BackgroundDietary and illness factors affect risk of growth faltering; the role of enteropathogens is less clear. As part of the Etiology, Risk Factors and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) study, we quantify the effects of enteropathogen infection, diarrhoea and diet on child growth.MethodsNewborns were enrolled and followed until 24 months. Length and weight were assessed monthly. Illnesses and breastfeeding practices were documented biweekly; from 9 to 24 months, non-breast milk intakes were quantified monthly. Routinely collected non-diarrhoeal stools were analysed for a broad array of enteropathogens. A linear piecewise spline model was used to quantify associations of each factor with growth velocity in seven of eight MAL-ED sites; cumulative effects on attained size at 24 months were estimated for mean, low (10th percentile) and high (90th percentile) exposure levels. Additionally, the six most prevalent enteropathogens were evaluated for their effects on growth.ResultsDiarrhoea did not have a statistically significant effect on growth. Children with high enteropathogen exposure were estimated to be 1.21±0.33 cm (p<0.001; 0.39 length for age (LAZ)) shorter and 0.08±0.15 kg (p=0.60; 0.08 weight-for-age (WAZ)) lighter at 24 months, on average, than children with low exposure. Campylobacter and enteroaggregativeEscherichia coli detections were associated with deficits of 0.83±0.33 and 0.85±0.31 cm in length (p=0.011 and 0.001) and 0.22±0.15 and 0.09±0.14 kg in weight (p=0.14 and 0.52), respectively. Children with low energy intakes and protein density were estimated to be 1.39±0.33 cm (p<0.001; 0.42 LAZ) shorter and 0.81±0.15 kg (p<0.001; 0.65 WAZ) lighter at 24 months than those with high intakes.ConclusionsReducing enteropathogen burden and improving energy and protein density of complementary foods could reduce stunting.

Objective: To assess risk factors and outcome in the early neonatal period of babies who were asphyxiated at birth. Methodology: This was a retrospective study conducted at Tribhuvan University Teaching Hospital (TUTH) over a period of one year from 15 th Feb 2007 to 14 th Feb 2008. All the term babies who had Apgar score of less than < 6 at 1 minute of birth were included. Detailed maternal risk factors during pregnancy and labor were analyzed. The newborn babies who required admission in neonatal unit were again analyzed for development of hypoxic ischemic encephalopathy (HIE) and their outcome. Results: During the study period, out of 3594 term babies, 327 babies (9%) were asphyxiated. Of the total asphyxiated babies, 85% and 15% had moderate and severe asphyxia, respectively, at 1 minute of birth. Out of these asphyxiated babies, 51% and 7% had intrapartum and maternal risk factors, respectively. Intrapartum risk factors like meconium stained liquor, non-vertex presentation, and fetal heart rate abnormalities accounted for 4 fold risk of asphyxia. Of these babies, 26% required admission in nursery and 29% developed hypoxic ischemic encephalopathy. Among the admitted babies 6%expired, 2% left against medical advice and rest were discharged. Conclusion: Early identification and close monitoring of high risk mothers studies with maintaining partograph during labor will help to reduce neonatal asphyxia.

Introduction: The perinatal mortality rate (PMR) in Nepal is still very high. In major hospitals of Nepal, it is still ranging from 20-30 per thousand births. This study was carried out with the objective to review PMR and classifying it according to Wigglesworth classification to identify the causes of perinatal deaths at Tribhuvan University Teaching Hospital (TUTH), Kathmandu, Nepal over the past 13 years and assess need for improvement in care. Material and Methods: It was a retrospective study carried out in TUTH. Data of all stillbirths from 28 weeks of pregnancy and neonatal deaths within first seven days of life in the hospital was taken from monthly perinatal audit and annual mortality review. All the perinatal deaths were then classified according to Wigglesworth classification. Results: Over a 13 year period, there were total 42,746 births and 921 perinatal deaths giving a perinatal mortality of 21.5 per thousand births. Over this period PMR has decreased from 31 to 18 per thousand births. Still births contributed almost 50% of the perinatal deaths; deaths related to prematurity show an increasing trend and have increased by almost 70% in past 5 years. Deaths due to perinatal asphyxia were static. Conclusion: PMR over the years has shown declining trend at TUTH. There is need to improve antenatal, obstetric as well as intrapartum services to further reduce the still birth as well as deaths due to prematurity and perinatal asphyxia.

Precocious puberty is a rare condition characterized by the development of secondary sexual characteristics before the median age for the sex. It is either gonadotropin dependent also called as central or gonadotropin independent also known as peripheral type. Hypothalamamic Hamartoma is a common cause of the central or precocious puberty due to organic brain lesion. Here we present a two year male who presented us with precocious puberty due to a hypothalamic Hamartoma.DOI: http://dx.doi.org/10.3126/kumj.v9i4.6353 Kathmandu Univ Med J 2011;9(4):315-7

We describe a clinical grading system for the assessment of neonatal encephalopathy developed for a large prospective study in Kathmandu. Inter‐observer variability testing of our system on 27 infants showed high agreement (kappa value 0.87). Validity for the prediction of major neuro‐developmental impairment at 1 y of age was tested using a cohort of 57 survivors of encephalopathy, all of whom were assessed using a combination of the Denver Developmental Screening Test and Bailey 2 at 1 y. We compared this with a modification of a scoring system previously validated in Cape Town. Both schemes converted a pretest probability of 31% (the prevalence of major impairment at 1 y of age in this cohort) to a post‐test probability of 55%. This showed only marginal improvement over the traditional risk marker of neurological abnormality at discharge (post‐test probability 51%). At 6 wk of age acquired microcephaly increased the probability of major impairment to 79%. Conclusions: It seems to make little difference both in practical or predictive terms whether one describes the neurological condition of the neonate using a descriptive or scoring system. The important thing is to perform repeated systematic neurological examinations on a daily basis during the neonatal period. Many clinicians will justifiably continue to use the discharge examination as the deciding factor for the need for continued neurodevelopmental surveillance.