Department Of Pediatric Medicine Research Articles

Etiology, risk factors and antibiotic resistance in neonatal sepsis.

Objective: To determine the etiology, risk factors and antibiotic resistance in neonatal sepsis. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: October 2023 to March 2024. Methods: A total of 174 neonates of both genders, with suspected neonatal sepsis were analyzed. Neonatal and maternal characteristics were noted. Blood sample was collected in aseptic environment and sent to institutional laboratory for blood culture and drug susceptibility testing. Results: In a total of 174 neonates, 101 (58.0%) were boys. The mean age, and weight were 9.61±7.86 years, and 2.25±0.85 kg, respectively. Neonatal sepsis on the basis of positive blood culture was reported in 38 (21.8%) neonates. Preterm birth had significant association with neonatal sepsis (44.7% vs. 26.5%, p=0.019). History of maternal UTI during pregnancy had significant linkage with neonatal sepsis (36.8% vs. 11.0%, p<0.001). History of maternal fever during pregnancy had statistically significant association with neonatal sepsis (34.2% vs/ 19.1%, p=0.049). E. Coli, and Klebsiella were the most commonly found bacterial isolates, noted in 8 (21.1%), and 4 (10.5%) neonates, respectively. Most commonly used antimicrobial drugs were found to have high resistance rates against most frequent bacterial isolates. Conclusion: E. Coli, and Klebsiella were the most commonly found bacterial isolates in neonatal sepsis. Preterm birth, maternal history of UTI, and maternal history of fever were found to be significant factors linked to neonatal sepsis. Most commonly used antimicrobial drugs were found to have high resistance patterns which should raise alarms.

Prevalence of chronic kidney disease in children of school going age visiting outpatient department of A Tertiary Care Hospital in Karachi, Pakistan.

Objective: To determine the prevalence of chronic kidney disease (CKD) among children of school-going age. Study Design: Cross-sectional study. Setting: Department of Pediatric Medicine, National Institute of Child Health, Karachi, Pakistan. Period: July 2023 to December 2023. Methods: A total of 130 children of both genders, aged between 5-15 years, visiting outpatient department of pediatric medicine were analyzed. Demographic and clinical information were noted. Laboratory investigations like urinalysis and serum creatinine were performed. CKD was diagnosed on the basis of “Kidney Disease Outcomes Quality Initiative (KDOQI)” guidelines. Results: In a total of 130 children, 67 (51.5%) children were male. Overall, the mean age was 8.43±2.45 years. Hypertension was diagnosed in 10 (7.7%) children. Anemia was present in 103 (79.2%) patients. The mean hemoglobin, serum creatinine, and blood urea nitrogen were 9.41±1.98 g/dl, 0.48±0.37 mg/dl, and 34.20±33.18 mg/dl, respectively. CKD was diagnosed in 10 (7.7%) children. Among these 10 children diagnosed with CKD, 7 were having CKD stage-1 whereas CKD stage-2 was noted in 3 children. Presence of hypertension (p=0.006), and albuminuria (p<0.001) were associated with CKD. Conclusion: The prevalence of CKD in school going age children was 7.7%. Presence of hypertension, and albuminuria were linked with CKD.

Association of Simple Febrile Seizure with Iron Deficiency Anemia in Children: A Case Control Study

Abstract: Background: Febrile seizure is an established entity in Pediatrics which characterizes with absence of any intracranial infection or metabolic disorders. Simple febrile seizure carries a favorable prognosis without any sequelae. Still, it emerges as the most common etiology of seizure till the age of five years. Iron deficiency anemia is a commonly witnessed micro-nutrient deficiency with a worldwide distribution. Objective: To establish relation of simple febrile seizure with iron deficiency anemia in paediatric population. Materials and Methods: Case-control study, conducted in Pediatric Medicine Department, King Fahad Armed Forces Hospital Southern Region, Khamis Mushayat, Kingdom of Saudi Arabia, from1st January 2022 to 30th June 2023. The 102 children, having age six months to five years, with a diagnosis of first simple febrile seizure were assessed. Likewise, the control group included 102 febrile children without convulsion. The hematological parameters evaluated for diagnosis of iron deficiency anemia included hemoglobin, mean corpuscular volume, serum ferritin, serum iron, total iron binding capacity & red cell distribution width. Result: The mean age for first simple febrile seizure was 23 months. Acute respiratory infection was the most common etiology (80%). Iron deficiency anemia was identified in 17% of cases of simple febrile seizure, in contrary to 6% of cases with febrile illness without seizure, with odds ratio of 3.2. Conclusion: This study demonstrated that the children with iron deficiency anemia are at significantly higher risk of having febrile convulsions compare to control group with fever but without anemia. Keywords: Fever, Febrile seizure, Iron Deficiency anemia, Serum ferritin, Hemoglobin, Convulsion, Mean corpuscular hemoglobin.

