Dhaka Shishu Research Articles

Detecting Developmental Delay and Autism Through Machine Learning Models Using Home Videos of Bangladeshi Children: Development and Validation Study.

BackgroundAutism spectrum disorder (ASD) is currently diagnosed using qualitative methods that measure between 20-100 behaviors, can span multiple appointments with trained clinicians, and take several hours to complete. In our previous work, we demonstrated the efficacy of machine learning classifiers to accelerate the process by collecting home videos of US-based children, identifying a reduced subset of behavioral features that are scored by untrained raters using a machine learning classifier to determine children’s “risk scores” for autism. We achieved an accuracy of 92% (95% CI 88%-97%) on US videos using a classifier built on five features.ObjectiveUsing videos of Bangladeshi children collected from Dhaka Shishu Children’s Hospital, we aim to scale our pipeline to another culture and other developmental delays, including speech and language conditions.MethodsAlthough our previously published and validated pipeline and set of classifiers perform reasonably well on Bangladeshi videos (75% accuracy, 95% CI 71%-78%), this work improves on that accuracy through the development and application of a powerful new technique for adaptive aggregation of crowdsourced labels. We enhance both the utility and performance of our model by building two classification layers: The first layer distinguishes between typical and atypical behavior, and the second layer distinguishes between ASD and non-ASD. In each of the layers, we use a unique rater weighting scheme to aggregate classification scores from different raters based on their expertise. We also determine Shapley values for the most important features in the classifier to understand how the classifiers’ process aligns with clinical intuition.ResultsUsing these techniques, we achieved an accuracy (area under the curve [AUC]) of 76% (SD 3%) and sensitivity of 76% (SD 4%) for identifying atypical children from among developmentally delayed children, and an accuracy (AUC) of 85% (SD 5%) and sensitivity of 76% (SD 6%) for identifying children with ASD from those predicted to have other developmental delays.ConclusionsThese results show promise for using a mobile video-based and machine learning–directed approach for early and remote detection of autism in Bangladeshi children. This strategy could provide important resources for developmental health in developing countries with few clinical resources for diagnosis, helping children get access to care at an early age. Future research aimed at extending the application of this approach to identify a range of other conditions and determine the population-level burden of developmental disabilities and impairments will be of high value.

Association of Chest Radiograph with Community Acquired Pneumonia among the Children Admitted in Dhaka Shishu Hospital

Background: Community-acquired pneumonia (CAP) is an infectious disease and common reason for hospitalization of children throughout the world. There are few published data about radiological findings and their relationship with community-acquired pneumonia (CAP) severity.
 Objective: This study was conducted to evaluate radiological findings in children with community acquired pneumonia (CAP) of different severity.
 Materials and method: A prospective study was conducted in the department of Paediatric Respiratory Medicine (Pulmonology) in Dhaka Shishu Hospital from November 2016 and April 2017. A total number of 35 children of 1 month to 10 years, who were admitted with cough or respiratory difficulty and radiological pneumonia were included in this study.
 Results: Majority of the study participants 18 (51.43%) were infants with a male preponderance. The most common symptom was cough (94.29%) followed by fever (82.86%) and respiratory distress (42.86%). Crepitation (54.29%), tachypnoea (42.86%) and chest indrawing (28.57%) were the most common signs. Out of total 35 children 17 (48.57%) cases had pneumonia and 18 (51.43%) cases had severe pneumonia. Among chest X-rays, severe pneumonia had greatest frequency of primary end point consolidation (PEP) on right side (n=10, 55.55%), right infiltrates (n=5, 27.78%), bilateral infiltrates (n=2, 11.11%) followed by right sided pleural effusion (n=3, 16.67%) and pneumothorax (n=2, 11.11%). There was no association found between CAP severity and presence of radiological findings of pneumonia.
 Conclusion: This study shows that severe CAP may not always be associated with positive radiological findings. This finding may be taken into consideration during the diagnosis and management of CAP.
 Delta Med Col J. Jan 2019 7(1): 21-25

