Journal of Comprehensive Pediatrics
Year:2013 | Volume:3 | Issue:5|Papers Count:11

Introduction: Breastfeeding is not only one of the human rights, but also an important strategy to reduce children’s mortality and increase their survival (1). A longer breastfeeding period as well as more frequent health care visits have been two important protective factors for 1-59-month-child mortality (2). Child mortality rate (CMR) is an important determinant of the population’s health status and level of human development. It is also a vital target of the Millennium Development Goals (MDG) to be achieved (3, 4). As breastfeeding is the unique nourishment method for babies, it has been determined as a health priority for many years.

Iranian Society of Pediatrics expresses its most sincere condolences on the occasion of this sad event to his kind wife, dear children, relatives and the esteemed family of the late professor Dr. Mohammad Garib, friends, and the venerable society of Iranian Medicine. On the event of this occasion a brief biography of Dr. Mohsen Ziai, his fruitful life and valuable services is presented here:Dr. Mohsen Ziai was born in Khorasan, the eighth generation of his family of doctors from Torbat-e-Heidarieh region. He was born in 1928 and passed away in April, 2013. He pursued his studies up to the end of high school in Torbat-e-Heidarieh, Mashhad and Tehran and went to Johns Hopkins University (Baltimore) for General Medicine courses.

Background: Accurate diagnosis of tuberculosis in infants is important. There are a few studies around tuberculosis in infancy in the literature.Objectives: This study defines the clinical and radiological features of tuberculosis in infants less than one year of age.Materials and Methods: The medical records were reviewed for all infants aging 12 months or less with diagnosis of tuberculosis at TB wards of National Research Institute of Tuberculosis and Lung Disease (N.R.I.T.L.D.) in Tehran, Iran between 2006-2012 retrospectively.Results: Nine infants with a median age of eight months were identified, all of whom had endothoracic Tuberculosis. The cause of medical evaluation was the unset of symptom in five infants and close contact with infected patients in four. Common symptoms and signs included cough in four, Night sweat in three and Crackles in two patients. Chest X-ray showed consolidation in three, nodular lesions in three, consolidation and ground glass in one, mediastinal bulging in one. Chest CT scan revealed consolidation in three, disseminated pulmonary nodules in one, tiny nodules in two, ground glass lesion in two, right Para-tracheal and subcarinal lymphadenopathies in two, pre-bronchial thickening in one and bronchiectasis in one. Culture was obtained from all of the patients and was positive in one. All infants promptly responded to the treatment. No complications and deaths occurred.Conclusions: Pulmonary tuberculosis predominates in infants. Prompt diagnosis and treatment seem to reduce morbidity and mortality in this age group. Chest CT may be supportive in the diagnosis of infants with characteristic lymphadenopathy.

Background: Croup, or acute laryngotracheobronchitis, is the most common cause of upper airway obstruction in children. Objectives: In this study, the efficacies of intramuscular and oral dexamethasone administration are compared for treatment of croup.Patients and Methods: This is a single-blind randomized trial involving 68 children divided into two groups, the first group received 0.6 mg/kg intramuscular dexamethasone and the second group received 0.6 mg/kg oral dexamethasone. The clinical score, respiratory rate, heart rate, O2 saturation and clinical response were assessed before and then hourly for four hours after treatment.Results: The respiratory rate of two groups was significantly different at the first hour of treatment (P=0.02), but it did not vary between study groups at the second, third, and fourth hour of treatment. There was no statistical difference among clinical score, heart rate, O2 saturation and clinical response in any of the measurement times.Conclusions: Oral and intramuscular administrations have the same effectiveness for treatment of croup and oral dexamethasone was proposed because this is a non-invasive procedure.

Background: Febrile seizure (FS) is one of the most common neurological conditions in childhood. It seems that zinc and calcium deficiency are related to seizure activity.Objectives: The aim of the present study was to measure zinc and Calcium levels in the serum and cerebrospinal fluids of febrile convulsive children referred to Zanjan University, Valie Asr hospital.Patients and Methods: Three hundred and ten consecutive children with febrile seizure, who were admitted from January 2009 to December 2010, were studied. Forty five children required lumbar puncture based on the discretion of treating physician. Levels of zinc and calcium were measured in the serum and cerebrospinal fluid specimens of patients using atomic absorption spectrometry method.Results: The mean levels of serum calcium, serum zinc, cerebrospinal fluid calcium and cerebrospinal fluid zinc were 14.51±3.69 mg/dL; 184.04±65.49 mg/dL; 5.23±2.21 mg/dL and 87.06±28.25 mg/dL respectively.Conclusions: We did not find any clear abnormality in plasma or cerebrospinal fluid calcium and zinc levels in children with febrile seizures in our patient population.

