Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:8 (56)|Papers Count:15

Thyroid enlargement and nodules are very rare in children, but when they occur, the chance of malignancy among these nodules is very high. Thyroid carcinoma is rare in childhood, but in the last two decades, its incidence has increased two-fold. A painless nodule in the neck is the most common presentation of the disease. Dysphagia, hoarseness, cervical lymphadenopathy, weight loss, and fatigue are other presentations. Surgical resection is the primary therapy for thyroid cancer. Levothyroxine and Iodine-131 (I131) are usually used as adjunctive therapy. This article presents the case of a 9-year-old girl who referred to our center with the chief complaint of a neck mass. Her symptoms had begun 6 months earlier.

Background: Understanding causes of death among children is crucial to decrease mortality rate. Identifying specific causes of under-five mortality help in developing possible prioritize preventive interventions. This study aimed to identify rates and common causes associated with child deaths in a Tertiary Care Centre in North Jordan. Materials and Methods: At a retrospective study, death registration records and certificates were reviewed for children who died in years from 2010 to 2015, at a main hospital in Irbid government, Jordan. The data collected, was including date of birth, date of death, unit of admission, medical diagnosis and death cause as recorded by a physician in the death records. Results: According to the center's computerized death registration system, a total of 529 child deaths registered in the study period. The most related cause of child deaths was related to genetic and congenital anomalies (35%); followed by prematurity (24%), and non-communicable diseases (16%) which include cardiac, renal, respiratory and blood disorders, and cancer. Infectious diseases such as sepsis, pneumonia, encephalitis, diarrhea, meningitis, and hepatitis were the leading causes of deaths among 14% of the study sample; while, accidents including road traffic accidents, falling, blast injuries, burns, insect bites, suffocations, aspiration and sudden unexpected deaths were found to be the leading cause of 12% of total registered deaths. Child death rate was 19. 2 per 1000 live births. Infant mortality rate (IMR) was 14. 1 per 1000 live births, and 7. 1 per 1000 live births was reported for neonates. Conclusion: The largest contributor to child deaths was the congenital and genetic anomalies; while prematurity is the most killer of infants.

Background Congenital heart disease (CHD) is the most common cause of major congenital birth defect. The aim of this study was to investigate the association of CHD with serum levels of Tumor necrosis factor-α (TNFα ), Interleukin 6 (IL-6), and B-type Natriuretic Peptide (BNP) in infant and children. Materials and Methods The present study was conducted in Heshmat heart hospital and 17 Shahrivar hospital Rasht city, Iran. In 50 children, 25 with CHD and 25 age and sex-matched healthy children (were selected from companions or patients without heart disease), 3 ml vein blood samples of right hand were taken by a trained nurse and samples were sent to a private laboratory. After separation, the plasma placed at temperature of-20 ° c. ELISA kits used for measuring BNP and eBioscience Bender MedSystems GmbH kit for measuring IL-6 and TNF-α . The results were entered into SPSS software (version 20. 0). Results Serum levels of TNF-α and IL-6 and BNP in the healthy and patient groups were evaluated and by comparing results of the two groups there was no significant difference in serum levels of TNF-α and IL-6, but the serum levels of BNP has significant difference between two groups (80. 7 ± 52. 5 pg/ml vs. 455. 4 ± 550. 4 pg/ml, P=0. 003). There was no significant relationship between BNP changes with changes in serum TNF-α , IL-6 levels. Conclusion Our study provided conclusive evidence BNP level is elevated in children with CHD; and significant relationship was observed between incidents of CHD respect to changes in serum BNP level.

Over the past two decades, laparoscopy has advanced and multiple techniques for inguinal hernia repair have been established. Laparoscopic-assisted percutaneous extraperitoneal closure (LAPEC) for inguinal hernia repair in children, is one of the most simple and reliable methods. The present study aimed to assess the safety and feasibility of the LAPEC of inguinal hernia in children. From January 2014 to January 2016; 21 conventional LAPEC procedures were performed prospectively at our center (Group 1). Over this period, 21 patients of the same age and the same gender had open inguinal herniorrhaphies (Group2). The choice of whether to perform a LAPEC procedure was made according to the surgeon preference. All operations were performed by the same surgeon. No significant differences were found between the 2 groups in terms of sex ratio, mean age, and operating time (p=0. 19; student test). There were no operative complications in group 1. Two patients (9. 5%) in group 2 presented inguinal hernia recurrence. Despite a relatively high recurrence rate, LAPEC may be a practical alternative to conventional open herniorrhaphy. Comparative studies must be conducted to test advantages and disadvantages of this procedure in comparison with standard open herniorrhaphy and conventional laparoscopic repair techniques in a more extensive trial.

