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Objective: To find out the prevalence of different types of arrhythmias in children with congenital heart defects (CHDs) presenting at a tertiary care hospital. Study Design: Cross-sectional study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: A total of 120 children of both genders aged 1 day to 16 years and presenting to study setting with confirmed CHDs were evaluated. At the time of enrollment, demographical information and disease history were noted. Necessary laboratory investigations like complete blood count and serum electrolytes were analyzed while standard electrocardiography (ECG) was performed. Prevalence of different types of arrhythmias was noted. Results: In a total of 120 children with CHDs, 64 (53.3%) were boys. Mean age was be 2.7±2.1. Most common electrolyte abnormalities were noted to be hyponatremia and hypermagnesemia found in 39 (32.5%) and 26 (21.7%) children respectively. There were 31 (25.8%) children who were diagnosed to have arrhythmias. Out of these 31 children, first degree A-V block was the most common types of arrhythmias observed in 24 (77.4%) cases while ectopic A-V rhythm were found in 3 (9.7%). Conclusion: The findings of this research revealed that arrhythmias are quite common among children having CHDs. There is a need to routine assessment for the possible presence of arrhythmias among children presenting with CHDs.

Objective: To analyze children of congenital heart defect hospitalized with lower respiratory tract infections (LRTIs). Study Design: Cohort study. Setting: Department of Pediatrics, Rai Medical College Teaching Hospital, Sargodha Pakistan. Period: July 2021 to June 2022. Material & Methods: Echocardiography confirmed known CHD cases of both genders aged 1 month to 10 years and hospitalized with LRTI were included. Demographic and clinical data were noted while relevant radiological examination and bacterial culture / respiratory virus panel from nasopharayngeal swabs examined. Types of CHD (acyanotic or cyanotic), types of bacterial causative agents and outcomes in terms of duration of hospitalization (days) and mortality or discharged were noted. Results: In a total of 63 children, 34 (54.0%) were male. The mean age was 1.56±1.42 years while 46 (73.0%) children were aged below 1 year. Assessment of causative agents revealed that 9 (14.3%) had viral involvement, 8 (12.7%) bacterial agents. Majority of the children, 44 (69.8%) had acyanotic CHD while remaining 19 (30.2%) had cyanotic CHD. Need for pediatric intensive care unit (PICU) admission was noted in 22 (34.9%). Although, need for PICU stay was more among children with acyanotic CHD when compared to cyanotic CHD, but the difference did not reach statistical significance (40.9% vs. 21.1%, p=0.1292). Likewise, duration of hospitalization was relatively more among children with acyanotic CHD when compared to children with cyanotic CHD but the difference did not reach statistical significance (17.65±8.21 vs. 14.3±6.84, p=0.1243). Conclusion: Majority of the children with CHD hospitalized with LRTI were below 1 year of age. Acyanotic CHD was the most common CHD type. Mortality was relatively low and most of the children with CHD hospitalized with LRTI were treated and discharged successfully.

Objective: To find out the prevalence and risk factors of systemic hypertension. Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: July 2020 to June 2021. Material & Methods: A total of 298 children of both gender aged 4-12 years, visiting pediatric outpatient department of the study institution were enrolled. A child was labeled as normotensive if blood pressure (BP) measurement was below 90th percentile, pre-hypertensive if BP between 90th to 95th percentile and hypertensive if BP more than 95th percentile. The data was analyzed using SPSS version 26.0. Results: In a total of 298 children, 171(57.4%) were male. Overall, mean age was found to be 7.6+2.1 years while 159 (53.4%) were below 7 years of age. Majority of the children, 166 (55.7%) belonged to rural areas of residence. Family history of hypertension was noted in 150 (50.3%) children. Hypertension was found in 56 (18.8%) children, pre-hypertension in 9 (3.0%) while remaining 233 (78.2%) children were normotensive. Age less than 7 years (p=0.0023), overweight/obesity (p=0.0026) or family history of hypertension (p=0.0118) were found to have significant association with hypertension. Conclusion: High prevalence of systemic hypertension was noted in children. Younger age, high body mass index and family history of hypertension were found to be significantly associated with hypertension.

