Background: Pediatric Intensive Care Units (PICUs) are essential for the management of critically ill children. This study aimed to analyze the admission patterns and clinical outcomes of children admitted to the PICU at B.P. Koirala Institute of Health Sciences (BPKIHS), a tertiary care center in eastern Nepal. Methods: A descriptive cross-sectional study was conducted over one year (January–December 2024) among 200 children aged 1 month to 15 years admitted to the PICU. Data on demographics, diagnosis, interventions, and outcomes were collected and analyzed using SPSS version 11.5. Logistic regression was used to identify factors associated with poor outcomes. Results: The majority of patients were male (69%) and infants under one year of age (36%). Respiratory illnesses, particularly severe community-acquired pneumonia, were the most common causes of admission (57.5%). Most admissions (76%) were through the emergency department. Mechanical ventilation was required in 24.5% of cases, and 19.5% developed shock. Overall, 84% of patients had good outcomes, while 16% had poor outcomes, including a mortality rate of 5.5%. Multivariate analysis identified illness duration of less than 7 days prior to admission (AOR = 9.06; 95% CI: 1.67–49.04) and the need for mechanical ventilation (AOR = 28.89; 95% CI: 4.92–169.85) as significant predictors of poor outcome. Conclusion: Most children admitted to the PICU had favorable outcomes. However, the need for mechanical ventilation and shorter duration of illness before admission were associated with poorer prognosis. Early referral and timely intervention remain critical to improving outcomes.
Introduction: Helping Babies Breathe (HBB) is a simulation-based education program developed to reduce neonatal deaths by teaching skills to care for healthy newborns and babies who do not breathe at birth. The American Academy of Pediatrics (AAP) and World Health Organization (WHO) updated the HBB course to align with current WHO recommendations and guidelines, and renamed it Essential Newborn Care 1 (ENC 1). The inability to teach the course in-person during the COVID-19 pandemic motivated the development of an online platform for ENC 1. The purpose of this study is to determine whether these two teaching methods result in comparable learning outcomes in a teaching hospital setting in Nepal. Methods: Among 48 participants, 26 (54.2%) took in-person training and 22 (45.8%) took online training at Scheer Memorial Adventist Hospital (SMAH) and College of Nursing, Banepa, Kavre, Nepal. The participants’ knowledge and skills were evaluated before and after the training using a multiple-choice questionnaire, bag-mask ventilation skills test, and two objective structured clinical evaluations (OSCEs). Results: There was no significant difference between the in-person (N=26) and online (N=22) training participants’ knowledge on pretest (t = -1.085; df = 46; P > 0.05); knowledge on posttest (t = 1.025; df = 46; P > 0.05); OSCE A on posttest (t = .496; df = 46; P > 0.05); or OSCE B on posttest (t = 1.314; df = 46; P > 0.05). Conclusion: The results of the study indicate that the online ENC 1 training is equally as effective as in-person training for acquisition of knowledge and skills.
Extra-uterine growth retardation (EUGR) or postnatal growth failure (PGF) can be sought as an outcome indicator of postnatal growth of very or extremely low birth weight preterm neonates. Commonly, it is defined as weight below 10th percentile at the time of hospital discharge, although this cross-sectional definition has some inaccuracy. A longitudinal definition based on fall in weight percentile over a certain time period is more appropriate. Moreover, other growth parameters (length, head circumference and body composition) should also be considered. EUGR has been found to have a close correlation with neurodevelopmental outcome. Many researchers observed its association with poor cognitive function as well as poor mental and psychomotor developmental indices. Also, association has been established with retinopathy of prematurity and future risk of cardio-metabolic diseases. Sub-optimal dietary intake and increased energy expenditure secondary to morbidities linked with prematurity are the most common causative factors for growth faltering in these children. Regular growth monitoring, provision of optimal nutritional support and prompt identification and treatment of morbidities can lead to better growth during postnatal and infancy period. Here, we enlighten the importance of an appropriate definition and associated factors of EUGR, parameters of growth assessment, long term consequences of this condition as well as strategies to optimize nutrition in such children.
