فهرست مطالب
Iranian Journal of Pediatrics
Volume:27 Issue: 6, Dec 2017
- تاریخ انتشار: 1396/10/10
- تعداد عناوین: 18
-
-
Page 1Growing pain, still preserving its charm, is the most common form of recurrent musculoskeletal pain in childhood. Approach to diagnosis requires significant care in geographical regions with familial Mediterranean fever (FMF) endemicity. We discuss data and a current approach to growing pains in children in an FMF endemic region.
The symptomatology may be confused with different diseases. Although unnecessary tests may be performed to reach diagnosis, sometimes patients may be misdiagnosed as having growing pain without revealing the primary underlying pathology. Definite algorithms are not developed for diagnosis of growing pains. Diagnosis is mainly based on typical clinical features of the condition. However laboratory tests and imaging methods may be used for diagnosis and differential diagnosis especially in atypical course suggesting diseases such as inflammatory ones or malignancies. Vitamin D deficiency should be investigated to give supplementation if necessary.
Some helpful algorithms may be used in evaluation of patients. In order to evaluate myalgia as growing pain in areas where FMF is endemic, fever, abdominal pain, elevated acute phase reactants and history of FMF and/or amyloidosis in family should be carefully excluded. It is important to inform parents about the alarming symptoms of extremity pain and when to urge medical advice again.Keywords: Growing Pain, Fever, Children, Diagnosis, Management -
Page 2Obstetric brachial plexus palsy (OBPP) refers to upper limb paralysis secondary to a sustained traction or compression injury to the brachial plexus during birth. The reported incidence in developed countries is 2 per 1000 live births. The assessment and planning of appropriate treatment is important in the early stages of OBPP. The aim of our study was to examine the relationship between the range of motion and upper extremity function of the shoulder in patients with OBPP who were treated by tendon transfer. This study included 48 patients who had shoulder tendon transfer at least 6 months ago in Istanbul Medical Faculty, Department of Plastic and Reconstructive Surgery, Department of Surgery of the Hand. Range of motion measurements were performed using a universal goniometer and the modified mallet classification was used to categorize global shoulder function. Pediatric evaluation of disability inventory (PEDI) and Canadian occupational performance measure (COPM) were used to evaluate functional ability, activity and participation. When examining relationships between range of motion and functional scores, there was a statistically significant relationship between COPMP score and external rotation, and no relationship was found between other motion functional scores. The study demonstrated that, the use of the pattern of development and motivation of patients to participate is also important among range of motion and muscle strength for upper extremity function.Keywords: Brachial Plexus, Upper Extremity, Range of Motion
-
Page 3BackgroundIn daily ENT practice foreign bodies in children are a frequent occurrence. In most instances, removal of the foreign body is easily accomplished. In some cases removal is only possible under brief general anesthesia.ObjectivesThe present work is intended to provide an overview of the first aid management of foreign bodies in the ENT field.MethodsThe study was conducted at the Charite University Hospital Berlin, campus Virchow Klinikum (Germany). All children referred to the otolaryngologist on duty in the emergency room between 2009 - 2013 with a suspected foreign body were included in the retrospective study.Results517 children were included in our study. We removed foreign bodies from the following sites: ear 161, nasal cavity 237, nasopharynx 8, and oropharynx 29. Furthermore, 15 foreign bodies were found at other sites in the aerodigestive tract. 51 foreign bodies were removed under general anesthesia.ConclusionsThe management of foreign bodies in ENT in children should be adapted to the location, the nature of the foreign body and the childs age in order to ensure a safe and gentle removal. Interdisciplinary collaboration is required in particular to avoid complications.Keywords: Children, Foreign Body, Removal, Emergency Room
-
