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 determine the prevalence of iron deficiency anemia in children with febrile fits. Study Design: Prospective study Place and Duration of Study: Paediatric Medicine, Abbas Institute of Medical Sciences (AIMS) Muzafarabad, AJ Kashmir from 01-04-2021 to 31-03-2022. Methodology: Ninety patients within the age limit of 6 months to 5 years were enrolled. The inclusion criteria were based on the all the children suffering from febrile fits. The enrolled patients’ blood sample comprising of 4cc was pooled and sent for biochemical analysis of hemoglobulin, serum ferritin as well as red cell distribution width. The results of each patients’ reports were used for analysis of their anemia status. Results: The mean age of the patients was 2.6±1.5 years with more boys suffering from febrile fits.. Most of the children belonged to the age group of 1-3 years. The biochemical blood analysis reports revealed that there were 56.25% those children who were suffering from hemoglobulin level less than 10g/dl. The overall prevalence of iron deficiency anemia was found to be 33.75 among boys while 25% within the girls. Conclusion: There is a percentage of iron deficiency anemia as 58.75% in children with febrile fit. Key Words: Prevalence, Anemia, Febrile fits.

Aim: To determine the prevalence of hypocalcemia fits in exclusively breast fed infants. Study design: Prospective study. Place and duration of study: Department of Paediatric Medicine, Abbas Institute of Medical Sciences/Medical College Muzafarabad AJ Kashmir from 01-04-2021 to 31-03-2022. Methodology: One hundred breast fed infants were enrolled. A 0.5cc blood of child was withdrawn for conductance of serum calcium and 25(OH) vitamin D3 test while 2cc of mother blood was also withdrawn for analyzing their calcium levels as well as vitamin D status in duplicate batches. Radiological imaging through x ray image of wrist for detection of rickets was performed in each infant. Infants having complain of fits were specifically observed fit/seizure time duration of the fit, the time when it occurred, eye rotation and cyanosis condition. Any family history regarding epilepsy especially in mothers was also noted. Results: The mean age of the infants was 5.5±2.3 months with a range of 1-12 months. Majority of the infants were male gender with a parentage of 66% while there were 34% female gender infants. Within the total number of infants included 30 children were having clinically defined rickets with 25 such infants who were having vitamin D level below the level of 20ng/ml. Conclusion: There is a low prevalence of hypocalcemia fit among breast fed infants. Keywords: Prevalence, Hypocalcemic fits, Breast fed infants.