Background: Children with blunt abdominal trauma (BAT) can be risk stratified for intra-abdominal injury (IAI) through a combination of readily accessible clinical variables. The aim of this study was to identify ultrasound and laboratory studies that accurately identify IAI while limiting unnecessary CT-scan among children without injury. Materials and Methods We conducted a prospective, observational study of 2-12 years old children with BAT who referred to the emergency department (ED) at Al-zahra and Kashani hospitals in Isfahan city, Iran, from January 2013 to May 2014. Children were undergone abdominal ultrasound and abdominal CT scan was done at the discretion of the treating physicians and according to the CT protocols. The tests obtained to assess for an IAI were including hematocrit (HCT), amylase, aspartate aminotransferase (AST) or alanine aminotransferase (ALT) and urinalysis (U/A). The outcome were any IAI and intra-abdominal injury undergoing acute intervention (IAI-I). Results: We enrolled 101 children with a median age of 6. 75 ± 3. 2 years. There were 18 (17. 8%) patients with IAI, and 5(5%) patients with IAI-I. The sensitivity, specificity and positive predictive value and negative predictive value of ultrasound compared to CT-scan were 72. 2%, 85. 5%, 52%, and 93. 3%, respectively. It is notable that all 18 patients with IAI (Se=100%) had at least one positive test. The combination of ultrasound, ALT/AST, HCT, urinalysis and amylase tests (with at least one positive test) has negative predictive values of 100%. Conclusion: It can be argued that ultrasound combined with selected laboratory studies can be used to predict the risk of IAI accurately among children who sustain BAT. According to the results of this study, we can say that ultrasound and laboratory studies should be obtained as a screening tool in these cases.

Background Jaundice is one of the most common problems in neonatal period. Although the efficacy of exchange transfusion in the treatment of neonatal jaundice is known and quickly reduces blood bilirubin levels, but severe neonatal hyperbilirubinemia is associated with significant morbidity and mortality. We conducted this study to investigate the risk factors of severe hyperbilirubinemia in neonates undergoing exchange transfusion in Imam Reza Hospital Kermanshah, Iran. Materials and Methods In this retrospective study, records of newborns with hyperbilirubinemia who were undergoing exchange transfusion to Imam Reza hospital in Kermanshah from of 2012 to 2016 were studied. Information were extracted from the patient case and recorded in the data collection form. Data analyzed using SPSS software (version 24. 0). Results Birth weight of 42. 1% of neonates was less than 2, 500 gr and 43. 1% were preterm. The most common causes of severe hyperbilirubinemia including: unknown causes (42. 2%, n=38), ABO incompatibility (27. 8%, n=25), and sepsis (12. 2%, n=11). The most common complications of exchange transfusion in this study were thrombocytopenia (33. 4%), hypocalcaemia (18. 7%), hyperglycemia (12. 3%), and hypoglycemia (12. 3%). Conclusion According to the results, major risk factors for the occurrence of severe hyperbilirubinemia in neonates were birth weight less than 2, 500 gram, gestational age below 37 weeks, age less than 5 days, and weight loss more than 10% of birth weight at the time of admission.

