Iranian Journal of Pediatrics
Year:2005 | Volume:15 | Issue:3|Papers Count:19

Background: Neonatal hyperbilirubinemia, as a very common problem in neonatal period, can lead to kernicterus which is a common cause of neuro-sensory hearing loss and an avoidable cause of deafness. The aim of this study was to detect toxic effect of severe hyperbilirubinemia on brain stem and auditory tract before and after exchange transfusion (ET) by Auditory Brainstem Responses (ABR).Methods: ABR were measured in 12 full term newborns with severe hyperbilirubinemia (case) and 12 non-icteric full term neonates (control). Total bilirubin concentration in jaundiced cases was ≥ 20mg/dl and direct bilirubin≤ 2mg/dl. ABR was performed before, 6 days and 3 months after ET. Birth weight, gestational age and age on admission were 3066 ± 477gr, 39 ± 1.4 weeks, and 4.25± 3.1 days respectively. None of the newborns showed clinically symptoms and signs of bilirubin encephalopathy. Data are analyzed by SPSS software. Results: Two neonates did-not show ABR waves before ET, these appeared after ET. The mean latencies time of wave V of ABR before, after and at 3 months of age was 7.53 ± 0.34, 7.43 ± 0.33, 6.99 ± 0.29 milliseconds (P<0.001) respectively. This showed marked improvement. The mean inter-peak -Intervals (IPI) of waves III-V were 2.58 ± 0.19, 2.65 ± 0.19, 2.32 ± 0.16 respectively (P<0.009) and the IPI of waves I-V were 5.38 ± 0.29, 6.16 ± 0.32, 4.84±0.28 (P<0.004) respectively. This means shortening of IPI after ET. Conclusion: Our results suggest that bilirubin neurotoxicity rapidly disappears after ET. Therefore, we recommend ABR for screening and early detection of bilirubin ototoxicity for necessary audiological intervention in all cases of severe neonatal hyperbilirubinemia.

Background: Urinary tract infection (UTI) is common in childhood with serious sequelae. Among infants, boys are more likely to develop UTI. The aim of this study was to determine circumcision effects in decreasing UTI incidence and appropriate age of circumcision. Methods: During a prospective study lasting 7 years, 166 boys with UTI, aged less than 6 years, were allocated into 2 groups. They had no urinary tract abnormalities. In the first group 79 boys ranging in age from 2 months to 5.5 years (mean 11.3 ± 3.1 mo) were circumcised after UTI treatment and then observed for 6 months with taking urinalysis (U/A) and urine culture (U/C) 1-2 times monthly. The second group consisted of 87 boys aged 40 days to 5.5 years (mean 12.1 ± 3.4 mo). After treatment of UTI, the boys were observed 6 months with taking U/A and U/C, then circumcised and served for another 6 months. The incidence of UTI in the two groups was compared using Chi-square test. For comparing the incidence of UTI in 6 months before and 6 months after circumcision in the second group we used Mcnemar method.Findings: There was significant difference (P=0.009) in occurrence of UTI in first and second group. There was also significant difference (P<0.0001) in incidence of UTI in 6-month periods before and after the circumcision in second group patients.Conclusions: The present study indicated that circumcision decreases the risk of UTI in boys, independent of age. Therefore circumcision should be considered in newborn period and any patient with UTI or urinary tract abnormalities. Routinely performing cystourethrography in boys with first attack of UTI without urinary tract abnormalities (proven by history, physical examination and sonography) is questionable and needs further studies.

Background: Tuberculosis is a worldwide infectious disease and BCG is the only available vaccine against this infection. This vaccine is injected intradermally (0.05 cc) in the first day of life. The complications of BCG vaccine are: local ulceration, regional lymphadenopathy, lymphadenitis, abscess formation and fistulization, osteitis or osteomyelitis, systemic reactions, hypersensitivity and granulomatosis reactions. There has been hardly any study on complications of BCG in Iran; therefore we decided to evaluate the rate of the most important complications of this vaccine (lymphadenopathy, lymphadenitis, abscess formation, and fistulization) in Semnan. Methods: All 557 babies born at Amir-al-Momenin and Shafa Hospitals during a 6-month period between March and September 2003 were assessed. In our study, BCG vaccination was performed for all these neonates at the hospitals. Then, the babies were examined monthly by a physician and the questionnaires were filled in.Findings: The rate of lymphadenopathy, lymphadenitis and fistulization of the abscess after BCG vaccination were 2.2%, 0.54%, and 0.18% respectively. There was no significant difference between the incidences of the complications in the two hospitals. Moreover, no significant difference was observed between the sex of the babies and the occurrence of the complications.Conclusion: The survey illustrated a higher rate of lymphadenopathy and lymphadenitis after BCG vaccination compared with the other countries studies.