Objective: To find out efficacy of sildenafil for the treatment of persistent pulmonary hypertension of the newborn (PPHN). Study Design: Observational study. Setting: Department of Neonatology, Sughra Shafi Medical Complex, Sahara Medical College, Narowal. Period: May 2020 to April 2021. Material & Methods: A total of 22 neonates of both genders with diagnosis of PPHN were enrolled during the study period. Demographic characteristic along with information about perinatal and postnatal characteristics were recorded among all neonates at the time of admission. X-ray chest were asked. Oral sildenafil was administered as 2mg/kg per dose thrice a day to all study cases and continued till extubation. Outcome was recorded on the basis of difference in FiO2 need after initiating sildenafil, time required to get ventilator off or mortality. Results: Out of a total of 22 neonates, 13 (59.1%) were male. Majority of the neonates, 15 (68.2%) were term newborns. Mode of delivery was lower segment cesarean section in 17 (77.3%) cases. APGAR score at 5 minutes was between 7 to 10 in 13 (59.1%) newborns. There were 13 (59.1%) newborns who required immediate resuscitation following birth. Meconium aspiration syndrome was the commonest associated condition found among 8 (36.4%) neonates. As per echocardiographic findings, 13 (59.1%) neonates had severe PPHN, 5 (22.7%) moderate and 4 (18.2%) mild. Mean oxygenation index at the time of admission was noted to be 46+14. Inotropic support was administered to 19 (86.4%) cases. Mean length of neonatal intensive care unit was 15+5 days. Mortality was reported among 10 (45.4%) neonates. Conclusion: Oral sildenafil was found to be a promising option for the treatment of neonates having PPHN. Oral sildenafil was found to successfully improve oxygenation among neonates having PPHN.

Objective: To find out the effectiveness of prophylactic parenteral paracetamol to minimize rates of ductus patency among preterm infants. Study Design: Case-control study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: March 2020 to February 2021. Material & Methods: A total of 70 neonates (35 cases and 35 controls) having gestational age less than or equal to 34 weeks were enrolled. All 35 cases were administered prophylactic parenteral paracetamol as 20 mg per kg stat and 7.5 mg per kg 6 hourly for 1st 3 days of life while all controls were given no drugs. Echocardiography was performed in all 70 neonates after 1st three post-natal days to identify PDA. Data was analyzed using SPSS 26.0. Results: In a total of 70 neonates, 37 (52.9%) were male and 33 (47.1%) female. Overall, mean gestational age was noted to be 32.1+1.47 weeks while mean body weight was recorded to be 1424.6+229.7 grams. There were 6 neonates (17.1%) among cases who were found to have PDA in comparison to 23 (65.7%) in controls (p

Objective: To find out characteristics and clinical features of children presenting with acute myocarditis at a tertiary care hospital. Study Design: Observational Study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan. Period: February 2020 to February 2021. Material & Methods: A total of 71 children aged 1 month to 15 years admitted with acute myocarditis were enrolled. Acute myocarditis was labeled as short history of illness in otherwise healthy child, echocardiography evident of left ventricular dysfunctioning, cardiac biomarkers showing cardiac damage as well as electrocardiography showing acute myocarditis. Age was represented as mean and standard deviation whereas qualitative variables like gender, area of residence and clinical features were shown as frequency and percentages. Results: Out of a total of 71 children, there were 38 (53.5%) were male. Median age was recorded to be 16.6 months. Majority of the cases, 42 (59.2%) belonged to rural areas of residence. Tachycardia was the commonest clinical feature noted in 65 (91.5%) children, irritability was seen in 50 (70.4%), tachypnea in 48 (67.6%) while poor feeding was noted 44 (62.0%) children. Hepatomegaly was noted in 39 (54.9%) children. Hypotension was recorded in 35 (49.3%) children. Conclusion: Male predominance was seen among children presenting with acute myocarditis. Tachycardia, irritability, tachypnea and poor feeding were the commonest clinical features observed.

