Journal of Pediatric Perspectives
Year:2016 | Volume:4 | Issue:8 (32)|Papers Count:17

Foreign Body Aspiration (FBA) is a common and sometimes life-threatening problem in children and in higher age groups. FBA highest incidence rate is during the second year in children and the sixth decade of life in adults, and often foreign bodies due to their shape and size pass through larynx and trachea and place in bronchi. The most common aspirated body by children are nuts. Symptoms of aspiration can be asphyxia, cough, or cyanosis. Although in some cases patients may have no symptoms, an accurate and positive history even without clinical signs must be suspected doctor to a foreign body aspiration. However, in some cases, radiological intervention is normal and helps to diagnose and should be performed in all suspected cases to FBA. FBA definite diagnosis is by bronchoscopy, and to prevent complications and possibly death, timely removing of foreign body is vital and necessary. Most of the complications of delayed diagnosis and treatment and early detection are associated with few complications. FBA potential complications include pneumomediastinum, pneumothorax, atelectasis, bronchiectasis, lung abscess, and recurrent pneumonia. Most of these complications are irreversible in people with problems diagnosed too late. Technological advances and clinical application of bronchoscopy have caused the majority of foreign bodies are removed from the respiratory system are without sequela. The removal of foreign body through undergone rigid bronchoscopy is the preferred method of treatment, but in certain cases may require surgical intervention to remove the foreign body. This report is a case of 17-month-old infant with fever, coryza, and cough symptoms with a diagnosis of pneumonia was hospitalized due to suspected pulmonary mass by chest x-ray or chest CT scan and bronchoscopy was performed and the seed was removed from the right lung.

Gaucher Disease (GD) is the most common type of Lysosomal Storage Disorder and it is divided into three distinct subtypes. The authors here report four different cases of Gaucher Disease, with varying clinical manifestations, and the diagnosis of each established by the low level of Beta-Glucosidase enzyme as well as genetic DNA testing. The study also highlights the importance of early diagnosis of the disease in order to initiate the appropriate therapeutic management to help prevent further progression of the disease.

It is estimated globally 3. 2 million children were living with HIV in 2014, that mostly in sub-Saharan Africa. However, the majority of them infected to HIV from their mothers during pregnancy, during delivery or breastfeeding (1). Antiretroviral therapy (ART) use during and after pregnancy is essential for prevention of mother-to-child transmission (PMTCT) of HIV (2). In the absence of any interventions HIV transmission rates are the range of 15-45% (3). In this letter our goal is to describe the situation of transmission of HIV/AIDS from mother to child in Iran compared other regions of the world, and expressed which indicators should be upgraded. As shown in Figure. 1, estimated numbers of infected children in Iran were 1900 (1400 – 2800) in 2015. This situation is much better of many African countries with more than 11, 000 infected children. For many countries in Europe, South East Asia and America, this information was not available (4). Regarding coverage of pregnant women who receive antiretroviral therapy (ARV) for PMTCT index, that's mean percentage of infants born to HIV-positive women receiving a virological test for HIV within 2 months of birth (Figure. 2), Iran is among the countries with less than 36% coverage. However, this indicator for many countries in South Africa, South America and Central Asia is more than 85% (5). Also, early diagnoses of HIV infected infants in Iran not have suitable conditions, and like many countries of North Africa and Southeast Asia less than 36% of them were timely diagnosed (Figure. 3).

Background: It is necessary to achieve information on malnutrition situation in children for resource allocation and health policy making, therefore this study aimed to identify the role of human development and its components on malnutrition situation in children under-five years of old worldwide. Materials and Methods: This ecological study was performed on the relation of the malnutrition situation of children under 5 years of old and human development index (HDI). Data about the HDI and its components were obtained for 188 countries from the United Nations Development Programme (UNDP) database and Data about prevalence of wasting, stunting and overweight in children under 5 in 2014 for 121 countries were obtained from World Health Organization (WHO). Correlation bivariate method was used to evaluate correlation between the prevalence of malnutrition status and the HDI. Results: Globally mean prevalence of stunting, wasting and overweight were 23. 4 (21-25. 7), 6. 2 (5. 4-7) and 7. 1 (6. 3-8) percent respectively. There was a negative statistically significant correlation between prevalence of stunting and wasting with HDI and its components, physician per population, maternal mortality rate (P<0. 001); while positive significant correlations were observed between prevalence of overweight and HDI and its components (P<0. 05). Conclusion: Stunting and wasting were common in low developed regions, while overweight mainly is a health problem in high development regions. HDI and its components can change the prevalence of malnutrition aspects across countries. Developed and developing countries need to provide more health education and preventive interventions about malnutrition in under-five children.

