DS Children Research Articles

Clinical Presentation and Outcome of Management of Congenital Heart Diseases Associated with Down Syndrome in a Tertiary Care Hospital

Introduction: Treatment of children with Down syndrome having congenital heart defects has not been reported well in Bangladesh. This study has been carried out to inform practitioners about findings from cases in Combined Military Hospital, Dhaka. Methods: Three years retrospective observational study (clinical data, hospital course and follow-up) was carried out on 114 patients (49 males and 65 females, age range 1 month to 12 years) who underwent diagnostic and therapeutic work up in the pediatric cardiology department CMH Dhaka between January 2018 and December 2020. Results: Among 114 patients ,64 were (57%) were infants and 50 were older children (43%) , twenty-five had congestive cardiac failure and eighteen had hypothyroidism. The study showed that 33.3% were atrioventricular septal defect (AVSD), 28.1% were patent ductus arteriosus (PDA),8.75% were tetralogy of Fallot (TOF) ,5.25% were coartation of aorta (COA) ,3.5% were patent ductus arteriosus with coarctation of aorta 3.5%, double outlet right ventricle with pulmonary stenosis were 3.5%, ventricular septal defect were 7% whereas atrial septal defect along with ventricular septal defect were 5.3% ,atrial septal defect were 3.5%, transposition of great arteries with multiple ventricular septal defect were 1.8%.Forty (35%) patients using per cutaneous intervention,had 100% procedural success and no mortality .45 patients underwent surgery,few of them were not operated due to severe pulmonary hypertension. Conclusion: Congenital heart disease was more frequent in DS children,having worse prognosis.Children with DS required special attention due to increased risk of pulmonary hypertension. Delayed treatment was an important risk factor for poor prognosis.So early diagnosis is needed in order to provide optimal intervention and surgery ,before occurrence of irreversible PAH. J Bangladesh Coll Phys Surg 2023; 41: 7-14

Mothers of children with Down syndrome: a clinical and epidemiological study.

Down syndrome is the main genetic cause of intellectual disability. Many studies describe the clinical characteristics of DS patients; however, few have investigated the clinical profile of mothers who have children with DS. Advanced maternal age (≥ 35years old) is a risk factor for DS. Although there is an overall increase in pregnancies among women with advanced maternal age, there is still a lack of awareness of the increased risk of aneuploidy. Here, we reported the clinical and epidemiological profile of DS children and their mothers in a public reference hospital in the State of Rio de Janeiro, Brazil. For data collection, we performed a face-to-face interview guided by a structured questionnaire with closed-ended questions. A total of 344 individuals, 172 mothers and their DS children, were included in this study. Our results show that 56% of the mothers sampled were ≥ 35years of age at childbirth. Although 98% of them received prenatal care, only 4% obtained a prenatal diagnosis of DS. Most mothers reported not drinking alcohol or smoking cigarettes during pregnancy. Furthermore, 91% of women took prenatal vitamins and supplements; however, 47% were not aware of their benefits for a healthy pregnancy. Given the strict correlation between advanced maternal age and DS, prenatal care should include genetic counseling for women over 35years of age. This study highlights the importance of prenatal care and the urgent need for better DS screening allowing for immediate postnatal care, positively impacting the life expectancy of these patients.

Hypocalcemic Seizures in Infancy and its Relationship with Maternal Vitamin D Deficiency

Background: Hypocalcemia accounts for a large number of seizures in infants presented at the emergency department of our hospital.
 Objective: To evaluate the role of Vitamin D deficiency as the etiology of hypocalcemic seizures in infancy and its relationship with maternal Vitamin D levels.
 Methods: Cross sectional hospital based study over a period of 35 months from July 2016 to June 2019. Total 60 infants with hypocalcemic seizures were enrolled into the study. Blood samples were taken for serum total calcium, inorganic phosphate, alkaline phosphatase, albumin, 25(OH)D and PTH from the child. Maternal serum 25(OH)D levels were measured as well.
 Results: The mean age of the studied infants was 3.6 (±1.2) months. All patients had low total calcium (mean 6.5 mg/dl) and most of them had low inorganic phosphate (mean 3.5 mg/dl), while all of them had raised alkaline phosphatase (mean 1093.50 IU/L) and PTH levels (mean104 pg/ml) at presentation. Forty percent of infants were severely deficient and 60% were deficient in vitamin D; none of them were vitamin D sufficient. Among their mothers, none were sufficient, 10% were insufficient, 45% were deficient, and 45% were severe deficient of vitamin D. Neonatal 25(OH)D showed strong negative correlation with their serum PTH levels and strong positive correlations with maternal serum 25(OH)D levels.
 Conclusion: All infants in our setting presented with hypocalcemic seizures were found due to Vitamin D deficiency and it was mostly related to maternal Vitamin D deficiency.
 DS (Child) H J 2021; 37(2): 98-102

