Journal of Comprehensive Pediatrics
Volume:7 Issue: 3, Aug 2016

Supraventricular Tachycardia (SVT) is the most frequent arrhythmia requiring a medical treatment in neonates.
The aim of our study was to evaluate and manage neonatal supraventricular tachycardia.
This study was performed on 22 newborns that were diagnosed with SVT at two neonatal intensive care units (NICU) in south west of Iran from October 2012 to October 2015. Data on gender, age, weight, maternal age, gestational age, presence of congenital heart disease, blood pressure in admission, duration of hospitalization period, duration of SVT, medicine for the control of SVT, list of medicine administered at releasing time were collected. Echocardiography was performed for all patients. Data was analyzed by the SPSS version 18 software.
Twelve neonates were male (54.5%) and ten (45.5%) were female. The mean age was 11.68 ± 8.17 days. Three neonates (13.6%) had congenital heart disease. The mean duration of hospitalization was 6.54 ± 3.98 days. Nine patients (41%) only had responded adenosine. One patient had hypotensive that received D/C shock.
We concluded that in most SVT patients, conventional treatment can be helpful and an only minor percentage of patients need to receive flecainide as the last line of treatment.

Rhesus incompatibility is a preventable cause for severe neonatal hyperbilirubinemia, hydrops fetalis and still births. The prevalence of the Rh-negative blood group among Indian woman varies from 2% - 10%. Despite declining the incidence of Rhesus incompatibility, due to availability of anti-D immunoglobulin, and improved antenatal care of the Rh-negative pregnant woman, it still accounts for a significant proportion of neonatal hyperbilirubinemia and neuro-morbidity. The prevalence of Rh-negative women having Rh-positive neonates is 60%.
This study aimed to estimate the incidence of Rh iso-immunization and evaluate the outcomes of Rh iso-immunized neonates.
This prospective observational study was conducted in a tertiary level neonatal intensive care unit, Princess Esra hospital, Deccan college of medical sciences, Hyderabad, Telangana, India. Consecutive intramural and extramural neonates admitted to neonatal intensive care unit with the Rh-negative mother’s blood group and hyperbilirubinemia were enrolled. Neonates born to Rh mothers were excluded. Neonatal gestational age, birth weight, age at admission, duration of phototherapy, duration of hospitalization, neonatal examination and investigations were recorded in a predesigned, pretested performa.
A total of 90 neonates were born to Rh-negative mothers, of which 70% (63) had the Rh-positive blood group and 30% had the Rh-negative blood group. Of these 63 neonates, 48 (76.2%) had hyperbilirubinemia and 43 neonates (68.3%) had significant hyperbilirubinemia (total serum bilirubin > 15mg/dL). Among them, 2%, 75% and 23% were born to primi, multi and grandmutli, respectively. Also, 14.5% of the neonates were large for dates (LFD), 75% appropriate for dates (AFD) and 10.5% were small for dates (SFD). Premature and SFD neonates had higher incidence of hyperbilirubinemia. Significantly higher incidence of jaundice occurred within 72 hours of life. The mean serum bilirubin level among neonates with significant hyperbilirubinemia was 17.98 ± 1.76 (95% CI:17.43 - 18.52) while that of neonates without significant hyperbilirubinemia was 13.1 ± 0.53 (95% CI:12.47 - 13.77) with statistical significance (P Incidence of Rh-positive phenotype in neonates born to Rh-negative mothers is 70%. Incidence of hyperbilirubinemia among them is 76.2% and that of significant hyperbilirubinemia was 68.3%. The incidence of DCT positivity was 20.9%. Maternal multiparity, positive DCT and abnormal NSG were important associates of high serum bilirubin levels.

The aim of this study was to investigate the prevalence of metabolic syndrome, in children with type one diabetes mellitus (T1DM) for the first time in a population in the Middle East, and assess the influence of type of insulin therapy, daily dosage of insulin, family history of type 2 diabetes, gender and level of HbA1c on the prevalence of metabolic syndrome.
This cross-sectional study was conducted on children with T1DM aged 2 years during years 2013 to 2014. Waist circumference, blood pressure, height and weight of children with diabetes, for calculation of body mass index (BMI), were measured by one physician. Fasting blood glucose and lipids were also measured. According to the age-modified standards of the ATPIII, metabolic syndrome was defined. All data were analyzed using the SPSS 18 software.
In this study, 87 children with diabetes (48 females and 39 males) aged 12.38 ± 4.2 were enrolled. Overall, 40.9% of our patients had hypertension, 55.2% had hypertriglyceridemia, 36.8% had low high-density lipoprotein (HDL) and 6.9% of patients had abdominal obesity. Furthermore, 29.9% of these children had metabolic syndrome, which did not have a significant association with the type of insulin regimen (P = 0.97), nor the daily dosage of insulin (P = 0.234), however the serum concentration of HbA1c had a significant correlation with metabolic syndrome (P = 0.027).
This study provides evidence indicating high prevalence of metabolic syndrome in children with T1DM in southern Iran. Preventive programs aimed towards decreasing the risk factors of metabolic syndrome and interpretation of a healthier diet and physical activity for children with T1DM should be considered in our country.

