Iranian Journal of Pediatrics
Year:2008 | Volume:18 | Issue:1 (SUPPLEMENT)|Papers Count:21

Objective: External genital anomalies are common congenital anomalies, especially in male newborns. It seems that the incidence of these anomalies is increasing. Although the etiology of these anomalies is obscure in most cases, genetic and environmental factors have important roles. This study aimed to determine the types and frequency of these anomalies in newborn babies and to compare the results with those of a study which was conducted in the same hospital in 1991. Methods: In a descriptive analytic and cross-sectional study, all babies born March 2005 to February 2006 in Alzahra Hospital, Tabriz, were recruited. Findings: 6800 newborns consisting of 3475 (51.1%) boys and 3325 (48.9%) girls were studied. No anomaly was found in girl newborns, but 6.6% of boys had external genital anomalies. Undescended testis and hypospadias were first and second common anomalies. In comparison with the previous study, the frequency of anomalies was higher in preterm and low birth weight babies, babies of related parents and older mothers. Conclusion: The frequency of external genital anomalies had an ascending trend in the last decade. Low birth weight, preterm delivery, high maternal age, and related parents are risk factors for these anomalies.

Objective: The study of the effect of age, especially children under 15 years, on cholera morbidity during a period of ten years (1996-2005) was carried out in Iran. There are no other studies on this topic in Iran and other countries. Methods: In this cross sectional study, we used cholera surveillance data collected in Center for Disease Control. All cholera cases were divided into two groups: under 15 years and above 15 years. Incidence rate of cholera per 100000 was calculated in total population and the two mentioned groups during 10 years. The relative risk of less than 15 year-olds group to above 15 year-olds was calculated with 95% CI for 10 years by EPI6 and SPSS software. Findings: The trend of cholera incidence during the past 10 years shows two epidemic peaks in 1998 and 2005 by the rate of 15.7 and 1.63 per 100000, respectively. During the year with no epidemic and the years between two peaks, the age group under 15 year-olds was more affected with significant relative risk. For example, in 2001 this rate was 4.53. So, we can consider this age group as a risk factor to cholera morbidity. The age group of above 15 year-olds was more affected to cholera during epidemic years (1998, 2005) and relative risk was less than one. So, the age was protective on cholera morbidity for children in these years. Conclusion: One of the most important causes of periodic cholera epidemics every 5-6 years is changing of herd immunity. During the years between two epidemics adults have sufficient immunity and children are more affected because of first exposure and less immunity. With reduced herd immunity epidemics occur. We recommend continuing and strengthening of cholera surveillance system for detection of epidemics and treatment of highly sensitive age groups.

Objective: Transient lower esophageal sphincter relaxation (TLESR) is the major cause of gastro esophageal reflux disorder (GERD) in patient with reflux disease. GERD is the most common esophageal disorder in children. The GABA agonist baclofen decreases acid reflux through the inhibition of TLESRs and should similarly decrease non-acid reflux. The aim of this study was to evaluate the effect of baclofen on GERD in children. Methods: Thirty children with GERD were included in this clinical trial. Baclofen 0.25 mg/kg was given for three months. End points were assessed for weeks and months.Findings: Baclofen significantly improved the weight gain pattern and the mean of weight gain demonstrated a significant difference between base line value and weight on consequent months after therapy (P<0.0001). Restlessness showed a significant improvement between baseline and threes month after treatment (P<0.001).Vomiting significantly decreased on follow up visits (P<0.001). It is also increased the time and volume of feeding significantly 3 month after treatment (P<0.001). We have not found serious complications. Conclusion: Baclofen reduces the symptom of TLESRs and may have a role in treating GERD.

