Iranian Journal of Pediatrics
Year:2008 | Volume:18 | Issue:2|Papers Count:21

Objective: Asthma, allergic rhinitis and eczema as a common chronic disorder in childhood, has many epidemiologic variations in different geographic areas. Uniform and standard epidemiologic researches are able to clear and modify scientific questions in this field. We carried out this study to determine the prevalence and intensity of pediatric allergic disease in our region.Material & Methods: This analytical-cross sectional study was performed on 2 groups of children; the first group aged 6-7 years (n=3240) and the second group aged 12-14 years (n=3254) during 2002-03. According to ISAAC programming, sample size consisted of 3000 children in each group. From all students 99.3% of primary students and 88.8% of guidance students entered into study. Data was gathered by ISAAC first phase questionnaire and analyzed by SPSS 10 and Chi square test.Findings: The 12-month prevalence rates of symptoms were as follow: wheezing 16.8% and 21.7%, allergic rhinitis symptoms 14.5% and 19.9% and atopic dermatitis symptoms 4.5% and 8.2%, for younger and older age group, respectively. The prevalence of wheezing and current wheeze did not show differences according to sex (P>0.05) but it was significantly higher in students of guidance school (P<0.05). The prevalence of previous history of asthma, speech disorders, wheezing after physical exercises and dry cough at night, rhinoconjuntivitis, recurrent rhinitis, eczema with pruritus, recurrent lesions and history of eczema was significantly higher in boys and in students of guidance school (P<0.05). The prevalence of flexor lesion did not show a significant difference according to age (P>0.05) but in boys it was higher than in the girls (P<0.05). Conclusion: According to our findings asthma, allergic rhinitis and eczema have a moderate prevalence in this region of our country.

Objective: Asthma is the most common chronic illness in childhood and despite significant improvements for disease control and development of many different drugs, its prevalence is increasing worldwide.  Recently, the use of complementary and alternative medicine (CAM) in treatment of many diseases is increasing.  The aim of this study was to investigate the effect of massage therapy on children with asthma. Material & Methods: In this work, 44 asthmatic children aged 5 to 14 years were studied in the allergy and asthma clinic. The samples were chosen randomly divided into two groups. The first group received massage therapy the second group received routine therapy and care (control group). Parents in the massage group were instructed and asked to conduct a 20 minutes child massage every night at bedtime for one month. The massage involved stroking and kneading motions in face, head, neck, shoulders, arms, hands, legs, feet and back. Data was collected through interview and spirometry measurements. The control group received only standard asthma therapy for one month. A spirometry along with exercise was done in both groups at baseline. A one month ambulatory observation followed. Descriptive and inferential statistics were used to analyze the findings. Findings: There was a statistically significant difference in mean spirometric indexes in massage group at baseline and after one month follow up [forced vital capacity (FVC) with (P=0.05) Forced expiratory volume in 1 second (FEV1) with (P=0.02) and FEV1 after exercise with (P= 0.0005). Indeed; there is significant difference between mean changes of FVC (2-1) with (P=0.05) and FEV1 (2-1) in two groups with (P=0.04).Conclusion: According to the obtained results, daily massage can improve airway tonicity, decrease airway sensitivity, and better control of asthma. Applying this method can decline the use of non reasonable drugs and can be considered as a complementary method to pharmaceutical methods.

Objective: The aim of this study was estimation of prevalence of jaundice readmission and observes neonatal jaundice risk factors in singleton infant with birth weight more than 2500 gr. Material & Methods: This study was done among women who delivered a normal singleton infant with birth weight of ³2500 gr in Najmieh Hospital, Tehran, from 2004-2005. Maternal age, race, blood group and Rh, drug consumption during pregnancy, oxytocin consumption during labour, rupture of membranes together with neonatal sex, weight, maturity, gravity and length of nursery stay were recorded. The infants were followed during neonatal period to see if they were readmitted, and the reason of admission. The prevalence of readmission for neonatal jaundice was assessed and the risk factors for neonatal jaundice were compared between the icteric and non-icteric babies.Findings: The prevalence of readmission because of jaundice was 12.6%. The maternal data recorded from all mother-baby pairs were not significantly different except for maternal race, Rh group and drug consumption during pregnancy. Arab mothers compared with other race groups had more icteric babies (P=0.001). Rh-negative mothers had more icteric infants (17.9%) compared with Rh-positive mothers (12%) (P=0.01). Premature infants were hospitalized significantly more than mature babies (20.3% versus 12.1%, P=0.04). The length of primary nursery stay differed significantly between two groups [mean (SD) 27 (9.8) hours for icterics versus 30 (2.5) hours for non-icterics, P<0.001]. The mean age of readmission was fifth postnatal day.Conclusion: We conclude that infants, especially infants of Arab or negative Rh group mothers and premature babies, discharged early from the nursery should be advised to visit a pediatrician within the next 48-72 hours of birth to avoid complications of severe jaundice.

