Frequency of Retinopathy of Prematurity in a Tertiary Care Hospital

Introduction: Retinopathy of prematurity (ROP) is one of a preventable cause of blindness in neonates. Screening of preterm infants for ROP in Pakistan is currently under-recognized. The aim of this study was to determine the frequency of retinopathy of prematurity (ROP) in premature and very low birth weight neonates (birth weight ≤ 1500 g and gestational age ≤ 32 weeks) in a tertiary care hospital, Karachi, Pakistan.Methods: This was a cross-sectional study carried out in the neonatal intensive care unit (NICU) of Civil Hospital Sukkur from 1st June 2014 to 17th June 2015. Preterm neonates with birth weight ≤ 1.5 Kg and gestational age of ≤ 32 weeks were referred for ROP eye examination as an outpatient were included in the study after taking consent from parents. Premature neonates with major congenital malformations, chromosomal anomalies or congenital cataract or tumours of the eyes or those who died before eye examinations or did not attend the out-patient department for eye examination were excluded. Eye examination for ROP was performed on all infants, at 4 to 6 weeks chronological age, by a trained ophthalmologist, having at least 10 years of relevant experience.Results: A total of 86 babies enrolled in the study. Of them, 46 (53.5%) were male and 58 (67.4%) babies were 4 weeks old. ROP was identified in 9 (10.5%) neonates at the first eye examination. ROP was significantly associated with birth weight (p-value 0.031), gestational age (p-value 0.033) and chronological age (p-value\u3c0.001).Conclusion: It was concluded from this study that frequency of ROP was 10.5%. ROP is significantly associated with birth weight, gestational age, and age of the infant

Prevalence and Determinants of Postpartum Depression in a Tertiary Care Hospital

Purpose: Postpartum depression is one of the common complication of postpartum period and a major public health issue. It adversely affects the mother, her child, and the family. To determine the prevalence and determinants of postpartum depression in women delivered in a tertiary hospital Karachi.Methods: This was a cross-sectional study carried out in a private hospital of Karachi, from 1st February 2014 to 31st January 2016. All women having age between 20-49 years between 4-6 weeks postpartum period consented to participate were included. Women with pre-existing co-morbid like diabetes mellitus, hypertension, physical and psychiatric illnesses, having multigestation and had the previous history of perinatal loss were excluded. A pretested research proforma was translated into local (Urdu) language and data on demographic and determinant were collected. PPD was assessed using Edinburgh Post Natal Depression Scale and score of \u3e12 was considered having PPD.Results: A total of 600 patients were enrolled in this study. The mean age of enrolled participants was 26.2±3.2 years and mean gestational age was 38.5±1.1 weeks. One hundred and thirty-four women had an EPDS score of \u3e12 giving the prevalence of PPD of 22.3%. Multivariable analysis adjusted for age and gestational age showed no family support OR 2.01 (95% CI: 1.07-3.75), primiparity OR 2.28 (95%CI: 1.28-4.07), uneducated women OR 1.78 (95% CI: 1.04-3.05), women experience complications at time of delivery OR 7.55 (95% CI: 2.98-19.12), unintended pregnancy OR 2.82 (95% CI: 1.59-5.02), obesity OR 3.84 (95%CI: 2.3-6.43) and financial issues OR (95% CI: 1.78-11.01) were independent determinants of postpartum depression.Conclusions: It was concluded from this study that the prevalence of postpartum depression was 22.3%. No family support, parity, educational status, complications during delivery, unintended pregnancy, obesity and financial issues are independent determinants of post-partum depression

Success of Bubble CPAP in Treatment of Respiratory Distress Syndrome in Preterm Infants

Background: To observe the survival of preterm infants with respiratory distress syndrome treated with bubble CPAP in a tertiary care hospital.Methods: This prospective observational study was conducted in the NICU of Civil hospital Sukkur from 1st July 2013 to 18th August 2015. All consecutively born preterm neonates with gestational age between 27 weeks to 36 weeks of gestation, admitted to the neonatal intensive care unit with respiratory distress are included in the study.These neonates were managed by Bubble continuous positive airway pressure (bCPAP) in combination with surfactant (bovine derivative) via intubation, Surfactant replacement, extubation (INSURE) protocol Success was considered when neonates were clinically stable and required 90% and PaCO2 Results: Mean age of enrolled infants was 1.35 ± 0.60 days, 70 (57.9%) were males and 51 (42.1%) were female, mean weight was 1.76 ± 0.37 kg and mean gestational age was 33 ± 2.3 weeks. Overall 77 (63.6%) preterm infants were successfully weaned off from CPAP. Multivariable analysis showed weight of infant less than 1.5 kg or 8.63 (95% CI: 1.71-43.57), respiratory rate of more than 70 breaths per minute, or 9.59 (95% CI: 2.59-35.52), nasal flaring or 3.35 (95% CI: 1.08-10.31) and typical findings of RDS on chest X-rays 12.04 (95% CI: 1.89-76.52) are independent risk factors for failure of bCPAP. However, gestational age 0.70 (95% CI: 0.54-0.89) is protective against failure.Conclusion: bCPAP has a high proportion of success in the management of respiratory distress syndrome in preterm. It could be most useful in resource-constrained settings

