Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:10 (46)|Papers Count:20

Elevated enzyme activities in plasma may at times be attributed to the presence of macro-enzymes. The macro-enzymes are often serum enzymes in complex with immunoglobulins, resulting in a greater molecular mass that cannot be filtered by renal glomeruli and are, hence, retained in the plasma. The aspartate aminotransferase (AST) can exist as a macro-enzyme, although it has been rarely reported. We describe a pediatric patient with persistently elevated serum AST activity, due to macro-enzyme formation between AST and an immunoglobulin. This is to highlight the importance of early diagnosis of macro-AST in an otherwise asymptomatic pediatric patient with isolated AST-elevation and to avoid unnecessary costly testing.

A 7-year-old male child presented with the complaints of tense abdominal distension and swelling over feet since 1 month. The patient had repeated episodes of similar complaints since last two years with partial or complete relief after taking various forms of allopathic therapy. On imaging, Budd-Chiari syndrome was diagnosed which was hallmarked by occluded Inferior venacava (IVC), caudate lobe enlargement and heterogeneous liver enhancement. Initially thrombolysis done leading to complete remission for the patient for 15 days, later on again the patient developed similar complaints for which balloon venoplasty and hepatic vein stenting was done.

Background: The incidence of a child chronic disease causes high levels of stress and anxiety in the parents and caregivers. This study aimed to investigate the coping strategies of parents with chronic ill children who hospitalized in educational hospitals of Ahvaz-Iran. Materials and Methods: This cross sectional study conducted in two hospitals that affiliated to Jundishapur University of Medical Sciences in 2016. The total number of respondents was 252 parents (150 mothers and 102 fathers) of 150 children with chronic disease that were selected using convenience sampling. Data collection tools were a self-administered demographic and clinical checklist and standard questionnaire Of Coping Inventory for Stressful Situation (CISS). Data analysis runs using SPSS version 22. 0. Results: The results showed that the dominant strategies of parents who had a child with chronic disease were task-oriented (52. 3%), and emotion-oriented (54%) strategies, respectively. The average score of problem-focused strategy in fathers was (53. 67± 11. 1) and the average score of emotionfocused coping strategy in mothers was (53. 33± 10). Mothers were used emotion oriented and social diversion coping strategies significantly more than fathers. Child gender, child age, and having another ill child were significant variables in correlation with mother’ s distraction; however family economic state was significant variable in correlation with social diversion (P<0. 05). In fathers taskoriented coping strategies were in correlation with child age, disease duration, numbers of hospitalizations, education, job and having another ill child. Emotion oriented coping strategies was in correlation with father’ s age and distraction was in in correlation with father’ s job (P<0. 05). Conclusion: To provide optimal care for families with chronic ill child, assessment of psychological needs and coping strategies of parents is necessary. Moreover, families with lower economic and educational level are prior for further attention.

Background: Exclusive breastfeeding is beneficial to not only infants, but also mothers. Since prolactin stimulates milk production, increasing its levels through dopamine antagonists, such as metoclopramide, may enhance milk production. However, the efficacy of this method should be further studied. Therefore, this systematic review sought to determine the effects of metoclopramide on prolactin levels in breastfeeding mothers. Materials and Methods: In this systematic review study, International and National data bases such as PubMed, Google Scholar, Cochrane Library, Scopus, Web of Sciences, SID, Magiran, and Iranmedex were searched for the keywords of lactation, breastfeeding, prolactin, metoclopramide and breast milk. Articles published during 1979 to 2016 in either English or Persian was selected. The review was limited to human clinical trials examining the effects of metoclopramide on mothers’ serum prolactin levels. Two authors independently evaluated the eligibility the studies and cases of disagreement were resolved through consensus. Results: Five studies on the effects of metoclopramide on mothers’ serum prolactin levels were included in this systematic review. Based on their results, compared to placebo, two weeks of metoclopramide administration did not have significant effects on mothers’ serum prolactin levels (mean difference: 73. 06; 95% confidence interval [CI]:-19. 99 to 166. 11) However, placebo-controlled studies showed significant changes in prolactin levels after using metoclopramide for three weeks (mean difference: 111. 06; 95% CI: 1. 93 to 220. 20). Conclusion: The result of meta-analysis showed that the use of 10 mg of metoclopramide three times a day for three weeks increased mothers’ serum prolactin levels after childbirth.