Background: Congenital intestinal malrotation as an abnormal embryonic intestinal rotation and fixation leads to various clinical presentations of high complete or incomplete intestinal obstruction, especially midgut volvulus and extensive intestinal loss that may cause short bowel syndrome or death of the patient. we conducted this study to assay clinical presentations, surgical findings, mode of management and outcome of neonates with intestinal malrotation.Methods: We studied retrospectively data of 25 neonates with intestinal malrotation in 3 hospitals of the Tehran University of Medical Sciences (1985-2003).Results: Patients consisted of 17 males and 8 females. 5 (24%) patients had extensive intestinal gangrene that resulted in short bowel syndrome in 2 patients. 7 (20%) patients died, 5 of them due to intestinal volvolus and 2 other due to associated anomalies and sepsis. Most common clinical signs and symptoms were vomitus (96%), bilious vomiting (80%), constipation (24%),), coliky abdominal pain (23%). Abdominal distention was observed only in patients with volvolus (38%). Obstipation (31%) and rectorragia were seen only in patients with volvolus and intestinal gangrene. 28% of neonates had associated anomalies. Malrotion was suggested by abdominal X-ray in 3 out of 12 (25%), barium enema in 9 out of 11 (81.8%), and gastrointestinal follow through in 3 out of 4 (75%) examinations. 3 patients were surgically managed according to only one abdominal X-ray. Ladd procedure was performed in all patients and other necessary corrective operations for associated anomalies included intestinal resection with anastomisis in 5 and intestinal resection with entrostomy in 2 cases.Conclusion: To prevent extensive intestinal loss due to intestinal volvolus in neonates with abrupt bilious vomiting, malrotation must be excluded, and if a volvulus is suspected, emergency laparotomy should be undertaken.

Background: Assessment of national children's growth has shown that a large percent of country's children are afflicted with growth failure. In recent decade, different models have been used for growth promotion, but there is yet a long way for achieving the desired state of children's growth. In this study we present the CIPP (Context, Input, Process, and Product) Evaluation Model.Methods: The present study is a community-based field trial and has been rendered on 74 mothers, with children less than three years of age. A model was designed for increasing mothers' participation. On the basis of this Model, a group of volunteer mothers were instructed in the subjects of growth monitoring and child nutrition. Then, these instructed other participants (beneficiaries) in the study. For the evaluation of this model, special indices and criteria were considered. The collected data was analyzed by SPSS software and suitable statistical tests.Findings: We report in this article only the results of impact evaluation. The growth state of children was significantly improved after intervention (P<0.005). Indices like understanding and knowing how to draw growth charts by mothers as well as other indices of child care were also improved (in the two cases, the difference was meaningful P<0.001). Conclusions: Considerable improvement of growth state of the children and other considered indices shows the efficacy of this Model. Systemic approach and the capability of step by step evaluation are other characteristics of the Model. As the present Model is designed on the basis of cultural and social background of the country and in accordance with its Health System, it can be also used in other regions and for development of other Health Services.

Background: Psychological debriefing is a way for prevention and reducing post traumatic stress disorder (PTSD) symptoms. Many studies have shown the efficacy of cognitive-behavioral therapy in treatment of PTSD. Few evidence is available for using of these techniques in large scale disasters. This study was carried out to evaluate the efficacy of psychological debriefing and cognitive-behavioral group therapy combination on Bam earthquake-related PTSD symptoms in adolescents.Methods: In a before-after trial, we evaluated the efficacy of one session psychological debriefing and three sessions of group cognitive-behavioral therapy in Bam earthquake adolescents survivors with PTSD symptoms. The mean age of participants was 16.4 years and no one had severe PTSD or other psychiatric disorder that needed pharmacological intervention. Before, immediately and 3 months after interventions we evaluated PTSD symptoms using Clinical Administrated PTSD Scale for DSM-IV and analyzed them. Findings: 30 persons were included in the study, 8 of whom were excluded during interventions because of migration. The mean frequency of PTSD symptoms reduced immediately after interventions which was statistically significant (P<0.05). There was no efficacy for intensity and severity. Conclusions: Psychological debriefing and group cognitive-behavioral therapy may be effective in reducing the frequency of avoidance symptoms.

