Iranian Journal of Pediatrics
Year:2006 | Volume:16 | Issue:4|Papers Count:27

Background: Uric acid has been shown to be increased in congenital heart diseases (CHD) and Eisenmenger syndrome. The present study was undertaken to investigate the incidence of hyperuricemia, renal dysfunction and the exacerebrating factors in congenital heart diseases (CHD).Methods: We studied prospective cross sectionaly 500 patients, aged one month to 18 years. Blood for serum uric acid, hemoglobin (Hb), hamatocrit (Hct), arterial blood gas (ABG), blood urea nitrogen (BUN), creatinine (Cr) and urinalysis (U/A) as well as pulmonary and aorta arterial pressures were obtained during catheterization.Findings: 24.8% of patients with cyanotic congenital heart diseases (CCHD) had a serum uric acid level of greater than normal, related directly to the degree of polycythemia, but 0.06% in non cyanotic congenital heart diseases. Also 13% of patients with pulmonary hypertension (PH) had hyperuricemia corresponding to PH value. In these groups, hyperuricemia increased parallel to age. 24 % of hyperuricemic cyanotic patients and 10% of hyperuricemic PH had abnormal proteinuria without increased BUN and Cr. Conclusion: Serum uric acid increased proportional to polycythemia and PH in CHD and may cause nephropathy without increase in BUN and Cr.

Background: The purpose of the present study was to identify the prevalence of neonatal conjunctivitis and its bacteriological causes in neonates hospitalized in Imam Khomeini and Vali-e-Asr hospitals during 5 years and to investigate the maternal and newborns' data in conjunctivitis cases.Methods: All newborns born in or referred to the two abovementioned hospitals being clinically suspicious of conjunctivitis and with positive microbiology were studied.Findings: Of 4021 neonates hospitalized in the two hospitals, 198 (4.9%) had conjunctivitis. 65% of conjunctivitis cases were delivered by cesarean section. 47% had a history of maternal premature rupture of membrane (PROM) and 11% genitourinary infection. 65% were preterm. 61% had low birth weight and 32% an APGAR score below 7 at birth. Also 22% had septicemia. The most common organism causing ophthalmia was S. aureus (31%). Other pathogens consisted of E. coli (23%), S. epidermidis (22%), Klebsiella (10%), N. gonorrheae (3%), C. trachomatis (2%), and Pseudomonas aeruginosa (2%). In neonates with septicemia, the most common cause of conjunctivitis was E. coli (38%). Neonates with E. coli conjunctivitis had significantly (p<0.05) higher rate of history of maternal genitourinary infection and higher rate of septicemia compared to non-E. coli cases.Conclusion: Data such as birth weight, APGAR score, presence of septicemia, maternal genitourinary infections and PROM may play a role in developing neonatal conjunctivitis with different pathogens.

Background: During the past few years several pediatric intensive care units (PICU) are opened across the country. The effective use of PICU beds is an important issue because they are expensive and have limited resources. The aim of this study was to evaluate the PICU bed utilization in a new established general PICU in a university children’s hospital.Methods: In a three-month period after opening PICU, the criteria of admission and discharge of all admitted and discharged patients were reviewed and compared with the standard criteria of admission and discharge of American Academy of Pediatrics.Findings: Fifty six patients (34 males and 22 females) with median age of 2.8 years were admitted in this period and totally stayed 254 days. Wrong admission rate was 20%, these patients consumed about 10% of the days of care. Early (wrong) discharge was found in 6% of patients. The average and median duration of stay was 4.5 and 2 days, respectively. Only 9% of patients stayed for 14 or more days.Conclusion: Adherence to standard guidelines of admission and discharge improves the utilization of PICU beds.

