Pattern of Paediatric Mortality of hospitalized patients in a Tertiary Care Hospital Rawalpindi

Introduction: Mortality of children is the prime indicator of a country’s health status and its development. Understanding child mortality among different age groups is one of the valuable public health insights. Therefore, studies regarding child mortality patterns are essential for re-evaluating existing health services. Objective: The objective of this study is to describe the pattern of paediatric mortality in our hospital. Materials and Methods: A retrospective analysis was done with the medical records of Pediatric patients (up to 12 years)who died in the Pediatrics department of Benazir Bhutto Hospital, Rawalpindi from 1stJan2018 to 31stDec 2018. Results: A total of 15,500 children were admitted to the Paediatric department from 1st January 2018 to 31st December 2018. A total of 1738 deaths were recorded. The overall mortality of 11.3% was noted in the cases admitted to the Paediatric Department. Conclusion: Septicemia, Acute respiratory infection(ARI)/Pneumonia, Birth asphyxia, and low birth weight (LBW)/prematurity were the major causes of pediatrics mortality

Impact of Comorbidities on the Severity of Disease & Outcome in Children with COVID 19 at a Tertiary Care Pediatric Hospital, Rawalpindi.

Introduction: Coronavirus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was initially identified in Wuhan, China, in December 2019. The virus affects almost all countries of the world. It has infected humans in all age groups, of all ethnicities, both males and females. It is considered that COVID-19, in those with underlying health conditions or co-morbidities, has an increasingly rapid and severe progression, often leading to death. This study is designed to evaluate the impact of co-morbidities on the severity and outcome of COVID-19 infection in children. Methods: This retrospective observational study was conducted at the pediatric department, Benazir Bhutto Hospital Rawalpindi from March 2020 to September 2021. Every confirmed COVID-19 admitted case according to inclusion criteria was enrolled for the study. Data were retrieved from hospital records; data was recorded on a predesigned study questionnaire, entered and analyzed in SPSS version 24 for descriptive statistics and bivariate analysis. Results: 109 children were enrolled with confirmed COVID-19, of these 64(58.7%) were males and 45(41.2%) were females. The age of the patients ranged from infants to 12 years with a mean age of 27.25 months. Comorbidities were present in 70 patients     (64.2%).CHD was the most common co-morbid condition (n=18, 16.5%). Most of the patients experienced mild to moderate symptoms (n=64.2%) while severe symptoms were found in (n=35.8%) patients. 27 patients (24.8%) required Ventilatory support, and of these 20 patients (18.3%) had underlying co-morbidity. The total number of patients who expired was 27(24.7%), and 30.3% of patients who expired had co-morbid conditions. the patients with co-morbid conditions had a longer stay in the hospital. 35 patients (32.1%)with underlying co-morbidity remained admitted for more than a week and 13 patients(9%)for more than two weeks. Conclusion: Pediatric patients with co-morbidities have a higher risk of severe COVID-19 and associated mortality than children without underlying disease. Children with underlying conditions need to be carefully assessed and closely monitored. Further data are required to define these associations and adequate guidelines to manage high-risk children with COVID-19. Keywords: Coronavirus, COVID-19, Pediatrics, Co-morbidity, Severity, Outcom

Complications of Measles in Malnourished Children, a Descriptive Cross-Sectional Study at a Tertiary Care Hospital Rawalpindi

Objective: To determine the frequency of common complications of measles in malnourished children. Materials and Methods: This study was conducted in the Department of Pediatrics Benazir Bhutto Hospital, Rawalpindi from January 2018 to December 2018. Through a Descriptive Cross-Sectional Study Design, a total of 110 cases of measles with malnutrition presenting to the Paediatrics Department were selected and observations were recorded on follow up. Results: The mean age was 2.7 years (SD±1.2) of which 61% (n=67) were male and 39% (n =43) were female patients. 35.5% (n=39) presented with grade I, 24.5% (n=27) in grade II and 40% (n= 44) in grade III malnutrition. On follow up, pneumonia was observed in 39.1%, diarrhea in 36.4%, otitis media in 10% and encephalitis in 8.1% of children. The most frequent complications were observed in grade II and grade III malnourished children and children of younger age groups. Conclusion: Measles and malnutrition are still calamity in our population as once together, the complications of each other are more prevalent and preventive projects must be designed with full efficacy against both these conditions