Dear Editor-in-chief: Under-five mortality rate is the probability per 1, 000 that a newborn baby will die before reaching age five, if current age-specific mortality rates be continued. Under-5 mortality, a Millennium Development Goal indicator, is a leading indicator of child health and overall development. This indicator measures child survival. It also, reflects the social, economic and environmental conditions in which children (and others in society) live, including their health care, and also it is a one of health development index (HDI) in world (1, 2). 1-1. Situation and trends in the World Globally, 5. 9 million children under-five years old died in 2015, about 16 000 death every day. The risk of a child dying before completing five years of age is still highest in the WHO African Region (81 per 1000 live births), about 7 times higher than that in the WHO European Region (11 per 1000 live births). Many countries still have very high under-five mortality, particularly those that located in WHO African Region, indeed several countries in this region have an under-five mortality rate above 100 deaths per 1000 live births. Figure. 1 shows under-five mortality rate in the World in 2015 (3, 4). But, generally, under-five mortality rate has decreased by 53%, from an estimated rate of 91 deaths per 1000 live births in 1990 to 43 deaths per 1000 live births in the world in 2015. The average annual rate of reduction in under-five mortality has accelerated from 1. 8% a year over the period 1990– 2000 to 3. 9% for 2000– 2015 (Figure. 2). About 19 000 fewer children died every day in 2015 than in 1990. Percentage of children aged under-five mortality rate, according to different regions of WHO, illustrated in Figure. 3. The highest deaths rate of children under 5 years related to African Region and South – East Asia. WHO has suggested that under-five mortality rate should reach to less as 25 per 1000 live births. Currently, 79 countries have an under-five mortality rate above 25, and 47 of them will not to 25 deaths per 1000 live births in 2030, if they continue their current trends in reducing under-five mortality. So, for reach to under-five mortality rate less as 25 per 1000 live births, serious and global measures are required (1, 3).

Background Parents having a baby with infantile colic experienced thoughts and emotions such as hopelessness, fatigue and concern. This study presents a review to provide better insights into the life of parents living with a colicky infant. The aimed of this meta-synthesis was to analyze and synthesize findings from qualitative studies about the experiences of parents of colicky infants. Materials and Methods This meta-synthesis follows the guidelines of Sandeowski and Barroso and was designed to synthesize findings from previous qualitative studies. The following biomedical archives were searched: PubMED, Web of Science, PsycINFO, Cochrane library, ProQuest. Recently published articles and books on the experiences of parents living with a colicky infant were reviewed. The searches covered the years from 2000 to 2016 and found three studies, which fulfilled the inclusion criteria. Results The findings of all studies selected were categorized into the themes of "eclipse of normal life" and "relief through parental adaptation". The findings reveal that the experiences of parents living with a colicky infant are important for constructing an insightful child care protocol and improving interpersonal interactions in the family. Conclusion The pathic or non-diagnostic knowledge that emerged from this qualitative review may be helpful for improving treatment of colicky infants and a provide relief for their parents.

Background HIV/AIDS is one of the major public health problems and a barrier to the progress of human civilization that is considered as a big concern for people all around the world. Premarital sexual abstinence is introduced as the most effective way to avoid HIV/AIDS. This study aimed to determine associated factors in the preventing behaviors of HIV/AIDS among young people using the Extended Health Belief Model. Materials and Methods This research was a cross-sectional descriptive analytical study which was conducted on 577 students in different universities in Shiraz. The participants were enrolled in the study using random stratified sampling method. A researcher-made questionnaire based on Extended Health Belief Model was implemented to collect data. Data were analyzed with SPSS V. 18 using independent t-test, ANOVA, and Pearson correlation coefficient. Results In this study, the intention of premarital sexual abstinence had a statistically significant association with the constructs of knowledge, perceived susceptibility, perceived benefits, perceived barriers, perceived self-efficacy, subjective norms, and religious beliefs (P<0. 05). Conclusion When designing programs for the prevention of HIV/AIDS and for the promotion of the premarital sexual abstinence, it might be useful to utilize the Extended Health Belief Model and focus on religious beliefs and subjective norms.

