NLS Update 2022

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Update to NLS instructors in Nepal about recent changes in guidelines. Preseneted by Madhavi and moderated by Anil.

  • In management of the umbilical cord, clamping after at least 60 seconds is recommended, but if this is not possible cord milking is an option in babies > 28 weeks gestation.

  • In non-vigorous infants born through meconium, immediate laryngoscopy with or without suction after delivery is not recommended.

  • Laryngeal mask may be considered in infants of ≥ 34 weeks gestation (>~2000g) if face mask ventilation or tracheal intubation is unsuccessful.

  • If there is no response to initial inflations despite an open airway, consider increasing the inflation pressure.

  • A starting pressure of 25 cm H2O is suggested for preterm infants < 32 weeks gestation.

  • Initial delivered oxygen concentration depends upon gestation:

    • ≥ 32 weeks gestation - 21% oxygen

    • 28-32 weeks - 21-30% oxygen

    • < 28 weeks - 30% oxygen.

  • In babies < 32 weeks, delivered oxygen concentration should be titrated to achieve saturations of > 80% at 5 minutes.

  • Intraosseous access is an alternative method of emergency vascular access if umbilical access is not possible.

  • Both initial and subsequent IV/IO adrenaline doses are 20 micrograms kg-1 (0.2 mL kg-1 of 1:10,000 adrenaline (1000 micrograms in 10 mL)), in the absence of a response to CPR give repeat doses every 3-5 minutes.

  • Stopping resuscitation should be considered and discussed if there has been no response after 20 minutes and exclusion of reversible problems.

Charity Donation

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I was overwhelmed to receive a donation for our charity from Mrs Norah Beach. She is a sweet old lady who has been my patient for a long time. Last time when she was in the clinic, one of the nurses told her about HExN charity. I told her that I was originally from Nepal and gave her our leaflet to explain our work. Today suddenly, I got a call from discharge lounge to come and see her. She gave me a cheque for £100 which I believed is valued relatively more than any other big donations. Long live Britain Nepal friendship.

School eye screening

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HExN was delighted to support Dr Sangeeta Shrestha and her team to conduct two days eye screening program on 23 & 24 Dec 2021 in Ganesh Secondary School, Budhanilkantha, Kathmandu. Their team screened 362 students out of which 64 had refractive errors, which with correction will enable students to see better and help concentrate on studies. They also found other problems in 12 students.

Child Protection Recognition and Response (CPRR) Course, Nepal

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Dr Deepak Upadhyay

The Child Protection Recognition and Response (CPRR) Course, designed for healthcare professional   was developed by the Royal College of Paediatrics and Child Health in the UK in response to the recommendations from Lord Laming Enquiry in 2003. In spring of 2016, a 4 days CPRR course was held at Kanti Children Hospital, Kathmandu delivered by the visiting Paediatricians and Nurses from the UK. The aim was to raise the awareness of child abuse and neglect, to encourage effective response including referrals to the appropriate agency and to support the development of a multiagency response in the Nepalese context when a child abuse is suspected. Since then a number of courses have been held between 2017 and 2019, led by the local doctors and nurse at Kanti Children Hospital, with support from the visiting UK Paediatricians & nurses. Between 2019-2021, with restrictions due to Covid-19, a series of virtual (ZOOM) CPRR courses were organised for the Paediatricians and Nurses from the regional and Zonal Hospitals of Nepal.

The course was rated highly from the participants, and subsequent stakeholders meeting was attended by the Ministry of Health representative, UNICEF, CWIN, Police department, local Journalist s and was successful in escalating this issue to the Government and non-Government stakeholders. There has been ongoing collaboration between the Nepal Paediatric Society and Nepal Paediatric Nursing Association and Child Rights group of Nepal.

These courses have been funded by two Nepal focussed charities, So The Child May Live (STCML) and Health Exchange Nepal (HExN), UK.

What we have achieved

1.       More than 150 doctors and nurses have been trained, including a dedicated pool of trainers to take this work forward.

2.       Two Senior Paediatricians from Kathmandu have taken part in Advanced child protection training programme at Alderhey Children Hospital, UK with huge impact on the progress of this project.

3.       Two Nepal focussed Charities in UK, ‘So The Child May Live’ and ‘Health Exchange Nepal ’ have agreed to fund this project for further 3 years with the aim for continuing training of the doctors and nurses from the Hospitals in 7 provinces of Nepal.

4.       The project has helped to identify the designation of Named doctors and nurses in participating hospital, and establishment of effective multi-agency referral and management pathways for the children presenting with suspected abuse or neglect.

5.       The project showcases an example of effective collaboration between professionals from high-income and low-income countries for the best interest of children worldwide.

Gauri Subarna Trust Fund

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In the memory of HExN Member Late Dr Subarna Shrestha, his wife Dr Gauri Shrestha has established ‘Gauri Subarna Trust Fund’. Five million Nepalese Rupees was donated to Nepal Heart Foundation (NHF) to support poor patients in Nepal for pacemaker implant and prevention of Rheumatic Heart Disease. Established in 1988, NHF (https://nepalheart.wixsite.com/nehfc)  promotes public awareness to reduce the incidence of heart diseases, which is increasingly becoming the leading cause of morbidity and mortality in Nepal.