Objective: Scientific articles are indicators of research interests and efforts in every country. The aim of our study was to compare the scientific output between universities of medical sciences in Iran on pediatrics in the Pubmed database. Methods: In a descriptive study, we searched in Pubmed in order to assess the Iranian pediatrics publications with these words: "(Pediatric [*MeSH] OR Neonate [MeSH] OR Newborn [MeSH] OR Infant [MeSH] OR Child [MeSH] OR Children [MeSH] OR Adolescent[MeSH] OR Adolescence [MeSH])" AND (Iran [*AD] OR Iranian [AD] OR Persian [AD]). The identified articles were published May 1957 to December 2007 and we selected all articles from universities of medical sciences in Iran. We extracted year of publication, affiliation of authors and impact factor from hard copy of articles. Findings: From 819 papers published, 565 were authored by members of universities of medical sciences. Tehran University of Medical Sciences with 142 articles (17.3% of all, 25.1% from publications of universities of medical sciences) held the first place, Shiraz University of Medical Sciences with 116 (14.2% of all, 20.5% from publications of universities of medical sciences) the second place and Shaheed Beheshti University of Medical Sciences with 88 (10.7% of all, 15.5% from publications of universities of medical sciences) the third place. Regarding Impact Factors (IF) Tehran, Shaheed Beheshti and Shiraz Universities of Medical Sciences with 153, 93 and 81 were in the first, second and third place, respectively. Conclusion: Tehran University of Medical Sciences had twenty five percent of pediatric science production in Iran. This university had published higher number of papers on pediatrics among universities of medical sciences in Iran.

Objective: Beta major thalassemia is a variant of beta thalassemia syndrome which could be treated with bone marrow transplantation or if not available, regular blood transfusion. In the latter case, supportive therapy is the mainstay of treatment because of low folate intake or absorption. But the main cause of insufficient supportive therapy is the increasing need of bone marrow for ineffective erythropoiesis in the absence of regular blood transfusion. The purpose of regular blood transfusion in b major thalassemia patients is to maintain the range of hemoglobin level between 9 and 11 gr/dl to stop insufficient erythropoiesis completely. Therefore, by regular blood transfusion, supportive therapy with folic acid would not be needed. The aim of this study is to determine serum folate level in regular transfused b major thalassemia patients in Mofid Children's Hospital during 2006. Methods: This is a cross sectional descriptive-analytic study performed on 100 b major thalassemia patients receiving regular blood transfusion and desferal. Post-storage leukodepleted blood is used for transfusion. Patients’ data is achieved from information data sheets. Serum folate level is determined with Electrochemiluminescence method in one of the most reliable laboratory centers. Normal serum folate level was 3-17.5 ng/ml in this laboratory with the sensitivity of 0.6 ng. Data analysis is performed with SPSS analysis software, and with chi squared, T-test and Spearman test. Findings: 56 (56%) girls and 44 (44%) boys entered this study with a median age of 156 (±71.2) months and an age range of 14-288 months. Patients’ median hemoglobin level was 9.5 (±0.87) g/dl, with minimum of 7.5 and maximum of 11.9 g/dl. Mean MCV was 84.2 (±4.20) fl, with the range of 73.4 -95.3 fl. Serum folate level was in the range of 1-19 ng/ml and median of 9 (±4.9) ng/ml. Serum folate was less than 3 ng/ml in 3% of evaluated patients. Hemoglobin level was equal or more than 9 g/dl in 73% of patients. Conclusion: It seems that if major b thalassemia patients receive regular blood transfusion, their serum folate level would be in normal range and supplementation therapy with folate will not be necessary.

