Neonatal Intensive Care Unit Admissions among Preterm Babies in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Preterm babies are born before 37 completed weeks of gestation. It is an important cause of neonatal morbidity and mortality. This study aimed to find out the prevalence of neonatal intensive care unit admissions among preterm babies in a tertiary care centre. Methods: A descriptive cross-sectional study on a total of 133 preterm infants was conducted in a tertiary care centre from November, 2020 to April, 2021 with ethical approval from the Institutional Review Committee (Reference number: 380). Preterm babies who met the eligibility criteria were included in the study. Convenience sampling was done. Data were analysed using the Statistical Package for the Social Sciences version 20.0. Point estimate at 95% Confidence Interval was calculated along with frequency and percentage for binary data. Results: Out of 133 preterm babies, 54 (40.60%) (32.25-48.95 at 95% Confidence Interval) had neonatal intensive care unit admissions. Hyaline membrane disease was the most common illness in preterm neonates 34 (62.96%) followed by neonatal sepsis 20 (37.03%). Conclusions: The prevalence of neonatal intensive care unit admissions among preterm babies in our study was similar to other studies done in similar settings. Preterm newborns are significantly vulnerable and maternal risk factors should be taken into account. Anticipated preterm deliveries should have mandatory institutional delivery and adequate postnatal care is needed to improve the outcomes of preterm babies. Keywords: morbidity; mortality; neonatal intensive care unit; preterm infants.

Patterns of Clinically Identifiable Congenital Defects in Neonates.

BACKGROUND: The study is aimed at highlighting the pattern of congenital defect in a tertiary care hospital. Congenital anomalies are recognized as a growing cause of neonatal morbidity and mortality in developing countries and a major cause of distress to parents. METHODS: This was a prospective descriptive study conducted between September 2019 and August 2020 with the objective to determine the types of congenital anomalies among live born neonates at Manipal Teaching Hospital (MTH), Pokhara and to determine their immediate outcome. Neonatal and maternal characteristics were noted. RESULTS: Twenty four out of 2515 live births had congenital anomalies during the study period, giving an incidence rate of 9.42 congenital anomalies per 1000 live birth per year. Single system involvement was seen in 79.2 % cases, remaining 5 (20.8%) neonates had involvement of more than one system; 54.2% of these newborns were discharged, 33.3% expired, 8.3% left against medical advice and 4.2% were referred out. CONCLUSIONS: This study highlights the importance of clinical examination of neonates to detect anomalies in our setting.

Bacterial contamination of neonatal intensive care units: How safe are the neonates?

BACKGROUND: Intensive care units (ICU) are essential healthcare facility for life threatening conditions. Bacterial contamination of objects/instruments in ICU is an important source of nosocomial infections. This study is aimed to determine the level of bacterial contamination of instruments/objects which are commonly touched by healthcare workers and frequently come in contact with the neonates. METHODS: This hospital based prospective study was conducted in neonatal intensive care unit (NICU) of Manipal Teaching Hospital, Pokhara, Nepal. A total of 146 samples collected from surfaces of incubators, radiant warmers, suction tips, ventilators, stethoscopes, door handles, weighing machines, mothers' beds, phototherapy beds, laryngoscope, telephone sets, blood pressure machine, etc. formed the material of the study. Isolation, identification and antibiotic susceptibility of the bacterial isolates was performed by standard techniques. Blood culture isolates from NICU patients during the study period were compared with the environmental isolates. RESULTS: Out of 146 samples, bacterial growth was observed in 109. A total of 119 bacterial isolates were retrieved from 109 samples. Three common potential pathogens isolated were Escherichia coli (n = 27), Klebsiella species (n = 21) and Staphylococcus aureus (n = 18). Majority of E. coli and Klebsiella isolates were from incubators, suction tips and mothers' beds. Majority of S. aureus isolates were cultured from radiant warmers. Among S. aureus isolates, 33.3% (6/18) were methicillin resistant. Majority of the bacterial isolates were susceptible to gentamicin and amikacin. Common potential pathogens isolated from blood culture of NICU patients were S. aureus and Klebsiella species. CONCLUSION: High degree of bacterial contamination of objects/instruments in NICU was recorded. Isolation of potential pathogens like E. coli, Klebsiella species and S. aureus is a major threat of nosocomial infections. Blood culture data of NICU reflects possibility of nosocomial infections from contaminated sites. Gentamicin and amikacin may be used for empirical therapy in suspected cases of nosocomial infections in NICU.

Leave Against Medical Advice amongst Pediatric Patients Admitted in a Tertiary Teaching Hospital in Nepal: A Descriptive Cross-sectional Study.