Objective: The goal of this study was to identify the risk factors of retinopathy of prematurity (ROP) in neonatal intensive care unit in preterm infants born with birth weight 1000-2000g or at gestational age less than 34 weeks. Material & Methods: From August 2000 to December 2001, 50 preterm newborn infants with birth weights less than 2000 g or gestational age less than 34 weeks admitted to the NICU were studied. Newborn infants with birth weight between 1200-2000g who received more than 6 hours oxygen and newborn infants with birth weight 1000-1200 g regardless of oxygen therapy, who survived until 4 weeks postnatal, were enrolled and followed. Patients underwent indirect ophthalmologic examination by two ophthalmologists between 4-8 weeks post partum. The newborn infants who had ROP were assigned to case group and those without ROP to control group, both groups were reexamined every 2-4 weeks or according to international classification of retinopathy of prematurity (ICROP) advice.Findings: Fifty newborn infants, 36 (72%) in control group, 14 (28%) in case group, were studied. Gestational age and birth weight of the patients with ROP were significantly lower than those of control group. Duration of oxygen therapy, hyperoxia, acidosis, hypercarbia, hypocarbia and phototherapy are suggested as risk factors contributing to ROP. Conclusion: The results of this study demonstrate that the ROP frequency remains elevated among premature and very low birth weight infants. Infants at risk for ROP should have screening eye examinations and proper treatment.

Objective: Acute post streptococcal glomerulonephritis (APSGN) is the most common type of in-patient glomerulonephritis (GN) in childhood. It has not been studied well in this region yet. Here, we report our experience with APSGN in a tertiary referral center during a five-year period.Material & Methods: Hospital records of all 137 children who had been admitted to Nemazee hospital, between 2001 and 2006, with diagnosis of acute glomerulonephritis (AGN) were reviewed. All demographic, clinical, paraclinical data and consumed medications were obtained. Findings: Among 137 children diagnosed as AGN, 122 (89%) had APSGN. Other 15 (11%) children had membranoproliferative glomerulonephritis (n=4), mesangioproliferative glomerulonephritis (n=4), IgA nephropathy (n=2), lupus nephritis (n=2), rapidly progressive glomerulonephritis (n=2), and focal segmental glomerulosclerosis (n=1). Mean (SD) age in children with APSGN was 8.5 (3.5) (range, 3.5-13) years, 117 (96%) children developed APSGN following a sore throat and 5 (4%) following an impetigo, with 95 (78%) during the cold seasons of the year. Periorbital edema was found in 97.5%, hypertension 75%, gross hematuria 72%, oliguria 37%, generalized edema 19%, azotemia (BUN>20) 80%, and nephrotic-range proteinuria 24.5%. A high anti streptolysin–O (ASO) titer and a low C3 level was detected in 84% and 86%, respectively. There was dilutional anemia in 51.5%, hyponatremia in 27%, and hyperkalemia 14%. With regard to medications, 19 patients received only furosemide, 73 cases furosemide and nifidipine, and 10 patients furosemide, nifidipine, and another antihypertensive medication. Hypertensive encephalopathy occurred in 3 cases, but no mortality was reported during the study period.Conclusion: APSGN is the most common type of glomerulonephritis in this region. It follows sore throat in the majority of cases. It usually has an uneventful course.

Objective: Frequency of red cell alloimmunization in patients with b-major-thalassemia in Mofid children's hospital. Tehran. Iran.Material & Methods: This is a cross-sectional descriptive study conducted in Mofid children's hospital, March 2007. A total of 121 major thalassemia patients on regular blood transfusion were included in this study. Clinical and laboratory data were collected and analyzed to find out the frequency, pattern and factors influencing red cell immunization secondary to multiple blood transfusions in these patients.Findings: Mean age of patients was 13 (6.19) from 2-26 years. They had received regular blood transfusions during periods ranging from 1 to 25.5 years. Red cell alloimmunization was found in 9 patients (7.4%). In female group, 5 out of 66 (7.6%) patients and in male group 4 out of 55 (7.3%) patients had evidence of alloimmunization. The mean age of patients with alloimmunization was 9.6 (6.5) years (range 3.7-20). Four patients (44.4%) with alloimmunization were more than 3 years old at the time of first blood transfusion.  The mean age at first blood transfusion in patients with alloimmunization and without alloimmunization was 2.8 (2.4) and 1.7 (2.0) years (P=0.1). The differential rate of splenectomy as a risk factor between patients with and without alloimmunization (11.1% and 8% respectively) was not statistically significant (P=0.5). Direct or indirect antiglobulin tests were positive in 5 (62.5%) patients. The blood alloantibodies by a panel of antibodies using standardized blood bank methods were detected in 4 patients, which were of anti-K and anti-D types. Conclusion: The rate of red blood cell alloimmunization is relatively low in our patients. The age at first blood transfusion and splenectomy were not statistically significant as risk factors for alloimmunization in this study.

