Bangladesh Journal of Child Health 2019-08-07T15:26:24+00:00 Professor Dr. Md. Al-Amin Mridha Open Journal Systems <p>The official organ of the Bangladesh Paediatric Association. Full text articles available.</p> Intervention in Congenital and Structural Heart Diseases in Children 2019-08-07T15:05:11+00:00 Mohd Zahid Hussain <p>Abstract not available</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :72-73</p> 2019-08-07T08:45:53+00:00 ##submission.copyrightStatement## Clinico-Laboratory Profile and Drug Sensitivity Pattern in Urinary Tract Infection of Children in a Tertiary Care Hospital 2019-08-07T15:05:12+00:00 Nibedita Paul Nadia Nusrat Md Rafiqul Islam Farhana Rahman Neshwa Rahman <p><strong>Background</strong>: Urinary tract infection (UTI) is common in children. About 7% girls and 2% of boys suffer from symptomatic, culture positive UTI by 6 years of age. These children present with poor feeding, irritability, vomiting, fever, abdominal pain or failure to thrive. Now a days antibiotic resistance is a global problem which hampers appropriate treatment of urinary tract infection in children. This study was done to see clinical profile, common pathogens and their drug sensitivity pattern in UTI.</p> <p><strong>Methodology</strong>: It is a prospective study conducted in Delta Medical College &amp; Hospital, Dhaka. All cases collected from outdoor patient or inpatient who were clinically suspected as UTI were enrolled in this study from January 2015 to July 2017. Total 200 cases were included. History was taken properly. Diagnosis of UTI was confirmed by urinalysis and culture sensitivity (C/S). All informations were recorded in preformed data sheet.</p> <p><strong>Results</strong>: Usual presentations of UTI were fever, abdominal pain, vomiting, constipation, urinary complaints, poor feeding, labial adhesion, jaundice, excessive straining. Out of 200 cases 168 were culture positive. Group III age group (&gt; 1year- 5 year) showed higher rate of UTI. UP to one year of age males were more affected than female and beyond one-year females were more affected than male. Most common isolated uropathogen was Escherichia coli. Most sensitive drugs for the pathogen were Imipenem and meropenem (89.39%) - Injectable form and nitrofurantoin (73.48 %)- Oral form.</p> <p><strong>Conclusion:</strong> Presentation of UTI in case of young infant is different from older children. Clinical suspicion is important for early detection of UTI. Before starting antimicrobial therapy, we must do urinalysis and culture sensitive test to prevent recurrent UTI.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :74-79</p> 2019-08-07T08:46:02+00:00 ##submission.copyrightStatement## Comparative Efficacy of Nebulized 7% Hypertonic Saline versus 0.9% Normal Saline with Salbutamol in Children with Acute Bronchiolitis 2019-08-07T15:05:20+00:00 Md Saiful Islam Md Abid Hossain Mollah Rokeya Khanam Abu Sayeed Chowdhury Md Mahfuzur Rahman Shah Abdullah Al Baqui Muhammed Anisur Rashid <p><strong>Background: </strong>Acute bronchiolitis is an acute viral lower respiratory tract infection of infants and is the leading cause of hospitalization of infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 0.9% normal saline with salbutamol and 3% hypertonic saline has been found effective. This study was undertaken to assess the efficacy of 7% hypertonic saline on recovery from acute bronchiolitis.</p> <p><strong>Methodology: </strong>This was a randomized controlled trial, carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Bangladesh between January 2015 to December 2015. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted as acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 0.9% nebulized normal saline with salbutamol (Group-II = 45). The efficacy was determined by assessing clinical severity score and length of hospital stay. Data were analyzed using computer software SPSS version 19.