Iranian Journal of Pediatrics
Volume:17 Issue: 1, 2007

Background: Recurrent and chronic infections of ear، nose، and throat (ENT) such as sinusitis (rhinosinusitis) and otitis media are one of the most common health care problems worldwide and significantly impact quality of life in both children and adults. Antibody deficiencies are the most common type of primary immunodeficiency and also the most likely to present with recurrent ENT infections. Methods: A study was carried out to search for underlying immunodeficiencies in 103 patients with recurrent or chronic ear، nose and throat infections. Serum total IgG، IgA، and IgM levels were measured by kinetic nephelometry، and IgG subclasses by enzyme-linked immunosorbent assay (ELISA). All patients were immunized intramuscularly with polyvalent pneumococcal vaccine (PENEUMO 23). Blood samples were drawn immediately before and 21 days after vaccination and antibodies to pneumococcal antigens were measured using a modified ELISA technique. Finding: Of 103 patients twenty one (20%) were found to have an immunodeficiency. One had a common variable immunodeficiency (CVID)، 5 had selective IgA deficiency (one of them was associated with IgG2 deficiency and one with specific antibody deficiency). Eight patients had IgG-subclass deficiency including seven with an IgG2 deficiency and one patient with IgG3 deficiency. In 75 patients antibody titers of whole pneumococcal antigens were determined before and 21 days after immunization. Ten patients were found to have abnormally low antibody titers. Conclusion: The results of this study suggest that in a subpopulation of patients with a long standing history of ENT infections، a low serum immunoglobulin concentration or hypo responsiveness to pneumococcal antigen would be associated with susceptibility to recurrent infections.

Background: Advances in perinatal medicine have increased the survival rate of infants admitted to neonatal intensive care unit (NICU). Many perinatal conditions may also cause hearing impairment. Early detection of hearing loss by screening and appropriate intervention are critical to speech، language and cognitive development. The aim of this study was to determine the rate of hearing damage in neonates admitted to NICU in Amirkola Children''s Hospital، Babol، Iran. Methods: This is a prospective cross-sectional، descriptive analytic study، carried out from March 2003 to April 2004. 330 neonates were screened first by Transient Evoked Otoacoustic Emissions (TEOAE) (Echocheck، Otodynamics Ltd، England)، and if failed، by Auditory brainstem response (ABR) (Bera 2 Hortman Version، Beyer Dynamic Dt-48، Germany). ABR was performed with 40 db hearing level click stimulus to each ear. Data was analyzed by SPSS software using T-test and Fisher exact test. Findings: 58% of 330 NICU patients were born preterm and the rest in term. 24 neonates (7.3%) failed on TEOTE test and were referred for ABR. Before ABR testing 8 neonates died and 4 neonates had conductive hearing loss (otitis media). Finally 7 (2.1%) developed permanent hearing loss. Conclusions: Findings of this study showed that 7.3% of NICU patients failed on TEOTE and 2.1% had permanent hearing loss on ABR examination. Based on these findings، we recommend hearing screening of high risk neonates admitted to NICU.

Background: According to the fact that the reduction of Neonatal Mortality Rate is correspondent to improvements in health and hygienic status of the society، understanding the major neonatal mortality causes will help the society to plan better prenatal and neonatal care systems. Methods: On this retrospective study، the major causes of the mortality of the dead neonates were extracted from files of Vali-Asr hospital according to the International Coding of Disease Ver 10 (ICD10). Data were analyzed in proportion to gestational age، birth weight، gender and neonatal age. Findings: Mortality rate was higher during the first week of life (78%). Generally five main causes of death were; prematurity، respiratory distress syndrome، intra cerebral hemorrhage، multiple congenital anomalies and air leak syndromes. It was also revealed that the causes of death of low birth weight neonates were similar to those of premature neonates (respiratory distress syndrome، prematurity، intra cerebral hemorrhage، septicemia and air leak syndromes). Similarly there was no difference between the causes the of death in mature neonates and appropriate for growth age neonates. The main causes of death in these two groups were; congenital disease، infections (septicemia and Pneumonia)، asphyxia، diffuse intra vascular coagulation، intra cerebral hemorrhage، meconium aspiration and complications of pregnancy. Data analysis indicated significant relationships between death and gestational age، neonatal age and birth weight (P=0.001) but it was not related to gender. Conclusions: With due attention to the easy application of ICD 10 for determining the major and underlying causes of death of neonates and the fact that autopsy is not routinely applicable in neonatology wards، routine using of ICD 10 for classifying the causes of death in death certificates is highly recommended.