Objective: Captivity has political, mental and social effects on captives. According to stress severity, captivity duration, religious idea, resistance and affective susceptibility, captivity causes significant mental and neurological effects. Present study was aimed to evaluate mental situation of captives' children in Isfahan Province.Material & Methods: This was a cross-sectional analytic observational study. Strengths and difficulties questionnaire (SQD) was used for mental evaluation of captives' children. We selected 384 objectives by random sampling. Findings: There was a significant difference between emotional signs, disruptive and communicational problems and social behaviors related with the age of children. A significant difference was also seen between emotional signs and educational level of children. Conclusion: Captivity of the father in long term has unsuitable physical and mental effects on children. Rate of these effects depends on mother's reaction to loss of spouse as well as age, and the social support provided for children.

Objective: The importance of cardiovascular risk factors like hypertension, obesity and dyslipidemia in prediction of later coronary artery disease (CAD) in offspring of high-risk family is well known. This study was performed to compare the level of lipoprotein (a) and apolipoproteins as new risk factors in children and adolescents with and without a family history of premature CAD.Material & Methods: This case-control study was performed from November 2004 until September 2005. All patients with premature myocardial infarction hospitalized in the coronary care units (CCU) of Vali-e-Asr hospital, who survived and had children between 2-14 years old, were defined as parents of the case group. 86 of them were chosen with simple non-random method. Only one child from each family was selected randomly. The control group consisted of children with nearest age and sex to children of the case group from the neighbors with equivalent socioeconomic status, without a family history of premature myocardial infarction. Subjects had been instructed to fast for 12 to 14 hours. Venous blood was analyzed for lipoprotein (a) and Apolipoprotein A1 and B100.Findings: The level of lipoprotein (a) was significantly higher in the case group. There was not a significant difference of lipoprotein levels between the two groups. Conclusion: Measurement of lipoprotein (a) is recommended in screening programs in offspring of high-risk families.

Objective: The aim of this study was to determine the prevalence of idiopathic hypercalciuria (IH) in school children in Ahvaz, a city with different ethnic groups located in the Southwest of Iran.Material & Methods: In a descriptive cross sectional study from October to December 2006, we determined urinary calcium (UCa) and urinary creatinine (UCr) in the morning urine samples of 500 primary school children. The levels of 24-hour UCa and UCr were measured in these children. Level of 24-hour UCa exceeding 4 mg/kg/day was considered as hypercalciuria, and UCa/UCr ratio exceeding 0.21 (mg/kg) was considered abnormal. Children who had hypercalciuria with a normal concentration of serum Ca were categorized as idiopathic hypercalciuric.Findings: Of 500 children aged 6-12 years, 231 were males and 269 females. In the first screening, 64 (12.8%) children (45 males, 19 females) had an abnormal UCa/UCr ratio. But in the end only 15 had the criteria of IH, i.e. the prevalence of IH was 3% (1.8-4.8%, confidence interval of 95%). The prevalence in females and males was 0.74% and 5.6%, respectively (P= 0.003). Of these children 10 had hematuria (including 2 cases of gross hematuria), 8 children gave a history of recurrent abdominal pain, 5 children suffered from dysuria and 3 persons had a history of personal or familial urolithiasis.  Conclusion: The study showed that 3% of primary school children in Ahvaz had IH predisposing to short-term and long-term complications of the disease. IH was significantly more common in boys than in girls.

Objective: Nocturnal enuresis is a common developmental-behavioral problem in children. The present study was conducted to estimate the prevalence of primary nocturnal enuresis and to determine its impact on physical growth of the first grade elementary school children.Material & Methods: This is a cross-sectional study carried out on 350 first-grade children (6 to 6.5 yr old) elementary schools in Gonabad through random stratified sampling. All children had primary nocturnal enuresis. A questionnaire containing demographic criteria and various factors that may play a role in bed-wetting was filled out; a digital scale and a non-expanding measuring tape were used to collect data. Diagnosis of enuresis considered nocturnal voiding twice a week for at least three consecutive months.Findings: The prevalence of primary nocturnal enuresis was 21% for boys and 14.9% for girls, and the overall prevalence was 17.5%. The average weight of enuretic children was lower than that of the non-affected ones. In addition, these children were in average shorter compared to those without enuresis.  Conclusion: This study demonstrates that growth failure is a coexisting problem in children with primary nocturnal enuresis. Since enuresis and other stressful conditions in family can cause growth failure in children, the treatment of enuresis eliminating a stressful condition could be an effective measure in improving children's physical growth.

