Caspian Journal of Pediatrics
Volume:4 Issue: 2, Sep 2018

The methods of baby's position are an important critical factor in ventilation and oxygenation of tissues. Although the prone position as one of the recommended position has beneficial effect on the development of premature infants, little research has been done. In a clinical trial among mechanically ventilated infants, hospitalized in the neonatal intensive care units (NICUs), 35 preterm infants were selected in 2014-2015. Each infant was positioned in a supine (control group) and prone (case group) positions for 2 hours, respectively. The values of blood oxygen saturations (SpO2) and heart rates were assessed and recorded every 10 minutes by a cardio-respiratory monitoring device. Data analysis was performed using SPSS v.22. The mean heart rates were 136.909±2.861 and 136.600±2.560 beats per minute in the supine and prone positions, respectively. Heart rates were within the normal ranges in both positions, but the range of fluctuation was slightly lower and statistically non-significant in the prone position (p-value=0.805). The average of SpO2 was 92.364% and 95.046% in the supine and prone positions, both of them were within the normal range. This study showed that the prone position compared to the supine position has a more favorable effect of SpO2 and heart rate fluctuations in preterm infants.

Identifying the onset of obesity in children can be helpful to design the prevention programs for obesity and its complications. The aim of this study was to evaluate the onset of obesity in children. This cross-sectional study was conducted on the first grade of primary school children in Sari (urban areas) (Mazandaran Province, Iran) in 2014. The names and contact information of the first grade of primary school children (6–7 years old) were obtained through referring to Sari Health Center (Schools Health Unit). The onset of obesity was identified and recorded based on a body mass index (BMI) higher than 95% (for age and gender) and the weight/age and height/age Centers for Disease Control and Prevention (CDC) growth charts which were available in the child health records. There were 127 obese children (71 boys, 56 girls) in the current study. The mean weight, height and BMI of children were 32.63±4.918 (kg), 123.02±5.166 (cm) and 21.52±2.369 (kg/m2), respectively. Furthermore the chance of obesity increased as the child grew up and there was an upward trend from 3 to 6 years old. According to the results the obesity frequency remains high; thus, it is important to pay special attention toward children's weight gain during this period even if it is not within the overweight/obesity range.

Neonatal seizure is a common problem and associated with a great mortality rate, high risk of chronic neurodevelopmental impairments, also difficult to diagnosis and treatment. The aim of this study was to determine the neurodevelopmental outcome, clinical presentation and etiology of seizures in neonates admitted to Amirkola Childrenchr('39')s Hospital (ACH).

In this cross-sectional study, 42 neonates with the initial diagnosis of seizure, aged less than 28 days, hospitalized in ACH, northern Iran, from April to September 2016 were selected using convenient sampling method. The patientschr('39') information was gathered during hospitalization period and 6 months after discharge. Data were analyzed using SPSS 22 through descriptive and chi-square tests.

Among preterm and term neonates with seizures, the main diagnosis in neonates with seizures was idiopathic (38.1%) and hypoxic-ischemic encephalopathy (HIE) (14.3%), hypoglycemia (9.5 %) hypomagnesaemia (7.1%) and opiate withdrawal (4.8%). Twenty-three neonates underwent brain computed tomography (CT) scan and 6 (14.3%) of them had abnormal brain imaging. Seizure control with antiepileptics (P=0.006), metabolic disturbance (P=0.002) and time of drug discontinuation (P<0.001) were significantly associated with adverse neurodevelopmental outcome.

Since idiopathic encephalopathy and HIE were the most common cause of neonatal seizures, it should be attempted to improve care during delivery.

Type I diabetes mellitus (T1DM) with growing frequency which is considered as a world health threatening problem is an autoimmune disease with insulinupenia. Considering the relationship between the incidence of T1DM and environmental factors, the aim of this study was to assess seasonal incidence of T1DM and its association with birth season. This cross-sectional study was conducted on 112 diabetic patients (66 males, 46 females) less than 18 years, referred to Pediatric Endocrine Clinic (Amirkola Children's Hospital) during 2011-2017. All the needed information was extracted from the patient's files and asking questions of their parents. Data were collected in a checklist. Comparison between different seasons and age groups was done by Pearson's chi-square test. Data were analyzed using SPSS 19 and p£0.05 was considered significant level. The mean age of the patients during diagnosis of T1DM was 7.34±3.70 years. The incidence of T1DM was significantly increased in the cold seasons (especially winter) (P<0.008). A more increased incidence was seen in cold seasons in the aged group of 5-9 years old compared to other groups. However, no significant difference was found in all groups in terms of birth season. The results of this study suggest the effects of season as an environmental factor on diabetes incidence. This seasonal diversity is more prominent in the age less than 10 years. So, attention to maintaining the public health and to preventing from viral infections in cold seasons is recommended.

Atypical hemolytic uremic syndrome (aHUS) is a life-threatening and scarce disorder characterized by acute renal failure and disease, non-immune microangiopathic hemolytic anemia and thrombocytopenia, leading to end-stage renal failure or death, and consequently maybe accompanying by extra renal manifestations.  We reported aHUS accompanied by autoimmune hemolytic anemia in a 40-month-old girl with chief complaint of fever and tea-colored urine starting on the morning of the same day. The aHUS was diagnosed based on patient's clinical manifestations, increased serum creatinine, hemolytic anemia, thrombocytopenia and no history of diarrheal disease. Since the atypical hemolytic–uremic syndrome has a poor prognosis, its death rates is as high as 25% and it progresses to end-stage renal disease in half of the patients. It seems that an upper respiratory infection caused both autoimmune hemolytic anemia (AIHA) and aHUS in our patient.

Tumor lysis syndrome (TLS) which mostly occurs in lymphoproliferative malignancies after the start of chemotherapy is an oncologic emergency. Manifestations of metabolic imbalance including increasing hyperkalemia, hyperphosphatemia, hyperuricemia and hypocalcemia are common presentation of TLS.  We present two cases of spontaneous TLS; a rare presentation of TLS before cytotoxic chemotherapy. These cases were admitted with presentation of TLS without any history of chemotherapy with mediastinal mass in chest X-ray (CXR) and subsequent diagnosis of lymphoblastic lymphoma and T-cell acute lymphocytic leukemia (ALL). After several hemodialysis sessions, their conditions were improved and they underwent chemotherapy. It was found that the presentation of mediastinal mass in cases of lymphoma and acute leukemia might be associated with TLS before chemotherapy. In addition, it is important to pay attention to CXR, when we face to a patient with acute renal failure related to TLS.