Dhaka Shishu Hospital Research Articles

Socio-Demographic Factors of Children with Nephrotic Syndrome and Their Clinical Correlation

Background: Nephrotic syndrome (NS) is a chronic kidney disease in children marked by variability in treatment response, potentially influenced by socio-demographic and clinical factors. In resource-limited settings such as Bangladesh, understanding these potential influences is crucial for tailored healthcare strategies. This study investigates the socio-demographic profile of children with nephrotic syndrome and its clinical correlation to treatment outcomes. Methods: This cross-sectional study was conducted at Dhaka Shishu (Children) Hospital over six months, involving 168 children with nephrotic syndrome selected through convenient purposive sampling. Data were collected via structured interviews, focusing on socio-demographic factors and clinical outcomes. Statistical analysis was conducted using SPSS, with chi-square tests used to examine associations between socio-demographic factors and treatment response. A p-value <0.05 was considered significant. Results: Of the 168 participants, 61.31% were male, and half were aged 4 to 7 years. Most participants (70.24%) resided in rural areas, with 64.88% belonging to the lower socio-economic class. In terms of treatment response, 48.81% achieved remission, 38.10% experienced a relapse, and 13.10% were resistant to treatment. Although trends were observed, such as higher relapse rates among male children and resistance in females, no statistically significant associations were found between socio-demographic factors and treatment outcomes. Conclusion: The study highlights observed trends in socio-demographic characteristics and treatment outcomes in children with nephrotic syndrome in Bangladesh; however, no significant associations were identified. These findings underscore the importance of larger, more comprehensive studies to further investigate these variables and support the development of tailored management approaches in resource-limited settings.

Prediction of Cerebral Palsy and Other Motor Developmental Trajectories in High-Risk Neonate Using the Rapid Neurodevelopmental Assessment (RNDA)

Background: Cerebral Palsy (CP) is a prevalent motor disability affecting children globally, emphasizing the need for early identification and intervention. The Rapid Neurodevelopmental Assessment (RNDA) offers a comprehensive approach to predict CP and other motor developmental trajectories in high-risk neonates. Objective: This longitudinal cohort study aims to evaluate the effectiveness of RNDA in predicting CP and motor developmental trajectories. Method: Seventy term neonates from Dhaka Shishu (Children) Hospital were included, with neurodevelopmental assessments conducted using RNDA. Assessments were performed at 3 months and 6-9 months, with CP evaluation at 12 months using clinical examinations. Results: Prolonged labor (44.3%) and delayed cry after birth (31.4%) were common among the study patients (n=70), with varying modes of delivery including normal vaginal delivery (50.0%), vaginal delivery with complications (12.9%), and lower uterine cesarean section (37.1%). Muscle tone, primitive reflexes, gross and fine motor skills, epilepsy, and microcephaly were evaluated across visits to identify impending CP. Significant associations were found between hypertonicity, primitive reflex impairment, gross motor impairment, and fine motor impairment with impending CP across visits, particularly in the 3rd visit (p<0.05). Sensitivity, specificity, accuracy, and predictive values varied across parameters and visits, with fine motor skills and gross motor skills showing the highest sensitivity in the 3rd visit (86.4% and 100.0%, respectively). Additionally, abnormal EEG, USG of the brain, and MRI findings were significantly associated with impending CP, with USG of the brain demonstrating the highest sensitivity (93.3%) and MRI showing the highest specificity (70.0%). Conclusion: RNDA emerges as a valuable tool for early prediction of CP and motor developmental trajectories in high-risk neonates. Early identification through RNDA facilitates timely interventions, optimizing long-term neurodevelopmental outcomes.

Arsenic modifies the effect of folic acid in spina bifida prevention, a large hospital-based case-control study in Bangladesh