</p> <p><strong>Result: </strong>In this study the two groups were almost similar with respect to their demographic and baseline clinical severity score. After intervention the clinical severity score of both treatment modalities were reduced (Group-I(HS) were 7.9, 6.8, 3.8, 1.4, 1.33 while in Group-II(NS+ Salbutamol) score were 8.6, 7.6, 4.9, 3.11, 2.12) but the reduction was significant more in children who received 7% nebulized hypertonic saline than those who received 0.9% nebulized normal saline with salbutamol. Majority 42(93.3%) of group-I(HS) children recovered at the end of 72 hours whereas 17(37.8%) of the children of group-II (NS+ Salbutamol) recovered from the disease during the same period. Length of hospital stay was shorter in hypertonic saline group compared to normal saline with salbutamol group (56.36±12.33 hours vs71.07±13.48 hours, p&lt;.001). The patients of hypertonic saline group required a shorter duration of oxygen therapy compared to normal saline with salbutamol group (12.53±3.58) hours vs (20.25± 4.15) hours, (p=0.009).</p> <p><strong>Conclusion: </strong>7% hypertonic saline was found more effective than 0.9% normal saline with salbutamol in terms of reducing clinical severity, length of hospital stays and duration of oxygen therapy.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :80-84</p> 2019-08-07T08:46:10+00:00 ##submission.copyrightStatement## Efficacy of Preoperative Intramuscular Testosterone Therapy for Micro-phallic Hypospadias 2019-08-07T15:05:27+00:00 Md Ayub Ali Paritosh Kumar Palit Md Hasanuzzaman <p><strong>Background: </strong>Surgical corrections of genital defects were formally proposed when the size of the penis is sufficient to permit easy surgical repair. In micro phallic hypospadias, temporary stimulation with testosterone either topical or parenteral to enlarge the penile size has been reported. The aim of this study was to evaluate the efficacy of preoperative intramuscular testosterone therapy in micro phallic hypospadiac patients.</p> <p><strong>Methodology</strong>: This prospective interventional study was carried out in the division of pediatric surgery, Dhaka Shishu (Children) Hospital. A total of 70 boys having micro phallic hypospadias were included in the study from July 2014 to December 2017. All patients received 3 dose of IM testosterone (2mg/kg) at 1 month interval. Alteration of penile length, glans width and the adverse effects of testosterone therapy were recorded. Data were analyzed by using SPSS version 22.</p> <p><strong>Results</strong>: The mean length of penis before treatment was 2.61±0.57 cm, and after intramuscular testosterone was 3.93±0.39 cm, which is statistically significant (p&lt;0 .05).The mean glans width before treatment was 1.09±0.18 cm and after treatment was 1.62±0.11 cm (p &lt; 0.05).Few adverse effect were noted.</p> <p><strong>Conclusion: </strong>Significant penile growth was observed with less adverse effects after using intramuscular testosterone. Hormone therapy preceding surgical correction of micro phallic hypospadias improves aesthetic and functional qualities of the penis.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :85-89</p> 2019-08-07T08:46:17+00:00 ##submission.copyrightStatement## Predictors of Ventilator Associated Pneumonia of Neonate in a Neonatal and Paediatric Intensive Care Unit 2019-08-07T15:05:32+00:00 Uzzal Kumar Ghosh Mohammad Monir Hossain Mahfuza Shirin Md Shafiul Hoque Sheikh Farjana Sonia Tithi Islam <p><strong>Background: </strong>Ventilator Associated Pneumonia (VAP) is defined as nosocomial pneumonia develops 48 hours or more after initiation of mechanical ventilation. Hospital acquired infection (HAI) is the second most common infection for the pediatric population. VAP about 20% of all HAI among patients in NICU &amp; PICU. Higher mortality and morbidity rate for mechanically ventilated pediatric patients with VAP compared to those without VAP. Few data &amp; very few researches exist regarding VAP in pediatric patients to identify risk factors of VAP and that might be helpful for preventing VAP. This study was done to find out the predictors of VAP of neonate in Neonatal and Pediatric Intensive Care Unit.