Pakistan Pediatric Journal

MALNUTRITION AND ITS DETERMINANTS AMONG 6 TO 59 MONTHS OF CHILDREN VISITING PEDIATRICS OUTPATIENT DEPARTMENT OF A PRIVATE TERIARY CARE HOSPITAL, LAHORE

2024-06-01T06:37:52+00:00

Background:

Malnutrition remains the most significant health issue and main reason of sickness and deaths among children under 5. This study was conducted to determine the frequency of undernutrition among ambulatory children 6-59 months old visiting Pediatrics Outpatient Department of a private hospital and to assess the association of under-nutrition with socio-demographic and feeding practices.

Methods:

A cross-sectional study was carried out in Pediatrics Outpatient Department of a private tertiary care hospital Lahore after approval from Institutional Review Board. A sample of 245 children of required age group was selected using nonprobability purposive sampling technique. The data was recorded from their mothers after taking written consent from them on a pretested structured questionnaire and weight and height of children were measured. Data analysis was done on SPSS Version 21.0. A Chi-square/Fisher test was applied to find out the determinants of malnutrition and p-value of ≤0.05 was taken as significant.

Results:

The frequency of stunting, underweight and wasting among children was 31.43%, 19.2% and 24.90% respectively. Underweight among children is associated statistically with low birth weight, family size and parental decision making for health seeking (p- values=0.031, 0.045 and 0.05) respectively. Whereas there is statistically significant association of stunting with education of the mother (p-value=0.038) and wasting had shown significant relationship with age and exclusive breast feeding (p-value=0.05 and0.042) respectively.

Conclusion:

There is high frequency of undernutrition among children between 6−59 months and there is significant association of undernutrition with birthweight, family size, education of mother, age of child and breast feeding.

Neonatal Hearing Screening using Transient Evoked Otoacoustic Emissions in Gulab Devi Teaching Hospital

2025-03-12T06:24:12+00:00

Objective:

The aim of the study is to find out the frequency of hearing loss by Universal Neonatal hearing screening program.

Methodology:

An analytical cross–sectional study was performed on the sample size of 712 neonates. Non-probability sampling technique were used in this study. Data was collected from newborn nursery of Pediatric Department of Gulab Devi Teaching Hospital from February 2023 to December 2023. All healthy neonates discharged from Hospital were included in this study. Neonates with any medical conditions were excluded. The SPSS version 23.0 package was used for statistical analysis. Frequencies and percentage were used to report qualitative variables such as age, gender and results of hearing screening.

Results:

Total Sample size of was 712, out of which 381 (53.5%) were male and 331 (46.5%) were female. Both ears of 501(70.4%) neonates were pass and 211(29.6%) were referred. Out of referred ears 182 (25.6%) were due to noise. The ears of 590(82.9%) subjects were tested after 24 hours and ears of 122 (17.1%) were tested within 24 hours. Only 34(4.8%) patients visited after 4 weeks for follow-up, out of which 24(3.3%) passed hearing screening and 10(1.4%) were referred

Conclusion:

Our study shows High “pass” percentage and low ‘referral’ percentage for universal newborn hearing screening as well as in follow-up cases. A large number of neonates were “referred” due to noisy test environment and on whom tests were performed before 24 hours of age as there could be possibility of physiological changes and debris in the ear canal etc.

Keywords:

Hearing impairment, TEOAE’s, Neonatal screening.

Sense of Competence, Religious Coping and Post-Traumatic Growth in mothers of children with Cerebral Palsy

2024-11-20T06:38:25+00:00

Objectives: The present study aimed to determine relationship of parenting sense of competence and religious coping with post-traumatic growth in mothers of children with cerebral palsy (CP) after controlling for covariates.

Method: Cross-sectional research design was used. Sample consisted of 74 mothers, aged 20-45 years, whose children were diagnosed with CP with age range from 2 to 9 years, was collected through purposive sampling from different physiotherapy centers and special education schools, Lahore. Parenting sense of competence scale, brief RCOPE and post-traumatic growth inventory were used to measure sense of competence, religious coping and post traumatic growth respectively.

Results: Hierarchical multiple regression showed that mother’s education(p<.01) positively predicted appreciation of life. Monthly income(p<.05) negatively predicted post traumatic growth and its subscales (spiritual change and appreciation of life). Religious inclination(p<.001) positively predicted spiritual change. Results also revealed that skills subscale of parenting sense of competence(p<.05) positively predicted personal strength. Moreover, positive religious coping(p<.001) positively predicted post-traumatic growth(p<.001) and its subscales [relating to others(p<.05), personal strength(p<.01), spiritual change(p<.001) and appreciation of life(p<.001)] after controlling covariates. However, negative religious coping negatively predicted personal strength(p<.01) after controlling covariates.