Causative agents for diarrhoea in under 5 children in a tertiary care hospital

Background: nfectious diarrhoea is a major public health problem in developing countries like Bangladesh. Bacteria and parasites are important etiological agents for diarrhoea in infants and children.
 Objectives: To isolate and identify the causative organisms of diarrhoea from diarrhoeal stools in under 5 children.
 Methodology: This was an observational cross sectional study carried out at Microbiology Department of Sir Salimullah Medical College, Dhaka. A total of 217 diarrhoeal patients upto 5 years age, attending Pediatric unit of Sir Salimullah Medical College and Mitford Hospital, Dhaka and Dhaka Shishu Hospital, Dhaka during the period of July 2015 to June 2016, were enrolled in the study. For isolation of enteric bacteria, diarrhoeal stools were inoculated on Mackonkey agar media and for Campylobacter spp. diarrhoeal stools were inoculated on selective Modified Campy-BAP media and nonselective Blood agar media with membrane filter. Positive culture was confirmed by Gram stain morphology and standard biochemical tests. Oocysts of Cryptosporidium were identified by Modified Ziehl Neelsen staining and other parasites were identified by wet mount preparation.
 Results: Out of 217 diarrhoeal stools bacteria were isolated from 97 (44.7%) patients. Among 97 cases, Escherichia coli were detected in 51(52.58%) patients; Campylobacter spp. were detected in 23(23.71%) patients; Shigella spp. were detected in 15(15.46%) patients and Salmonella spp. were detected in 8(8.25%) patients. Microscopic finding of diarrhoeal stools were detected by pus cells with or without RBCs in 90(70.31%) samples. Cysts of Giardia intestinalis were found in 9(4.14%) samples, cysts of Entamoeba histolytica in 2(0.9%) samples, eggs of Trituris trichiura in 2(0.9%) samples and oocysts of Cryptosporidium were found in.5(2.30%) samples.
 Conclusion: Escherichia coli was the most common bacteria and Giardia intestinalis was predominant parasite causing diarrhoea in under 5 children.
 Bang Med J (Khulna) 2018; 51 : 25-28

Predisposing Factors and Surgical Management of Obstructive Sleep Apnoea in Children

Obstructive sleep apnoea (OSA) is a condition characterized by episodic partial or complete obstruction of the upper airway during sleep. This cause apnoea or cessation of breathing. During sleep, muscles around the airway relax causing the throat and upper airway to narrow. This leads to snoring, but it can also lead to the airway being blocked. Trying to breathe against a blocked airway causes oxygen levels to fall and carbon dioxide to rise. This cross-sectional study was conducted in Department of ENT, Dhaka Shishu (Children) Hospital and Dhaka Medical College Hospital from April to September’2015. The purpose of the study was to prevent significant morbidity and enhancement of child growth. One hundred children of OSA were studied by detail history and clinical examination. All children whose parents consulted their ENT surgeon in Dhaka Shishu(Children) Hospital and DMCH for snoring or laboured breathing during sleep (nocturnal sweating particularly in the nuchal area, unusual sleeping positions, restless sleep, awakening and excessive movements, intercostals recession and dry mouth) were included in the study. More common predisposing conditions for OSA were obesity and Craniofacial anomalies which were 34% and 27% respectively. In present study most of the children (73%) were managed by Adenotonsillectomy and 27% children were manage by Adenoidectomy. Outcome data have demonstrated that surgical therapy can be successful in the treatment of OSA.
 Bangladesh Med J. 2017 May; 46 (2): 22-25

Management of Meconium Ileus: 5 years' experience at Dhaka Shishu (Children) Hospital