Background Menstruation is a challenging situation for young women in whom a poor hygiene practice can result in infertility and reproductive system diseases. Attitude and knowledge are two factors related to each other, and reflected in people’ s practice. This study aimed to assess the KAP, and their association among teenage girls in Western Iran. Materials and Methods A cross-sectional study of 728 girls, selected randomly among 28, 370 school girls studying in classes 7th (12y) and 10th (15y) was conducted in 2016, in Kermanshah, West of Iran. A self-made questionnaire was used to gather data including participants’ demographic characteristics and their KAP toward menstruation. Using SPSS software (version 23. 0) the relationships between outcome variables and predicting variables were evaluated. Results Participants’ mean age and menarche age were (14. 6± 1. 4 years), and (12. 5± 1. 0 years), respectively. About 92% were found to have a relatively positive attitude, 64% had a poor knowledge and 81% expressed a poor practice toward menstruation. Mothers (37. 4 %) were the main source of information for most participants. Age (r=0. 360), family income (r=0. 186), and the source of information (r=0. 112) were significantly positively associated with their level of knowledge. Participants 'practice regarding menstruation was significantly associated with age and mother's education (P ≤ 0. 05). Conclusion Although the total attitude of school girls in terms of menstruation was at a relatively positive level, mostly had poor knowledge and practiced poor. Given the poor level of knowledge and practice, school girls in Western Iran need to be trained regarding menstruation hygiene and developing their skills to care for themselves during menstruation periods.

Background Transient tachypnea of the newborn (TTN) is a respiratory disorder caused by delay in the evacuation of the lung fluids. Prophylactic antibiotic therapy is recommended for the risk of sepsis. We aimed to evaluate the effect of the prophylactic antibiotic in infants with TTN. Materials and Methods This randomized clinical trial study was conducted on all infants, admitted to TTN at Fatemiyeh Hospital, Hamadan, Iran, in 2017. Infants with TTN were randomly stratified into two groups based on whether they received antibiotic or not. Then, the clinical outcomes and laboratory results were examined in the two groups. The categorical data were compared with Chi-square test and the continuous data with t-test using Stata software version 14. 0. Results Out of 100 term and late preterm infants were admitted to TTN. No significant difference was found between two groups in terms of gender (p = 0. 228), gestational age (p = 0. 728), birth weight (p = 0. 974) and other baseline characteristics. Results revealed that no case of sepsis, pneumonia and death were seen in the group received prophylactic antibiotic and the other group did not receive it, but the admission time was lower in infants, who did not receive antibiotic (137. 76 ± 32. 42 versus 159. 36± 33. 85, p= 0. 001). Conclusion This study showed that antibiotic prescription in TTNs infants without perinatal risk factors has no impact on the disease outcome, and prophylactic antibiotic can be avoided. However, more evidence based on large sample size is required.

Background Adequate access to health services has tremendous effects on the usefulness and efficiency of health care. Therefore, this study aimed to investigate the access of girls under the age of 14 years old to pharmacies in Kermanshah, Iran. Materials and Methods In this cross-sectional study, the access of <14 years old girls to pharmacies in Kermanshah city, Iran, was investigated. The study population included 81, 450 girls under the age of 14 years. The latest published population statistics on the Population Census in 2011 (Iran) were used as the basis for the analyses, and the information about the public and private pharmacies were collected from the Kermanshah University of Medical Sciences, Iran. Also, Geographic Information Systems (GIS) program was used for data analysis. Results In terms of access to 25 pharmacies through walking, the findings revealed that lacked access as much as 48. 83%. In terms of access to daytime pharmacies through walking, 88. 05% had improper access. Furthermore, in terms of access to 25 pharmacies through driving, the results were as follows: with five minutes of driving (24. 75% no access), with 10 minutes of driving (9. 07% no access), and with 15 minutes of driving (1. 97% no access). As for access to daytime pharmacies through driving, the results were as follows: with five minutes of driving (5. 42% no access), with 10 minutes of driving (2. 15% no access). Conclusion The results of the present study demonstrated that the access for girls under the age of 14 years to pharmacies through walking was in poor condition. However, it was found out that access through driving was much better than access through walking.

