Nepal: Kanti Childrens Hospital

Baby of Geeta Kayastha

Receives Surgery for Bowel Obstruction

Geeta Kayastha’s 14-day-old son from Bhaktapur was admitted to the Pediatric Surgery Department of Kanti Children’s Hospital on August 25, 2017 with a provisional diagnosis of small bowel atresia/obstruction. According to the mother, the baby was delivered full term in a hospital, and the birth had no complications. At the age of 14 days, the baby began to vomit after every feeding. After examining the baby, the doctor did not initially find any health problems. However, during the consultation, the baby vomited. At that time, the physician changed his mind about the baby’s health status, told the parents that he suspected intestinal obstruction, and advised them to take him to a pediatric surgeon.

The baby was quickly brought to Kanti Children’s Hospital’s Emergency Unit for further treatment. He went through all baseline laboratory tests and a plain x-ray of the abdomen was done. All the laboratory test results were normal.  The patient was kept in observation on IV fluid as he was still vomiting bile in spite of normal bowel movements and a soft abdomen. The next morning when the mother was asked to breast feed, the baby vomited bile again. Doctors decided to conduct a barium follow through, a type of stomach and small bowel examination that revealed more evidence of a small bowel subacute obstruction. Emergency surgery was planned, but it took 3-4 hours to get informed consent from the parents who at the time believed surgery was not necessary.

All the required presurgical laboratory tests were done before patient’s admission to the surgical ward, and a blood transfusion was arranged. Perioperative findings revealed incomplete intestinal malrotation, a congenital disorder which affects the position of the intestines, and Ladd’s procedure was performed to correct it. The surgery was successful. Following surgery, the patient was kept in the SICU for 4 days on IV fluids, antibiotics, and analgesics. He began feeding 5 days after the operation and was transferred to the general surgical ward. The patient was discharged 6 days after the operation with postoperative care instructions and a follow-up appointment scheduled in the Surgical Outpatient Department. The patient was seen in the SOPD with no further complications.

Baby of Bishnu Maya Shrestha

Treated for Hirschsprung’s Disease

Bishnu Maya Shrestha’s 3-day-old son from Dolakha was admitted to the Pediatric Surgery Department of Kanti Children’s Hospital on September 22, 2017 with a provisional diagnosis of Hirschsprung’s Disease (HD), a congenital disorder of the large intestine. According to the mother, the baby was delivered vaginally at 36 weeks of gestation at Bharatpur Hospital and his birth weight was 2.5kg. The baby was admitted to the neonatal ICU for continuous positive airway pressure (CPAP) for respiratory distress which was improved within 6 hours.

Upon examination, the baby was found to have abdominal distension and had not passed his meconium (first bowel movement). An abdominal x-ray showed a dilated bowel loop and no rectal gas. The patient was admitted to a surgical ward where it was found that he had a large amount of gastric content not composed of bile.

During his stay at the hospital, the baby passed scant amounts of stool. A detailed history of both patient and mother was taken, and it was found that during the antenatal period the mother had gestational diabetes which required insulin therapy. All baseline laboratory tests were run, and an abdominal x-ray revealed evidence of neonatal small left colon syndrome (NSLCS). The baby passed large amount of meconium after contrast enema.

The patient was kept in SICU for 3 days. He began feeding 2 days after admission and was discharged after 5 days with instructions and a follow-up appointment in the Surgical Outpatient Department. The patient had no complications as of his follow-up appointment.

Aviyana Magar

Receives Surgery for Diaphragmatic Hernia

Aviyana Magar is a 2-year-old girl from Naikap-4, Kathmandu. She was admitted in to the Pediatric Surgery Department of Kanti Children’s Hospital on July 17, 2017 for elective surgery for a right sided diaphragmatic hernia which was diagnosed when she was 6 months old. According to the mother, the patient was delivered at the Primary Health Care Center after a normal pregnancy. At 7 days old, Aviyana started having shortness of breath and difficulty feeding. She was taken to local doctor, prescribed medication for a chest infection, and sent back home. Aviyana’s symptoms subsided, and she felt well until she reached 5 months of age when the symptoms recurred along with a fever, and she was taken to a local clinic for treatment. As her symptoms were not relieved by any medication, she was referred to Kanti Children’s Hospital’s Outpatient Department for the further evaluation and management.

Aviyana was given a provisional diagnosis of pneumonia and diaphragmatic eventration, a condition in which the diaphragm is elevated abnormally, and was admitted to the Pediatric Ward. A chest x-ray revealed a rare case of right sided diaphragmatic hernia (left-sided diaphragmatic hernias are far more common). The patient was treated and discharged, and a CT scan and follow-up in the Pediatric Surgery Department for further management were advised. As Aviyana was in stable condition, elective surgery was planned.

All the baseline presurgical laboratory tests were done, and a blood transfusion was arranged before the patient was admitted to the surgical ward. Aviyana was prepared for the operation on July 18, 2017. The surgery went as planned, and she was kept in the SICU for 4 days on fluids, antibiotics, and analgesics. Aviyana was transferred to the general surgical ward 5 days after the operation and discharged 2 days later with postoperative care instructions and a follow-up appointment scheduled in the Surgical Outpatient Department, where she was seen with no further complications.

Baby of Rita Majhi

Rescued from Critical Condition

Rita Majhi’s 1-day-old son was brought to Kanti Children’s Hospital as a referral case from Sindhuli Hospital. When he entered the hospital’s triage area, he was lethargic and turning blue. The baby also seemed to have a very low birth weight. Immediate response was needed, so RMF Nurse Samita tagged the baby with code red, and the on-duty doctor attended the case promptly.

The baby’s vital signs were weak, his respiration was forceful and irregular, and his oxygen saturation was only 78%. Upon weighing, the baby was only 1.5 kg. It was discovered that the baby was born prematurely, and basic tests such as septic screening were done, as premature babies are often susceptible to neonatal sepsis and its complications.

The patient’s vital signs were frequently monitored as he was in critical condition. He needed incubator and intensive care, thus an NICU consultation was done and the baby was moved to the NICU. An IV access was opened, and IV fluid was started in order to maintain the baby’s blood glucose levels as well as fluid and electrolyte levels. Antibiotics were also started in order to control infections.

RMF Nurse Samita counseled the parents during their child’s stay in the Emergency Unit, and they cooperated well throughout the treatment of their baby. They also thanked the Nurse Samita for her swift medical attendance and for initiating the treatment of their only child.

Heera Majhi

Recovers from Pneumonia

Heera Majhi, a 4-year-old girl from Sindhupalchok, was admitted to the Medical Ward on September 1, 2017 with a diagnosis of pneumonia. According to the patient’s mother, she had a fever on and off for 3 weeks as well as abdominal pain and a headache for 1 week. On arrival at the ward, Heera had a high temperature and was breathing rapidly. Her oxygen saturation level was also lower than normal, and she was coughing intermittently.

After a general examination, Heera was positioned comfortably and given nebulizer therapy to ease the cough and other respiratory symptoms. She was given medication to control her fever, and her mother was also taught other methods of temperature reduction such as cold sponging, room ventilation, and giving warm fluids.

With industrious care from RMF Nurse Rusa, Heera’s general condition drastically improved over the next few days. Nurse Rusa taught the mother about the importance of maintaining hygiene and nutrition for the improvement of general health and recovery from illness. She also taught the mother the importance of preventing contact between the sick child and others to prevent the spread of infection.

As Heera’s condition was improving, she became more active and began to engage in play activities. She was discharged after 7 days, and at the time of discharge Nurse Rusa taught the mother about medication and follow-up.