</p> <p><strong>Methodology: </strong>A prospective cohort study was carried out in NICU &amp; PICU of Dhaka Shishu (Children) Hospital, Dhaka. Neonates those not had pneumonia; requiring mechanical ventilation at least 48 hours in the NICU or PICU were taken for this study. Then VAP patients were selected by radiographic changes after 48 hours of intubation. Portable chest x-ray was done after 48 hours and as required after initiation of ventilation. Then details history were taken and some relevant investigation were done.</p> <p><strong>Result: </strong>Majority (51.4%) of the neonates belonged to age group 0-10 days. Male female ratio was 2.8:1. More than half (51.4%) were of gestational age 34 to &lt; 37 weeks. Sixty nine point four percent of the neonates had Weight &lt; 2.5 kg. Transferred from other NICU or PICU was found in 34.7% , prolonged mechanical ventilation was found in 40.3%, reintubation were 36.1%, prior antibiotics use were 73.6%, nosocomial infection were 76.4%, oropharyngeal aspiration were 11.1% and those having VAP were 79.2%. Age group 11-20 days (RR=1.41; 95% CI 1.18 to 1.67), gestational age &lt;37 weeks (RR=1.48; 95% CI 1.12 to 1.96), weight &lt;2.5 kg (RR=2.24; 95% CI 1.20 to 4.18%), nosocomial infection (RR= 3.21; 95% CI 1.53 to 6.73%), transferred from other NICU &amp; PICU (RR=1.47; 95% CI 1.21 to 1.79), Prolonged Mechanical Ventilation (RR=1.50; 95% CI 1.01 to 2.23%) and Reintubation (RR=1.48; 95% CI 1.21 to 1.81%) were found independent predictors for developing VAP. P value was found statistically significant (p&lt;0.05).</p> <p><strong>Conclusion: </strong>Age group 11-20 days, gestational age &lt;37 weeks, weight &lt;2.5 kg, transferred from other NICU &amp; PICU, prolonged mechanical ventilation, reintubation and nosocomial infection were regarded as predictors for VAP and those predictors were significantly associated with VAP.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :90-96</p> 2019-08-07T08:46:25+00:00 ##submission.copyrightStatement## The Clinical Efficacy of Multi-strain Probiotics in the Management of Acute Watery Diarrhoea of Children aged 2 Months to 5 Years-a Randomized Controlled Trial 2019-08-07T15:05:34+00:00 Mohammad Monir Hossain Ayesha Siddika Md Iqbal Hossain AKM Harunur Rashid SM Alinoor Islam Md Al Amin Mridha <p><strong>Background: </strong>Acute gastroenteritis is considered as one of the most common causes of under-five morbidity and mortality worldwide. Standard treatment is the use of oral rehydration solution (ORS), intravenous fluid if indicated, and zinc supplement. Recently, the use of probiotics has been introduced as an adjunct to the treatment of acute gastroenteritis. The aim of this study is to determine the clinical efficacy of multi-strain probiotics as adjunct treatment of acute gastroenteritis.</p> <p><strong>Methodology: </strong>A randomized controlled trial was done in 250 bed district Sadar Hospital, Brahmanbaria, Bangladesh from January 2016 to June 2017. After fulfilling the inclusion criteria, 507 children aged 2 months to 5 years were enrolled in this study. Those with dysentery, chronic diarrhea, diarrhea due to known genetic disorder, chronic illness, malnutrition, systemic infection, CNS disorder and congenital malformation were excluded. Children were divided into two groups randomly. One group was With Probiotic, zinc and standard WHO (ORS) as case and other group was Without Probiotic, zinc and standard WHO ORS as control.</p> <p><strong>Results: </strong>Among 507 children, 257 were without probiotic while 250 were with probiotic. The mean difference in stool frequency between the two groups were 3.3 after 24 hours, 3.5 after 48 hours and 1.6 after 72 hours after hospitalization which was statistically significant (p=0.000). Reduction of stool frequency was highest after 48 hours of admission. Mean duration of hospital stay was 4.40±1.22 days in control and 4.03±.89 days in case group. Probiotic group children with exclusive breastfeeding had mean recovery time of 3.95±0.85 days and those who were not exclusively breastfeed had recovery time of 4.2±0.95 days (p=0.025).</p> <p><strong>Conclusion: </strong>Probiotic is efficacious in reducing purging duration and frequency of acute watery diarrhea in children.