Introduction: Pulse oximetry is widely used in Neonatal intensive care setting. Both wrist and ankle are widely used as substitute sites for probe placement in place of more commonly used sites such as palm and sole. However, little is known about the accuracy and response time of pulse oximetry when the probe is placed at wrist or ankle of neonates. Objectives: The primary objective of this study was to compare the values of SpO2 reading at wrist with palm and ankle with sole in terms of correlation and accuracy. The secondary objective was to compare the response time to get a valid SpO2 reading at wrist with palm and ankle with sole. Methodology: This was a prospective observational study conducted at Neonatal intensive care unit of Biratnagar Hospital from October 2020 to January 2021. After approval from institutional review committee, a total of 152 consecutive neonates admitted in NICU of either gender both term and preterm were enrolled for the study. Recording of SpO2, heart rate and response time was done by two pulse oximeters simultaneously. The SpO2 measurements at right palm and right wrist were recorded at 0, 30 seconds and 1 minute then simultaneous recording was done for the left palm and left wrist, right sole and ankle and left sole and ankle. Response time was also recorded for each of the readings. Results: The results of our study show good correlation using regression analysis and good agreement using Bland- Altman plots between the values of SpO2 reading of paired measurements. The response times of the paired measurements were not significantly different. There was good correlation between the SpO2 of paired measurements. The correlation for right palm and wrist was 0.927 (P-value = 0.01) and that of left palm and wrist was 0.85 (P-value = 0.01). Similarly the correlation between right sole and ankle and left sole and ankle were 0.937 (P-value = 0.01) and 0.875 (Pvalue = 0.01) respectively. The bias (average difference) and precision (standard deviation of differences) were calculated. The bias and precision of the right palm and wrist, left palm and wrist, right ankle and sole; and left ankle and sole were (-0.00289, 0.76105), (-0.17982, 0.95049), (-0.03509, 0.786342) and (-0.14474, 0.859241) respectively. Conclusion: Wrist and ankle can be used as substitute sites for pulse oximter placement in neonatal intensive care setting.

Introduction: Malnutrition in children has health and physical consequences resulting in delayed physical growth and motor development, behavioral and social problems as well as susceptibility to contracting diseases.The Screening Tool for Assessment of Malnutrition in Pediatrics (STAMP) is a specially constructed tool that uses anthropometric measurements, body composition, and patient's clinical status to predict the risk of malnutrition for inpatients at admission. There is no agreement on the ideal screening tool or scales for detecting and determining the level of malnutrition in pediatric inpatients. Various studies in the pediatric population have analyzed the association of malnutrition during hospitalization with patient outcomes, but few have analyzed whether the STAMP tool in particular could be used to predict length of hospital stay and disease severity in these patients. Objectives: We studied the use of STAMP screening tools to assess the risk of malnutrition in inpatients by including a nutritional screening in the admission process and analyze the association between the risk of malnutrition and patient outcomes (length of hospital stay and severity of disease).  Methodology: We conducted a prospective single-center study between May to July 2021 at a tertiary care hospital. All patients admitted to the pediatric ward aged 1 month to 15 years with a length of stay of at least 24 hours were included into the study. Data were collected about clinical, anthropometric and demographic variables for each patient including STAMP grading, length of hospital stay and severity of disease. Results: Our study suggests comparable demographic and other patient-related variables in the three categories (mild, moderate and severe) of STAMP grading (p-value >0.05). STAMP grading was not significantly associated with both length of hospital stay and severity of disease. Conclusion: The use of STAMP as a malnutrition screening tool for pediatric inpatients is not significantly associated with length of stay or severity of disease.