Background Studies declare the possibility of thyroid abnormalities in the obese patients and return of normal thyroid activities after weight loss. Therefore in this study, the effect of educational intervention on body mass index (BMI) and thyroid function tests in obese children has been evaluated. Materials and Methods: The current randomized clinical trial research included 126 overweight or obese children and adolescents with an age range of 7 to 18 years, form Birjand city (Iran), who were divided into two control and intervention groups for 6 months between 2015 and 2016. The educational intervention consisted of 1 session per month (each session was 60 minutes), which was done by the researcher. BMI, thyroid stimulating hormone (TSH), free triiodothyronine (FT3) and free thyroxine (FT4) in both groups were measured and compared before and after the intervention, and data were analyzed using SPSS software version 19. 0. Results: In the intervention group, the average of TSH and FT4 after 6 months of intervention showed both significant decreases and increases, respectively (p=0. 003 and p< 0. 001). In the control group, both THS and BMI average had a significant increase (p<0. 001), and FT3 and FT4 significant decrease (p=0. 009 and p=0. 001, respectively). After 6 months, BMI and TSH average in the intervention group compare to the control group had significant decrease (p = 0. 02 and p<0. 001, respectively), and average of FT4 and FT3 was significantly increased (p <0. 001 and p=0. 025, respectively). Conclusion: Educational intervention was effective in reducing BMI and improving thyroid tests; hence, is highly recommended for the modification of BMI and the improvement of thyroid tests in obese children and adolescents.

Background Meconium ileus (MI) is one type intestinal obstruction due to inspissated meconium at the level of the terminal ileum. The purpose of this study is to present the non-ionizing ultrasound-guided approach for the treatment of meconium ileus. Materials and Methods This study was performed, prospectively, at Dr. Sheikh and Akbar children's Hospitals, Mashhad University of Medical Science (Mashhad city, Iran) from March 2017 to March 2018. The 21 newborn patients with suspicious meconium ileus were referred to Radiology department for contrast enema and ultrasound examination. The hydro colonic ultrasound-guided treatment was considered for four cases with simple form of meconium ileus. Ultimately, plain abdominal radiography was taken to documentation of entrance of solution to dilated proximal loop and evaluation of probable complications. Results In ultrasound exam, air bubbles are floating in fluids on proximal dilated loops, and no air is seen in bowel loops contain inspissated meconium. Ultrasound showed a collapsed microcolon in addition to inspissated meconium as a hypoechoic beaded intraluminal material in comparison to adjacent bowel mucosa. During ultrasound-guided enema, overt distention of unused colon and ileum was seen with coating and detachment of meconium plaques from bowel wall and floating and movement of the plaques toward the dilated proximal loops. The successful treatment in our study was occurred in two-third of cases. Conclusion Ultrasound-guided hydrostatic (hydro colonic) treatment can be a non-ionizing nonsurgical procedure for successful treatment of newborns with uncomplicated meconium ileus.

Background The most common cause of death during neonatal period is prematurity. Nutritional tolerance is very important in this period. If during this period the problems of feeding the preterm infant are not resolved, chronic disorder occurs in normal growth. Materials and Methods In this randomized controlled clinical trial we selected 60 preterm infants in the neonatal intensive care unit of Motahhari Hospital in Urmia, Iran, and randomly assigned to control and intervention groups. The infants were touched using Field technique by olive oil in two steps in the morning and evening, with a time of 15 minutes by first researcher. Nutritional tolerance was evaluated using the "Daily Observation Chart" and by gavage milk volume, abdominal circumference, the frequency of defecations and gastric residual volume. The data were collected during 4 consecutive days and the results were compared on the fourth day, with the first day. Data were analyzed using SPSS software version 17. 0. Results According to the results, the abdominal circumference after touch was less in the intervention group (1. 77± 1. 38) compared to the control group (1. 43± 1. 22) (p <0. 05). However, the frequency of defecations (1. 03± 0. 61) and the volume of the gavage milk (9. 83± 2. 68) was increased (p <0. 05), but there was no significant difference between the frequency of vomiting in fourth day group. Conclusion According the results, touching in premature infants using Field technique in two steps in the morning and evening, with a time of 15 minutes can improve nutritional tolerance of premature infants.