Conclusion: Literate mothers who had high religious inclination and perceived themselves as effective parents experienced more growth, as an outcome of dealing with their child’s special needs. Moreover, mothers who employed positive religious coping strategies to cope with challenges posed by disability of their child reported more post-traumatic growth and mothers who reported use of negative religious coping strategies reported less post traumatic growth.

Progression of Myopia among youngsters due to increase screen time during COVID-19

2025-01-15T07:51:28+00:00

OBJECTIVE: To determine the progression of myopia due to increase screen time during Covid 19.

STUDY SESIGN: It was a Comparative cross sectional study

PLACE & DURATION OF STUDY:The study was conducted in the ophthalmology department of a tertiary care hospital from December 2019 till June 2022.

METHODOLOGY:There were 202 patients. Myopic patients with a spherical equivalent ≤ -0.5D were included.A detailed history regarding daily screen time, type of smart digital device and time spent in outdoor activities before and during Covid 19 was recorded. Previous myopic corrections and present correction were recorded. Magnitude of myopic progression was calculated from the difference between the two records and graded.

RESULTS:

A total number of patients in this study were 202, with 117 (57.9%) males. Mean age was 13.97±4.19 SD years. Students were 179 (88.6). More than one gadget was used by 156 (77.2%) patients with mean follow up of 12.41±4.02 SD months. Mean pre covid myopia in right eye was 2.75±2.02 D and left eye was 2.83±2.14 D. Mean myopia during covid in right eye was 3.36±2.12 D and left eye was 3.45±2.26 D with a p value<0.001. Majority of the patients had mild progression of myopia in right eye i.e. 134(66.3%) and left eye in 132 (65.3%) patients.

CONCLUSION: The progression of myopia is related to an increase in screen time among youngsters during covid 19. There was mild myopia progression in most of the patients. Progression was more marked in female gender as compared to males and more marked in students as compared to employed.

THE ROLE OF BODY TEMPERATURE ON RESPORATORUY RATE IN CHILDREN WITH ACUTE RESPIRATORY INFECTIONS

2024-09-26T08:12:53+00:00

Background: Acute Respiratory Infections (ARIs) are among the most common illnesses in children and are a leading cause of morbidity and mortality worldwide. Understanding the physiological responses, changes in respiratory rate and body temperature, is crucial for effective management and treatment of these infections.

Method: It is a cross sectional study conducted at CMH Lahore from May 2023 till May 2024. After screening, 214 patients were included in this study. Body temperature and respiratory rate were recorded upon presentation, then every 6 hours for 24 hours. Data was entered and analyzed using SPSS 24. It was presented as mean, standard deviation, and percentages. P-values of ≤0.05 will be considered statistically significant.

Result: The study included a total of 214 children with acute respiratory infections, with an average age of 22.6 ± 17.9 months. Among the participants, 60.28% (129) were male and 39.72% (85) were female. At the time of presentation, body temperature was 37.5± 1.8°C and respiratory rate was 38.7±11.5 breaths per minute (bpm). Six hours later, the body temperature slightly decreased to 37.1± 1.1°C, with a decrease in the respiratory rate to 36.3± 10.2 bpm. By the 12-hour mark, the body temperature had increased to 37.9± 1.9°C, and the respiratory rate raised to 39.1± 9.5 bpm. Finally, at 24 hours, the body temperature was 36.5± 0.6°C, and the respiratory rate further decreased to 27.1 ± 6.2 bpm.

Conclusion: This study highlights the significant role of body temperature in influencing respiratory rate among children with acute respiratory infections

Key words: body temperature, respiratory rates, acute respiratory infections

Clinical Spectrum of Childhood Tuberculosis

2024-12-31T08:09:53+00:00

Abstract:

