Dhaka Shishu Research Articles

Clinical and Biochemical Profile of Children with Chronic Kidney Disease in a Tertiary Care Hospital of Bangladesh

Background: Chronic kidney disease (CKD) is an insidious and irreversible condition that eventually progresses to end stage renal failure and important cause of morbidity and mortality in children worldwide. However, the care of these patients represents a challenge for health care providers, which must pay attention not only to renal disease, but also to the various extra renal manifestations that affect growth and development. Evaluation of clinical and biochemical profile of children with chronic kidney disease can help to meet up this challenge. Methods: This cross-sectional observational cohort study evaluated clinical, anthropometric and biochemical variables of children with chronic kidney disease aged 2 to 16 years in the department of Pediatric Nephrology, Dhaka Shishu (Children) Hospital, Bangladesh, during July’ 2018 to December’ 2018. A total of thirty-six children with chronic kidney disease with creatinine clearance <60ml/min/1.73 m2 and on supportive treatment and haemodialysis were included. In control group, equal number of age and sex matched healthy children without any preexisting chronic diseases were included. Both study group and control group were assessed for sociodemographic data, nutritional status, clinical and biochemical parameters. Results: The mean age was 9.09±3.01 years in case group and 7.85±3.69 years in control group. In case group, 22 patients (61.1%) were male and 14 (38.9%) were female and the ratio was 1.5:1. In this study we found that a statistically significant decrease in Z-score for (Weight, Height and Body Mass Index) in the CKD patients’ group than control. In terms of blood pressure, 66.7% of patients in the cases group were hypertensive (P = 0.001). There was no significant difference of hypertension among CKD stages in this study. CKD Patients were found anemic with significant decrease in hemoglobin level. Anemia found in 35 patients (97.2%) in the case group than control (P=0.001). CKD stage 5 children had significantly lower hemoglobin level. Serum phosphate and potassium were significantly higher while serum calcium was significantly lower and parathyroid level was higher in case group than control. Conclusion: The present study stated that CKD patients had significantly lower BMI and hemoglobin but hypertensive in comparison to case group. Serum potassium, phosphate and parathyroid higher but serum calcium level was lower in case group. J Bangladesh Coll Phys Surg 2023; 41: 120-125

Comparison of the Outcome of Interrupted Suture and Continuous Suture in Tubularized Incised-Plate (TIP) Urethroplasty Hypospadias Repair

Introduction: The tubularized incised plate (TIP) urethroplasty has obtained worldwide acceptance for distal hypospadias repair due to its low complication rate, good cosmetic result, and technical simplicity. Aim of the Study: The aim of this study was to compare the surgical outcome between Continuous suture & interrupted suture in case of tabularized incised plate (TIP) urethroplasty. Methods: This prospective randomized comparative study was conducted in the Division of Pediatric Surgery, Bangladesh Institute of Child Health & Dhaka Shishu (Children) Hospital, Dhaka from July 2017 to June 2019. Total 40 patients were included in this study and divided in two groups which are Group A and Group B. Result: In the current study, the mean age of participants was 41.15±24.46 months in group A and 38.05±25.14 months in group B. There was no significant difference between ages of two groups as the p = 0.695. The mean penile length of participants was 31.90±7.04 mm in group A and 27.95±5.04 mm in group B. There was significant statistical difference between penile lengths of two groups as the p value was 0.049. Operation time in group A and group B was 66.86±3.51 minutes and 79.38±5.04 minutes respectively. The result showed that there was strong statistical difference between operation time in two groups as the p=0.0001. Operation cost in group A and group B was 18810.00±818.79 TK and 18385±1962.08 TK respectively. The result showed that there was no statistical difference between operation cost in two groups as the p=0.377. Hospital stay in group A and group B was 8.1±0.45 day and 8.0±0.0 day respectively. The result showed that there was no statistical difference between hospital stay in two groups as the p=0.324. There is no wound infection occurred in group B patient. There was no significant statistical difference between wound infection of two groups as the p value was >0.05. There was no significant statistical difference between occurrence of UC fistula .......