Genetic hyperchylomicronemia is a rare autosomal recessive disorder of lipoprotein metabolism estimated to affect approximately one per million individuals. We report a case with a rare mutation identified. It’ s a genetic chylomicronemia in a Moroccan newborn baby, with massive hypertriglyceridemia and clinical signs of acute pancreatitis. She was a newborn female, first-degree of consanguineous parents. She was hospitalized for hypertriglyceridemia, complicated by acute pancreatitis; serum was noted to be milky. The genetic study found a mutation of the Lipoprotein Lipase (LPL) gene: homozygous pathogenic variant c. 1019-3C > A. She enjoyed good health, developed well and the triglyceride was maintained at a concentration of <12 g/l, after a digestive rest of five days. This mutation is the second case discovered in the world and the first case in children. The identification of the molecular etiology of these dyslipidemias explain the wide variety of phenotypes observed, some of which are accessible to targeted therapies.

Background Constipation is one of the most common disorders in children. The purpose of this study was to compare paraffin and polyethylene glycol (PEG) in the treatment of children with chronic constipation. Materials and Methods This study is a double-blind randomized trial. Total 160 children aged 2-12 years old with chronic constipation attending the pediatric clinic of Mousavi Hospital in Zanjan (Iran) were examined by the same pediatric gastroenterologist. They randomly received PEG solution (1cc/kg/day divided in two doses) or paraffin at the same dose. Patients were assessed regularly once a week up to one month and then monthly until 6 months. Data were analyzed by SPSS version 16 software. Results From children enrolled in the study, 43. 1% were boys with mean age 5. 27± 1. 3 years. The male to female ratio in Paraffin and PEG groups was similar (35/45 vs. 34/46; respectively, P-value= 1. 27). The mean age of the participants in paraffin group and PEG group were 5. 28± 1. 4 and 5. 24± 1. 9 years, respectively. The good and intermediate response to PEG in comparison to paraffin were 11. 3% and 38. 8% vs. 23. 8% and 35%; respectively (P=0. 111). In children lower than 3 years old, the improvement after receiving paraffin was significantly higher (P=0. 048). The frequency of adverse effects was similar and didn’ t differ significantly between the two groups. Conclusion There was no significant difference between two groups (PEG and Paraffin groups) in terms of gender and adverse effects of drugs. However paraffin had better therapeutic effect among children less than 3 years of age.

Background Neonatal mortality comprises a large part of infant mortality, and it depends largely on neonatal birth weight. Besides maternal diseases, it seems that other important factors such as maternal demographic characteristics, mental health and marital satisfaction, affects their infants birth weight. This study conducted aiming to evaluate these affecting factors on neonatal birth weight. Materials and Methods This study was descriptive – correlative, and conducted on all of the mothers and their neonates who were 200 mothers and neonates born during the summer 2015, in Urmia Kosar hospital that lasted 6 months. We used the GHQ (General Health Questionnaire), to evaluate the mental status of mothers and ENRICH for the evaluation of marital satisfaction. Demographic characteristics of mothers collected to special forms. Results In this study, 200 mothers, and 200 neonates born in Kosar Hospital were studied. The mean age of the mothers was 28. 06 ± 6. 34 years and the duration of pregnancy was 39. 14 ± 1. 21 months. The amount of obtained was significant for pregnancy duration in predicting neonatal birth weight. In marital status parameters, beta amounts for economic, family and communication was significant in predicting neonatal birth weight. Among parameters of maternal mental health, correlation of depression was significant in predicting neonatal birth weight. Conclusion According to results, in white race low maternal age was a risk factor for bearing low birth weight baby. Marital satisfaction and bearing no stress from husband lets the fetus grow well and reaches normal birth weight.