Risk Factors and Outcome of Neonatal Hyperbilirubinemia: A Case Control Study in a Tertiary Level Paediatric Hospital

Introduction: Neonatal jaundice is one of the most common morbidities observed during the neonatal period. Several risk factors are responsible for this condition.
 Objective: This study was aimed to determine the possible risk factors and immediate outcome for jaundice in newborns.
 Methods: This case control study was performed over a period of 18 months (March 2019 -August 2020) in the Special Care Newborn Unit (SCANU) of Dr. M R Khan Shishu Hospital & Institute of Child Health (ICH). Risk factors for jaundice were evaluated by comparing cases with jaundice and controls having no jaundice.
 Results: A total of 230 neonates with jaundice and 250 neonates having no jaundice were enrolled. Maternal age between 31-40 years, less than 4 antenatal visits, primi, presence of maternal diabetes, babies born via caesarian section, small for gestational age, prematurity and intra-uterine growth restriction were significantly associated with jaundice in neonates (p value < 0.05). Multi-variate analysis revealed, babies with mothers having <4 antenatal visits were found to have 13 times more risk of developing jaundice than their matched controls (p= 0.00, CI= 0.78-14.9). Mean duration of phototherapy was longer for babies having jaundice due to blood group incompatibilities (4.82 ± 1.94). Most of the patients (91%) were discharged to home.
 Conclusion: Less than four antenatal visit is a significant risk factor for neonates to develop significant jaundice requiring treatment. Babies with blood group incompatibilities tend to require longer duration of phototherapy wherever most of the babies discharged to home with good recovery.
 DS (Child) H J 2021; 37(2): 109-115

Experience of Paediatric Acute Lymphoblastic Leukemia Service in A Newly Established Haemato-Oncology Center in Bangladesh: Opportunities and Challenges

Background: Acute lymphoblastic leukemia (ALL) is the most common childhood malignancy and its modern management is complex. We are reporting early experience of establishing a paediatric ALL service in a multidisciplinary paediatric hospital in Bangladesh.
 Methods: This is a retrospective review of children below 18 years of age with confirmed diagnosis of ALL from July 2020 to June 2021 in Dr. M R Khan Shishu Hospital and ICH, Dhaka, Bangladesh, who received treatment adapted from the standard arm of ICICLE (Indian Childhood Collaborative Leukemia Group) protocol. Data were collected which included demographic, clinical, laboratory features of all patients at the time of presentation and also morbidities and outcome during all phases of chemotherapy. Analysis was done using descriptive statistics.
 Results: Of 51 patients, 16 were newly diagnosed patients, 32 received continuation care and 3 had relapsed disease. Treatment was initiated in 12 (75%) of 16 patients with newly-diagnosed ALL. Median age was three years, 50% were girls, one had TALL and 5 (42%) had high presentation leucocyte count (³50,000/mm3). Complete cytogenetic testing was available for one patient alone, no patient had Ph+ ALL. Eleven (92%) showed good prednisolone response. All nine patients who completed the induction phase achieved morphological remission, with high minimal residual disease (³0·01%) in two (22%). At last follow-up (30-06-2021), two patients were midway through induction, two died from sepsis (one each in Induction and Consolidation, both high risk ALL) and eight (67%) are alive in remission, on treatment 2-12 months from diagnosis. Continuation care included intrathecal treatments (n=119) and vincristine-corticosteroid pulses (n=53); 94% patient remained in complete remission, while two (6%) relapsed during the course of treatment.
 Conclusion: Risk-stratified ALL treatment is feasible in a newly established resource limited setting but limited by availability of high-quality diagnostics, specifically cytogenetics. Our study revealed that, during intensive phase approximately two-third children and during maintenance phase majority of children remained in complete remission.
 DS (Child) H J 2021; 37(2): 116-122