Page 4BackgroundNecrotizing enterocolitis (NEC) is a common dangerous gastrointestinal emergency in neonatology, especially in premature infants, which can cause serious problems.ObjectivesThis study was conducted to find out whether administration of probiotics could lead to prevention and/or treatment of NEC.Methods115 premature newborns weighting 750 - 1500 g or less than 32 weeks gestation were checked daily for NEC signs and weight gain and mean day of full feed achievement was recorded.ResultsThe incidence of NEC and C-reactive protein (CRP) rise showed a significant difference (P = 0.02) between the two (case and control) groups, but the difference regarding mean duration of oxygen therapy, TPN, full feeding achievement, and hospitalization was not significant.ConclusionsThese results showed positive effects of probiotics on preventing and treating NEC, especially NEC grade 3 in ELBW and VLBW neonates.Keywords: Probiotics, NEC, Premature Neonate
-
Page 5BackgroundThere is a lack of evidence about the upper extremity impairments and function in children with diparetic cerebral palsy.ObjectivesThis study was planned to investigate the upper extremity impairments, dexterity, grip strength and function in the daily living activities in children with diparetic cerebral palsy (CP).MethodsEighteen children with diparetic CP and 15 typical peers between the ages 5 - 12 years were included in the study. Manual Ability Classification System (MACS) was used for the classification of upper extremity fine motor skills; WeeFIM for activities of daily living; Abilhand-Kids for the manual abilities; and Pediatric Evaluation of Disability Inventory (PEDI) for the disability in the daily living activities respectively. Grip strength was evaluated with Jamar Hand Dynamometer, hand functions were assessed with Nine-hole Peg Test and Jebsen-Taylor test.ResultsChildren with diparetic CP were affected in manual abilities and functions, grip strength, activities of daily living, and levels of disability and the results were statistically significant (PConclusionsAs a conclusion, upper extremity impairments, dexterity, grip strength, and functions in the activities of daily living are affected in children with diparetic CP. Physiotherapy interventions for upper extremities and hand should be included as well as the lower extremities in the treatment of the spastic diparetic children.Keywords: Cerebral Palsy, Upper Extremity, Rehabilitation
-
Page 6BackgroundThere are various techniques for treatment of proximal hypospadias disease.Surgical correction is often associated with complications. Proximal hypospadias can be repaired by Duckett or Bracka two-stage repair procedure. This study was to evaluate the outcomes, complications and long term follow-up of these two techniques in our referral hospital.MethodsFrom January 2006 to January 2015 totally 1550 cases of hypospadias were diagnosed in our hospital, of which 164 patients with high type hypospadias underwent Duckett (78 cases) and modified Bracka (86 cases) surgical repair procedures. Sufficient data were analyzed for age at operation, type of pathology, chordee type, number of operations, complications, outcomes and follow-up.ResultsOne hundred sixty four cases with a mean age of 2.70 ± 2.6 (range 0.5 - 13) years underwent proximal hypospadias repair. Follow up ran in average to 5 (range 1 - 10) years.Chordee was seen in 19 (11.58%) cases which 15 (78.9%) cases released and 4 (21.1%) corrected by dorsal Nesbit plication. Fifteen of 164 (9.1%) cases had meatal stenosis: 5 in Bracka and 10 in Duckett group, all of which were repaired by dilatation. Six patients in Duckett group and only one in Bracka series had urethrocutaneous fistula. One case in Bracka group and five cases in Duckett series underwent re-operation.ConclusionsOur study shows that proximal hypospadias repair with modified Bracka procedure has significantly a lower complication rate, also a better and more cosmetic outcome than Duckett technique.Keywords: Hypospadias, Modified Bracka Technique, Duckett Technique, Outcome, Children
-