Background: Risk factors of non-communicable disease (NCD) origin from early life, and exposure to environmental pollutant may be a predisposing factor. This study aimed to investigate the association of air quality index (AQI) and fine particulate matter (PM2. 5) with some NCD risk factors in a sample of Iranian children and adolescents. Materials and Methods: This cross-sectional study was conducted in 2014 to 2016 among children and adolescents, aged 6-18 years, in Isfahan, Iran. Physical examination, including weight, height, and blood pressure, was conducted by standard methods. Fasting blood sample was obtained for fasting blood glucose, total cholesterol, high density lipoprotein-cholesterol, low-density lipoproteincholesterol, and triglycerides. The mean AQI and PM2. 5 values from the study time till one year prior to the survey were used. Multiple linear regression analysis was conducted for the association of AQI and PM2. 5 with other variables. Results: Participants consisted of 186 children and adolescents with mean (SD) age of 10. 52(2. 38) years. Exposure to higher level of PM2. 5 had significant associations with higher levels of systolic blood pressure, low-density lipoprotein cholesterol, and triglycerides. It also had positive relationship with other risk factors and inverse association with low-density lipoprotein cholesterol (LDL-C), but these associations were not statistically significant. The corresponding figures were not significant for AQI. Conclusion: At current study results showed that exposure to higher levels of fine particulates was associated with some NCD risk factors in children and adolescents. Early life prevention of NCDs can lead to large reductions in disease risk; adverse effects of ambient pollutants should be considered in this regard.

Background Health is influenced by different factors, the most important of which in the family environment is mothers. This study aimed to determine the anxiety levels of school-age children and their relationship with the general health of mothers in the city of Dezful, Iran. Materials and Methods In this descriptive-analytical study, 623 children aged 9-to 12-year-old studying in the fourth to sixth grades and their mothers were selected from the schools of the city of Dezful, Iran. The data collecting tools was a test battery including a demographic questionnaire, the School Anxiety Scale (SAS) designed by Philips, and the General Health Questionnaire (GHQ). The obtained data were analyzed using SPSS version 16. 0 software. Results In this study, of 623 participants, 226 (36. 3%) students were female and 397 (63. 7%) students were male. The results demonstrated that the anxiety of school-age children were without 37. 2% anxiety, 48. 8% normal anxiety and 14% severe anxiety. The general health of mothers were 46. 1% normal healthy, 45. 4% partial healthy, 8% on the eve of the disease, and 0. 5% unhealthy. It showed there was a significant positive correlation between general health of mothers and anxiety score of children (P < 0. 001, r = 0. 245). Moreover, the children’ s anxiety scores were associated with all the dimensions of the mother GHQ. Conclusion There was a significant relationship between the health of mothers and their children’ s anxiety level. Thus, it is recommended to utilize strategies including conducting training programs and providing counseling for such children and their families in schools and health centers.

We are reporting an infant with persistent abnormal liver function, neonatal jaundice, and intermittent hypoglycemia. Evaluation confirmed congenital hypopituitarism, in the absence of congenital anomalies and midline defect. His jaundice and abnormal liver function improved after treatment with Levothyroxine and hydrocortisone.

Background The current study was designed to compare the effectiveness and side effects of oral, vaginal, and sublingual misoprostol in termination of second-trimester pregnancy. Materials and Methods: In this clinical trial (2014 to 2015), 85 pregnant women in the second trimester of pregnancy were included in Imam Reza hospital, Kermanshah, Iran. They were randomly divided into three groups as follows: oral misoprostol (n=28), vaginal misoprostol (n=30), and sublingual misoprostol (n=27). Misoprostol was administered orally (oral misoprostol group), vaginally (vaginal misoprostol group), or sublingually (sublingual misoprostol group). The dosage was similar in three groups (400 micrograms every four hours up to a maximum of five doses). The mothers were followed and induction-abortion interval time, number of dosages required, and misoprostol side effects were documented. The data were analyzed by SPSS version 20. 0 software. Results: The mean (standard deviation) age of the sample was 28. 27 (± 4. 97) years. Mean gestational age was 16. 58 weeks and mean gravidity was 1. 99. Mean number of administered misoprostol doses was 3. 89 and most patients responded to three doses of misoprostol. Mean abortion time was 20. 08 hours. No side effects were reported in 60% of the subjects. Others experienced side effects such as nausea (16. 5%), fever and chills (12. 9%), and vaginal bleeding (9. 4%). The abortion duration in 35. 3% of the subjects was within 18 hours. The most successful method was oral route (82. 1%), followed by vaginal route (80%), and sublingual route (70. 4%). The abortion duration was statistically different between the three groups (P= 0. 001). Conclusion: Finding of the presented study showed that misoprostol is a safe medication to be used for medical abortion in the second trimester of pregnancy. Oral route of administration was superior to vaginal or rectal use of misoprostol.