Objective: Medication errors are the most common type of medical error and an avoidable cause of iatrogenic injury in pediatric patients. These errors can occur at any point in the process of ordering, transcribing, dispensing, administering, or monitoring medications. This study was conducted to verify medication errors by analyzing medication orders and the nursing staff's reports in medical notes of children admitted in Madany Pediatric Hospital, Khoramabad, Iran, in the first 6 months of 2004. Methods: This is a descriptive cross-sectional and hospital information based study. Samples included 898 medical charts of children selected by random sampling. The data collection instruments were a demographic questionnaire for patients, physicians and nurses, a scale for analyzing medication orders and a scale for analyzing the nursing staff's reports. Data are analyzed by SPSS Ver.11.5 software. Findings: Analysis of the medication orders indicated that in 74.1%, drug administration precautions were not written down, in 47.8%, exact time or intervals of drug administration were not recorded, in 45.5%, drug unit was not stated or it was incomplete or ambiguous, and in 20.5%, orders had at least one drug interaction. Analysis of nursing staff's reports indicated that in 77.5%, drug administration precautions were not indicated, in 14.9%, drug interactions were not noted, in 14.8%, time or intervals of drug administration were not according to orders, and in 6.3%, medication was not administered by nurses. Conclusion: In the busy and complex environment of pediatric units, medication errors can occur frequently. However, most of these errors are trivial and do not harm patients. The types of errors indicate the need for continuous education and the implementation of management tools that allow the promotion of the practice and monitoring results as medication errors are indicators of the quality of the healthcare provided. Therefore, their detection and systematic analysis of their causes can contribute to their systematic prevention, thus improving the healthcare.

Objective: Allergic Rhinitis (AR) is an inflammatory disorder of the nasal mucosa characterized by nasal congestion, rhinorrhea and itching and often accompanied by sneezing and conjunctival irritation. Two prerequisites for the expression of AR are sensitivity to an allergen and its presence in the environment. Recognition of allergens and removal and avoidance of them can decrease the prevalence of AR. This study aims to evaluate the prevalence of AR in Hamedan, Iran, and recognition of effective factors involved in expression of AR. Methods: The study was undertaken between October 2005 and June 2006 among 13- to 14-yearold children in middle-schools of Hamedan. Data were collected using the standardized ISAAC written questionnaire for prevalence of AR and another questionnaire for effective factors on AR including gender, season of expression of AR, smoking parents, keeping pets and birds, apartment plants, breast milking and family size. In the second phase the students with AR were examined for signs of AR. Findings: A total of 1600 (900 girls and 700 boys) children participated in the study. 17.7% of the children had symptoms of allergic rhinitis sometime in their life. There was no significant difference between prevalence of AR between boys and girls (18.6% in the boys and 17% in the girls) (P>0.05). 37.2% of the cases were perennial and 62.8% of them were seasonal or mixed type. AR was more prevalent in spring (21%). The prevalence of the disease between students with smoking parents and non smoking parents were 30.6% and 11.2% respectively (P<0.001). The prevalence of the disease between students with pets and without pets were 23.1% and 17.7% respectively (P=0.001). Presence of apartment plants, type of nutrition and family size had no effect on prevalence of AR (P>0.05). The most common signs of AR were allergic shiners (54%) and clear and dilute nasal secretion (51%). Conclusion: Compared with previous studies conducted in other Iranian cities using similar method, the prevalence of allergic rhinitis was lower in Hamedan. The prevalence of AR may be reduced with avoidance of smoking and removal of pets.

Objective: Exclusive breastfeeding has a major effect on decreasing the mortality of the children, particularly in developing countries. The aim of this survey was to study the effect of type of delivery on success of exclusive breastfeeding. Methods: In a case-control study, 344 women including two equal groups of 172 cases were chosen based on the type of delivery, vaginal or by cesarean section, and followed for 6 months the way of feeding their infants and the rate of exclusive breastfeeding among them. Findings: The rate of exclusive breastfeeding was significantly lower in the mothers delivered by cesarean section than who delivered vaginally (13.4% vs. 41.8%). The average duration of breastfeeding among the women with vaginal delivery was significantly longer than the cases with cesarean delivery (4.5±1.7 months vs. 4.0±1.5 months). The rate of the onset of breastfeeding in the first hour of delivery was significantly higher among the group with vaginal delivery than the group with cesarean section (82 % vs. 38 %) and finally the rate of formula feeding among the infants of the mothers with cesarean section was higher than in the infants of the mothers with vaginal delivery (33% vs. 22%).Conclusion: Cesarean section decreases the exclusive breastfeeding and hence attempts should be made to encourage the mothers for vaginal delivery and breastfeeding as well. Besides, discussing the benefits of breastfeeding for both mother and infant, supports the fact that mothers should be advised to attain executive breastfeeding.