Effect of Vitamin D Supplementation in Children with Severe Acute Malnutrition

Background: Malnutrition accounts for about 35% of under-five mortality, of which 4.4% is specifically because of severe wasting. Prevalence of vitamin D deficiency in malnourished children ranges from 31% to 61%. Addition of high dose vitamin D supplementation in children with severe acute malnutrition would be effective in elevating serum vitamin D concentration and thus improve weight gain. The association of vitamin D and malnutrition is well recognized but data are scarce. Objectives: To see the effect of vitamin D in the treatment of severe acute malnourished children. Methods: This prospective randomized controlled trial study was conducted among children 6 months to 5 years old with a diagnosis of SAM in the pediatric ward of Dhaka Shishu (Children) Hospital in Bangladesh from July 2018 to January 2020.Sample was collected through simple random sampling then randomized into two groups by lottery method. Finally, 50 patients were included in the study, among them 25 patients received 6 lac IU vitamin D orally in day 1 in addition to the standard treatment of SAM and the other 25 patients received only the standard treatment of SAM. Demographic data and other related information regarding clinical feature, laboratory feature, outcome variables were recorded and anthropometric measurement and Z-scoring was done to assess malnutrition. Collected data was checked manually and analyzed by computer-based program SPSS for Windows (version 20.0). Outcomes were: Length of hospital stay and average weight gain between the two groups. Comparison of parameters among the group were done by unpaired t-test and chi-square test. Results: There were no statistically significant difference in length of hospital stay (16.24 ±3.29 versus 15.34±2.64) days, p=0.291 but there was statistically significant difference in average weight gain (9.08±2.99 versus 7.52±2.06) gm/kg/day, p=0.037 and wasting (weight for height z score) improved significantly on follow ups (p=0.241 on first, p=0.039 on 2nd, p=0.009 on 3rd and p=<0.001 on 4th follow up). Conclusions: Vitamin D supplementation causes significant weight gain in children with severe acute malnutrition.

Psychological Well-Being of Parents with Hospitalized COVID-19 Infected Children in Bangladesh

Objective: Not only has COVID-19 caused unprecedented changes in every sphere of human lives, but it has also simultaneously triggered a wide range of psychological problems within the community. Naturally, parents are prone to being anxious about their children amidst this pandemic. This becomes particularly serious when their children are being affected and hospitalized due to exposure to COVID-19, leading to increased anxiety and depression. Our study aims to assess the level of anxiety and depression and the predictor factors for depression and anxiety among the parents of hospitalized COVID-19-infected children. Method: This cross-sectional study incorporated 160 parents of COVID-19 infected children who were admitted to Mugda Medical College Hospital, Dhaka Shishu (Children) Hospital, and Kurmitola General Hospital between April 2020 and October 2020. Result: The study has revealed that among the 160 participants, every one in five parents (19.37%) was suffering from moderate to severe anxiety, while 43.10% of parents were suffering from moderate and moderately severe depression. More than fifty per cent of the respondents were suffering from minimal anxiety (54.38%), while 43.80% of parents were suffering from minimal depression. City dwellers were more prone to developing both anxiety and depression. Conclusion: About 43.1% of parents suffered from moderate and moderately severe depression, while 54.38% of parents suffered from minimal anxiety. These parents need to be addressed, and proper support & intervention must be ensured.

Evaluation of Complications Related to Exchange Transfusion due to Hyperbilirubinaemia in Newborns with or without Comorbidities

Introduction: Exchange transfusion (ET) is the first successful treatment introduced for severe neonatal jaundice considered to be a safe procedure but not risk free. Present study aimed to determine the complications related to exchange transfusion and to compare the incidence of severe complications between healthy and ill newborns. Methods: This cross sectional study was done in Neonatal Intensive Care Unit (NICU), Dhaka Shishu Hospital and Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, over 6 months from January to June 2010, included 50 newborns who underwent exchange transfusion due to hyperbilirubinaemia. Newborns with hyperbilirubinemia alone were classified as healthy, while hyperbilirubinaemia associated with other medical problems were classified as ill. Adverse events were analyzed and compared between two groups. Results: Out of 50 patients who underwent ET, 27 were healthy had jaundice only and 23 were ill. Most of the newborns with comorbidities (87%) developed at least one complication following exchange transfusion (p<0.001). Newborns with co-morbidities developed hypoglycemia (13%), hypocalcaemia (17.4%), thrombocytopenia (26.1%), sepsis (26.1%), apnoea (4.3%) and in newborns without co-morbidities, hypoglycemia, hypocalcaemia, thrombocytopenia each was found in 7.4% cases and septicemia (14.8%). Thrombocytopenia was significantly higher in ill newborns (p = 0.039). About 9% of newborns died in ill group compared to 3.7% in healthy group (p = 0.439). Conclusions: Complications and mortality were significantly higher in newborns having hyperbilirubinemia with comorbidities. Thrombocytopenia was the most frequent complication. Majority of the hyperbilirubinemic neonates with comorbidities develop at least one complication after exchange transfusion. J Bangladesh Coll Phys Surg 2023; 41: 40-45

The Prevalence of Anaemia and Haematological Parameters in Children and Adolescents; A Hospital Based Study