Page 7BackgroundThe concept of family-centered care is increasingly being recognized at the international level.ObjectivesDevelopment of a support system for parents of premature infants (PPI), based on family-centered care and scientific evidences.MethodsThe method is based on four key steps. 1) Explaining parents needs, including comprehensive review of quantitative studies, meta-synthesis of qualitative studies conducted in Iran by search of Iranian databases (IranMedex, Magiran, and SID) and international resources (PubMed, Scopus, and Google Scholar) and comparative study. 2) A comprehensive review to identify effective interventions in supporting PPI and ranking interventions. 3) Designing a model to support PPI. 4) Evaluating designed system for supporting the PPI.ResultsThe results of this study identified five critical steps which the PPI experienced and 14 effective interventions to support them. Preconception: care before the next pregnancy; prenatal: preparing parents to see their baby for the first time, supporting parents in breastfeeding (BF), kangaroo care (KC) and infant massage; neonatal: spiritual self-care, individualized behavioral and developmental care programs, using scales to assess infant's behavior, supporting parents in BF, KC and infant massage, support forums for parents, relieving parents stress, sharing information and communication, family nurture interventions, supporting parents in transferring between neonatal units (NU), facilitating collaborative care in NU; discharge: discharge planning, support forums for parents, sharing information and communication and home: home support programs, individualized behavioral and developmental care programs, supporting parents in BF, KC and infant massage. Support forums for parents, sharing information and communication.ConclusionsOur proposed system provides a parent-centered system which can be implemented to provide high-quality care for PPI.Keywords: Family-Centered Care, Infants, Prematurity, Parent's Experiences
-
Page 8BackgroundIn JIA, cell-mediated immune response results in secretion of different inflammatory products from activated lymphocytes, macrophages, fibroblasts and leukocytes in synovial joints. Adenosine deaminase (ADA) regulates this immune system activity by metabolizing adenosine through purine metabolic pathway.ObjectivesThe aim of this study was to compare the level of serum ADA with synovial fluid ADA in JIA patients and to see whether it can be utilized as a marker for the activity of the diseaseMethodsJIA was diagnosed based on International League of Associations for Rheumatology diagnosis criteria. ADA was measured using special kits.Results80% of the patients had oligoarticular and 20% polarticulare JIA. There was a significant relation between erythrocyte sedimentation rate (ESR) and high level of synovial fluid ADA. Synovial ADA level was significantly higher than serum ADA in polyarticular JIA. C-reactive protein (CRP), leukocytes and platelets count were increased in high levels of synovial fluid ADA. No correlation was observed between level of serum and synovial fluid ADA.ConclusionsSynovial fluid ADA seems a more precise index than serum ADA to assess the inflammatory condition. In addition, acute-phase response reactants such as ESR, CRP, and platelets count could be suitable predicting parameters for arthritis.Keywords: Juvenile Idiopathic Arthritis, Adenosine Deaminase, Synovial Fluid, Acute-Phase Reactant, ADA
-
Page 9BackgroundPercutaneous balloon pulmonary valvuloplasty (BPV) is treatment of choice for valvular pulmonary stenosis (VPS) as it is highly effective and safe in children and adults. This study evaluated the immediate results of BPV and also heart remodeling in midterm follow up.MethodsIn this prospective study, we first reviewed immediate outcome of 104 pediatric patients with mean age of 3.64 ± 4.33 years and mean weight of 11.32 ± 7.7 kg at the time of BPV who were treated at our tertiary pediatric heart center from June 2010 to August 2014, and then on midterm follow up (mean follow up time was 2.0 ± 1.87 years) the patients were reassessed by 2D, M-mode, Doppler and tissue Doppler echocardiography for cardiac remodeling and pulmonary valve function. P value less than 0.05 was considered as statistically significant.ResultsThis study showed right ventricular pressure and pulmonary valve stenosis decreased significantly immediately after procedure and peak instantaneous pressure gradient remained acceptable on follow up. However, the patients had significant diastolic dysfunction in midterm follow up while tricuspid inflow velocities and E/A ratio had no statistically significant correlation with right ventricular pressure and residual VPS. These patients had significant increased tricuspid valve Aa velocity and E/Ea ratio and had significant difference with normal references of age during follow up period. Also pulmonary artery diameters were in normal range for body surface area after the procedure.ConclusionsAlthough BPV is a safe and effective treatment for children with VPS, right ventricular diastolic dysfunction may persist in midterm follow up.Keywords: Balloon Valvuloplasty, Cardiac Function, Pulmonary Valve Stenosis, Children