Background : Meconium ileus (MI) is one of the common cause of intestinal obstruction in neonate. It can be present with various complications (about 50%) like volvulus, atresia, and gangrene of the gut, perforation and meconium cyst.
 Objective : This study aimed to compare various surgical procedures used in the treatment of meconium ileus and to assess their efficacy regarding survival and complications in our center.
 Methods : This retrospective study was done to all cases of meconium ileus admitted in the Department of neonatal surgery of Dhaka Shishu (Children) Hospital during the past 5 years (2011 to2016). The medical records of all patients with meconium ileus were studied. The surgical procedures were Mikulicz procedure, Bishop-Koop procedure done in case of complicated cases and Mikulicz procedure, Bishop-Koop and T tube ileostomy done in uncomplicated cases. Outcomes were compared between complicated and uncomplicated group and between the surgical procedures.
 Results : Total patients were 224. Among them 8 were excluded due to incomplete data. The mean age was 3.23 days. Twenty four neonates were preterm. Fifty-two percent were uncomplicatedMI and 48.15% were complicated. Among 112 uncomplicated cases, Mikulicz procedure done in 33 cases, Bishop-Koop procedure done in 37 cases and rest were treated by T tube ileostomy procedures. Among 104 cases of complicated meconium ileus, Mikulicz procedure done in 75 cases and 42 cases were treated by Bishop-Koop stoma. Predominant complications in Mikulicz procedures were high output fistula (67.6%), sepsis (34.84%) and skin excoriation (58.33%), while in Bishop-Koop procedure were sepsis (59.25%), anastomotic leak and reoperation (25.75%). In T tube ileostomy, complications were intra-peritoneal leak with reoperation and sepsis (9.52%). Twenty five (11.6%) stoma prolapse were found in Mikulicz ileostomy. The overall mortality of meconium ileus was 36.6%, in simple MI 23 out of 112 and in complicated MI 56 out of 104. This difference was significant.
 Conclusion : Considering the study result we concluded that complications occur more frequently in Mikulicz procedure and it is significantly associated with mortality, Bishop- Koop ileostomy can be considered but anastomotic leak is still an important complication of this procedure. In uncomplicated cases T tube ileostomy found as the best option.
 Northern International Medical College Journal Vol.10(1) Jul 2018: 326-329

Study of clinical profile and antibiotic response in typhoid fever: A study in a Dhaka shishu (children) hospital, Dhaka, Bangladesh

The objectives of this Crosse sectional e analysis study is to gauge the clinical profile and pattern of varied medication employed in the treatment of infectious disease. A retrospective analysis of medicine patients littered with infectious disease was done at Department of Pediatric, Dhaka Shishu (Children) Hospital, and Dhaka throughout the year 2017-2018. Designation of patients was supported clinical options, agglutination test and blood culture. The mode of presentation, clinical course, treatment history, and laboratory investigations reports, antibiotic administered, response to medical care and also the complications were recorded. Total variety of 50 cases of infectious disease were studied. Out of those 23 (46%) were males and 27 (54%) were females. Average age of presentation was 8.2 years. Average length of hospital keep was 10.8 days. Fever was gift altogether patients. Resistance of S. typhi to ceftriaxone, Cipro, Azithromycin were considerably high. Antibiotic drug conjointly showed resistance in 21.4% of cases. Sensitivity to antibiotic was 100 percent in our study. Antibiotic drug was the foremost normally used antibiotic in our study (26 patients). Chloromycetin alone was employed in 2 patients and in 3 patients it had been given once 6 days of antibiotic drug treatment. Third generation antibiotic (ceftriaxone) alone were employed in ten patients. Indiscriminate use of medication in infectious disease ought to be discouraged. Acceptable antibiotic as indicated by sensitivity tests ought to use to forestall the event of resistant strains of S. typhi.

Assessment of hypoxic ischemic changes in perinatal asphyxia of first ultasonogram of brain: a study in Dhaka shishu children hospital, Dhaka, Bangladesh

Assessment of hypoxic ischemic changes in perinatal asphyxia of first ultasonogram of brain: a study in Dhaka shishu children hospital, Dhaka, Bangladesh