BackgroundSpina bifida, a developmental malformation of the spinal cord, is associated with high rates of mortality and disability. Although folic acid-based preventive strategies have been successful in reducing rates of spina bifida, some areas continue to be at higher risk because of chemical exposures. Bangladesh has high arsenic exposures through contaminated drinking water and high rates of spina bifida. This study examines the relationships between mother’s arsenic exposure, folic acid, and spina bifida risk in Bangladesh.MethodsWe conducted a hospital-based case-control study at the National Institute of Neurosciences & Hospital (NINS&H) in Dhaka, Bangladesh, between December 2016 and December 2022. Cases were infants under age one year with spina bifida and further classified by a neurosurgeon and imaging. Controls were drawn from children seen at NINS&H and nearby Dhaka Shishu Hospital. Mothers reported folic acid use during pregnancy, and we assessed folate status with serum assays. Arsenic exposure was estimated in drinking water using graphite furnace atomic absorption spectrophotometry (GF-AAS) and in toenails using inductively coupled plasma mass spectrometry (ICP-MS). We used logistic regression to examine the associations between arsenic and spina bifida. We used stratified models to examine the associations between folic acid and spina bifida at different levels of arsenic exposure.ResultsWe evaluated data from 294 cases of spina bifida and 163 controls. We did not find a main effect of mother’s arsenic exposure on spina bifida risk. However, in stratified analyses, folic acid use was associated with lower odds of spina bifida (adjusted odds ratio [OR]: 0.50, 95% confidence interval [CI]: 0.25-1.00, p = 0.05) among women with toenail arsenic concentrations below the median value of 0.46 µg/g, and no association was seen among mothers with toenail arsenic concentrations higher than 0.46 µg/g (adjusted OR: 1.09, 95% CI: 0.52–2.29, p = 0.82).ConclusionsMother’s arsenic exposure modified the protective association of folic acid with spina bifida. Increased surveillance and additional preventive strategies, such as folic acid fortification and reduction of arsenic, are needed in areas of high arsenic exposure.

Clinical and Laboratory Predictors of Mortality in Pediatric Patients with Severe Dengue at Dhaka Shishu Hospital

Background: Dengue fever, particularly in its severe form, poses a significant health challenge in tropical regions like Bangladesh. Understanding the clinical and laboratory predictors of mortality in pediatric patients with severe dengue is crucial for improving management strategies and patient outcomes. Methods: This cross-sectional analytical study was conducted at the Department of Pediatrics, Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh, from January 2019 to December 2020. It included 300 pediatric patients diagnosed with severe dengue. Results: Of the 300 participants, 286 (95.33%) survived, while 14 (4.67%) succumbed to the disease. Major bleeding, refractory shock, a significant rise in hematocrit, signs of pleural effusion, and ascites were significantly associated with mortality. Hematologically, a low platelet count (<15000/mm3) was a strong predictor of mortality. Elevated serum ferritin levels (>500 micrograms/L) were also significantly associated with increased mortality risk. Conclusions: The study highlights major bleeding, refractory shock, significant hemoconcentration, pleural effusion, ascites, low platelet count, and high serum ferritin levels as key predictors of mortality in pediatric patients with severe dengue. These findings underscore the need for comprehensive clinical monitoring and targeted management strategies to improve outcomes in pediatric dengue patients. J Rang Med Col. March 2024; Vol. 9, No. 1:10-15

Prediction of Cerebral Palsy and Other Motor Developmental Trajectories in High-Risk Neonate Using the Rapid Neurodevelopmental Assessment (RNDA) and Prechtl’s Method of Qualitative Assessment of General Movement (GMsA)

Background: The integration of the RNDA and Prechtl's Method offers a promising approach to identify high-risk neonates and predict their motor developmental trajectories. This early identification can guide clinicians in providing timely interventions, improving the long-term outcomes and quality of life for infants affected by CP and other motor disorders. Objective: The study investigates the predictive potential of the Rapid Neurodevelopmental Assessment (RNDA) and Prechtl’s Method of Qualitative Assessment of General Movement (GMsA) in high-risk neonates. Method: This longitudinal cohort study at Dhaka Shishu Hospital (January 2016-December 2017) enrolled 16 high-risk neonates. GMsA and RNDA were conducted from birth to 20 weeks post-term age. Muscle tone, primitive reflexes, gross and fine motor skills were evaluated. Impending CP diagnosis was at 1 year. Statistical analysis was performed using SPSS 23.0. Results: The study investigates the association between various developmental markers and the risk of cerebral palsy (CP) in infants. Results reveal a higher prevalence of muscle tone impairment in impending CP cases across preterm, term, and post term ages. Sensitivity, specificity, and predictive values for CP prediction based on muscle tone are presented, showing significant associations. Primitive reflexes also demonstrate higher impairment rates in impending CP cases across different age points, with corresponding sensitivity, specificity, and predictive values. Gross motor and fine motor impairments exhibit significant associations with impending CP, along with predictive values. The distribution of categorical scores for GMsA and RNDA across various age points emphasizes the prevalence of impairments in impending CP cases. Findings indicate a strong association between GMsA scores and CP risk, with significant predictive capabilities across different visits. Overall, the study highlights the utility of these developmental markers in predicting CP ....