Background: Complications related to vascular access are among the most important causes of morbidity in children chronically on hemodialysis. This study was designed to determine the prevalence of the central vein catheters (CVC) and arterio-venous fistulae (AVF) in children on chronic hemodialysis.Methods: This study includes 68 children who have been treated with hemodialysis in Dr. Sheikh Hospital, Mashhad, Iran, during 2000-2005.Physical examination, clinical and paraclinical findings were recorded in special charts.Findings: Out of 68 patients treated with hemodialysis 29 (42.6%) were female and 39 (57.3%) male. The average duration time of hemodialysis was 15.8 months. Before performing AVF, the central venous catheters were placed in subclavian vein in 28 patients (41.1%) and internal jugular vein in 26 patients (38.2%). The fistula placed was radiocephalic in 29 (42.6%) and brachio-basilic in 33 children (48.5%). 48 patients (77.4%) underwent only one surgery for AVF. The most frequent complications of central venous catheters were: catheter infection (48.1%), inadvertent extraction of the catheters (7.4%), cardiac arrhythmia (1.8%) and hemothorax (1.8%). The most common complications of AVF in decreasing order of frequency were: nonfunctional fistula due to thrombosis or hematoma (20.9%), infection (12.9%), aneurysms (11.2%) and ischemia of the hand presenting as paresthesia, dysesthesia and pain (11.2%). Overall, 10 (18.5%) patients were hospitalized due to the complications of CVC and 20 (29.4%) for the complications of AVF.Conclusion: The most frequently observed complications of CVC and AVF were catheter infection and non-functional fistula. The risk factors for AVF dysfunction were young age, hypotension and hemodialysis without administration of heparin.

Background: The study evaluates whether facial landmarks can be used to estimate an appropriate laryngoscope blade length for oral endotracheal intubation in children. We tested the hypothesis that the laryngoscope blade measuring 10 mm or less distal or proximal to the angle of the mandible (when the flat portion of the blade follows the facial contour from the upper incisor teeth to the angle of the mandible) will demonstrate greater success and ease of oral tracheal intubation.Methods: In an observational and prospective study, 60 children 8 years old or younger were undergoing direct laryngoscopy for oral endotracheal intubation in the operating room, were enrolled in the study. Intubations at first time considered successful and intubation with more than one attempt considered unsuccessful. Ease and success of oral tracheal intubation were compared with distance measurements from the angle of the mandible to the tip of the laryngoscope blade. Blade lengths considered too short (blade lengths >10 mm proximal to the angle of the mandible) and too long extending longer than 10 mm past the angle of the mandible.Finding: Only 66% of the intubations using the shorter blade were performed on the first attempt as compared with 88.3% of the intubations using the recommended length or 81.2 % of the intubations using blades extending longer than 10 mm past the angle of the mandible (Chi-square, p=0.02). Fisher exact test showed that recommended blade was more successful than longer blade (p=0.048).Conclusion: Our findings suggest that facial landmarks seem to be excellent clinical criteria for laryngoscope blade length selection for pediatric intubations. When the blade is placed at the upper midline incisor teeth and the tip is located within 1 cm proximal or distal to the angle of the mandible, oral tracheal intubations can be accomplished on the first attempt.

Background: The increased prevalence of resistant gram negative organisms in our hospital is documented in our previous retrospective study during 1996-1998. The present study was conducted to determine the resistance frequency of gram negative organisms responsible for infection in children.Methods: In a descriptive prospective study within 2 years (2002-2003).We surveyed 101 children aged 1 month-14 years hospitalized in pediatric and ENT wards of Rasool Akram hospital selected by simple sampling. All gram negative organisms isolated from blood, CSF and other sterile sites (middle ear; mastoid; sinus; trachea) were evaluated first by disc diffusion and then E-testing for MIC to find appropriate antibiotics for the isolated organisms.Findings: The isolated germs consisted of Pseudomonas aeroginusa (47.5%), Klebsiella pneumoniae (22.8%); E. coli (17.8%), entrobacter and Acinetobacter (4.9%), Fusobacter and Salmonella paratyphi (1%).Resistance of pseudomonas was high (80%) for gentamycin; cotrimoxazole and rifampin; moderate (50%) for ceftazidim and amikacin, but low (<15%) for imipenem. Resistance of Klebsiella to ampicillin, gentamycin, amikacin, cotrimoxazole and ciprofloxacin was high (70%), but showed lower resistance for ceftriaxone and imipenem (30%). More than 90% of E. coli was resistant to ampicillin, cotrimoxazle, with moderate resistance (20%) to gentamycine and cephalexin. Resistance of Entrobacter to ceftriaxon was less than 40%. More than 80% of Acinetobacter was sensitive to amikacin and cotrimoxazole.Conclusion: Ceftazidime, despite increasing resistance of pseudomonas to it, combined with amikacin is still adequate for empiric treatment in admission. For other resistant types, cefepime or imipenem is useful. For Klebsiella pneumoniae, ceftriaxone and imipenem; for E. coli, amikacin or ceftriaxon; and if it does not respond imipenem or azteronam. Cefriaxon is the best choice for early treatment of Enterobacter infections.