Background: Self-medication by people is one of the major issues in the world that can be lead to numerous medical and economic problems, this especially issue in children under 2 years who are at the age of growth and development have great importance. The aim of this study was investigate the effects of model-based educational interventions on self-medication behavior in mothers with children under 2 years of age who referred to the health centers of Firoozkooh city (Iran). Materials and Methods: This study was quasi-experimental interventional study. The study population consisted of mothers with children under 2 years old referring to health centers of the Firoozkooh city, Iran. The data collection tool was researcher made questionnaire which its validity and reliability was assessed than was used. The required information was collected before and after the educational intervention. Then 4 months after the educational intervention, evaluation was done and data analysis was using SPSS-20. Results: Significant difference was not found between mean scores of knowledge, perceived sensitivity, severity, benefits, barriers, self-efficacy with performance (self-medication) before the educational intervention (P>0. 05). But after the educational intervention, statistically significant difference was found between mean scores of knowledge, perceived sensitivity, severity, benefits, barriers, and self-efficacy with performance (P<0. 05). Conclusion It seems that Model-Based Educational Intervention may be promoted the knowledge and performance of mothers about self-medication in children. Notifying mothers in this filed through the mass media such as radio and television and health care personnel can be used to reduce the self-medication.

Background Infant formula means a breast-milk substitute specially manufactured to satisfy, by itself, the nutritional requirements of infants during the first months of life up to the introduction of appropriate complementary feeding. We aimed to determine the cost and burden of formula feeding on the family in Al-Amara city, Iraq. Materials and Methods A cross-sectional analytic study was carried out in Al-Sadder Teaching Hospital in Al-Amara city, Iraq, during period from August/2015 to February/2016. The study performed on 100 mothers of infant less than 6 months who were attended the pediatric ward. Data was collected then calculating the average of ounces consumed per a day for each age group with calculating their cost per a day. Results The mean cost of ounces consumption per a day for each infant who was exclusively on formula feeding during the first month of age was (1, 584 IQD: Iraqi Dinar), while for the second month and 3-6 months age group were (1, 806 IQD) and (2, 322 IQD) respectively. The cost was significantly higher than those infants on mixed feeding in all age groups, the P-values are 0. 007, 0. 005 and 0. 002 in 1st month, 2nd month and 3-6 month of age respectively. Conclusion In general the cost of formula milk feeding in infancy was high and causing a burden on the family. Saving money, health and emotional wellbeing will direct our vision toward breast feeding.

Background Maturity and its related sexual and mental changes are one of the most important events in the life of every individual. The purpose of this study was to determine the effect of puberty health education based on Health Belief Model on health behaviors and preventive among students boy first secondary school in Marivan city in 2015. Materials and Methods This research is an experimental intervention study that was conducted in 2015. The study participants were 64 male students of second year of first secondary school boys who were selected randomly with cluster sampling from two schools among 12 schools in first grade of high school in the Marivan city. Totally 32 students were selected randomly in the intervention group in the one of the schools and 32 students in the control group in the other school. The data collection instrument was a questionnaire developed by the researchers based on the health belief model. The validity and reliability of questionnaire was confirmed. Statistical analysis was carried out using SPSS version 17, Chi square, descriptive statistics and independent t-tests. Results Results showed significance differences after educational intervention in the mean scores of awareness, perceived susceptibility, perceived severity, perceived benefits, cues to action and performance in the intervention group (p<0. 05), but there were no significant differences about perceived barriers. Conclusion The findings of this study emphasize and describe the efficiency of educational intervention based on health belief model in adopting the preventive and controlling behaviors in principles of maturity health describing the maturity.