Frequency of Birth Defects and its Relationship to Parents Having Interfamily Marriages at a Tertiary Care Hospital

Background: Inter family cousin marriages carries a risk of increased birth defects. The exact contribution of interfamily to birth defects risk is controversial. The aims of this study were to determine the frequency of birth defects in in relation to interfamily or outside family marriages.Methods: This cross sectional study was conducted in the Civil hospital Sukkur from 9th November 2013 to 13th December 2015. Mothers giving birth to babies married in interfamily or outside family with their consent obtained were included in the study. Mothers not giving consent for study and having any known major illnesses were excluded from this study. Data was analyzed using SPSS version 21.0.Results: The mean age of enrolled participants is 26.72 ± 7.07 years, the mean years of marriage was 5.95 ± 6 years and 49.4% were residents of urban area. Overall 89.9% were Muslims, 8.4% Christians and 2.8% Hindus, 60.7% infant had gestational age of 11.4% of newborns have congenital malformations. Frequency of congenital malformations among interfamily marriages was 15.6% compared to outside family marriages accounted for 3.7% cases (p=0.021).Conclusion: It was concluded from this study that congenital malformations are common among participants of interfamily marriages

Vaccination Status and Factors for Non- Vaccination in Children at a Tertiary Care Hospital

Immunization is a very effective strategy to prevent against common infectious disease. The objectives of the study were to determine the immunization status and reasons for non-vaccination of children coming to Civil Hospital Sukkur. This cross-sectional study was conducted pediatric OPD at Civil Hospital Sukkur from January 1, 2013, to June 30, 2013. Parents of children under five years of age brought their child to Outpatient Department of Civil Hospital Sukkur for any illness were asked to participate in the study. Parents who gave informed consent were included in the study. Data were collected using a small questionnaire by the researcher himself. A total of 500 parents gave consent to participate in the study. The average age of children was 20.4±16.3 months, 257 (51.4%) were males and 243 (48.6%) were females. Four hundred and four (80.4%) children were fully vaccinated and 98 (19.6%) were not vaccinated. Parents don’t know about immunization, busy parents, illness of a child, fear of immunization and parents who are not considering immunization as important are independent factors of non-vaccination

Frequency and Etiology of Community-Acquired Bloodstream Infection in Hospitalized Febrile Children

Background: Blood stream infection is a serious problem that needs immediate attention and treatment. We aim to identify the frequency of common organisms in blood culture of febrile pediatric patients so that empirical antibiotic therapy can be started timely.Methods: This cross-sectional study was conducted in pediatric ward Civil Hospital Sukkur from 1st May 2013 to 31st October 2014. Children of both genders who are between the age of one month to 15 years admitted to the pediatric ward with a fever of \u3e 38.0 c and with a history of fever ˃ two days and whose blood culture has been sent were included in this study. Informed consent was taken prior to enrollment. The patient’s blood culture was taken under aseptic technique. Samples were sent to microbiology lab civil hospital Sukkur. 1st culture on admission to be taken to avoid confounding with hospital-acquired the infection. The frequency of organisms grown in the culture was documented.Results: The median age of enrolled participants was 48.5 (46.6) months, 153 (38.5%) were male and 158 (61.5%) were the female and median weight of enrolled participants was 15.9 (9.7) kg. Overall, 178 (69.3%) cases had a history of prior antibiotic use; blood cultures sent within 24 hours were 117 (45.5%) cases. Twenty-two (8.4%) cases were positive. Six were positive for Salmonella typhi cases followed by E. coli.Conclusions: It was concluded from this study that the frequency of community acquired blood stream infection was 7.6%. Salmonella typhi, E. coli were found to be common pathogens

Screening for G6PD deficiency among neonates with neonatal jaundice admitted to tertiary care center: a need in disguise