Objective: Stroke is defined as the sudden occlusion or rupture of cerebral arteries or veins resulting in focal cerebral damage and clinical neurologic deficits. The risk factors for stroke in children are numerous and differ from those in adults. Identification of these factors can prevent subsequent strokes. The aim of this study is to determine the etiology of stroke in children. Methods: In this descriptive prospective study, children who were referred to pediatric neurology clinic in Mofid Children's Hospital due to acute hemi paresis during 2 years period (Sep 2003-Sep 2005) were evaluated and their diagnosis was cerebrovascular disorders, in the view of physical examination and brain imaging. Findings: The study group consisted of 40 children in age groups between 3 months to 14 years old. The most common age group at presentation was 2 to 5 years old. Occurrence was predominant during autumn and winter (70%). The most common clinical presentations were acute hemiparesis (85%) and seizures (40%). The other symptoms were as follow: 15% decreased level of consciousness, 12.5% fever, 7.5% VI nerve palsy, and 2.5% cerebellar signs. 20% of patients suffered from hemorrhagic and 80% had ischemic stroke. In 60% of the patients specific etiologic factors were identified and in the rest of the group, risk factors could be delineated. The most common etiologies were: 17.5% cardiac diseases or procedures and 10% hematologic disorders. Other etiologies included: 7.5% prothrombotic states, 7.5% CNS infection, 5% mitochondriopathy, 2.5% for each of the head trauma, migraine, serum lipid abnormality, hypertension and arteriovenus malformation. The most common risk factors consisted of 40% anemia and 20% infections. Conclusion: This study demonstrates that stroke in children is a multifactorial process. Identification of the underlying risk factors for cerebrovascular disorders is highly desirable because many of the risk factors can be prevented, resulting in reduction of the risk of subsequent strokes.

Objective: Atherosclerosis is a process that begins during childhood, progresses asymptomatically, and generally shows no clinical manifestations until adulthood. Hyperlipidemia and high blood pressure have been associated with an increased risk of atherosclerosis and cardiovascular disease.  The purpose of this study was to evaluate the serum lipid and blood pressure levels in children and adolescents aged 3-18 years with the history of early onset of myocardial infarction in their parents; and to compare them with the control group. Methods: This is a case-control study in which 209 children and adolescents, aged 3-18 years, with a family history of early onset myocardial infarction as case group were selected and compared to 209 individuals of the same age group, without the history of early onset myocardial infarction as the control group. Their serum lipid and blood pressure levels were measured. Data was analyzed by SPSS software. Findings: Mean cholesterol, LDL and triglycerides were 171.64, 112.26 and 97.32 mg/dl, respectively in the case group; 150.04, 104.82 and 181.57 mg/dl in the control group which showed significant difference. Mean HDL level was 38.86 mg/dl in the case and 39.59 mg/dl in the control group which had no significant difference. Mean systolic and diastolic blood pressure were 110/22 and 71/84 mmHg in the case and 99/13 and 60/31 mmHg in the control group that shows significant difference. Conclusion: Serum lipid and blood pressure levels in children and adolescents with a history of early onset myocardial infarction in their parents are higher in the control group, therefore, these children are at high risk for coronary artery disease.

Objective: The purpose of this study was to compare the mortality and morbidity rates of neonatal respiratory distress syndrome (RDS) treated with and without surfactant in ventilated patients. Methods: In this descriptive-analytical study, the morbidity and mortality rates of RDS in 50 patients of the study group treated with surfactant were compared with 66 patients of control group treated without surfactant. The children of the control group received treatment at a time when surfactant was not available in market. Surfactant was used as Survanta during the first 24 hours of life with a dose of 4 ml/kg in four different positions through tracheal tube only once. Findings: The two groups were comparable in baseline parameters including birth weight, sex, gestational age and primary diagnosis. Mortality reduced significantly. There were no differences in the incidence of severe complications including, intraventricular hemorrhage and patent ductus arteriosus, but pneumothorax, sepsis and pulmonary hemorrhage occurred more common in the control group.Conclusion: Use of surfactant in neonatal respiratory distress syndrome significantly decreased mortality, pneumothorax, sepsis and pulmonary hemorrhage.

