فهرست مطالب

Pediatrics - Volume:29 Issue: 1, Feb 2019

Iranian Journal of Pediatrics
Volume:29 Issue: 1, Feb 2019

  • تاریخ انتشار: 1397/11/18
  • تعداد عناوین: 15
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  • Fatemeh Sadat Rahnemaie , Elham Zare , Farzaneh Zaheri , Fatemeh Abdi * Page 1
    Context
    Breastfeeding initiation is an important event during the postpartum period. Despite the significance of exclusive breastfeeding in infant health, some common breast issues lead to the early cessation of breastfeeding. Therefore, various complementary medicine techniques are used to increase the length and quality of breastfeeding.
    Objectives
    The current review study collected evidence on the impacts of complementary medicine on successful breastfeeding and breastfeeding-associated problems in the postpartum period.
    Data Sources
    A systematic search was performed on PubMed, Embase, Web of Science, Scopus, and ScienceDirect databases and all randomized clinical trial, quasi-experimental, observational, and case-control studies published from 1999 to 2018. The quality of the selected papers was measured based on their adherence to the strengthening the reporting of observational studies in epidemiology (STROBE) checklist. After careful examinations, 18 papers were selected and reviewed.
    Results
    According to the results of the current review, point massage was beneficial to prevent low milk supply postpartum. Oketani breast massage significantly increased total solids, lipids, and casein content, as well as the gross energy of breast milk and thus improved its overall quality. Reflexology enhanced breast milk supply. The Gua-Sha therapy, Oketani massage, and hollyhock leaf compress decreased the mean severity of breast engorgement. The six-step recanalization manual therapy (SSRMT) could be used as a safe and low-cost method to treat plugged milk ducts after delivery. Nipple fissures could be relieved by the use of Pistacia atlantica resin, silver impregnate medical cap, lanoline, menthol essence, and Ziziphus jujuba fruit.
    Conclusions
    Supplementary medicine techniques are inexpensive and safe methods to resolve breastfeeding problems and empower mothers to perform successful breastfeeding. These methods can thus promote exclusive breastfeeding and decrease infant morbidity and morbidity. However, further details are needed in this area.
    Keywords: Complementary Medicine, Breastfeeding, Massage, Breast Problem
  • Touran Shahraki*, Salehe Omrani Mehr , Ivor D. Hill , Mansour Shahraki Page 2
    Background
    Dental enamel defects and other oral manifestations are reported to occur more commonly in children with celiac disease (CD). Our aim was to investigate the frequency and distribution of enamel defects and dental caries, and the presence of other oral findings in children with CD and to compare them to a group of children without CD.
    Methods
    From 200 index cases with CD, 65 cases aged between three to 16 years accepted to participated in the study after an oral explanation for the parents. In addition, 60 healthy, age, and sex matched subjects without CD were chosen as control group. Enamel defects were classified according to the Aine criteria and dental caries was recorded by calculation of DMFT/dmft indices. The presence of other oral findings, such as aphthous ulcers and xerostomia, were recorded. Chi-Square test and Mann-Whitney test were used for comparison of data. P values < 0.05 were considered statistically significant.
    Results
    A total of 65 children with CD and 60 non-CD subjects were studied. There were significantly more enamel defects in children with CD compared to the control group (P = 0.01). Grade I was the most common enamel defect in both groups. Symmetric and non-specific enamel defects were observed in 45% and 14% of CD subjects and in 12% and 12% of the control group (P = 0.001). The location of enamel defects in permanent and deciduous teeth was more prominent in anterior teeth with a coronal distribution involving the incisor and middle parts of the teeth. The dmft index was significantly higher in the control group compared to the CD group (P = 0.003). With the exception of xerostomia, there was no difference in other oral manifestations between groups.
    Conclusions
    Enamel defects are more common in children with CD compared to those without this disease. This finding should alert health care providers to consider testing for CD.