Introduction: Anemia is a common health problem worldwide. It is an important cause of morbidity and mortality of young and growing children in rural areas of developing countries. Young growing anemic children have various clinical symptoms including, pallor, Jaundice, fever, cough, breathlessness, hyper-pigmentation, tremors, and hepatosplenomegaly. Aim of the Study: Aim of the study was to evaluate the clinical manifestations, and grades of anaemia in different age groups. Methods: This retrospective observational study was conducted in the Department of Paediatrics at Dhaka Shishu Hospital, Dhaka, Bangladesh. A total of 95 patients were enrolled and analyzed in this study from July 2021 to December 2021. Result: In the present study of the prevalence of anemia and hematological parameters in children aged 1-18 years 10(10.53%) children were <1 year, 37(38.95%) were between 1-5 years, 28(29.47%) were aged between 6-10 years, and 11(11.58%) were between 11-15 years. Types of anemia were 46.32% had iron deficiency, 29(30.53%) had thalassemia. The clinical manifestation included 95 (100%) pallor, 79(83.16%) weakness and fatigability, 35(36.84%) fever, 25(26.32%) Icterus, 19(20.00%) shortness of breath, 17(17.80%) hepatomegaly. According to grade of anemia, 21.05% of patients had mild, 46.32% of patients had moderate anemia, and 32.63% had a severe grade of anemia. Conclusion: Besides haematological investigations for typing of anemia, Haemoglobin electrophoresis establishes the disease in haemoglobinopathies. Adequate health and healthy nutritional habits and prescription of Iron supplements are of great importance in the prevention and management of anemia in children assisted by public health services.

Identifying the Importance of Cerebrospinal Fluid C - reactive protein (CSF-CRP) in Establishing a Diagnosis of Acute Bacterial Meningitis

Introduction: Acute meningitis is a major cause of death and disability worldwide. Differentiating bacterial from nonbacterial meningitis is very important in deciding on treatment. Bacterial meningitis is a life-threatening neurological condition and needs prompt parenteral antibiotics, compared to viral and aseptic meningitis which carries relatively better outcomes. Aim of the study: The aim of the study was to identify the importance of the CSF-CRP test in diagnosing acute bacterial meningitis. Methods: This cross-sectional observational study was conducted at the Department of Pediatric Medicine, Dhaka Shishu Hospital, Dhaka, Bangladesh. The study duration was 6 months, from January 2017 to June 2017. A total of 100 children visiting the inpatient department of the hospital were selected for the present study following inclusion and exclusion criteria. Result: 57% were diagnosed as bacterial meningitis cases, while 43% were diagnosed with aseptic meningitis. Among the 57 cases of bacterial meningitis, 61.40% belonged to the youngest age group of 0-2 years, while among the aseptic meningitis cases, 37.21% belonged to the age group of 3-6 years. Total WBC and PBN were significantly higher among the bacterial meningitis cases. The sensitivity of CSF-CRP was 89.47%, specificity 90.69%, accuracy 90%, a positive predictive value of 92.72%, and a negative predictive value of 86.66% in diagnosing bacterial meningitis. Conclusion: The study findings conclude CSF-CRP to be an important prognostic factor and initial testing method in diagnosing acute bacterial meningitis. CSF CRP has high diagnostic accuracy in determining the incidence of acute bacterial meningitis.

The Specificity, Sensitivity, and Diagnostic Accuracy of CSF-CRP in the Diagnosis of Acute Bacterial Meningitis- A Hospital-Based Study

Introduction: Bacteria that enter the bloodstream and mobile to the brain cord cause bacterial meningitis. The disease is less frequent in developed countries compared to developing countries. In Bangladesh, bacterial meningitis constitutes 25% and the case fatality rate was 14%. The mortality from meningitis is near 100% in untreated individuals and can still be up to 40% in children who received appropriate antibiotic therapy in developing countries. Aim of the Study: The study aims to investigate the specificity, sensitivity, and diagnostic accuracy of CSF-CRP in the diagnosis of Acute Bacterial Meningitis (ABM). Methods: An observational cross-sectional study was carried out in the Department of Pediatric Medicine, Dhaka Shishu Hospital (DSH), from 01 Jan-2017 to 30 Jun-2017. A total of 100 patients were enrolled in this study following the inclusive criteria. Data were collected using the predesigned semi-structured questionnaire. Verbal consent was taken before recruiting the study population. Completed data forms were reviewed, edited, and processed for computer data entry. Result: Among the study population majority of patients (43, 43.0%) were 0-2 years old. One-third of bacterial meningitis (35,35.0%) occurs commonly at an early age (0-2 years). Out of fifty- seven cases (n=57) of bacterial meningitis, twenty-two cases were culture negative and thirty-five cases were culture positive. In the case of bacterial meningitis, in fifty-one cases (51,89.4%) out of fifty-seven, the CSF CRP test was truly positive, with mean±SD 21.7±10.9, false negative were only six cases (6, 10.5%). In aseptic meningitis thirty-nine cases (39,90.6%) out of forty-three cases, the CSF-CRP test was truly negative, and false positive were four cases (4,9.3%). The sensitivity of CSF CRP in differentiating bacterial meningitis from aseptic meningitis was 89.47%, specificity 90.69%, & diagnostic accuracy was 90%. Conclusion: Bacterial meningitis is fatal and more communal in children under one year of age to sixteen years of age. Increased consciousness and initial gratitude and apposite antibiotic treatment can decrease morbidity and mortality. Diagnostic accuracy can be applied as the initial test for the diagnosis of bacterial meningitis.