Spectrum of Upper GI Endoscopy in Children: A Tertiary Centre Experience from Bangladesh

Background: Upper gastrointestinal endoscopy is an essential, safe and sensitive investigation for diagnosing pediatric gastrointestinal diseases. In resource-limited countries like Bangladesh, the practice of pediatric endoscopy remains rudimentary, lacking in trained pediatric endoscopists and appropriate-sized endoscopes. There is limited study on paediatric upper GI endoscopy in our country.
 Objectives: The aim of the study was to find out the indications, common endoscopic findings and immediate post procedure complication of UGI endoscopy in children.
 Methods: This is a retrospective study; the records of all the patients whose age is less than 18 years and who underwent endoscopy in the last 6 years were studied.
 Results: Among the total of 384 children (age <18 years), the most common indications were recurrent abdominal pain in 133 (34.7%) patients followed by hematemesis±melena in 99 (25.8%), esophageal varices (follow up with eradication) in 67 (17.5%), recurrent vomiting in 31 (8.1%), foreign body, CLD screening, suspected celiac disease, isolated splenomegaly, corrosive injury, and weight loss. The most common abnormal findings were gastritis in 103 (26.9%) children followed by esophageal varices in 73 (19.2%), duodenitis in 26 (6.8%), foreign body, esophagitis, hiatus hernia, esophageal stricture, esophageal ulcer, gastric ulcer, duodenal ulcer etc. Minor adverse events occurred in 7.0% of children.
 Conclusion: The commonest indication for Pediatric UGI endoscopy was recurrent abdominal pain and the commonest endoscopic feature was gastritis. No significant post procedure complication was noted in the study.
 DS (Child) H J 2021; 37(2): 123-128

Complications of Paediatric Ventriculoperitoneal (VP) Shunt: Experience in A Tertiary Care Hospital

Background: Ventricloperitoneal (VP) shunt is the most commonly used shunt procedure in children because of the capacity of the peritoneum to resorb fluid like Cerebrospinal fluid (CSF). Primary and subsequent peritoneal catheter placement is relatively easy procedure to be done. VP shunt procedures are associated with varieties of complications.
 Methods: A prospective study was done from July 2017 to June 2021 in Faculty of Paediatric Surgery, Bangladesh Shishu Hospital & Institute. A total number of cases underwent VP shunt surgery were 192. We had analyzed 82(42.71%) patients of VP shunt surgery who had various shunt related complications and analyzed the predisposing risk factors and spectrum of complications.
 Results: The mean age was 16±14 months and median age was11.75 months. Out of 82 patients 56 (68.29%) were male and 26(31.71%) were female. Seventy (85.37%) patients had single complication and 12(14.63%) had more than 1 complications. Twenty four (29.27%) patients had infective complication and 58(70.73%) had mechanical complication. Infective complications (24, 29.27%) include shunt tract abscess (41.66%), CSF leak (16.67%) exposure of shunt tube through anus (16.67%), wound infection (16.67%). Mechanical complications were present in 58(70.73%) cases and 40(48.78%) had ventricular end malformation, 24(29.27%) peritoneal end and 18(21.95%) had both end malformation.
 Conclusion: With this prospective study of complications of VP shunt, age at initial shunt surgery, insertion and important patient-related predictors of shunt failure. The different predominant etiological factors the interval between the age of initial shunt placement and onset of complications were the most responsible for early and late shunt failure were infective and mechanical complications respectively.
 DS (Child) H J 2021; 37(2): 129-134