    Keywords: Dental Enamel, Dental Caries, Pediatrics, Celiac Disease, Iran
  • Hamid Ahanchian , Mina Davari , Fatemeh Behmanesh , Javad Fadaee * Page 3
    Background
    Urticaria is one of the most commonly diagnosed pediatric skin disorders. Limited studies have been carried out to investigate acute urticaria-related allergens in Iranian children.
    Objectives
    The purpose of this study was to evaluate the prick test findings in Iranian pediatric patients with acute urticaria.
    Methods
    This cross-sectional study was performed on pediatric patients with acute urticaria September 2012 to 2017. Background data, such as age, gender, and history of other allergic diseases, were recorded. The subjects experienced the skin prick test to assess allergy to 45 aeroallergens, food, contact and insect allergens.
    Results
    One-hundred twenty-nine children (male to female ratio: 1.22) with a mean age of 5.93 ± 4.29 years were studied. The most common food allergens were pepper (21.7%), egg white (20.9%), and walnut (17.8%). The most common aeroallergens were Salsola kali (37.5%), Dermatophagoides farinae (33.6%) and trees (32.6%). The mean age of patients with a positive reaction to sesame, pepper, Chenopodiaceae, Salsola kali, grass, Ash, and trees was higher than subjects with negative results, whereas sensitization to milk, beef, and lamb was common in younger children.
    Conclusions
    According to the results of this study, the most common food allergens in Iranian pediatric patients with acute urticaria currently appear to be pepper, egg white, walnut and egg yolk.
    Keywords: Urticaria, Food Allergy, Skin Prick Test, Children
  • Ying Deng , Li Qiu * Page 4
    Background
    Mushroom poisoning is a global problem and can be a source of major mortality and morbidity. Children can easily be exposed to inadvertent mushroom ingestion.
    Objectives
    The aim of this study was to assess the demographic, clinical, and laboratory features of pediatric patients with mushroom poisoning.
    Methods
    This was a retrospective and observational study of reported cases of exposure to mushroom poisoning at the Department of Pediatrics at West China Second University Hospital of Sichuan University and Wan Yuan Central Hospital between June 2011 and July 2016. The patients’ demographic, clinical, and laboratory features were evaluated.
    Results
    Fifty-eight patients aged between 1.22 and 16.71 years old were studied; 24 patients were female (41%) and 34 were male (59%). Thirty-seven (63.79%) patients had consumed mushrooms in the summer. The most frequent complaints were nausea and vomiting (98.28%). The onset of mushroom toxicity symptoms was divided to early-onset (< 6 hours after ingestion) and late-onset groups (6 to 24 hours). The incidence of life-threatening cases was higher in the late-onset group than that of the early-onset group (88.9% versus 12.2%, P < 0.0001). Three patients with mushroom poisoning died due to fatal hepatic failure, and one patient died due to cardiac arrest (myocardial toxicity). The value of White Blood cell Count (WBC), total bilirubin, and number of involved organs were significantly higher in the group who died than that of the survived group (14.9 × 109 versus 11.8 × 109, P = 0.002; 125 versus 8.5, P = 0.0001; 4.5 versus 1, P < 0.0001, respectively). The level of hemoglobin was lower in the group who died than those who survived (111 versus 132, P = 0.001).
    Conclusions
    Parents and children must be taught to avoid eating unknown mushrooms. Life-threatening poisoning cases are often encountered in patients with late-onset mushroom toxicity symptoms. When children present nausea and vomiting during the rainy season, doctors should maintain keen vigilance towards mushroom poisoning. Acute liver failure is the main cause of death, yet myocardial toxicity should also be considered.
    Keywords: Mushroom Poisoning, Late-Onset Symptoms, Children
  • Sung Hoon Kim , Younghwa Kong , Jinyoung Song , I, Seok Kang , Ji, Hyuk Yang , Tae, Gook Jun , June Huh *, Pyo, Won Park Page 5
    Objectives
    The aim of this study was to report the early and mid-term outcomes of the left ventricular volume reduction surgery (LVVRS) and to carry out an observational analysis of prognostic factors related to early and late death after LVVRS, especially in pediatric patients with idiopathic dilated cardiomyopathy (DCMP).