Comparison of Iron-Supplementation Versus Combination of Vitamin-A & Iron-supplementation in Childhood Iron Deficiency Anaemia

Background and Objectives: childhood anemia is highly prevalent worldwide and its effective treatment is the cornerstone to improve health of these children. This study was conducted to compare the mean rise in haemoglobin (Hb) after iron-alone versus the combination of vitamin-A & iron supplementation in childhood iron-deficiency anemia.Methods: This randomized controlled trial was done at Paediatrics Medicine Department, Jinnah Hospital, Lahore from January-2019 to June-2019. A total of 60 cases, as per inclusion criteria were enrolled from the Paediatric Medicine Department of Jinnah Hospital Lahore. Group-A was supplemented with a combination of vitamin-A and iron while Group-B patients were supplemented with Iron alone. Hb was checked at baseline and after 3 months of treatment as per the designated group. All information, as per predesigned proforma, was entered and interpreted using SPSS version 23.0. An Independent sample t-test was applied and a p-value < 0.05 was considered statistically significant.Results: Sixty patients were included, keeping 30 in each group i.e. Group-A (Vitamin-A + Iron) & Group-B (Iron-alone). In both groups, most of the patients were male, i.e. 22(73.3%) and 23(76.7%) in group-A and group-B respectively. In group-A, the mean age was 1.96±1.6 years while 2.12±1.5 years in group-B. In group-A, the mean rise in Hb level after 3-months of treatment was 3.0±0.99 g/dl, on the other hand, it was 1.96±1.00 g/dl in group B, with a p-value of 0.00014.Conclusion: Vitamin-A supplementation combined with iron replacement therapy is recommended for substantial improvement among children with iron deficiency anemia.Keywords: Vitamin-A, Iron-Supplementation, Hemoglobin (Hb), Iron Deficiency Anemia (IDA).

Hematological manifestation of Pediatric Systemic Lupus Erythematosus (SLE) - A single centered cross-sectional study.

Systemic lupus erythematosus (SLE), the commonest type of lupus, is an autoimmune multisystemic disorder that can affect any organ system of the body, especially blood vessels and connective tissues, causing widespread inflammation. Pediatric onset of SLE is a rare condition with more hematological involvement. This study was undertaken to observe various hematological abnormalities and their association with various autoantibodies present in pediatric SLE in Eastern India. It was a single-centered, cross-sectional, observational, hospital-based study conducted in the Department of Pediatric Medicine in collaboration with the Department of Rheumatology in IPGME and R and SSKM Hospital, Kolkata. The duration of the study was 1.5 years, and a total of 30 children up to 12 years of age of either gender were enrolled. Study participants were evaluated for various parameters like demographic, hematological (anemia, neutropenia, leucopenia, lymphopenia, and thrombocytopenia), biochemical (CRP, Lactate dehydrogenase (LDH), and bilirubin), autoantibodies (anti-dsDNA, anti-Ro 52, and anti-Ribonucleoprotein [RNP]), and SLE related pathologies (Cutaneous, nephritis, serositis). In the present study, most of the participants had arthritis, muscle pain (86.66%), and hematological involvement (80%). Among cytopenias, anemia was the commonest. dsDNA autoantibody was positive in most of the patients (83%), and about one-third suffered from autoimmune hemolytic anemia (AIHA). No association was observed between autoantibodies and various hematological manifestations. It can be concluded from the present study that anemia is the most common cytopenia in pediatric SLE, but there is no association between autoantibodies and these cytopenias. However, study on larger population may give better results.

Breastfeeding practices among infants at Madina Teaching Hospital in Faisalabad: A comprehensive analysis.

