Short-Term Outcome of Mechanical Ventilation in Neonates.

Mechanical ventilation of newborn has been practiced for several years with several advances made in the way. As compared to the Western world and our neighbouring countries, neonatal ventilation in our country is still in its infancy. Objectives: To analyze the common indications and outcome of neonates requiring mechanical ventilation. Methods: This was a prospective observational study conducted on neonates requiring mechanical ventilation within first 24 hours of birth over a period of nine months. Results: Birth asphyxia was the commonest indication for ventilation (59.67%) followed by asphyxia with meconium aspiration syndrome (MAS) (17.74%), hyaline membrane disease (HMD) (8.06%), MAS (6.45%) and intrauterine pneumonia (6.45%). Out of 62 babies, 22 (35.48%) survived. Babies with asphyxia had highest survival rate (51.35%). Neonates with HMD did not survive. Term babies and babies weighing ≥2500g had higher survival rate of 40.47% and 41.46% respectively, while babies less than 32 weeks had survival rate of 16.66% only. Conclusions: Mechanical ventilation reduces the neonatal mortality; hence, facilities for neonatal ventilation should be included in the regional and central hospitals providing level II neonatal care.

Fetal Hydantoin Syndrome: A Case Report.

A term baby born to an epileptic mother who was treated with Phenytoin until 10weeks of pregnancy was born with multiple congenital anomalies and diagnosed to have Fetal Hydantoin Syndrome. Infants of mothers who have taken hydantoin during pregnancy have been found to have broad multisystem patterns of abnormalities, including mental retardation, craniofacial anomalies, nail and digital hypoplasia and prenatal onset of growth deficiency. The discussion aims to bring to attention the potential hazard of the use of hydantoin drug during reproductive age to all medical practitioners.

A 14-year-old boy with Isolated Tuberculous Orchitis.

The genitourinary tract is the most common extrapulmonary site affected by tuberculosis1. The male genital organs are involved in more than 50% of patients2. The epididymis is the commonest structure to be involved, followed by the seminal vesicles, prostate, testis, and the vas deferens3. An isolated tuberculous orchitis without epididymal involvement is rare. This case report describes extra pulmonary tuberculosis with exclusively testicular presentation. The confirmatory diagnosis of which was made by FNAC of the testis. It provides a successful diagnosis, thereby preventing unnecessary orchidectomy.

Kangaroo Mother Care for Low Birth Weight Babies: A prospective Observational Study.

Introduction: Kangaroo Mother Care is the low cost, humane technique for caring low birth weight babies by direct skin to contact with the mother. Objective: The Prospective observational study was done to see the effect of KMC especially on weight gain on low birth weight babies weighing 2000 grams or less at Special Care Baby Unit of Paropakar Maternity and Women’s hospital, Kathmandu. Method: The study was conducted in Special Care Baby Unit (SCBU) of Paropakar Maternity and Women’s Hospital over 7 months period May 2007 to Nov. 2008 (from Baishakh 2064 to Kartik 2065). The method of care consisted of skin to skin contact between the mother and the infant. Result: It was observed that babies had good weight gain of average 30gms/day and had short duration of hospital stay of average 9 days. Babies had less morbidities like hypothermia, apnea, skin infections and oral thrush.100% babies had exclusive breast feeding and KMC was acceptable to mothers. Conclusion: Kangaroo Mother Care shows early and good weight gain in low birth weight babies. It is simple, low cost technique and well acceptable by mother and family and can be continued at home.

Langerhans Cell Histiocytosis - A Case Report.

Histiocytosis is a heterogenous group of disorders that are characterized by proliferation and activation of mononuclear phagocyte system. Langerhans Cell Histiocytosis (LCH) or Class I histiocytosis is a rare disorder of unknown etiology with proliferation of Langerhan cells which may infiltrate a single or multiple organs. This disease is more common in infants and children. It is usually sporadic but a familial pattern is known. The term embraces the whole clinical spectrum of the disorder from single bone lesions (eosinophilic granuloma) to an aggressive widespread multisystem disease in very sick child (Letterer-Siwe disease) with a wide variety of intermediate forms including the Hand-shuller Christian triad. The cause of LCH is not firmly established and most investigators in the field have long suspected that LCH is immunologic disorder either in its etiology or in its pathophysiology1,2. Recent evidence suggests that LCH is a clonal disorder rather than reactive disease3. LCH is classified according to sites of involvement into single system disease and multisystem disease4. Single system disease can be either unifocal or multifocal. Multisystem disease can be either without organ dysfunction or with organ dysfunction. Clinical course of LCH with single system disease is usually benign with high chance of survival5,6. However, its clinical course is often unpredictable and patients can experience spontaneous remission and exacerbations. Histiocytic diseases are currently classified by the writing group of the Histiocyte Society7 in the three classes, namely; Class I: Langerhans Cell Histiocytosis (LCH) Class II: Histiocytosis of mononuclear phagocytes other than Langerhans Cells Class III: Malignant Histiocytic disorders

Intussusception- A Case Report.

Intussusception, the invagination of a portion of the intestine into itself, is one of the emergencies in infancy and childhood. The etiology may be idiopathic or secondary to some pathology within the wall of the bowel. Most cases (90%) are idiopathic1,2 with no identifiable lesion acting as the lead point or pathological apex3 of the intussusceptum Children may present at any age but this occurs most commonly in the first year. The mode of presentation may vary depending upon the time of presentation. A case of intussusception confirmed with the help of an abdominal ultrasound in 10 month old infant who presented with only persistent vomiting but in the absence of classic features is reported with brief review of literature.

An Overview of Neonatal Admissions at College of Medical Sciences (COMS).

Objective: To know the profile of newborn admissions and its outcome and the factors associated with neonatal mortality. Methods: The study included both intramural and extramural cases of 180 newborn babies admitted in nursery over a period of 6 months from 01/08/06 to 31/01/07. The relevant data were recorded on a pre-designed proforma meticulously. Results: There were 180 newborn babies during the study period. The mean birth was 2.7 kg.. Majority, 77.8 %( 140) of the babies weighed equal to or more than 2.5 kg. Low birth weight (LBW) was seen in 22.2 %( 40) babies. There were 80 %( 144) full term babies and 20 %( 36) preterm babies. Majority of the mothers in the age group between 20-30 years had incomplete antenatal check- ups. There were 86 %( 155) normal vaginal deliveries, 4.5 %( 8) forceps deliveries and 9.5 %( 17) caesarean sections. Birth/perinatal asphyxia 39(22%), prematurity 36(20%) and neonatal septicemia 30(17%) comprised of leading admissions. There were 27deaths (15%) in total.13 (7%), 8(5%) and 6(3%) babies died of severe perinatal asphyxia, neonatal septicemia and prematurity respectively. Most of the deaths occurred during the first 72 hours. Conclusions: The mean birth weight is good. The major causes of neonatal death are birth/perinatal asphyxia, prematurity and neonatal septicemia. The factors influencing neonatal mortality are low and poor antenatal care, meconium stained liquor, delay in coming to the hospital, PROM, eclampsia. The study emphasises the importance of regular antenatal care, timely referral of pregnant women with complications to appropriate centers and conducting delivery in a clean environment for lowering neonatal mortality.