Background: After national mass catch-up campaign of measles-rubella (MR) immunization on 5-25 year-old individuals in December 2003, in Iran, this research was conducted to assess the role of mothers' MR vaccination on persistence of passive immunity against measles-rubella in their infants before MMR, and the effect on the immunogenicity of MMR vaccine in these children.Methods: From June 2005 to March 2006, all healthy 12 month-old infants presented for routine MMR vaccination were enrolled. Before and 4-8 weeks after immunization, sera samples were collected. According to their mother's history of MR vaccination, infants were divided into two-groups. Anti-measles-mumps–rubella antibodies were measured by quantitative ELISA method. The difference of seroconversion rates and mean concentration of antibodies (MCA) between the two-groups of infants were analyzed by descriptive statistical methods using SPSS 11.Findings: Totally 112 infants (mean age 12.1 months, 58% male) from 112 paired mothers (mean age: 24.3 years, 75% MR vaccinated) were recruited. From sera taken before MMR vaccination, 7, 2 and 12 were positive against measles, mumps and rubella, respectively. All seropositive cases for measles and rubella were born to MR vaccinated mothers. Seroconversion rates were: 90.5%, 80% and 53% in infants for measles, mumps and rubella, respectively. Seroconversion rate differences between the two groups of infants for measles, mumps and rubella were not statistically significant (measles: 88.3% of vaccinated vs 96.4% of non-vaccinated, rubella: 51.4% vs 57.1%, respectively).However, anti-measles and anti-rubella MCA differences between the two groups were significant. Conclusions: These study findings indicate that MR vaccination of mothers causes more prolongation of passive immunity persistence in their infants, and may influence the immunogenicity of MMR vaccine in infants. Also results showed that immunogenicity of rubella component of MMR vaccine was not satisfactory.

Background: Liver disease can complicate primary antibody deficiency in several ways. This study investigates the prevalence and causes of hepatobiliary disease in 62 Iranian patients with primary antibody deficiency.Methods: Sixty-two primary antibody deficient patients were followed up and signs and symptoms of liver disease were recorded. All patients were tested for hepatitis C virus (HCV-RNA) and almost all for Cryptosporidium parvum (CSP). The patients with liver involvement were examined from clinical, laboratory and radiological aspects on a regular basis.Findings: Clinical evidences of liver disease were documented in 22 patients (35.5%). Eight patients (13%) had clinical, radiological and laboratory criteria of chronic liver disease. Only one patient was HCV-RNA positive, he had stigmata of chronic liver disease and pathologic evidence of chronic active hepatitis with cirrhosis. One patient with hyper-IgM syndrome was found to be positive for Cryptosporidium parvum. In liver biopsy of patients with liver involvement, one had histological findings related to sclerosing cholangitis, five had mild to moderate chronic active hepatitis with unknown reason.Conclusions: Hepatobiliary disease is a frequent complication in primary antibody deficiency (13%). Liver disease in HCV-RNA negative patients usually accompanies other organ involvements.Chronic active hepatitis with unknown origin is the most common feature of liver injury in Iranian patients with primary antibody deficiency.

