Journal of Pediatric Perspectives
Year:2020 | Volume:8 | Issue:4 (76)|Papers Count:10

Background: The timing of umbilical cord clamping may affect the need to blood transfusion and other morbidities of preterm infants. This study aimed to compare three different cord clamping timing (immediate cord clamping, delayed cord clamping and umbilical cord milking) in preterm infants delivered by cesarean section (CS). Materials and Methods: A controlled randomized clinical trial was done in preterm infants with gestation age less than 32 weeks delivered by CS in AlZahra hospital, Tabriz, Iran from June 2018 up to the end of January 2019. They were randomly allocated in three groups consisted of 30 neonates in each group. Umbilical cord was clamped within 10 seconds after infant delivery in immediate cord clamping (ICC) group, 60 seconds after delivery in delayed cord clamping (DCC) group. Cord was milked toward the infant three times over two seconds duration in umbilical cord milking (UCM) group. All patients were followed until discharge for needing the blood transfusion, bronchopulmonary dysplasia and mortality. Results: A total of 20 neonates of 90 studied neonates needed blood transfusion during hospital stay, of which, 4 neonates (13. 3%) were in UCM group, 7 neonates (23. 3%) in DCC group and 9 patients (30%) in ICC group (P= 0. 27). The mean hemoglobin was significantly higher in UCM group at admission and 30 days after birth (P<0. 05). Conclusion: UCM may be as effective as DCC to increase hemoglobin in preterm infants delivered by CS. Although the hemoglobin of infants with DCC and UCM was significantly higher than infants with ICC, the rate of blood transfusion was not significantly decreased during hospital stay.

Background: Atrial septal defects (ASDs) are the most common third congenital heart defects. This study aimed to evaluate the clinical course of ASDs and the relationship between its complications, location closure and size. Materials and Methods: This cross-sectional study was conducted in the cardiac center of the pediatric ward in Zahedan, Iran. The study was carried out on 529 children with ASD between 2003 and 2018. The ASD children underwent echocardiography and complete examination such as physical exams, ECG and chest X-ray at every visit during follow-up. A diagnosis of ASDs was confirmed by a transthoracic echocardiography. A unique cardiologist applied transthoracic echocardiography to get information about size, location, and the number of the defects as well as hemodynamic information such as pulmonary artery pressure and any associated lesions. The data were analyzed using SPSS software version 20. 0. Results: From 529 ASD children, 278 (52. 5%) were girls. Most were medium (46. 1%). 44. 2% were closed by surgery; about 90. 9% were secundum. 133 closed spontaneously and 14. 6% by device. ASDs size had significant association with closure, location, and complication (P<0. 001). The sinus venosus occurred in 29 patients, of which 62. 07% and 37. 93% were medium and large, respectively. PH was observed in nine children, 88. 89% were large. ASD closure had significant association with location, and complication (P<0. 001). From secundums, surgery and occluder devices closed 40. 75% and 15. 80, respectively. From those closed by surgery, 8. 12% had residuals, 10. 26% were partial anomalous pulmonary venous connection (PAPVC) as comorbidities, and 3. 42% had pulmonary hypertension. Conclusion: From the study concluded ASDs size had significant association with closure, location, and complication and ASDs closure had significant association with location and complication.

Background: Dental caries is one of the most common oral diseases in pre-school children. Several factors can affect caries process. Aim of this study was comparison of some of the chemical properties of saliva such as total antioxidant capacity, total protein, pH, nitric oxide level in caries free (CF), and caries active (CA) children. Materials and Methods: This cross-sectional based study was designed with random selection of 80 healthy population including 40 CF and 40 CA children (3-5 years old) from several public kindergartens in Sari, Iran in 2019. Caries status was assessed using DMFT (Decayed/Missing/Filled Teeth) index according to WHO criteria. Un-stimulated saliva samples were collected from children in the morning. Then, several caries-related factors including total antioxidant capacity, nitric oxide, total protein concentration and pH were assessed in saliva samples. Data were analyzed using SPSS software version 16. 0. Results: Significant higher total antioxidant capacity and total protein concentration were observed in the saliva of CA than in the CF children. On the other hand, nitric oxide level was markedly lower in CA samples. In addition, a decrease in pH of saliva was observed in CA children. Conclusion: Based on the results, increase in the total antioxidant capacity and total protein as well as decrease in nitric oxide levels in the saliva of CA children can be considered as valuable evidence of dental caries occurrence among children.