Effect of Carica Papaya Leaves Juice on Plasma Leakage and Platelet Count among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to be increase platelet count and improve haematocrit. Objective: This study aimed to determine the effect of Carica papaya leaf juice on plasma leakage and platelet count in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p>.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p<.001. Haematocrit values become significantly normal in group A then group B by 72 hours and p˂.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p<.001. Conclusion: Administration of Carica papaya leaf juice increase platelet count, maintain .......

Effect of Carica Papaya Leaves Juice on Duration of Hospital Stay among Children with Dengue Fever and Dengue Haemorrhagic Fever

Background: Over the last 10-15 years, dengue fever (DF) and dengue hemorrhagic fever (DHF) have become the leading causes of hospitalization and death among both children and adult. Carica papaya leaves juice is said to increase platelet count, reduce complication and duration of Hospital stay. Objective: This study aimed to determine the effect of Carica papaya leaf juice on duration of Hospital stay in child patients with DF and DHF. Methods: This randomized controlled trial was conducted among 77 children with DF and DHF. Patients were purposively selected from the inpatient department of Dhaka Shishu hospital from July 2018 to December 2019. Patients were randomly allocated in group A and group B. Group A patients received standard treatment along with a bottle containing C. papaya leaves juice 10 ml single morning dose 15 minutes after breakfast for three consecutive days and group B patients received only standard management as per the National Guideline for Clinical Management of Dengue Syndrome, 2018. Three patients in group A and two patients in group B dropped out from the study. Results: There was no significant difference between the groups regarding age, sex, mean duration, type and severity of fever between the groups (p>.05). In group A, the mean platelet count increased from 105000.00/ mL to 152428.57/mL after 48 hours and it reached to 212228.57/mL at 72hrs. In group B, the mean platelet count initially decreased from 129485.71/ mL to 91114.28/mL after 48 hours and then it increased to 96142.85/mL at 72 hours. There was highly significant statistical difference between group A and group B at 48 hours and at 72 hours regarding mean platelet count as p <0.001. Haematocrit values become significantly normal in group A than group B by 72 hours and p value ˂0.05. There was highly significant statistical difference between group A and group B regarding mean hospital stay as p <0.001. Conclusion: Administration of Carica papaya leaf juice shorten hospitalization in patients with Dengue fever and Dengue haemorrhagic fever.

Antibiotic Sensitivity Patterns in Pediatric Enteric Fever: A Cross-Sectional Study at a Tertiary Care Hospital in Bangladesh

Background: This cross-sectional study aimed to investigate the antibiotic sensitivity patterns among pediatric patients with enteric fever at the Department of Paediatrics, Bangladesh Institute of Child Health, Dhaka Shishu Hospital, during the period from July 2005 to June 2006. The primary objective was to identify the prevalent antibiotic sensitivities in order to enhance the efficacy of treatment strategies for typhoid fever in children. Methods: Ninety-eight suspected cases of enteric fever, aged between 2 and 12 years, were selected from admissions to the above-mentioned hospital. Blood culture and sensitivity testing were performed for Salmonella typhi and paratyphi. Demographic information, pre-admission antibiotic usage, and sensitivity profiles to various antibiotics, including Ceftriaxone, Cefixime, Chloramphenicol, Ciprofloxacin, Azithromycin, Amoxicillin, Imipenem, Nalidixic acid, and Ampicillin, were analyzed. Results: The majority of patients (62.2%) were in the 5-9 years age group, and males constituted 61.22% of the study population. Blood cultures revealed 71.44% sensitivity for Salmonella typhi and 28.57% for paratyphi. Among the antibiotics tested, Ceftriaxone exhibited 100% sensitivity, followed by Cefixime (80.2%), Chloramphenicol (78.57%), Ciprofloxacin (65.20%), Azithromycin (60%), Amoxicillin (54.6%), Imipenem, Nalidixic acid (Intermediate sensitive, 56.3%), Ciprofloxacin (Intermediate sensitive, 25%), and Ampicillin (Intermediate sensitive, 18.8%). Nearly half of the patients (47.3%) received antibiotics before admission, and 43.8% of culture-positive patients had a history of pre-admission antibiotic use. Conclusion: The study concludes that understanding antibiotic sensitivity patterns is crucial for successful typhoid fever treatment in children. Ceftriaxone and Cefixime emerged as highly effective, while the unnecessary use of antibiotics prior to admission may influence sensitivity patterns. This information underscores the importance of judicious antibiotic prescribing practices to ensure optimal therapeutic outcomes in pediatric enteric fever cases.
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Bacteriological Profile and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Cross-Sectional Study at Dhaka Shishu Hospital

