Editorial

ABSTRACT

Objective: To determine the frequency of Acute Kidney Injury in perinatal asphyxia.
Study Design: Cross–sectional study
Place and Duration of Study: The Neonatal Intensive Care Unit, Pediatrics Department, Combined Military Hospital, Multan; from 26th August 2017 To 25th February 2018.
Material and Methods: Total 120 patients were included with suspected birth asphyxia. Serum Lactate was sent within 30 min of birth. Blood samples were collected from the neonates at 24 hours of life and sent for serum creatinine analysis to ascertain acute kidney injury in these neonates.
Results: There were 56.7% male and 43.3% female neonates. Mean gestational age was 38.05 ± 1.22 weeks. Mean 5 minutes APGAR score was 4.64 ± 1.32. Mean serum lactate and serum creatinine were 5.15 ± 0.63 mmol/L and 128.03 ± 6.17 µmol/L respectively. Fetal distress on CTG was found in 47.5% cases while delayed cry was observed in 56.7% neonates. Most common grade of HIE was grade II in 57.55% neonates. Of these 120 patients, 13.3% neonates were found to have acute kidney injury.
Conclusion: Current study demonstrates 13.3% AKI among patients with perinatal asphyxia. Gender, gestational age, and mode of delivery were found to have significant association with AKI.
Key Words: Acute kidney injury, Frequency, Neonates, Perinatal asphyxia

ABSTRACT
Objective: To determine the association of prolonged duration of latency after premature rupture of membranes (PROM) and adverse neonatal outcomes.
Study Design : Cross sectional study
Place and Duration of Study: Karachi Adventis Hospital, 3 months
Material and Methods: A total of 155 full-term neonates born after 18 hours of premature rupture of membrane were selected. Neonates were divided into two groups of 18-24 hours and >24 hours based on duration of latency. After delivery gender, birth weight, heart rate, respiratory rate, APGAR score at 5th minute, need for resuscitation and umbilical cord compression, NICU admission or death were noted. Blood samples were sent to laboratory. Multivariate logistic regression analysis was done to find out the association between duration of latency after PROM and adverse outcomes. Odd ratio was calculated. P value <0.05 was considered as statistically significant.
Result: The mean duration of latency was 29.7 + 10.69 hours. Duration of latency was 18-24 hours in 80(51.6%). 86 (55.5%) were male. Multivariate logistic regression analysis showed that risk of APGAR score <7 at 5th minute was 1.9 times, sepsis 3.4 times, hypoglycemia 6.1 times, need for resuscitation 7.1 times, NICU admissions 2.08 times and mortality was 4.1 times higher in neonates born following latency >24 hours.
Conclusion: It can be concluded that prolonged latency duration of > 24 hours after PROM is associated with a considerable increase in adverse neonatal outcomes like decreased APGAR score, sepsis, hypoglycemia, NICU admission, need for resuscitation, and mortality.
Key Words: PROM, Latency, Neonatal outcomes

ABSTRACT
Objective: To compare the frequency of survival in very, moderate and late preterm neonates.
Study Design: It was a descriptive study.
Place and Duration of Study: Neonatology Department, The Children’s Hospital & Institute of Child Health, Lahore over a period of six months from March 2017 to September 2017.
Material and Methods: One hundred and fifty preterm neonates fulfilling the selection criteria were enrolled. Very, moderate and late preterm neonates were recorded. The neonates were followed to record survival during hospital stay.
Results: The mean age at the time of presentation of neonates was 2.00 ± 1.72 days. There were 103 (68.7%) males and 47 (31.3%) female neonates. There were 35 (23.3%) early preterm, 45 (30%) moderate preterm and 70 (46.7%) born late preterm, while mean birth weight of preterm neonates was 1955.07 ± 593.94 grams. Among early preterm neonates, 14 (40%) survived while 21 (60%) died. Among moderate preterm neonates, 26 (57.8%) survived while 19 (42.2%) died. Among late preterm neonates, 51 (72.9%) survived while 19 (27.1%) died. The difference was significant (p<0.05).
Conclusion: Prematurity is a significant problem worldwide. The survival pattern varies from country to country according to the facilities available. The percentage of survival improves with increase in birth weight and increasing gestational age.
Key Words: Preterm, Mortality, Survival, Gestational age, Neonates

