Construction and validation of ShaMaq developmental screening tool.

INTRODUCTION: The diagnosis of developmental delay and early intervention ameliorates long-term sequelae. There is a need for an appropriate, regionally adapted and reliable developmental screening tool to be used in low and middle-income countries with scarce resources. AIM: The aim of this research is to construct and validate a screening tool for identifying developmental delay in Pakistani children. METHOD: ShaMaq developmental screening tool (SDST) was developed consisting of five proformas to be administered at different age groups: 6-8 weeks (Group 1), 6-10 months (Group 2), 18-24 months (Group 3), 3-3.5 years (Group 4), and 4.5-5.5 years (Group 5). On an average, Groups 1-3 took 10-15 min, whereas Groups 4 and 5 took 20-25 min. We sampled children between the ages of 6 weeks to 5.5 years and tested them all within their designated age groups. Internal consistency was assessed by Cronbach's alpha. Interobserver testing was done for reliability and concurrent validity was undertaken by using the senior consultant developmental paediatrician's final diagnosis as the gold standard. RESULTS: Out of 550 healthy children, 8-19% in the five groups were found to have some form of developmental delay using SDST. Approximately 50% of the families were in the low-to-moderate income bracket, and nearly 93% lived in a joint family system. Internal consistency of items in the five groups ranged from 0.784 to 0.940, whereas both interobserver reliability and concurrent validity ranged from 0.737 to 1.0. SDST showed 94.4% sensitivity and 92.9% specificity. CONCLUSION: SDST is an effective tool for identifying delay in healthy children with good internal consistency, reliability, and validity.

Short to midterm follow-up of multi-system inflammatory syndrome in children with special reference to cardiac involvement.

OBJECTIVES: We aim to describe the early and upto 16 months follow-up of post-coronavirus disease (COVID), multi-system inflammatory syndrome in children (MIS-C), with special reference to cardiac involvement. STUDY DESIGN: This cohort non-interventional descriptive study included patients <18 years admitted between May, 2020 and April, 2021. Based on underlying similarities, children were classified as post-COVID MIS-C with overlapping Kawasaki Disease, MIS-C with no overlapping Kawasaki Disease, and MIS-C with shock. Post-discharge, patients were followed at 1, 3, 6, 12, and 16 months. RESULTS: Forty-one patients predominantly males (73%), at median age of 7 years (range 0.2-16 years) fulfilled the World Health Organisation criteria for MIS-C. Cardiac involvement was seen in 15 (36.5%); impaired left ventricle (LV) function in 5 (12.2%), coronary artery involvement in 10 (24.4%), pericardial effusion in 6 (14.6%) patients, and no arrhythmias. There were two hospital deaths (4.9%), both in MIS-C shock subgroup (2/10, 20%). At 1 month, there was persistent LV dysfunction in 2/5, coronary artery abnormalities in 7/10, and pericardial effusion resolved completely in all patients. By 6 months, LV function returned to normal in all but coronary abnormalities persisted in two patients. At last follow-up (median 9.8 months, interquartile range 2-16 months), in 36/38 (94.7%) patients, coronary artery dilatation was persistent in 2 (20%) patients. CONCLUSIONS: Children with MIS-C have a good early outcome, though MIS-C with shock can be life-threatening subgroup in a resource-constrained country setting. On midterm follow-up, there is normalisation of LV function in all and recovery of coronary abnormalities in 80% of patients.

Reflection as a Learning Tool in Postgraduate Medical Education.

OBJECTIVE: To explore the reflective capacity as a learning tool in pediatric residents. STUDY DESIGN: Survey. PLACE AND DURATION OF STUDY: The Children's Hospital Lahore, Pakistan from 20th March to 30th March 2021. METHODOLOGY: In this cross sectional online survey, the participants were postgraduate residents and registrars of Paediatric Medicine, Paediatric Surgery, and Paediatric Diagnostics, working at The Children's Hospital, Lahore, Pakistan. Reflective practices questionnaire (RPQ) was used for measuring the reflective practices and SPSS-24 for data analysis. RESULTS: Out of a total of 175 study participants, 144 (82.3%) were paediatric medicine residents followed by paediatric surgery 18 (10.3%) and paediatric diagnostic 13 (7.4%) with a slight female preponderance 91 (52%). All years of trainees participated; majority was 4th year trainees 58 (33.1%), and 1st year the lowest 17 (9.7%). The overall mean score of the questionnaire was 69.97 ± 10.79 (95% CI: 68.36 ± 71.58) out of 96 total score. The highest score was of critical appraisal 18.52 ± 3.16 (95% CI: 18.04 ± 18.99) out of 24. There was no difference in mean score of different sub-domains and mean scores based on gender, specialty or year of training (p=>0.05). CONCLUSION: The overall reflective capacity of paediatric postgraduate residents is good irrespective of specialty, gender or year of training. Critical appraisal of interaction in the reflection is the highest scored domain. Key Words: Postgraduate, Residents, Medical education, Reflection, Practice, Learning tool.

