Monday, December 1, 2014

RDS or Hyaline membrane Disease - Classic X ray

A Preterm 33+ weeks male with Perinatal asphyxia presented with Rerpiratory distress at 16 Hour of life. The baby was in respiratory failure so was Intubated immediately and put under mechanical ventilation. The baby required high PIP as lungs were stiff.

Xray was ordered with showed-

Bilateral White out lung field with Air Brochogram.

In Such cases of RDS of Prematurity, best management would have been-
1, Dexamethasone or Betamethasone therapy intrauterine atleast 24 hrs before delivery to provide maturation of lungs.
2. Early CPAP to prevent collapsing of alveoli after delivery if any signs of Distress
3. If feasible , Surfactant therapy within 6 hours with FiO2 requirement increases.

Sunday, November 30, 2014

Newborn Resuscitation Protocol - AHA 2010 changes compared to 2005

Neonatal Resuscitation Guidelines by AHA 2010-

1.Introduction of Preductal Saturation cart
2. Removal of Color in assessment
3. MRSOPA - to check if ventilation has been effective
4. CPAP introduced
5. Bagging with Room Air
6. Heart Auscultation over Cord pulsation
7. Medication needed only 3

Saturday, November 8, 2014

Cooperaton For Improvement of oral health of Children in Nepal

Childhood is considered the golden period of life but it is also a phase when diseases are lurking in every nook and corner to attack these tiny buds. Like systemic diseases there are a number of oral health problems that affect children which includes tooth decay, various habits like thumb sucking, gum diseases, oral lesions and early tooth loss. Among these early childhood tooth decay is the number 1 chronic disease affecting young children and is 5 times more common than asthma and 7 times more common than hay fever. Teeth are at risk of dental caries from the time they start to appear in the mouth, putting children from approximately six months of age onwards at risk. Severe form develops very quickly and teeth may be destroyed within six months of its onset. Many of the dental diseases of the childhood can be prevented with proper education of the parents. To achieve this objective, a greater interaction between Pediatricians and Pediatric Dentists are important.

Pediatric Dentistry is the branch of dentistry dealing with children from birth through adolescence including children with special health care needs. Pediatric Dentists are the Pediatricians of Dentistry. Pediatric Dentists promote the dental health of children as well as serve as educational resources for parents. American Academy of Pediatric Dentistry (AAPD) and the American Academy of Pediatrics (AAP) recommend that a dental visit should occur within six months after the presence of the first tooth or by a child's first birthday. A Pediatric dentist has two to three years of specialty training (course) following dental school and limits his/her practice to treating children only. The American Academy of Pediatrics (AAP) recommends a child to visit a pediatrician 6 times in the first year of life and 10 times by 3 years of age. Pediatricians have the opportunity to provide care for children 6 times before the recommended visit to a dentist. In May 2003, the AAP developed a policy statement on oral health risk assessment timing and establishment of the dental home. The policy states “pediatricians and pediatric oral health professionals should develop the knowledge base to perform oral health risk assessments on all patients beginning at 6 months of age to identify high risk children at an early age in order to provide anticipatory guidance, behavior modifications in terms of oral hygiene and diet”.


The importance of dentistry during the early years of child’s life has been well documented. Pediatricians are considered to be in a unique position to contribute to the dental health of their child patients because children often visit their offices at a young age and the parents accept their recommendation well. They can contribute to oral health in the following manner:

Educate parents in many areas such as 
Good oral hygiene: educating the parents about the basics of maintaining oral hygiene.

Prevention  of dental injuries

Prevention of nursing caries by establishing proper feeding habits. Education about the  harmful effects of putting the baby to sleep with a bottle of milk as well as the effects of sugars from juice or milk  on a baby's teeth. The role of feeding habits on development of baby bottle tooth decay. 

Diet counseling demonstrating food guide pyramid and importance of healthy food habit for healthy teeth

Educating parents about the importance of the first dental visit, which is recommended at the time of the eruption of the first tooth and no later than 12 months of age.(AAPD guidelines)

CARIES PREVENTION:  assess whether infants receive optimal fluoride exposure from drinking water or in fluoride-deficient areas by supplementation.

REFERRAL of all children for routine dental care to limit destruction associated with the milder forms of caries as well as referral of infants with cleft lip and palate for fabrication of feeding obturators.

LIFTING THE LIP examination of the child during well baby visits to assess the initiation of decay as well as identify the oral hygiene status and other oral lesions.


Initial reverible stage: Chalky, white spots or lines; no pain.

Deep stage : Yellow or brownish discoloration or cavities; pain or sensitivity to hot or cold.

Damaged Stage: Advanced decay with loss of tooth structure. Moderate to severe pain.

Traumatic Stage: severe tooth decay and fractures of one or more carious teeth

Any of the above findings warrants a need to visit the dentist as soon as possible to prevent further progress and complications.


                        Initially in Nepal there was a dearth of Pediatric Dentists but today there are around 15 Pediatric Dentists registered in Nepal, working in various Dental institutions, hospitals and dental clinics. BPKIHS has started Post Graduate degree in PediatricDentistry and the first batch students have already acquired the degree. The only problem with people not seeking care at the proper place is lack of awareness regarding it. The Pediatricians are the first doctors for a child so they can play a major role in being the messiah of oral health by educating and referring the child to the proper channels. The co-operation from their side can help us nurture a child with a positive dental attitude as well. 
               With a little effort and co operation, together we can provide healthy smiles to children all over our nation.