Objective: To gain insight into the breastfeeding practices of new mothers within a tertiary care facility. Study Design: Descriptive, Cross-sectional Approach. Setting: Department of Pediatric Medicine, Madina Teaching Hospital in Faisalabad. Period: Jan 2023 to June 2023. Methods: The study included 350 infants, of both genders, aged between 6 months and 1 year, who were attending the outpatient department for a routine checkup. Infants with congenital respiratory or cardiac conditions, as well as congenital anomalies such as cleft lip, diaphragmatic hernia, tracheoesophageal fistula, and congenital pneumonia at birth were excluded from the study. The researcher in training meticulously recorded data in the structured study Performa, utilizing this instrument to gather information on breastfeeding practices. Results: Findings revealed that 34.57% of mothers initiated breastfeeding within an hour after childbirth, while 53.43% did so between one and twenty-four hours later. Additionally, 30.57% of mothers chose not to provide their newborns with colostrum, whereas 69.43% did. Only 32.86% of women exclusively breastfed their infants. Furthermore, 35.71% of mothers fed their babies honey, 33.71% used ghutti, 17.14% opted for top feed, and 1.43% provided water. A backache hindered 32% of women from breastfeeding, while weakness affected 40.57%. Additionally, nostalgia, experienced by 13.43% of mothers, and depression experienced by 11.71%, also posed obstacles to breastfeeding. Conclusion: The study indicated that while the majority of mothers possessed knowledge about breastfeeding, there was a noticeable gap between knowledge and its application in practice. Surprisingly, a relatively small percentage of women engaged in exclusive breastfeeding.

Neonatal Hematological Abnormalities Associated with Maternal Pre-eclampsia at Birth

Background: Pre-eclampsia (PE) can cause hematological abnormalities that can further exacerbate the existing morbidity in newborns. This study aimed to investigate neonatal hematological abnormalities associated with maternal pre-eclampsia at the time of birth. Methods: This cross-sectional was conducted from January 2023 to July 2023, involving 122 neonates born at the Department of Pediatric Medicine, Sohail Trust Hospital in Karachi, Pakistan. It analyzed neonates of either gender, aged from birth to 24 hours of life, and born to pre-eclamptic mothers, and their demographic details were recorded. At delivery, 2 ml of umbilical venous blood was collected by a trained pediatric nurse and then sent to the institutional laboratory. Hematological changes like leukopenia, thrombocytopenia, or neutropenia were noted. To assess the influence of various factors on hematological outcomes, chi-square tests were applied, with a significance threshold set at p<0.05. Results: In a total of 122 neonates, the mean age was 8.14±6.49 hours. The mean gestational age was 38.87±3.15 weeks. There were 68 (55.7%) neonates who were male. Low birth weight (LBW) was less than 2500 grams in 45 (36.9%) newborns. Thrombocytopenia, leukopenia, and neutropenia were identified in 32 (26.2%), 25 (20.5%), and 23 (18.9%) neonates respectively. Stratification of leukopenia concerning study variables revealed that gestational age and LBW had a significant association (p=0.0036, p=0.0072) with leukopenia. Moreover, neutropenia also had an association with LBW (p<0.0001). Conclusion: These findings underscore the importance of early hematological screening for neonates born to pre-eclamptic mothers to facilitate timely diagnosis and care.

Acute kidney injury in birth asphyxiated patients: A cross sectional study at Bahawal Victoria Hospital.

The presence of perinatal asphyxia and its severity appear to correlate with increasing incidence of Acute kidney injury (AKI). The objective of this study is to determine the frequency of AKI and its outcome in birth asphyxia. This cross-sectional study was carried out in the Department of Pediatric Medicine from March 2019 to September 2019. A total of 111 newborns with birth asphyxia of gestational age 37-41 weeks were included. Neonates born to mothers having hypertension and diabetes mellitus, patients with congenital kidney anomalies like polycystic kidney disease and renal agenesis, and mothers taking nephrotoxic drugs or any other known cause of AKI like hypovolemic shock were excluded. Urine output (UOP) and final outcome of the patient were also noted. AKI was noted. The mean gestational age was 38.29 ± 1.07 weeks. The mean weight of neonates was 3.08 ± 0.31 kg. The frequency of AKI in birth asphyxia was 20 (18.02%) neonates. Complete recovery in AKI patients was seen in 07 (35.0%) and death in 13 (65.0%) patients. This study has shown that the frequency of AKI in birth asphyxia was found in 18.02% neonates with complete recovery seen in 35.0% and death in 65.0% patients.