Association of Blood Groups with the Severity and Outcome of COVID-19 Infection in Children.

The objective of this study was to find out the association of ABO blood groups with the severity and outcome of corona virus disease 2019 (COVID-19) in children. It included all laboratory-confirmed cases of COVID-19 and post-COVID multisystem inflammatory syndrome in children (MIS-C)/ Kawasaki disease (KD) like illness, admitted from March to September, 2020 to The Children's Hospital, Lahore. Out of 66 children, 45 (68.2%) were COVID-19 and 21 (31.8%) MIS-C/KD temporally associated with SARS-C0V-2. The mean age was 7.9 ± 4.2 years. Majority of children had mild to moderate illness 38 (57.6%), while 23 (34.8%) had severe or critical disease. Among all patients, 24 (36.4%) had some underlying comorbidity. Blood group A was significantly associated with severe and critical disease (p=0.030). COVID-19 in children had generally a good outcome, but children with blood group A were more susceptible to severe/critical disease. Key Words: Coronavirus disease 2019, ABO blood groups, Children, Severity, Outcome.

Is leukopenia and lymphopenia a characteristic feature of COVID-19 in children?

OBJECTIVES: To analyze whether leucopenia and lymphopenia a characteristic feature of children with COVID-19 and to find out its association with the disease severity. METHODS: This was a descriptive cross-sectional study conducted at The Children's Hospital Lahore from March 2020 to October 2020. All confirmed cases of COVID-19 infection and post-COVID MIS-C/Kawasaki Disease diagnosed on the basis of RT-PCR and Antibody test respectively were included. Complete blood and differential counts were performed on the day of admission. RESULTS: Out of a total of 83 patients 60 (72%) were diagnosed as COVID-19 and 23 (28%) as post-COVID MIS-C/KD. The mean age of children was 7.0±4.3 years (95%CI: 6.07 - 8.75) with a male preponderance 51 (61%). Twenty (24%) children had an underlying comorbidity and 7 (8%) were surgical cases. Our case fatality rate was 5 (6%) and all children who died had an underlying comorbid condition. In both, COVID and MIS-C/KD the mean leukocyte count was (14.0 ± 12.5 vs 13.6 ± 6.9 x109/L), respectively (p=0.888). The mean lymphocyte count in children with COVID was (39.1 ± 21.4%). Patients with MIS-C/KD showed significantly higher levels of neutrophil count (76.5 ± 15.0%) as compared to children with COVID (52.0 ± 22.1%), absolute lymphocyte count was (5.02±4.81 vs 2.13±0.95 x109/L) in COVID and MIS-C respectively (p=<0.001). In 60 COVID-19 patients, the mean neutrophil lymphocyte ratio (NLR) in mild-moderate and severe-critical group was 2.00 and 5.08 respectively (p=0.009). CONCLUSION: The blood picture of COVID-19 in children does not show leukopenia. NLR was a prognostic factor to assess the severity in COVID-19 patients. The presence of an underlying comorbid conditions is significant a risk factor for poor outcome.

Awareness of quantity of ORS and Zinc among mothers of under five children with diarrhoea at a tertiary care Centre Lahore.

OBJECTIVE: To assess mothers' knowledge about the quantity of oral rehydration salt and zinc in the management of diarrhoea. METHODS: The cross-sectional study was conducted from May to August 2019 at The Children's Hospital, Lahore, Pakistan, and comprised mothers accompanying children aged <5 years admitted with diarrhoea complaints. Data was collected regarding demographics and mothers' awareness of signs of dehydration in diarrhoea, familiarity with the term oral rehydration salt, its correct preparation and administration and zinc supplementation. Data was analysed using SPSS 20. RESULTS: Of the 334 mothers interviewed, 154(46%) were able to identify the signs of dehydration. Maternal awareness regarding use of oral rehydration salt and zinc in diarrhoea were significantly associated with maternal education and socioeconomic status (p<0.05). CONCLUSIONS: There is a need to generate awareness among mothers about the use of oral rehydration salt and zinc in diarrhoea.