Background: Urinary tract infections (UTIs) are a prevalent concern in pediatric healthcare, causing distress to children, raising parental concerns, and potentially leading to lasting kidney damage. The highest incidence of first-time symptomatic UTIs occurs in infants during the first year of life, with a subsequent marked decrease. Febrile infants under 2 months, presenting with unexplained fever, constitute a critical subset requiring particular attention. Knowledge of the bacteriological profile and antimicrobial resistance patterns in specific regions is crucial for guiding effective treatment strategies. Methods: A cross-sectional study was conducted at 250 Bedded General Hospital, Jamalpur, Bangladesh from Feb 2016 to Aug 2016 to assess the bacteriological profile and antibiotic resistance patterns in pediatric UTIs. A total of 147 culture-positive UTI patients were included. Bacterial isolates were identified, and colony counts for samples with ≥105 CFU/mL bacteria were considered positive. Antimicrobial susceptibility testing was performed using twelve agents, and resistance patterns were analyzed. Results: Among the 147 culture-positive UTI patients, Escherichia coli (E-coli) was the predominant isolate (70%), followed by Klebsiella spp. (13.6%), Pseudomonas (5.44%), Enterobacter spp (3.40%), Staphylococcus Aureus (3.40%), Proteus (2.72%), and Enterococcus (1.36%). Antimicrobial resistance analysis revealed varying patterns, with Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%), and Ceftazidime (CTM) (48.98%) showing higher resistance rates. No drug exhibited 100% resistance against urinary pathogens, indicating a dynamic resistance landscape. Conclusion: This study highlights the importance of understanding local prevalence and resistance patterns in guiding empirical antibiotic selection for pediatric UTIs. The observed decrease in antimicrobial resistance underscores the need for continuous surveillance and tailored antibiotic strategies. Clinicians should base their treatment decisions on the specific epidemiological context rather than relying solely on universal or national guidelines.

Comorbidities of Autism, Dhaka Shishu (Children) Hospital Based Study

Comorbidities of Autism, Dhaka Shishu (Children) Hospital Based Study

Ultrasonography along with Clinical Finding is enough for the Diagnosis of Infantile Hypertrophic Pyloric Stenosis

Introduction: Infantile hypertrophic pyloric stenosis (IHPS) is characterized by hypertrophy of the pyloric muscular propria, predominantly involving the circular layer and subsequent narrowing of the pyloric outlet. Aim of the Study: To see the ultrasonographic diagnosis of infantile hypertrophic pyloric stenosis. Material & Methods: This retrospective study was conducted in Dhaka Shishu (Children) Hospital, Dhaka, Bangladesh during the period conducted from February 1997 to October 1998 in a period of 21 months. The data were collected for all 31 patients. Following, collection of all the required data, these were checked and tabulated into the computer using the SPSS/PC software 23. Results: During the study period February 1997 to October 1998 total surgical admission was 4006 and infantile hypertrophic pyloric stenosis patients (IHPS) were 31. So IHPS represented .77% of the total surgical admission during the study period in DSH. Correlation of clinical and ultra-sonogram findings with operative finding, clinical findings true +ve 20(64.52%), true –ve 2(6.45%), false +ve 1(3.23), false –ve 8(25.81) and ultra-sonogram observation true +ve 27(87.10%), true –ve 2(6.45%), false +ve 2(6.45%), false –ve 2(6.45%) and then finally operation needed IHPS ware 29(93.35%) also others than IHPS 2(6.45%). Correlation of pattern of sensitivity and specificity in clinical findings 93.1% and 50%, ultra-sonogram findings 71.43% and 66.67%. Conclusion: In conclusion, we would like to advise that infantile hypertrophic pyloric stenosis is the most common cause of non-bilious projectile vomiting in an infant. The diagnosis being mode primarily by non-bilious projectile vomiting in a neonate, which usually starts 2-4 weeks after delivery and ultrasonography can confirm the diagnosis.