ABSTRACT

Objective: The aim of this study was to assess the impact of care education on the anxiety of mothers of children with leukemia.
Study Design: This is a clinical trial study.
Place and Duration of Study: This study was conducted among 70 mothers of children with leukemia admitted to a pediatric hospital affiliated to Yazd University of Medical Sciences, Yazd/Iran over a period of 8 weeks.
Material and Methods: Participants were selected using stratified random sampling method. The control and the study group both included 35 mothers. The study group was given classes and educational material. Depression Anxiety and Stress Scales (DASS) was used to evaluate mothers' levels of anxiety.
Results: The study findings showed that before intervention, the mean score of anxiety among mothers in control and intervention groups were 16.6 8 ±10.5 and 13.2 ± 8.34 respectively (p= 0.129). But after educational intervention, the mean score of anxiety in intervention group (4.22 ± 3.68) was less than control group (13.2 ± 8.66) and there was a significant statistical difference between two groups (p<0.001).
Conclusions: According to present study findings, we recommended that for control of anxiety among mothers in children with laukemia were used an educational based care approach in nursing care plan. This educational approach can include booklet, lecture and question-answer classroom.
Key Words: Anxiety, Childhood cancer, Care education

ABSTRACT

Objective: To compare the efficacy of levetiracetam (LEV) versus sodium valproate (VPA) in pediatric patients with status epilepticus (SE)
Study Design: Randomized controlled trial
Place and Duration of Study: Study was conducted in the department of Pediatrics, Jinnah Hospital, Lahore. Its duration was six months from January 2021 to June 2021.
Material and Methods: Total of 144 patients who fulfilled the inclusion criterion were divided into two groups. In group A, sodium Valproate (VPA) while in group B, Levetiracetum (LEV) was given intravenously. The efficacy was noted after 24 hours. All the data were entered and processed by using SPSSv 25.0. Data were stratified for age, gender and weight to deal with effect modifiers. Post-stratification, Chi-square test was used. A p-value ≤ 0.05 was considered significant.
Results: 144 patients were divided in two groups A and B. In group A (VPA), 51 (70.8) were males and 21 (29%) females, while in group B, there were 53 (73.6%) males and 19 (26.4%) females. The mean age of patients in group A was 8.3 + 3.6 year and in group B was 8.1 + 3.7 year. According to efficacy, 34 (47.2%) has efficacy with (VPA) and 49 (68.1%) with LEV with a p value 0.011 which in statistically significant.
Conclusion: Levetiracetam can be used as a safe and effective antiepileptic in the treatment of children suffering from status epilepticus.
Key Words: Sodium valproate, Levetiracetam, Status epilepticus.

ABSTRACT

Objective: This study aimed to evaluate the frequency of celiac disease (CD) among children who presented to a private tertiary care hospital with recurrent abdominal pain.
Study Design: Retrospective, cross sectional study.
Place and Duration of Study: Department of pediatrics, Dr. Suleman Al-Habib Medical Center Riyadh, KSA between the period of 2015 to 2018.
Material and Methods: Confirmed celiac disease cases according to the ESPGHAN criteria were enrolled in this study and reviewed for recurrent abdominal pain. The patient’s demographic data, clinical characteristics, medical treatments received, and investigations were recorded and analyzed.
Results: A total of 267 children with recurrent abdominal pain were seen over the 4-year period. Sixteen (5.9%) children met the criteria for CD on serological analyses and 14 patients were confirmed on small bowel biopsies. The mean (SD) age was 8.25 ± 2.2 years (range: 3–18 years). The group comprised more girls than boys with a ratio of 1.8:1. All of the children’s primary complaints were recurrent abdominal pain of variable durations that fulfilled the Rome IV criteria. Using the modified Marsh criteria, 12 patients had grade 3c and two patients had grade 3b celiac disease.
Conclusions: Celiac disease was not an uncommon diagnosis among the children who presented with recurrent abdominal pain in this study. CD should be included with other organic causes of recurrent abdominal pain in differential diagnoses.
Key Words: Celiac disease, Recurrent abdominal pain, Children, Modified marsh criteria.