Background: Newborns routinely undergo painful procedures.Several methods have been used to relieve pain in neonates. The objective of this study was to assess the analgesic effect of 50% glucose and water during hepatitis B vaccination.Methods: In this randomized controlled trial, 90 term neonates were studied. Infants were randomly assigned to one of the three equal sized groups. First, heart rates were measured by ECG monitor. Then, 2mL of either 50% glucose or sterile water was administered into the mouth of infants in group one and two, respectively. No intervention was undertaken for group three. During and up to three minutes after the vaccination crying of the babies was recorded. The heart rates were measured during injection until 60 seconds. Findings: The mean values of duration of crying for glucose, water, and no-intervention groups were 21.1 s, 33.3 s, and 56.9 s, respectively, which were significantly different (p=0.0003). Post hoc test revealed substantial differences between group one and three (p=0.0001) and between group two and three (p=0.006). However, groups one and two were not statistically different (p=0.19). Moreover, heart rate did not rise significantly in any of these groups.Conclusion: Both 50% glucose and water showed an analgesic effect in neonates.

Background: Almost 7.7 percent of all newborns weigh less than 2500 g in different countries. One of the most important reasons that lead to low birth weight, is maternal anemia during pregnancy. On the other hand, if maternal hemoglobin is too high, the prenatal outcome is not good. In this research we studied the relationship between maternal hematocrit (Hct) and birth weight, as well as the risk of low birth weight (LBW).Methods: This is a cohort study on all pregnant women who used to come to Arash hospital to receive prenatal care (April 2003 – March 2004) and they also delivered there.Findings: If pregnant women have abnormal (higher or lower than normal) Hct level in the first or third trimester, the mean birth weight will be lower and the risk of LBW higher. Maternal Hct level, maternal height, maternal weight and gestational age at delivery have relation to the risk of LBW.Conclusions: It seems that an unfavorable level of maternal Hct is associated with a decrease in newborn's weight and LBW. So, special attention to the level of maternal Hct during pregnancy and control of it can decrease LBW incidence.

Background: Thalassemia is one of the most common human genetic diseases and like other chronic diseases affects different aspects and quality of patient's life. The present research attempted to investigate the effect of family-centered empowerment model on the quality of life (QOL) of school-age thalassemic children. Methods: The present semi-experimental practical research is performed on 35 (test group) and 15 (control group) thalassemic children. The research tools included the questionnaires of demographic information, children’s Quality of life (Peds QOL) and children’s quality of life in thalassemia dimension. After the collection of pre-test data, the family-centered empowerment model was implemented for children and parents in test group according to its four steps (perception threat, problem solving, educational participation and evaluation). The post test was carried out 1/5 months after the intervention.Findings: X2 test showed that there was no significant difference between the test and control groups in terms of demographic characteristics (P>0.05). Also before intervention we observed no significant difference in the QOL of the children both in general independent t-test. While, after the intervention, independent t-test showed a significant difference between the two groups in terms of the difference of means of Peds QOL and thalassemia dimension before and after the intervention. Also, the paired t-test showed a significant difference before and after the intervention in the test group in terms of the ped’s QOL and QOL in thalassemia dimension (P= 0.0001). Conclusions: Our findings showed that the family-centered empowerment model was effective on increasing the quality of life of school age thalassemic children.

Background: Jaundice is a common disorder in neonates and G6PD deficiency is one of its known etiologic factors that could result in kernicterus. This study was done to determine (1) incidence of this enzyme deficiency in icteric newborns and (2) the role of hemolysis in inducing jaundice in G6PD deficient neonates.Methods: This is a 3-year cross-sectional study performed on 505 icteric newborn infants admitted to 22e Bahman hospital in Mashad.G6PD activity was measured qualitatively in the patients. The case group consisted of 34 newborns with G6PD deficiency and the control group included also 34 neonates without this enzyme-defect.In addition to routine laboratory tests, hemolysis indicators were also evaluated in both groups and data were analyzed statistically with SPSS.Findings: The incidence of G6PD deficiency was 6.7% (85% male and 15% female). Mean level of total bilirubin was significantly higher in case group (22.73 mg/dl vs 19.25mg/dl in control group with pv<0.05). In each group hemolysis was proved to exist in only 2 neonates and Coombs test was negative in all of the patients. There were no significant differences in the mean level of hematocrit and reticulocyte counts between the two groups (pv<0.05).Conclusions: With respect to the high incidence of G6PD deficiency in this study (6.7%) and significant incidence in females, measurement of G6PD activity should be recommended in all newborns with jaundice regardless of sex. Hemolysis plays a minor role in inducing jaundice in these newborns and most of them have nonhemolytic jaundice, so that exchange transfusion should be done according to the same indications of other nonhemolytic icterus cases. Because of higher level of serum bilirubin in G6PD deficient neonates, phototherapy must be started early and with lower levels of serum bilirubin.