Association of Blood Groups with the Severity and Outcome of COVID-19 Infection in Children.

The objective of this study was to find out the association of ABO blood groups with the severity and outcome of corona virus disease 2019 (COVID-19) in children. It included all laboratory-confirmed cases of COVID-19 and post-COVID multisystem inflammatory syndrome in children (MIS-C)/ Kawasaki disease (KD) like illness, admitted from March to September, 2020 to The Children's Hospital, Lahore. Out of 66 children, 45 (68.2%) were COVID-19 and 21 (31.8%) MIS-C/KD temporally associated with SARS-C0V-2. The mean age was 7.9 ± 4.2 years. Majority of children had mild to moderate illness 38 (57.6%), while 23 (34.8%) had severe or critical disease. Among all patients, 24 (36.4%) had some underlying comorbidity. Blood group A was significantly associated with severe and critical disease (p=0.030). COVID-19 in children had generally a good outcome, but children with blood group A were more susceptible to severe/critical disease. Key Words: Coronavirus disease 2019, ABO blood groups, Children, Severity, Outcome.

Perspective of health professionals on hand hygiene in a tertiary care center in Pakistan.

OBJECTIVE: To determine the awareness of postgraduate residents and nurses working in a tertiary care hospital about hand hygiene. METHODS: The cross-sectional study was conducted in October 2018 at The Children's Hospital and the Institute of Child Health, Lahore, Pakistan, and comprised postgraduate residents and nurses. Data was collected using a 31-item self-administered inventory. Data analysis was done using SPSS 21. RESULTS: Of the 360 subject, 152(42.2%) were postgraduate residents and 208(57.8%) were nurses. Overall score of knowledge 202(56%) was low compared to attitude 260(72%) and practice 283(78.6%). The combined score of all three domains was 245(68%), indicating moderate awareness. Postgraduate residents had significantly better knowledge 98(64%) compared to nurses 104 (50%) (p=0.01), while nurses had better attitude score 159(76.4%) compared to the residents 103(68%) (p<0.05). The practice subscale score was not significantly different between the groups (p>0.05). CONCLUSIONS: Both postgraduate residents and nurses showed moderately satisfactory knowledge, attitude and practice towards hand hygiene.

Complementary feeding practices among mothers of children aged six months to two years at Children's hospital Lahore.

OBJECTIVE: To analyse complimentary feeding practices among mothers of infants. METHODS: The cross-sectional study was conducted from September to December, 2015, at The Children's Hospital, Lahore, Pkistan, and comprised children aged 6-24 months. Data was collected regarding demographic profile, breast-feeding, initiation and adequacy of complementary feeding, maternal education and father's monthly income. Children's growth measurements were plotted using the World Health Organisation growth charts. Data was analysed using SPSS 20. RESULTS: Of the 202 children, 103(51%) were boys. The overall mean age was 14± 5 months. Among the mothers, 133(66%) were literate and 121 (60%) belonged to poor social class. Of the children, 145(72%) were exclusively breast-fed till 6 months of age. Breast-feed was not given in 51(25%) cases. Weaning age was appropriate in 88(44%) children. Overall, 53(26%) children were under-nourished. Lower social class, delayed initiation and inadequate amount of complementary feeding was significantly associated with poor nutritional status (p<0.05). CONCLUSIONS: Weaning practices were incorrect in terms of amount and frequency. Children aged 13-18 months belonging to lower social class and having delayed and inadequate complimentary feeding were more malnourished.

Identifying research obstacles; a cross sectional comparative study of perceptions of postgraduate medical and dental residents in three public sector medical colleges.

OBJECTIVE: To explore the attitude of postgraduate medical and dental residents about research work and to identify barriers in the way of research activities. METHODOLOGY: The cross-sectional study was conducted from May to July, 2018, at three public-sector medical and dental institutions in Quetta, the capital of Pakistan province of Balochistan, and comprised postgraduate residents. Data was collected using a pre-validated 16 item Likert scale questionnaire. Data was analysed using SPSS 23. RESULTS: Of the 72 subjects, 44(61.1%) were males. The overall mean age was 23.3±4.6 years (range: 28-30 years. The residents demonstrated willingness to conduct clinical research with a mean score of 4.36±0.65. There was no association of attitudes and barriers with socio-demographic and personal characteristics (p>0.05). Deficient lab facilities (p-<0.001), and inaccessibility to electronic and hospital data (p=0.003) were the major factors identified as research barriers. CONCLUSIONS: Barriers to research need to be addressed in designing research curricula to encourage and facilitate meaningful research.