Hepatitis A: Leading Cause of Paediatric Acute Liver Failure in Bangladesh

Background: Pediatric acute liver failure (PALF) is a multisystem disorder that gives rise to severe liver failure within days or weeks and occurs in children without pre-existing chronic liver disease. The etiology of PALF varies with age group and geographical area.
 Objectives: This study was aimed to evaluate the etiological factors of PALF in Bangladeshi children.
 Methods: This observational study was conducted at the Department of Paediatric Gastroenterology & Nutrition, Bangabandhu Sheikh Mujib Medical University, Bangladesh, from 2017 to 2020. Twenty-six PALF patients were included, purposively, excluding the acute-on chronic liver failure cases. Demographic data, vaccination history, and other information regarding etiology and complications were recorded. During hospital stay following investigations were performed: Serum bilirubin, liver enzymes, prothrombin time, serum albumin, serum creatinine and electrolytes. Fisher’s exact test determined the association between etiologies of PALF and past histories along with other descriptive statistics using the open-source PSPP software.
 Results: The average age of the 26 studied patients was 8.6±3.5 years, and 73.1% belonged to 5-12 years of age group. Half of the patients had a history of taking street food or unsafe water. Only six patients had a history of ingestion of herbal medicine. None of the patients had history of vaccination against Hepatitis A. The etiology of PALF patients varied. About 54% of the studied patients had HAV infection, in 23.1% etiology was not determined. About 71.4% of the study patients with HAV infection had a history of taking street food or unsafe water, and this association was statistically significant.
 Conclusion: This study found that hepatitis A virus infection is the leading cause of paediatric acute liver failure in Bangladesh. Timely preventive measures may help in lowering fatality from liver diseases in children in Bangladesh.
 DS (Child) H J 2021; 37(2): 93-97

Outcome of Dengue Patients Admitted in the PICU of Bangladesh Shishu Hospital & Institute

Background: Recent re-emergence of dengue patient among Bangladeshi children have created a huge burden in the morbidity and mortality of our children.
 Objectives: This study was designed to document the outcome of dengue patients, admitted in the ICU of Bangladesh Shishu Hospital & Institute (BSH&I).
 Methods: This retrospective observational study was performed among the children having dengue infection and who were admitted in the PICU of BSH&I from 1st June 2019 to 31st December 2019. All patients who were diagnosed as dengue fever by serological tests (NS1, Dengue IgG & IgM) and those who were admitted in the PICU were included in this study. Total one hundred and twenty-six patients were enrolled. Data were collected from hospital record of the Dengue patients.
 Results: Mean age of the Dengue patients were 5.91(±3.53) years. Most of the patients suffering from dengue fever were urban dwellers; among them 52.4% were female. Presenting symptoms during admission in the PICU were fever which was present in 119 patients (94.4%), followed by hypotension in 106 (84.1%) patients. Severe dengue (SD) was diagnosed in maximum number of cases (i.e., 62.7%), followed by Dengue fever with warning signs (DFWS) in (20.6%) and Expanded Dengue Syndrome (EDS) in 16.7%. Maximum cases received crystalloid (98.4%), about 51.6% patients received colloid. A good number of patients received blood transfusion (23%), plasma was received in (23%) and albumin was received in (33.3%) cases. Majority of the patients received Oxygen (80.2%); antibiotics were prescribed in 87.3% cases. Fifty-five percent patients received inotropes for the management of shock. The overall outcome revealed 75.4% patients were cured and discharged. Only 21.43% patients died in the PICU despite protocol-based management. Death due to severe dengue was 15(18.9%) out of 79, followed by death due to Dengue Hemorrhagic fever with warning signs which was 8 (30.7%) out of 26 and death in Expanded Dengue syndrome was 4(19.04%) out of 21.
 Conclusion: This retrospective study found that majority of the Dengue patients admitted in PICU has survived. However the death due to Dengue with warning signs was higher than death in severe Dengue cases. Delayed recognition of warning signs along with delayed referral to PICU may be responsible for such outcome.
 DS (Child) H J 2021; 37(2): 103-108

Effect of Intrahepatic Cholestasis of Pregnancy (ICP) on Neonatal Outcome

Intrahepatic cholestasis of pregnancy is a condition unique to pregnancy characterized by pruritus and elevated serum bile acids and/or aminotransferase levels. It usually manifests during second or third trimester of pregnancy and improves after delivery. But neonates are at increased risks of still birth, prematurity, respiratory distress syndrome and metabolic problems. Timely identification and appropriate intervention can reduce the adverse neonatal outcomes.
 DS (Child) H J 2021; 37(2): 135-139

Perspective of Parental Satisfaction with Academia of Children with Down Syndrome and Intellectual Disability

