Risk of neonatal hyperbilirubinemia in babies born to 'O' positive mothers: a prospective cohort study.

INTRODUCTION: Hyperbilirubinemia in a neonate is one of the most common problems that may occur in 60-70 % of term and 80% of preterm babies. It is known to be associated with significant morbidity like neonatal bilirubin encephalopathy and even death. Clinically, and almost exclusively ABO incompatibility occur in 'A' and 'B' blood group babies of O '+ve' mothers. These babies are reported to be at high risk of severe hyperbilirubinemia (serum bilirubin level more than 16 mg/dl). OBJECTIVES: To find out the incidence of hyperbilirubinemia in babies born to 'O' positive mothers. To estimate the risk of ABO incompatibility in babies born to 'O' positive mothers. MATERIAL AND METHODS: A prospective cohort study conducted in B. P. Koirala institute of Health Science (Department of Pediatrics and Dept. of Gynae and Obstetric) from July 2002 to June 2003. A total of 199 women having 'O' positive blood group admitted to the Department of Gynae and Obstetric were included in the study. A piloted proforma was used to collect information. The blood group of neonates was tested by tile and slide method and serum bilirubin was estimated by diazo method in the Central Laboratory Services and Emergency laboratory of BPKIHS. The data was observed and analysis was carried out using statistical software SPSS-10. RESULTS: Total 37 (18.5%) babies had developed hyperbilirubinemia and among them 14 (38%) were from group of babies having 'O' Positive blood group and 23 (62%) were from group of babies having other than 'O' Positive blood group. There was 2.6 times higher chance of having hyperbilirubinemia in the babies with ABO incompatibility than 'O' Positive babies after adjusting other significant variables. CONCLUSION: Among different significantly associated variables, ABO incompatibility was found to be a major risk factor for neonatal hyperbilirubinemia.It was seen that neonate with ABO incompatibility had two times higher chances of having hyperbilirubinemia than those babies with O '+ve' blood group. This finding in BPKIHS suggests that there is a need of screening cord blood bilirubin and continuous monitoring of bilirubin level in the hospital especially among ABO incompatible neonates.

Profile of renal diseases in Nepalese children.

AIM AND OBJECTIVES: To find out the profile of renal diseases in children hospitalized in the pediatric department of the tertiary care university teaching hospital in Eastern Nepal. MATERIALS AND METHODS: A retrospective chart review of all the patients admitted at the department of pediatric from April 2002 to March 2007 was carried out for the presence of any renal diseases on the basis of their clinical presentation, laboratory findings and final diagnosis. RESULTS: A total number of 10,396 children were admitted during the study period out of which 651 (6.3%) children had renal disease. Among them, nephrotic syndrome seen in 222 patients (34.1%) was the commonest renal disease, followed by post streptococcal nephritis in 187(28.7%) and hemolytic uremic syndrome 66(10.1%), other renal diseases seen were acute renal failure in 25 (3.9%), lupus nephritis 24 (3.7%), urinary tract infection in 23 (3.5%) Henoch-Schönlein Purpura (HSP) nephritis 26 (4%), chronic renal failure in 27 (4.2%) and other miscellaneous causes 51 (7.8%). CONCLUSION: A substantial number of children are hospitalised with renal diseases, and current trends indicate that majority of them are preventable. In near future, there is a need to develop a comprehensive service for the children with kidney diseases in Nepal.

Incidence of congenital heart disease in tertiary care hospital.

AIMS AND OBJECTIVES: The present study was under taken to determine the spectrum, clinical profile and outcome of patients with congenital heart disease (CHD) admitted to a tertiary care hospital. MATERIALS AND METHODS: This is a retrospective, observational hospital based study conducted during January 2006 to December 2006. Out of 14461 admissions, 84 were cases of CHD. Only patients with echocardiographic proof of CHD were included in the study. Detailed clinical and laboratory findings and outcome of all cases were noted in pre-structured formats. Data were entered in MS-excel. Data was analyzed by software SPSS version 10. RESULTS: The incidence of CHD was 5.8 per 1000 hospitalized patients. Out of 84 CHD cases, 51 were males and 33 females; with a male to female ratio of 1.5:1. CHD presented more frequently during infancy (46 %). Acyanotic heart disease was detected in 58 (69 %) cases while cyanotic heart disease was detected in 26 (31%) cases. Among acyanotic heart disease, ventricular septal defect (VSD) was found in 49 (58.3%), atrial septal defect (ASD) in 4 patients (4.8%), endocardial cushion defect (ECD) in 2 patients (2.4%) and dextrocardia was found in 3 patients (3.6%). Among cyanotic heart disease, Tetralogy of Fallot (TOF) accounted for 13.1%, total anomalous pulmonary venous connection (TAPVC) 3.6%, transposition of great arteries (TGA) with VSD 1.2% and unspecified cases of heart disease was found in 13.1%. VSD and TOF were the most common lesions while other CHD like ASD, dextrocardia, TAPVC, ECD, TGA with VSD were encountered less frequently. The most common clinical presentations were failure to thrive (FTT) and developmental delay (86.9%), breathlessness (69%), lower respiratory tract infection (LRTI) (52%), congestive cardiac failure (CCF) (46%), cyanosis (20.2%), cyanotic spell (9.5%) and infective endocarditis (9.5%). The mortality rate was 20 %. CONCLUSION: The incidence of CHD was 5.8 per thousand hospitalized children. VSD, TOF were the most common congenital cardiac lesion. VSD was observed either isolated or associated with other lesions like TGA. The mortality rate was 20 %. The mortality usually occurred in those patients complicated with congestive cardiac failure, lower respiratory tract infection and infective endocarditis.

Retinopathy of prematurity in a tertiary care hospital in eastern Nepal.

World Health Organization's Vision 2020 program has recognized Retinopathy of Prematurity (ROP) as an important cause of childhood blindness in industrialized and developing countries. In the last few years, it has been identified in many under developed countries as well, as a result of improved neonatal intensive care. In Nepal, ROP screening is carried out in a few tertiary hospitals but there is no published data on this disease. The purpose of this study was to find out the incidence, severity and risk factors of ROP among infants screened in a tertiary care hospital in the Eastern Region of Nepal. A prospective cohort study was carried out in neonates with gestational age of 34 weeks or less and, or birth weight of 1700 gm or less born over the period of one year. Dilated fundus examination of all babies was done by indirect ophthalmoscopy between 2-4 weeks after birth and followed up till the retinal vascularization was complete. Classification of ROP was done according to international classification (ICROP). Maternal and neonatal risk factors were also noted. A total of 55 babies fulfilled the screening criteria. ROP was present in 25.45% (n=14) of the babies. Threshold disease was noted in 5.45% (n=3) of the babies screened. Low birth weight (p<0.01) and low gestational age (p<0.01) was significantly associated with the incidence of ROP. Oxygen supplementation (p=<0.01) was an independent risk factor. ROP screening should be performed in all preterm low birth weight infants where there is availability of good neonatal intensive care units. The examination should be intensified in those having risk factors like oxygen. Further studies in the other tertiary care hospitals in Nepal would help to establish the screening criteria for Nepalese infants.