Sensitivity and Specificity of Toxic Granules in WBC and Immature to Total Neutrophil Ratio in Diagnosis of Neonatal Sepsis

Background: Septicemia is the commonest cause of neonatal mortality and severe morbidity. Positive bacterial blood culture result confirms clinically suspected sepsis but it is too late to start antibiotic. We need a easy, reliable and cost effective test to diagnose sepsis in time.
 Objective: To see the relation of toxic granule and immature neutrophil with neonatal sepsis.
 Material & Methods: This hospital based, cross-sectional study was conducted on 152 neonate with suspected sepsis admitted in Dhaka Shishu Hospital during January 2013 to April 2014. After enrollment all studied neonate were investigated with complete blood cell count, CRP and Blood culture before starting treatment with antibiotic. Raised immature to total neutrophil ratio >0.2 and toxic granules in neutrophil were correlated with positive blood culture test using x2 test.
 Result: Out of 152 studied neonate 61.89% were male, 41.94% premature, 48.85% low weight. Blood culture result was found positive in 7.24% neonate. Leukopenia (WBC<5000/mm3), Neutropenia (Neutrophil <1750/mm3), Immature to total neutrophil ratio (I:T) >0.2 and toxic granules were present significantly in sepsis. The sensitivity and specificity of toxic granules to diagnose neonatal sepsis was correspondingly 91.67% and 75% & that of I: T>0.2 were 90.91% and 66.67%.
 Conclusion: Toxic granules and Immature to total neutrophil ratio (I: T) >0.2 can be considered as useful tools in the diagnosis of neonatal sepsis to start antibiotic earlier, especially where there is limited modern investigation facilities.
 BANGLADESH J CHILD HEALTH 2021; VOL 45 (3) : 141-146

Mental Stress of Parents Having Thalassemic Children

Background: Thalassaemia is an emerging global public health concern. It is considering as a rapidly growing major health burden for low- and middle income countries. The prevalence of thalassaemia is increasing in Bangladesh, indicates that thalassemia will be an emerging health burden for our country. Objective: To assess the level of mental stress among parents with a thalassemic child. Materials and Methods: A cross-sectional study was conducted among the 141 parents with a thalassemic child in the purposively selected two hospitals’ Dhaka Shishu Hospital and Bangladesh Thalassemia Hospital in Dhaka. ‘Parental stress scale’ (PSS) was used to measure the level of stress. Results: The mean age of the parents was 36.2±8.8 years and nearly two-thirds (63.8%) of them were aged below 40 years. Almost half of the participants (49.6%) and their spouses (59.6%) completed their education upto the higher secondary level. The mean monthly family income was 27,113.5±46,696.9 taka. More than half of the parent’s (53.2%) had low level of mental stress. The education, occupation, monthly family income, presence of >1 thalassaemic child in family, received blood from a voluntary blood donor, normal growth of thalassaemic child and history of thalassaemic child death were significantly associated with the level of mental stress by PSS scores of the parents (p<0.05). The level of stress was low among the parents, whose educational level was up to primary level (68.6%), occupation as a business (68.4%), monthly family income ≥50,001 taka (85.7%), presence of >1 beta thalassaemia major child (47.6%), received blood from a voluntary blood donor (50.0%), had a history of normal growth of thalassaemic child (60.4%) and had no history of thalassaemic child death (50.0%). Conclusion: Existence of the children with thalassemia in a family cause massive stress and anxiety for parents. Psychological supports for them are essential as a part of comprehensive medical care along with clinical management of the thalassemic child. The burden of disease can be reduced through effective preventive approaches, such as carrier screening, prenatal counseling and diagnosis. KYAMC Journal Vol. 13, No. 02, July 2022: 102-107

Clinico-epidemiological characteristics of pediatric COVID-19 patients in Bangladesh