Background: Neonatal mortality rate is one of the main health problems which is affected by prenatal status، maternal، fetal and perinatal conditions. Low birth weight (LBW) is one of the main causes of neonatal and infantile mortality. The aim of this study is an evaluation of the LBW causes in neonates. Methods: This descriptive cross sectional study was done on 1500 neonates، born in Fatemieh Hospital، Hamedan، 2004. Data such as birth weight، sex، maternal age، gestational age، birth interval، history of abortion، prenatal care، maternal occupation، level of education، systemic and underlying diseases، history of infections and smoking were extracted from medical records. Data were statistically analyzed by SPSS ver.13 using chi-square، t-test and fisher''s exact test. Findings: 19.1% of neonates were LBW newborns. Mean values for maternal age، gestational age، maternal weight and height، and the interval between births of LBW neonates were significantly lower compared with normal birth weight neonates. The number of siblings of LBW neonates was more than normal birth weight neonates. Maternal infections and systemic diseases، occupation، the presence and absence of prenatal care in LBW neonates، showed no significant differences with normal birth weight newborns. Smoking and history of abortion in the mothers of LBW neonates were more than those of normal birth weight neonates. Maternal educational level of LBW neonates was lower than mothers of normal birth weight neonates. The most common maternal infection was vaginitis and the most common maternal systemic disease was hypertension. Conclusions: The results revealed a correlation between LBW in neonates with maternal age، gestational age، maternal weight and height. There was also a correlation with the interval between pregnancies، number of siblings، maternal smoking، previous abortion and level of mothers'' education.

Background: In addition to numerous nutrients، human milk contains several antioxidants as bioactive components protecting newborns from a hyperoxic challenge due to transition to an environment much richer in oxygen. The aim of this study was to evaluate the changes of total antioxidant capacity of human milk during the first six months of lactation. Methods: 535 milk samples were collected from 145 healthy women with full term newborns. Analyses included colostrum (at 2±1 day postpartum)، transitional milk (at 7±3 days postpartum) and mature milk (at 30±5، 90±7 and 180±10 days postpartum) and also maternal plasma at 90±7 days. The total antioxidant capacity of samples was measured by Ferric Reducing/Antioxidant Power (FRAP) assay. Results: Colostrum showed a significant higher antioxidant capacity than the transitional and mature milks (589.8±278.1 vs. 508.5±284.1، 453.5±210.8، 479.3±254.3 and 402.6±168.0 μmol/l respectively). Also a significant decrease in antioxidant capacity was observed in the mature milks (p<0.05). The relationship between the antioxidant content of breast milk and maternal plasma was significant too (p<0.05، r=0.267). Conclusions: These data suggest that colostrum، with high antioxidant capacity، during the first days of life is vital; moreover، reduction in total antioxidant capacity during the course of lactation is notable and requires sophisticated measures.

Background: The objective was to determine the role of newborn workshop in promoting mothers'' knowledge. Methods: This is an interventional study (before and after study). Training courses in neonatal care were held with participants including 150 women visiting the child health center. Learning material was offered in two parts، 1. taking care of healthy newborn and، 2. common neonatal problems. Findings: The rate of correct answers to the questions related to neonatal problems was significantly higher than that of incorrect answers. In one half of the questions concerning nutrition and neonatal care there was no difference between rates of correct and incorrect answers، and in the other half، the rate of correct answers was significantly higher than incorrect ones. The study also showed a significant difference between mothers'' knowledge before and after workshops (p=0.00). Several variables، such as age، job، number of pregnancies، number of children، and mother''s level of education were evaluated. Results showed that none of them had any effect in increasing mothers'' knowledge before and after classes. Conclusions: Regarding the extension of necessary information for mothers and to exterminate wrong attitudes facing neonates (especially first child)، there is a need for education of mothers dealing with neonatal daily care، breast feeding and common neonatal problems.