Objective: To compare the Salbutamol alone and Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR. Study Design: Randomized Controlled Trial. Setting: Pediatrics Emergency, KRL Hospital Islamabad. Period: 1st August 2016 to 31 January 2017. Material & Methods: Group A patients were given only Salbutamol (0.15mg/kg per dose with minimum 2.5 mg, maximum 5 mg/dose). Group B was given Ipratropium Bromide supplemented Salbutamol (250 mcg/dose for 20kg of Ipratropium Bromide with same dose of Salbutamol as prescribed for Group A). Baseline spirometry was performed on each patient and after measurement of baseline peak expiratory flow. The outcome was measured by Peak flow meter and reassessed at 60 minutes. Results: Comparison of salbutamol alone and ipratropium bromide supplemented salbutamol in children with exacerbation of asthma in terms of PEFR shows that 40.5 + 4.28 in Group-A and 59.5 +4.75 in Group-B, P-value was calculated as 0.0001, showing a significant difference between the two groups while the difference in increase was recorded as 19%. Conclusion: We concluded that salbutamol alone is significantly less effective when compared with Ipratropium Bromide supplemented Salbutamol in children with exacerbation of asthma in terms of PEFR.

Objective: To find out pattern along with age and gender wise distribution of congenital heart disease (CHD). Study Design: Cross Sectional study. Setting: Department of Pediatrics, Sughra Shafi Medical Complex, Narowal. Period: January 2019 to February 2020. Material & Methods: During the study period, a total of 151 children aged between 1 month to 15 years as confirmed case of CHD according to echocardiography were enrolled for this study. Gender, age categories, area of residence and types of CHDs were represented as frequency and percentages. Patients with different types of CHDs were distributed between both gender and different age categories. SPSS version 26.0 was used to handle and analyze all study related data. Results: During the study period, a total of 151 confirmed cases of CHD were enrolled. There were 82 (54.3%) male and 69 (45.7%) female representing a male to female ratio of 1.2:1. Most of the cases were aged less than 1 year. There were 118 (78.1%) children below 1 year of age while 22 (14.6%) between 1 to 5 years of age and 11 (7.3%) above 5 years of age. Ventricular septal defect (VSD) and ASD were noted to be the most frequent types of acyanotic heart lesions in 41 (27.2%) and 29 (19.2%) cases respectively whereas TOF was the most frequent type of cyanotic heart lesion in 23 (15.2%) cases. Conclusion: VSD followed by ASD and TOF were noted to be the most frequent types of CHD.

Objective: To compare the mean hemoglobin levels and frequency of polycythemia in full term neonates after early and delayed cord clamping. Study Design: Randomized Controlled Trial. Setting: KRL General Hospital Islamabad (Labor Room/ Neonatology). Periods: December 2017 to June 2018. Material & Methods: 190 full term neonates were selected and divided into 2 equal groups randomly: Early cord clamping group after delivery and late cord clamping group. Two hours after clamping the venous blood samples were taken for the hemoglobin and hematocrit levels. Mean and standard deviation were calculated for gestational age, birth weight, hemoglobin and hematocrit. Frequency and proportions were calculated for gender and polycythemia. Results: Mean gestational age of the mothers was 39.27 ± 1.50 weeks. Of 190 neonates, 91 (47.9%) were males, 99 (52.1%) were females. Mean birth weight was 3.64 ± 0.72 kg while mean Hb and HCT levels were 16.07 ± 2.30 g/dl and 63.26 ± 5.32% respectively. Keeping cut off value of 13.5 g/dl of Hb to label anemia or no, 35 (18.4%) neonates were anemic in this study. The polycythemia (HCT >65%) was present in 72 (37.9%) of neonates. There was no difference between groups in terms of gender, anemia, gestational age and birth weight (p values 0.663, 0.852, 0.700 and 0.491 respectively). The distribution of polycythemia was different among groups (p value 0.007). The mean hemoglobin level in group A was 15.52 ± 1.90 g/dl while in group B it was 16.62 ± 2.53 g/dl (p value 0.001). Mean Hb levels were statistically not different among some of the groups (gestational age 4 kg. Rest of the stratification groups showed significant difference. Conclusion: The delayed cord clamping in neonates results in increased mean hemoglobin and hematocrit levels with increased frequency of polycythemia as compared to early cord clamping.