Background 25-hydroxy vitamin D [25(OH) VitD] deficiency is a highly prevalent condition, present in approximately 30% to 50% of the general population. A growing body of data suggests that low 25(OH) VitD levels may adversely affect cardiovascular health. The present study aimed to measure the serum levels of 25(OH) Vit D in Congenital heart disease (CHD) children compared to healthy children. Materials and Methods A case-control study performed on 270 children who equally distributed in case and controls and selected randomly from those who referred to the Ali Asghar Clinic and Ali Ebne Abi Talib Hospital in Zahedan, Iran, in the year of 2017. In patients, CHD diagnosed based on clinical manifestation and echocardiography by pediatric cardiologist, Serum 25(OH) Vit D measured by kit made of Italy. Results The level of 25(OH) Vit D serum means were lower in case (31. 68± 17. 37) compared to controls (42. 20± 14. 31) significantly (P<0. 001); also in cyanotic and acyanotic were 23. 689± 12. 317 and 33. 772± 17. 924, respectively with lower level in cyanotic significantly (P=0. 006). There was a significant difference in serum levels of 25(OH) Vit D in age groups of patients (P=0. 117), so that it was lower in elder patients (26. 07 ± 19. 76) compared to youngers. The results showed that the levels of 25(OH) Vit D serum in patients were similar in male and females (p=0. 782). Conclusion The present study concluded that serum level of 25(OH) Vit D was lower in CHD children, and among the patients, was lower in cyanotic. Considering the results of the present study suggested that the serum level of 25(OH) should be checked in CHD children specially those who suffered from cyanotic.

Background Allergic rhinitis is one of the most common types of rhinitis. Allergen avoidance is the most important way of preventing this disease. The present study is carried out to determine the frequency of common aeroallergens in patients with allergic rhinitis in Gorgan city by skin prick test (SPT) reactivity. Materials and Methods In this cross-sectional study 270 patients referring to the Asthma and Allergic Center in Gorgan city, Iran, were enrolled. Diagnosis of allergic rhinitis was confirmed by specialist asthma and allergy. A questionnaire containing demographic data and patient’ s history was completed. Skin prick test containing standard allergen extracts, histamine, and physiologic serum was performed on patients. The data were analyzed using SPSS software version16. 0. Results: In the present study, 270 patients (113 males and 157 females) had perennial allergic rhinitis (PAR), seasonal allergic rhinitis (SAR), and mixed allergic rhinitis (MAR) (n=166, 54, 47, receptivity). Out of these patients, the most common aeroallergens was a house dust mite called Dermatophagoides pteronyssinus (43. 7%), other common allergen were: weeds (40. 7%), Dermatophagoides farinae (40. 4%), grasses (32. 5%), beetles (30%), trees (22. 5%), and molds (16. 3%). There was a significant relationship between prevalence of allergy to grasses and gender (P=0. 016), weeds and age (P<0. 05). Conclusion According to the results, the most prevalent aeroallergen was house dust mite. Weeds and beetles were also common among patients, respectively. Because of the high prevalence of allergy to mites in this region, we suggest finding some useful preventive strategies to reduce sensitivity to mite allergens.

Background Febrile convulsion (FC) is the most common neurological problem in children which can occur in 2 to 5% of this population. The most important issue is to identify the cause of fever and rule out bacterial meningitis. The purpose of this study was to evaluate the association of aseptic meningitis due to Measles-Mumps-Rubella (MMR) vaccine in admitted children with febrile convulsion. Materials and Methods This study was a retrospective cross-sectional. Children aged 6 months to 5 years old with FC that admitted to Mousavi Hospital in Zanjan, Iran, during one year (from 2016 to 2017) were enrolled. The demographic information of patients and laboratory parameters of meningitis in their CSF fluid were recorded in a researcher made questionnaire. Results A total of 275 children were admitted due to FC. Of these children, 36. 3% had respiratory infections, 33. 8% nonspecific febrile infections, 16% gastroenteritis, 5. 8% urinary tract infection, 5. 1% acute otitis media and 2. 2% meningitis. All cases of meningitis were aseptic without evidence of bacterial compromise. There was a significant relationship between the age of febrile convulsion and meningitis (P=0. 012). The age of children with meningitis were between 385 to 395 days (equivalent one year and 20-30 days), which coincide with 20 to 30 days after receiving the MMR vaccine. Conclusion In the study, all cases of meningitis occurred 20 to 30 days after the MMR vaccine at one year of age. It is strongly suspected the association between aseptic meningitis and the MMR vaccine. LP is recommended in children with febrile convulsions in this age range.