Objective: Genitourinary anomalies in patients with imperforate anus are a frequent source of significant morbidity. Variability of reports on the incidence of associated anomalies with imperforate anus mandates investigation on this issue.Material & Methods: The case records and imaging studies of 105 patients who underwent surgery for imperforate anus over a 10-year period are retrospectively reviewed. Voiding cystouretherography, intra venous pyelography (IVP) and ultrasound were performed in  patients with intermediate or high level anorectal lesions.Findings: During 10 years, there were 48 boys (45.7%) and 57 girls (54.3%) with imperforate anus. Genitourinary anomalies were seen in 34 (48.6%) patients with intermediate or high level anorectal lesions. Eighteen of them (52.9%) were shown to have vesicouretral reflux, only 6 of them required surgical correction. Vesicoureteral reflux was the most prominent urologic anomaly; other anomalies such as ureteropelvic junction (UPJ) stenosis, hydronephrosis, hypospadias, renal agenesis and undescended testis were seen in these series. Conclusion: Patients with anorectal malformations should be evaluated for urinary tract and spinal anomalies.

Objective: Osteogenesis imperfect (OI) is an inherited disorder of type1 collagen synthesis with varied complication. OI type II is a perinatally lethal variety, characterized by short limbs, broad long bones, radiologic evidence of severe osseous fragility and defective ossification. These patient usually are stillborn or die in early infancy of respiratory failure.  It has a wide range of phenotypic expressions, but cardiovascular anomalies tend to be rare association. When they do occur, they usually consist of aortic or mitral valve disease. Case Presentation: Here we come across a rare case of OI type II in a neonate with acyanotic congenital heart disease. Echocardiography revealed moderate size ostium secundum atrial septal defect without pulmonary hypertension. The patient expired after 6 hour of life.Conclusion: Any case of OI should be screened for congenital cardiovascular defect and another abnormality.

Objective: Relapsing Polychondritis (RP) is an uncommon inflammatory disorder of unknown cause characterized by an episodic and progressive course affecting predominantly the cartilage of the ears, nose and laryngotracheobronchial tree. It has seldom been described in children.Case Presentation: We report on a 2-year old girl with a preliminary diagnosis of Juvenile Chronic Arthritis (JCA), when she was 1 year old. She was treated with Non Steroidal Anti-inflammatory Drugs (NSAIDs) and oral steroids. Six months later her polyarthritis relapsed and she had additional bilateral auricular chondritis; at this time RP was diagnosed due to the appearance of criteria of McAdam-Michet et al.Conclusion: RP should be considered in differential diagnosis of JCA. Steroids and systemic immunosuppressants can be used to treat the RP.

Objective: Fibrous hamartoma of infancy (FHI) is a rare, benign soft tissue tumor that typically occurs within the first two years of life. It has a specific histologic appearance comprising of three different mesenchymal tissues with variable proportions in an organoid fashion. The clinical course is typically benign with excellent prognosis. We report two cases of this rare lesion and review its cilinicopathologic characteristics.Case(s) Presentation: The first case was a 15-month-old girl who had a subcutaneous mass in the right axillary region and the other one was an 18-month-old boy with a mass on the medial surface of his right ankle. The masses were successfully excised. After 6 and 30 months follow up no recurrence occurred.Conclusion: Although the clinical and imaging findings of FHI are quite similar to those of malignant soft tissue tumor, histologic characteristics of this tumor will guide to the definite diagnosis that will prevent aggressive and mutilating procedures.  

Objective: Vaginal purulent discharge in children is mainly due to nonspecific enteric bacterial agents and specific agents such as group A beta-hemolytic streptococcus, hemophilus influenzae and staphylococcus aureus. Lack of protective effects of estrogen in vaginal mucosa is the main predisposing factor. Persistent or recurrent foul smelling and/or serosanguineous vaginal discharge, not responsive to medical therapy in most cases, might be caused by a missed vaginal foreign body.Case Presentation: We present a 7-year old girl because of persisting foul smelling, occasionally blood stained vaginal discharge for about 4 years despite a few courses of medical therapy by gynecologists. Ultrasonography didn't achieve to demonstrate the presence of the foreign body, but pelvic x-ray showed a radio-opaque body resembling a roll plaque. Vaginoscopy discovered a cap of eyebrow pencil in the upper vagina. This removed by forceps led to improvement of the disease.Conclusion: In a child presenting with vaginal discharge not responsive to hygienic measures and medical therapy, possibility of vaginal foreign body must be considered. Although MRI is the most proper technique for evaluation, sonography and/or x-ray are more available and helpful in most cases. 

Airway foreign bodies as a preventable event have been a major cause of morbidity and mortality, resulting in 500-3000 deaths annually. Foreign body aspiration may result either in airway compromise and death or in serious sequels such as recurrent pulmonary infections, atelectasis, or bronchiectasis. To prevent these complications, prompt diagnosis and removal of the foreign body is mandatory.