Antibiotic Resistance Pattern in Children with UTI: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Urinary tract infection (UTI) is one of the most common pediatric infections. It distresses the child, concerns the parents, and may cause permanent kidney damage. Occurrences of a first-time symptomatic UTI are highest in boys and girls during the first year of life and markedly decrease after that. Febrile infants younger than 2 months constitute an important subset of children who may present with fever without a localizing source. For resistance knowledge of etiology pathogens of UTIs and their antimicrobial resistance patterns in specific geographical location may help clinicians in choosing the appropriate antimicrobial. Our aim was to assess bacteriological profile and antibiotic resistance pattern in pediatric UTI. A cross sectional study was conducted at Dhaka Shishu Hospital during the period from Feb 2016 to Aug 2016. A total of 147 culture positive UTI patient were considered for analysis. Colony counts for these samples were identified, and the profile of antibiotic resistance was identified. Here, samples with a colony count of ≥105 CFU/mL bacteria were considered positive. A total 147 culture positive UTI patients were enrolled. Here, Escherichia coli (E-coli) was found as the most prevalent isolates 103 (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%. Twelve (12) antimicrobial agents were used for antimicrobial susceptibility testing. The most resistant drugs we found were Colistin (CL) (94.55%), followed by Cefradine (79.59%), Co-trimoxazole (SXT) (69.39%), Nalidixic acid (NA) (66.67%) and Ceftazidime (CTM) (48.98%). None of the drug found was 100% resistance against urinary pathogens. Antimicrobial drug resistance is decreasing among urinary pathogens. We suggest that, empirical antibiotic selection should be based on knowledge of the local prevalence of bacterial organism and their antibiotic resistance in a specific area rather than on universal or even national guidelines.

Role of Human Recombinant Erythropoietin (rHuEPO) in Perinatal Asphyxia-a randomized controlled trial

Background : Perinatal asphyxia is an insult to the fetus or newborn infant due to lack of oxygen (hypoxia) and/or a lack of perfusion (ischemia) to various organs, which will manifest as difficulty in establishing spontaneous respiration evident by delayed cry after birth, at least after one minute. World-wide, perinatal asphyxia accounts for about 900,000 deaths each year. In Bangladesh it is a major cause of neonatal death. A substantial proportion of the children that survive suffer late effects such as cerebral palsy and epilepsy.
 Objective : To determine the efficacy of erythropoietin in improving the neurological outcome of term neonates with perinatal asphyxia (HIE stage II and III).
 Materials and methods : A Randomized Controll Trial was carried out in the Neonatal ward and NICU of Dhaka Shishu Hospital from 1st April 2014 to 30th Sep 2015. A total 68 neonates with perinatal asphyxia (both HIE stage II and III) who fulfill the inclusion criteria were enrolled and randomly assigned to intervention group (n=35) and control group (n=33). Intervention group received rHuEPO 300- 500 U/kg/dose daily subcutaneously for 5 days within first 48 hours of birth along with the standard treatment protocol and control group received standard treatment protocol only.
 Results : Baseline clinical characteristics, USG of brain during hospital stay were almost similar in both groups. Statistically significant effect was noted in seizure control, tolerance of oral feeding, hospital stay and neurological outcome at 3 months of age (p=008). USG of brain at 3 months of age also improved significantly (p=0.027).
 Conclusion : This study demonstrates the effectiveness of early administration of rHuEPO to term neonates with moderate to severe asphyxia, beneficial effect on short term outcomes like seizure control, tolerance of oral feeding and neurological outcome at 3 months of age. A large multicenter study would be done for further evaluation of these findings.
 Northern International Medical College Journal Vol.10(1) Jul 2018: 330-334

Recurrent and Persistent Pneumonia in Dhaka Shishu (Children) Hospital: Clinical Profile and Etiology

Background: Recurrent and persistent pneumonia have become a challenge for the physicians. The aim of this study was to evaluate the clinical profile and determine the underlying causes of recurrent and persistent pneumonia among the children admitted in Dhaka Shishu (Children) Hospital.
 Methods: In this study, retrospective analysis of medical records of the children was done, who met the criteria of recurrent pneumonia and persistent pneumonia. Analyzed Patients were admitted in Dhaka Shishu (Children) Hospital from January 2016 to Decembe 2016.
 Results: A total of 30 patients were analyzed during the study period. Twenty-four patients presented with recurrent pneumonia (80%) and six patients presented with persistent pneumonia (20%) during the study a period. After analysis of clinical profile, identified causes were pulmonary TB (23.3%), congenital heart disease (13.3%), cystic fibrosis (16.6%), aspiration syndrome (13.3%), bronchial asthma (10%), immune deficiency disorders (10%), bronchiectasis (6.6%), congenital lung agenesis (3.3%), unknown cause (3.3%).
 Conclusion: The most frequent underlying cause for recurrent and/or persistent pneumonia was pulmonary TB followed by congenital heart disease and cystic fibrosis among the patients admitted in Dhaka Shishu (Children) Hospital.
 Bangladesh J Child Health 2018; VOL 42 (3) :125-129