Background Background: Hearing loss is the most common congenital disorder the incidence of which is further increased in the presence of risk factors for hearing loss among newborns admitted to the neonatal intensive care unit (NICU). The aim of this study was early diagnosis and intervention for hearing loss in newborns discharged from NICU. Materials and Methods This prospective cohort study was conducted on 3, 362 newborns discharged from the NICU in several hospitals in Babol, Iran. Each newborn was evaluated through the transient evoked otoacoustic emission (T) EOAE test. In the absence of any result, retests including TEOAE and diagnostic auditory brainstem response (ABR) were conducted. In case of hearing loss, intervention programs including hearing aids fitting and cochlear implant were considered for infants. Each newborn infant was follow-up for four years. The infant’ s age was also calculated during the hearing loss diagnosis and the intervention program. Results Sensorineural hearing loss (SNHL) was diagnosed in 35 (1. 04%) of the infants at an average age of 105. 65 + 96. 72 days. Most of hearing loss diagnosis (51. 43%) was before the age of 3 months. Hearing aids were fitted for 25 infants (80. 64%) with a mean age of 9. 61 + 7. 64 months. Cochlear implants were done for two (8%) children. At the end of the follow up, all of the children except one case (3. 22%) were able to use verbal communication. Conclusion Hearing screening of the high risk NICU graduate babies has reduced the age of hearing loss diagnosis to 3 months. The presence of severe to profound hearing loss in this population highlights the importance of early diagnosis and intervention.

Background To this date, there has been no specific therapy proven to be effective for cyclic vomiting syndrome (CVS) in controlled trials. Multiple regimens have been proposed including: cyproheptadine, propranolol, amitriptyline, and phenobarbital. These medications are not without major side effects. The aim of this study was to describe the authors’ experience with hydroxyzine in children with CVS. Materials and Methods This was a systematic retrospective review of charts from March 1st 2012 till December 31st 2014. Patients diagnosed with CVS and treated with hydroxyzine were included in this study. Demographic criteria as well as response to therapy were reviewed. Results 48 patients were diagnosed with CVS during the period of two years and nine months. Female to male ratio was 2: 1. The average age at diagnosis was 10. 4 years. Fifteen patients were treated with hydroxyzine. Overall success rate was 86. 7%. The rates of complete and partial remission were respectively 61. 5% and 38. 4%. Only 2 patients failed to respond. Conclusion Hydroxyzine seems to be a safe and effective alternative prophylactic treatment in children with CVS. Further randomized controlled studies are needed to support this specific indication for prescribing hydroxyzine.

Background: The association of duration of breastfeeding (BF) with weight disorders remains controversial. This study aimed to evaluate the association of BF with anthropometric measures and weight disorders in Iranian children and adolescents. Materials and Methods: Using multistage random cluster sampling method, a representative sample of 25, 000 school students were selected from urban and rural areas of 30 provinces of Iran (2011-2012). Through a validated questionnaire, data was recorded for every participant. Anthropometricand measures and duration of BF were measured under international standard protocols by using calibrated instruments. Results: Overall, 23, 043 students completed the survey (participation rate: 92. 17%). They consisted of 50. 8% boys, 73. 4% urban residents, with a mean age of 12. 55 ± 3. 31 years. Significant association was found between BF duration and overweight (P<0. 05). In multivariate model, longer duration of BF (BF ≥ 6 months versus < 6 months), was associated with lower risk of becoming overweight [odds ratio(OR): 0. 86(0. 74, 0. 99)]. There was no significant association between duration of BF with body mass index(BMI), waist circumference, hip circumference, neck circumference, wrist circumference, generalized obesity and abdominal obesity. Conclusion: Although the longer duration of BF is associated with lower risk of becoming overweight, does not seem to be associated with anthropometric measures in childhood and adolescence. To confirm the results of the present study, more longitudinal studies in Iranian children and adolescents are warranted.

Background The present study was designed and conducted to determine the relationship between self-efficacy and marital satisfaction among married and single students. Materials and Methods The sample of this study consisted of 50 married students of Payame Noor University in IZEH city, South West of Iran; then simple random sampling method was used to select samples. To measure self-efficacy questionnaire Scherer and Enrich marital satisfaction questionnaire was used. Data were analyses using SPSS-20. Results The mean age of students were 23 + 0. 739 years. In terms of demographic characteristics, 50% of the study population were women and 50% were men. Results showed that there was a significant negative correlation between self-efficacy and marital satisfaction of male students (r=-0. 55 and P=0. 001), respectively. Also, there was a significant negative correlation between self-efficacy and marital satisfaction in married women students (r=-0. 47 and P=0. 001), respectively. Conclusion The root of many marital problems, including divorce, the factors they are directly or indirectly marital satisfaction. Therefore, considering these variables can be important to prevent disputes in married life and many negative consequences for physical and mental health will bring the couple and their children that can affect the beneficial aspects of married life.