Background: In this study prevalence of abnormal birth weight was estimated in live-born neonates in 2006 and compared with that of 2002 in Talleghani Hospital، Arak، Iran. Methods: Low birth weight (LBW) was classified weight of less than 2500 gram. The prevalence of LBW was explored base on sex، type of delivery and place of the living. The original supine length and weight data were calculated as body mass index (BMI) and compared with BMI at birth of Iran reference data. Results: Overall prevalence of LBW was %9.1 that was less among boys in compare to girls. The LBW value in caesarean delivery was less than normal delivery. This index in mother lives in town was less than mothers who''s living in rural area. Over two thirds of neonates had normal weight and more than 5% were overweight or obese. Girls BMI centiles was less than boys. Conclusions: In this study neonates were relatively free of overweight. The rate of neonatal underweight was striking. The LBW in 2006 was less than this value in 2002 in Talleghani Hospital; however، it was greater than the statistics in development country.

Background: Foot ulceration and lower limb amputation are still common complications of Diabetes mellitus (DM). Diabetic foot problems account for more hospitalization days than any other diabetic problem. The main etiologic factors are diabetic neuropathy and peripheral vascular disease. An easy، simple to use and low cost method for screening of diabetic peripheral neuropathy will be very useful. Methods: From May 2003 to May 2004، all diabetic patients (type 1) referred to endocrine clinic of Namazi Hospital were evaluated for diabetic peripheral neuropathy (DPN)، using the bedside scoring procedure. A score of 3-5 indicated mild، 6-8 moderate، and 9- 10 severe DPN. The perception of vibration، temperature، pinprick and ankle reflex was examined. Tuning fork (128 Hz)، neuropen، cold and warm water and reflex hammer were used for evaluation. Findings: In this study we evaluated 80 patients (34 male and 46 female) with type 1 DM، with the age range of 6-31 years (Mean±SD 18.16±5.22 yr). The overall prevalence of DPN was 13.75%: mild in 7.5%، moderate in 5% and severe in 1.25% of the patients. The most common physical finding was the absence of ankle reflex. Patients were divided into 2 groups based on the presence of DPN. The prevalence of DPN was significantly associated with age، duration of DM and BMI (P< 0.05). There was no significant correlation with sex، HbAlc، puberty، parental consanguinity and family history of DM. Conclusions: Bedside scoring procedure is a simple، low cost and easy method for screening of DPN in patients with type 1 DM in outpatient clinic. Examination of ankle reflex is very important. It is concluded that the diabetic patients need better follow-up and more education.

Background: Physiological growth is a sensitive long-term indicator of child health. Impaired growth of children may be the first manifestation of a serious chronic disease. Short stature is a common pediatric endocrine problem. The short stature، although not a disease per se، is a manifestation of several diseases. Its early diagnosis and treatment is most of the time rewarding. Methods: Children between the age group of 2 to 15 years with growth retardation attending endocrine clinic in Loghman Hospital، Tehran، in October 2003 through October 2005were evaluated for short stature. Evaluation included: detailed medical history، physical examination and laboratory tests such as blood count، thyroid function، growth hormone screening، bone age estimation، and karyotypes. Centers for Disease Control (CDC) growth charts was used for percentiles. Findings: 188 children (110 boys، 78 girls) with growth retardation، whose heights were below 2 standard deviation score for age and gender، attended endocrine clinic. Normal variations accounted for 85.5% of all etiologies for reasons such as constitutional delay 49% and familial short stature 26.5% and a combination of both 9%. The rest (14.5%) consisted of pathological short stature. Growth hormone deficiency and hypothyroidism were the most common causes of pathological short stature Conclusions: The most common cause of short stature was a normal variance followed by short stature caused by endocrine disturbances. In both sexes constitutional growth delay followed by familial short stature counted to the most common non-endocrine causes of short stature.