FACTORS LEADING TO TRANSIENT TACHYPNEA OF NEWBORN (TTN) IN BABIES, DELIVERED BY SPONTANEOUS VAGINAL DELIVERY AT TERTIARY CARE HOSPITAL KARACHI

Neonatal respiratory distress is a common issue, and one of its types is Transient Tachypnea of the Newborn (TTN), which happens when leftover lung fluid is not removed from the body on time. TTN usually occurs within the first 24 to 72 hours after delivery. This study aims to determine the frequency of TTN in newborns delivered vaginally and spontaneously at a tertiary care hospital in Karachi and identify the factors that may contribute to the condition. The study adopted a cross-sectional design and was conducted in the Neonatal Intensive Care Unit of the Department of Pediatric Medicine, Ziauddin Hospital, Karachi. After obtaining the necessary approvals, the study lasted for 9 months, from December 2021 to September 2022. Both quantitative and qualitative data were collected, assembled, and analyzed. Stratification was employed to adjust for effect modifiers, and a chi-square test was used to test for statistical significance with a p-value of 0.05. The study included 153 patients who met the inclusion and exclusion criteria. The average gestational age, height, weight, OFC, length of hospital stay, and mother's age were 30.7 ± 4.3 weeks, 49 ± 1.79 cm, 3.01 ± 0.38 kg, 36.65 ± 1.08 cm, 3.92 ± 4.65 days, and 39.8 ± 2.78 weeks, respectively. Of the 153 patients, 71 (46.4%) were male and 82 (53.6%) were female. 44.4%, 31.4%, 45.1%, and 31.4% of the patients had maternal diabetes, PROM, obesity, and low APGAR scores, respectively. The study found maternal diabetes and obesity were the primary risk factors for TTN in newborns. The study emphasizes the importance of good antenatal and obstetric care to detect any early problems during pregnancy that may contribute to the incidence of TTN.

Role of multi-strain probiotics in preventing severity and frequency of recurrent respiratory tract infections in children

BackgroundRespiratory tract infections are among the most common infections in the pediatric population throughout the globe. Globally around 20% of all deaths in children below 5 years of age are secondary to acute respiratory infections, mostly pneumonia. Probiotics are live microorganisms that when administered in adequate amounts confer a health benefit on the host. Their mechanism in preventing respiratory tract infections is not known but it is thought that probiotics act by modulating the immune system. This study was conducted to find out whether using probiotics is effective in decreasing the severity and frequency of recurrent respiratory tract infections or not.MethodsA Quasi-experimental study was conducted at the Pediatric Medicine Department of Abbassi Shaheed Hospital Karachi during 2021–2022. The study was approved by the institutional ethical review committee i.e. advanced studies and research board (ASRB). The sampling technique was non-probability consecutive sampling and the sample size was 70 patients with recurrent respiratory tract infections, aged six months to 12 years of age. All enrolled children were given probiotics containing Bifidobacterium, Lactobacillus Acidophilus for two weeks. Data were analyzed by using SPSS version 22. A p-value of < 0.05 was considered statistically significant.ResultsOut of 70 children with recurrent respiratory tract infections, 39 (55.71%) were male and 31 (44.29%) female. Around 75% of the children were below five years of age. The most common presenting complaint was fever (72.86%), followed by cough (68.57%), wheezes (45.71%) and nasal discharge/sneezing (32.86%), respectively. The most common RRTI was infectious rhinitis (30% of the cases), otitis media (24%) and pharyngitis/tonsillitis (21%). After giving probiotics for two weeks most significant decrease was found in recurrent infectious rhinitis (p-value 0.02), recurrent otitis media (p-value 0.03) and recurrent bronchiolitis (p-value 0.05) over the next six months.ConclusionThe results of our study indicate that the administration of probiotics reduces recurrent respiratory tract infections among children. This six months trial has demonstrated that there was a significant decline in respiratory symptoms among study participants. This study also observed a significant decrease in respiratory diseases during the follow-up.