Background: Birth is probably considered as the most highly dangerous event in every one's life. Although a few percent of newborns may require resuscitation in this stage, wrong methods or failures would lead to death or leave some irreversible complications. That is why it is of great importance to learn the proper methods and become skilful in resuscitation. This study was conducted to compare the effectiveness of conventional and recommended methods of teaching resuscitation to nursery students.Methods: The research is an interventional–semi experimental study.The samples were 46 nursery students of the third semester who were divided into two groups of 23 according to their place of residence. The resuscitation was taught through the conventional and recommended methods. The conventional method consists of teaching all the theoretical subjects by different instructors and performing the related team work. In recommended method the time specified to theoretical subjects is less, and most of the subjects are somehow included in practical work. A pretest was given in the two groups and after the training a final theoretical and practical test was held through the OSCE methods. The findings were analyzed by using the SPSS software and some statistical tests as: Mann Whitney U-test, Independent sample t-test, Pearson correlation, paired t-test.Findings: The findings of this study show that there is no significant difference between the primary knowledge of the students in the two groups. The post-test scores are higher in both groups and the difference is significant which suggests that training has been efficient in both groups. Comparing the post-test scores (practical and theoretical) shows no significant difference. There is no significant difference between the increase in practical and theoretical scores of both groups either. Conclusions: considering less time (1/2) and lower costs (1/4) spent on training in the recommended method, there was no change in efficiency.  

Background: Acute hepatitis B infection can debilitate a patient for weeks and occasionally has a fatal outcome, while chronic infection is a major threat to the individual. To assess the response of nonresponder and hyporesponder children to the booster dose of Cuban recombinant hepatitis B vaccine is the background of this survey.Methods An interventional, descriptive study has been conducted on children who had been immunized with Cuban recombinant hepatitis B vaccine and if their antibody titers were ≤10 mIU/ml (nonresponder) or 10-100 mIU/ml (hyporesponder) booster doses of the same vaccine were administered in their deltoid muscle. Findings: The response of 141 children, with a mean age of 1.9 years, to the first and second booster dose of vaccine was 94.3% and 100% respectively. The anti-HBs titers in nonresponders and hyporesponders were 468 ± 383 and 783 ± 346 mIU/ml respectively with significant differences between the two groups (P=0.001).Conclusions: This study demonstrates moderately increased antibody production in the majority of vaccines with single booster dose of the vaccine.

Background: Cardiopulmonary arrest is one of the most important affairs in pediatric emergency room. Medical identification of causes of cardiopulmonary arrest, the success rate and effective factors of resuscitation can lead to development of new methods to protect children from dangerous situations.Methods: This is an observational retrospective and case-series study.All of the children who underwent cardiopulmonary resuscitation (CPR) in Children's Medical Center, Tehran, entered this study.Findings: Totally 71 children entered the study (57.7% boys, 42.3% girls). 69.1% of these children were younger than 1 year. Almost half of them didn’t have any history of chronic illness before cardiopulmonary arrest. CPR was successful in 45 (68.4%) children. The most common causes necessitating CPR were respiratory and cardiac problems, seizure, hypothermia and intoxication.Conclusions: Regarding the dominancy of the respiratory causes of cardiopulmonary arrest in children, many of CPR cases will recover by simple procedures like opening the airway and applying ventilation. So, morbidity and mortality can be reduced by educating the families in primary resuscitation care.