Background: The objective of the study was to delineate the clinico-epidemiological characteristics of pediatric coronavirus disease-2019 (COVID-19) patients.Methods: This observational study included 290 pediatric patients with a definite diagnosis of COVID-19 admitted to Dhaka Shishu hospital, Bangladesh, from April 2021 to October 2021. Clinical and epidemiological characteristics were analyzed based on demographic data, medical history, laboratory tests, and outcome information. Data analysis was performed with SPSS 26. Ethical measures were taken in compliance with the current declaration of Helsinki, and final analysis was performed using SPSS 26.Results: Of all, 42 (14.5%) were neonates (<28 days), 88 (30.3%) were infants (28 days to <1 year) and 160 (55.2%) were children (1-17 years). The median age of the children was 18 (0.3-204) months, 58.3% were male, 62% had malnutrition, and presented with various clinical presentations. The main symptoms were fever (5.7%) and breathlessness (20%). Approximately 22% of children were asymptomatic, and 57% had at least one comorbidity. Fever and abdominal pain were predominant presenting symptoms in children compared with neonates and infants (p<0.01 for both), while cough and breathlessness were more frequent in infants (p<0.01 for both). The infants suffered significantly from neutropenia and lymphocytosis than neonates and children (p<0.001 for both). The discharge and death rates were 77.8% with 6.9%. Overall case fatality was higher among neonates than others.Conclusions: Compared to other pediatric groups, neonatal case fatality was higher, and COVID-19 in neonates, infants, and children has similar epidemiological and clinical manifestations. The findings from this study might help to guide the development of measures to prevent and treat this ongoing global pandemic of these particular age groups.

Different Types of Abnormalities of Newborn with Congenital Anomalies

Introduction: Congenital anomalies are structural, behavioral, functional, or metabolic defects that occur before the birth of a baby, and their nature and type are highly dependent on the causative agent. It refers to changes in embryonic or fetal development caused by genetic, environmental, or unknown factors that result in physical and/or mental impairment. This study aims to evaluate the various types of abnormalities in newborns with congenital anomalies. Methods: This prospective observational study was conducted at the Pediatric Medicine and Pediatric Surgery departments of Dhaka Shishu Hospital, Dhaka, Bangladesh. Eighty (80) newborns were included in the study using a purposive sampling method. The study was conducted during the time from April 2012 to September 2012. The aim of the study was to evaluate the various types of abnormalities in newborns with congenital anomalies. A pre-designed questionnaire was completed for every neonate including H/O regular maternal antenatal care with the taking of TT and MMR vaccine, any maternal disease or fever with rash, taking any offending drug, use of abortifacient, exposure to radiation or industrial hazards, feeding habit including smoking or use of alcohol and clinical and anthropological examination. Results: Eighty neonates were presented with congenital anomalies. Male infants were 52(65.0%) and female infants were 28(35.0%). Among congenital heart diseases TGA found in 4(5.0%), TOF 2(2.5%), VSD 4(5.0%), PDA 5(6.3) cases. According to the patient’s abnormalities, hydrocephalus was found in 14(17.5%), encephalocele in 4(5.0%) & meningocele, myelomeningocele was found in 13(16.3%) cases. Club foot in 8(10.0%) syndactyly, polydactyly was in 6(7.5%) and cleft lip and palate were in 16(20.0%) cases. Anorectal malformations were observed in 11(13.8%) cases. Ambiguous genitalia were 11(13.8%) cases. Previous maternal history of abnormal delivery shows Encephalocele, meningocele, myelomeningocele, club foot was 9(11.4%), IUGR 3(3.8%), preterm birth 7(8.8%), stillbirth 3(3.8%) and infants death was 3(3.8%). Conclusion: Most frequent birth defect was cleft lip and/or palate followed by congenital heart diseases, hydrocephalus, myelomeningocele, ambiguous genitalia, and anorectal malformations. The study of birth defects in underdeveloped countries should continue.

Retinopathy of Prematurity –Recent Screening Status in a Tertiary Care Hospital of Bangladesh

