Objective: To determine the prevalence of re-feeding syndrome in children treated for severe acute malnutrition (SAM). Methodology: This cross-sectional study was performed at Department of Pediatrics, King Abdullah Teaching Hospital, Mansehra, Pakistan from October 2020 to April 2021. A total of 186 children of either gender aged 1-5 years and admitted with SAM were included. Children with SAM were given F75-proxy every two hours for 2 days and then were fed with a locally made formula aimed to replace F-100 (F100-proxy), 6 times a day for a further duration of 2 days. After completing three days at the hospital, blood was drawn for measurements of blood and serum levels of phosphate, potassium, calcium and magnesium. Results: In a total of 186 children with SAM, the mean age was 3±1.21 years while 100 (53.8%) children were aged between 1-3 years. There were 146 (78.5%) boys and 40 (21.5%) girls representing a male to female ratio of 3.5:1. Re-feeding syndrome was noted among 25 (13.4%) children. Conclusion: Children with SAM were found to have high prevalence of re-feeding syndrome. Early recognition with appropriate treatment can be the key to a successful outcome in these children.

Objective: To compare frequency of anastomotic leak with ligation versus preservation of azygos vein in the primary repair of esophageal atresia (EA) with trachea-esophageal fistula (TEF) in neonates. Study Design: Randomized Controlled Trial. Setting: Department of Pediatric Surgery, Pakistan Institute of Medical Sciences, Islamabad. Period: October 2019 to September 2020. Material & Methods: This study involved 180 neonates (1-28 days of life) of both genders undergoing primary repair of EA with TEF and dividied in azygous vein ligation surgery and azygous vein preservation surgery. Outcome variable was frequency of post-operative anastomotic leak. Results: In a total of 180 neonates, mean age was 6.75±6.39 days. Majority (n=130, 72.2%) of the patients were aged ≤7 days. There were 107 (59.4%) male and 73 (40.6%) female neonates. The frequency of anastomotic leak was significantly lower in Azygous vein preservation group (6.7% vs. 20.0%; p=0.009) as compared to azygous vein ligation group. Conclusion: Preservation of azygous vein was associated with significantly lower frequency of post-operative anastomotic leak among neonates undergoing primary repair of EA with TEF.

There is little evidence that zinc supplementation will be effective in treating acute respiratory infection (ARI), but it may prevent respiratory infections when taken in conjunction with antibiotics. Objective: To assess the zinc supplementation for acute respiratory infection prevention in infants. Methods: A randomized controlled trail was conducted on 120 acute respiratory infected infants in Pediatric Unit, Qazi Hussain Ahmad Medical Complex, Nowshera from 1st January 2022 to 30th June 2022. Infants having 6-14 months of age with acute respiratory infections were enrolled. Infants were allocated to two groups: Group-I infants receiving Zinc (20 mg/5 mL) in terms of Zinc sulphate (N=60) and Group-II infants taking syrup (Placebo) (N=60). Results: Of the total 220 episodes, the frequency of episodes in zinc and placebo group was 106 and 114 respectively, accounting for 7.78 and 8.68 per child year after 5 months. Based on GEE regression model observed an insignificant decrease of 8% (Adjusted IRR 0.89, 95% CI 0.79-1.01) in episodes of acute respiratory infections in zinc group as compared to placebo group. However, acute respiratory infections episodes (Adjusted IRR 0.36, 95% CI: 0.25-0.35) decreased by 60% in zinc group. Zinc supplementation reduced the acute respiratory days significantly by 14% (Adjusted RR 0.83, 95% CI: 0.76-0.92). Conclusions:  Prophylactic zinc supplementation for two weeks decreased acute lower respiratory tract infection morbidity in apparently healthy infants and improved the infant’s recovery from acute respiratory infections and reduced their hospitalization as compared to placebo group