Tuberculosis is one of the most infectious and common disease in children in Pakistan. So, it is mandatory to control this killer disease which is possible only by early recognition of symptoms and signs. This study aimed to determine clinical spectrum and identification of risk factors. A cross-sectional study was conducted at Children Hospital Faisalabad in Paediatric Medicine Department in children under 15 years from March 2023 to February 2024. A total of 102 patients were enrolled in this study group. Most of the patients were females 53 (51.95%) and male patients were 49 (48.03%). Out of them 53 children were diagnosed as having pulmonary tuberculosis and 49 were with extra pulmonary tuberculosis. Among extra pulmonary tuberculosis, tuberculous meningitis was found commonest that is 26 (25.49%) patients then comes abdominal tuberculosis 13 (12.74%) patients. Patients with disseminated tuberculosis were 9 (8.82%). Among disseminated miliary pattern was found in 3 (2.94%) patients. Only one female (0.98%) patient who was admitted with suspicion of lymphoma was found having tuberculous lymphadenitis. Highest proportion of patients were found between 1 to 5 years that is 59 (57.8%) patients then between 5-10 years 24 (23.5%) patients then between 10 to 15 years 19 (18.6%) patients. Highest proportion of families of study subjects belonged to lower socio-economic class that is 53%, 47% belonged to middle class and only 2% is found to upper class. Contact was positive only in 30% and household contact was present in 22%. Ninety-two patients were Immunized according to history but BCG scar was present only in 49 patients. Ninety-four (92.15%) patients were taking un-pasteurized milk. Severe malnutrition was found in 57 (85%) patients.

Keywords: -

Pediatric pulmonary tuberculosis, extra pulmonary tuberculosis, clinical spectrum.

Maternal and Neonatal Factors Associated with Neonatal Hyperbilirubinemia at a Tertiary Care Neonatal Unit

2024-11-21T10:00:32+00:00

Introduction: Neonatal jaundice is a prevalent condition affecting neonates globally, with significant incidence. If the serum bilirubin level in a jaundiced baby increases above the normal range for that age and gestation, it is referred to as hyperbilirubinemia. Pakistan has limited data on maternal and neonatal factors associated with hyperbilirubinemia.

Objective: To identify maternal and neonatal factors associated with hyperbilirubinemia among neonates admitted to a tertiary care hospital in Lahore.

Study design: Cross-sectional observational study

Place and duration of study: Neonatal Unit, Mayo Hospital, Lahore, over six months (December 2022- June 2023)

Materials and methods: This study was conducted on 183 neonates with hyperbilirubinemia using non-probability consecutive sampling. Data on maternal and neonatal factors were collected through medical records, clinical examinations, and interviews with mothers.

Results: Neonates with gestational age from 28 to 42 weeks and birth weights from 800 g to 4200 g were included. Key neonatal factors contributing to hyperbilirubinemia included bruises (12%), neonatal sepsis (70.5%), birth asphyxia (34.4%), UTI (4.4%), infant of diabetic mother (7.1%), polycythemia (1.1%), cephalhematoma (16.4%), and jaundice in siblings (24.6%). A significant association was found between hyperbilirubinemia and age at admission (p=0.000), birthweight (p=0.034), age at onset of jaundice (p<0.000), resuscitation (p=0.002), mode of feeding (p=0.002), and constipation (p=0.006). No significant association was found with the studied maternal factors.

Conclusion: Neonatal hyperbilirubinemia was found to be associated with age at admission, birthweight, age at onset of jaundice, resuscitation need, mode of feeding, and constipation. No significant association was found with the studied maternal factors.

Keywords: Neonatal hyperbilirubinemia, neonatal jaundice, maternal risk factors, neonatal risk factors.

Battle of the Blood: Thrombocytopenia in children with Vivax Malaria

2025-01-28T10:03:55+00:00

Abstract:

Objective:

The study aimed to determine the incidence about thrombocytopenia in children plasmodium vivax malaria.

Methods:

After the approval from institution review board, this descriptive cross-sectional study was conducted at Department of Pediatrics, Combined military hospital Bahawalpur, 01 January 2024 to 31 may 2024. A sum of 132 children were recruited in this research. At first, those who had symptoms of sudden onset of high-grade fever without any other symptoms were selected. All the patients were gone through a detailed history and clinical examination. Patients who fulfilled the study's inclusion and exclusion criteria were considered for participation, Samples of 5 CC of blood were obtained from people who were thought to have malaria and were immediately sent to the hospital laboratory, for blood tests thick and thin smear microscopy. The peripheral smear was used to test for thrombocytopenia in patients with vivax malaria.

Result:

The male gender patients were 131, female were 90 out of which 155 and 58 males and females respectively were having thrombocytopenia 72 patients of age group 2-5 were having thrombocytopenia. The p value was less than 0.05.

Conclusion: Our study concludes that the frequency of thrombocytopenia was ... % in children presenting with in plasmodium vivax malaria.

