INTRODUCTION: Hyperbilirubinemia is a common problem in the neonates. It can progress to develop kernicterus unless intervention is initiated. Severity of jaundice and decision for management are usually based on total serum bilirubin (TsB) estimation which technique and results closely correlates with total serum bilirubin levels. OBJECTIVES: To compare the accuracy of visual assessment of jaundice by single trained observer based on Kramer's index with total serum bilirubin levels in healthy term neonates. To compare accuracy of non invasive bilirubin assessment with serum bilirubin levels, to compare trans-cutaneous bilirubin assessment on different sites (forehead and sternum) and to develop a cutoff point oftrans-cutaneous bilirubin level for serum bilirubin assessment. METHODS: This prospective study was conducted in the Neonatal unit of the department of Paediatrics at Kasturba Hospital ,Manipal. Study period was from October 2007 to June 2008. Clinical assessment of jaundice was done in healthy term neonates by observer (Trained Paediatric Post Graduate Resident) based on Kramer's index. Transcutaneous bilirubin assessment was done on the forhead and sternum of each baby using JM-103 Minolta. Air shields bilirubino meter. Serum bilirubin level was measured within 30 minutes of the clinical assessment for each baby. RESULTS: This study included 187 healthy term neonates. The mean birth weight was 2856.83gm ± 493.89gm and mean gestation was 38.25+ 1.030 SD. Clinical assessment and Transcutaneous bilirubin(TcB) significantly correlated with total serum bilirubin (TsB), with correlation co-efficient of 0.757 and 0.801 respectively (p 0.0001). Transcutaneous bilirubin assessment over forehead showed a tendency to under estimate total serum bilirubin, with mean difference of-0.31 mg/dl, SD 1.75 mg/dl with 95% confidence interval ofthe mean -0.60 and -0.02 mg/dl (p value 0.05).Transcutaneous bilirubin assessments between 10 mg/dl to 15 mg/dl correlated accurately with total serum bilirubin levels avoiding blood sampling. CONCLUSION: Trained observer clinical assessment of jaundice can be used for screening neonatal jaundice. Non invasive transcutaneous bilirubin assessment has demonstrated significant accuracy with serum bilirubin level estimates between 48 hours to 7 days on two different sites forehead and sternum. DOI: http://dx.doi.org/10.3126/jucms.v1i4.9567 Journal of Universal College of Medical Sciences (2013) Vol.1 No.04: 17-21

INTRODUCTION: In a developing country like Nepal, where proper medical care and obstetrical facilities are still scarce in the rural areas, neonatal sepsis is a major cause of neonatal morbidity and mortality. With limited resources, early diagnosis and treatment if crucial, may not be achieved. Objective of this study is to evaluate the role of micro ESR in the diagnosis of neonatal sepsis. MATERIAL AND METHODS: A prospective analytical study was done where all neonates with suspected sepsis admitted in NICU were included in the study. Micro-ESR was measured with relevant septic screening investigations. The micro-ESR was compared with age specific cut off value and the results were compared with various clinical presentations, laboratory findings and outcome variables. RESULTS: Out of 250 neonates, micro-ESR was elevated in 12% (29 neonates) of cases. Total proven sepsis is 6%, probable sepsis 60.8% and no sepsis in 33.2%. Correlation of elevated micro ESR was statistically significant with presence of clinical symptoms, clinical and systemic signs. It had significant clinical association with blood culture and CSF findings. The sensitivity, specificity and positive and negative predictive value of micro ESR compared to blood culture was 93.3%, 93.6%, 48.3% and 99.5%. CONCLUSION:- Micro ESR is a simple, relatively cheap and sensitive study in prediction of neonatal sepsis. It can be useful test in settings with limited resources.

Introduction: In developing countries like Nepal, iron deficiency anemia (IDA) is one of the major concern. The high rate incidence has been related to insufficient  iron  intake, accompanied  by chronic  intestinal  blood  loss  due  to parasitic  and  malarial infections. Therefore, a study was conducted to evaluate the prevalence of IDA in anemic patients of Universal College of Medical Sciences-Teaching Hospital (UCMS-TH), South Western region, Nepal. Material and Method It was a hospital based cross sectional study comprised of 100 anemic patients. Their detailed medical history and lab investigations, focusing on hematological parameters were documented. Peripheral smear examination and serum ferritin estimation were done to observe red cell morphology and iron status respectively.  Results: This study revealed that out of 100 anemic patients, 35% were that of IDA. The most affected age group was 21-40 years with frequency 42.55%. IDA was more common in females (42.85%) than in male (21.62%). Out of 100 anemic patients, microcytic hypochromic anemia was predominant in 47% followed by macrocytic anemia (31%) and then normocytic normochromic anemia (22%). Out of 47 microcytic hypochromic anemic patients, 12 had normal serum ferritin. There was a statistical significant difference in Hb (p=0.011), MCV (p=0.0001), MCH (p=0.0001), MCHC (p=0.0001) and serum ferritin (p=0.0001) among all types of anemia. There was a statistical significant positive correlation of ferritin with Hemoglobin (0.257, p= 0.01), MCV (0.772, p= 0.0001), MCH (0.741, p=0.0001) and MCHC (0.494, p=0.0001).  Conclusion: The peripheral smear in conjunction with serum ferritin estimation needs to be included for susceptible individuals to screen the IDA and other types of anemia.

Introduction: Healthy, full term, exclusively breastfed infants are expected to lose weight in the first days following birth. There are conflicting opinions about what constitutes a normal neonatal weight loss. This study was conducted to establish the reference weight loss pattern in exclusively breastfed neonates.  Materials and methods: A cross sectional observational study was conducted at a tertiary care hospital of western Nepal for a period of 12 months. All babies delivered were recruited. Newborns with birthweight of > 2500 grams without any congenital anomalies and Apgar score >7/10 were finally included for analysis. Breast feeding was started as soon as possible and all newborns were fed within 6 hours of life. If breast feeding was not possible within first 2 hours of life, expressed breast milk (EBM) or formula feeding was initiated as recommended. Data was analyzed showing distribution and frequency of various parameters like initiation of breastfeeding, weight of babies at different time intervals and weight loss patterns.  Results: Out of 1000 babies subjected to analysis, majority were males (n= 517, 51.7%). The average time of initiation of breast feeding was less than 6 hours. The weight loss pattern in babies was 7.1% at 72 hours of life.  Conclusion: Breast feeding was initiated as soon as possible in all healthy term neonates. The average weight loss pattern in all term healthy newborns were almost similar.