Iranian Journal of Pediatrics
Year:2018 | Volume:28 | Issue:4|Papers Count:15

Background: Understanding the risk factors for neonatal hypernatremic dehydration (NHD) may help to control the problem of these infants.Objectives: In this study, the level of platelets in NHD infants and its relationship with prognosis have been evaluated.Methods: This study consisted of 390 neonates who were referred to the Neonatal Clinic, EmergencyWard and Neonatal Intensive Care Unit in Ghaem Hospital, Mashhad, Iran from 2011 - 2017. Demographic data, symptoms of disease, physical examination, and laboratory investigations were evaluated in these patients. At first, based on the serum sodium level, the infants were divided into two groups: isonatremia (serum sodium level<150 mEq/L) and hypernatremia (serum sodium level³ 150 mEq/L). In the next stage, the infants were divided into two groups: hypernatremic dehydration with normal platelet levels (platelet³ 150, 000 /mcl) and hypernatremic dehydration occurring with thrombocytopenia (platelet³150, 000 /mcl). In the next step, the NHD infants were followed up using the questionnaire existing in Denver Developmental Test II (DDT II) at 6, 12, 18, 24, 30 and 36 months.Results: Thrombocytopenia was observed in 41% of patients with hypernatremia and 6% of isonatremic infants (P<0.05). Significant differences were found between the groups of normal platelet and low platelet levels in terms of age, sex, weight loss, blood glucose, sodium, blood urea nitrogen, creatinine, complications and prognosis (P<0.05).Conclusions: Our findings showed a strong relationship between hypernatremia and thrombocytopenia in NHD infants. There were more complications and worse prognosis in patients with thrombocytopenia (P<0.05).

Objectives: We aim to characterize cardiac morphological and functional changes by echocardiography that are present in theearly and late stages of Duchhenne type muscular dystrophy (DMD).Methods: Sixty-two patients with DMD and 62 healthy children were included in the study. Study group was divided into patients with systolic dysfunction group Ia and those without systolic dysfunction group Ib. Transthoracic echocardiography was performed in all individuals in the study. Left ventricular end diastolic diameter (LVEDd), left ventricular end systolic diameter (LVSd), posterior wall thickness (LVPWd), interventricular septal thickness (IVSD), ejection fraction and fractional shortening (FS), LV mass index (LVmassi), early (E) and late (A) transmitral inflow velocities, the ratio of early-to-late peak velocities (E/A) were recorded. Tissue Doppler measurements of the peak early (E’) and late diastolic (A’) annular velocities, Doppler measurements of pressure half time (PHT) and mitral valve area were measured.Results: DMDpatients had significantly higher LVmass, LVmass index and mitral valve area (P<0.05). Patients showed significantly lower EF values (P<0.001), SF (P<0.001), stroke volume (P<0.05), cardiac output (P<0.05), Mitral valve PHT (P<0.001), Mitral E’ (P<0.001), Mitral A’ (P<0.001), E’/A’ ratio (P<0.001) than the control patients. Group Ia patients had higher age, LVH and LV mass index, LVEDd (P<0.05), LVSd (P<0.05), IVSd (P<0.05) and LVPWd (P<0.05) compared to group Ib patients (P<0.05). There was a positive linear correlation between age and LVPWd (P<0.001, r=0.446).Conclusions: Our study showed that diastolic functions began to deteriorate in the early phase of DMD and systolic impairment begins subclinically in early stages.