Patterns of maternal nutritional status based on mid upper arm circumference.

OBJECTIVE: To determine the patterns of maternal nutrition status by using mid upper arm circumference (MUAC) and to examine the association of maternal nutritional status with the nutritional status of malnourished children under two years of age. METHODS: Descriptive study conducted at the Department of Pediatric Medicine of the Children's Hospital, Lahore from January 2017 to March 2018. A total of 227 mother accompanying their children admitted for nutritional rehabilitation were included. Demographics of participants along with MUAC of every mother was taken. Data analysis was done by SPSS 22. RESULTS: Mean maternal age was 28.29±5.30 years and mean age of children was 9.22 ± 6.05 months. Mean maternal MUAC was 25.53±3.63 cm. Normal nutrition was present in only 70 (31%), 35 (15.4%) had moderate to severe under nutrition and 68 (30%) were overweight and 17 (7.5%) were obese. Maternal illiteracy was common 150 (66%) and 203 (89%) belong to poor social class. Majority 150 (75%) children had <-3SD WHZ score. Only 42 (18.5%) children were exclusively breast fed. Maternal malnutrition was significantly associated with severity of child's undernutrition (p=0.045) and low rates of exclusive breast feeding practices (p=0.049). CONCLUSION: Malnutrition, in the form of both under nutrition and obesity is prevalent in mothers of malnourished children belonging to lower social class. Maternal illiteracy and low income are the major contributor in maternal malnutrition which in turn has an impact on child nutrition and breast feeding practices.

Students' perception about assessment environment of University of Lahore - Dental School: A cross-sectional survey.

OBJECTIVE: To evaluate the perception of undergraduate dentistry medical students about the assessment environment at their institution. METHODS: The cross-sectional descriptive study was conducted at the University of Lahore, Lahore, Pakistan, from April 2017 to September 2017, and comprised undergraduate dentistry medical students who were asked to complete the Assessment Environment Questionnaire. Students' individual perception scores were calculated and the means of both individual domain and global score were compared in terms of different academic years. SPSS 20 was used for statistical analysis. RESULTS: Of the100 subjects, 50(50%) each were from 1st year and 2nd year. Overall, the students perceived their assessment environment positive yielding a global mean score of 49.84}10.84 out of the maximum 80. Second year students scored significantly higher compared to first year students in all domains except feedback mechanism (p=0.0017), learning and performance (p=0.0014), information on assessment (p=0.0064), and total mean score of 53.5}8.24 compared to 46.12}11.7 (p=0.0004). CONCLUSIONS: The students' perception of the assessment environment was more positive than negative.

Prognostic factors and outcome of Post-Neonatal Tetanus in an intensive care unit of a Tertiary Care Hospital.

OBJECTIVE: To determine the prognostic factors and outcome of tetanus in children of post-neonatal age admitted in the intensive care unit (ICU) of a tertiary care hospital. METHODS: This prospective cross sectional study, carried out in the Pediatric ICU of The Children's Hospital Lahore from Jan 2013 to March 2017. Children of both genders with age range of two months to 16 years diagnosed clinically as tetanus were included. All 132 patients were scrutinized for all possible risk factors, need for mechanical ventilation and outcome. Data was analyzed by SPSS version 20. RESULTS: Mean age of children was 7.5±3.4 years with male predominance (70.5%). Only (38.6%) received three doses of vaccination but none had booster dose. Trauma (43.2%) encompassed maximum predisposing factor followed by ear or nose prick and ear discharge. Mean duration of ICU stay was 20±13.3 days. Mortality rate was (17.4%). Ventilator support was given to (78.8%). Neurological outcome was normal in (82.6%). Trauma, ear or nose prick in girls and ear discharge were significantly associated with poor outcome and death with p-value of <0.001, 0.011 and <0.001 respectively. Other factors associated with poor outcome were need for mechanical ventilation and neurological impairment with p-value of 0.001 and <0.001 respectively. CONCLUSION: Tetanus is causing our children to suffer from devastating disease. Vaccination status is not satisfactory and along with trauma, ear discharge and ear or nose prick are identifiable risk factors. To combat these issues large scale vaccination and booster doses remains promising option.