Background and Aim: Globally, Acute viral hepatitis A is the widespread type of hepatitis particularly in developing countries. Children under 5 year of age are at greater risk of asymptomatic infections, and if they do develop symptoms, they are likely to experience anicteric illnesses. The present study aimed to determine the incidence of hepatitis A virus as anicteric hepatitis cause among children under 5 years. Methodology: A cross-sectional study was carried out on 380 children (<5 years) in the Pediatric Medicine Department of Qazi Hussain Ahmad Medical Complex Nowshera for the duration from 1st July 2021 to 30th June 2022. Study protocol was approved by the institute ethical committee. Children with normal-colored urine, diarrhea, abdominal pain, vomiting, malaise, nausea, and low-grade fever (< 38.5 °C) were investigated. Demographic details and physical examination were recorded from children with elevated transaminase levels (ALT). Children with elevated transaminases were only enrolled and categorized into two groups: Group-I HAV-positive and Group-II HAV negative groups. Children with transaminases were the only ones who had IgM antibodies against HAV virus. ELISA was used to test for anti-HAV IgM. Results: Of the total 380 children, the incidence of elevated transaminases (ALT, AST) were 42.6% (n=162). The frequency of HAV positive and HAV negative was 13.6% (n=22) and 86.4% (n=140) respectively. Out of 162 children, there 84 (51.9%) male and 78 (48.1%) females. Age-wise distribution of patients were as follows: Age≥3 years 92 (56.8%) and age≤ 70 (43.2%). HAV infection rates were significantly higher among children over 2 years old (p <0.05). Abdominal pain, vomiting, diarrhea, nausea, Right hypochondrial tenderness, Arthralgia, and Hepatomegaly were different clinical manifestation of HAV negative and HAV positive found in 20.7% (n=29) versus 13.6% (n=3), 97.1% (n=136) versus 81.8% (n=18), 87.1% (n=122) vs 81.8% (n=18), 81.4% (n=114) versus 95.5% (n=21), 32.9% (n=46) versus 86.4% (n=19), 38.6% (n=54) versus 59.1% (n=13), 4.3% (n=6) versus 18.2% (n=4) respectively. Conclusion: Children with anicteric hepatitis under the age of 5 years were found to have 13.6% HAV infection. Diarrhea and vomiting were the most prevalent clinical manifestation of children < 5 years. A higher level of maternal education, older age, and poor sanitary conditions were various risk factors related to HAV infection. Keywords: Hepatitis A, Anicteric hepatitis, Children

Objective:To identify various predisposing causes and immediate consequences in new-borns presenting with acute renal failure. Study design: The study design was case series. Place & duration:In the Pediatric department of Shifa International Hospital, Islamabad for one-year duration from September 2020 to August 2021. Material and Methods:A total of 1300 cases were assessed for acute renal failure (ARF)and 98 established cases of ARF being included in the research. The neonates (0-28 days old) who met the criteria for ARF, i.e., anuria/oliguria plus a serum creatinine level more than 1.5 mg/dl, were included in this research. The patient's relevant medical history, physical examination, and laboratory tests were recorded on a separate proforma after given informed permission for the procedure. Each patient's outcome was precisely documented. The statistical software for social sciences was used to examine the data (SPSS20.0). A p-value of less than < 0.05 was considered significant. Results:A total of 98 cases (7.5 percent) were studied, with 68 (69.4 percent) males and 30 (30.6 percent) females. The ratio of males to females was 1.6:1. According to the study results, the mean age was 9.85± 7.20 days and the mean weight was 2.54± 0.65 kg. The majority of the infants were delivered at a hospital (73.5 percent). The most prevalent ARF symptoms in our neonates were birth asphyxia (30.6%), sepsis (24.5%), respiratory distress syndrome (RDS) (11.2%), and dehydration (9.2%), bleeding in (4.1 percent) and meconium aspiration in 3(3.1 percent). CCF and neurogenic bladder were both present in two patients. In 4 individuals, obstructive uropathy was found, including 2 cases of urethral valve (PUV) blockage and 2 cases of pelvic ureteric junction obstruction (PUJO). Neonates with ARF had a 28.5 percent overall death rate (28 cases). Conclusion:When it comes to neonates in critical care, acute renal failure is a frequent concern to observe. More than one predisposing factor for acute renal failure was present in the majority of the patients. Preventing acute renal failure in infants may be accomplished by early identification of risk factors and prompt treatment of underlying diseases. Keywords:Renal failure, Sepsis, Birth asphyxia, Neonates