Objectives: The present study aimed to investigate the efficacy of the ultrasound-guided wire localization of the anal tract and sphincter muscle complex in the patients with imperforate anus.Methods: This study was conducted on 20 patients (4 females and 16 males) with imperforate anus referring to the Doctor Sheikh and Akbar Pediatric Hospitals, Mashhad, Iran, between2016 and 2017. The trans-perineal ultrasonography was performed under general anesthesia to identify the location and direction of the anal tract, which was checked by a muscle stimulator. Then, the localization needle was inserted in the center of the anal pit and anal sphincter muscle complex until it reached the rectal pouch.Eventually, by using the wire as a guide, the rectum was brought to the middle of the sphincter complex through the minimally invasive pull-through procedure.Results: The anal sphincter muscle complex (concentric hypoechoic muscle) could be seen in all patients with the thickness of 1.8 -3.6mmand mean of 2.6mm. The anal pit (the multi-layer view) was visualized in all patients, except in two cases with clinically lowtype imperforate anus. Muscle stimulator findings showed that the wire was located in the middle of the sphincter muscle complex in all patients. Mean localization time was 38 min.Conclusions: The ultra sound-guided wire localization of the anal tract facilitated the implementation of a less invasive and anatomically corrected rectal pull-through operation in patients with imperforate anus.

Background: Doppler - derived fetal pulmonary artery acceleration time (PAAT) and acceleration - to - ejection time ratio (AT/ET) are important as predictors of a variety neonatal pulmonary diseases. The evaluation of PAAT and PA AT/ET are meaningful when simultaneous right and left heart studies are done. The unique cardiovascular physiology in the fetus, as the only period of life with physiologic systemic pulmonary hypertension, overemphasizes the significance of simultaneous study. However, studies on comparative fetal velocitometry of PA and aorta are scarce.Objectives: The aims of this study were to provide reference values for peak systolic velocity (PSV), pulsatility index (PI), acceleration time (AT), ejection time (ET) and AT/ET ratio of PA and aorta in the singleton pregnancies with healthy fetuses. We compared these Doppler parameters of PA and aorta.Methods: A cross - sectional study was performed on 146 fetuses. We measured PSV, PI, AT, ET and AT/ET in the PA and aorta and compared the values. We evaluated the correlation between these parameters and the fetal gestational age (GA).Results: MeanSD of gestational age of fetuses were 21±4 weeks. PSV, AT and AT/ET of PA and aorta increased with gestational age.PSV, PI, AT and AT/ET were significantly lower in the PA relative to the aorta.Conclusions: Despite equal pressures in PA and aorta in the fetal period, the PSV, PI, AT and AT/ET are lower in the PA. This study indicates that, in contrast to children and adults, PA pressure is not the major determinant of fetal PAAT.

Background: One of the most common problems noted in newborn hearing screening (NHS) programmes is the high rate of infants that are lost to follow-up at various stages of the programme.Objectives: The current studyaimedto explore factors associated with follow-up return rate in a risk-basednewbornhearing screening programme.Methods: A longitudinal, repeated measures research design was employed. Caregivers of participants who did not keep appointments while enrolled in a NHS programme were contacted to determine reasons for non-attendance.Results: Twohundred and sixteen of the 325 participants (66.5%) returned for the repeat screening. Follow-up return rate decreased significantly to below 50% for follow up diagnostic assessment. Reasons for non-attendance varied, with the most common reason being change of residential location. Results indicated a significant, but weak association between the hospital and whether or not infants returned for the repeat screening. The mean maternal age of mothers who returned with their newborns for diagnostic assessment was significantly higher than that of those who did not return.Conclusions: Reasons for follow-up default are influenced by contextual challenges, but may be improved by aligning appointments with other medical follow-up services. Follow-up return rate in the current study highlights the need to explore the need for risk-based surveillance programmes, as well as why follow-up return rates may differ between hospitals.

Objectives: Thyroid hemiagenesis (THA) is a congenital anomaly of unknown origin. The aim of this study was to assess for the firsttime whether there is any seasonality in the date of birth of patients with THA in comparison to general population.Methods: The studied group consisted of 105 patients with THA. The control data regarding total live births in Poland were derived from the Polish Statistical Annals (n=2 421 384). Both groups were subdivided according to the month of birth, season of birth and quarter of the year.Results: Analysis of the months of birth revealed that patients with THA were born significantly less often in October than control subjects (P=0.0217). Although a trend is observed, that more patients with THA were born in the 1st quarter of the year and in winter, while THA patients were less often born in autumn or in 4th quarter of the year, the difference did not reach statistical significance.Conclusions: Month of birth may exert some effect on the risk of developing THA. Studies on larger cohorts are needed to confirm the observation. The results suggest a potential modifying effect of environmental factors in the pathogenesis of THA.