Dr. Parajeeta Dikshit is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at Kantipur Dental College teaching hospital and research center Basundhara , Kathmandu and Consultant Pediatric Dentist at Smile Square Dental Care Center, Maharajgunj, Kathmandu.

Dr. Mamta Dali is an Assistant Professor, Dept of Pedodontics and Preventive Dentistry (Pediatric Dentistry) at BPKIHS, Dharan.

Friday, October 17, 2014

Healthy Food for Growing Children

Children require a steady supply of all the vital nutrients as they grow to facilitate healthy growth and development in general; physically, mentally and socially. In this article you will get to know about the necessary foods for growing kids, their nutrient compositions and their benefits to your child. Here is a detailed look:


Children spend most of their time playing and consequently utilize most of the energy present in their bodies. As such, it is important that carbohydrates be included in the child's diet so as to provide the body with sufficient energy to not only facilitate playing but also growth of strong and steady muscles, bones and wits.

Foods rich in carbohydrates and which are easy to find include:

Eggs Whole grains and cereals


Green vegetables


Fruits like citrus, berries, apples and watermelons among others.


Proteins are among the most vital nutrients for kids as they facilitate body building; directly affecting physical growth. They also help boost the body's immunity against certain illnesses, further ensuring healthy development. As such, you should ensure that your child gets a steady supply of proteins by eating foods like:

Eggs and other poultry products

Dairy products like milk, cheese and yoghurt

Beans and nuts

Lean meat

Vitamins and minerals

Vitamins are necessary for a healthy immune system in growing children. They help to directly improve the body's immune system, helping fight off infections which may be deadly if lest to spread in the body. Other vitamins also help improve the body's general capabilities like eyesight and skin firmness and texture among others. Minerals like calcium on the other hand facilitate growth of strong bones and teeth in the body.

Foods rich in vitamins and minerals include:

Potatoes, carrots and dark green leafy vegetables for vitamin A

Fruits like berries, tomatoes and citrus for vitamin C

Fish oil and cod liver oil for vitamin D to facilitate absorption of other minerals like calcium

Albeit it may not seem as important, fibers help keep the body's system clean and running smoothly while also improving digestion and proper body growth and development. They hence help keep your child feeling fit and comfortable.
They are easily obtained from foods like:

Legume like peas, beans and lentils among others

Fruits with peels like apples and peach

Brown rice and pasta made from whole grains

Bread made from whole wheat

Fats are considered to be generally bad by most people owing to the rising cases of overweight people. However, fats are just as vital as other nutrients. Furthermore, there is a wide range of natural foods with good fats as compared to unhealthy fats and cholesterol found in fast foods. Among other things, fats help store energy in the body for future use They also help give the skin a healthy and supple look and feel; enhancing a healthy and beautiful appearance.
Fats can be easily obtained from foods such as:

Dairy products like cheese, yoghurt and milk

Meat and oily fish

Avocados Margarine and butter

Conclusion. Ensuring that your growing child has a stable supply of these vital nutrients will facilitate strong and healthy body growth. This will consequently ensure that he/she is free of the common illnesses.

Author Bio:I am Jessica Cranwell, I am a Blogger and Freelancer. I love reading blogs, and writing for them on various themes like Travel, Auto, Lifestyle, Education and Health. As of now I am doing research of Ehic cards.

Tuesday, October 14, 2014

Blood Transfusion Guidelines in Neonates and Children- Red Cell Transfusion

Red Blood Cell transfusion is a common process in Neonatal Intensive care Unit, Pediatric Intensive care and in sick children. A guideline on when to give blood transfusion are provided below. These guidelines are derived from Worldwide accepted textbook - Nelson and Cloherty

Tranfusion Guideleines For Premature Infants- Cloherty

1.  Asymptomatic infants with Hct  less than 21 % and reticulocytes  less than 100, 000/UL (2%)

2. Infants with Hct less than 31% and any of below

  • hood O2 less than 36% or mean airway pressure less than 6 cm H2O by CPAP or IMV  
  • more than 9 apneic and bradycardic episodes per 12 h or 2/24 h requiring bag and mask ventilation while on adequate methylxanthine therapy 
  • HR more than 180/min or RR more then 80/min sustained for 24 h
  • Weight gain of less than 10 g/d for 4 d on 100 Kcal/kg/d 
  • Having surgery

3. Infants with Hct less than 36% and requiring more than 35% O2 or mean airway pressure 6-8 cm H2O by CPAP or IMV

CPAP = continuous positive airway pressure by nasal or endotracheal route; HR = heart rate; Hct = hematocrit; IMV = intermittent mandatory ventilation; RR = respiratory rate. From the multicenter trial of recombinant human erythropoietin for preterm infants.
Source: Data from Straus RG. Erythropoietin and neonatal anemia (Editorial). N Engl J Med 1994;330:1227.




   Acute loss of > 25% of circulating blood volume
   Hemoglobin < 8.0 g/dL[†] in the perioperative period
   Hemoglobin < 13.0 g/dL and severe cardiopulmonary disease
   Hemoglobin < 8.0 g/dL and symptomatic chronic anemia
   Hemoglobin < 8.0 g/dL and marrow failure

   Hemoglobin < 13.0 g/dL and severe pulmonary disease
   Hemoglobin < 10.0 g/dL and moderate pulmonary disease
   Hemoglobin < 13.0 g/dL and severe cardiac disease
   Hemoglobin < 10.0 g/dL and major surgery
   Hemoglobin < 8.0 g/dL and symptomatic anemia