    Methods
    We reviewed the medical records of 10 patients (M:F = 5:5) under 19 years of age who had LVVRS for idiopathic DCMP between March 1997 and February 2014. We reviewed clinical characteristics, pre-and postoperative functional evaluation, and early/late postoperative mortality.
    Results
    The mean age at diagnosis of idiopathic DCMP was 63.10 ± 44.39 (median 50, range 5.00 - 147.00) months and the mean age at the time of LVVRS was 83.30 ± 68.80 (median 63.5, range 14.00 - 210.00) months. The mean interval from diagnosis to LVVRS was 20.30 ± 35.34 (median 4, range 1.00 - 114.00) months. The failure of LVVRS was confirmed in seven cases. We defined failed LVVRS as death (n = 4) or heart transplant (n = 3) within two months of LVVRS. The most common cause of failed LVVRS was low cardiac output (n = 5, 71.4%), followed by ventricular tachycardia (n = 2, 28.6%).
    Conclusions
    Although high mortality after LVVRS was noted in children with idiopathic DCMP, some patients had favorable mid-term outcomes. LVVRS might be considered as a bridge therapy to heart transplantation in young patients.
    Keywords: Dilated Cardiomyopathy, Left Ventricular Volume Reduction Surgery, Transplantation, Child
  • Mandana Rafeey , Yalda Jabbari Moghaddam *, Saman Rezaeeyan Page 6
    Background
    Involvement of the upper respiratory tract and pathological changes in the nose and paranasal sinuses are common in patients with cystic fibrosis.
    Objectives
    We aimed to identify sinonasal manifestations in Iranian children with cystic fibrosis.
    Methods
    Forthy seven children with cystic fibrosis were enrolled and symptoms related to the nose and paranasal sinuses were recorded using a questionnaire. The patients’ nasal and sinus CT scan were investigated in terms of findings related to cystic fibrosis.
    Results
    The most common complaint was nasal congestion (61.7%). Ground glass opacity in the nasal cavity was found in 63.8% of the patients. Postnasal drip was observed in 36.2% of the patients. In nasal endoscopic examination, 15 (31.9%) patients had clear polyps in the nasal cavity.
    Conclusions
    History, CT scans, and initial clinical examination (rhinorrhea in anterior rhinoscopy) does not allow accurate diagnosis of chronic rhino sinusitis or nasal polyps in children with cystic fibrosis.
    Keywords: Cystic Fibrosis, Sinusitis, Polyps, Child
  • Youhong Fang , Wei Li , Hui Xu , Jianhua Mao , Shiqiang Shang * Page 7
    Objectives
    Interleukin-33 (IL-33) was one of the members of IL-1 family, and it was reported that the single nucleotide polymorphisms (SNPs) in the IL-33 gene was contribute to the susceptibility to immune related diseases, including rheumatoid arthritis, asthma, Behcet’s disease, systemic lupus erythematosus and ankylosing spondylitis. However, the potential association between SNPs in IL-33 gene and Henoch-Schönlein purpura (HSP) was not explored.
    Methods
    We designed a case-control study, a total of 181 HSP patients and 202 healthy pediatric controls were included, which aimed to study the relationship between the SNPs in the IL-33 gene (rs1929992, rs7044343) and HSP with a Chinese pediatric cohort.
    Results
    There were no evidence for the association of rs1929992 and rs7044343 polymorphism in IL-33 gene with pediatric HSP patients (C versus T, P = 0.622, OR = 0.931, 95% CI: 0.7 - 1.238; TT versus CC, P = 0.742, OR = 0.908, 95% CI: 0.513 - 1.609; CT versus CC, P = 0.158, OR = 0.714, 95% CI: 0.446 - 1.141 and C versus T, P = 0.920, OR = 0.986, 95% CI: 0.742 - 1.309; TT versus CC, P = 0.939, OR = 0.978, 95% CI: 0.549 - 1.741; CT versus CC, P = 0.416, OR = 0.817, 95% CI: 0.501 - 1.331, respectively). Moreover, association studies were performed on the correlation between IL-33 gene polymorphisms and HSP nephritis patients as well as patients with gastrointestinal manifestation and joint involvement. However, there were no significant association regarding the distribution of allele and genotype frequencies between HSP patients with different system involvement and healthy controls either.