Retinopathy of prematurity (ROP) results in severe visual impairment and blindness in newborns. In the recent days with development of the technology to save preterm infants, it’s incidence is increasing in both developed and developing countries. Only appropriate and timely screening program can prevent ROP and reduce the functional impairment of eyes. The aim of this study was to see the recent screening status of the hospital so that future plan of ROP treatment and prevention can be taken more appropriately. This prospective study was conducted from January 2018 to December 2018 in neonatology department of Dhaka Shishu (Children) Hospital. Neonates with gestational age < 34wks or birth weight, <1800gms were screened for ROP. First screening was done at 4 wks chronological age or 32 wks postmenstrual age of neonate which comes later. Then subsequent screening was done according to the findings upto 45 wks of postmenstrual age. The findings regarding incidence of ROP, types of ROP and treatment modalities of ROP along with other variables were recorded. Data were analyzed with SPSS version 17. Total 116 cases were screened for ROP. Mean gestational age was 30.7±2.4 wks and mean weight was 1420.9±313.8 gms. According to gestational age, 14 (12%) neonates with gestational age < 28 wks had ROP. Nine (7.8%) cases had ROP in both gestational age groups of 29-30wks and 31-32wks. Only 5(4.3%) cases with gestational age
 33-34wks had ROP. According to birth weight, neonates with birth weight <1000 gms had ROP in 1(0.9%). Twenty four (20.7%) and 12(10.3%) cases had ROP in weight groups of 1000-1499gms and 1500-1800 gms consequently. Thirty one (26.8%) cases were found ROP in their first visit. In 6(5.1%) cases ROP were found in 2nd and subsequent visits. Among the neonates, A-P ROP was present in 15(12.9%) cases, type -1 in 9 (7.7%), type- 2 in 11 (9.6%) and RD in 2(1.7%) cases. Three (2.6%) cases of type 2 ROP turned into type- 1 ROP in subsequent visits. Among the ROP cases, total 29(78%) needed treatment. Laser therapy was given in 7(24%) cases, both laser and intravitreal bivacizumab in 17 (59%) cases, only intravitreal bivacizumab in 2(7%) cases and surgery along with medical treatment was advised for 3(10%) cases. Thirty four (92%) cases had good outcome and 3 (8%) infant had no vision.The incidence of ROP was 31.9% in this study. Most of cases were A-P ROP then Z2S3 ROP. Laser plus intravitreal bivacizumab were given in most of the cases with ROP. The more number of advanced stages of ROP and a large number of babies required treatment indicates that these babies came to us in advanced stages due to irregularity and missing of follow-up.

Neonatal Vitamin D Status and Its Association with Birth Weight in a Tertiary Care Hospital of Bangladesh

Background: Now a days, vitamin D deficiency is a silent and neglected global public health issue. Vitamin D status during pregnancy is integral to maternal health, fetal development and optimal neonatal outcomes. Decreased maternal vitamin D level causes decreased Neonatal vitamin D level and birth weight. Objectives: To see the association between Neonatal vitamin D level and birth weight. Methods: This cross-sectional study was conducted at neonatology department in Dhaka Shishu (Children) Hospital from July 2020 to June 2021. All admitted term neonates, aged within 5 days, were taken as cases and venous blood was collected for S. vitamin D level. Data regarding age, sex, birth weight, S. vitamin D status etc. were collected and analyzed by SPSS version-26. Results: Out of 72 cases, male were 39 (53%) and female 35 (47%). Mean gestational age was 38.9±1.12 wks. Mean birth weight was 2607.4±420.5 gms. Neonates with normal birth weight were 40(54%) and LBW 34 (46%). Mean S. vitamin D level in neonates with normal birth weight was 22.50 ± 7.90 ng/ml (7.50 – 40.20) and that of LBW 18.40 ± 8.10 ng/ml (7.10 – 39.40) which was statistically significant (p <0.05). Thirty-six (48.65%) neonates had normal vitamin D, 20 (27.02%) insufficiency and 18 (23.32%) deficiency. In LBW cases the vitamin D deficiency and insufficiency were more than that of normal birth weight which were statistically significant (p <0.05). Neonatal vitamin D positively correlated with birth weight (r = +0.45; p <0.001). Conclusion: In this study, 49% cases had normal S. vitamin D, 27% insufficiency and 24% deficiency. Among all the term neonates, LBW was 46% and there was significant positive correlation between S. vitamin D level of neonates and birth weight.

Clinical profile of dengue among children in Bangladesh: observation from a single pediatric hospital

Background: To delineate the predominant clinical features of dengue infection among children in Bangladesh.Methods: A cross-sectional descriptive study was in Dhaka Shishu hospital, Dhaka, Bangladesh. All children of age <18 years admitted with suspected dengue infection starting from July 2019 till September 2019 were enrolled in this study. Demographic variables, presenting complaints and examination findings were recorded on a standard questionnaire. Data was analyzed by using SPSS version 27.Results: A total of 584 children were included in the study, of which 345 (59.1%) were male. Children ranged from age 1 month to 18 years with a mean of 5.6±4 years. Most of the children did not go to school or were less than 5 years of age 532 (91.1%). All the children presented with either high- or low-grade fever, and around half of them complained of vomiting. Notable symptoms among the children were abdominal pain in 20% cases, dehydration, and flu-like symptoms (cough and cold) in 10% of cases. Dengue warning signs were noted in 161 cases (27.6%), and vomiting was present in 43.7% of cases. Anaemia, respiratory distress, and pleural effusion were rarely noticed among the studied patients. Laboratory investigation of the dengue patients revealed that NS1 antigen was positive in 49 cases (8.4%). Haemoglobin was low in one-third of the cases, and leukopenia and thrombocytopenia were present in 23.5% and 38.7% cases, respectively. Among the dengue patients, around 12% (n=71) were infants.Conclusions: This descriptive study identifies that vomiting, abdominal pain, and dengue warning signs are the predominant clinical features of dengue infection among children in Bangladesh. Comparison with earlier studies reveals that clinical and laboratory features of dengue might vary by age, severity and region.