-
Page 10ObjectivesThis study aimed to find nursing diagnoses for non-physical health problems in mothers of children with cancer through a directed (deductive) qualitative content analysis of interviews with them.MethodsIn this qualitative study, eight mothers of children with cancer were interviewed, their problem list was matched with defining characteristics of each nursing diagnosis in non-physical domains of NANDA I taxonomy II, so that they were assigned in pre-determined subcategories and categories.ResultsResults showed some common health problems in domains of self-perception, role relationship, coping stress tolerance, life principles and perception/cognition.ConclusionsQualitative approach for assessment of mothers of children with cancer can help to find their health problems in non-physical domains, which is important to be included in the holistic family centered care plan of these children and their families.Keywords: Nursing Diagnosis, Cancer, Mothers, Children
-
Page 11BackgroundThe need for hospitalization of a premature infant in neonatal intensive care unit (NICU) is a risk for the mother-infant attachment and nursing support is essential for the family of such infants. Aim of the present study was to investigate the effect of supportive-training intervention of fathers of premature infants on mother-infant attachment.MethodsThe present clinical trial was conducted in the NICU of 29 Bahman hospital, Tabriz. Sixty fathers of hospitalized premature infants were divided into intervention and control groups. Before the intervention, the mother-infant attachment was measured by the AVANT cheek list. The training intervention was applied to the parents of the intervention group for 2 days and the fathers were conducted to bedside of their infants to visit them and exchange ideas with their wives. The control group only received the routine cares in the unit and ultimately, the mother-infant attachment was re-measured in both groups.ResultsNo significant difference was observed in the attachment score before and after the intervention in the control group. The attachment score was significantly different in the intervention group (12.8 ± 4.55 vs 2.1 ± 3.90).ConclusionsThe supportive-training intervention for the fathers of the premature infants and facilitation of the relationship of the parents with each other led to increased mother-infant attachment rate.Keywords: Object Attachment, Infant, Premature, Fathers
-
Page 12BackgroundIn spite of many reports on sickle cell disease, to our knowledge frequencies of nephrologic complications are not well defined especially in sickle thalassemia. The aim of this study was to assess the nephrologic complications of sickle cell syndrome.MethodsThis is a cross sectional study, including all of the patients with sickle cell syndromes (97 cases) in hematology-oncology clinics of Shiraz University of Medical Sciences. A complete history taken and physical examination was performed. Blood and urine samples were sent for different tests including micro albuminuria and Cystatin C to measure glomerular filtration rate.ResultsNinety seven patients with mean age of 8.5 ± 3.4 years (55.4% males) were divided into three groups; 30 cases with sickle cell disease, 31 patients with sickle cell trait, and 36 cases with sickle thalassemia. Enuresis was present in 20 (22.9%) patients > 5 years. Significant proteinuria was not observed, but micro albuminuria was found in 14 (14.4%) patients. GFR was in normal range when calculated with creatinine clearance, but glomerular hyper filtration was present in 5.2% by Cystatin C formula. Mean serum creatinine was in low normal range (0.5 ± 0.1) but mean serum Cystatin C (0.9 ± 0.1) was higher than the normal range especially in Sβ patients (P = 0.023).ConclusionsIn contrast to other reports, at least in the first two decades of life significant renal complications including renal failure and proteinuria were unusual in our patients with sickle cell syndrome.Keywords: Sickle Cell Anemia, Sickle Trait, Sickle Thalassemia, Micro-Albuminuria, Glomerular Filtration Rate
-
