Aim: To assess the diagnostic accuracy of complete blood count with band versus total neutrophil ratio and C-reactive proteins as an efficient analytical procedure for determining early onset sepsis in neonates. Study design: Cross sectional analytical study Place and duration of study: Department of Paediatric Medicine, Abbas Institute of Medical Sciences Muzafarabad, AJ Kashmir from 01-02-2022 to 31-07-2022. Methodology: Fifty patients were enrolled. Coulter counter was used for analyzing leucocytes of the neonates. Thin film-smears were generated by the laboratory scientist for identifying band neutrophils separately from mature neutrophils. C-reactive proteins level <5mg/dl was considered as negative. Thio-glycate-oxide in liquid form was used for 2ml neonatal blood culture analysis mixed in the 20ml medium at 36 degree celsius. Results: There were 28 (56%) males and 22 (44%) females. The mean age of the neonates was 1.6± 0.77 days. The mean weight of the neonates was 2.4±0.51kg with a range of 4-1.2kg. A variance of band versus total neutrophil ratio was significantly higher in cultures which were positive than negative such as 70% vs 25%. There was also significant percentage of C-reactive proteins positive in positive sepsis cultures in comparison to negative blood culture. Conclusion: A combination of complete blood count with differential count, white blood cell analysis with band versus total neutrophil ratio and c-reactive proteins is an efficient early analytical procedure for determining early onset sepsis in neonates as gold standard test blood culture is time taking. Key Words: Complete blood count, C-reactive protein, Total neutrophils ratio, Early onset neonatal sepsis.

Aim: To determine the efficacy of use of bubble continuous positive airway pressure in management of neonatal respiratory distress syndrome. Study design: Prospective study. Place and duration of study: Paediatric Medicine, Abbas Institute of Medical Sciences (AIMS) Muzafarabad, AJ Kashmir from 01-02-2022 to 31-07-2022. Methodology: Fifty new born who were admitted with respiratory distress syndrome was enrolled. On clinical examination their shake test was found positive for respiratory distress syndrome or in other cases the chest x-ray imaging was suggestive towards respiratory distress syndrome symptoms. Oxygen flow-meter was prepared and nasal-pong were closed for bubble prior attachment with neonate. Appearance, pulse, grimace, activity and respiration scoring at five min, primigravida, child temperature, vital signs, oxygen saturation rate, complications, post and pre-bubble continuous positive airway pressure were recorded. Results: The mean age of the neonates was 2.7±1.1 days. There were more male children than female new born who were suffering from respiratory distress syndrome. The mean maternal age was 32.3±3.5 years with 70% of the births to be in singleton Antenatal steroids were received by 66.7% of new born and the 5 minutes appearance, pulse, grimace, activity and respiration score presented 64% new born within a range of 8-10 points. There were 76.2% respiratory distress syndromes new born who were successfully weaned off from bubble continuous positive airway pressure. Conclusion: Bubble continuous positive airway pressure is a cost-effective technique in resource limited regions for reducing and treating respiratory distress syndrome cases and decreasing mortality. Keywords: Management, Respiratory distress syndrome, Management

Objective: To find out prevalence of iron deficiency anemia among hospitalized children aged 6-months to 5 years at a tertiary care hospital of Poonch, Azad Kashmir, Pakistan. Study Design: A cross-sectional study. Place and Duration of the Study: Department of Pediatrics, Sheikh Khalifa Bin Zayed Al Nahyan Hospital, Rawlakot from July 2020 to December 2020. Material and Methods: A total of 189 admitted children of both genders aged between 6 to 60 months were included. At the time of enrollment, age, gender, area of residence and socioeconomic status of all children were noted. To label IDA, a World Health Organization (WHO) criterion was adopted as hemoglobin below 11 g/dL. Chi square test was used to compare data between IDA and non-IDA children considering p-value < 0.05 as significant. Results: Out of a total of 189 cases, there were 103 (54.5%) male. Overall, mean age was 29.3±6.8 months while 106 (56.1%) children were aged between 6 to 24 months. There were 130 (68.8%) children who belonged to rural areas of residence. Socio-economic status was low in 110 (58.2%) children. Malnourishment was identified in 38 (20.1%) children. Gastrointestinal disorders were the commonest reasons of admission found in 82 (43.4%) children. The prevalence of IDA was noted in 103 (54.5%) children. Table-2 is showing association of anemia with respect to various variables studied. Younger age (p=0.0091), rural area of residence (p=0.0039), low socio-economic status (p=0.0036) and malnourishment (p=0.0001) were observed to have significant association with the prevalence of IDA. Conclusion: The prevalence of IDA was high (54.5%) in admitted children aged between 6 to 60 months. Younger age, rural area of residence, low socio-economic status and malnourishment were observed to have significant association with the prevalence of IDA. Keywords: Iron deficiency anemia, hemoglobin, malnourishment, gastrointestinal disorders.

Objective: To determine the frequency of non-breastfed infants presenting to the pediatric department with respiratory tract infection. Methodology: This cross-sectional study was carried out at Department of Pediatrics, Sheikh Zayed bin Sultan Nahyan Hospital CMH Muzaffarabad, during a period of six months from May 2020 to October 2020. All patients between 1 month to 12 months visiting OPD or admitting in pediatric ward with respiratory tract infection and either gender were included. Information regarding baseline demographic characteristics was recorded. The mothers were interviewed about feeding pattern of the infants. All information was recorded on the prescribed proforma. Results: A total of two hundred and forty-five children were studied, and their average age was 7.4±2.8 months. Males were 54.3% and females were 45.7%. Out of all 29.8% (n=73/245) of infants found who had never been breastfed. No significant difference was found according to the effect modifiers (P>0.05). Conclusion: A remarkable proportion of infants (29.8%) who presented with respiratory tract infection had never been breastfed. Counseling programs should be done for mothers to modify their perceptions regarding breastfeeding and its benefits. It is suggested that the public health authorities should launch awareness programs for the public about benefits of breastfeeding and its role in the prevention of infections in infants. Keywords: Breast feeding, Non-breastfed, Respiratory Tract Infection