    Conclusions
    The present findings indicated that both of rs1929992 and rs7044343 in gene IL-33 polymorphism were not related to the susceptibility to HSP and the different system involvement of HSP patients.
    Keywords: Henoch-Sch?nlein Purpura, Cytokines, Interleukin-33, Single Nucleotide Polymorphisms
  • Bahare Fakhri , Seyedeh Batool Hasanpoor–Azghady*, Leila Amiri Farahani , Hamid Haghani Page 8
    Background
    High stress levels in the parents of infants with colic have negative impacts on their quality of life. Maternal concerns with infants’ needs can be reduced through social support.
    Objectives
    The aim of this study was to assess the relationship between social support and perceived stress in the mothers of infants with colic.
    Methods
    This cross-sectional study was carried out on 200 mothers of infants with colic referred to 14 healthcare centers affiliated to Iran University of Medical Sciences in year 2017. A convenience sampling method was used. Demographic data form, Cohen perceived stress and Vaux’s perceived social support questionnaires were used for data collection. Descriptive and inferential statistics were used for data analysis. P < 0.05 was considered statistically significant.
    Results
    There was a statistically significant positive correlation between social support and perceived stress (r = 0.31, P = 0.001). In other words, with increase in social support, perceived stress would be increased. However, the support of the spouse in the form of childcare could reduce perceived stress in the mother (P = 0.001).
    Conclusions
    The results of this study showed that with increase in social support, perceived stress in the mothers of infants with colic also would be increased. However, spousal assistant in childcare is accompanied by a reduction in perceived stress in mothers.
    Keywords: Social Support, Perceived Stress, Infantile Colic
  • Gürkan Gürbüz*, Selvinaz Edizer , Aycan Unalp , zlem Nalbantolu , Selma Tunç , zlem Ba , Unsal Ylmaz , Rana Malatyali , Behzat zkan Page 9
    Background
    Asymtomatic santral nervous system disorder is frequently found in patients with diabetes. Neurophysiological tests were found to be objective and sensitive tool for detecting subclinical optic nerve and CNS disorders.
    Objectives
    Our aim is to evaluate of the central nerve conduction changes using visual evoked potentials (VEP) and to demonstrate the effects of various risk factors on VEP parameters in children with type 1 diabetes mellitus (T1DM).
    Methods
    Sixty children aged between 6 and 18 years and followed-up with a diagnosis of T1DM were enrolled in the study. Thirty healthy, age-matched children were enrolled as the control group. All patients and controls underwent the pattern reversal visual evoked potentials (PRVEP) test. Patients' HbA1c values, age, sex and duration of disease were evaluated from their hospital files.
    Results
    Both right and left VEP latencies were significantly longer in the diabetic group than in the control group (P = 0.001 and P = 0.001, respectively). The mean duration of T1DM in the patient group was 5.5 years (min: 1 - max: 15). There was a positive correlation between longer VEP latency values and duration of DM, with coefficients of 0.49 for the right eye and 0.513 for the left eye (P < 0.001 and P < 0.001, respectively).
    Conclusions
    We found that optic nerve conduction diminished significantly in children with T1DM. Visual evoked potential datas showed a significant prolongation of the latency of P-100. We recommend that all diabetic children be scanned with neurophysiological tests such as PRVEP for optic neuropathy.
    Keywords: Children_Visual Evoked Potential_Type 1 Diabetes Mellitus_Optic Neuropathy
  • Hüseyin Da , Okan Dikker , Murat Usta , Habip Gedik * Page 10
    Objectives
    Our aim in this study was to compare the values of omentin-1, which is an adipokine associated with postnatal metabolic complications, in the cord blood of newborns who were small for gestational age (SGA), appropriate for gestational age (AGA) and large for gestational age (LGA).