Divided and Separated Sigmoid Colostomy in Anorectal Malformation : Six Years Experience at Dhaka Shishu Hospital

Background : There are various surgical options for management of anorectal malformations (ARM). Colostomy is a common part of the management of high anorectal malformation in the pediatric population.Objective : The aim of this study was to find out the most common complications after formation of divided sigmoid colostomy.Methods : This prospective observational study was done in the Division of Pediatric Surgery, Bangladesh Institute of Child Health and Dhaka Shishu (Children) Hospital, Dhaka from January 2012 to December 2017. Divided and separated sigmoid colostomy was doneon 116 patients admitted with ARM during this period. Follow up on 2nd, 4th and 8th week after operation was done and in each follow up patients were assessed clinicallyfor wound infection, skin excoriation, prolapse of colostomy, retraction of colostomy and parastomal hernia. If colostomy complications were found then managed as per standard method.Results : The mean age of patients was 2.43±1.29 days and majority of the patients 66 (56.9%) were male.About half of the patients 50(43.1%) had fistula and 21(18.1%) patients had associated anomaly. Among 116 patients 51 (43.97%) developed complications after colostomy. The most common complication was skin excoriation found in 35 (30.2%) patients followed by wound infection in 8(6.9%). Prolapse and retraction of colostomy was found only in 6 (5.17%)and 2 (1.7%) cases respectively. No patient developed parastomal hernia and there was no mortality.Conclusion : Divided and separated sigmoid colostomy provided satisfactory outcome in the management of high anorectal malformation. Skin excoriation was the most common complication and few developed wound infection and prolapse of colostomy.Northern International Medical College Journal Vol.9(2) Jan 2018: 311-314

Pattern of Respiratory Diseases among Admitted Children in Pediatric Pulmonology Unit : A Tertiary Center Experiences

Background :_The spectrum of respiratory illness is wide and includes diseases of upper and lower airways, communicable and non-communicable types. The variation in pattern of morbidity mortality of respiratory illness may be affected by different environmental and climatic variation in different parts of the world.Objective : The present study intended to explore the pattern of respiratory illnesses seen in Bangladeshi children admitted with respiratory illnesses.Methods :_The present prospective observational study was conducted in children up to 12 years of age admitted with acute respiratory illness in pulmonology unit of Dhaka Shishu (Children) Hospitalfrom July 2012 to July 2013. All children between the age limit with acute respiratory illness were included in the study. A standardized questionnaire was formulated and pretested. Then the data were collected through interview by using the questionnaire. Data were analyzed using SPSS version 17.Results : Total 1169 patients were admitted under pulmonology unit during July 2012 to June 2013 among them 324(27.7%) were admitted with respiratory diseases. Among the respiratory diseases Pneumonia (71.2%), Acute Bronchiolitis (20.1%), Bronchial Asthma (4.2%) and TB (2.7%) were commonest. Bronchopneumonia, Acute Bronchiolitis, Bronchial Asthma and TB was common among under 5 children and less common after 5 years. Male were predominate in every cases. Majority of respiratory cases were belonged to poor socioeconomic status. Pneumonia (50.7%) and Acute Bronchiolitis (58.5%) cases were found during autumn and late autumn. Asthma was common during late autumn and winter and Tuberculosis was common throughout the year. Mortality was higher among pneumonia cases.Conclusions :_Respiratory illness contributes most common cause of admission in tertiary care pediatric hospital. Bronchopneumonia is still the commonest respiratory disease with leading cause of mortality.Northern International Medical College Journal Vol.9(2) Jan 2018: 308-310

Enteric Fever Cases in the Two Largest Pediatric Hospitals of Bangladesh: 2013-2014.