Background: It is recommended for mothers to start breastfeeding their infants within the first hour after birth and exclusively breastfeed them for the first 6 months of their life. Exclusive breastfeeding (EBF) has both short-and long-term benefits for both mother and infant. Main objective of this study was to establish the determinants of EBF practices among mothers in Kandahar, Afghanistan. Materials and Methods: This was a cross-sectional analytical study conducted in Kandahar, Afghanistan. Researcher-made questionnaire was used to collect the data from 1, 028 mothers with children <2 years of age who visited either of the seven health clinics of the city during a period of 6 months (June-November, 2018). Data was analysed using SPSS software version 22. 0 Results: Among 1, 028 mothers, 95. 9% were uneducated, 53. 9% had low socio-economic status, and 94. 2% had ante-natal care (ANC) visits. EBF rate was 51. 2% (526/1028). During first 6 months of life, 11. 1% of the infants were given foods other than milk while 51. 4% used pacifier. Weaning was started in nearly half (49. 2%) of the infants before 6 months of age. Main barriers to EBF were living in city, male gender, giving sedative syrup (Promethazine) to infant, breastfeeding the infant ≥ 8 times in 24 hours, and giving expressed milk. Conclusion: EBF rate in Kandahar is better than many parts of the world, but there are still many barriers that need to be removed. Main barriers of EBF rate in Kandahar needs to be decreased by increasing the health education and overall education status of the mothers.

Background: Neonatal jaundice is prevalent, and the presence of hyperbilirubinemia frequently requires medical attention and hospital readmission. The aim of the present study was to determine the effect of maternal vitamin D deficiency on increased risk for hyperbilirubinemia in term newborns. Materials and Methods: This cross-sectional study was conducted on all pregnant women with gestational age of 38-42 weeks from southwestern Iran who referred to Hafez Hospital affiliated to Shiraz University of Medical Sciences, Shiraz, Iran, from March 2018 to August 2018. Serum 25-hydroxyvitamin D was measured from 300 included pregnant women during birth time. The level of bilirubin was measured in their newborns at 3rd to 5th days of life. The obtained data were analyzed using SPSS software version 22. 0. Results: The level of 25-hydroxyvitamin D was low in 277 (92. 3%) pregnant women. Hyperbilirubinemia was detected in 38 (12. 6%) newborns at the 3rd to 5th days of life. Maternal vitamin D during pregnancy showed a significant correlation with the levels of bilirubin in newborns (r=-0. 458, P<0. 001). Conclusion: The results of this study showed that maternal vitamin D deficiency could be associated with the increased risk for neonatal hyperbilirubinemia.

Background: Acute respiratory infection is still the leading cause of morbidity and mortality in children under five in many countries. We aimed to assess the incidence and risk factors predicting the outcome of Acute Respiratory Infection (ARI). Materials and Methods: This is a hospital-based case study conducted at Minia University Children's Hospital, Egypt from December 2016 until December 2018. Children from 2 months till five years and presented by criteria of ALRI according to WHO criteria were included in the study and evaluated for clinical presentation, risk factors and outcome. Routine investigations such as CBC, CRP and chest X-ray were done for all cases. Results: Out of 586 children admitted to pulmonology unit only 215 (36. 7%) fulfill the WHO criteria of ARI program, with higher incidence among infants below 6 months (48. 8%) and male children (58. 6%), majority of children had anemia (87%), and PEM (60%), according to WHO criteria we found that 18. 6% of cases had pneumonia and 49. 7% of cases had severe pneumonia. Need of change in antibiotics, duration of stay and outcomes were significantly associated in relation to pneumonia severity (p=0. 04, p=0. 03 and p=0. 01, respectively); while need for oxygen therapy was highly significant (p=0. 001) and 15% required mechanical ventilation. Lobar pneumonia (32. 5%) was the most common diagnosis and sepsis was the most frequent cause of death and mortality rate was 9. 3% (n=20). Conclusion: Young age, malnutrition and poor socioeconomic status play an important role in in the morbidity; effective management of malnutrition, improving the living standards and proper health education programs, can reduce mortality from respiratory infection in children, ARI burden and severity.

Background: Pulmonary hypertension (PH) in congenital heart disease (CHD) affects the patient prognosis. QRS and QTC intervals prolongation in ECG may exaggerate life-threatening dysrhythmia in these patients. We aimed to investigate the correlation between QRS, QTC and JTC intervals prolongation in ECG with PH in CHD children. Materials and Methods: In a cross-sectional study that was performed in pediatric cardiology clinic of Besat hospital (Hamadan, Iran), during 2016-2018, patients with CHD and PH as case group (n=40) were compared to simple CHD patients without any evidence of PH as control group (n=40). Based on Pulmonary Artery (PA) to systemic pressure ratio, lower than 1/2 was considered as mild PH and equal and more than 1/2 was considered severe PH; then QRS, QTC, JTC intervals in ECG and RVMPI, TAPSE in echocardiography were compared between case (PH group), and control groups. We also compared these ECG and echocardiographic findings between mild and severe PH group. Results: There was significant difference in QRS (p=0. 005), and QTC (p=0. 036) intervals between two groups, but there was not any significant difference between JTC interval between two groups (p=0. 714). Of 40 patients with PH, 19 subjects were in the mild PH group and 21 subjects were in severe PH group, in which nine patients had irreversible PH or Eisenmenger syndrome. QTC (p<0. 001) and QRS (p=0. 018) intervals in the severe PH group with Eisenmenger syndrome were significantly different from the Mild PH group. Conclusion: Based on the results, in spite of rising QRS and QTC intervals in the PH group of CHD, JTC interval did not rise significantly.

