International Journal of Children and Adolescents
Volume:5 Issue: 2, May 2019

The purpose of this study was to compare the topical effect of breast milk, chlorhexidine, and dry cord care on the umbilical cord bacterial colonization in premature infants hospitalized in a neonatal intensive care unit.

This randomized controlled double-blinded trial was performed on premature infants admitted to the NICU of Valiasr Hospital, Birjand in 2016.  The infants were allocated to one of the three study groups of breast milk, chlorhexidine, dry cord care. The data were analyzed using the SPSS (v.21.0) at the level of p-value≤0.05.

25 infants were included in each group matched for gender, type of delivery, birth weight, and gestational age. The density (p<0.001) and the number p<0.05) of bacterial colonization reduced after intervention in all groups, significantly. However, the was no difference between the groups.

The results of this study indicated the effect of the three procedures of dry cord care, application of chlorhexidine, as well as use of breast milk in the control of the umbilical cord bacterial colonization in preterm infants, although no difference was reported between the study groups.

Predicting adverse neurovascular complications due to diabetic ketoacidosis (DKA) particularly in children leads to more appropriately management of disease as well as achievement of acceptable patientschr('39') survival. Cerebral edema is a life-threatening adverse event following DKA responsible for high mortality rate. Recently, authors have focused introducing new risk assessment tools for predicting occurrence of brain edema to early prevention of nervous defects and losing consciousness following DKA. The present study aimed to present a new scoring system for predicting brain edema as a serious consequence of DKA among children.     

A retrospective chart review was conducted on 112 children with the definitive diagnosis of DKA who were admitted to Ali-e-Asghar Hospital, Tehran, between 2014 and 2017. The multivariable logistic regression modeling and analysis of the ROC curve were used to determine and stratify parameters predicting high risk groups for cerebral edema.

In multivariable logistic regression model, using infant formula (OR = 4.153, p = 0.020), tachypnea on admission (OR = 3.342, p = 0.027), and raised serum creatinine (OR = 1.658, p = 0.026) could effectively predict the likelihood of brain edema following DKA in children. The children with three parameters were scored as 3, two of three parameters scored as 2, one of three parameters scored as 1, and none parameters scored as 0 considering as very high risk (with 8-fold risk for brain edema), high risk (with 5 to 6-fold risk for brain edema), moderate risk (with 2 to 4- fold risk for brain edema) and low risk for brain edema following DKA.

We presents a new scoring system for early identifying children prone to cerebral edema following DKA. This scoring system considers triad of history of using formula, tachypnea on admission and raised serum creatinine and thus can stratify DKA patients to low, moderate, high and very high risk for cerebral edema.

Diabetic ketoacidosis (DKA) is one of the leading causes of mortality in diabetic children. This study aimed to determine the frequency of mortality and complications of DKA during treatment in order to make the necessary modifications with regard to the common treatment problems.This was a cross sectional study, where patients were selected by examining the records of 112 children under the age of 15 who had been admitted to the pediatric intensive care unit of Ali Asghar Childrenchr('39')s Hospital during 2014-2017 with DKA diagnosis. Required information were extracted from the records. Statistical analysis was performed using Chi-square (χ2) test, independent samples T-test and SPSS, Version 16. P value less than 0.05 was consider significant.The mean age of the children was 9.9 ± 3.15 years. In 66% of the patients, the first manifestation of diabetes was DKA. Regarding the type of serum therapy, hyponatremia was observed in 15%, hypernatremia in 4.6%, hyperkalemia in 4.5%, and hypokalemia in 15.2% of the patients during treatment. The mortality rate was 2.7% (3case). While other complication such as cerebral edema were reported in 20 cases (17.9%). Another important point in our study was that, among the initial markers, several clinical and laboratory markers had a high potential for predicting DKA-related mortality, including the need for intubation  at the time of admission, increased inflammatory factors, severe hyperglycemia, evidence of renal dysfunction, hypophosphatemia, and vitamin D deficiency. Also, in predicting cerebral edema, various base markers were identified as predictors that consist of low GCS on admission, tachypnea, increased level of inflammatory factors, increased BUN, severe metabolic acidosis, leukocytosis, thrombocytosis, hypophosphatemia, vitamin D deficiency and increased Hb A1C.