ABSTRACT

Objective: The objective of the study was to assess the pattern of accidental poisoning in children at Ziauddin Emergency.
Study Design: Retrospective cohort study.
Place and Duration of Study: This study was carried out in the Emergency Department of Ziauddin Hospital, Nazimabad. between March 1, 2020 and February 28, 2021.
Material and Methods: After getting exemption from ethical review committee, retrospective review of medical records of all children who presented with accidental poisoning in emergency department from March 1, 2020 and February 28, 2021 was done. Demographic variables, etiological agents (type of poison) and time between ingestion and arrival at hospital in children were recorded. The data was obtained in predesign questionnaire.
Results: There were a total 41 children presenting in the emergency department with the mean age of 5.18 ± 4.32 years. Most of the children were of 1-2 year of age. Kerosene oil (26.9%) was the leading cause of poisoning followed by pharmaceutical products (24.4%), rat poison (17.1%), Dettol liquid (4.9%) and all the remaining toxic substances constitute 2.4 %.
Conclusion: Kerosene oil continues to be the most common found toxic substance in children followed by pharmaceutical drugs. Further studies are needed to identify risk factors of poisoning in children. Use of safety containers for household cleaners/chemicals and child-resistant packaging of pharmaceutical products indeed is a need of time along with government initiated educational programs for guardians for better prevention.
Key Words: Accidental poisoning, Childhood poisoning, Pediatric emergency.

ABSTRACT

Objective: To estimate the prevalence of undiagnosed Otitis Media with Effusion (OME) in children aged 6 months to 59 months admitted in pediatric medical wards.
Study Design: Observational cross-sectional study
Place and Duration of Study: The study was conducted in Pediatric Medicine wards at The Children’s Hospital, Lahore from August 2020 to May 2021
Material and Methods: 319 patients selected through non-probability consecutive sampling and fulfilling the inclusion and exclusion criteria were assessed for signs of OME by otoscopy. The collected data was analyzed and stratified into gender, age and reason of admission. Frequency and percentages were used to estimate the prevalence of undiagnosed OME while chi-square test was used to analyze the effect of variables on its frequency.
Results: The mean age of cases was 30.12 ± 15.09 months with 182 (57.05%) males and 137 (42.95%) females. A total of 39 (12.2%) patients had undiagnosed OME. There was no significant difference when stratified for gender and age (p-values of 0.546 and 0.276 respectively). In patients admitted with lower respiratory diseases, OME was seen in 20 (24.69%) cases which was significantly higher than the cases with other diagnoses on admission (p-value of 0.002)
Conclusion: Significant percentage of children admitted in pediatric units have undiagnosed OME. Prevalence of OME is higher in patients with lower respiratory disorders.
Key Words: Otitis media, Otitis Media with effusion, Otoscopy

ABSTRACT

Objective: The study was done to assess the Knowledge, Attitudes and Practices (KAP) about Airborne Communicable Diseases among parents of pediatric patients in teaching hospital.
Study Design: This study was descriptive and cross-sectional.
Place and Duration of Study: This study was conducted over one year from 1st June 2018 to 31st May 2019 at Pediatric Department of Ayub Medical Teaching Institute, Abbottabad.
Material and Methods: Parents of children (n=305) of either sex over one month age presenting with airborne communicable diseases like chicken pox, measles, mumps, pertussis and meningococcemia were included. Patient sex, age, weight, height, history of contact, schooling, vaccination status, parent’s education status and attitude documented on proforma. Data analyzed with SPSS 20 and results taken significant with chi-square p value < 0.05.
Results: A total of 305 patients were enrolled in the study comprising, 187 (61.3%) males and 118 (38.7) females. Of these, 51.1% was school going children. Parents in 17.7% cases were aware of the disease transmission route. There is significant relationship between contact history with siblings and disease in-patient with p value of 0.001. There is also significant relationship between parent’s knowledge and disease in children with p value of 0.004.
Conclusion: Lack of knowledge in parents regarding mode of disease transmission is the major reason for airborne diseases spread utilizing the hospital resources and burden on health system. There should be public campaign to give awareness to parents about airborne diseases spread.
Key Words: Communicable airborne diseases, Children, Knowledge

ABSTRACT
Objective: To assess correlation between knowledge assessment and ability to perform Heimlich maneuver in infants.
Study Design: Cross-sectional study design.
Place and Duration of Study: Study was conducted in OPD of CMH, Rawalpindi and PIMS, Islamabad for six months’ time, from 16 -06-2019 to 25 -01-2020.
Material and Methods: This study was conducted after informed consent and comprised of questionnaire to in-coming patients and general medical professionals of hospitals, then performance ability of those individuals was scored who knew how to perform. Random sampling was done.
Results: 47.2% of participants were aware of the lifesaving maneuver in infants, out of the total. 43.1% responded for a red signal to perform it while 23.6% were not sure to perform. Among 33.3% who agreed to demonstrate it, 14.8% were scored 1= skilled, while 11.2% were given a score of 3=unsatisfactory.
Conclusion: Although majority of our participants were not aware of Heimlich maneuver in infants, one third candidates from our sample size, knew the difference in technique and demonstrated it correctly. Among the performing candidates, majority were health related professionals thus we have recommended different strategies to educate general population regarding this very important lifesaving procedure.
Key Words: Heimlich maneuver, Infants, Adults, Performance