Socio-economic Factors Responsible for Delayed Presentation of ROP in a Tertiary Neonatal Care Unit in Bangladesh

Purpose: To evaluate the socio-economic factors responsible for delayed presentation of ROP in a tertiary neonatal care unit in Bangladesh. Methods: This observational study was conducted on fifty babies, who were presented delay at screening were purposively selected for the study at Dhaka Shishu Hospital, National Institute of Ophthalmology & Hospital. Study period was 12 months and data collection was done by face to face interview from legal guardians with pre designed questionnaire. Information regarding gestational age, birth weight, condition of health at birth,parents education level and economic condition were obtained by face to face interview from parents. They were also asked whether the baby was advised for screening or not. Screening was done by indirect ophthalmoscopy by using 20D condensing lens. Results: Among the 50 babies, prevalence of ROP was 66.0% (95% CI: 52.87-79.13). Mean gestational age was 29.10(±1.5) weeks and mean birth weight was 1250(±0.24) gm. After taking account of all possible confounders, we found that place of residence of the parents is associated (p=0.011) as well as adviced for screening is marginaly assocated (p= 0.05) with delayed presentation of ROP for screening. Conclusion: There are many risk factors for delayed presentation of ROP at screening. Among the factors palce of residence (rural) and advice for screening are found to be significant. Further study regarding this issue is necessary to explore all other factors and formulate plans to overcome them. J.Natl.Inst.Ophthalmol.2023;6(1): 9-15

Diagnostic Validity of Flagellin Gene (fliC) in Urine for the Detection of Typhoid Fever

Background: Accurate diagnosis of typhoid fever is important issue for the treatment of the patients. Objective: The purpose of the present study was to evaluate the nested PCR for the diagnosis of suspected cases of typhoid fever targeting the flagellin gene (fliC) of Salmonella Typhi from urine. Methodology: This cross sectional study was conducted in the Department of Microbiology of Dhaka Medical College (DMC), Dhaka. Specimens were collected from OPD of DMCH, Dhaka Shishu Hospital (DSH), Dhaka and National Institute of Neurosciences and Hospital (NINSH), Dhaka from July 2013 to June 2014 for a period of one year. All suspected patients of typhoid fever irrespective of age, sex and history of antibiotic intake who attended the OPD of DMCH, DSH and NINSH were selected for this study. Diagnosed cases of febrile illness other than typhoid fever were excluded from the study. Blood and urine were collected and all isolates were tested for antimicrobial susceptibility by Kirby-Bauer modified disc-diffusion technique. Widal test and CRP were performed. Nested PCR was performed in the urine and blood to detect the DNA of Salmonella Typhi. Results: Among 72 typhoid fever patients, 33(45.8%) were Widal test positive and 42(55.5%) were blood culture positive. Out of 30 blood culture negative patients nested PCR in urine was positive in 5(16.7%) cases. The sensitivity, specificity, PPV, NPV and accuracy of nested PCR in urine were 97.6%, 83.3%, 89.1%, 96.1% and 91.7% respectively. Conclusion: In conclusion the nested PCR for the diagnosis of typhoid fever targeting the flagellin gene (fliC) of Salmonella Typhi from urine may be very useful diagnostic tool. Bangladesh Journal of Medical Microbiology, January 2023;17(1):34-39

