Caspian Journal of Pediatrics
Volume:1 Issue: 1, Mar 2015

Neonatal jaundice is a common problem that can result in serious neurological side effect such as Kern icterus. Several drugs are used to prevent neonatal jaundice. The effect of clofibrate in the prevention of hyperbilirubi-nemia in healthy term neonates has not been paid attention to. This study aimed to evaluate the preventive effect of clofibrate on neonatal jaundice in term neonates. This clinical trial was conducted on 80 healthy newborns randomly divided in to cases and control groups. The case group received clofibrate (50 mg/kg of body weight) orally in the first hour after birth and after the first period of breastfeeding. Serum bilirubin levels were measured in cord blood and again at 24, 48 and 72 hours after birth in both groups and were compared. Babies with clear jaundice on the first day, direct neonatal jaundice>1 mg/dl, sick infants, and infants of mothers treated with phenobarbital and preterm infants weighing less than 2500 gr were excluded. The mean bilirubin level in cord blood and its level at 24, 48 and 72 hours after birth in control groups were 1.99±0.46, 2.88±0.88, 5.94±1.15, 7.65±1.69, respectively and in the case group were 2.12±0.75, 2.89±0.95, 5.8±1.16, 7.18±1.57, respectively. Thus, the mean bilirubin in the case group is lower, but it was not statistically significant. Also, sex distribution, Rh-blood group incompatibility and G6PD deficiency in both groups showed no significant difference. Our results showed that prophylactic clofibrate application reduced neonatal hyperbilirubinemia, but wasn’t statistically significant.

Due to difficulty of obtaining a 24h urine (especially in children), a random urine calcium sample is recommended to detect of hypercalciuria. However, recent studies have shown that the urinary calcium/creatinine ratio varies with age and geographic areas. So, the aim of this study was determining the normal value of urinary calcium to creatinine ratio in healthy adolescent’s children. Four hundred eight children of 12 to 14-year-old were randomly selected from middle school in Babol (north of Iran) and early morning urinary samples of them were studied for determining normal urine Ca/Cr, Na/Cr and K/Cr ratios. Children who had the family with the history of renal disease were excluded from this study. In this study the 50% and 95% of urinary Ca/Cr ratio were 0.08±0.02 and 0.13 mg/mg for the whole group. The mean of urinary Ca/Cr ratio in boys and girls were 0.08±0.03 and 0.08±0.02, respectively. The mean of urinary Na/Cr ratio in boys was 1.4±0.48 and in girls was 1.21±0.33. Also, the mean of urinary K/Cr ratio in boys and girls were 0.30±0.11 and 0.29±0.10, respectively. This study was shown that the urinary Ca/Cr ratio of these children is different from other geographic areas. Also, a direct relationship was seen between urinary Ca/Cr ratio, Na/Cr and k/Cr ratios.

Functional Constipation (FC) is one of the important digestive disorders in pediatrics. Its prevalence varies in different communities. The purpose of this study was to determine the prevalence of FC in our area between the school children and the impact of school on it. This study was done on 4 to 12 years old children of nine schools and kindergartens of Amirkola, (2007). After completing the constipation questionnaires by parents and children, all constipated children referred to gastroenterologist to confirm the diagnosis of functional constipation. All children were followed in summer when they didn’t go to school and in next year-the winter of 2009. Age, sex, the incidence of constipation in the school time and the summer holiday, health status of the toilets in school and the age of children were recorded when they learned to clean themselves. Of all 493 studied cases the prevalence of FC was 21.3% (105 cases). There was no significant difference between the genders (p=0.913). All 99 constipated cases were reevaluated for constipation in summer and only 25 (18 boys and 7girls) of them were constipate. In the next school year the number of constipated case reaches to 90 cases again that there was significant relation between constipation and school months (p<0.01). The prevalence of FC in children was significantly high and school attendance had a great impact on it. We advise that the awareness of school officials and parents can reduce the prevalence of FC.