Keywords:

pediatric, thrombocytopenia, children, plasmodium, vivax malaria, kids

Clinico-epidemiological profile of children presenting with febrile illness

2025-02-04T07:02:03+00:00

Abstract

Objective: To identify the clinico-epidemiologic characteristics, bacteriological profile, and antimicrobial susceptibility patterns in children presenting with febrile illnesses in a tertiary care setting. Materials and Methods: A descriptive cross-sectional study was conducted in the Department of Pediatrics, Services Hospital Lahore, from September 2024 to December 2024. A total of 180 children aged 1 month to 12 years with fever (≥38°C for >72 hours) were included using non-probability consecutive sampling. Blood cultures were processed for pathogen identification and antimicrobial susceptibility. Demographic data, host risk factors, hygiene practices, and clinical outcomes were analyzed using SPSS v.21. Results: The mean age was 3.08 ± 3.58 years, and 53% of participants were male. Vaccination was complete in 57%, incomplete in 36%, and absent in 7%. Malnutrition (24%) was the leading comorbidity. Enteric fever was the most common diagnosis (33%), with Salmonella Typhi as the predominant pathogen. Blood culture positivity was 34%, with S. Typhi (52%) and Pseudomonas aeruginosa (12%) being the most frequent isolates. Resistance to commonly used antibiotics, including ceftriaxone and ciprofloxacin, was noted. S. Typhi showed high sensitivity to meropenem (93%). Conclusion: Febrile illnesses in children, predominantly caused by multidrug-resistant pathogens, emphasize the need for targeted empiric therapy and strengthened vaccination programs. Improved hygiene practices, early diagnosis, and rational antibiotic use are essential for better outcomes and combating antimicrobial resistance.
Keywords: Febrile illness, Salmonella Typhi, antimicrobial resistance, pediatric sepsis, blood culture.

dr IFRAH NASR

2025-01-15T07:21:35+00:00

Jeunes syndrome is an autosomal recessive disease in which there is narrow rib cage and short limbs. Majority of babies (almost 70%) suffering from the disease die in neonatal life or early infancy due to pulmonary hypoplasia and respiratory distress. Those who survive through respiratory failure suffers from chronic renal failure and growth retardation. Here in our institute a 2-year-old male baby was brought with history of recurrent respiratory infections and diagnosed as Jeunes syndrome clinically and radiologically. Child was given oxygen support and symptomatic treatment and discharged to home after 5 days.

ADENOSINE KINASE DEFICIENCY

2024-11-05T09:37:04+00:00

Adenosine kinase deficiency is an autosomal recessive disorder of methionine metabolism which results in elevated methionine levels and liver damage. Effected child has dysmorphic features and is developmentally delayed due to central nervous system involvement. Repeated jaundice and URTIs are commonly reported symptoms.

The disease needs to be confirmed through genetic analysis and diagnosed cases can be offered methionine free diet as the only known treatment option which does not result in complete recovery; however, it can sometimes improve liver functions and overall standard of living.

A case of 8-year-old Pakistani girl is reported with characteristic features of ADK deficiency, she is developmentally delayed, has tall stature, DDH, muscular hypotonia, epilepsy and hepatic dysfunction along with some rare features not commonly found in other reported cases.

This report would help the clinicians decide when the testing for ADK deficiency is required, and how an early diagnosis can control the worsening of symptoms and prolong life expectancy.

DIFFICULT AIRWAY MANAGEMENT IN PEDIATRIC ANESTHESIA: INSIGHTS FROM A MUCOPOLYSACCHARIDOSIS CASE.

2024-10-22T18:01:31+00:00

This case report describes the challenging airway management of a 11-year-old boy with Mucopolysaccharidosis Type II (MPS II) who presented for cervical laminectomy. The combined use of Dexmedetomidine and low-concentration sevoflurane effectively in managed a difficult airway in this case. Definitive airway management was achieved through LMA-assisted fiber optic intubation providing a safe alternative for handling challenging airway situations in pediatric anesthesia

Long-term neurodevelopmental outcome of preterm infants discharged from a tertiary care NICU in Pakistan

2024-12-21T06:37:55+00:00

Introduction

Long-term neurodevelopmental outcomes in preterm neonates in low- and middle- income nations are poorly understood. The objective of the present research was to record the long-term outcomes of infants who were born preterm and required neonatal intensive care from one tertiary care neonatal intensive care unit in Pakistan.