Presenting clinical features of COVID-19 in neonatal age group

Background : In December, 2019 a cluster of pneumonia cases spread in Wuhan City, Hubei Province, China caused by a novel corona virus (named as “2019-nCoV”). Although it is thought to be a disease of adult but it can occur in children and neonates also.
 Objective : The aim of this study was to see the incidence of Neonatal COVID-19 and its mode of presentation in neonatal age group.
 Methods : This cross sectional study was done in Dhaka Shishu (Children) Hospital from April, 2020 to October, 2020. All suspected neonates for COVID-19, RT PCR were done from nasopharyngeal swab. Suspecting sign were fever, respiratory difficulty, reluctant to feed, neonate not responding to conventional treatment, or referred from endemic area or having any household contact. Routinely RT PCR was done preoperatively who needed surgery. Then all the data were collected and analyzed using Statistical Package of Social Science (SPSS), version 26.
 Results : Total 5521 neonates were admitted and 299 neonates were suspected for COVID-19 infection during this study periods and undergone RT PCR, out of which 47 cases were test positive. The incidence of COVID-19 cases was 0.85% among hospitalized neonates. Thirty one were male and 16 were female. Male female ratio was 1.9:1. Thirtythree cases admitted in medicine and 14 cases in surgery division. Twenty three (49%) cases presented symptoms after 7 days of age and 13(28%) cases got admitted within 3 days, among them 2 cases were admitted at 24 hours of age with symptoms. Respiratory difficulty (25.5%), convulsion (19.1%), fever (17%) and reluctant to feed (17%) were common presenting symptoms. The associated diagnosis with COVI-19 cases were mostly perinatal asphyxia, septicemia and pneumonia. Regarding chest X-ray, one neonate had patchy opacities in right lower lobe, another had bilateral ground-glass opacity and in case of third one few patchy opacities was found in the right perihilar region. Out of 47 positive cases 23 patients could discharge after improvement, 14 patients referred to COVID specialized hospital, 2 cases went as LAMA (Leave against medical advice) and 8 patients died at our hospital.
 Conclusion : In this Study the incidence of COVID-19 in newborn was 0.85% among hospitalized newborn. The common clinical features were respiratory difficulty, convulsion, fever and reluctant to feed. It could not be differentiated whether these clinical features were due to COVID-19 or associated diseases.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 526-529

Risk factors of persistent diarrhea in children below 5 years of age

Background: Persistent diarrhea is a known cause of mortality, morbidity, and malnutrition in developing countries. With recent improvement of rehydration therapy death due to acute diarrhea has been reduced. Though persistent diarrhea accounts for 2-20% of total diarrhea cases, it accounts for 23-62% of all diarrhea related deaths. Objective: The study was done to identify the risk factors associated with persistent diarrhea in children below 5 years of age.
 Methods: This prospective observational study was conducted in the department of Pediatric Gastroenterology, Hepatology and Nutrition of Dhaka Shishu hospital from July 2019 to June 2020. It included 50 children with persistent diarrhea age between 1 month to <5 years. Detailed history, examination and appropriate investigations were done for all children. Crude odd ratio was calculated for each risk factor by univariate analysis and adjusted odds ratio was calculated by multivariate logistic regression.
 Results: Most of the children (52%) were under the age of 6 months to 1 year. Male (84%) were more affected than female (16%). Acute malnutrition was observed in 44% cases; among them severe acute malnutrition was in 40% cases. Unsafe drinking water, severe acute malnutrition, diarrhea within past 2 months, bottle feeding, persistent of dehydration more than 24 hours, feeding of cow’s milk, lack of exclusive breast feeding, prior antibiotic used, UTI, LRTI were statistically significant risk factors by univariate analysis. Unsafe drinking water (OR-1.6; 95% CI- 0.27- 2.78), severe acute malnutrition (OR-1.92; 95% CI-0.64 - 5.72), Feeding of cow’s milk (OR-3.90; 95% CI- 1.21- 12.49), lack of exclusive breastfeeding (OR-5.77; 95% CI- 1.44- 23.10), irrational use of antibiotics (OR-3.37; 95% CI- 1.01- 11.38), LRTI (OR-1.16; 95% CI- 0.49- 1.53) were found to be independent risk factors by multivariate logistic regression analysis.
 Conclusions: The results of this study concluded that use of unsafe drinking water, severe acute malnutrition, feeding of cow’s milk, lack of exclusive breastfeeding, irrational use of antibiotics are significant risk factors for the incidence of diarrhea in the present study population.
 Northern International Medical College Journal Vol. 12 No.2 Jan 2021, Page 539-543

Effect of maternal food habits in periconceptional life with the occurrence of birth defects