Background: Down syndrome is the disorder in which physical, mental, and functional deformity is present due to trisomy twenty one, the existence of three chromosomes instead of two normal chromosomes in human genome. Children who have intellectual disability they have neurodevelopmental deficit regards to limited in intellectual operation and adaptive behaviors. One of the safeguards variables as a favorable adaptability to a challenging conditions, like managing a handicapped kid, is marital satisfaction. Higher levels of marital happiness are linked to reduce depression levels, less parenting stress, and better parental planning (Kersh, Hedvat, Hauser-Cram, & Warfield, 2006) Objective(s): To find out parental satisfaction with academia of Down syndrome and Intellectual disability in Pakistan. Methodology: A standardized tool PSCDDI is used and data were collected from special education school of Lahore and Gujranwala city. Data were collected from 385 parents of down syndrome and intellectual disable child parents through questionnaire which were provided to parents and take their opinion. After data collected we analyze the data and concluded the results. Results: In this study we find out that parents are unsatisfied to academic performance of their child most of child and most of the parents are not sure and disagree. Down syndrome child are 38.9% and 60.9% child were intellectual disable and they are all in pre to 3rd grade. Most of the child were in the age range of 5- 8 years. The parents of DS and ID child have non-Consaginous marriage is 53.6% and 46.4% are Consaginous marriage. Conclusion(s): The overall study of parental satisfaction towards the developmental disability of their children shows unsatisfaction. . In Pakistan parents who have their children with disability faced many challenges in society. Keyword: Down syndrome, intellectual disability, parental satisfaction, academia

Prevalence and Antibiotic Sensitivity Pattern of Pseudomonas Aeruginosa Isolates from Urine Samples in A Tertiary Care Hospital

Background: Urinary tract infection (UTI) is one of the leading causes of infection worldwide. P. aeruginosa is a versatile opportunistic pathogen and it is the third most common organism causing nosocomial urinary tract infections. With the widespread use of antibiotics, multidrug resistance pseudomonas continues to go up rapidly. This multidrug resistance pseudomonas increases the risk of mortality and morbidity.
 Objective: To determine the prevalence of P. aeruginosa and to understand the current statistics of its antimicrobial resistance pattern.
 Methods: This retrospective study was conducted from January 2019 to December 2020 in the Department of Microbiology, Bangladesh Medical College Hospital, Dhaka. Clean catch mid-stream urine samples were collected in sterile containers. The samples were cultured on CLED agar media with a standard calibrated loop and incubated at 370C overnight. P. aeruginosa grows well at 25°C to 37°C, and its ability to grow at 42°C helped to distinguish it from other Pseudomonas species. Antibiotic sensitivity test was done according to Clinical and Laboratory Standard Institute (CLSI) guideline.
 Results: A total of 10427 urine sample were received in the department of Microbiology of BMCH during these two years. Isolation rate of P. aeroginosa was 4% in 2019 and it increased to 6% in 2020. Piperacillin/Tazobactam showed sensitivity which was 63.33% in 2019 and 82% in 2020, followed by imipenem, meropenem, amikacin, ciprofloxacin, ceftazidime and aztreonam; which were 50% to 60% on an average. Sensitivity of the organism to Gentamycin (13.33% in 2019 & 30.3% in 2020), Netilmicin (20% in 2019 & 30.3% in 2020) and Ceftriaxone (13.33% in 2019 & 12.3% in 2020) was found very low.
 Conclusion: P. aeruginosa isolates in urine culture is increasing in hospital admitted patient and becoming resistant to multiple antibiotics which is frightening.
 DS (Child) H J 2021; 37(1): 40-44