Background: Pakistan is a resource limited country with one of the highest neonatal mortality rate (NMR) in the world. Kangaroo Mother Care (KMC) helps in reducing the mortality and improving the care of preterm babies. The objective of this study was to identify the benefits of KMC in hospitalized newborns in terms of better weight gain and early discharge from hospital. Subjects and methods: A retrospective case-control study was conducted in the Neonatal Department of Services Hospital from 01.02.2019 to 31.01.2020. A total of 144 case notes, who met inclusion criteria were included. Subjects were divided in 2 Groups of 77 each. Group 1 did not receive KMC and Group 2 received KMC (partial or complete). Admission weight, gestational age at birth, duration of hospital stay and the average weight gain was noted for subjects in both groups. SPSS version 23 was used to analyze data. Independent samples t-test was applied. A p-value of ˂0.05 is taken as significant. Results: Mean weight gain in Group 1 was 5.521 g/kg/day (±6.664), whereas in Group 2 was 15.635 g/kg/day (±9.268). Mean hospital stay in Group 1 was 12.558 days (±10.856) and in Group 2 it was 8.208 days (±6.473). Weight gain and duration of hospital stay was significantly better in KMC Group with a p-value ˂0.05. This benefit was observed both for partial and complete KMC. Conclusion: KMC (partial or complete) leads to better weight gain and reduces the duration of hospital stay.

Objectives: Community acquired pneumonia (CAP) is frequent amongst pediatric population all over the world while hyponatremia is a common electrolyte abnormality in hospitalized patients that has been shown to be associated with considerable morbidity and mortality. We aimed to determine the frequency of hyponatremia in children with community acquired pneumonia (CAP). Study Design: Cross Sectional study. Setting: Pediatrics Department, Services Hospital, Lahore. Period: July 2018 to January 2019. Material & Methods: A total of 100 cases up to 2 years of age of either gender, diagnosed cases of CAP during the last 72 hours, were enrolled. Demographic profile, age and gender were recorded. Every child with CAP was evaluated for the presence of hyponatremia. Mean and standard deviation were calculated for age. Frequency and percentages were noted for categorical variable like gender and presence/absence of hyponatremia. Results: Out of 100 cases of CAP, 57 (57.0%) were male and 43(43.0%) female. There were 45 (45.0%) cases who were less than 1 year of age while 55 (55.0%) were between 1-2 years of age. Mean age was calculated as 1.55 years with standard deviation of 0.52 years. Frequency of hyponatremia in children with CAP was recorded in 24 (24.0%) whereas 76 (76.0%) had no findings of the morbidity. Conclusion: Frequency of hyponatremia was high (24.0%) among children with CAP. Every patient who present with CAP should be evaluated for hyponatremia.

Objective: To find out clinical profile and etiological agents involved in Pediatric infective endocarditis. Study Design: A descriptive observational study. Place and Duration of the Study: The Department of Pediatrics, Sughra Shafi Medical Complex, Sahara Medical College, Narowal, Pakistan from April 2017 to March 2021. Material and Methods: A total of 195 children of both genders aged below 14 years and having endocarditis were enrolled. Endocarditis was labeled as per modified Duke’s criteria. Data was entered and analyzed using SPSS version 26.0. Quantitative data like age was represented as mead and standard deviation. Qualitative data like gender, area of residence, clinical presentation, types of isolated microorganisms and underlying disease were shown as frequencies and percentages. Results: Out of a total of 195 children, 124 (63.6%) were male. Overall, mean age was noted to be 5.48+2.1 years. Fever was the commonest type of clinical presentation noted among 148 (75.9%) children followed by shortness of breath 101 (51.8%) and chest pain/discomfort 48 (24.6%). Congenital heart defects were the commonest form of underlying disease observed in 95 (48.7%) children. Blood culture findings revealed 112 (57.4%) samples to produce no growth while coagulase negative staphylococcus was the commonest etiological agent noted in 37 (19.0%) children. Conclusion: Majority of the children with infective endocarditis were male. Most common types of clinical presentation were fever and shortness of breath. Congenital heart defects formed major chunk of underlying disease. Coagulase negative staphylococcus was found to be the most common etiological agent. Keywords: Infective endocarditis, fever, shortness of breath, congenital heart defects.