BackgroundEnteric fever predominantly affects children in low- and middle-income countries. This study examines the burden of enteric fever at the 2 pediatric hospitals in Dhaka, Bangladesh and assesses their capacity for inclusion in a prospective cohort study to support enteric fever prevention and control.MethodsA descriptive study of enteric fever was conducted among children admitted in 2013–2014 to inpatient departments of Dhaka Shishu and Shishu Shashthya Foundation Hospitals, sentinel hospitals of the World Health Organization-supported Invasive Bacterial Vaccine Preventable Disease surveillance platform.ResultsOf 15917 children with blood specimens received by laboratories, 2.8% (443 of 15917) were culture positive for significant bacterial growth. Sixty-three percent (279 of 443) of these isolates were confirmed as the cases of enteric fever (241 Salmonella Typhi and 38 Salmonella Paratyphi A). In addition, 1591 children had suspected enteric fever. Overall, 3.6% (1870 of 51923) were laboratory confirmed or suspected enteric fever cases (55% male, median age 2 years, 86% from Dhaka district, median hospital stay 5 days).ConclusionsThe burden of enteric fever among inpatients at 2 pediatric hospitals in Dhaka, Bangladesh is substantial. Therefore, inclusion of these hospitals in a prospective cohort study will be useful for the generation of credible disease burden estimates of enteric fever in Bangladesh.

Enteric Fever and Related Contextual Factors in Bangladesh.

.Enteric fever remains a major public health problem in the developing world. With the emergence of antimicrobial resistance, disease prevention is becoming essential. There is evidence that improvement of contextual factors, such as socioeconomic development and water supply and sanitation, reduce the burden of this disease. However, such positive results are not universal. This study describes enteric fever trends in Bangladesh along with these factors’ progress between 1990 and 2014. Retrospective enteric fever data were collected from Dhaka Shishu (children) Hospital (DSH), Shishu Shasthya Foundation Hospital (SSFH), International Center for Diarrheal Disease Research, Bangladesh, and Popular Diagnostic Center (PDC). Contextual factors data were gathered from relevant organizations and their websites and plotted against time to see trends. During 2001–2014, data for a total of 131,449 blood cultures were available at DSH, SSFH, and PDC. Of those, 7,100 (isolation rate 5.4%) yielded either Salmonella enterica serovar Typhi or Salmonella enterica serovar Paratyphi growth without visible change in isolation rate trends. Contextual factors data were reported from 1990 to 2014. There were significant developments for sanitation facilities, drinking water supply, female literacy, and reduction in poverty head count ratio. During this time period, population density also increased significantly. Despite improvements in these contextual factors in Bangladesh, the enteric fever trend seems steady, possibly because of high population density and unplanned development of water supply and sewerage system. Although proper development of these two factors is important, immunization with an effective vaccine is instrumental to prevent this disease immediately in endemic countries such as Bangladesh, specifically to overcome the challenge of emerging resistance to available antibiotics.

Recent Change in Management Pattern of Meconium Ileus at Dhaka Shishu Hospital

Background : Meconium Ileus (MI) accounting for 9–33% of neonatal intestinal obstruction and one of the common cause of intestinal obstruction in neonate. Near about 50% can be present with various complications. Options for surgical management of MI include resection of dilated ileum with primary anastomosis, Bishop–Koop ileostomy, Santulli procedure or Mikulicz procedure and T tube ileostomy. In our center, before January 2015, mostly Mikulicz and few Bishop- Koop procedures were done for MI. But, the complications were high. From 2015, we started to perform T tube ileostomy and Bishop-Koop procedure in simple MI. In complicated cases Mikulicz and Bishop-Koop procedure were done and the scenario changed. This study was done to compare the outcome of MI surgery before and after January 2015.Methods: This was a retrospective study done in our center during January 2011 to December, 2016 (5 years). All cases were divided into two groups (Group-A: January 2011 to December 2014 and in Group-B: January 2015 to December 2016). Demographic data and surgical outcomes were compared.Results: Total 216 cases were included, in Group-A: 123 patients and others were in Group- B. Simple MI were 49% in Group-A and 56% were in Group-B. Complicated MI presented with small gut volvulus (43.3%) gangrene of loaded ileum (32.2%) perforation with peritonitis (37.8%) intestinal atresia with adhesions (16.3%) and meconium pseudocysts in 12 cases (16%). 11 patients had more than one complication. All the postoperative complications were found significantly high in Group-A except anastomotic leakage. Mortality was also significantly high in Group-A.Conclusion: Morbidity and mortality were significantly reduced with increasing practice of T tube ileostomy and Bishop-Koop procedure in simple and complicated Meconium ileus.Chatt Maa Shi Hosp Med Coll J; Vol.16 (2); July 2017; Page 5-8