Background: Acute leukemia is the most common malignancy in children and acute lymphoblastic leukemia (ALL) accounts for 75% of acute leukemia cases. New treatment protocols have resulted in complete remission rates up to nearly 100% in children with acute lymphoblastic leukemia. Today, one of the most important prognostic factors in acute lymphoblastic leukemia is intensity of the treatment. Risk stratification is accomplished based on clinical, morphological, immunophenotypic and cytogenetic findings. The aim of this study was to determine some prognostic factors in children with acute lymphoblastic leukemia. Methods: In this retrospective study information about age at onset of acute leukemia, sex, initial white blood cell count, FAB-subtype, immunophenotype, and clinical course of newly diagnosed acute lymphoblastic leukemia were extracted from medical records of children admitted to pediatric oncology department of Mofid Childrens Hospital from 1997 to 2000.Findings: There were 81 (58.3%) male and 58 (41.7%) female. 3.6% of patients were under 1 year old, 18.7% were above 10 years and 77.7% were 1-10 years old. Initial WBCs more than 50,000/ mm3 were observed in 24.5% of patients. 91.4% of patients showed FAB-subtype of L1, 7.9% of L2 and L3 was detected just in 0.7% of cases. Lymphoblasts were of B-cell lineage in 92.7% of patients, with pre-B cell in 74.8%, early pre-B cell in 17.1% and mature B cell in 0.8%. As a whole, complete remission was observed in 79.3% of the patients. 12.9% of patients had a relapse, second remission was achieved in 2.6% of relapsed cases. Conclusion: In this study, FAB-subtype L1 and pre-B cell immunophenotype was more common than previous studies. Other results were the same as reported in older studies.

Background: Neonatal weight and length at birth are important indexes of newborn health which can show not only the quality of intrauterine growth of he fetus but also the quality of maternal prenatal care. The aim of this study was to determine the weight and length of newborn infants at birth and some of their risk factors at hospitals affiliated to Tehran University of Medical Sciences. Methods: A cross-sectional study was performed from September 2003 to September 2004. 995 newborns were studied. Neonatal data included sex, gestational age, fetal presentation, existence of congenital anomalies collected from medical records. Maternal data contained age, gravidity, parity, history of abortion or infertility, placental position, history of chronic disease, and delivery type in interviews with the newborns' mothers. Neonatal weight and length were measured at birth. Findings: The mean weight and length was 3139±542 g and 49.33±2.62 cm respectively. There was significant statistical relation between the newborns mean weight or length and neonatal sex, gestational age, singleton pregnancy, maternal gravidity or parity. Maternal age, delivery type, history of maternal infertility, placental position, maternal chronic disease or neonatal congenital malformation had no significant effect on the mean neonatal weight or length. Conclusions: It seems that prevention of premature delivery by offering proper prenatal care services leads to a better intrauterine growth of the fetus and increased body size at birth.

Background: Brucellosis is a common worldwide disease of both humans and animals. Iran is one of the endemic areas infected with Brucellosis and a prevalence of 225 in 100,000. Early diagnosis and prompt treatment will save the child from death and disabilities. Considering that Wrights test is easy, feasible and fast to use, it is one of the most common tests used in the diagnosis of Brucellosis. It has a high sensitivity but a low specificity. A titer >1/160 is considered positive. Due to the prevalence of Brucellosis in Iran a titer >1/80 in suspected patients should be a matter of concern and further investigation. Methods: This prospective cross-sectional descriptive analytical study was performed with the aim to determine Brucella antibody level (Wright's test) in healthy primary school children in 19 educational sectors of Tehran. Findings: A total of 1531 children were enrolled, 674(44%) and 857 (56%) of whom were boys and girls with a mean age of 9.17 1.55 years. 99.7% of the children had a titer less than 1/80 and 5 children (0.3%) had a titer≥1/160. There was a significant statistical relation between Wright's titer and gender (p=0.005). There was, however, no significant statistical relation to age (p=0.4) or different geographical regions of Tehran (p=0.2).Conclusion: The rate of Brucella infection in school children in Tehran was unremarkable. According to the results of our study, particularly in endemic areas, a Wright's titer of 1:80 in suspected cases for Brucellosis can be taken as a diagnostic titer.