Background: Iodine deficiency is the most common cause of endemic goiter. Frequency of goiter has remained >5% despite iodide supplementation and sufficient iodide intake. Other causes have to be investigated. This study was conducted to assess influences of malnutrition on persistence of goiter frequency while iodine intake is sufficient. Methods: 1504 school age children (8-10 year) were selected randomly and examined in south of Iran – Firoozabad. 102 cases with goiter grade 2 and 3 were found. 100 completely normal children regarding thyroid examination were also selected randomly as control. Growth parameters (Weight for age، Height for age and Body Mass Index) and urinary iodine as an indicator of iodine intake were assessed in both groups. Findings: Median of urinary iodine was 21 μg/dL in patients. (>10μg/dL indicates sufficiency of iodine intake.) Regarding growth indicators there was not statistically significant difference between the two groups، which rules out malnutrition as a cause of persistence of goiter. On the other hand our study may show that malnutrition (several nutritional deficiencies) could be as a cause of goiter just in the presence of iodine deficiency. Larger studies in iodine sufficient but with more severe malnutrition or comparison of frequency of goiter before and after nutritional improvement in a population with malnutrition and iodine sufficiency may be more helpful. Conclusions: Malnutrition per se could not be considered as a cause of goiter when iodine intake is sufficient.

Background: Leptin، is a adipocyte-derived hormone. Exogenous leptin allows the recovery of the reproductive function. In humans، leptin correlates positively with body mass index (BMI). The aim of the study was to investigate the association of leptin with toxic effects of iron overload. Methods: In a cross sectional study in 2006، we compared the serum leptin level of thalasemic patients with normal group. Blood samples were collected from 219 patients with Cooley’s anemia، (119 males، 100 females) and 137 normal subjects (86 males، 51 females). Leptin was measured by a commercial ELISA kit. Data were analyzed by SPSS software. Findings: Mean serum leptin level was 5.33±5.02 ng/ml in thalassaemic males. It was significantly lower than controls (9.43±7.8 ng/ml) (P<0.001). Thalassaemic females had lower leptin levels (12.12±11.4 ng/ml) than normal females subjects (14.6±13.1 ng/ml) (P<0.001). Furthermore، the physiologically positive BMI/leptin relationship disappeared in thalassaemic patients. Conclusions: It seems that the adipocytes of thalassaemic patients are unable to maintain adequate leptin production. These results suggest that adipose tissue dysfunction can be considered as one of the endocrine pathies affecting thalassaemic patients.

Background: The most common dental disease in childhood is dental caries. This study was carried out to recognize the components of saliva which are protective factors in children in order to evaluate and predict caries susceptible and caries resistant individuals. Methods: A total of 75 subjects of either sex aged 3-5 years old from kindergartens in Tehran were selected and divided into 3 groups (case group: dmft>6، control group 1: 10.05). However، the results showed that salivary phosphate and alkaline phosphatase in caries free group and calcium in the group with severe caries was somewhat more than those in other groups. Conclusions: Despite the results of the present study، the relationship between salivary components and caries rate in children remainslcontroversial. So، more and wide studies are necessary to achieve some practical criteria for predicting dental caries، recognition of susceptible persons and finally prevention of caries in children.

Background: The purpose of this research is to estimate the effect of empowerment model on quality of life of diabetic adolescents. Methods: The present semi experimental applied research was carried out on 47 diabetic adolescents in two health centers using census approach in order to investigate the effect of empowerment – model on their quality of life of diabetic adolescents in 2005-2006. The samples were randomly divided into two groups of case and control. The research tools included: the questionnaires of demographic information (characteristics)، special quality of life، knowledge، self-efficacy and self-esteem of the adolescents. The validity and reliability of the questionnaires were evaluated by content validity and alfa–chrounbach tests respectively. After collecting the pre-intervention data، the empowerment–model was performed on the samples of the case group according to its triple steps (perceived threat، problem solving and evaluation). Then، the data were collected and analyzed 2/5 months after the empowerment intervention. Findings: The obtained results are as follows: Chi–square test showed no significant difference between the groups of case and control in terms of their demographic characteristics (such as age، gender، literacy) (P>0.05). Independent t-test indicated no significant difference between the two groups in terms of their quality of life before and after the empowerment intervention (P>0.05)، but there was a significant difference between the two groups after the intervention in terms of dif-scores of the quality of life (P<0.001). Based on the results of applied paired t-test، there was a significant difference before and after the intervention in the case group in terms of their mean quality of life (P<0.001). Conclusions: Overwhelmingly، according to our findings in the present research، implementation of the empowerment–model intervention has been highly effective on the diabetic adolescent''s quality of life، and we suggest this model to be applied on other age groups of our society in a wider range.