Epidemiology of Otitis Media With Otorrhea Among Bangladeshi Children: Baseline Study for Future Assessment of Pneumococcal Conjugate Vaccine Impact.

Otitis media (OM) poses a high disease burden on Bangladeshi children, but little is known about its etiologies. We conducted a surveillance study in the largest pediatric hospital to characterize pathogens responsible for OM. In the outpatient ear-nose-throat department of Dhaka Shishu Hospital, which serves 0 to 18-year-old children, we collected ear swabs from OM children with otorrhea from April 2014 to March 2015. We cultured all specimens for bacterial pathogens and assessed serotype and antimicrobial susceptibility of Streptococcus pneumoniae (Spn) and Haemophilus influenzae (Hi) isolates. We recorded 1111 OM episodes; 88% (981/1111) involved otorrhea, and we collected samples from 91% (891/981) of these children. Fifty-one percent (452/891) were culture positive (contaminants excluded), with Hi (21%, 187/891) and Spn (18%, 164/891) most commonly detected. Overall, 45 distinct single and mixed pathogens were revealed. Dominant pneumococcal serotypes were 19A, 19F, 3 and 14; 98% of Hi isolates were nontypeable. Pneumococcal conjugate vaccine (PCV)10 and PCV10 + 6A serotypes accounted for 8% and 9% of all OM and 46% and 49% of pneumococcus-positive cases, respectively, and were more likely to be nonsusceptible to at least 1 antibiotic (erythromycin and/or trimethoprim-sulfamethoxazole) than nonvaccine serotypes (91% vs. 77%). Staphylococcus aureus (9%, 83/891) and Pseudomonas aeruginosa (4%, 38/891) were also found. Nontypeable Hi (NTHi) and Spn are predominant causes of OM in Bangladesh. PCV10, introduced in March 2015, is likely to reduce pneumococcal and overall OM burden. Data collected post-PCV10 will provide comprehensive insight into the effects of this vaccine on these pathogens.

Laparoscopic management of nonpalpable testis: 5 years’ experience at Dhaka Shishu (Children) Hospital

Laparoscopic management of nonpalpable testis: 5 years’ experience at Dhaka Shishu (Children) Hospital

Occurrence of Measles among Children Admitted in Tertiary Care Hospital

Background: Despite widespread vaccination against measles in Bangladesh outbreak continue to occur. The Objective of the study was to see the demographic characteristics of patients who had the diagnosis of measles at Dhaka Shishu (Children) Hospital and occurrence of measles from the time of vaccination.Methodology: This retrospective study was conducted on patient who were diagnosed as measles at Dhaka Shishu (Children) Hospital between 1st January 2017 to 30th April 2017. The diagnosis of measles based on clinical features and laboratory confirmation. Demographic characteristics of patients and occurrence of measles from the time of vaccination was recorded. Data were analyzed by using SPSS version 21.Results: Total 13864 patients were admitted during the study period and among them 23 were confirmed as measles. Rate of measles was found as 0.16% among hospitalized children with male predominance. Among the measles patients age of onset was <9 months in 2(8.7%), 9-12 months in 8(34.8%), 13-14 months in 11(47.8%) and 15 months and above in 2(8.6%) cases. Among 23 measles patients vaccine was not given in 2(8.7%) patients, one dose of vaccine was given in 19(82.60%) patients and two doses of vaccine were given in 2(8.7%) patients. Most of the measles patients came after one vaccination which means after first dose. Though measles incidence significantly reduced after the successful introduction of measles vaccination in EPI, still measles are prevalent in our country and occurs before completion of two doses of vaccine.Conclusion: Majority of measles cases developed before completion of two doses of vaccine though the successful measles vaccination are going on.Bangladesh J Child Health 2018; VOL 42 (1) :15-18