Background: Cystic fibrosis (CF) is one of the most common genetic disorders in children. CF patients are susceptible to chronic lung infections and malabsorption. Although patient longevity is increased by multidisciplinary care, patients still suffer from respiratory failure and low quality of life. In this situation, CF patients tend to use complementary treatments. To the best of our knowledge there is no research about curcumin supplementation in CF patients; thus, we decided to investigate the effects of curcumin supplementation on anthropometric indices, and quality of life in children with cystic fibrosis. Materials and Methods: This randomized control-controlled clinical study was conducted in Tabriz University of Medical Sciences, Iran. Forty CF patients were randomly sorted into intervention (n=20), and control (n=20) groups. Patients received 3 curcumin nanoparticles (80 mg; total dose 240 mg/d) for six consecutive months. Before and after intervention, height and weight were measured and quality of life of patients was evaluated by the Pediatric Quality of Life Inventory (PedsQL) 4. 0 (CITE). Results: After intervention, the percentage of weight changes showed a significant increase in the curcumin group compared to the control group (7. 48± 4. 68 vs. 4. 15± 4. 68 kg, p=0. 03). Following the intervention, only the percentage of change in emotional functioning scores was significant (p=0. 01). Subjects in the curcumin group showed a trend towards more improvement in terms of percentage change in physical functioning (19. 28± 31. 65 vs. 15. 24± 47. 14), and school functioning scores (40. 96± 42. 93 vs 23. 90± 14. 82) compared with the control group. Conclusion: Our findings suggest that curcumin may be a useful, inexpensive, and safe supplement in combination with conventional therapy to improve body weight in CF children.

Background: To manage the pain, one of the alternative methods entails the essential oils usage. Aim of this study is to give comprehensive information about the effect of lavender for aliavative painful producer in infants and children. Materials and Methods: A systematic search was conducted on English databases of Scopus, Medline, Cochrane Library, EMBASE and Web of Science up to the end of February 2019. Authors performed search without any time restrictions. Two authors independently performed search and assessed their quality. Results: The five studies (n=414 participants) were included. In the first study, the change of NIPS score was significantly lower in lavender than control groups. The duration of crying was 75. 47 (60. 675), and 105. 22 (75. 739) seconds in the lavender and the control groups, respectively, which was significantly different. In second study, aromatherapy with lavender was unable to change the VAS score (p=0. 40); while heart rate decreased to a significance borderline level (p=0. 0639). In the third study, significant differences in the mean SpO2, respiratory rate, and heart rate at different time points between the aromatherapy with lavender and the control groups in preschool children. In the fourth study, the lavender group exhibited lower NIPS score compared to the amniotic fluid and breast milk groups. In fifth study, 80 term infants were assigned into case (n=40), and control (n=40) groups, there was a significant difference in pain scores between the two groups, lavender and control. Conclusion: This study showed that the lavender as non-pharmacological effective way is effective to alleviate the blood sampling-related pain in infants and children, though it did not affect the duration of crying.

Background: Seizures may occur in as many as 1% of children. The most urgent type of seizures is generalized tonic-clonic seizures (GTCS). N-terminal prohormone of brain natriuretic peptide (NT-proBNP) has been considered as a promising biomarker in numerous acute illnesses. We aimed to evaluate usefulness of NT-proBNP for diagnosis of generalized seizures in children. Materials and Methods: This prospective case control study was conducted upon 80 children who were classified into four groups; Group I: included 20 patients with idiopathic generalized epileptic seizures. Group II: included 20 patients with focal epileptic seizures. Group III: included 20 patients with febrile seizures. Group IV: included 20 apparently healthy, age and sex matched children as a normal control. Complete blood count (CBC), blood chemistries, including random blood glucose, calcium, sodium, C-reactive protein (CRP) level, serum prolactin and NT-proBNP were performed for all children. Results: Our results revealed significant increase of both prolactin and NT-proBNP in generalized epileptic and febrile seizure groups than in focal epileptic and control groups (p< 001). The ROC curve analysis showed NT-proBNP, at a cut-off value of > 384 pg/ml, sensitivity (90 %), and specificity (70. 2%) which was near the results of prolactin at a cut-off value> 25. 9 ng/ml, and showed sensitivity (95. 1%), and specificity (71. 3%). Conclusion: Based on the results, NT-proBNP increase in generalized seizures either epileptic or febrile; and may be a promising marker to adjust the diagnosis of it at the emergency setting, when history and clinical presentation are equivocal.