Diagnostic Accuracy of Cord Blood Bilirubin in Predicting Neonatal Hyperbilirubinemia, Taking Neonatal Hyperbilirubinemia within One Week of Birth as Gold Standard

Objective: To determine the diagnostic accuracy of cord blood bilirubin in predicting neonatalhyperbilirubinemia, taking neonatal hyperbilirubinemia within one week of birth as the gold standard.Study Design: Across-sectional study.Place and Duration of Study: The Study was conducted at the Department of Pediatric Medicine, Sheikh Zayed Hospital, Rahim Yar Khan, Pakistan from 7 September 2020 to 6 March 2021.Methods: A total of 366 term neonates of both gendersgenders were included. Neonates with congenital hypothyroidism, neonatal hepatitis, biliary atresia, and sepsis were excluded. After getting informed consent from parents, a cord blood sample was taken and sent to the institutional laboratory for measuring total bilirubin levels, and neonatal hyperbilirubinemia (yes/no) was noted. All neonates were followed by the researcher for one week and neonatal hyperbilirubinemia was noted.Results: The study yielded 193 true positive and 14 false positive cases, along with 7 false negative and 152 true negative cases, with a statistically significant p-value of 0.0001. Overall, the diagnostic accuracy of cord blood bilirubin in predicting neonatal hyperbilirubinemia, using neonatal hyperbilirubinemia within one week of birth as the gold standard, was found to be 96.50% for sensitivity, 91.57% for specificity, 93.24% for positive predictive value, 95.60% for negative predictive value, and 94.26% for diagnostic accuracy.Conclusion: This study has shown that cord blood bilirubin has a rather good diagnostic accuracy for predicting newborn hyperbilirubinemia.&#x0D; How to cite this: Majeed M, Ahmed D, Hanif D, Khaliq H, Ahmad A, Khan ZA. Diagnostic Accuracy of Cord Blood Bilirubin in Predicting Neonatal Hyperbilirubinemia, Taking Neonatal Hyperbilirubinemia within One Week of Birth as Gold Standard. Life and Science. 2023; 4(4): 401-409. doi: http://doi.org/10.37185/LnS.1.1.347

Knowledge of Caretakers about the Use of Oral Rehydration Solutions in Children with Acute Diarrhea

Background: Diarrhea is known to be the major factor causing morbidity and mortality, especially among pediatric age groups globally. This study was done to assess the knowledge of caretakers regarding the use of oral rehydration solution (ORS) in children with acute diarrhea. Methods: This cross-sectional study was conducted at the Department of Pediatric Medicine, Children’s Hospital and Institute of Child Health, Multan, Pakistan, from February 2023 to July 2023. We analyzed caretakers of children aged 1-12 years who presented with acute diarrhea that had less than 14 days of duration. Both male and female caretakers, with ages ranging from 25 to 50 years, were included. Knowledge of the formulation of ORS, the process of its preparation, and usage were asked. Participants describing all correct answers about the formulation, preparation, and use of ORS were considered as having knowledge of ORS. Effect modifiers were stratified, and applying the post-stratification chi-square test, their effects on outcome were observed. A p-value≤0.05 was considered significant. Results: In a total of 240 study participants, the mean age of caretakers was 36.01±8.08 years. There were 23 (9.6%) male and 217 (90.4%) female caretakers. Among caretakers, 79 (32.9%) had knowledge of ORS while 161 (67.1%) did not know ORS. A statistically significant association of knowledge about ORS was found with residential status (p&lt;0.001), socio-economic status (p&lt;0.001), and source of drinking water (p&lt;0.001). Conclusion: This study found that among caretakers of children having acute diarrhea, there was a lack of knowledge regarding ORS use, formulation, and preparation.

Frequency of Aplastic Anemia in Children (1-15 years) with New-Onset Pancytopenia

Background: Pancytopenia is a medical disorder in which the usual quantities of red blood cells, white blood cells, and platelets are depleted. This condition can arise from various factors, including diminished production of hematopoietic cells, ineffective hematopoiesis, or the destruction of these cells in the peripheral blood. Objective: To determine the frequency of aplastic anemia in children (1-15 years) with new-onset pancytopenia presenting at Children Hospital Lahore. Study Design: Cross sectional study. Settings: Department of Pediatric Medicine, Children Hospital, Lahore Pakistan. Duration: From August 2022 January 2023. Methods: This research included 250 children, covering both genders, with ages ranging from 1 month to 15 years old. These children had all been diagnosed with pancytopenia within the past month. The primary focus of the study was to determine the prevalence of aplastic anemia within this group of children. This prevalence was then examined in relation to their age, gender, and socioeconomic backgrounds. Results: The patient group had a mean age of 6.74 years, primarily consisting of children aged 1-10 years (86.4%). Gender distribution was fairly balanced, with 55.2% males and 44.8% females. Most patients belonged to the middle class (48.8%), followed by the lower class (35.2%) and high class (16.0%). Pallor was the most common, with 86.36% of patients experiencing it. Fever and bruises/purpura were also frequent, affecting 64.55% and 59.55% of patients, respectively. Aplastic anemia was observed in 33.60% of the children, while 66.4% did not have this condition. Conclusion: In children who had recently developed pancytopenia, the incidence of aplastic anemia was determined to be 33.60%. Interestingly, no noteworthy disparities in the occurrence of aplastic anemia were observed with regard to age, gender, or socioeconomic status.