ABSTRACT

Objectives: This study intended to look at how people were receiving information on COVID-19, how children spent time during the COVID-19 pandemic and if the screen time for children had increased during the pandemic.
Study Design: The study was descriptive in nature and a quantitative
Place and Duration of the Study: Data was collected from parents visiting OPDs in four hospitals of Lahore, Peshawar and Karachi in three months from July to September 2020.
Material and Methods: Quantitative survey design was used, data (N=923) were collected using self-administered scale and checklist.
Results: Most of the information about COVID-19 was received either through TV (50.8%) or through online social media (33.6%). Most children were spending their time either playing (32.2%) or watching cartoons/movies (19.6%). Screen time of children in the lockdown period was increased. 87.4% children used screens for at least 2 hours per day during the lock down whereas 69.1% used screen for more than 2 hours before COVID-19. Most often used devices were mobile/tablet/PC in 64.2% whereas TV was viewed 34.9% of the time.
Conclusion: Most COVID-19 related information was gathered online, and a large proportion of children spent their time in front of screens. There is a need to understand the serious implications of increased screen time for children and to develop effective strategies to reduce screen time of the children.
Key Words: Screen time, Children activities, COVID-19 lockdown in Pakistan

ABSTRACT

Objective: The current study intends to look at how COVID-19 pandemic affected parenting practices during COVID-19 in Pakistan and if the children were exposed to more abuse and neglect at home.
Study Design: A quantitative design survey.
Place and Duration of the Study: Data was collected from parents visiting outpatient departments (OPDs) in four hospitals of Lahore, Peshawar, and Karachi in three months from July to September 2020.
Material and Methods: A quantitative design survey was used, and data (N=923) were collected using a self-administered COVID-19 Parenting Response Scale (α = 0.74).
Results: The primary responsibility of taking care of children rested with mothers in most of the cases. Ratio of severe disciplinary practices like shouting, yelling, cursing, and slapping children was increased significantly during the lock down as the anger and frustration in the parents also mounted. This effect was more pronounced in families from lower socioeconomic groups as well as for those who suffered income loss during COVID-19.
Conclusion: Financial and emotional stress caused by COVID-19 exacerbated the already difficult parenting practices. Ultimately children suffered more violence at the hands of parents. In Pakistani society there is little awareness on building one’s capacity on good parenting and little availability of such trainings. There is a need to understand implications for good parenting and create awareness of positive parenting methods.
Key Words: COVID-19, Children, Child abuse, Parenting practices, Child maltreatment

ABSTRACT

Objective: To determine the perceptions of medical students towards online learning during COVID 19
Study Design: Cross sectional online survey
Place and Duration of Study: The Department of Pediatrics, Post Graduate Medical Institute/Ameer-ud-Din Medical College, Lahore General Hospital, Lahore, Punjab, Pakistan from November 2020 to March 2021.
Materials and Methods: Undergraduate medical students of fourth and final year MBBS were included in the study after approval from Institutional Review Board. They had to answer a questionnaire sent to them as Google Forms TM. Responses from 171 students were received and analyzed using SPSS version 24.
Results: Among 171 students, 56 (32.7%) were male and 115 (67.3%) were female. Smart phone (56.7%) was the most common gadget used for online learning. Ability to stay home (69%) was the most frequent advantage recorded followed by access to online materials (68.4%),. while lack of patient interaction was the most common disadvantage (73.7%) followed by technical problems with IT equipment (52.6%). Online learning was considered to be less effective than traditional learning in terms of ability to increase knowledge, clinical skills and social competences. Students were less active during online classes as compared to traditional face to face teaching and majority (66%) rated online learning as unenjoyable.
Conclusion: Undergraduate medical students rated online learning less effective and less enjoyable than traditional learning. Necessary measures should be taken to improve quality of online learning of undergraduate medical students during COVID 19 pandemic.
Keywords: Perceptions, medical students, online learning, COVID 19

