Nepal: Kanti Childrens Hospital

Laxmi Balami’s Baby

Intestinal Obstruction

The 4-day-old son of Laxmi Balami was brought from Makawanpur to the Emergency Department of Kanti Children’s Hospital on September 21, 2018 at 12:30am with multiple episodes of vomiting and abdominal distention. He also had not passed a stool since birth.

The patient appeared very ill, although his vitals were stable. All the baseline laboratory tests and investigations were done, including an abdominal x-ray. The x-ray revealed bowel obstruction with multiple air-fluid levels, and a provisional diagnosis of jejunal atresia, a congenital disorder that affects the small intestine and colon and causes obstruction, was made.

The patient was admitted to the Surgical ICU of Kanti Children’s Hospital and underwent emergency surgery on the same day. The surgical process began with an exploratory laparotomy (an investigative surgical procedure), followed by a resection and end-to-back anastomosis to reconnect the structures. During surgery, the diagnosis of jejunal atresia was confirmed.

The patient stayed on the SICU postoperatively for 7 days until he was transferred to the Surgical ward where he stayed for 3 more days. The patient was recovering well and was discharged on the 10^th postoperative day. The baby’s parents are glad that their son’s surgery and full course of treatment were successful, and that he has fully recovered.

Bipin Chaudhary

Receives Surgery for Diaphragmatic Hernia

Bipin Chaudhary, a 4 -year-old boy from the rural village of Dang, was brought to Kanti Children’s Hospital on August 24, 2018 with occasional difficulty breathing since the age of 1. He was diagnosed with a congenital left diaphragmatic hernia one year prior to admission and came to Kanti Children’s Hospital for a planned surgery to treat the condition. As a result of his diaphragmatic hernia, Bipin also has a history of recurrent pneumonia and respiratory tract infections and has been hospitalized several times.

Bipin was admitted to the Surgical ward and underwent surgery to repair the diaphragmatic hernia on August 26, 2017. The surgery was complicated, and it took around three hours. He was kept in Surgical ICU for 5 days postoperatively until he could feed normally and his general condition stabilized. Later, he was transferred back to the Surgical ward and was discharged from the hospital on September 3.

Bipin’s mother accompanied him in the hospital, while his father was out of the country for foreign employment. However, they were both happy that Bipin was treated for his congenital disorder at Kanti Children’s Hospital, and they were thankful to the doctors and other staff.

Sushila Mijar

Begins Emergency Treatment

Sushila Mijar, a 9-year-old girl, was received in the Emergency ward at 4:30 pm on July 29, 2018. On arrival, she was in poor general condition; she had been suffering from a cold, cough, and fever for 9 days and having difficulty breathing. Her oxygen saturation was low at 86%, so oxygen therapy was started. When her vital signs were recorded, her temperature was 97°F, her pulse was 132bpm, and her respiration was 38 breaths/min. She was given antibiotic injections of Taxim and Fluclox, as well as a dextrose injection to maintain her electrolyte levels. She also received nebulizer therapy with salbutamol to open up her airways.

Sushila’s general appearance was abnormal; a dilated vein was present on her scalp, and she showed clear signs of delayed growth and development. The treatment process was ongoing, but Sushila’s condition was not improving, so doctors planned to transfer her to the PICU. The patient’s party was also counseled about her condition and PICU referral.

Kabiraj Karki

Recovers from Bronchiolitis

Kabiraj Karki, a 3-month-old boy from Ramechhap, was admitted to the Medical ward on September 22 with a diagnosis of bronchiolitis. According to the mother, Kabiraj was well until 4 prior to admission when he developed a cough as well as abnormal breathing sounds. He was taken to the local health care facility where he received nebulizer therapy, and from there patient was referred to Kanti Children’s Hospital.

When Kabiraj arrived in the Medical ward, he had a fever of around 101°F, so a cold sponge was used to cool his body, and 6 paracetamol drops were administered. His SpO2, or blood oxygen saturation, was at only 84%, so he was started on oxygen therapy via headbox. Nebulization therapy with Asthalin, a respiratory medication, was administered every six hours during hospitalization. Kabiraj also received of 350mg of the antibiotic Taxim via IV, as well as 35mg of hydrocortisone, Kidperd syrup to treat inflammation, and Beta2-agonists to further help open his airways.

Different lab investigations such as complete blood count (CBC), biochemistry, urinalysis, and an x-ray produced normal results. Once Kabiraj’s condition had improved, he was discharged on September 25 with a follow-up planned after 5 days. At discharge, hospital staff explained the key danger signs to the patient’s party and advised them to bring Kabiraj to the health facilities immediately if those symptoms arise.

Manisha Dahal

Suffers from Enteric Fever

Manisha Dahal, a 12-year-old girl, was admitted to the Medical ward on September 22 with a diagnosis of enteric fever. According to the patient’s party, she was well until one week prior to admission when she developed abdominal pain. She had no history of painful urination or joint pain.

When Manisha was received in the Medical ward, her temperature was 100.8°F, her pulse was 82bpm, her respiratory rate was 26 breaths/min, and her SpO2 without oxygen therapy was 85%. As a result of her low SpO2, she was started on oxygen therapy via face mask at 2 liters per minute. Her SpO2 level was monitored regularly, and on the first day of admission it reached normality, and oxygen therapy was discontinued. 1000ml of dextrose normal saline (DNS) was administered via IV every 24 hours throughout hospitalization.

Various lab investigations came back with normal results. Since Manisha’s fever was continuous, the patient’s party was provided a cold sponge. The patient also received 250mg paracetamol tabs for her fever, a 1g Monocef antibiotic injection, and 15mg of Aciloc to relieve gastric discomfort. Upon discharge, she was prescribed Cefexime antibiotic syrup, Aciloc, and Vigoran, a vitamin B oral complex, for five days. Once Manisha’s body temperature returned to normal and her abdominal pain subsided, she was discharged on September 25 with a follow-up planned after a week.