Tuberculous meningitis with intraparenchymal tuberculomas represents a rare but serious form of neurotuberculosis. We describe a 14‑year‑old adolescent who presented with isolated abducens nerve palsy, papilledema, and recurrent headaches. Conventional tests were inconclusive, and lumbar puncture was deferred due to raised intracranial pressure. Neuroimaging revealed diffuse cerebral edema, basal leptomeningeal enhancement, and ring‑enhancing lesions, while chest X‑ray showed miliary infiltrates, confirming the diagnosis. Treatment with mannitol, corticosteroids, and anti‑tuberculosis therapy was initiated. This case highlights diagnostic challenges and underscores the critical role of imaging and timely intervention in preventing complications.
Despite reduced neonatal mortality in developing countries, intact survival—ensuring healthy development—remains a challenge in rural areas. Late preterm infants face higher risks of neurological issues, often undetected due to limited follow-up. Affordable tools like milestone checklists and trained community health workers can enable early detection and cost-effective interventions, promoting equitable outcomes.
Autism spectrum disorder (ASD) is a global neurodevelopmental condition yet diagnosis, care and treatment remain highly unequal. Around 95% of people with ASD live in low and middle income countries. Digital health tools like screening apps, caregiver education platforms and telehealth programs have improved early detection and service delivery in many high income settings. But most tools require english literacy with smartphones and a steady internet. This makes them hard to use in low resource settings.Nepal shows these gaps clearly. There are few validated Nepali language diagnostic tools. Specialist services are limited. Many frontline and community health workers receive little training in neurodevelopmental disorders. This leads to delayed recognition and delayed diagnosis compared with high income contexts. A more context responsive approach is needed. Digital autism tools should be redesigned for low literacy and low resource environments. Key priorities include language and cultural adaptation, simple interfaces and multimedia coaching for caregivers. Partnership with community health systems is also essential including female community health volunteers. Evidence from Nepal based community programs suggests that early identification can be feasible and cost effective when tools are adapted to local realities. Equity focused and locally grounded digital autism care can reduce diagnostic delays, strengthen caregiver capacity and support more inclusive neurodevelopmental services across low and middle income countries.
Introduction : Despite neonatal sepsis being a major contributor of mortality and morbidity, its diagnosis continues to be challenging due to unreliable biomarkers. CRP to albumin ratio (CAR) outperforms CRP or albumin alone in predicting the presence and severity of neonatal sepsis. While CAR has been studied extensively in adults none have specifically focused on early onset sepsis (EOS). EOS has a distinct pathophysiology and etiology which may influence biomarker performance. Hence a separate study is required to assess the diagnostic utility of CAR in EOSand determine optimal cut off values. Methods : This is a case control study over 6 months. 162 neonates were enrolled and divided into sepsis group and control group. Demographical details, clinical data and lab investigations were recorded. ROC curves were plotted to determine the diagnostic performance and optimal cut off value of CAR. Results : CAR demonstrated excellent discriminative ability with an AUC of 84.4% for sepsis and 90.8% for severe sepsis. At a cut-off of ≥ 1.532, CAR showed 100% sensitivity and negative predictive value (NPV), 80.2% specificity and 83.5% positive predictive value (PPV) for predicting sepsis. When the cut-off value was set as ≥ 4.24 for severe sepsis, the sensitivity and NPV were 100%, PPV was 78.43% and specificity was 72.5%. Logistic regression analysis identified CAR as a significant independent predictor of sepsis and severe sepsis,with an odds ratio (OR) of 1.183 (95% CI: 1.05-1.32; p=0.003). Conclusion: CAR is a rapid and accessible biomarker for EOS especially in low to middle income countries.