Background: Patent ductus arteriosus (PDA) is a common cause of morbidity and mortality among preterm infants. This study aimed to assess the efficacy of prophylactic parenteral paracetamol dosage to decrease rate of ductus patency in preterm infants.Methods: The study was a randomized double-masked clinical trial that was conducted at Afzalipour tertiary medical center (Kerman, Iran) between Novembers 2015 and 2016, recruiting 160 neonates with gestational age less than 34 weeks who were equally divided into case and control arms. The neonates of case group received parenteral paracetamol with the loading dose of 20 mg/kg and maintenance dose of 7.5 mg/kg every 6 hours during first three postnatal days and the neonates of control group received nothing.Thereafter, echocardiography was done at the day 4 to detect any ductus patency.Results: Among the included infants and after intervention, 12 (15%) in case group and 57 (71.25%) in control group had PDA. Ductus patency incidence among the neonates of case group was significantly lower than in control group. Means of assisted ventilation requirement, cardiac shortening fraction and mortality rate were not significantly different comparing the two groups.Conclusions: This study showed that the prophylactic dosage of parenteral paracetamol can prevent ductus patency and accounts as a trustworthy alternative to the traditional drugs e.g. Ibuprofen or Indomethacin.

Background: Cow milk protein allergy (CMPA) has been reported to be associated with the alterations of gut microbiota. However, changes in the fecal microbial community for children aged 5 - 8 years with CMPA have not been clearly elucidated.Objectives: The aim of the study is to assess the differences and relationship between fecal microbiota and levels of fecal short-chain fatty acids (SCFAs) and lactic acid in 5 - 8-year-old children with CMPA, compared with the normal children.Methods: We enrolled6CMPAchildrenand8 healthy children from Harbin children’s hospital (Heilongjiang, China). Total bacterial DNA of all fecal samples was extracted and prepared for bioinformatics analysis by 16S rDNA amplicon sequencing. Lactic acids and SCFAs were measured by the high-performance liquid chromatography (HPLC) technique.Results: Compared with healthy individuals, the fecal microbial community of CMPA children showed a significant increment of Firmicutes and depletion of Proteobacteria (P<0.05). At the class level, the number of Clostridia was observed to be significantly increased in the CMPA children’s fecal microbiota. Meanwhile, the diversity ofRuminococcaceae and Subdoligranulum was higher in the fecal microbiome of CMPA children than in healthy children (P<0.05). Furthermore, linear discriminant analysis of effect size (LEfSe) revealed some significantly enriched taxa of CMPA children and control subjects. There are 40 and 5 enriched taxa in the fecal microbiota of children with CMPA and healthy children respectively. The concentration of total SCFAs was lower in feces of CMPA children than in healthy children. Lactic acid had a significantly negative correlation with the abundance ofBacteroides.Conclusions: Alterations in the composition of fecal microbiota and SCFAs in the 5 - 8-year-old children with CMPA may reduce immune function and potentially promote this allergy.

Background: Transfusion-associated graft-versus-host disease is a complication being mortal in 90% of cases. Today, Co-60 devices are utilized for the suppression of the lymphocytes to prevent this complication. Due to problems such as radioactive source age, problems in source replacement, and protection risks, we sought to replace a linear accelerator for this purpose and carefully determinate the X-ray dose and other settings.Methods: First, the venous blood of the right-handed people with blood group O+was exposed to different radiation doses of Linac and diluted. The proliferative responses of the exposed cells were examined by MTT assay and TB in comparison with controls after 48h. The average percentage of cell survival at each delivered dose and the required dose of radiation for the inhibition of lymphocyte proliferation were checked and the optimal dose of radiation was obtained as 25 Gy in a special radiation condition.Results: The results indicated that the irradiation with 25 Gy at 3.5 Gy/min in the internal mid-plan by compact 6MV for 30*30-field size at an 8 cm-distance of the samples to the source and 1370-monitor unit could completely suppress the lymphocytes. Under the same condition and 1096-monitor unit for total 20 Gy, we did not find optimal results.Conclusions: In this research, we found that a linear accelerator in a specific exposure condition is a suitable alternative for Cobalt-60 sources and the above-mentioned condition of irradiation can be used to overcome the GVHD concern.