    Methods
    This prospective, cross-sectional study was carried out with the measurement of omentin-1 values by Enzyme-Linked Immunosorbent method in the cord blood of the infants who were born at the delivery room of Ministry of Health, Istanbul Okmeydani Training and Research Hospital between 01/08/2016 and 31/01/2017.
    Results
    In the study, omentin-1 values of 30 infants with AGA, 25 infants with LGA and 20 infants with SGA were measured and compared with each other. The mean of cord blood omentin-1 values in the newborn group with SGA was found to be significantly low compared to that of the newborns with AGA. However, no statistically significant difference was found between omentin-1 values of the three groups.
    Conclusions
    We have determined serum omentin-1 levels to be lower in infants with SGA. Metabolic follow-up of infants with SGA is thought to be beneficial because low levels of omentin-1, which is an adipokine in metabolic functions in infants with SGA, may lead to the development of metabolic complications.
    Keywords: Newborn, Cord Blood, Omentin -1, Insulin
  • Bahareh Nazemisalman , Faezeh Jafari , Abdolreza Esmaelzadeh , Soghrat Faghihzadeh , Surena Vahabi *, Hamidreza Moslemi Page 11
    Background
    Dental caries is one of the most common diseases during childhood. Saliva can modulate the process of decay, as a rich source of host factors. It has been shown that tumor necrosis factor-alpha (TNF-α) is secreted more in the saliva of individuals with active caries. No study has addressed the relationship between TNF-α levels and age or compared children’s immune response at different age groups and during adolescence.
    Objectives
    The present study aimed at evaluating the pro-inflammatory cytokine level of TNF-α in saliva and its association with caries in different age groups of children and adolescents.
    Methods
    In this case-control study, 128 children and adolescents were divided to four age groups of 32. In each group, half of the individuals had no decay (control group) and the other half had > 4 decayed teeth (case group). Overall, 5 mL of non-stimulated saliva was spitted in sterile tubes for 15 minutes. Furthermore, 1 mL of each sample was centrifuged for five minutes at 12000 rpm. Salivary level of TNF-α was measured using the Enzyme Linked Immunosorbent Assay (ELISA) standard kit.
    Results
    A total of 79 children were studied. The mean TNF-α levels in the case group was 35.20 ± 16.23 Pg/mL and in the control group, this was 26.20 ± 6.25 Pg/mL (P value = 0.001). The mean TNF-α level was significantly higher in the age group of six to 12 years than the age group of 13 to 18 years (P value = 0.01).
    Conclusions
    The results of this study indicated that decay plays an important role in increasing cytokine TNF-α in non-stimulatory saliva, there is no confirming evidence of the direct effect of age on immune function yet.
    Keywords: Dental Caries, Pro-Inflammatory Cytokine, TNF-?, Saliva
  • Yoshimitsu Fujii *, Tetsuji Morimoto Page 12
    Introduction
    Lubiprostone is considered as a useful laxative for functional constipation in adults. However, although lubiprostone is described in the Guideline of Pediatric Chronic Functional Constipation Treatment (Japanese), it has never been used as a pediatric medicine in Japan because there is no clinical usage experience in children. Here, the current research describes the first pediatric experience of lubiprostone in Japan, with a focus on measures against lubiprostone-induced nausea.
    Case Presentation
    Lubiprostone 24-µg capsules, 0.38 to 1.06 µg/kg/time, were used with eight administrations in six patients with intractable functional constipation. All administrations improved defecation, fecal frequency, and the Bristol stool scale score. Complete remission was obtained within four months in five patients (83.3 %). Lubiprostone-induced nausea occurred in two administrations of greater than 0.69 µg/kg/time. However, a dose of 0.90 µg/kg/time with simultaneous administration of trimebutine maleate did not induce nausea in one repeat administration.
    Conclusions
    Lubiprostone is useful for intractable functional constipation in children.