Background It has been documented that maternal nutrition is associated with positive birth outcomes. This study was aimed at determining the predictors of healthy eating behavior among pregnant women in Qazvin, Iran in the context of the theory of planned behavior (TBP). Materials and Methods In this longitudinal study, 182 pregnant women who were referred to teaching hospitals in Qazvin in 2016 were recruited for participation. Data were obtained using TPB-specific questionnaires at baseline. The same pregnant women were asked to complete a food frequency questionnaire (FFQ) 3 months later. A series of hierarchical regression analysis was conducted to examine factors associated with healthy eating behavior among pregnant women. Results The pregnant women reported low amounts of whole grain consumption and low-fat dairy product consumption. All TPB variables significantly predicted healthy eating behaviors at three-month follow-up. Perceived behavioral control (PBC) and behavioral intention were found to be the strongest predictors of healthy eating behaviors among pregnant women. The pregnant women’ s subjective norms had the weakest relationship with healthy eating behaviors. The TPB model together with age provided a moderate to high explanation of consumptions in low-fat dairy products (R2=0. 57, P<0. 01), fruit (R2=0. 30, P<0. 01), vegetable (R2=0. 28, P<0. 01) and whole grains (R2=0. 44, P<0. 01). Conclusion The TPB explained significant variation in intention and healthy eating behaviors among pregnant women. Future studies should target on the PBC and intention to promote healthy eating behaviors among pregnant women.

Background: The attention deficit/ hyperactivity disorder (ADHD) is one of the most compromising mental disorders of childhood and adolescence. Subsequently, different studies in recent years were conducted on the relationship between sleep disturbances and ADHD in children. About 30% of children and 60% to 80% of adults with ADHD develop sleep disorders, which may result in cognitive and behavioral changes in the patients. The current study aimed at comparing sleep disorders in children with ADHD and their normal peers in Tabriz, Iran. Materials and Methods: The current case-control study was conducted on the target population of children within the age range of 6 to 12 years, which included 50 children with ADHD receiving medication, 55 children with ADHD symptoms without receiving any medication, and 71 normal children, all of which screened from the school students of Tabriz using the child symptom inventory-4 (CSI-4) and selected by the multi-stage cluster sampling method. The children's sleep habits questionnaire (CSHQ) was completed by their mothers and data were analyzed using the multivariate analysis of variance (MANOVA). Results: According to the results of the current study, a significant number of children with ADHD showed sleep disorder that can accounts for some degree of their behavioral dysregulation. There was a significant difference among the study groups regarding the subscales of sleep resistance and sleep duration, daytime sleep, parasomnia, and sleep apnea (p<0. 05). However, evaluation of the sleep onset delay, anxiety, and nighttime awakening hypotheses showed no significant difference between ADHD and normal children (P> 0. 05). Conclusion: Since children with ADHD usually have more sleep problems, considering the sleep quality in such children is of great importance; in the treatment of such children their sleep problems should be considered particularly.

Congenital umbilical cord hernia is fairly common in infants and it is rarely associated with other anomalies. Sometimes, large umbilical cord hernia is confused with Small omphaloceles. We report an unusual case of umbilical cord hernia associated with patent vitello-intestinal duct (PVID), and Meckel's diverticulum underwent surgery and discharged with good general condition.