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :97-101</p> 2019-08-07T08:46:36+00:00 ##submission.copyrightStatement## Skeletal Manifestations in Acute Lymphoblastic Leukaemia 2019-08-07T15:05:35+00:00 Mahmuda Begum LE Fatmi Khandaker Tarequl Islam Syeda Mehnaz SM Shamsul Huda Farhana Rahman <p><strong>Background: </strong>Skeletal manifestations associated with ALL in children are common findings with a high prevalence (11.6 to 50%). The most common skeletal manifestations are bone pain, arthritis, failure to use an extremity as well as other complaints mimicking orthopedic condition such as osteomyelitis. The objective of this study is to determine the rate of skeletal manifestations commonly present in ALL to reduce mortality and morbidity.</p> <p><strong>Methods: </strong>This cross-sectional study was carried out in the department of Pediatrics in Dhaka medical college Hospital, BSMMU and Dhaka Shishu (Children) Hospital between January 2010 to July 2010. Total Fifty patients of ALL were Selected consecutively from the study population. At first, we assessed skeletal manifestations like bone pain, arthritis, radiological findings present or not in ALL. Then specify the rate of bone pain, arthritis, radiological findings of ALL patients.</p> <p><strong>Results: </strong>After six months 35 patients were present with skeletal manifestations. Among them 20 patients, presented with bone pain,10 patients presented with arthritis and 5 patients presented with radiological manifestations. Out of 5 patients 3 patients had soft tissue swelling 1 patient had periarticular osteoporosis and 1 patient had joint effusion in x-ray findings.</p> <p><strong>Conclusion: </strong>Skeletal manifestations may be the only presentation in ALL.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :102-105</p> 2019-08-07T10:16:26+00:00 ##submission.copyrightStatement## Foreign Body Ingestion in Children: Urgency of Management 2019-08-07T15:05:14+00:00 Md Wahiduzzaman Mazumder ASM Bazlul Karim Md Rukunuzzaman Fahmida Begum Khan Lamia Nahid <p>The majority of foreign body ingestions occur in children between the ages of six months and three years. Most cases are brought to medical attention by their parents because the ingestion was witnessed or reported to them. Commonly ingested objects include coins, button batteries, toys, toy parts, magnets, safety pins, screws, marbles, bones, and food boluses. Many of the children are asymptomatic or have transient symptoms at the time of the ingestion. A careful history and physical examination are the keystones in diagnosing an esophageal foreign body and to the prevention of its complications. Imaging can be used to confirm the findings and to localize the site of the foreign body. Clinical management focuses on identifying and treating the cases at risk for complications, which depends on the location and type of foreign body. Timing of removal depends on nature of ingested object and signs &amp; symptoms of the airway/intestinal obstruction. Flexible endoscopy for most foreign body extractions is preferred.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :106-112</p> 2019-08-07T10:16:33+00:00 ##submission.copyrightStatement## Ketotic Hypoglycemia in Children: A Review 2019-08-07T15:05:22+00:00 Md Al Amin Mridha Abdul Matin <p>Ketotic hypoglycemia is the most common form of childhood hypoglycemia. Hypoglycemic episodes typically occur during periods of intercurrent illness when food intake is limited. The term ketosis should not be confused with Ketoacidosis. Children with ketotic hypoglycemia have plasma alanine concentrations that are markedly reduced in the basal state after an overnight fast and decline even further with prolonged fasting. The classic history is of a child who has eaten poorly or misses an evening meal, is difficult to rouse from sleep the next morning, and displays neuroglycopenic symptoms that may range from lethargy to seizure. Hypoglycemic episodes are especially likely to occur during an illness, when food intake is limited. Clinical diagnosis is made by identification of ketones in plasma and urine, Whipple’s triad hypoglycemia, and exclusion of endocrine/metabolic disease. It is therefore essential that appropriate investigation is performed at the time of hypoglycemia to exclude other causes This condition usually presents between the ages of 18 months to 5 years and it commonly remits spontaneously by the age of 8 to 9 years.