Comparison between Perimeatal-Based Flap (Mathieu) and the Tubularized Incised-Plate Urethroplasty (Snodgrass) in Distal Hypospadias

Introduction: Hypospadias can be defined as a state in which the opening of the urethra is on the underside of the penis instead of at the tip. The specific cause of the hypospadiac penis is unknown but some factors such as endocrine & genetic factors are likely to be involved. The perimeatal based flap urethroplasty developed by Mathieu is commonly used for the correction of distal hypospadias. The pediatric urologist Warren Snodgrass described a newer procedure for distal hypospadias repair with a combination of incising the urethral plate & a meatal based flap with a low complication rate & better cosmetic outcome. A prospective comparative study was conducted to determine whether the Snodgrass or Mathieu urethroplasty is more appropriate for distal hypospadias in terms of complications, cosmesis of the meatus & glans. Aim of the study: This study aimed to determine whether the Snodgrass or Mathieu urethroplasty is more appropriate for distal hypospadias in terms of complications, cosmesis of the meatus & glans. Methods: This prospective study was conducted in the Department of Pediatric Surgery, Dhaka Shishu Hospital, Dhaka the period from 1 February 2002 to 30 "April 2003 for a total period of 15 months. A total number of 30 patients with distal penile hypospadias were selected for clinical study, of which 15 patients belong to group A (study group) treated surgically by SNODGRASS technique and another 15 patients belonging to group B (control group) surgically treated by MATHIEU technique. All these 30 patients were followed up for a minimum of 3 months and a maximum of up to 12 months (The average follow up was 7.5months). Urinary diversion in the form of urethral catheters was kept in position for 6-10 days. On the 4th to 6th post-operative day, the dressing was changed usually and details of the healing patterns and other findings were registered. Data were analyzed with SPSS-10 and MS Excel-16. Result: By comparing the surgical outcome of hypospadias .....

Influence of Febrile Seizure in Children’s Neurodevelopment

Background: Febrile seizure is one of the most common diseases in early childhood. The impact of early-life Febrile Seizure on the developing brain is an important issue to detect.
 Objectives: To observe the neurodevelopment of children suffering from different types of febrile seizures.
 Methods: This was a prospective observational study; the study was conducted in Dhaka Shishu (Children) Hospital, Dhaka from July 2012 to August 2013. Total 71 children were included in the study who fulfilled the selection criteria. History was taken thoroughly. Rapid neurodevelopmental assessment (RNDA) was performed for initial assessment and subsequent follow up and was advised accordingly.
 Results: Total 71 cases were included where mean age was 17.76±8.03 months, median was 16 months; in both the group male child had slight high preponderance. Majority of seizures were <10 minutes duration in both group which was not statistically significant. Important postictal event was found, 12 cases (26.7%) in simple seizure and 16 cases (61.5%) in complex seizures which was found statistically significant, but there was no risk for further seizure. On follow up, RNDA detected risk of impairment in vision, cognition, speech and behavior. In complex group statistically significant association was found with impairment of cognition only at initial and follow up at 3 month.
 Conclusion: Neurodevelopment impairment is not influenced by types of febrile seizure but significant cognitive impairment was found in complex seizure.
 DS (Child) H J 2021; 37(1): 45-50

Consanguinity and Risk of Congenital Heart Defects in Bangladesh

Background: Consanguineous marriage have been associated with an increased risk to various forms of inherited disease. Potential role of consanguinity in certain common birth defects is less clear especially with congenital heart defects (CHDs).
 Objective: This study was conducted to evaluate the potential role of consanguinity as a risk factor for congenital heart defects (CHDs) in Bangladesh.
 Methodology: It was a case control study, conducted from July 2018 to July 2019 at Dhaka Shishu (Children) Hospital. Parents of the children with CHD visited the outpatient department was considered as case. Control was taken from parents of the children who didn’t have congenital heart disease. Informed written consent was taken from parents. Data were collected by using a structured questionnaire containing all the variables of interest and analyzed by using SPSS version 21. Chi square test (S«2), Odds ratio (OR) and 95% confidence intervals (CIs) were calculated to estimate the associations between parental consanguinity and all CHDs. Risk factors on bivariate analysis were introduced into a logistic regression model as independent factors and dependent variable was CHDs to find out the association between CHDs and consanguinity.
 Results: Among study population consanguinity was present in 33(6.11%) cases. In the case group 23 children (8.85%) were born to consanguineous parents and in control group 10 children (3.57%) were born to consanguineous parents. CHDs were found significantly higher in children born to consanguineous parents (p<0.05). On logistic regression analysis consanguinity (p=0.02) was independently associated with CHDs. Children who born to consanguineous parents had 2.5 times risk of developing CHDs compared to those who were not born to consanguineous parents.
 Conclusions: Parental consanguinity is significantly associated with CHDs.
 DS (Child) H J 2021; 37(1): 34-39