CLINICAL PROFILE OF DENGUE INFECTION IN PEDIATRIC AGE GROUP AT SOCIAL SECURITY TEACHING HOSPITAL,LAHORE

Dengue viral infection is a significant tropical disease and have become a major global public health concern. The present study sketches the evolving clinical spectrum of dengue especially highlighting the unusual manifestations. Methodology: Data of 120 suspected dengue fever cases was collected, compiled, and analysed during the monsoon and post-monsoon seasons in the year 2022 at the Department of Pediatric Medicine, Social Security Teaching Hospital, and Lahore. Patients with serological confirmation of dengue infection were classified according to Dengue GCP Guidelines 2020. Clinical parameters were studied. Results: Out of 120 suspected patients with dengue fever enrolled in the study, 48 (40%) had serologically confirmed dengue infection. Out of 120 cases, 68 (56.66%) patients were males and 52(43.33%) were females. 66.66 % patients had classical dengue fever while 33.33% had dengue hemorrhagic fever. DHF grade I/II was seen in 25 % cases and grade III DHF in 8.33% The most common symptoms after fever were vomiting (85.4% ), abdominal pain ( 68.75%), headache (37.5%), rash (20.83%) and itch (16.66%). Hemorrhagic manifestations were observed in 43.75% patients. Atypical manifestations were documented in 4 patients (8.33%) patients. Overall outcome in this study was good with no mortality.&#x0D; Conclusion: Dengue infection has posed a huge burden to the health-care system. Its spectrum ranges from mild self-limiting disease to severe fatal disease. It can have varied and multi-systemic manifestations which can go unnoticed. Pediatricians should have a high index of suspicion for atypical manifestations so revelation of the exact clinical profile is important for patient effective management.

Effect of Intravenous Magnesium Sulphate on in-Hospital Mortality in Neonates with Perinatal Asphyxia: A Prospective Cohort Study

Background: Early neonatal deaths in Pakistan account for 7% of global neonatal mortality rate, with perinatal asphyxia being responsible for 23% of these cases. Controversy exists in the literature regarding role of magnesium sulphate administration on reducing in-hospital mortality in newborns with perinatal asphyxia.&#x0D; Objectives: To determine the effect of intravenous magnesium sulphate on in-hospital mortality in neonates with perinatal asphyxia.&#x0D; Methods: This prospective cohort study was conducted at the Department of Pediatric Medicine, Nishtar Hospital Multan over a period of six months from January 2022 to June 2022. A total of 183 consecutive full-term neonates, weighing ≥ 2500 grams, with Apgar score &lt; 7 at 5-minutes after birth, presenting within 48-hours of life were included in the study. Neonates presenting within 6-hours after birth received intravenous magnesium sulphate (MgSO4) – exposed group and neonates presenting after 6-hours did not get MgSO4 – unexposed group. Baseline characteristics and survival outcome was recorded. Binary logistic regression analysis was run and Kaplan-Meier survival curve is constructed for the assessment of mortality.&#x0D; Results: There were 90 neonates in exposed group and 93 in unexposed group. Males constituted 53% of the study population. Overall mortality rate was 15.8% (n=29). Severe asphyxia (RR 8.5, 95% CI 4.0 – 18.0; p &lt; 0.001) and spontaneous vaginal delivery (RR 1.8, 95% CI 1.1 – 2.9; p = 0.02) were the independent predictors of mortality. Mortality (7.8% vs. 23.6%, p-value 0.003) was significantly higher in unexposed group compared to exposed group. In exposed group the median survival time was 16 days (95% CI- 8.7 – 23.3) compared to 11 days (95% CI 9.9 – 12.0) in unexposed group (Log-rank test: χ2 = 6.03, df -1, p = 0.01). &#x0D; Conclusion: Magnesium sulphate was effective in lowering neonatal mortality due to moderate-severe perinatal asphyxia. In order to further validate its impact on mortality, multi-center studies are suggested.&#x0D;