Introduction: The goal of the PICU is to treat and closely monitor sick patients who are at the risk of mortality. Several scoring systems are used to assess the severity of morbidity and predict the risk of mortality. The present study aimed to compare the predictive value of ACR with PIM-3 score, in regards to the mortality. Methods: This is a hospital based observational study conducted from August 2023 to August 2024. The study enrolled 100 patients aged one month to 14 years with systemic inflammatory response syndrome. Urinary ACR was estimated on admission, and PIM-3 score was calculated within one hour of admission. The predictive value of urine ACR was compared with PIM-3 score, in regard to mortality. Results: Microalbuminuria was found in 69% of patients with a median ACR of 121.5 mg / g and median PIM-3 score of 2.7. The area under the ROC curve for ACR (0.849) was comparable to that of PIM-3 (0.978). The cut off value of ACR derived to predict mortality was 176 mg / g and that of PIM3 Score > 6.4. PIM-3 Score has higher sensitivity and specificity while ACR had higher PPV. Both showed statistically significant comparision in regards to predicting mortality. Conclusions: The study concludes that urine ACR and PIM3 score are comparable in predicting the mortality in critically ill children.
Introduction: Afebrile seizures occur most commonly in children less than 3 years of age with decreasing frequency in older children. The etiology of these afebrile seizures varies widely. Calcium estimation is usually ordered in these children. We aimed to study clinical characteristics and hypocalcemia in children aged 1 month to 2 years presenting with afebrile seizures. Methods: Clinical characteristics of children aged 1 month to 2 years presenting with afebrile seizures were collected. Venous blood of one mL was collected and sent immediately for estimation of serum calcium. Hypocalcaemia was defined as total serum calcium <8.8 mg/dL or ionized calcium <1.1 mg/dL. Results: A total of 58 children with afebrile seizures were studied. The most common type of seizure was generalized onset (62%) and focal onset comprised 38%. Developmental delay, consanguinity, family history of seizures, and perinatal asphyxia were found to be associated factors in children with afebrile seizures. Six (10.3%) children had hypocalcemia. Two children with hypocalcemia were exclusively breast, four were on mixed feeding and four had normal development. All these six children were born at term gestation. All six children had clinical signs of vitamin D deficiency. Two children had severe Vitamin D deficiency, elevated alkaline phosphatase and high serum parathormone. Conclusions: Generalized seizures predominate among afebrile seizures in children less than two years of age. Hypocalcaemia contributes to about 10% of afebrile seizures in young children. Whether vitamin D supplementation prevents this type of seizure needs to be studied further.
Introduction: Neonates, more often preterm and sick babies undergo various painful procedures when admitted at neonatal units. Despite evidence-based guidelines for the neonatal pain management, implementation is poor. This may lead to short-term effects like cardiovascular instability, sleep disturbance along with long-term developmental, neurobehavioral issues. This quality improvement project is planned to improve pain control interventions from baseline to 75% at level II special newborn care unit (SNCU) of Dhading hospital in 6 months from 1st of Asoj to 30th of Falgun with special focus on infant and family centered developmental care. Methods: QI team was formulated and problem was analyzed using fish bone diagram. IFCDC principle was emphasized. Specific non-pharmacological pain control measures was identified and implemented. Multiple Plan-Do-Study-Act (PDSA) cycles were conducted to achieve the desired result. Result: A total of 138 babies were admitted in 6 months during which 345 painful procedures were performed. Neonatal pain interventions increased from 26.3% during pre -intervention period to 70.5% in 6 months. Mouth pain (136, 59.92%) was the most commonly performed pain measure. Conclusion: Neonatal pain management is often overlooked. QI project can be an effective tool in improving neonatal pain interventions in a neonatal care unit.