    Keywords: Child, Functional Constipation, Gastrointestinal Motility-Regulating Agent, Lubiprostone, Nausea
  • Ehsan Aghaei Moghadam , Azin Ghamari *, Mohammad, Taghi Majnoon Page 13
    A 13-year-old girl, as a known case of type III Gaucher disease, was referred to us for a cardiac assessment. Our investigations revealed wall thickening and calcification in the ascending thoracic aorta, transverse arch, and isthmus. Calcification was also present in the proximal portion of the brachiocephalic trunk while the osteal narrowing of right common carotid was also notable. The other finding included isolated thrombocytopenia. We decided to perform surgery after two months of enzyme replacement therapy.
    Keywords: Type IIIC Gaucher Disease, Aortic Stenosis, Mitral Valve Stenosis, Calcinosis, Thrombocytopenia
  • Mahdieh Sadat Mousavi , Raheleh Assari , Fatemeh Tahghighi , Hamid Eshaghi , Vahid Ziaee * Page 14
    Introduction
    Macrophage activation syndrome (MAS) is a rare and potentially fatal complication of Kawasaki disease (KD). Typically, MAS presents as the exacerbation of KD, manifested by prolonged fever and resistance to treatment. Early and accurate diagnosis might be challenging due to overlapping features of MAS and intravenous immunoglobin (IVIG)-resistant KD and lack of validated diagnostic criteria.
    Case Presentation
    In this article, we report four cases of KD with prolonged fever that were eventually diagnosed and treated as MAS. Three cases were boys and one infant was a girl. The mean age of the cases was 29 months. Three cases had typical and one case had atypical KD. Two cases had abnormal findings in echocardiography and three cases had hepatomegaly. In laboratory evaluation, all of them had thrombocytopenia, increased liver enzymes, and hyperferritinemia. All the patients were treated with intravenous high-dose methylprednisolone (pulse therapy) after IVIG therapy, two cases with oral cyclosporine, and one case with infliximab. There was no mortality in our cases, and in long-term follow-up, all the patients had normal clinical, laboratory, and echocardiography findings.
    Conclusions
    KD resistant to IVIG and sustained fever have high diagnostic values in MAS with underlying KD.
    Keywords: Kawasaki Disease, Macrophage Activation Syndrome, Prolonged Fever, Pancytopenia, Serum Ferritin
  • Fatemeh Heydarpour , Maryam Soltani , Farid Najafi , Hamid Reza Tabatabaee , Koorosh Etemad , Mahmoud Hajipour , Mehran Babanejad , Tannaz Valadbeigi , Halimeh Yaghoobi , Shahab Rezaeian *+ Page 15
    Background
    Undesirable health outcomes of anemia impact all different groups of people within a society especially pregnant women (PW).
    Objectives
    This study aimed to evaluate other fetal and maternal complications of anemia in various trimesters of pregnancy.
    Methods
    A large retrospective cohort study was conducted on Iranian PW in 2017. The first and third trimesters of pregnancy were assessed as a separate study. The first study included 1038 anemic and 2463 non-anemic PW and the second comprised 756 anemic and 1986 non-anemic PW. The outcome-related pregnancies were analyzed for each study.
    Results
    After adjusting for the potential confounding factors, the odds of neonatal mortality (OR = 1.63; CI 95%, 1.25 - 2.13) were significantly higher and the odds of cesarean delivery (OR = 0.6; CI 95%, 0.46 - 0.75) were significantly lower in women who had anemia during the first trimester. The chance of pre-term delivery (< 37 weeks; OR = 2.15; CI 95%, 1.6 - 2.91) and abortion (OR = 1.68; CI 95%, 1.11 - 2.53) was significantly higher in women who had anemia during the third trimester, while the chance of low birth weight (< 2500 kg) (OR = 0.66; CI 95%, 0.46 - 0.93) was lower in anemic women during the third trimester than in those without anemia.
    Conclusions
    Pregnant women who experience anemia in both first and third trimesters of pregnancy have different unpleasant pregnancy outcomes. Since anemia is preventable during pregnancy, many of these outcomes such as neonatal mortality, low birth weight, preterm and cesarean delivery, and abortion could be prevented and decreased by providing health education before pregnancy.
    Keywords: Neonatal Mortality, Anemia, Retrospective Cohort Study, Iran