Increasing numbers of children and adolescents annually participate in the sports competitions, in which the pre-participation evaluation (PPE) is a necessity. Unfortunately, no proper outcome is attainable in our country despite the huge volume and significant costs. The primary goals of the PPE are to detect conditions that may predispose to injury, disability, or death and to meet legal and insurance requirements. It is recommended that PPE be performed 4- 6 weeks prior to an athlete starting practice. There are 3 types of PPE: office based, assembly line, and station. Medical history and physical examination are two essential components of PPE. In this regard, family history and special attention to cardiovascular, pulmonary, musculoskeletal and neurologic systems are particularly important. Most guidelines do not recommend any further paraclinical testing including ECG. At the end of examination, the physician should determine the level of contact and intensity of the given sport and finally decide regarding the safe clearance of the athlete. Due to the importance of PPE as a valuable preventive method, national standardization of the PPE, endorsement of these standards by all organizations and performing the PPE by only appropriately trained physicians are the main strategies to improve the quality of evaluations.

Objective: Inherited metabolic diseases, including glycogen storage disease (GSD), are frequently seen in Iranians due to the high consanguinity rate, but the distribution of various types of GSD is unknown. Hypoglycemia, hepatomegaly, growth retardation, hyperlipidemia, hyperlactacidemia, and hyperuricemia are the common features of GSD type 1, inflammatory bowel disease (IBD)-like colitis is a known entity in GSD.Case presentation: We report a female patient with type Ia GSD (GSD Ia) who was followed-up for more than 17 years. GSD Ia was diagnosed based on biochemical tests and the pathology from a liver biopsy as she was 3 years old.Conclusion: With ageing, more and more complications will develop; of which those related to liver adenomas are likely to be major causes of morbidity and mortality.

Objective: Group A streptococcus (streptococcus pyogenes) is a common cause of upper respiratory tract and skin infections, which may rarely infect other areas as well. Infection with this organism is rare in neonatal period. In addition to local infection such as omphalitis and cellulites, involvement of other sites like pneumonia, meningitis, osteomyelitis, and sepsis has been infrequently reported. Case Report: This report is about a 13-day-old male neonate who was admitted to the neonatal intensive care unit of the Children’s Medical Center in Tehran with respiratory distress, fever, and poor feeding, followed by patchy echymotic lesions over right lower limb which was gradually extended over entire body. 4 hours after hospitalization without any response to extensive management, he expired in septic shock state accompanied by multiorgan dysfunction, and disseminated intravascular coagulation (DIC).Blood culture was positive for Group A Streptococci. Autopsy revealed purulent involvement of various organs, and disseminated intravascular coagulation.Conclusion: Although infection with Group A Streptococci is rare in neonatal period, we should think about it, especially in a neonate with septic shock and multiorgan dysfunction with deep soft tissue involvement.

Background: massive ovarian edema is a rare condition that affects young women. Its cause is not clearly understood but some suggest recurrent ovarian torsions to be responsible. This disease is reported in 1969 for the first time and until recently only 80 cases are reported. Clinical presentation usually is recurrent abdominal pain. Microscopic examination shows severe edema which involves ovarian tissue especially in medulla. Rapid growth, large size of the ovary and absence of true neoplastic changes are characteristic of this disorder.Case report: Our case showed itself by intermittent abdominal pain in a 10-year-old girl. Sonography revealed an ovarian enlargement measuring 10×7×7 cm in diameter and CT scanning showed a mass with water density in the ovary. It was grossly pale, soft and encapsulated. Frozen section histology revealed ovarian edema. The patient underwent partial oopharectomy. Permanent sections confirmed the diagnosis.Discussion: the most important differential diagnosis is fibroma and myxoma of the ovary. This disorder is benign and current therapeutic modalities include partial oopharectomy and fixation of ovaries to prevent recurrent torsions. When an ovarian mass is found in a young woman, a frozen section examination can be helpful in diagnosis and to avoid unnecessary oophorectomy. Awareness of surgeons and pathologists is essential to achieve this goal.