Background: Liver is prone to different diseases including metabolic, congenital, infections, drug injuries, and malignancies. Liver biopsy is an aggressive but definitive way to diagnose liver diseases.Objectives: The present study is designed to evaluate the results of liver biopsies in children referred to the Pediatric Gastroenterology Department of Nemazee Hospital.Materials and Methods: The present retrospective study was conducted on 308 liver biopsy specimens from children suspected to liver diseases who had been referred to Pediatric Gastroenterology Department affiliated to Shiraz University of Medical Sciences between March 2003 and March 2008.Results: Totally 308 liver biopsies from the children aged less than 18 years was investigated. There were 128 girls and 180 boys with mean age of 6.04±5.97 years and Male/Female ratio of 1.4/1. The most common pathologic findings were chronic hepatitis (n=71; 23.1%), metabolic diseases (n=37; 12.1%), cirrhosis (n=27; 8.8%), secondary hemochromatosis (n=22; 7.1%), neonatal hepatitis (n=22; 7.1%), and hepatic malignancies (n=21; 6.8%). Liver biopsy was non diagnostic in 16.2% (n=50) of the patients.Conclusions: Chronic hepatitis, metabolic liver diseases, cirrhosis, and neonatal hepatitis are the most common liver diseases in children in our center. In this study a high percentage of liver biopsies were non-diagnostic. Therefore, providing the necessary facilities and equipment for special assessment of liver tissue are essential in this center.

Background: Respiratory distress syndrome (RDS) is considered as one of the most popular prematurity-related respiratory problems and among the most prominent reasons of deaths in preterm infants.Objectives: Brain Natriuretic Peptide (BNP) is the secret of the volume and pressure overload response of the vessels and decreases due to resistance as well as rises in systemic vessels and also in decline of pulmonary artery pressure. In the present paper, BNP is considered as a biomarker for prediction of RDS scoring.Materials and Methods: In this case, 65 preterm infants under 37 weeks with an Apgar score more than seven and 65 healthy term infants were chosen. All of them were controlled for three days in NICU and then divided into 4 groups based on the RDS scoring and intensity, as well as chest x-ray findings; normal, mild, moderate, and severe. Serum BNP of all the infants was measured through ELISA kit and a questionnaire was filled up for each infant based on his/her demographic information and clinical findings. The collected data were analyzed by SPSS software based on the independent statistical t-test, one-sided variance analysis and X2. P<0.05 was considered as the significant.Results: The study results revealed a significant difference between the two groups regarding the pregnancy age, weight and type of delivery between cases and control groups (P³0.05); but there was no significant difference between BNP in cases and control groups (P£0.05). However, the comparison between the mean of pregnancy weight, pregnancy age, and BNP based on RDS frequency among the patients was significant (P³0.05).Conclusions: The results of this study demonstrated that serum BNP level correlates with increased RDS scoring. Therefore, it is possible to use BNP as the prediction marker for the progressive changes of RDS which occur in premature infants.

Background: Preeclampsia is a major cause of maternal, fetal and neonatal morbidity and mortality.Objectives: The aim of this study was to determine the laboratory disorders in neonates born to preeclamptic mothers.Patients and Methods: This descriptive-retrospective study was conducted in the neonatal units of Shahid Beheshti and Shabihkhani Hospitals on neonates born to preeclamptic mothers during 2009 - 2012. Neonatal data including gestational age, gender, mode of delivery, birth weight and laboratory reports were extracted from their medical records and analyzed.Results: A total of 2600 newborns were admitted during the study period, of which 84 infants were born to mothers with preeclampsia. The laboratory disorders were neutropenia in 32 cases (37%), anemia in 33 (39.2%), leucopenia in 24 (28.5%), thrombocytopenia in 23 (27.3%), hypoglycemia in 28 (33.3%), hypocalcemia in 22 (26.1%) and hyperbilirubinemia in 33 (39.2%) patients. Thirty one infants (35.6%) had positive cultures. Twenty nine patients (35%) developed coagulative disorders with prolonged PT and PTT. Evaluation of ABG showed 16 infants (19%) with metabolic acidosis, 23 (27.3%) hypoxia and 24 (28.5%) respiratory acidosis cases. All the laboratory abnormalities were more common in preterm and low birth-weight-infants.Conclusions: Early detection and timely management of laboratory disorders in preeclamptic infants may lead to improvement of the neonatal outcomes.

Introduction: Drug Rash with Eosinophilia and Systemic Symptoms (DRESS) syndrome is a severe form of adverse drug reaction which describes a potentially life threatening condition, associated with a high mortality rate. This syndrome is rarely seen in childhood even though a large number of children receive anticonvulsant treatment.Case Presentation: We report here two infants under two months of age, whose findings were consistent with DRESS syndrome due to phenobarbital usage. Considering their age, these two cases appeared to be unique to our knowledge. Good responses were observed in both cases after stopping the culprit drug and administration of systemic corticosteroid.Discussion: Early recognition of DRESS syndrome is of a particular importance. Although rare, in newborn infants with the presence of skin rash, liver involvement, hyper-eosinophilia and lymphadenopathy, DRESS diagnosis should be highly suspected and prompt intervention including withdrawal of causative drug is required to prevent potentially fatal outcomes.

We are writing this letter regarding the importance of Pseudomonas aeruginosa (P. aeruginosa) colonization in patients with Cystic Fibrosis (CF) lung disease and the significance of new therapeutic approaches, including the development of different innovative aerosol formulations. P. aeruginosais the main cause of chronic airway infection in this complex inherited disease, as confirmed by an interesting study of one of your articles published in this journal (1).

Cystic fibrosis (CF) is recognized as a serious, life-limiting autosomal recessive inherited condition, affecting multiple organs. Improvements in both diagnosis and management of CF has led to the recognition of a range of phenotypes, from mild to severe, with varying rates of disease progression.