Background: Nephrocalcinosis to the presence of calcium salts within renal tissue. Infants and children are more likely to have an underlying etiology for nephrocalcinosis including inherited errors of metabolism, anatomic abnormalities of the urinary tract, renal disorders, vitamin D excess, medication and prematurity. The body growth and renal function have rarely been investigated concerning children with nephrocalcinosis (NC).Objectives: This study aimed to evaluate effect of NC on growth index and kidney function of patients according to its cause.Methods: This study was conducted on twenty-eight now 2-27-year-old patients with NC who were admitted or referred to Loghman Hakim Hospital within 2006 and 2013. The patients’ data were recorded in terms of age, gender, NC etiology, clinical presentation, GFR, standard deviation scores of height and weight, and follow-up period. Data was imported to the SPSS software version 18 and analyzed using statistical tests.Results: Mean age of the participants was 2.5±2.2, ranging from 0.1 to 9.7 years. Fourteen (47%) patients were male. Mean follow-up time period was 7.1±5.2, ranging from 1.0 to 20.9 years. The most common clinical presentations leading to the NC diagnosis were urinary tract infection (25%) and growth retardation among 18% of the patients. The NC was rooted in distal renal tubular acidosis (dRTA) regarding 34.5% of the subjects, idiopathic hypercalciuria (IHC) in terms of 17.2% participants, Bartter syndrome in 10.3% and other different factors in 31.1% of the participants and cause of the NC was unknown in 6.9% of the subjects. Mean glomerular filtration rate (GFR) was 75.6±29.1 in presentation and 105.7±21.9 ml/min/1.73m2 in follow-up (P<0.001). There was no significant decrease in height and weight SDS from the first to last observation. Also, a significant increase of BMI was observed from first to last observation.Conclusions: Findings revealed that nephrocalcinosis has no significant effect on growth index and glomerular filtration within a long term and its impact depends on the underlying causes.

Dear Editor, Thank you for providing us an opportunity to report a case of rare atypical Kawasaki disease (KD). As we know, KD is an acute febrile illness of childhood associated with vasculitis of medium-sized arteries, especially the coronary arteries.Through this letter, we would like to share our experience managing the case of a 7-month-old boy suffering from a rare atypical KD, which presented as intestinal pseudo-obstruction without fever. …

Background: Effective and safe procedural sedation is necessary for percutaneous liver biopsy in children. There are a number of different protocols for this purpose. The current study investigated ketamine and DPT cocktail (meperidine (Demerol â) +promethazine (Phenergan â) +chlorpromazine (Thorazine â)).Methods: The current cohort of 80 Iranian children aimed at investigating percutaneous liver biopsy. Each of the 2 study groups (ketamine and DPT) included 40 patients. Both groups were matched by age (number of participants under and above 7 years old).The current study evaluated the efficacy of 2 protocols by CHEOPS (children’s hospital of Eastern Ontario pain scale) and visual analogue scale (VAS) pain scoring system and sedation scoring A, B, C, and D.Results: Ketamine group was sedated and recoveredmuchmorerapidly than the DPT receiving patients. Also, they had significantly less pain during the biopsy. The mostcommonside effect of ketamine was vomiting (27%); in the other group, transient hypotension and tachycardia were more common.Conclusions: Ketamine is a safe and effective choice for procedural sedation in percutaneous liver biopsy in children.