Background The aim of this study was to determine the relationship between maternal anemia during pregnancy and pregnancy outcomes. Materials and Methods This systematic review was conducted in domestic (Sid, Iran. doc, Iran medex and Magiran) and international (PubMed, Science Direct, Cochrane, Medline, Web of Science, Scopus, Springer, Embase, Google scholar) databases from January 1, 1990 to April 10, 2016 with using standard key words "Pregnancy", "Pregnant women", "Hemoglobin/ haemoglobin", "Anemia/ anaemia", and "Pregnancy outcome". Relative risks (RR) and confidence intervals were extracted from each study. Results Overall 30 studies with a total sample size of 1, 194, 746 were entered into the final meta-analysis. Maternal anemia in the first trimester showed a significant relationship with low birth weight (RR: 1. 28, 95% CI, 1. 10-1. 50, P<0. 01), pre-term birth (RR: 1. 26, 95% CI, 1. 11-1. 44, P<0. 01) and small for gestational age (RR: 1. 12, 95% CI, 1. 05-1. 19, P<0. 01`), that means maternal anemia in the first trimester raises the risk of these outcomes. Even though, maternal anemia in the second trimester has no significant relationship with low birth weight (RR, 1. 19, 95% CI, 0. 65-2. 17, P>0. 05) and pre-term birth (RR: 1. 35, 95% CI, 0. 54-3. 24, P>0. 05). Similarly, maternal anemia in the third trimester has also, no significant relationship with low birth weight (RR: 1. 23, 95% CI, 0. 97-1. 55, P>0. 05) and pre-term birth (RR: 1. 55, 95% CI, 0. 83-2. 88, P>0. 05). Conclusion Maternal anemia during pregnancy in the first trimester in particular can be considered as a risk factor for pregnancy outcomes and must be treated as an advance.

Background Langerhans cell histiocytosis (LCH) is a rare disease in which monoclonal migration and proliferation of specific dendritic cells is seen. The disease primarily affects the bones and skin, but there is a possibility that involves other organs or appears as a multi-systemic disease. Case Report In oral examination of a nine-month girl, two deep wounds with a yellow membrane with approximate size of 1 × 1 cm on both sides of mandibular alveolar ridge were seen. The edges of the wounds were swollen and proliferated and redder than the surrounding mucosa. At the touch the edges of the wound were not indurated. The wound were created from the third-month and the size of wounds had become slightly larger within 6 months. According to the chronic wound and being non-responsive to various systemic and local treatments, incisional biopsy was taken from the wounds. Langerhans cell histiocytosis was confirmed histologically and immune histochemically. Conclusion Mouth ulcers may be the only symptoms of Langerhans cell histiocytosis. Therefore, the role of dentist could be important in diagnosis of this disease.

Background Short stature is a manifestation of a wide variety of conditions that some of which may be amenable to timely treatment and a suboptimal growth rate may be an early marker pointing to the cause of growth retardation. This study was conducted to evaluate the diagnostic utility of growth rate in differential diagnosis of children with short stature. Materials and Methods All children between the ages of 2 and 18 years who visited in pediatric endocrinology clinic in a five years period were recruited in a prospective cohort study. Children with standing height <2 standard deviation (SD) below normal for age according to Center Of Disease Control (CDC) charts were enrolled in the study and their growth rates were checked for a period of at least six months. Children who lost their follow-up before six months were excluded. Thyroid function tests were done in all children and growth hormone status, were checked, if deemed necessary. Results One hundred forty three patients fulfilled the inclusion criteria. Mean follow up period was 14. 4± 10. 9 months. Etiologies of short stature were: constitutional growth delay (CGD) 46. 9%, familial short stature (FSS) 28. 7%, hypothyroidism 4. 2%, growth hormone deficiency (GHD) 4. 2% and miscellaneous causes in 16% of patients. Mean Z-score for children with constitutional growth delay was-2. 3± 0. 69, in familial short stature was-2. 3± 0. 65 and for other condition was-2. 7± 1. 49. There was a meaningful statistical correlation between growth rate and etiology of short stature (P<0. 05), but there were no correlation between Z-score and etiology of short stature (P>0. 05). Conclusion There was significant difference in growth rate between children with constitutional growth delay and familial short stature in comparing to short stature due to endocrine problem and other etiologies. Assessment of growth rate has some utility in diagnosing the etiology of short stature.