Background: The aim of this study was to investigate the prevalence of congenital heart defects in children with Down''s syndrome in Imam Khomeini Hospital in a period of 2 years (2001-2002). Methods: Based on their medical files and echocardiographies، 32 patients with Down’s syndrome were evaluated during study. Findings: The cytogenetic analysis in these patients (19 males and 13 females) revealed that 29 cases (90.7%) had trisomy 21، 2 cases (6.2%) had translocation and only one case (3.1%) was mosaic. Family history for heart diseases was positive in 2 patients (6.2%). The findings of echocardiography were as follow: endocardial cushion defect (ECD) in 16 cases (50%)، ventricular septal defect (VSD) in 7 cases (21.8%)، atrial septal defect (ASD) in 6 cases (18.7%)، tetralogy of Fallot (TOF) in 2 cases (6.2%)، patent ductus arteriousus (PDA) in one case (3.1%). Conclusions: The diagnosis of congenital heart defects in children with Down’s syndrome is crucial because treating them in due course results in dramatical decrease in the mortality and morbidity rates of these patients.

Background: Cow milk allergy can present as many gasteroenterological manifestations like gasteroesophageal reflux (GER). The aim of this study was to investigate the prevalence of GER in infants with CMA in Imam Khomeini Hospital (2002-2003). Methods: 51 children with CMA were evaluated. Radiographic and endoscopic assessments were performed in GER suspected cases. These cases underwent challenge test and after 2 weeks with cow milk-free diet، they were evaluated again. Findings: 5 cases (10%; 3 females and 2 males) had concomitant GER (age ranged 3-17 months، mean age: 10.6 months). 3 patients took only mother’s milk and 2 cases were fed with both mother’s milk and formula. All mothers took dairy cow products in their daily diet. Skin prick test was positive in only one infant. Interestingly، after 2 weeks of cow milk protein-free diet both allergic and GER manifestations disappeared. Conclusions: Evaluation of children with CMA for concurrent GER seems to be necessary، because treating CMA can control GER as well، suggesting an association between the two conditions. Thus an additional antireflux treatment in these patients can be prevented.

Background: Foreign body ingestion is a potentially serious problem in children. Most of ingested foreign bodies pass through the gastrointestinal tract spontaneously، but some of them (20%) need endoscopic or surgical removal. Sharp foreign object may cause serious complications and need an emergency intervention. The aim of this study was to characterize the clinical features associated with foreign bodies in the upper gastrointestinal tract and to determine the clinical factors for their successful removal by endoscopic techniques. Methods: We analyzed retrospectively 120 cases of foreign bodies in the upper gastrointestinal tract at Children’s Medical Center، Tehran. Depending on the type of the swallowed foreign body and its site obtained by routine neck and chest x-ray as well as existing symptoms، we decided to fulfill an emergency endoscopy or to wait. Findings: Of 120 patients with a mean age of 4 years، 75 (62.5%) were males and 45 (37.5%) females. There was a history of parents'' presence as a witness in 93.3% of cases. Common sites of foreign bodies were stomach (66.6%)، esophagus (25%)، and duodenum (2.5%); a coin was the most common foreign body (30%). Other foreign bodies were disc battery (12.5%)، and sharp foreign bodies (10%). Most of patients were brought in the first 24 hours after ingestion of the foreign body. In only 8 patients، complications occurred. Conclusion: Foreign body ingestion in children is a serious problem which may need an emergency procedure. Still the best way is its prevention; children should not be allowed to play with coins، metallic objects، safety pins etc.