Background: Advances in neonatal care have resulted in improved survival for very low birth weight infants (VLBWIs). However, the main factors that lead to early weight Z-score [standard deviation score (SDS)] changes during hospital stay in VLBWIs still need to be studied more.Objectives: In this study we aimed to investigate the differences in specific factors that relate to VLBWIs’ early weight Z-score changes as the scientific basis for clinical practice of VLBWIs during the entire hospital stay.Methods: We retrospectively reviewed baseline characteristics, nutrition management, clinical outcomes, and complications between non-catch-down (NCD) (Dweight SDS³ -0.67) and catch-down (CD) groups (Dweight SDS<-0.67) in VLBWIs during hospital stay.Results: A total of 227 infants (NCD group=117, CD group=110) met the inclusion criteria. No significant differences were found in baseline characteristics between the two groups. The NCD group received higher parenteral lipids (g/kg/d) from day 5 to day 7 and higher enteral feeding volume (mL/kg/d) from day 5 to week 5. The NCD group had higher protein: energy ratios at day 2 to day 4 and day 7 and higher total energy (kcal/kg/d) during the first six weeks. The NCD group had lower incidence of bronchopulmonary dysplasia (BPD) and parenteral nutrition-associated cholestasis (PNAC).Conclusions: This study showed that adequate parenteral lipid and energy at the first week of life and earlier enhanced enteral feeding volume might significantly improve the VLBWIs’ weight Z-scores during hospital stay. The VLBWIs with catch-down growth might be more prone to developing BPD and PNAC.

Background: Respiratory distress syndrome (RDS) is the leading cause of mortality and morbidity in preterm neonates that can be diagnosed by clinical and radiographic findings. Surfactants are highly effective for the diminution of neonatal mortality. The question, however, is which type of surfactant is more efficacious.Methods: This was a double-masked randomized clinical trial conducted from November 2015 to November 2016. For this study, 240 preterm neonates with established RDS were recruited who were then equally divided into two major groups. The first group received BLES while the second one received Curosurf. These two major groups were subsequently divided into equal subgroups based on positive and negative maternal history of betamethasone administration. The other demographic characteristics of the enrolled neonates, such as sex, gestational age, and severity of RDS, were matched.Results: The observations showed that maternal betamethasone was associated with the indices like oxygenation index, hospital stay, assisted ventilation, surfactant induced adverse effects, and expenses, but it did not affect the indices such as repetitive doses of surfactants and mortality. The type of applied surfactant was not associated with the aforementioned indices but the expenditure of those receiving BLES was less than that of the opposite group. This could be attributed to the lower cost of BLES.Conclusions: Given the beneficial effects of prenatal corticosteroid administration, it is highly recommended for imminent preterm labor. Furthermore, with respect to almost similar therapeutic efficacy of BLES compared with Curosurf, it can be considered as a valuable candidate for surfactant therapy.

Background: Food allergy is an abnormal immunologic reaction to food proteins. During infancy, allergic colitis presents with bloody stool of a healthy child. calprotectin is released into the intestinal lumen by macrophages and neutrophils and is a reliable and non-invasive biomarker for evaluating inflammation of the digestive system.Objectives: This study evaluated the changes of fecal calprotectin after modification of mother’s diet, on breastfed infants with food allergy.Methods: This study was conducted on 29 infants less than one year old with allergic colitis, referred to the Besat hospital of Sanandaj (Iran) from 2013 to 2014. All infants were breast-fed. The fecal calprotectin levels were measured on admission; two and six weeks after starting hypo-allergenic diet for mothers and its levels were correlated with clinical findings.Results: With the onset of maternal hypoallergenic diet, clinical symptoms showed a statistically significant reduction (P<0.05).The fecal calprotectin levels decreased during the study. Despite the declining trend of the fecal calprotectin levels, there was no statistical correlation between clinical and laboratory findings (P=0.741 and P=0.284).Conclusions: This study showed that changes on fecal calprotectin levels are not a good indicator for assessment of clinical improvement in food allergy. There was no statistically significant difference between the fecal calprotectin levels on admission, two weeks and six weeks after the intervention.