INTRODUCTION: Leave against medical advice has a potentially deleterious effect on the health of a child. This is particularly alarming in case of pediatric patients as they are unable to understand the implications of it and rely on parents to make decisions regarding their health. This study was undertaken to find out the prevalence of leave against medical advice among pediatric patients admitted in a tertiary teaching hospital in Nepal. METHODS: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Manipal Teaching Hospital between August 2019 and July 2020. Ethical clearance was obtained from the Institutional Review Committee (Ref: 256). Convenient sampling method was used. Data entry and analysis was done on Statistical Package for Social Sciences version 23. Point estimate at 95% Confidence Interval was calculated along with frequency and proportion for binary data. RESULTS: Out of 1608 pediatric admissions taken in our study, the prevalence of leave against medical advice was found to be 67 (4.2%) at 95% Confidence Interval (3.22-5.18). Maximum 22 (33%) and minimum 6 (9%) patients respectively belonged to the age group from birth to 7 days and more than 10 years. Out of 67 cases, there were 36 (54%) males and 31 (46%) females. CONCLUSIONS: The prevalence of leave against medical advice among admitted pediatric patients in our study was similar to that of other studies. It is a social health problem which can be prevented by increasing the awareness and facilitating the use of health insurance schemes. More effective communication is required between the treating physicians and the parents to prevent this detrimental practice.

Time trend of neurocysticercosis in children with seizures in a tertiary hospital of western Nepal.

INTRODUCTION: Neurocysticercosis is a common cause of seizure disorders in children of Western Nepal. The clinical presentation is variable. The incidence varies depending on the food habits and ethnicity of the population. The present study was undertaken with the objective of studying the mode of presentation, radiological findings and to determine the recent trend of the disease in children of Western Nepal. METHODS: Records from the Department of Pediatrics, Manipal Teaching Hospital, Pokhara, Nepal of children aged 0-17 years admitted from 2003 to 2015 and with the discharge diagnosis of seizure and neurocysticercosis (NCC) were reviewed. The diagnosis was primarily based on clinical features, neurological involvement and CT and MRI studies. Seizures due to other CNS pathologies were excluded. Patients with NCC were treated with Albendazole15mg/kg/day for 28 days with supportive treatments for seizures and raised intracranial pressure. Patients were followed up for one year after the completion of the treatment. RESULTS: There were 1355 cases of seizure disorders, out of which 229 (16.90%) were NCC. There were 99 (43.23%) in the age group 6-10 years followed by 91 (41.09%) in the age group of 11-15 years. Seizures were the most common presenting symptom in 88.65%, followed by raised ICP in 9.61%. Neuropsychiatric changes were noted in 38 cases (16.59%). CT scan findings revealed single lesion in 78.16% and multiple lesions in 21.83%. Poisson regression analysis showed statistically significant decline of year-wise incidence of NCC cases (p<0.05) from 2003 to 2015. CONCLUSION: The decline in the incidence of NCC in recent years is most probably attributed to improved hygiene with the construction of household toilets to avoid open defecation and biannual deworming with Albendazole as a part of School Health and Nutrition Project.

Is Cerebrospinal Fluid C-reactive Protein a Better Tool than Blood C-reactive Protein in Laboratory Diagnosis of Meningitis in Children?

OBJECTIVES: This study aimed to test whether C-reactive protein (CRP) measurement could differentiate between different types of meningitis and become a routine test. METHODS: A prospective study included 140 children admitted to Manipal Teaching Hospital, Pokhara, Nepal, between July 2009 and June 2011. The subjects had a blood test and detailed cerebrospinal fluid (CSF) analysis, including blood and CSF CRP levels. RESULTS: Of those admitted, 31.1% had pyogenic meningitis (PM), 26.2% partially treated meningitis (PPM), 33% viral meningitis (VM), and 9.7% tubercular meningitis (TBM), with 26.4% controls. Organisms were isolated in 12.5% of the cases by blood culture and 25% of cases through CSF culture. Blood CRP was positive in all groups, with the highest values in PM (53.12 ± 28.88 mg/dl) and PPM (47.55 ± 34.34 mg/dl); this was not statistically significant (P = 0.08). The CSF CRP levels were significantly higher (P <0.001) in PM (45.75 ± 28.50 mg/dl) and PPM (23.11 ± 23.98 mg/dl). The sensitivity and specificity of blood CRP was 90.62%, 88.88%, 64.7%, 70% and 32.4%, 30.97%, 24.52%, 26.12% and that of CSF CRP was 96.87%, 66.66%, 20.58%, 10% and 74.73%, 63.71%, 50.94%, 55.35% for PM, PPM, VM and TBM, respectively. CONCLUSION: Because of its high sensitivity, both CSF CRP and blood CRP can be used to screen for bacterial meningitis (both PM and PPM). CSF CRP screening yielded results with a higher specificity than blood CRP; hence, it can be a supportive test along with CSF cytology, biochemistry, and microbiology for diagnosing meningitis.