Background: Meckel''s diverticulum is one of the most common congenital anomalies of gastrointestinal tract. Our aim was to study pathologic features of surgical specimens of the diverticulum and to assess the type of lining mucosa، presence of Helicobacter pylori and inflammatory changes. Methods: We studied patients'' medical records and pathology files of the years 1994 through 2004، of the patients who underwent surgery with the diagnosis of Meckel''s diverticulum in Children''s Medical Center، Tehran. Pathologic features such as length and lining of the diverticulum and other variables such as age، gender and clinical signs were studied. Findings: We found 45 specimens in this period (80% male 20% female). The mean age was 3.8 years (25 days to 11 years) and most of the patients were between 2 to 4 years old (33.6%). Most common clinical symptoms were abdominal pain (17) and hematochesis (4); 20 patients had combined symptoms such as abdominal pain and melena. Only 9 patients with lower gastrointestinal bleeding had Technetium scan and all of them were positive. Associated findings during surgery included appendicitis and invagination. Twenty diverticulae were inflamed in pathologic report، 8 with gangrene and 5 with perforation. Pathologic examination of specimens revealed a mean diameter of 2 cm (range: 0.4-4.5) and a mean length of 3.8 cm (range: 1-10). Lining was of intestinal type in 27 (60%)، gastric in 10 (22.2%) and combined in 8 specimens (17.8%). 11 specimens from 18 that were lined by gastric type of mucosa showed no Helicobacter pylori in Giemsa stain (2 had mucosal necrosis). Conclusions: Clinical findings of Meckel''s diverticulum in our study were rather the same as in literature. The most efficient way of diagnosis was Technetium scan. Pathologic examination of specimens revealed that most diverticulae were lined by intestinal type of mucosa. None of those with gastric type of mucosa showed Helicobacter Pylori infection.

Objective: Kawasaki disease is a vasculitis with unknown cause، which is most commonly seen in children younger than 5 years old. The incidence of the disease is between 0.8-3% and male/female ratio is 1.37. Kawasaki is diagnosed basd on prolonged fever at least five days with four of five clinical criteria. Recurrent diseases occur in 1-3% of cases. Multiple recurrences have been reported rarely. Case report: We report on a 4-year-old boy that experienced three attacks of Kawasaki disease. All three clinical features were complete diseases and he was treated with IVIG. He was healthy after 6 months of follow up after the third recurrence. Conclusion: We report a case of multiple recurrent Kawasaki disease with coronary aneurysm in different portion. There was no adverse sequelae، after he is treated with IVIG.

Objective: Pheochromocytoma is a neoplosia of chromaffin cells that is very rare in children. Its signs and symptoms result from the release of catecholamine. It is usually a solitary، unilateral encapsulated tumor. The predominant clinical findings are crises of hypertension، palpitation، abdominal pain، paleness، vomiting، sweating، and weight loss. Its diagnosis requires a certain degree of suspicion. Case report: We report on a 3-year-old child with pheochromo cytoma of difficult clinical management. Diagnosis was confirmed by anatomico- phathological study.The patient recovered after surgical resection of the tumor. Conclusion: The patient was a rare case of pheochromocytoma، his problems being especially hypertension and was cured after surgical resection of the tumor. This demonstrates the beneficial effect of early diagnosis and treatment.

Fetal and extrauterine life form a continuum during which human growth and development are affected by genetic، environmental، and social factors. Perinatal mortality is influenced by prenatal، maternal، and fetal conditions and by circumstances surrounding delivery. The majority of infants'' deaths and developmental disorders are due to disorders relating to prematurity and unspecified low birth weight (LBW)، as well as maternal complications of pregnancy and congenital malformations (chromosomal and metabolic). Birth weight less than 2500 g (as result of preterm delivery and/or intra uterine growth restriction) is a major cause of both neonatal and infant mortality rates and، together with congenital anomalies (eg. cardiac، central nervous، and respiratory system)، contributes significantly to childhood morbidity. Low birth weight is caused by preterm birth، intrauterine growth retardation (IUGR)، or both factors. The predominant cause of LBW in developed countries is preterm birth، whereas in developing countries، the cause is more often IUGR. Although IUGR does not appear to further increase the risk of mortality in preterm infants، both morbidity and mortality are increased in term growth-restricted infants. Infants weghing less than 1500 g are most often premature (<37 weeks of gestation)، although IUGR may also complicate the early delivery. Eventhough very low birth weight occurs in only 1-2% of all infants، these births represent a large proportion of the neonatal and infant mortality and infants with both short- and long-term complications، including neurodevelopmental handicaps. At school age، VLBW infants have poorer physical growth، cognitive function، and school performance. These disadvantages appear to persist into adulthood and therefore have broad implications for society. A number of well-designed clinical research studies have demonstrated a powerful interaction between biological and environmental risk and protective factors within the infant and the environment.