Knowledge of clinicians/pediatricians about neonatal resuscitation in a tertiary care hospital.

OBJECTIVE: To analyze the knowledge of the doctors dealing with pediatric patients about neonatal resuscitation. METHODS: This was a cross sectional study conducted at The Lahore General Hospital over one year. Total 137 doctors related to pediatrics with different job descriptions were enrolled and requested to fill a questionnaire proforma regarding their knowledge about basic equipment required and about neonatal resuscitation steps. Data was entered and analyzed using SPSS 20. RESULTS: Out of 137 participants, majority (71%) had >2 years of experience in pediatrics and 52.5% had higher postgraduate qualification. Neonatal resuscitation workshop was attended by 57% doctors. In resuscitation of newborns at the time of delivery, resuscitating doctors were assisted by nurse in 50%, by junior doctor in 35%, paramedic staff 11% and it was done by single doctor in 4% cases. Oxygen (central or O2 cylinder) and warmer facilities were available in 90% and 82% of health facilities respectively. Majority (86%) of participants were of view that every neonate must be attended at birth. Not a single doctor followed all the standard steps of neonatal resuscitation although 90% had knowledge about resuscitation equipment and common resuscitation drugs. CONCLUSION: Pediatric health care professionals had knowledge about neonatal resuscitation but there are gaps in the practical application. There is a strong need of frequent neonatal resuscitation workshops for improving neonatal outcomes.

Shprintzen-Goldberg Syndrome: A Rare Disorder.

The Shprintzen-Goldberg syndrome (SGS) or velo-cardio-facial syndrome (VCFS) is an extremely rare disorder of connective tissue with a characteristic facial dysmorphism, marfanoid features, craniosynostosis, dolichocephaly, cardiovascular anomalies and mild to moderate mental retardation. It may be a de novo gene mutation or inherited as an autosomal dominant disorder having SKI gene and Fibrillin-1 gene (FBN1) mutations, located on chromosome 15q21.1. We report a case of a 3-month, developmentally delayed male infant admitted to the hospital with syndromic facies, craniosynostosis, joint laxity and on echocardiography, aortic root dilatation. A probable diagnosis of SGS was made on the clinical grounds. We did not have the facility for genetic chromosomal analysis. He was discharged with family counselling and follow-up for future developmental rehabilitation.

Comparison of Weight-for-Height Z-score and Mid-Upper Arm Circumference to Diagnose Moderate and Severe Acute Malnutrition in children aged 6-59 months.

OBJECTIVE: To compare weight for height (WHZ) and mid upper arm circumference (MUAC) to diagnose malnutrition in children aged 6-59 months and to determine the association of various risk factors with the nutritional status of the children. METHODS: Descriptive study conducted at the Department of Paediatric Medicine of The Children's Hospital Lahore from May 2017 to April 2018. A total of 257 children 6 to 59 months of age having MUAC of <125mm were included. WHZ scoring was done and compared with MUAC. RESULTS: There was slight male predominance 135 (52.5%). Mean age of children was 13.43 + 8.81 months (95% CI: 12.34-14.51). Mean MUAC was 103±13.5 mm (95%CI: 101-105mm). Exclusive breast feeding was present in 82 (32%). Maternal illiteracy was common in SAM (p = was 0.001). More children (73.2%) were identified as SAM by MUAC of <115 mm as compared to WHZ of <-3SD (70%). The ROC curve analysis for MUAC (cut-off value:103, 95%CI; AUC: 101-107 mm) showed it as an excellent predictor (p=<0.001) for children having SAM and WHZ <-3SD, with (AUC= 0.786 [95%CI; 0.725-0.848]). CONCLUSION: Both MUAC and WHZ showed fair degree of agreement to diagnose moderate and severe acute malnutrition among children aged 6-59 months. At the community level of resource limited countries, MUAC can be used as an appropriate rapid diagnostic method to identify malnourished children to be managed in nutritional rehabilitation programs.

Burnout among pediatric residents and junior consultants working at a tertiary care hospital.