STUDY OF CLINICO-LABORATORY PROFILE IN ENTERIC FEVER AT TERTIARY CARE CENTRE IN RAJASTHAN

Objective: The objective is to know the clinical profile of hospitalized patients with enteric fever and study the association of those clinical profiles with laboratory investigations. Methods: It was a hospital-based, prospective, cross-sectional, observational study, performed in the Department of Paediatric Medicine, SMS Medical College, Jaipur, over a period of 1 year from May 2021 to November 2022 to know the clinical profile of hospitalized patients of enteric fever and study association of that clinical profile with laboratory investigations. Prior permission from the institutional ethical committee was obtained. This study included a total of 100 children diagnosed with enteric fever. Results: Among study participants, the most common symptoms were fever (95), vomiting (39) and diarrhea (32). Other symptoms were pain abdomen (31), cough (23), anorexia (16), and headache (13). Among the signs, pallor was present in 26, icterus in 17, and hepato-splenomegaly in 16 children. Various hematological abnormalities found were as follows-leucopenia (87), leukocytosis (27), thrombocytopenia (16), pancytopenia (6), eosinopenia (66), and anemia (53). Hyponatremia and hypokalemia were found in 16 and 17 participants, respectively. Transaminitis was present in 32 participants. Mean Serum glutamic-oxaloacetic transaminase and serum glutamic-pyruvic transaminase was 48.6±65.2 and 48.9±71.8 IU/L, respectively. Positive C-reactive protein was found in 84 participants and blood culture was positive in 61 children. Among study participants various complications found were hepatitis, and bronchitis in 10 participants each followed by bronchopneumonia and encephalopathy in 2 participants each.

NEUROLOGICAL ABNORMALITIES IN CHILDREN WITH TYPE 1 DIABETES MELLITUS

Objective: The objective of the study is to find out the prevalence of neurological abnormalities in children between 5 and 15 years with type-1 diabetes mellitus (T1DM) of at least 2 years duration and the risk factors associated with the development of neurological abnormalities. Methods: Hospital-based cross-sectional study on 150 Children of 5–15 years of age having type I diabetes of at least 2 years’ duration by simple random sampling fulfilling the inclusion criteria, at Department of Pediatric Medicine, Sardar Patel Medical College and P.B.M. Hospital Bikaner. Results: Mean age was 10.9±3.6 years, male to female ratio was 1.63:1. The prevalence of peripheral neuropathy was 42.3% when 1 abnormal attribute in at least 1 nerve was considered, it was 7.3% when 2 abnormal attributes in 2 nerves were considered, 4.6% had autonomic neuropathy and 4% had cognitive abnormalities. The peripheral neuropathy was subclinical in a substantial number of cases as up to 39.4% and 39.3% of T1DM cases having peripheral neuropathy had normal neuropathic symptom score and neuropathic disability score, respectively. Female with longer duration of diabetes, higher mean age of diagnosis, and higher mean HbA1c level were significantly more likely to develop peripheral neuropathy. Conclusion: Neurological complications begin quite early and insidiously in T1DM patients highlighting the importance of early and regular screening by nerve conduction study.

Aetiology, Clinical Presentation and Outcome of Patients Presenting with Acute Flaccid Paralysis in a Tertiary Care Hospital

Objective: To determine the aetiology, clinical presentation and outcome of patients presenting with acute flaccid paralysis.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Department of Pediatric Medicine, Agha Khan Hospital, Karachi Pakistan, from Jan 2015 to Dec 2019.&#x0D; Methodology: Medical record of 150 children fulfilling the selection criteria were selected. The clinical presentations of the patient were recorded in terms of the following: fever, cough, vomiting, weakness, difficulty in swallowing, altered sensorium, changes in heart rate and blood pressure and difficulty in breathing. The outcome of children with acute flaccid paralysis, i.e. clinical improvement in symptoms, complete recovery or death during the hospital stay, was noted. &#x0D; Results: The mean age of patients was 10.13±5.01 years. The most common disease at presentation was Guillain bare syndrome 55(36.7%), followed by viral myositis 37(24.7%). Weakness was noted in all patients (100%), fever and headache in 64(42.7%), vomiting in 25(16.7%), and difficulty in breathing in 19(12.7%). After treatment, some improvement was noted in 104(69.3%) cases, while 27(18.0%) patients had no improvement; residual neurological disability was noted in 19(12.7%) cases, and 3(2.0%) died during follow-up.&#x0D; Conclusion: Acute Flaccid Paralysis (AFP) in children is a big challenge for physicians, and Guillian Barre Syndrome is the most common cause of acute flaccid paralysis in children. It almost invariably presents with weakness of the body. Keywords: Acute flaccid paralysis, Aetiology, Clinical presentation, Residual neurological disability.