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :113-116</p> 2019-08-07T10:21:24+00:00 ##submission.copyrightStatement## Atypical Presentation of Unicuspid Unicommissural Aortic Valve in Infant 2019-08-07T15:05:16+00:00 Md Tariqul Islam Mohd Zahid Hussain Tahmina Karim Md Mostafizur Rahman Bhuiyan <p>Unicuspid aortic valve (UAV) is a very rare congenital heart defect with an ill-defined natural history. It’s very important to diagnose early as UAV has a risk of sudden cardiac death and association of other congenital anomalies. Here we present a case of unicommissural UAV with severe AS, severe LV dysfunction diagnosed by colour doppler TT echo, successfully treated with balloon valvoplasty (BAV).</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :117-121</p> ##submission.copyrightStatement## Congenital Pulmonary Agenesis of Left Upper Lobe 2019-08-07T15:05:24+00:00 Probir Kumar Sarkar Nabila Akand Md Shakibur Rahman Md Kamruzzaman <p>Underdevelopment of lung is a group of congenital anomalies classified into agenesis, aplasia, and hypoplasia of lung, on the basis of presence or absence of lung parenchyma, bronchial tree, and pulmonary artery. The pathogenesis of such anomalies is not accurately known with several proposed theories. It is often associated with anomalies of the cardiovascular &amp; genitourinary systems. An isolated left upper lobe pulmonary agenesis is rare and more commonly involves the right upper and middle lobes. The prevalence of this condition has been noted to be 0.0034–0.0097%. It is associated with the absence of lung parenchyma, bronchial tree, pulmonary vasculature, and may remain undiagnosed until adulthood. Treatment depends on patient’s symptoms, with most patients being treated conservatively. Herein, we report an eight month old infant who presented with fever, cough, and respiratory distress and treated as a case of left sided pneumonic collapse consolidation without radiological improvement and finally diagnosed as a case of left upper lobe pulmonary agenesis with low serum IgA level.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :122-125</p> 2019-08-07T10:56:50+00:00 ##submission.copyrightStatement## Miliary Tuberculosis with Tubercular Uveitis Presenting as Fever of Unknown Origin: A Case Report 2019-08-07T15:05:29+00:00 Roksana Parvin Mahbub Mutanabbi Shamima Sharmin Shova Maria Kibtiar Farzana Sharmin <p>Miliary tuberculosis is a form of disseminated tuberculosis, which is more frequent in immunocompromised patient. Ocular involvement of mycobacterium tuberculosis is also an uncommon presentation of disseminated tuberculosis. Tubercular uveitis is most frequent form of ocular tuberculosis. If treatment is delayed, it may cause loss of vision. In many case of the systemic TB with ocular involvement, there may be no eye symptoms in early stage. On the other hand, many cases of ocular TB may not have any evidence of systemic TB. Here we have described a case of miliary tuberculosis with ocular uveitis who initially presented with fever without any significant physical findings and later developed eye symptoms including diminished vision.</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :126-130</p> 2019-08-07T10:56:57+00:00 ##submission.copyrightStatement## Abstract from Current Literature Vol.43(2) 2019-08-07T15:05:17+00:00 The Editor <p>Abstract not available</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :131-132</p> 2019-08-07T10:57:04+00:00 ##submission.copyrightStatement## Notes and News Vol.43(2) 2019-08-07T15:05:18+00:00 The Editor <p>Abstract not available</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) :133</p> 2019-08-07T10:57:57+00:00 ##submission.copyrightStatement## Corrigendum Vol.43(2) 2019-08-07T15:05:19+00:00 Md Al Amin Mridha <p>Abstract not available</p> <p>Bangladesh J Child Health 2019; VOL 43 (2) : 134</p> 2019-08-07T11:15:13+00:00 ##submission.copyrightStatement##