Background: To achieve the optimal care of baby, mothers need to have sufficient self-efficacy in infant care. This study aimed to compare the effects of educational software and training booklet on the maternal self-efficacy and infant care behavior. Materials and Methods: This randomized controlled trial was done on 126 Iranian pregnant women. The Participants were assigned into two intervention groups (42 women received software and 42 women received booklet) and a control group (42 women received routine trainings) through block randomization. A training session was provided orally to the participants in both intervention groups. Then they were provided with the booklet or software. The questionnaires of standard maternal selfefficacy and researcher-made infant care behavior were completed before intervention and at the end of the fourth week of postpartum. Results: Before the intervention, there was no significant difference in terms of the mean scores of the maternal self-efficacy (P=0. 192) and infant care behavior (P=0. 937) between groups. Controlling the baseline values, a statistically significant increase was observed in the mean scores of the maternal self-efficacy in the booklet group (mean difference: 3. 7; 95% Confidence Interval: 2. 2 to 5. 2) and software group (2. 5; 1. 0 to 3. 9) compared to the control group; however, no statistically significant difference was observed between the two intervention groups. In addition, there was no statistically significant difference in the infant care behavior mean score between the groups at the end of the study (P=0. 398). Conclusion: The results indicate the effectiveness of both the software and booklet in enhancing the maternal self-efficacy. The effect of booklet was more compared to the Educational Software, but not statistically significant.

Background In recent years, the tendency to use drugs has been increasing in the treatment of neonatal jaundice. Several drugs have been used since then, but the effect of probiotics on serum bilirubin level (SBL) is not so clear. This study was conducted to evaluate the effect of probiotics on SBL and the duration of phototherapy in term neonates with hyperbilirubinemia. Materials and Methods: In this randomized clinical trial, we studied 150 term neonate with jaundice hospitalized for phototherapy in Amirkola Children’ s Hospital, Babol-Iran, during October 5, 2016 till May 19, 2017. Eligible neonates were randomly divided into two; intervention (n=75), and control (n=75) groups. Both groups received standard conventional phototherapy, but the intervention group received 10 drops/day of probiotics (Pedilact Zisttakhmir. Co. Iran), until hospital discharge. The outcome variables were SBL and the duration of phototherapy. The data were analyzed by SPSS 22. 0 and the P (0. 05 was considered significant. Results: The mean SBL before intervention in the intervention and control groups was 16 ± 1. 9 and 16. 9± 1. 9 mg/dl, respectively (P>0. 05). After 24, 48 and 72hours it decreased to 13. 73± 1. 72, 10. 92± 1. 87 and 10. 25± 1. 32 in the intervention and 13. 66± 1. 91, 11. 01± 1. 69 and10. 09± 1. 38 in the control groups, respectively, but a comparison of the amount of SBL reduction between the two groups was not significant (P>0. 05). The duration of phototherapy in the intervention group and the control group was 3. 61± 1. 17 days and 3. 72± 1. 18 days respectively (P>0. 05). Conclusion Oral probiotics in neonates with jaundice have no significant effect on SBL and the duration of phototherapy. Further studies are needed with longer time follow-up.

Background Fruit and vegetable consumption increases students' health and growth and strengthens their mental activities. The present study aimed to investigates a training program based on PRECEDE model on fruit and vegetable consumption by female students in high schools of Fasa, Iran. Materials and Methods This is a quasi – experimental study. The research sample includes 100 female high school students in Fasa city, Fars Province, Iran, who were randomly assigned to two groups of control (n=50) and experimental (n=50) groups. Data collection instrument was a questionnaire that included items on demographic characteristics and the PERCEDE model components (knowledge, attitude, enabling and reinforcing factors and performance). Educational intervention for the experimental group was carried out in four sessions which each lasting 55 to 60 minutes, and subjects were followed for 2 months. The questionnaires were administered to both groups before and 3 months after the intervention. The collected data was analyzed by SPSS version 18. 0 statistical software. Results: The average performance score of experimental and control groups regarding fruits and vegetables consumption was 15. 15± 2. 44 and 14. 96± 2. 12 (before the intervention) and 28. 22± 2. 22 and 16. 1± 11. 32 (after the intervention). Mean scores of predisposing (knowledge and attitude), reinforcing, and enabling factors showed a significant difference in the experimental group in comparison the control group (P<0. 05). Conclusion The significant increase in student performance scores regarding fruits and vegetables consumption at the end of the study indicates the positive effect of education on promoting knowledge and changing attitudes of individuals. Therefore, the design and implementation of the training program based on the PRECEDE-PROCEED model can promote healthy eating habits and increase fruits and vegetables consumption among students.