Page 13BackgroundThe aim was to describe reference values of oxygen saturation (SpO2) and heart rate (HR) in preterm infants immediately after birth.MethodsThe preterm (ResultsTotally 151 infants were analyzed. At 1 minute, the median (IQR) preductal SpO2 and HR were 61% (57 - 66) and 100 (90 - 107.3) bpm, rising at 5, 10 and 15 minutes to 80% (75 - 84) and 155 (142 - 164) bpm, 90% (88 - 92) and 155 (150 - 160) bpm, 96% (94 - 98) and 155 (149 - 162) bpm respectively.ConclusionsOxygen saturation levels of preterm infants in delivery room are lower than reported in NRP guidelines. Clinicians who use pulse oximetry in HR follow up of premature babies should know HR may beKeywords: Newborn, Premature Infants, Oxygen Saturation, Heart Rate
-
Page 14BackgroundAge-related legal problems are particularly common in underdeveloped parts of Turkey. Age determination is important in terms of both laws and penalties in the legal process.ObjectivesThe aim of the present study was to compare the validity of the Demirjian and Willems methods in southern Turkish children.MethodsIn this retrospective study, panoramic radiographs of 745 southern Turkish children (382 boys and 363 girls) aged between 4 and 15.99 years were examined by one investigator. According to Demirjian and Willems method, the mean difference between chronological and dental age was calculated for each sex and age group. The Wilcoxon test was used to compare all data. Statistical analysis was performed to test the validity of Demirjian and Willems methods by comparing the mean estimated and chronological age.ResultsThe Demirjians method overestimated age with a mean accuracy of 0.832 in females and by 0.923 in males, while Willems method overestimated it by 0.202 in females and 0.434 in males.ConclusionsThe dental age estimation by Willems method was found to be more accurate than Demirjian method in contemporary Turkish pediatric population.Keywords: Age Estimation, Chronologic Age, Dental Age, Demirjian's Method, Willem's Method, Forensic Odontology
-
Page 15BackgroundAlthough the activity of the cytosolic hepatic enzyme phenylalanine hydroxylase is impaired in phenylketonuria (PKU), the microsomal function, necessary for the metabolism of xenobiotics, has never been assessed. The aim of the study was to assess the microsomal liver function in PKU patients by 13C-methacetin breath test (13C-MBT), which measures cytochrome P450 activity.MethodsTwenty patients with classical PKU, aged 15 - 34 years, were enrolled in the study. The control group comprised of 20 healthy subjects matched for age and sex. The 13C-MBT was performed in every subject at rest after an overnight fast.ResultsThe values of cumulative percentage dose recovery at 120 minutes of the test (CPDR median ) were significantly lower in the PKU group than in the control group (25.1 vs 32.8 ; P = 0.0067). The lower values of the maximum momentary 13C recovery (Dmax) were observed in the PKU group than in the control group (26.6 vs. 32.1 ; P = 0.0227). The values of time to reach Dmax (Tmax) did not differ (20 vs. 20 ; P = 0.8410). The values of CPDR, Dmax and Tmax were not different between the group with abnormal (> 10 mg/dL) and normal (ConclusionsThe present study demonstrates that the cytochrome P450 activity in PKU patients may be reduced. However, further research is required, particularly in regards to the effect that patient diet compliance has on the microsomal liver function.Keywords: Phenylketonuria, Microsomal Liver Function, Cytochrome P450, 13C Methacetin Breath Test
-
Page 16BackgroundChildren with nephrotic syndrome (NS) may be at risk for metabolic bone disease because of biochemical derangement caused by renal disease as well as steroid therapy. Osteocalcin (OC) functions as an inhibitor of bone mineralization. We aimed to evaluate linear growth and bone turnover markers (including serum osteocalcin) in children with steroid-dependant/frequently-relapsing and steroid resistant NS in comparison to a matched control group.MethodsOur study was a cross-sectional study conducted at childrens hospital, Cairo University, Egypt from July 2014 to August 2015. The study included 60 patients, aged 2 - 15 years recruited from outpatient nephrology clinic. Twenty eight age- and sex- matched healthy children were included as a control group. Serum OC was measured by immune-radiometric assay.ResultsSerum OC levels were significantly higher in both SDNS/FRNS and SRNS than in control group, with P value 0.02 and 0.01, respectively. There was statistically significant negative correlation between OC and serum calcium. There was a negative correlation between height for age percentile and number of relapses. There were also negative correlations between height for age percentile and steroids, cyclophosphamide and cyclosporine duration of treatment. We found that both of our patients groups (SDNS/FRNS and SRNS) showed lower height for age percentile compared to control group (P = 0.017 and 0.001 respectively).ConclusionsHeight as a growth parameter is more affected when recurrent relapses occur with multiple courses of steroid therapy. Use of OC as screening tool is recommended for bone turnover while patients on steroids.Keywords: Osteocalcin, Nephrotic Syndrome, Children
