Background Small for gestational age (SGA) is common among newborns in low‐income countries like Nepal and has higher immediate mortality and morbidities. Objectives To study the prevalence and prognostic factors of SGA babies in Western Nepal. Methods A cross‐sectional study (November 2016‐October 2017) was conducted in a tertiary care hospital in Western Nepal. Socio‐demographic, lifestyle factors including diet, and exposures including smoking and household air pollution in mothers who delivered newborns appropriate for gestational age (AGA), SGA and large for gestational age (LGA) were recorded. Logistic regression was carried out to find the odds ratio of prognostic factors after adjusting for potential confounders. Results Out of 4000 delivered babies, 77% (n = 3078) were AGA, 20.3% (n = 813) were SGA and 2.7% (n = 109) were LGA. The proportion of female‐SGA was greater in comparison to male‐SGA (n = 427, 52.5% vs n = 386, 47.5%). SGA babies were born to mothers who had term, preterm, and postterm delivery in the following proportions 70.1%, 19.3%, and 10.6%, respectively. The average weight gain (mean ± SD) by mothers in AGA pregnancies was 10.3 ± 2.4 kg, whereas in SGA were 9.3 ± 2.4 kg. In addition to low socioeconomic status (OR 1.9, 95% CI 1.1, 3.2), other prognostic factors associated with SGA were lifestyle factors such as low maternal sleep duration (OR 5.1, CI 3.6, 7.4) and monthly or less frequent meat intake (OR 5.0, CI 3.2, 7.8). Besides smoking (OR 8.8, CI 2.1, 36.3), the other major environmental factor associated with SGA was exposure to household air pollution (OR 5.4, 4.1, 6.9) during pregnancy. Similarly, some of the adverse health conditions associated with a significantly higher risk of SGA were anemia, oligohydramnios, and gestational diabetes. Conclusions SGA is common in Western Nepal and associated with several modifiable prognostic factors.

Introduction: Feeding intolerance is common among the preterm neonates and is associated with different co-morbidities like respiratory depression, respiratory distress syndrome, apnea, hyperbilirubinaemia, and hypoxic ischaemic encephalopathy. Aim: To find the incidence of feeding intolerance in preterm neonates from 28-34 weeks of gestation along with the clinical signs and co-morbidities associated with feeding intolerance. Materials and Methods: A prospective observational hospital based study was conducted in Neonatal Intensive Care Unit (NICU) and postnatal ward of Universal College of Medical Sciences, a tertiary care hospital situated in western Nepal for 12 months (June 2018 to May 2019). All admitted preterm neonates between 28-34 weeks of gestation were included in the study and were followed-up for any neonatal morbidities along with feeding intolerance. Feeding intolerance was defined when the newborn had vomiting and/or abdominal distension and/or increased gastric residual volume with normal disruption of feeding process. Babies with feeding intolerance were subjected to final analysis for clinical signs and co-morbidities. Results: Out of 490 admitted preterm babies (28-34 weeks), 54 (11.02%) had feeding intolerance with 33 (61.1%) babies in the very low birth weight group. The mean birth weights of the total enrolled babies (n=490) and feed intolerant (n=54) babies were 1550 gm and 1418 gm, respectively. Different co- morbidities associated with feeding intolerance were respiratory distress (25.9%), respiratory distress syndrome (22.2%), jaundice (16.7%), apnea (5.6%) and necrotising enterocolitis (3.7%). Among the total 37 preterm deaths, four babies were in the feeding intolerance group. Majority of all feed intolerant babies had vomiting 49 (90.7%) followed by gastric residue (57.4%), abdominal distension (55.6%), and reduced or absent bowel sounds (7.4%), respectively. The incidence of feeding intolerance was increased in babies fed with formula feed (p=0.46) and when feeding was started <24 hours (p=0.22) but the results were statistically insignificant. Conclusion: The incidence of feeding intolerance was 11.02% in the preterm neonates (28-34 weeks) with high proportion in very low birth weight babies. Vomiting, gastric residue and abdominal distension were three important signs of feeding intolerance in newborns.

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.

Objectives. Chikungunya and scrub typhus infection are important causes of undifferentiated fever in tropical zones. The clinical manifestations in both conditions are nonspecific and often overlap. This study compares the clinical manifestations and the outcome of chikungunya with chikungunya-scrub typhus coinfection in children. Methods. A hospital-based observational study was conducted in children below 15 years of age over 16-month duration in 2017-2018. Chikungunya was diagnosed by IgM ELISA. All positive chikungunya cases were subjected to scrub typhus testing, dengue testing, leptospira testing, and malaria testing. Clinical manifestations and outcomes of all patients were recorded. Results. Out of the 382 admitted cases with fever, 11% ( n = 42 ) were diagnosed with chikungunya, and the majority ( n = 30 , 71.4%) were male. Among the 42 chikungunya cases, 17 (40.5%) tested positive for scrub typhus and one positive for falciparum malaria. Out of a total of 42 chikungunya cases, myalgia, nausea/vomiting, headache, abdominal pain, lymphadenopathy, hepatomegaly, splenomegaly, and edema were 81%, 73.8%, 66.7%, 64.3%, 59.5%, 52.4%, 40.5%, and 38.1%, respectively. Besides, altered sensorium (31%), jaundice (26.2%), dry cough (21.4%), shortness of breath (19%), and seizures (16.7%) were other clinical manifestations present in this group of children. Patients with chikungunya-scrub typhus coinfection reported headaches, pain in the abdomen, dry cough, shortness of breath, seizures, and splenomegaly, significantly more ( p value < 0.05) compared to those with chikungunya only. Thirteen (31%) children developed shock, five in the chikungunya group and eight in the chikungunya-scrub typhus coinfection group. Six children in the coinfection group received inotrope. Among the chikungunya-only cases, 22 recovered and one died, whereas in the chikungunya-scrub typhus coinfection group, fourteen recovered and three died. Conclusions. Both the chikungunya and scrub typhus coinfection groups shared many similar clinical manifestations. In children, coinfection with scrub typhus often leads to modification of the clinical profile, complications, and chikungunya outcome.