Correlation of Serum Electrolyte Changes with Severity of Birth Asphyxia in Newborns

Background: To compare the changes in serum electrolytes in asphyxiated newborns of different severity with control group.Methods: In this case control study 150 cases were enrolled and divided into three groups of 50 cases each. Group one included asphyxiated patients with Sarnat stage II, group two included asphyxiated patients with Sarnat stage III and group three included control group with no birth asphyxia. Cases and controls were full term babies weighing 2.5kg or more. Cases included newborns with APGAR score less than 7 at 5 min of birth. Controls included newborns with APGAR score 7 or more at 5 min after the birth. Neonates with congenital anomalies, serum creatinine >1.5mg/dl, suspected metabolic diseases or infants of mothers with hypertension, diabetes mellitus, toxemia of pregnancy, mothers who received general anesthesia or drugs that cause CNS depression in newborn, mothers with history of febrile illness upto two weeks before delivery and mothers with abnormal serum electrolytes status pre and immediately post delivery were not included.Cord Blood samples of all three groups were taken within 5 minutes of birth for estimation of serum electrolyte levels (Na+, Ca++, K+). Mean values of serum electrolytes were compared by ANNOVA test and p < 0.05 was taken as significant.Results: Mean serum sodium levels were found decreased in cases of group I and II as compared to the control group (133.76+4.98 & 132.96+6.01 mEq/L Vs 139.64+2.36 mEq/L respectively p<0.05). Mean serum calcium levels were also found significantly reduced in cases of group I and II as compared to the control group (8.68+0.70 & 8.54+0.92 mg/dl Vs 9.55+0.43 mg/dl respectively p<0.05) while mean serum potassium levels were found higher in group I & II cases versus controls (4.8+0.62 &4.63 +0.35 mEq/L Vs 4.42 +0.41 mEq/L respectively p<0.05).Conclusions: Hyponatremia and hypocalcaemia showed linear correlation with severity of birth asphyxia, while serum potassium levels remained within high normal range

Etiological Spectrum of Pancytopenia / Bicytopenia in Children 2 Months to 12 Years of Age

Background: To determine the etiological spectrum of pancytopenia / bicytopenia in children aged 2 months to 12 years.Methods: In this cross sectional descriptive study patients from 2 months to 12 years of age presenting with different cytopenias were included. Demographic profile and clinical findings were noted. Degree of malnutrition was assessed according to Gomez classification. Blood complete picture and peripheral smear were carried out for every patient having pancytopenia(leucopenia, anaemia and thrombocytopenia) or bicytopenia (if only two parameters from the full blood count are low) were further subjected to bone marrow aspiration and trephine biopsyResults: A total of 105 patients were included in the study..More than half of the patients (61%) were 2 - 60 months of age . Out of these 64 patients, 71% were malnourished (second and third degree malnutrition according to Gomez classification) and it was statistically found to be significant (p value.004) . Fever (82.9%) was the commonest presentation . Inadequate dietary history was present in 51.4%. About half of the patients (56.2%) received blood transfusion before bone marrow examination .Forty eight (36.3 %) patients had features of infection at presentation. Pneumonia was the leading cause of infection. Hepatosplenomegaly was seen in 27.6% and isolated splenomegaly in 4.8%, while 5.7% had generalized lymphadenopathy. Severe anemia (Hemoglobin < 5gm %) was found in 25.7%, leucopenia (TLC < 4000/cmm) in 45.7%, severe thrombocytopenia (platelet count ≤ 20,000/cmm) in 31.4%. Approximately half of the patients (62.9%) had bicytopenia and 37.1% had pancytopenia on blood complete picture . More than one third(41.9%) patients were diagnosed. Megaloblastic anemia on bone marrow examination and it was the leading cause of bicytopenia / pancytopenia in patients aged 13-60 months. Out of 40 patients of this age group 20 had Megaloblastic anemia and 18 out of these 20 patients (90%) were with grade II – III malnutrition (p valve 0.02) .Infective etiology was the cause of bicytopenia / pancytopenia in 19%, aplastic anemia in 13.3% and acute leukemia in 10.5% patients.Conclusion: Megaloblastic anemia was the commonest cause of pancytopenia / bicytopenia followed by infective etiology, aplastic anemia and acute leukemia. Malnutrition was seen in majority of patients with megaloblastic anaemi