysterectomy. Indication for total abdominal hysterectomy were fibroid uterus 12 (24%), DUB 8 (16%), CIN 4 (8%), chronic cervicitis 1 (2%). II U-V prolapse with previous LSCS 1 (2%), endometriosis 1 (2%). Prophylactic for Ca breast 1 (2%), Postmenopausal bleeding 1 (2%). All cases of vaginal hysterectomy were performed for 2nd degree U-V prolapse. Intra operative complication during surgery were two cases of haemorrhage (4%) each in both total abdominal hysterectomy and vaginal hysterectomy. There was one case of bladder injury during abdominal hysterectomy. Postoperative complication noted were febrile morbidity 1 (2%) in abdominal hysterectomy. Urinary tract infection remains the single most common febrile morbidity. There was one case of secondary haemorrhage in both type of hysterectomy. One was managed conservatively and other required laparotomy. There were three (6%) cases of wound infection in abdominal hysterectomy of two which were sanguineous discharge and one was frank pus which required secondary suture.