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Introduction: Sepsis is a major cause of mortality in children. Understanding the clinical profile of sepsis helps in early diagnosis, treatment and prognostication of the patients. Objectives: This study was done with an objective to assess the clinical features, disease course, etiology and outcome of children diagnosed with sepsis. Methodology: A prospective observational study was conducted over a period of six months among 43 children of age group 1 month to 14 years of age admitted to the Pediatric Intensive Care unit with a diagnosis of sepsis. Convenience sampling technique was used. The patients were enrolled at admission and daily follow up was done till discharge. Clinical details and outcome were recorded and analyzed through Statistical Package for Social Science version 20. Results: Out of 43 patients enrolled, 58% were males. The median age of the patients was 3 years (Inter Quartile Range 1, 10). Respiratory distress was the most common presenting clinical feature. Severe pneumonia (37%) was the most common cause. In this study, 22 (51.2%) patients died. Factors like presence of prior comorbidity, septic shock, Acute Respiratory distress syndrome, Multiple Organ Dysfunction Syndrome, severe sepsis, abnormal finding on chest X ray, hyperlactatemia, metabolic acidosis, ionotropes and Mechanical ventilation use were higher in the Non-survivor group as compared to the survivor group. Conclusion: This study showed increased mortality in patients having prior comorbidity, septic shock, Acute Respiratory distress syndrome, Multiple Organ Dysfunction Syndrome, severe sepsis, an abnormal finding on chest X ray, hyperlactatemia, metabolic acidosis, use of ionotropes and use of Mechanical ventilation.

Background: Bacterial meningitis is a severe infection of the central nervous system with varied clinical presentations. It is associated with substantial mortality and morbidity. Objectives: The objective of this study was to assess the clinical profile, including the clinical features, laboratory and radiological parameters, clinical course, treatment, response to treatment, complications, and outcome of children at discharge. Methods: A prospective observational study was conducted among 52 inpatient children of acute bacterial meningitis aged one month to 14 years over a period of six months. The patients were enrolled during admission and followed up daily till discharge. Socio-demographic, clinical, and diagnostic details and outcomes were recorded and analysed using statistical package for social sciences version 20. Results: The median age of the patients was two years with male to female ratio of 2:1. Fever (45, 87%), vomiting (37, 71%), seizure (33, 64%) and headache (22, 46%) were the most common symptoms. The cerebrospinal fluid culture was positive in three (6%) cases. Complications were seen in 20 (39%) patients including four (7.7%) deaths. Patients with prolonged fever, malnutrition, loss of consciousness, ear discharge, presence of meningeal signs, abnormal pupil, high cerebrospinal fluid protein, positive cerebrospinal fluid, and blood culture, low blood pH, and hyperlactataemia were significantly associated with complications (p

Introduction: Trends are changing to allow parents and families to be with their child during invasive procedures. Because of the intense workload, there is a tendency to overlook the parents’ feelings. Attitudes of physicians and nurses are the common obstacles for this. Objective: To determine health care professionals’ attitudes toward parental presence during invasive procedures. Methodology: A cross-sectional study was conducted among the health professionals in the department of Paediatrics and Adolescent Medicine of a tertiary care center in Eastern Nepal. Ethical clearance was obtained from the Institutional Review Committee of the institute. Total sample size was 112 (83 nursing staff and 29 physicians). Attitudes of physicians and nursing staff towards parental presence during various invasive procedures were recorded in the predesigned proforma. Data was entered in MS Excel and analysed using SPSS version 21.0. Frequency, percentage, mean, standard deviation, chi-square test, independent t-test and one-way ANNOVA were used for data analysis at p

Background: Timely detection and treatment of pathological hyperbilirubinemia in newbornscan prevent acute bilirubin encephalopathy and its consequences. We aimed to identifyitsoccurrence, presentationtime, phototherapyduration, need for exchange transfusion,and outcome. Methods: In this cross-sectional study, we enrolled all the babies admitted for pathological neonatal hyperbilirubinemia in the university hospital ofBPKIHSin a one-yearduration. Babies with life-threatening congenital malformations or conjugated bilirubin >20% of total serum bilirubin or >2 mg/dl were excluded. Obstetric profile of mothers, clinical and laboratory parameters of babies, onset time of pathological jaundice, duration of phototherapy, need for exchange transfusion or intravenous immunoglobulin were recorded. Neonatal outcome was classified as good and poor and its association with potential predictors analyzed. Results: One-hundred and fifty babiesdeveloped neonatal jaundice requiring treatment. The most common causes includedABO and Rh setting. No cause was found in 26 (18%) babies. One-hundred and eight babies (72%) were only managed withphototherapy whereas 42 (28%) required both phototherapy and double volume exchange therapy. The majority (84.5%) had good outcome without any residual neurological deficit at discharge.Babies with total serum bilirubin >20 mg/dl at presentation, duration of phototherapy >44.8 h, ABO setting, hemolysis, and out born statussignificantly developed poor outcome (p < 0.05). Conclusion: About 15% of the babies with hyperbilirubinemia had acute bilirubin encephalopathy at discharge suggestive of poor outcome. Babies with high bilirubin at presentation, longer duration of phototherapy, ABO settings, hemolysis, and out born statusdeveloped poor outcome.

Background: Neonatal hyperbilirubinemia is common morbidity in the first week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus assessment of serum calcium levels after phototherapy should be done in neonates with jaundice. Background: Neonatal hyperbilirubinemia is common morbidity in the 1st week of life. Approximately 5-10% of them requires intervention like phototherapy and even exchange transfusion. Phototherapy has various adverse effects and hypocalcemia is one of them. Thus, assessment of serum calcium levels after phototherapy should be done in neonates with jaundice. Objectives were to study prevalence of hypocalcemia in neonates with unconjugated hyperbilirubinemia receiving phototherapy and to observe association of hypocalcemia with duration of phototherapy.Methods: This was a prospective observational study conducted over a period of 18 months among 75 neonates (both term and preterm) in the neonatal intensive care unit of Manipal teaching hospital, Pokhara. Total serum calcium level was measured at 0 hours (control), 12 hours, and after 48 hours and data were analyzed using statistical package for social sciences version 21.Results: Hypocalcemia was found only in term neonates (n=8; 14%). Of those who had hypocalcemia, the majority experienced hypocalcemia after 48 hours of starting phototherapy. The mean difference of total serum calcium level before and after phototherapy in preterm and term neonates was found to be statistically significant. Hypocalcemia was not found to be associated with the duration of phototherapy.Conclusions: The present study concludes that though there is a reduction in the serum calcium with increased duration of phototherapy, however, it does not fall to the level where treatment is required. Hence it is not recommended to monitor serum calcium levels in neonates receiving phototherapy.

Introduction: Children with idiopathic nephrotic syndrome (INS) are steroid responsive but have relapses in subsequent non-treatment period. The objective of the present study was to analyze the factors which could predict relapses in these children.Material and Methods: Forty patients of INS aged 1-14 years of both gender were enrolled over one year period and followed for six months after treatment of initial episode of Nephrotic Syndrome.Results: The median age of children was 4.5 years and male to female ratio 1.9:1. There were 24(60%) relapses and 16(40%) non-relapses. The relapses had significantly higher mean total leukocyte count, serum urea, potassium and cholesterol than non-relapses. It was also observed that the median age of onset in relapses was significantly lower than non-relapses (p