Introduction: Neonates, more often preterm and sick babies undergo various painful procedures when admitted at neonatal units. Despite evidence-based guidelines for the neonatal pain management, implementation is poor. This may lead to short-term effects like cardiovascular instability, sleep disturbance along with long-term developmental, neurobehavioral issues. This quality improvement project was planned to improve pain control interventions from baseline to 75% at level II special newborn care unit (SNCU) of Dhading Hospital in six months duration with special focus on infant and family centered developmental care. Methods: QI team was formulated and problem was analyzed using fish bone diagram. IFCDC principle was emphasized. Specific non-pharmacological pain control measures were identified and implemented. Multiple Plan-DoStudy-Act (PDSA) cycles were conducted to achieve the desired results. Results: A total of 138 babies were admitted in six months during which 345 painful procedures were performed. Neonatal pain interventions increased from 26.3% during pre - intervention period to 70.5% in six months. Mouth pain (136, 59.92%) was the most commonly performed pain measure. Conclusions: Neonatal pain management is often overlooked. QI project can be an effective tool in improving neonatal pain interventions in a neonatal care unit.
Introduction: Congenital hypothyroidism (CH) is an important preventable cause of intellectual disability. Cord blood thyroid-stimulating hormone (TSH) measurement is widely used for neonatal screening, but local reference values are lacking in rural parts of Nepal. Establishing normative TSH range is essential for accurate diagnosis and timely intervention. Method: A retrospective cross-sectional study was conducted on 378 neonates delivered at Sindhuli District Hospital. Data on cord blood TSH, birth weight, gestational age and sex were extracted from medical records. TSH values were non-normally distributed; normative range was defined using 2.5th–97.5th percentiles. Correlations between TSH, birth weight, and gestational age were analyzed using Spearman’s rho, Kendall’s tau-b, Mann-Whitney U, and Kruskal-Wallis tests. Result: The study included 191 males (50.5%) and 187 females (49.5%). Median birth weight was 3016.5 g (IQR: 2770–3350), with 4% low birth weight. Median cord blood TSH was 9.66 mIU/L (IQR: 6.99–14.22), with a normative range of 2.68–37.74 mIU/L. TSH showed no significant correlation with birth weight (Spearman’s rho -0.054, p=0.296) or gestational age (p=0.388). Median TSH was slightly higher in low birth weight and post-term neonates, but differences were not statistically significant. Conclusion: This study provides the first normative cord blood TSH reference values for a rural Nepali neonatal population. These data are essential for improving early CH screening and management in rural healthcare settings, despite the absence of significant associations with birth weight or gestational age.
Introduction: Neonatal Sepsis, a leading cause of morbidity and mortality among newborns, is a clinical syndrome with or without accompanying bacteremia in the first month of life. This study aimed to determine the risk factors of neonatal sepsis among neonates admitted to a tertiary hospital. Methods: A hospital-based matched case-control study design was used. The consecutive sampling technique was used to collect a total sample of 124 neonates (62 cases and 62 controls) in a ratio of 1:1. Ethical clearance was obtained from the ethical review committee, Institute of Medicine, 54 (6-11) E2, 080/081. Data was collected from 17th Sept to 14th Oct 2023, by in-person interview using a semi-structured questionnaire. Data were analyzed under SPSS 16 using descriptive and inferential statistics. Results: Findings of the study revealed that, maternal age below 20 years, educational status below secondary level, labor pain duration > 6 hours, prolong rupture of membrane, intrapartum fever, gestational age below 37 weeks, birth weight < 2500 grams, breastfeeding initiation after 1 hour of birth, pre-lacteal feeding were significantly associated with the risk of sepsis after univariate analysis. After multivariate analysis, only Maternal age below 20 years (AOR= 7.142; 95% CI: 1.481-34.482) and intrapartum fever (AOR= 7.650; 95% CI: 1.370-42.713) were found to be predictors of neonatal sepsis. Conclusions: Maternal and neonatal characteristics were significantly associated with the risk of neonatal sepsis, which highlights the need for special attention during preconception, antenatal, and intrapartum periods with infection prevention strategies and routine assessment of the neonate that helps to prevent neonatal sepsis.