Nutritional Study of Picky Eaters: A Case Control Study

Background: Picky eating is a relatively common problem during childhood. Picky eating may cause parents considerable concern leading to physician visits and may cause conflict between parents regarding handling of their child’s eating behavior.
 Objectives: The present study was conducted to compare the nutritional status and daily calorie consumption among children with and without picky-eating-behavior.
 Methods: The present study was conducted out in the Department of Paediatrics, Sir Salimullah Medical College and Mitford Hospital, Dhaka and private chambers of paediatrician, general physician from July 2013 to December 2013. The case was defined as a child who had anorexia or took one or two favorite foods as explained by the parents in an otherwise healthy child with picky eating disorder, while a control was defined as a child without having picky eating disorder.
 Results: Thirty percent of the parents of cases complained that their children were not growing well as opposed to only 4% of the control group (p<0.05). Complaint of abdominal pain was considerably higher in the former group than that in the latter group (p<0.05). The history of forceful feeding was present in 20% of the cases compared to none in the control (p>0.05). The mean 24 hours intake of calorie was lower in the cases than that in the control, but the difference did not reach the level of significance (p>0.05). In terms of nutritional status very few children (8%) with picky eating behavior were wasted (low weight-for-height) (p>0.05). However, 26% of the picky-eaters were underweight in terms of BMI compared to 7% of the controls, but the difference was not statistically significant (p>0.05).
 Conclusion: The study concluded that the children with picky-eating-behavior are almost similar to their control counterparts in terms of nutritional status (wasting, stunting and BMI) and calorie consumption.
 DS (Child) H J 2021; 37(1): 59-63

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

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

Clinico-pathological Profile of Childhood Nonhodgkin Lymphoma (NHL) in A Tertiary Care Hospital in Bangladesh

Background: Non-Hodgkin Lymphoma (NHL) is the third most common childhood malignancy. With histopathology based intensive chemotherapy and CNS-directed therapy, survival can reach more than 80%.
 Objective: The study was conducted to observe the clinico-pathological findings of NHL in Bangladeshi children.
 Methods: A prospective observational study was conducted in the Paediatric Haematology and Oncology Department of BSMMU from June 2012 to December 2012. Newly diagnosed NHL patients were included in the study. Patient’s initial clinical presentations, time interval from onset of symptoms to diagnosis were recorded. Diagnostic and staging workups were done by CBC, biochemistry, radio-imaging, histopathology (FNAC/excision biopsy), serous fluids/CSF cytology (cytospin), and bone marrow aspiration.
 Result: Among the 34 patients, BL had preponderance (n=23, 68%) then LL. Median age was 7.6 years. Male: female ratio was 2.1:1. Delayed diagnosis was found in 59% patient. Primary sites were abdomen (65%), thorax (32%), and head-neck (3%). At initial presentation, 83% patients of Burkitt NHL and 100% Lymphoblastic NHL patients came with advanced disease. Bone marrow involvement was found in 23.6% patients and 12% had CNS involvement at their presentation. Irrespective to histology, most common stage was stage-III, which was 53% and then stage-IV was 35%. Median LDH was 1719 U/L. Patient with abdominal variety of NHL came with abdominal complaint like pain (66%), distension (65%), ascites (48%), mass like hepatomegaly (39%), splenomegaly (26%), intussusceptions (8%), testicular involvement (4%). B symptoms were commonly found in 74% patient. Pallor (82%), anorexia, nausea & vomiting (48%), oedema (25%), peripheral lymphadenopathy (49%) were also noticed. In case of thoracic variety of NHL, most common presentation was respiratory distress (90%), superior mediastinal syndrome (SMS) (45%), with high incidence of B symptoms (90%), peripheral lymphadenopathy (72%) with other respiratory finding like chest bulging, mediastinal mass, pleural effusion was also found.
 Conclusions: About 59% childhood NHL patients tend to present with delayed diagnosis and 88% with advanced disease. Burkitt NHL is the commonest childhood lymphoma, mostly presented with abdominal complaint. Thoracic variety is mostly Lymphoblastic lymphoma. Histopathological findings following excisional biopsy is the most significant and confirmatory for diagnosis. Serum LDH were found significantly high level in both varieties.
 DS (Child) H J 2021; 37(1): 21-27

Care of Neonates and Children During Corona Crisis and Importance of Continuation of Essential Services

The corona virus disease (SARS-CoV-2) has rapidly spread across the world and global population including children are facing unprecedented health crisis. The chance of vertical and perinatal transmission of SARS-CoV-2 virus in children is not proven yet. The effect of the virus on neonate and infant appears to be small. On the other hand, pregnant women suffering from corona virus disease may give birth to premature or IUGR babies who will need extra care. Breast feeding is considered as gold standard in almost all situation. Continuation of breast feeding along with other essential services have reduced the risk of transmission of corona virus.
 DS (Child) H J 2021; 37(1): 5-8