Cut off Value of Red Cell Distribution Width (RDW) in Screening and Diagnosis of Iron Deficiency Anemia and b Thalassemia Trait

Background: The most concerning consequences of iron deficiency in children are the alterations of cognitive, motor, and behavioral performance. Persistent neurocognitive changes despite iron repletion have increased the importance of prevention and early detection of iron deficiency.
 Objectives: To evaluate the cut off value of red cell distribution width (RWD) in the screening and diagnosis of iron deficiency anemia (IDA) and â thalassemia trait (BTT).
 Methods: It is a cross sectional study performed at Dhaka Shishu (Children) Hospital from July 2006 to July 2008. Total 52 patients, age ranged from 1-12 years were included in the study. Among them 27 cases were IDA and 25 cases were BTT. Complete blood count (CBC), serum ferritin and hemoglobin (HB) electrophoresis were measured. The sensitivity, specificity, positive and negative predictive value of differential and cutoff value for RDW discrimination index in differentiation between IDA and BTT were performed.
 Results: Age ranged from 1-12 years. In IDA group male were found 16(59%), female were 11(41%) and in BTT group male were 15(60%), female were 10(40%). The Hb% value in IDA group was significantly (p<0.0001) lower than value for BTT. An elevation of RBC distribution width (>14.6) in IDA had a sensitivity of 81%, specificity of 84%, positive predictive value (PPV) of 85% and negative predictive value (NPV) of 81%; value of RBC distribution width (<14.6) in BTT had a sensitivity of 84%, specificity of 81%, positive predictive value (PPV) of 81% and negative predictive value (NPV) of 85%. An elevation of RBC distribution width (>16) had a sensitivity of 67%, specificity of 92%, and positive predictive value (PPV) of 90% in distinguishing iron deficiency anemia from thalassemia trait. Moreover, eleven (11) of 27 patients with iron deficiency had RBC distribution width values greater than 18 compared to one (1) of the patients with thalassemia trait. An elevation of RBC distribution width ³18 specificity of 96% and positive predictive value (PPV) of 92%.
 Conclusion: The rersult of the study, in patients with microcytic hypochromic anemia, RDW value e³14.6% and Hb level< 10gm/dl, iron deficiency is the most likely diagnosis. RDW value (>16) is a reliable diagnostic tool in differentiation between IDA and BTT. Red cell distribution width (RDW) above 16% is the best index of IDA.
 DS (Child) H J 2021; 37(1): 51-58

Prevalence of Infection and Changing Pattern of Organisms Causing Infections in Childhood Nephrotic Syndrome

Background: Infection remains an important complication of children with nephrotic syndrome. It results in significant morbidity and may also be responsible for a poor response to steroid therapy or induce relapse in child who has already attained remission.
 Objectives: This study was conducted to find out pattern of infection and type of organisms causing infections in nephrotic syndrome.
 Methods: This cross sectional study was conducted in the Paediatric Nephrology Department of Dhaka Shishu (Children) Hospital from January 2010 to November 2010. One hundred fifteen (115) cases of nephrotic syndrome, age between 1 to 13 years were enrolled according to the inclusion criteria. Along with routine investigations, urine, blood and throat swab culture and sensitivity and MT test were done. Risk factors of infection were also determined. Statistical analysis was done by SPSS version 12. Level of significance was taken as <0.05.
 Results: Prevalence of infection in nephrotic syndrome was 54.78%. Infections were more common in childhood nephrotic syndrome below 6 years of age. Infections encountered in nephrotic syndrome were UTI 51(44.34%), septicemia 4(3.47%), pneumonia 5(4.34%), peritonitis 1(0.87%), cellulitis 1(0.87%) and tuberculosis 1(0.87%). Statistically significant risk factors associated with infection were generalized edema, steroid dependence, steroid resistance, persistent proteinuria and high spot urine protein creatinine ratio. In case of UTI E. coli was the commonest 27(52.9%) organism followed by Morganella and Pseudomonas 5(9.8%).
 Conclusion: Prevalence of infection in nephrotic syndrome is very high and E. coli is the commonest organism found in this study. Generalized edema, persistent proteinuria, hypoalbuminemia, steroid dependence, steroid resistance are important risk factors for infection.
 DS (Child) H J 2021; 37(1): 28-33