Introduction: Sleep plays a crucial role in infant growth and neurodevelopment. Sleep practices vary across cultures, and data on infant sleep in Nepal, particularly in early infancy, are limited. This study aimed to assess sleep patterns and associated factors in infants below six months using the Brief Infant Sleep Questionnaire-Revised (BISQ-R). Methods: A cross-sectional observational study was conducted among 180 infants aged <6 months attending pediatric outpatient services of a tertiary care centre. Data were collected using the BISQ-R questionnaire (expanded version). Infant Sleep (IS) score, Parental Perception (PP) score, and Parental Behavior (PB) score were obtained. Associations with IS scores were evaluated using independent t-test, one-way ANOVA, and Pearson’s correlation. Results: Co-sleeping was almost universal (98.9%). Most infants (95%) fell asleep while being held or rocked. Mean sleep latency was 23.3 minutes, with median night awakenings of 3 per night. The mean IS score was 47.2, while the mean PP and PB scores were higher (77.5 and 76.6, respectively). IS score showed a weak-to-moderate positive correlation with PP score (r = 0.466, p < 0.001) and PB score (r = 0.296, p < 0.001). Higher IS scores were associated with female gender, absence of play activities and electronic exposure at bedtime, and higher caregiver confidence. Conclusion: Infant sleep patterns in this population are characterized by frequent night awakenings and strong parental involvement. Parental behaviors and perceptions significantly influence infant sleep. These findings support the need for culturally appropriate sleep counseling strategies in early infancy.
Introduction: More than two-thirds of malnutrition-related child deaths are associated with inappropriate feeding practices during the first two years of life. This study has been planned to estimate the indicators of IYCF practices and their associated factors among children aged 6 - 23 months. Methods: This cross-sectional study was conducted among 210 children aged between six and 23 months over a period of one year, using a pre-designed semi-structured questionnaire based on WHO IYCF indicators. The association between sociodemographic factors and feeding practices with IYCF indicators were analysed using bivariate and multivariable logistic regression analysis. Results: Children having minimum diet diversity (MDD) and minimum meal frequency (MMF) were found to be 49% and 93.3% respectively. 49% of children received a minimum acceptable diet (MAD). Children aged 12 months {AOR 1.98 (1.08 – 3.61)} and those with other milk intake apart from breastfeeding {AOR 2.38 (1.28 - 4.43)} were found to have significantly better MAD. Children more than 12 months were four times more likely to consume egg and meat {AOR 4.55 (2.31 - 8.94)}. Children aged more than 12 months {AOR 2.03 (1.07 - 3.82)}) and those belonging to upper socioeconomic status {AOR 1.91 (1.00 - 3.65)} were twice as prone to consume unhealthy food. Conclusions: Although the MMF rate was higher than the national average, the rate of MAD was lower due to a lower MDD rate. Children aged above one year had a higher rate of MAD as well as egg and meat consumption. Children in higher socio-economic status had a higher risk of consumption of sweetened beverages and an unhealthy diet.
This case report highlights a rare and fatal convergence of Prune Belly Syndrome and Cook’s Syndrome in a term male neonate. The patient presented with wrinkled abdominal skin, cryptorchidism, an enlarged bladder, anonychia, brachydactyly, anorectal malformation, and clubfoot. Initial evaluation revealed severe renal dysfunction. Despite early surgical decompression and intensive neonatal care, the infant experienced rapid clinical deterioration. Complications included worsening renal failure, severe electrolyte imbalances, and systemic infection, leading to death from multiorgan failure on day six. This case emphasizes the diagnostic complexity of multisystem congenital anomalies and the critical need for comprehensive prenatal screening.
Mycoplasma pneumonia exhibits symptoms such as high fever, sore throat, nonspecific exanthema, and cough, and is generally diagnosed without difficulty using laboratory examinations. However, the symptoms of mycoplasma pneumonia can be mimicked by group A streptococcal infection. Herein, we report a 6-year-old girl who was initially diagnosed with group A streptococcal infection, but was finally diagnosed with mycoplasma pneumonia using loop-mediated isothermal amplification. Thus, mycoplasma pneumonia can be hidden in group A streptococcus-positive patients. Loop-mediated isothermal amplification may be useful for the correct diagnosis of mycoplasma pneumonia in patients with group A streptococcus positivity.