Background Hydatidosis is a conventional health public problem in most parts of the world. Safe treatment of patients with hydatidosis has been a topic of debate for a long time. Surgical treatment always was associated with high morbidity and mortality. Medical treatment is also controversial. In this study, alternative procedure named Percutaneous, Aspiration and hypertonic Saline Instillation (PAHSI) was applied to treat patients with hydatidosis. Materials and Methods In this single-blind clinical trial, thirty-eight patients, ranging in age between 6 months and 16 years, with 81 hepatic hydatid cysts underwent PAHSI treatment. The consecutive steps including sonographic guidance, aspiration of cyst content and injection of 15% saline hypertonic were carried out in this method. Patients with multiple cysts also were treated by this procedure. Results Participants were 18 boys (47. 3%) and 20 girls (52. 6%) with mean age of 8. 08+ 3. 92 years. Almost half of the patients had single cyst (52. 63%). During 2-year follow-up, no recurrences were observed; therefore, re-hospitalization and possible complications reduced considerably. Furthermore, this method was applicable to cure multiple cysts. Conclusion In PAHSI strategy, it seems that the complications of surgery (laparotomy and anesthesia) decreased since no complications observed after procedure, and cosmetic results in future are much better due to avoidance of incision.

Background This study performed to assess the efficacy of ultrasound in screening upper and lower extremities fractures in comparison with standard X-ray in pediatric trauma patients. Materials and Methods This was a prospective diagnostic study conducted at the emergency department of Imam Khomeini Complex Hospital, Tehran, Iran. All patients with the age under 18-year-old admitted with limb trauma were first evaluated by attending emergency medicine physician using ultrasound and then underwent necessary X-rays. Thereafter, the ultrasound reports were compared with X-ray reports regarding measurement of its accuracy. Results Forty patients with the mean age of 9. 47 ± 5. 26 years (minimum of 2 and a maximum of 17 years) entered the study (75% were male). The average time of performing ultrasound in pediatric population is 3. 99± 0. 83 minutes which is statistically significant compared to X-ray, 16. 12 ± 4. 15 minutes (P<0. 001). The overall sensitivity, specificity and accuracy of ultrasound in detecting fractures in evaluated pediatrics were 100%, 100% and 100%, respectively. The results showed an almost perfect agreement between ultrasound and X ray for detecting upper and lower extremity fractures in pediatrics population (k=1. 00). Conclusion It is likely that ultrasound could be an accurate and time saving substitute for X-ray in screening for limb fractures in pediatric trauma patients admitted in emergency department.

Background Urinary tract infection (UTI), are the most frequent and serious infection in childhood around the world. The present study aimed to evaluate antibiotic sensitivity of urinary tract pathogens among children in Zahedan, South East Iran. Materials and Methods This cross-sectional study analyzed 396 patients aged 1-18 years with positive urine and suspected UTI. Gender and age of children, kind of isolated bacteria in urine culture, susceptibility and resistance of these bacteria to current antibiotics were studied. Bacterial growth for more than 105 CFU/ml was considered as positive. Data analyzed by SPSS version 21. 0. Results The most common age of urinary tract infection were < 1 year and 1-7 years for boys and girls, respectively, and the variation of sex distribution was significant in different age groups (P = 0. 003). The most prevalent cause of UTI was Escherichia coli (E. coli) (77%), in total ages and both gender, afterward was Enterobacter (8. 1%) and Klebsiella (7. 1%). E. coli sepsis was highly sensitive to nitrofurantoin (74. 7%), ciprofloxacin (72. 5%), and amikacin (64. 6%), both highly resistant to trimethoprim and sulfametoxazole (74. 8%), ampicillin (66. 9%), and nalidixic acid (51. 1%); and its resistance to ceftriaxone was increasing. Conclusion In this study resulted that E. coli was the first responsible pathogen in proven culture of UTI in children, which was increased in resistance to popular antibiotics like Ampicillin, Sulfamethoxazoletrimethoprim and Nalidixic acid. In several countries, emphasize the need for local population specific surveillance for guiding empirical therapy for UTI in children.