Background: Maternal periconceptional period can be defined as the critical window surrounding the period of conception. The periconceptional period consists of preconception, conception, implantation, placentation and embryo or organogenesis stages, and specific cellular events that occur during the distinct stages of embryogenesis. On the other hand, birth defects are structural changes present at birth that can affect almost any part of the body. They may affect how the body looks, works, or both. This study aimed to find maternal food habits in periconceptional life with the occurrence of birth defects. Methods: This case-control study was conducted in both the Pediatric Surgery and Medicine Department of Dhaka Shishu (children) Hospital, Dhaka, Bangladesh during the period from January 2012 to December 2013. In total 280 ‘0-364 days old infants’ were included as the study subjects and divided into two equal groups in number, cases having a structural birth defect and controls without any birth defect. A pretested questionnaire was introduced after getting informed written consent from the mothers. Data were analyzed by statistical package for the social sciences (SPSS) 16.0 version, by univariate, bivariate and multivariate analyses and were presented by tables and graphs. Results: In this study, most of the defects were distributed to the gastrointestinal system (18%), genito urinary system (16%), CVS (14%), NTD (13%), defect of the face (13%) and skull (11%). The isolated defect was in 80% of patients, multiple defects in 17% of patients and 3% syndromes were present. In this study, mothers ‘who took no meat/week’, ‘who took no fish/week’, ‘who took no egg/week’, ‘who took no milk/week’, experienced BD more and the difference was statistically significant (p<0.05) between the groups. However, mothers who took vegetables less than once/week experienced BD more frequently, but the difference between the groups was not statistically significant (p>0.05). Conclusions: In maternal food habits; less intake of meat, fish, milk and egg is significantly correlated with the occurrence of birth defects but there is not any significant correlation with vegetable intake.

Demographic and clinical status of the neonates admitted to an intensive care unit in Bangladesh

Background: The neonatal intensive care unit is a fundamental sector for the survival of high-risk newborns. Such a unit involves high-complexity assistance with teams trained in newborn care, reconciling technological advances with proper approaches to humanized care practices. Usually, the outcomes of neonatal intensive care unit patients depend upon the demographic and clinical status of the patients. In Bangladesh, we have very limited research-based information regarding this issue. This study aimed to assess the demographic and clinical status of neonates admitted to an intensive care unit in Bangladesh. Methods: This was an observational cohort study that was conducted in the Neonatal Intensive Care Unit (I.C.U.) of Dhaka Shishu Hospital, Dhaka, Bangladesh during the period from October 2009 to September 2010. In total 230 neonates admitted to the Neonatal Intensive Care Unit, after fulfilling the inclusion criteria were enrolled in this study as study subjects. Properly written consent was taken in favour of all the participants before data collection. All data were processed, analysed and disseminated by using MS Excel and SPSS version 15.0 program as per necessity. Results: Among the total of 230 participants, the male-female ratio was 1.7:1 and gestational age was found as >37 weeks in 60% of neonates. The age of the majority of the neonates (53%) was <7 days. The diaphragmatic hernia was present in the highest number (n=17) of cases as a single congenital anomaly. As the disease pattern, perinatal asphyxia with complications, preterm low birth weight with sepsis and congenital anomalies were found in 24.8%, 20.4% and 23% of cases respectively. Among the total of our patients, in 55% of cases, acid-base derangements were present. Conclusions: The higher frequency of ICU admission of male neonates is alarming for the neonatal care system. The first week of neonatal ICU may be considered the most critical period, especially for preterm babies. Neonates with perinatal asphyxia, preterm low birth weight with sepsis and congenital anomalies are some common features among neonatal ICU care patients.

Adverse Effects of Topiramate in Neonate with Moderate to Severe Perinatal Asphyxia: A Randomized Controlled Trial

Introduction: A harmful pregnancy condition that harms both the mother and the fetus is perinatal asphyxia. It frequently happens as a result of challenges during labour, including protracted or challenging delivery, concerns with the umbilical cord, placental abnormalities, or maternal health conditions. Topiramate, an anticonvulsant, works through a variety of different methods. Topiramate looks to be effective as a neuroprotective agent as well as an anti-seizure medication in animal models of newborn brain injury. Angiogenesis, neurogenesis, and neuronal anti-apoptotic pathways are all stimulated and regulated by topiramate. In light of this, this observational study was conducted to ascertain Topiramate's negative consequences in kids with mild to moderate neonatal hypoxia. Methods: This observational case-control study was carried out in the Neonatal ward and ICU of Dhaka Shishu Hospital from April 2015 to March 2016. A total of 64 neonates were enrolled in this study and were assigned Group A -the interventional group (n=32) received topiramate and standard treatment protocol, and Group B or the control group (n=32) received only standard treatment protocol. The data were analyzed according to standard procedure. Results: Among the study neonates, based on sex in case and control groups, respectively, seventeen (17,53%) and twenty-one (21,66%) neonates were male, and fifteen (15,47%) and eleven (11,44%) neonates were female. Statistically, the sex distribution between groups was not significant (p=0.44). USG finding of the neonates after treatment was normal in 12 (48%) and 13(41%), and abnormal in 20(32%) and 19 (59%) neonates in the control and case groups, respectively. Out of 27 neonates in the control group, 11 (41%) were neurologically normal, and 16 (59%) had abnormal neurological findings. Out of 29 neonates in the case group, 24 (73%) were neurologically normal, and 5(17%) showed abnormal neurological findings. Statistically, significant variation ..