-
Page 17BackgroundExtracorporeal membrane oxygenation (ECMO) is used in a variety of indications worldwide. One of the most important subsets is postoperative congenital cardiac surgery cases unresponsive to conventional therapies. In this study, we present our ECMO experience in a single congenital cardiac surgery center.MethodsECMO was used in a total of 34 postoperative congenital cardiac surgery cases, whose operations had been performed by the same congenital cardiac surgery team. Patients ages were between 3 days to 15 years. ECMO was used in four different indications; in case of unsuccessful weaning from cardiopulmonary bypass (OR-ECMO), in low cardiac output syndrome (LCOS-ECMO), in refractory post cardiac arrest (CPR-ECMO) and in respiratory insufficiency after RSV infection (RSV-ECMO).ResultsThe follow-up period of patients ranged from 1 to 80 months, whereas ECMO duration ranged from 23 to 2218 hours. Six cases were OR-ECMO, 13 were LCOS-ECMO, 12 were CPR-ECMO and 3 were RSV-ECMO. Out of a total of 34 cases, 20 (58%) cases were weaned from ECMO. Two of the patients, who were able to be weaned from ECMO passed away in the hospital; however, the other 18 patients (52.9%) were discharged from the hospital without having any significant neurological deficits. The top survival rate (69%) and weaning from ECMO was in the LCOS-ECMO group and the worst weaning from ECMO support (33%) was in the RSV-ECMO. The worst survival rate (25%) was in the CPR-ECMO group. Sepsis and associated multiple organ dysfunction were observed as the major cause of mortality in these patients. The most common complications were bleeding and mechanical complications related to cannulation.ConclusionsECMO may be required in postoperative congenital cardiac surgery cases in whom all other conventional therapies have failed. Indications, timing and maintenance of equipment are very important points in successful ECMO management. Increasing ECMO experience in the near future, will provide much decrease in mortality of congenital cardiac surgery.Keywords: Extracorporeal Membrane Oxygenation, Pediatric Heart Surgery, Extracorporeal Life Support
-
Page 18BackgroundAbdominal tuberculosis, the sixth commonest extrapulmanory tuberculosis, is easily misdiagnosed due to nonspecific gastrointestinal symptoms. The diagnosis is highly dependent on clinicians suspicion of the disease; therefore to increase awareness we retrospectively reviewed clinical features of eight children in a four year-period.MethodsThe medical records of children with abdominal TB were retrospectively reviewed. The diagnosis of abdominal TB was defined as Mycobacterium tuberculosis infection of gastrointestinal tract along with peritoneal or solid organ involvement.ResultsThere were six girls and two boys with a mean age of 13.6 ± 2.8 years (range, 7 - 16 years). Abdominal pain and weight loss were common complaints in all patients (100%) at presentation; fever was present in four (50%) patients and abdominal distension in two (25%) patients. Mean duration of symptoms before diagnosis was 2.5 ± 1 months. Laparotomy performed in six patients, and the peritoneum was the most common infection site (in 5 patients). Chest X-rays of 7 patients indicated lung involvement. The most common abdominal computed tomography and ultrasonography finding was ascites. Bowel wall thickening was recorded in 2 patients and ileal thickening in 1 patient. Inguinal lymphadenopathy and multiple mesenteric lymphadenitis were present as single cases.ConclusionsThe abdominal tuberculosis should be suspected in children with ongoing abdominal pain, fever, and abdominal distension, laparoscopy or laparotomy could be useful in the differential diagnosis and utilizing imaging techniques, invasive methods with clinical suspicion may prevent delay of the diagnosis.Keywords: Abdominal Tuberculosis, Clinical Manifestations, Diagnosis, Children