Introduction : Sufentanil, an opioid analgesic, is an analogue of fentanyl, and has been used for the induction and maintenance of anaesthesia, and for postsurgical analgesia. It has shorter distribution and elimination half-lives, and is a more potent analgesic than fentanyl. Methods :This is a retrospective observational cohort study included patients under 19 years of age admitted to the pediatric intensive care unit (PICU) in a tertiary care children’s hospital between March 2024 and September 2025, in whom sufentanil was used as the first-choice continuous analgosedative drug. Results :In total, 120 patients were included. The most common reason for PICU admission was postoperative care (28.33%), followed by respiratory failure (25.0%), and cardiac problems (20%). The initial median starting and maximum doses of sufentanil were 0.5 μg/kg/hr (interquartile range [IQR], 0.3–1.0). The median durations of sufentanil use, mechanical ventilation support, and PICU stay were 1 days (IQR, 4–12), 6 days (IQR, 1–17) and 9 days (IQR, 5–27), respectively. In 97 (80.83%) patients, an appropriate analgesia/sedation level was achieved with sufentanil alone. However, 22 patients required additional drugs such as midazolam and ketamine infusion after administering the maximum dose of sufentanil, indicating the necessity for supplementary agents. No significant adverse effects or withdrawal symptoms were associated with sufentanil use. Conclusion : Sufentanil may be a promising option for analgesia / sedation in critically ill paediatric patients, as it demonstrated no significant side effects or withdrawal symptoms.
Low birth weight (LBW) remains a major contributor to neonatal morbidity and mortality in South Asia and other developing regions. Infants born with LBW are at increased risk of respiratory distress, sepsis, impaired growth, and long-term neurodevelopmental complications, placing substantial burden on pediatric health services. This study aimed to synthesize evidence from cohort studies conducted in Asia to identify major risk factors for LBW and to explore research trends using bibliometric analysis and systematic review. This review was conducted following PRISMA 2020 guidelines. Cohort studies published between 2014 and 2023 were identified from the Scopus database according to predefined inclusion criteria. Bibliometric mapping was performed using VOSviewer, and content analysis categorized reported risk factors. Thirty-two cohort studies met inclusion criteria. Publication trends increased over the study period, with China and India contributing the largest number of studies. Risk factors were grouped into demographic, maternal, paternal, environmental, and fetal domains. Demographic factors included rainfall, ambient temperature, region type, and access to health facilities, all of which were reported to be significantly associated with LBW. Maternal factors including extremes of age, anemia, inadequate gestational weight gain, hypertension, infections, and poor nutritional status were most consistently associated with LBW. Environmental exposures such as temperature and pollution, and fetal factors such as sex, prematurity and intrauterine growth restriction, were also significant contributors. The findings emphasize the multifactorial etiology of LBW and support early risk identification to improve neonatal outcomes.
Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome is a rare congenital disorder characterized by agenesis of the uterus and cervix. A 16-year-old adolescent girl presented with complaints of the inability to menstruate since birth. Hormone assessment and secondary sexual characteristics were normal. Ultrasonography pelvis revealed non-visualization of the uterus and bilateral ovaries with the presence of mullerian duct remnants. Followed by MRI of the pelvis was done, which revealed a hypoplastic uterus and cervix. Karyotype revealed 46, XX genotype. A diagnosis of Mayer-Rokitansky-Küster-Hauser was made. MRKH syndrome should be suspected if a well-looking adolescent girl does not have menstruation. Magnetic resonance imaging is a preferred investigation for the evaluation of primary amenorrhea in teenage girls for the diagnosis of MRKH syndrome. Clinicians must be aware of this rare congenital disorder, as early diagnosis can significantly reduce infertility and related psychological issues in these patients.