Neurological Complications of Intrathecal Chemotherapy in Children: Experience in A Tertiary Care Hospital in Bangladesh

Background: Intrathecal (IT) chemotherapeutic agents have a narrow therapeutic index and high potential for toxicity. Though severe side effects are rare, but sometime consequences of IT chemotherapy can be catastrophic.
 Objectives: The objective of the study was to observe the neurological complications of intrathecal chemotherapy administrations in patients getting treatment for childhood malignancy.
 Methods: This prospective study included 33 patients who received IT chemotherapy on 76 occasions from July 2020 to December 2020 at Dr. M R Khan Shishu Hospital and ICH. We documented all the neurological complications within two weeks of IT chemotherapy. We defined minor neurological complications as headache, backache, fever, nausea, or vomiting. Major neurological complications were defined as nuchal rigidity, paresthesia, paralysis, or chemical arachnoiditis. All the cases were managed according to the internationally standard protocol.
 Results: Among the patients who received IT chemotherapy 64% were male and 36% were female. The mean age of child was 7 years. The most common diagnosis was BCP (B cell precursor) ALL (75.8%), followed by T-cell ALL (15.1%), APML (Acute promyelocytic leukemia) (6.1%), and B lymphoblastic Lymphoma (3%). Therapy consisted of methotrexate alone in 73 (96.1%) occasions, and cytarabine alone in 3(3.9%) occasions. Minor events occurred in 17(22.4%) occasions but no patient developed major events after administration of IT chemotherapy. Among the side effects a total of 5 (6.6%) occasions children developed nausea, 4 (5.3%) had back pain, 3 (3.9%) had headache, 2 had (2.6%) vomiting, 2 (2.6%) had dizziness and 1(1.3%) developed fever after IT chemotherapy administration. No patient developed major neurological events like neck rigidity, paralysis and chemical arachnoiditis. About 77.6% occasions, children did not develop any side effects after IT chemotherapy administration.
 Conclusion: No major toxic neurological events occurred but only minor neurological complications developed after IT chemotherapy administration. It is important for clinicians to be aware of the adverse events and consider them when treating patients with IT chemotherapy.
 DS (Child) H J 2021; 37(1): 15-20

Status of Red Blood Cell Indices in Iron Deficiency Anemia and β Thalassaemia Trait: A Comparative Study

Background: Iron deficiency anemia (IDA) and b thalassemia trait (b -TT) are the two important differential diagnosis of microcytic hypochromic anaemia. It is important to distinguish between the above two conditions to avoid unnecessary iron therapy. Red blood cell (RBCs) indices are simple, easy, and cost effective method to get a primary and valuable information regarding the diagnosis of IDA and b -TT.
 Objectives: This study was aimed to compare the RBC count, hemoglobin (Hb), hematocrit (Hct%), RBC indices, mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH), mean corpuscular hemoglobin concentration (MCHC), red cell distribution width (RDW) and redcell distribution width index (RDWI) in Iron deficiency anemia and b thalassemia trait.
 Methods: This cross-sectional comparative study was conducted in the department of clinical pathology, Dhaka Shishu Hospital, Dhaka from July 2019 to March 2020. Total 107 patients with microcytic hypochromic anaemia (64 subjects of IDA and 43 subjects of b -TT were tested for RBC count, Hb%, MCV, MCH, MCHC, RDW, and PCV from venous blood by haematology analyser. Serum ferritin was measured by Enzyme Linked Immunosorbent Assays (ELISA). Statistical analysis was performed by SPSS version 22. Statistical significance was set at p value less than 0.05.
 Results: RBC count, Hb, and Hct,MCV, MCH and MCHC were significantly lower and RDW and RDWI was significantly higher in IDA group than in b- TT group (p< 0.001). Similar result was observed in male and female participants when compared them in separate group.
 Conclusion: The study showed that RBC count, Hb, Hct, MCV, MCH, and MCHC were significantly lower in IDA group than in b-TT group, whereas RDW and RDWI were significantly higher in IDA group than in b-TT group.
 DS (Child) H J 2021; 37(1): 9-14

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