Non-alcoholic fatty liver disease (NAFLD) is increasingly a common disease which is created by the accumulation of fat in the liver. About 20% of adults and 5% of children suffer from this disease. In some studies, half of obese children had fatty liver disease and approximately 90% of the patients with fatty liver were obese. The aim of this study was to evaluate fatty liver disease in obese children referred to the pediatric clinic in Kashan, Iran, in 2012. This study was done on 200 children aged 5-15 years with Body Mass Index (BMI) more than 95% and other causes of obesity were ruled out. Liver ultrasonography for evaluation of fatty liver and blood sampling were performed for these children. Of 200 studied children, 122 (61%) and 78 (39%) were male and female, respectively with mean age of 9.07 years. The average of BMI was 27.9. According to liver sonography, 118 (59%) patients had fatty liver that 91.5% of them were grade I and 8.5% grade II. Liver enzyme levels, serum lipids and uric acid were significantly higher in obese children with fatty liver. Fatty liver had a significant relationship with insulin levels but no with Fasting Blood Sugar (FBS). In this study, the prevalence of fatty liver and associated disorder in obese children was high (59%). Therefore, the lifestyle changes are necessary to prevent childhood obesity and some measures should be carried out for the treatment of fatty liver in children.

The most common congenital abnormality of esophagus is esophageal atresia (EA) that can occur with or without tracheoesophageal fistula. Other associated anomalies are the leading cause of death in these patients. The present study aimed to evaluate the main complication, outcomes and cause of death in neonate with EA repaired in Amirkola Children’s Hospital (ACH), Iran within a 13 years period. This cross sectional study was done on infants that underwent surgical repair for EA in Amirkola Children’s Hospital during 1994-2007. All information such as demographic, birth weight, type of atresia, associated anomaly, complication of surgery, duration of hospital stay and cause of death were obtained from patient medical records. Of all 37 studies cases with the mean gestational age (±SD) 37.2±1.7 weeks and the mean birth weight 2601±504 gram, 3 cases were preterm. The most frequent type was EA with lower segment fistula to trachea. In 37.8% cases there was an associated anomaly that the cardiac anomalies were more common. Surgical complication was seen in 59.5% of cases and 11 of them died in hospital that 63% of them had associated anomaly. Association of other congenital anomalies plays an important role in the survival of patients.

Neonates are highly vulnerable to drug toxicities because of their age-related limitations in drug metabolisms and renal excretion. Lack of the knowledge and/or education for medical professionals about the right dose administration and the lack of neonate-specific formulations are the additional dilemmas. Cases Presentation: Here, we reported six neonates presented with severe drug toxicities, including acetaminophen, digoxin, theophyllin, lidocaine and opium and they were successfully treated in NICU at Amirkola Children’s Hospital, Babol– in the north of Iran. Most of the toxicities were originated from the lack knowledge of physician or parents for selecting the right drug and dose of drug for newborn babies. Better education of medical professional and parents are needed to avoid neonatal drug toxicities.

Arterial tortuosity syndrome (ATS), an autosomal recessive rare connective tissue disorder characterized by tortuosity, elongation and stenosis in the large and medium sized arteries. It manifestations include vascular and nonvascular connective tissue related symptoms. In this literature we describe the first cases of ATS from Iran.Case report: A six-months-old female was presented with a heart murmur in the right upper sternal edge that was followed up for diaphragmatic hernia repair. Positive sign include right axis deviation in electrocardiography (ECG), abnormal long and tortuous aortic arch with tortuosity of its branches in angiography, increased right ventricular pressure up to 60 mmHg and slight right ventricular hypertrophy with severe stenosis of pulmonary artery bifurcation. ATS does not present with a unique set of clinical features and its manifestations depend on the mutation type. The most common presentation is tortuous artery and more report of this rare case can help to better diagnosis of ATS.

Cloacal malformation is an extremely rare fetal pathological condition but an important anomaly that presents as a variety of defects. It predominantly affects females, with prevalence of 1 in 50,000 births.Prenatal ultrasonography usually showed oligohydramnios and the fetus having a large cystic mass in the lower abdomen with a single septum, bilateral hydronephrosis, ambiguous genitalia and a single umbilical artery. Postnatal finding including ambiguous genitalia and rectal atresia with a single perineal opening. Case report: The purpose of this case series was to illustrate characteristic prenatal sonographic features of cloacal malformation by using imaging from 3 cases seen in all academic centers to augment published data. The imaging feature common to all cases was a central cystic pelvic mass containing a characteristic fluid-fluid level. The children were followed at regular intervals by an urologist, surgeon and nephrologist throughout life. Medical teams were committed to providing long-term care for children with cloacal anomalies.