Common variable immune deficiency disease (CVID) is one of the most common primary immunodeficiency disorders. It causes reduction of immunoglobulin levels and specific antibodies production and enhancement of recurrent and chronic infections risk, especially respiratory infections and gastrointestinal tracts. Here, we report a case of CVID in a 3 years old male with recurrent hospitalizations because of gastroenteritis and sinobronchitis infections that was treated as allergic disease for a long time but he does not improved. During receiving IVIG he had sever reaction and treated as anaphylaxis an admitted to ICU.

Preterm birth is a public health problem and late preterm birth (deliveries between 34-36 weeks of gestation) accounts for 75% of all preterm births. Antenatal Betamethasone can reduce the severity of respiratory distress in preterm infants and its effect is accepted in 24-34 weeks of gestation. Our goal was to determine the neonatal outcomes of Betamethasone prescription in late preterm births.

In a prospective cohort study in a tertiary teaching hospital, the women at 34-36 weeks of gestation and at risk for imminent preterm delivery took one course of Bethametasone arbitrarily according to the on-call physician order (Betamethasone group) and the rate of neonatal respiratory distress and NICU admissions was assessed, and we compared the results with the results of late preterm deliveries without taken antenatal Betamethasone (Control group).

We had 213 patients in control group and 187 in Betamethasone group. There was a significant difference between results, in two groups in 34 and 35 weeks deliveries. Frequency of need to respiratory support in Control group was 33.3% and in Betamthasone group was 9.6%. NICU admission in Control group was 33.8% and in Betamethasone group was 10.7% (P=0.00).

In 34 and 35 weeks of gestation, one antenatal Betamethasone course, even a single dose of Betamethasone has a significant effect on reduction of the respiratory distress and NICU admission rate.

Renal abscesses are rare in childhood. They have vague manifestations and  any delay in proper diagnosis and treatment could lead to morbidity and mortality. We present a 5 year old girl with multiple renal abscesses after pyelonephritis that lead to total nephrectomy due to multiple drug resistance. The renal abscess may have subtle symptoms. Early diagnosis and treatment strongly prevents undue mortality and morbidity. This case highlights the need of timed diagnosis and proper treatment.  There must be a clinical suspicion of renal abscess if treatments hve not enough effect on clinical condition of patient.

Ventilator-associated pneumonia (VAP) is the most widespread infection among individuals hospitalized in intensive care units leading to high mortality and morbidity as well as a high cost burden. We aimed to compare the bacterial strains obtained from respiratory secretions using the mini-BAL technique within four days of intubation in children admitted to PICU.

This cross-sectional study was conducted on all consecutive children who were admitted to PICU ward at Ali-Asghar referral children hospital in Tehran in 2018 with that assessed for qualitative and quantitative analysis of respiratory secretions by Mini-BAL due to suspicion to VAP.

In total, 53 children suspected to VAP were included into the assay. Assessing the respiratory secretion at the first day of intubation found two positive cultures for klebsiella strain indicating an infection rate of 3.7%. Assessing the results of bacterial cultures at the fourth days of intubation revealed 18 positive cultures for different species including klebsiella in 7 cases, pseudomonas in 3 cases, Acinetobacter in 2 cases, Serratia in 1 case, Alcaligenes in 1 case, Enterobacter in 1 case, Enterococcus in 1 case, Escherichia Coli in 1 case and candida albicans in 1 case yielding an overall VAP rate of 34.0%.

VAP is a common event among children who are intubated in PICU and the likelihood of this complication can be raised over time from intubation as about one-third of our assessed children suffered from VAP at the fourth day after intubation. The most common strains affecting such children include klebsiella followed by pseudomonas and Acinetobacter.