ABSTRACT
Objective: To assess diarrhea knowledge and prevention practices along with its associated factors like hand washing, water treatment, and breastfeeding among mothers of children less than five years of age in the community of Murree, District Rawalpindi.
Study Design: It was a community-based descriptive cross-sectional study.
Place and Duration of Study: The study was conducted in Murree during June and July 2019.
Material and Methods: The mothers with one child below five years of age with complaints of vomiting and diarrhea in the past three months were included. A structured and pretested questionnaire was used to collect data from104 participants after their informed consent. SPSS version 20 was used for data cleaning and analysis.
Results: According to mothers 94 (90%) children had at least one episode of diarrhea during the last 3 months. A significant proportion of mothers 46 (44%) either reduced or completely stopped breastfeeding during the episode of diarrhea. Most of the mothers 73 (70%) were not aware of serious complications of diarrhea. Only 45 (43.3%) mothers could explain the correct method of preparing ORS.
Conclusion: The findings showed that diarrhea prevention practices among under-five children mothers were low. There is a dire need for health education of mothers about diarrhea, its causes, prevention, and proper treatment all around Pakistan. 70% of mothers were unaware of the serious complications of diarrhea.
Key Words: Diarrhea, Health education, Knowledge, Prevention practices, Hygiene

ABSTRACT

Objective: Aim of this study earmark the role of hand arm bimanual intensive therapy (HABIT) in enhancing manual activities of upper extremity in adolescents with athetoid CP.
Study Design: A quasi-experimental study
Place and Duration of Study: The study was conducted at Dimensions institute over duration of 6 months.
Material and Methods: 42 Athetoid CP children have participated in the study with age range 13-18 years. Severity in impairments of manual abilities and motor functions were assessed through manual ability classification system (MAC) and gross motor functional classification system (GMFCS) and patient at GMFCS level III and MAC level III were included in the study.
Duration of therapy was 90hours for 12 weeks. The questionnaire used to access HABIT interventions was ABILHAND-KIDS. Wilcoxon signed rank test was used for the comparison of pre-test and post-test results.
Results: Results showed significant improvement on ABLEHAND-KIDS. Non parametric analysis was used to interpret the data. P value was found to be significant i.e. 0.00. Z value of Wilcoxon signed rank test was -5.689a
Conclusion: HABIT is an effective technique in improving manual activities in upper extremities in adolescents with athetoid cerebral palsy.
Key Words: HABIT, Athetoid cerebral palsy, Manual activities, GMFCS, MAC.

ABSTRACT

It is extremely rare to see splenic infarction as a complication of extensively drug resistant (XDR) enteric fever. We present a case of 8-years-old boy who presented with high grade fever and pain in left hypochondrium for 3 weeks. Blood culture obtained at the time of admission turned out to be positive for XDR Salmonella typhi sensitive only to azithromycin. Ultrasonography and CT-abdomen revealed multiple splenic infarcts. Other possible causes of splenic infarct were ruled out and patient responded to antibiotics with complete resolution of symptoms and infarcts after 14 days of antibiotics. The diagnosis of splenic infarcts should be considered in any child with XDR enteric fever who has associated left upper hypochondrium pain with/without vomiting.
Key words: Enteric fever, Splenic infarcts, Salmonella typhi

ABSTRACT

Soil transmitted helminth infections are among the most common pediatric infections in the developing countries including Pakistan. These worm infestations are usually associated with general growth and cognitive stunting in children, but they can exhibit unique clinical manifestations. Soil transmitted helminth infections are rarely reported in infants. We describe two cases of intestinal helminths' infection presenting uniquely in infancy.
Soil transmitted helminth infections are rarely reported in infants. Spread of helminth infection in exclusively breastfed infant less than 6 months of age, mother could be a potential source via placenta or breast milk.
Key Words: Hook worm, Ascaris, Helminths in infants

ABSTRACT
Congenital lumbar hernia is a rare anomaly characterized by protrusion of abdominal viscera through a defect in lateral abdominal wall. It is found in association with rib and vertebral anomalies. We are presenting a newborn baby born to a diabetic mother having lumbar hernia, vertebral anomalies and preaxial polydactyly. The clinical features predict developmental defect associated with diabetic embryonopathy.
Key Words: Congenital lumbar hernia, Preaxial polydactyly, Diabetes mellitus, Diabetic embryonopathy