Transport Factors Affecting the Outcome of Referred Neonates Admitted in A Tertiary Care Hospital

Background: Adequate neonatal transport is a key component of care of the sick newborns who require referral to tertiary care center. Poor transportation is one of the iatrogenic factors associated with greater neonatal mortality. Neonatal transport is the greatest challenge faced today in our country. The purpose of this study was to find out characteristics of transport of referred neonates and to idention the factors that contribute to mortality.Methodology: This cross sectional study was conducted in Dhaka Shishu (Children) Hospital from June 2013 to November 2013. Both term and preterm neonates who were referred within first seven days of life were included and those with gross congenital abnormalities and left against medical advice were excluded from the study. After enrollment, data were collected using a structured questionnaire including birth details, interventions before transportation, reasons for referral, and details of transportation. Outcome & duration of hospital stay were also recorded. Neonates who were expired considered as group I and who were survived considered as group II. The study variables were analyzed for their association with immediate outcome by applying chi square test and t test. P value <0.05 was considered significant.Results: This study found that out of 332 neonates 181 were expired with 54.5% mortality rate. One eighty one neonates who were expired, considered as group I and one fifty one neonate were survived, considered as group II. The mortality was significantly high in male neonates [RR 0.80 (0.66-0.97)] and neonates those delivered at home [RR 1.34(1.10-1.64)] (p<0.05). Perinatal asphyxia, pre-term low birth weight, neonatal sepsis were the main causes of referral. It was found that transportation without any referral note [RR 1.40 (1.14- 1.71)], no advice regarding maintenance of airway[RR 1.50(1.17- 1.92)]and keeping warm [RR 1.51(1.17-1.950], resuscitation on admission [RR 1.63(1.23-2.17)] and transportation required > 3hours [RR 1.36(1.09-1.69)] were associated with significantly higher mortality among referred transported neonates(p<0.05).Conclusions: This study found that male neonates, home delivery, transportation without any referral note, no advice regarding maintenance of airway and keeping warm, resuscitation needed on admission and prolonged transportation time were significantly associated with mortality of referred transported neonates.Bangladesh J Child Health 2017; VOL 41 (3) :159-164

Radiological Findings of Pneumonia In Neonates Hospitalized in A Tertiary Care Hospital

Background: Pneumonia contributes to between 750,000 and 1.2 million neonatal deaths worldwide annually and neonatal pneumonia accounts for 10% of global child mortality. Chest radiography is the primary and most important imaging modality in the evaluation of neonatal pneumonia. The study was conducted to evaluate the common radiological findings of pneumonia among neonates to early diagnose the disease.Methodology: This prospective observational study was conducted in Dhaka Shishu (children) Hospital from April to September 2014. A total of 50 neonates admitted in the inpatient department were included who fulfilled the inclusion criteria’s like having difficult breathing, fast breathing>60 /min, severe chest indrawing, grunting, cyanosis, cough or fever. Diagnosis was confirmed by Chest X-ray. Positive X-ray findings like lobar or segmental consolidation, nodular or coarse patchy parenchymal infiltrate, diffuse haziness or granularity, air bronchogram were included into the study. X-ray changes were assessed.Results: Most commonly identified abnormality was patchy opacities (included nodular or coarse patchy opacities, diffuse haziness, air bronchogram), noted in 31(62.0%) cases. Followed by homogenous opacities (consolidation) were found in 19(38.0%) cases. Multifocal area involvement were found more 56.0 %(28) than single area. On right side radiological changes commonly noted, especially right upper zone involvement was the commonest 30 (66.0%). A comparison between severe and non- severe cases revealed that both types of opacities were found equally. But right sided Involvement was common in both groups.Conclusion: Multifocal patchy opacities were the most common radiological finding in cases of neonatal pneumonia. Pneumonia lesions were more common in the right lung among neonates and common site was right upper zone.Bangladesh J Child Health 2017; VOL 41 (3) :155-158