One of the serious challenges facing neonatal medicine is meconium aspiration syndrome, delays in the treatment of which can lead to high mortality.
This study was designed and conducted with the aim of determining the mortality rate and risk factors affecting this rate in newborn infants with meconium aspiration syndrome.
This study was conducted as a retrospective descriptive research on newborn infants with meconium aspiration syndrome hospitalized at the neonatal intensive care unit (NICU) of Fatemieh and Be’sat hospitals in Hamadan city during a 10-year period from 2004 to 2014. Demographic information of the mother and the newborn, hospitalization course, the need for mechanical ventilation, and complications and outcomes of disease were extracted and were analyzed using the SPSS software version 22.
Sixty-three newborn infants, diagnosed with meconium aspiration syndrome, were entered in this study, 40% of them were male, 85.7% wighed more than 2500 g, and 17.5% were post term, 25.3% had a five-minute Apgar Score (AS5min) of less than seven, 39.6% were nonvigorous at birth, 31.8% needed to be placed on mechanical ventilation, and 14.3% died during the hospitalization course. There was a significant relationship between the need for mechanical ventilation, nonvigorous state at the birth, complications of disease and mortality rate.
Despite the progress made in medicine, meconium aspiration syndrome is still one of the causes of newborn infants’ mortality. The mortality and morbidity rates can be reduced by improvement in perinatal care, prevention of post term delivery, timely caesarean and effective neonatal resuscitation at birth.

Tuberculosis (TB) is a globally significant cause of morbidity and mortality in children. Few data on tuberculosis in children and adolescents are available in Iran.
The current study aimed to describe the case characteristics and clinical-epidemiological aspects of children and adolescents with TB.
A retrospective review was undertaken on 203 patients aged less than 19 years admitted to a referral TB hospital from 2006 to 2011.
Out of the 203 children and adolescents diagnosed with TB, 57.6% of cases were female. Median age was 15 years and 51% were 10 -18 years old; 83% had pure pulmonary TB. The common type of extrapulmonary TB (EPTB) was pleuritis (64%) and 80% of the EPTB cases were observed in adolescents aged 15 - 18 years. Female adolescents aged 15-18 years were more likely to have positive smear (88%), cultural growth (63.6%) and drug resistant TB infection (71%).
In this referral hospital setting, more pediatric patients with TB were found among adolescent cases especially females. Early detection of adolescents at risk to developing infection is the essential constituent of TB control.

We report on a three-year-old child, a case of battered baby syndrome.
A three-year-old female child was brought with multiple bruises, fracture of left femur and features of raised intracranial tension. The etiology was unclear at presentation. Inconsistencies in history given by the mother, a background of poverty and single parenthood, presence of multiple bruises over the body, multiple infarcts in Computerized Tomography (CT) scan, absence of external calvarial injuries and finally subdural hematoma in the autopsy report led to the diagnosis of child abuse.
Every clinician must be alert to the possibility of battered baby in a child with multiple injuries.

Giant congenital right atrial aneurysm is a very rare congenital heart lesion, which may be asymptomatic or present a variety of symptoms, particularly supraventricular arrhythmias and intracardiac thrombosis formation.
This is a report on a 3.5-month-old male infant with imperforated anus and an unusual-shaped congenital giant right atrial aneurysm with retro-ventricular extension. This unusual shape prevented appearance of cardiomegaly on the chest X-Ray. Surgical resection of the aneurysm was attempted. However, posterior descending coronary artery, which was embedded in the wall of the aneurysm, was irreversibly damaged during the operation. The patient died in the operation room. We concluded that pre-operative delineation of coronary arteries in cases with congenital giant right atrial aneurysm (CGRAA) with extension to the posterior left ventricle is mandatory. Despite the current data that surgical excision of the aneurysm is the treatment of choice, our case required simple closure of the aneurysmal neck from inside the right atrium to be an easier and safer surgical approach for treatment of CGRAA with a tricky anatomy.
This case indicates that delineation of coronary artery anatomy in atypical congenital giant right atrial aneurysm is of vital importance. Closure of the aneurysmal sac, instead of aneurysmal resection, is a safer and more simple approach in atypical cases.

Renal vein entrapment, named nutcracker phenomenon, is a contraction of renal vein between abdominal aorta and superior mesenteric artery. Patients can be asymptomatic or clinically manifested, called nutcracker syndrome. Proteinuria, hematuria, flank pain, varicocele in males and pelvic congestion in females are reported in such patients.
The current report presented an eight-year-old girl with microscopic hematuria and chronic abdominal pain along with short review of anatomy, pathophysiology, clinical significance and management of this syndrome.
The nutcracker syndrome should be differentiated from unexplained chronic abdominal pain.