OBJECTIVE: To determine the burnout among postgraduate residents' and junior consultants in a tertiary care hospital. METHODS: This cross-sectional study was conducted among the postgraduate residents (PGR) and junior consultants (JC) working at The Children's Hospital Lahore in 2018. Participants were asked to complete Copenhagen Burnout Inventory questionnaire about burnout on 5 point Likert scale. '100 (always), 75 (often), 50 (sometimes), 25 (seldom) and 0 (never/almost never or according to intensity ranging from 'a very low degree' to 'to a very high degree'. Data was analyzed using SPSS version 22. Three questions were added related to hospital factors but scored separately. Students t-test and chi square test were used to compare the burnout. RESULTS: A total of 227 participants including 177 PGR and 50 JC completed the questionnaire with a response rate of 84% and 86% respectively. There was a female predominance, 140 participants (61.7%) were female. Majority was from pediatric medicine 173 (76.2%). The mean personal and work related-burnout was high among PGRs as compared to JCs (18.68±5.01vs 16.62±4.57) (p=0.008) and (21.14±5.57 vs. 18.56±5.52) (p=0.004) respectively. Similarly, there was significantly more burnout among pediatric medicine study participants as compared to surgery and diagnostic in all domains (personal BO; p=0.030, work-related BO; p=0.021, patient related BO; 0.033 and hospital related BO; 0.001). No difference were noted based on gender and year of training. CONCLUSION: Tertiary care hospital postgraduate residents and junior consultants face moderate burnout. Postgraduate residents had significantly more burnout as compared to junior consultants and majority was from pediatric medicine.

Frequency of risk factors, vaccination status and outcome of tetanus in children at the Children's Hospital Lahore.

OBJECTIVE: To determine the frequency of risk factors, vaccination status and outcome of tetanus in children beyond neonatal age at a tertiary care centre. METHODS: The prospective observational study was conducted at The Children's Hospital, Lahore, Pakistan, from January 2012 to December 2014, and comprised children aged between 1 month and 15 years of either gender admitted with diagnosis of tetanus. Variables recorded included age, gender, vaccination status in terms of number of diphtheria, tetanus and pertussis vaccine doses received per routine infant immunisation and booster doses of tetanus toxoid, risk factors as trauma, ear discharge, ear prick and duration of hospitalisation and outcome. Data was analysed using SPSS 16. RESULTS: Of the 74 patients, there were 47(63.5%) males and 27(36.5%) females. Overall, the mean age was 6.56+3.15 years 50(67%) were unvaccinated, none (0%) had received booster dose and posttrauma immune prophylaxis. Besides, trauma was the most common risk factor in 33(44.6%) cases followed by ear discharge 15 (20.3%) and ear/nose prick 2(2.7%), while the risk factor was unknown in 24(32.4%) cases. Mean duration of hospitalisation was 14.35±11.65. Mortality rate 16(21.6%) was significantly associated with shorter duration of stay (p<0.001). Mortality was high among unvaccinated children compared to vaccinated children (p=0.01). CONCLUSIONS: Vaccination coverage was found to be inadequate and post-trauma immune prophylaxis had been ignored..

Is human milk feeding protective for Retinopathy of Prematurity?

OBJECTIVE: To find the association between breast milk feeding with retinopathy of prematurity (ROP) in preterm infants. METHODS: This was a cross sectional study to examine the effects of breast milk feeding on ROP. Premature newborns below 34 weeks from neonatal unit retinopathy of prematurity program during the years 2015 to 2017 of The Lahore General Hospital were included. We recorded the gestational age, birth weight, presence of ROP and the type of feeding (breastfeeding vs. formula milk). RESULTS: Out of 428 preterm babies 210 (49%) were males. More babies were between 32-34 weeks of gestation 229 (53.5%) as compared to < 32 weeks 199 (46.5%). Among all 428 preterm infants 19(4.4%) developed ROP. Majority 13 (68.4%) who developed ROP were <32 weeks of gestation (p=0.042). The mean birth weight of infants without ROP was 1.51± 0.36 kg (95%CI; 1.47-1.55), while it was 1.36 ± 0.29 kg (95%CI; 1.22-1.50) with ROP and all who developed ROP were < 2kg. The estimated odds ratio of developing ROP for breast fed versus top feeding was (ORs: 0.571, 95% CI; 0.222- 1.489). There was a trend toward lower incidence of ROP in the group of newborns who received breast-feeding (36.8%) as compared to top feeding (63.2%) but almost similar percentage who didn't develop ROP were breast fed or top fed with statistically insignificant results (p= 0.24). CONCLUSIONS: Slightly lesser percentage of preterm babies who were breast fed developed retinopathy of prematurity.