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Introduction: Jaundice is an important problem in the neonatal period especially in the first week of life. Our objective of the study is to find out the immediate outcome of hyperbilirubinemic babies admitted in Kanti Children Hospital. Methodology: This is a retrospective study and carried out in tertiary care paediatric hospital. Results: Altogether 73 babies were enrolled in the study. Male babies outnumbered the female (72.6% vs. 27.4%).Only 2.4% babies were near-term. LBW babies constitute 19.2% of the study population.86.3% of babies also have clinical sepses as defined by WHO criteria. Almost half of the babies have mild hyperbilirubinemia (15-19.9 mg/dl). Most of the babies (94.5%) improved and the mortality was 5.5%. Conclusion: Healthy term babies with a serum bilirubin <17mg/dl should not be admitted for routinely as they do not need phototherapy. Phototherapy is effective in most of the time, but exchange transfusion should also be carried out when phototherapy fails. Causes of hyperbilirubinemia should be searched extensively especially to rule out haemolysis. Key words: hyperbilirubinemia, kernicterus, neonates, phototherapy DOI: 10.3126/jnps.v30i1.2457 Journal of Nepal Paediatric Society Vol.30(1) 2010 31-36

Introduction: Initiation of breastfeeding within one hour of birth is an important determinant of successful breastfeeding. National Family and Health Survey -3(NFHS-3) reported that only 23.4% of children < 3 years were breastfed within one hour of birth. Objectives: the purpose of this study is to study the determinant of initiation of breastfeeding within one hour of birth. Setting: Tertiary -level neonatal unit. Material and Methods: All mothers admitted in the postnatal ward were eligible for inclusion; mothers of sick and /or preterm infants were excluded. Enrolled mothers were interviewed between 24 and 72 hours after delivery. Results: The proportion of mothers who initiated breast feeding within one hour of delivery was 32%, between 1-6 hrs were 47% and between 6 to 48 hrs were 21%. Maternal age, education, socioeconomic status, occupation and antenatal or labor room counseling did not influence the initiation of breast feeding within one hour of delivery in univariate analysis. On multivariate analysis, admission in the general ward and delivery by caesarean section were found to be significantly associated with not initiating breastfeeding within one hour (adjusted ORs: 8.79, 2.48 to 31.08, p=0.001 and 6.79, 4.07 to 22.02 p=0.001 respectively). Only about 13% of the infants received prelacteal feeds. Conclusion: Mothers delivering by caesarean section or admitted in the general ward were at high risk of not initiating breastfeeding within one hour. Innovative strategies are required to ensure timely ignition of breastfeeding. Key words: Breastfeeding, Caesarean section, prelacteal feeds, time of initiation.   doi: 10.3126/jnps.v29i2.2042 J. Nepal Paediatr. Soc. Vol 29, No. 2, pp.74-78

Background: Neonatal sepsis is one of the major causes of neonatal morbidity and mortality globally. Current neonatal mortality rate of Nepal is 21/1000 live birth which is higher than that of the global average of 19.2 and slightly lower than the regional (South East Asia). Pathogenic strains of neonatal sepsis varies from place to place and also from time to time, so it is very important to know the common pathogens and its resistant pattern locally. The aim of this study is to find out the hospital based frequency of neonatal sepsis and characterize the bacteriological profile along with their sensitivity and resistance pattern. Materials and Methods: This is a retrospective study done in Kanti Children Hospital, Kathmandu, Nepal over the period of one year starting from July 2018 to June 2019.All culture positive cases were enrolled in the study and their sensitivity pattern were analyzed. Results were expressed as percentage, mean, P-Value and Odds Ratio. Results: A total of 107 cases were culture positive among 1064 probable sepsis accounting 10.05%. Predominant microorganism isolated in this study were staphylococcus aureus 66(61.7%), Klebsiella spp. 15(14%), Esherichia Coli 7(6.5%) followed by Acinatobacter spp 6(5.6%). Most of the Gram positive organisms were resistant to Ampicillin, Cetazidime, Cefotaxime and sensitive to Gentamicin, Amikacin, Imipenam, Vancomycin, Ofloxacin, and Tigecyclin. Whereas Gram negative organisms are resistant to Cephalexin, Ampicillin, Piperacillin/Tazobactum, Cefotaxime and sensitive to Tigecyclin), Vancomycin Chloramphenicol and Colistin. Conclusion: There was striking similarity in bacteriological profile in both early onset as well as late onset neonatal sepsis. Most of the pathogens were resistant to WHO first line antibiotics Ampicillin and also the resistance is increasing even in 3rd generation Cephalosporin.

Child abuse is common but still unnoticed, undiagnosed, neglected childhood problem in Nepal. Child abuse has diverse clinical manifestation ranging from minor injury to severe head trauma to simulating severe medical problem. The true incidence of intentional head injury in children remains uncertain in Nepal. We are reporting a case of child abuse with blunt head trauma with intracranial hemorrhage presenting as a loss of consciousness simulating as a diabetic ketoacidosis (DKA) Key words: Children, child abuse, DKA DOI: 10.3126/jnps.v30i1.2462 Journal of Nepal Paediatric Society Vol.30(1) 2010 53-56