This study was conducted to determine the association of Glucose-6-Phosphate Dehydrogenase (G-6-PD) deficiency among neonates admitted with jaundice at the neonatal intensive care unit, well baby nursery and neonatal step down nursery of the Aga Khan University Hospital, Karachi, Pakistan, from January to June 2010. A total of 205 neonates following the selection criteria were included. All selected neonates have their venous blood drawn, saved in EDTA bottle and sent to laboratory of The Aga Khan University Hospital (AKUH). The laboratory results of whether G-6-PD deficiency was present or not was recorded in the proforma. G-6-PD was deficient in 19 neonates (9.3%). All neonates were male

Childhood obesity, a public health crisis: Narrative review of public health interventions for childhood obesity

Introduction: Child obesity is the major pediatric public health crisis of the current century and its trend is increasing in the developing countries due to nutrition and epidemiologic transition. Considering the burden of childhood obesity and its associated outcomes need for obesity prevention in children has become priority both for government and researchers.Objective: The objective of this review is to provide the updated knowledge and evidence from various research studies, designed to provide interventions either in school or at home.Methodology: Electronic databases like Google scholar, PubMed and Sciencedirect were used as search engines. Key terms used during the review were obesity, overweight, childhood obesity, interventions for childhood obesity and Body Mass Index. Those intervention studies were selected which have been delivered to the 6-12 years old children either at home or at school or both.Findings: Schools are essentialsocial environmentfor children andmany endeavors have been made to utilize this environment to uphold healthy behaviors among youth, including healthful eating habit. Furthermore, greater involvement of family members has been suggested as a way of increasing the effectiveness of interventions aimed at weight control, weight maintenance, and weight loss.Conclusion: School curriculum including healthy eating, physical activity, development of movement skills, improvements in nutritional quality of the food supply in schools, environments, and cultural practices can play a vital role in preventing the obesity. Moreover, weight-loss interventions targeting food intake and/or physical activity might be most operative if they involve family members appropriately. Involving parents in the home setting to encourage children to be more active, eat more nutritious foods and spend less time in screen-based activities can prevent the childhood obesity

Risk of hearing loss in children exposed to gentamicin for the treatment of sepsis in young infancy: A community based cohort study in Pakistan

Objective: To determine the safety of gentamicin when used in a community setting to treat neonatal sepsis.Methods: The study was conducted in peri-urban areas of Karachi from September 2009 to April 2010. The exposed group consisted of children 6 months to 3 years of age who were treated for sepsis during 0-2 months of age in the community, with a regimen that included gentamicin for at least five days.The control group included children from the same area who never received gentamicin. The outcome measure was hearing loss, which was assessed by Brainstem Evoked Response Audiometry.Results: Of the 255 children enrolled, 125 (49%) received gentamicin, while 130 (51%) were not exposed to gentamicin. Children in the gentamicin exposed group were not at increased risk for hearing loss compared to controls (n = 30; 30.9% vs. n = 33; 31.4%, RR 0.98; 95% Cl: 0.60-1.61). Children with history of ear discharge (RR 1.7) and children with family history of deafness (RR 2.0) were more at risk for having hearing loss.Conclusion: No association was found between hearing loss and gentamicin exposure in a community setting for the management of sepsis in the first two months of life

Predictors and outcome of tetanus in newborns in slum areas of Karachi city: A case control study

Background: Tetanus in newborns, is an under-reported public health problem and a major cause of mortality in developing countries. This study aimed to determine the predictors and outcome of tetanus in newborn infants in the slums of Bin-Qasim town, Karachi, Pakistan.Methods: We conducted a case-control study at primary health care centers of slums of Bin-Qasim town, area located adjacent to Bin Qasim seaport in Karachi, from January 2003 to December 2013. Cases were infants aged ≤30 days with tetanus, as defined by the World Health Organization. Controls were newborn infants aged ≤30 days without Tetanus, who were referred for a checkup or minor illnesses. The case to control ratio was 1:2.Results: We analyzed 26 cases and 52 controls. The case fatality was 70.8%. We identified four independent predictors of Tetanus in newborns: maternal education (only religious education with no formal education OR 51.95; 95% CI 3.69-731), maternal non-vaccination (OR 24.55; 95% CI 1.01-131.77), lack of a skilled birth attendant (OR 44.00; 95% CI 2.30-840.99), and delivery at home (OR 11.54; 95% CI 1.01-131.77).Conclusions: We identified several potentially modifiable socio-demographic risk factors for Tetanus in newborns, including maternal education and immunization status, birth site, and lack of a skilled birth attendant. Prioritization of these risk factors could be useful for planning preventive and cost-effective measures