Background: Perinatal (stillbirths and fi rst week neonatal deaths) and neonatal (deaths in the fi rst 4 weeks) mortality rates remain high in developing countries like Nepal. As most births and deaths occur in the community, an option to ascertain causes of death is to conduct verbal autopsy. Objective: The objective of this study was to classify and review the causes of stillbirths and neonatal deaths in Dhanusha district, Nepal. Materials and Methods: Births and neonatal deaths were identifi ed prospectively in 60 village development committees of Dhanusha district. Families were interviewed at six weeks after delivery, using a structured questionnaire. Cause of death was assigned independently by two pediatricians according to a predefi ned algorithm; disagreement was resolved in discussion with a consultant neonatologist. Results: There were 25,982 deliveries in the 2 years from September 2006 to August 2008. Verbal autopsies were available for 601/813 stillbirths and 671/954 neonatal deaths. The perinatal mortality rate was 60 per 1000 births and the neonatal mortality rate 38 per 1000 live births. 84% of stillbirths were fresh and obstetric complications were the leading cause (67%). The three leading causes of neonatal death were birth asphyxia (37%), severe infection (30%) and prematurity or low birth weight (15%). Most infants were delivered at home (65%), 28% by relatives. Half of women received an injection (presumably an oxytocic) during home delivery to augment labour. Description of symptoms commensurate with birth asphyxia was commoner in the group of infants who died (41%) than in the surviving group (14%). Conclusion:The current high rates of stillbirth and neonatal death in Dhanusha suggest that the quality of care provided during pregnancy and delivery remains sub-optimal. The high rates of stillbirth and asphyxial mortality imply that, while efforts to improve hygiene need to continue, intrapartum care is a priority. A second area for consideration is the need to reduce the uncontrolled use of oxytocic for augmentation of labour.

Introduction: Febrile seizure is a common paediatric problem. Identifying children with febrile seizure who are at risk for recurrence is important so that special attention can be given to them. The objective of this study was to identify the risk factors for recurrence of febrile seizures in children. Materials and Methods: This was a prospective cohort study done at Kathmandu Medical College and Teaching Hospital, Kathmandu, Nepal. This study is a continuation of a previous study which looked at the leucocytosis in peripheral blood of children with febrile seizure. A detailed history including the risk factors for febrile seizure recurrence was obtained from the caregiver during follow up on subsequent days after discharge of children from the hospital who were previously admitted for febrile seizure. All children with febrile seizure belonging to age group of 6 months to 6 years were included in the study. Those with afebrile seizures or on anticonvulsants and those who refused to give consent were excluded. Each child was also examined and investigated for the cause of fever. Results: A total of 115 children with febrile seizure admitted for febrile seizure during the study period and all of them were followed up at outpatient department. Males accounted 62% and females 38%. Simple Febrile Seizures were seen in 80% of the cases and complex febrile seizures were seen in 20%. Out of all the cases 68(59%) had symptoms of viral prodrome. 59(51%) had recurrent febrile seizure. Low temperature at onset of Febrile Seizure (p=0.001), short duration of fever before onset of Febrile Seizure (0.026) and atypical Febrile Seizure (p=0.022) were the risk factors for recurrent febrile seizure. Conclusion: Febrile Seizure is a common paediatric problem commonly seen in males. Almost half of children with Febrile Seizure are at risk for recurrence in later date. The risk factors for these recurrences are modest rise in body temperature at the onset of febrile seizure, onset of seizure within 12 hours of fever and atypical presentation.

Background: Seizure is one of the common neurological manifestations and cause of morbidity leading to hospital admission in children. Asserting the causes and types of seizure is vital to management. Objectives: To identify the clinical profi le of children and the characteristics of seizures in them. Methods: This is a descriptive study of 32 months duration and involved analysis of the patient records including the demographics of the patients who presented with seizure. Also, type and duration of seizure were noted. All necessary investigations were done to explore the cause of seizure. Sample size was calculated using raosoft sample size calculator, and the data were entered in microsoft excel. Statistical analysis was done using statistical package for social sciences version 21. Results: Out of the 5229 children admitted, 533 (10.2%) were admitted for seizure. Male accounted for 346 (65%) cases. 424 (79.5%) of the children were below fi ve years. Fever was associated with seizure in 407 (75.5%) cases. Generalized tonic clonic seizure was observed in 436 (81%) children. 37 children (7%) presented in status epileptics. A total of 370 (68.6%) patients were diagnosed as febrile seizure, 86 (16%) epilepsy, 15 (2.8%) cerebral palsy, 13 (2.4%) neurocysticercosis, 13 (2.4%) tubercular meningitis, 12 (2.2%) viral meningitis, 11 (2%) pyogenic meningitis. The mean (standard deviation) duration of hospital stay was 3.3 (±2.84) days. Conclusion: Seizures are common in less than fi ve years of age and febrile seizure is the most common cause of hospital admission. Most of these seizures are generalized in nature.

Introductions: Congenital malformations need to be identified and intervened early to save lives and prevent sufferings. Many birth defects have well known incidence/prevalence rates but these have not been studied thoroughly in the local population of Nepal. The current study was undertaken to determine the prevalence of congenital malformation at birth, to classify them systematically, to study risk factors and immediate outcome of the newborn babies afflicted.Methods: This was a cross sectional study. All newly delivered babies were examined carefully for congenital malformation and when detected, the parents were interviewed in detail.Results: Over the 10 months of study period 7,922 babies were delivered out of which 90 were stillborn. The number of babies with malformations was 64 (0.81%). Polydactyli was observed in 12 (19%) babies whereas cleft lip/palate and malformations of ears in seven (11%) each. Musculoskeletal system was affected in 31 (35%) cases and craniofacial in 18 (21%). Nine (14%) mothers had bad obstetric history and eight (13%) had illness/medication during pregnancy.Conclusions: Congenital malformation is a significant cause of morbidity and mortality in Patan hospital. Our findings support many established thoughts like higher rates in stillbirths but also challenge some age-old beliefs like higher rates in babies born to older mothers.

Background: Urine collection in children especially in new born is a great challenge. A wide range of clinical interventions for urine collection is described in the literature, including non-invasive and invasive methods. Mid-stream urine collection is considered the most appropriate technique for older children. Here we are testing a method for obtaining mid- stream urine sample in newborns.Objective: To test a technique of urine collection for obtaining mid-stream urine sample in newborns.Method: A prospective feasibility study of a technique of urine sample collection based on bladder and lumbar stimulation maneuvers done in 100 newborns of less than 28 days of life over a period of one month. The main variable was the success rate in obtaining a midstream urine sample collection within four minutes and secondary variables were time required to obtain the sample and associated complications.Results: Mid- stream urine sample was collected successfully in 91% of babies. Mean time required for urine collection was 59.7 seconds with standard deviation of 46.4 seconds and median time was 47 seconds. No untoward complication other than controlled crying was seen.Conclusion: This is a quick and safe technique for mid-stream urine sample collection in newborn with high success rate and minimal discomfort.Journal of Kathmandu Medical CollegeVol. 5, No. 3, Issue 17, Jul.-Sep., 2016, Page: 82-84