Frequency of Acid-Base Derangements Among the Neonates Admitted to the Intensive Care Unit

Background: Every year deranged acid-base physiology drives admission to a critical care arena for a vast number of neonates. The neonatal intensive care unit is a fundamental sector for the survival of high-risk newborns. The acid-base disorder must always be considered in the clinical setting. The clinician should, in most cases, be able to predict the type of acid-base imbalance before the blood gas is available. Arterial blood gases (ABG-s) are the gold standard for assessing the adequacy of oxygen delivery, ventilation, and pH. This study aimed to assess the frequency of acid-base derangements among neonates admitted to the intensive care unit. Material & Methods: This was an observational cohort study that was conducted in the Neonatal Intensive Care Unit (I.C.U.) of Dhaka Shishu Hospital, Dhaka, Bangladesh during the period from October 2009 to September 2010. In total 230 neonates admitted to the Neonatal Intensive Care Unit, after fulfilling the inclusion criteria were enrolled in this study as study subjects. For each baby, a detailed history was recorded in a questionnaire form (enclosed herewith) from the mother or other caregiver. It was filled up by the researcher himself containing history (including antenatal history), physical examinations and laboratory findings. Arterial blood gas analysis was done (in a clinical biochemistry laboratory using an automatic analyzer machine) for each neonate at admission and that report was recorded for this study. Results: Among the total study subjects, 127 newborn babies (55.2%) had acid-base imbalances. Mixed acidosis prevailed in the highest frequency (23.9%) Then metabolic acidosis cases were at 17.8% and respiratory acidosis was at 13.9%. Metabolic alkalosis and respiratory alkalosis were absent. Normal blood gas was observed in 44.3% of newborns. All the neonates with pH <7 were dead. After Chi-Square analysis (at df=1), we found a highly significant correlation between mortality outcome with pH <7.35, CO2 >45, HCO3 < 22 mol/l and Base deficit >-10. All modalities of acid-base imbalances were significantly associated with mortality. Conclusion: In this study, a significant number of neonates who were admitted to the intensive care unit, can develop acid-base derangement. Mixed acidosis was found in the highest frequency. Metabolic, respiratory and mixed acidosis all has a significant correlation with death in a NICU. Metabolic alkalosis and respiratory alkalosis were found absent at admission.

Role of prophylactic fresh frozen plasma in critically ill neonate to prevent bleeding in disseminated intravascular coagulation: a randomized controlled trial

Background: Disseminated intravascular coagulation (DIC) has a high prevalence in critically ill neonates. In suspicion of DIC based on abnormal coagulation parameter is a common trigger to transfuse fresh frozen plasma (FFP), even in absence of bleeding. In past years, use of FFP has increased and has expanded to include prophylactic use in neonates especially in neonatal intensive care units (NICUs) as it contains several coagulation factors. Several studies suggest that, prophylactic use of FFP has no role to prevent bleeding in disseminated intravascular coagulation (DIC), but carries increase risk of transfusion related mortality and morbidity. Objective: To assess the effectiveness of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC. Methods: This randomized, open-label, blinded end-point study was conducted in Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital from July, 2019 to June, 2021. Term, critically ill neonates who had underlying disease, suspected to develop DIC were conveniently selected. Later, they were randomly allocated using software in intervention group, who received 10 ml/kg of FFP along with standard management and control group, who received only standard management. Coagulation parameters were checked before and 24 hour after intervention in both groups. Outcome was occurrence of bleeding as a indicator of DIC. Results: The mean age was 8.55 ± 3.5 days in intervention and 8.92 ± 6.1 days in control group. Male patients were predominant. There was no significant difference in baseline characteristics between two groups. The difference of mean ± SD of coagulation parameters between two groups were nonsignificant before intervention. Even after FFP transfusion, DIC developed among 40.1% neonates in intervention and without FFP transfusion among 48.9% neonates in control group without any significant difference (P-value >0.05). Conclusion: Study result found no role of prophylactic use of FFP in critically ill neonate to prevent bleeding in DIC. Bangladesh Medical Res Counc Bull 2022; 48: 146-153