Clinical spectrum and outcome of pancreatic disorders in children.

Objective: To determine the clinical spectrum and immediate outcome of pancreatic disorders in children attending National Institute of Child Health, Karachi, Pakistan. Study Design: Cross Sectional study. Setting: Inpatient and Outpatient Department of Pediatric Medicine, National Institute of Child Health, Karachi. Period: January 2022 to December 2022. Material &amp; Methods: A total of 49 children of either gender aged between 2 to 15 years presenting with clinical features of pancreatic disorders were analyzed. At the time of enrollment, data about demographic and clinical characteristics were noted. Important laboratory investigations were sent to local institutional laboratory. Ultrasound and/or CT scan of abdomen of each child was performed and reported by consultant radiologist having 3 years of experience for confirmation of the diagnosis. Immediate outcome was noted after 15 days of treatment among all children. Outcomes were labeled in terms of improved, not improved or expired. Results: In a total of 49 children, 30 (61.2%) were male while the mean age was 8.46±3.40 years. Epigastric pain, vomiting and whole abdominal pain were the most frequent presenting complaints noted in 40 (81.6%), 35 (71.4%) and 32 (65.3%) children respectively. Atrophy, inflammation and edema, calcifications, pancreatic duct dilation and pancreatic divisum were the commonest radiological findings noted in 10 (20.4%), 21 (42.9%), 18 (36.7%), 13 (26.5%) and 2 (4.1%) children respectively. Chronic pancreatitis was found to be the most frequent pancreatic disorder in 29 (59.2%) patients and they were associated with low fecal elastase level while acute pancreatitis was noted in 20 (40.8%) cases. Improved outcomes were observed in 44 (89.8%) children while no mortality was reported. Conclusion: Majority of the children with pancreatic disorders were male and aged between 6 to 12 years. Chronic pancreatitis was the most common type of pancreatic disorder. Epigastric pain, vomiting and whole abdominal pain were the most frequent presenting complaints. Outcome was generally good and no mortality was noted.

Frequency of Hypothyroidism in Patients with Beta-Thalassemia Major

Objective: To determine the frequency of hypothyroidism in patients with beta-thalassemia major in Paediatric department of Pak Emirates Military Hospital, Rawalpindi Pakistan. Study Design: Cross-sectional study. Place and Duration of Study: Paediatric Medicine Department, Pak Emirates Military Hospital, Rawalpindi Pakistan, from Nov 2018 to Oct 2019. Methodology: All transfusion dependant beta-thalassemia major (BTM) patient sir respective of age and gender were consecutively enrolled. For the assessment of thyroid function, a random sample of 3 ml venous blood was drawn. The presence of increased thyroid stimulating hormone and normal T4, T3 were labelled as compensated, increased thyroid stimulating hormone, decreased T4 and/or T3 as uncompensated. Results: Of 73 patients, the mean age of the patients was 7.0±3.87 years. All the patients were getting iron chelation therapy. The mean serum ferritin level was 3911.68±2017.36 ng/mL. Twenty-eight (38.4%) cases were hypothyroid. Subclinical hypothyroidism was documented in 25(89.3%) while clinical hypothyroidism in 3(10.7%) patients. Patients with age &gt;8 years (p=&lt;0.001), &gt;2 years of age at the time of 1st blood transfusion (p&lt;0.001)&gt;8 numbers of blood transfusion (p&lt;0.001) and &gt;4000ng/dl serum ferritin levels (p&lt;0.007) were noted as factors significantly associated with hypothyroidism. Conclusion: A considerable number of patients were affected with hypothyroidism. Moreover, high serum ferritin level and a high number of blood transfusions were found to be significant determinants.