Background: Zinc and copper belong to the essential trace metals needed for optimal growth and development. Measurement of serum zinc and copper in maternal blood and cord blood of neonates was carried out to study and compare the level of trace metals in term and preterm neonates and their mothers. Methods: 152 healthy neonates, both term and preterm and their mothers were selected. Measurement of serum zinc and copper was carried out by atomic absorption spectrophotometer. Findings: The mean serum zinc level in the term neonates and their mothers was 0.83 µg/ml and 0.62 µg/ml respectively. The mean serum zinc level in the preterm neonates and their mothers was 0.78 µg/ml and 0.47 µg/ml respectively. The mean serum copper level in the term neonates and their mothers was 0.55 µg/ml and 2.29 µg/ml respectively. The mean serum copper level in the preterm neonates and their mothers was 0.63 µg/ml and 2.17 µg/ml respectively. Cord blood zinc level was significantly higher and cord blood copper level was significantly lower than the corresponding maternal blood levels (p<0.05).Conclusion: There was no significant difference between cord blood zinc and copper levels in term and preterm neonates. The serum levels of zinc in both maternal and cord blood seem to be lower in our sample population compared to the levels found by other authors.

Background: Having sufficient daily activity has great physical, psychological and social impacts on children and adolescents' life. Diabetic youth are of no exception in this regard, but they are often exempted from sport activities and its benefits due to the general concerns about possible side effects of diabetes, like hypoglycemia. There has been a general unawareness about appropriate diet and tapering the medications with the level of physical activities. There are several influencing factors that may prevent or at least lessen these side effects. These may include, appropriate timing of the insulin administration and knowing the timing of its peak activity onset according to the type of insulin used. Also adjusting the carbohydrate intake with type and extent of exertion are of significant importance. Meanwhile, both diabetic athletes and their trainers must be educated about signs of hypoglycemia and how to manage it on the scene. Diabetic patients, whose disease hasnt been effectively controlled yet and suffer from poorly controlled blood sugar and side effects like diabetic ketoacidosis, must avoid any sport activities until they have reached to a steady metabolic state. When initiating a new exercise regimen, patients must check their blood sugar levels 3 to 4 times daily, until all the metabolic needs have been identified and met. Needless to say those diabetic patients who have previously adopted an inactive lifestyle must undergo a complete medical evaluation prior to engaging in any exercise routine. Those, who have no evidence of diabetes complications, may engage in any level of recreation or professional sports. As a matter of fact, aerobic sports are among those most recommended to diabetics. Conclusion: If the essential educations regarding diabetes be provided for both the diabetic adolescents and their coaches, sports may be introduced as a safe and invaluable experience in a supervised environment.

Background: Systemic fungal disease is related to administration of antibiotics, chemical therapy in malignancy, steroids therapy, etc in recent years. Methods: In a retrospective study from 1994 to 2004, we observed 26 patients. Findings: Most etiologic agents were Candida, Aspergillus, Mucormycosis and Cryptococcus. Predisposing factors in 80% of the patients were malignancy or chronic granulomatosis disease. Mortality occurred in 38% of patients.Conclusions: we recommend thinking to systemic fungal infections in high risk patients in order to diagnose and treat them properly.

Background: The dancing eye syndrome or Opsoclonus - myoclonus syndrome is so called because of the bizarre eye movements which are almost invariably present in this rare condition. They are jerky and correspond with jerky movements of the limbs particularly the arms. The cause of entity is not known with certainty but it is thought to be an autoimmune condition. In approximately 10 percent of cases the condition develops as complication of neuroblastoma. Case report: In this paper we introduce an 18-month old girl. A previously well child becomes irritable and unsteady, had coordinated jerks of arms and legs, and abnormal eye movements. Urine VMA, CSF analysis and EEG were normal. The final diagnosis was Opsoclonus-myoclonus syndrome and the patient was treated with prednisolon and IVIg.

A 25-month old male baby was brought to the emergency room with a clinical picture of septic shock. He had the history of hospitalization during the neonatal period because of pneumonia and heart failure. At that time coarctation of aorta and patent ductus arteriosus was diagnosed. Later in life he had frequently pneumonia, gastroenteritis, urinary tract infection, otitis media, recurrent sepsis, chronic oropharyngeal candidasis, local abscess at the site of BCG vaccination, and multiple draining lymphadenopathies in the left axilla, supraclavicular (the same side of BCG vaccination) and sub mundibular areas. Prolonged mumps parotitis, multiple sores in his mouth and anal area and abscesses in this region. At 5 months of age he underwent the surgical operation for correction of coarctation. Finally, with the diagnosis of (SCID), he was receiving intravenous immune globulin monthly.The results of all tests, particularly cultures were negative. Despite therapeutic measures the patient expired. We suspected viremia as the likely cause of his problem. The most interesting finding in this case was the unusual association between the SCID and the coarctation of the aorta and patent ductus arteriosus (PDA), as far as we are aware, a similar case is not reported in the literature as yet.