Objective: Obesity is currently the most prevalent nutritional disease of children and adolescents, prevention and treatment of which, is required. The purpose of this study was to identify the effect of dietary behavior modification on anthropometric indices in the obese adolescent female students of Shiraz, 2007. Methods: In this Quasi-experimental research, 53 obese adolescent girls (BMI>95th percentile), aged 11 to 15 years, participated in a behavior modification program which lasted for 16 weeks (4 hours each week). The Subjects were chosen from two different schools and were assigned to two groups of experimental (=24) and control (=29) randomly. The Program included teaching problem solving, stress management (yoga), teaching healthy eating, physical behavior and parent education. Anthropometric indices were assessed just before and after the program and also two months later for follow up. The data were analyzed by SPSS 11.5 by using descriptive and analytic test and the statistical significance was considered at P<0.05. Findings: There were significant differences in changes in body weight (-2.75 kg vs. 0.62 kg), BMI (-1.07 kg/m2 vs. 0.24 kg/m2) and arm circumference (-2.31 cm vs. 0.5 cm) in the experimental versus the control group (P<0.001). Conclusion: This study reveals that behavioral modification program has a great effect on decreasing the body mass index. Parents, school nurses and other support groups should be encouraged to participate in this program.

Background: Chicken pox is caused by Varicella zoster. Infected persons usually acquire permanent immunity and a reinfection is unusual. Case Presentation: We report on a leukemic girl aged 12 years and 4 months, who had two chicken pox infections during 2 months. Leukemia was diagnosed 20 months ago. In her past history she had a first chicken pox infection 2 years before leukemia was diagnosed.Conclusion: Recurrence of chicken pox is possible especially in immune comprised individuals. Our leukemic patent had 3 attacks of chicken pox.

Acute disseminated encephalomyelitis (ADEM) is an acute, inflammatory, monophasic, demyelinating and immune-mediated disorder of central nervous system; occurs mostly in children after systemic viral infections or vaccinations. Acute polysymptomatic neurologic signs such as encephalopathy, paralysis of limbs, cranial nerve involvement, ataxia and optic neuritis are common manifestations. Brain magnetic resonance imaging study is essential for diagnosis and enabling prompt diagnosis and treatment. Evidence of multifocal lesions of demyelination in subcortical white matter are seen. They are usually bilateral and asymmetrical. Treatment optins have included steroids, immunoglobulins, and plasmapheresis. ADEM is treatable and prognosis is good.

Phenylketonuria (PKU) is the most common autosomal recessive disease. Hyperphenylalaninemia is caused by deficiency or inactivity of the phenylalanine hydroxylase in liver. In this disorder phenylalanine in not metabolized to tyrosine. Increased levels of blood phenylalanine causes irreversible brain damage. As infants with PKU do not show any clinical signs in the postnatal period, first stage in treatment is an effective screening and diagnosis. Main treatment of PKU is diet therapy, which should be initiated before the third week of life and monitored by a team formed of a pediatrician, an experienced dietitian, a psychologist, a social worker and a nurse. Phenylalanine-restricted diet should provide enough protein–energy and other nutrients for an optimal growth and brain development and include tyrosine supplement to preserve the phenylalanine plasma concentration in a range of 2 to 6 mg/dl. The exact amount should be prescribed based on age, specific genotype, growth rate and individual need for energy. Successful management of PKU patients should be monitored by growth rate. Duration of diet therapy is controversial; continuing phenylalanine-restricted diet beyond adolescence is recommended.