Journal of Comprehensive Pediatrics
Volume:6 Issue: 3, Aug 2015

Liver abscess developing during hospital stay in pediatric patients on dialysis for acute kidney injury has been previously unreported. Impaired immunity, prolonged use of antibiotics, diabetes and malnutrition predispose to liver abscess in chronic hemodialysis patients.. We reported a case of liver abscess developing in a 6-year-old boy admitted with sepsis and multiorgan dysfunction syndrome including acute kidney injury. He received peritoneal and subsequently hemodialysis, as he did not improve on peritoneal dialysis. He developed fever while on hemodialysis, which was due to a liver abscess developing during the course of hospital stay. The abscess was in the right lobe of the liver with a volume of 40 mL. Staphylococcus aureus is the leading cause of pyogenic liver abscesses in children and infection acquired from hospital. The patient received vancomycin and responded well with complete resolution and did not require any drainage procedure. He may have acquired bacteremia during dialysis with subsequent hepatic seeding. Though rare, liver abscess may develop even in patients undergoing short-term dialysis therapy. Liver abscess is a medical emergency and if not treated promptly may lead to significant mortality. Invasive therapeutic procedures, like drainage is associated with further risk of complications. Therefore, a high index of suspicion should be kept when evaluating a patient who develops unexplained fever while being on hemodialysis. Early medical intervention through appropriate antibiotics can significantly reduce the morbidity and mortality. Strict infection control policies should be followed to prevent such nosocomial infections.

Recombinant activated factor VII (rFVIIa; NovoSeven® RT, Novo Nordisk, Bagsvaerd, Denmark) is a synthetic pro-coagulation factor derived from hamster kidney cells. The purpose of this study was to evaluate the prescribing patterns of recombinant factor VIIa (rFVIIa) at a single, tertiary care pediatric hospital by indication of usage and dose administered. Retrospective data was queried from the centralized pharmacy medication computer system. All patients receiving rFVIIa between September 2009 and September 2012 were included in the analysis. Over the three year period 887 doses of rFVIIa were administered to 186 patients. Only 4% of patients received rFVIIa for an FDA approved indication. The most common indication for off-label usage was refactory bleeding either during or following cardiothoracic surgery, accounting for 83% of all doses administered off-label. Despite being only a small portion of all patients receiving rFVIIa, the group receiving rFVIIa for an FDA approved indication received the majority of doses dispensed (72.6% of all doses). A significant difference (P < 0.0001) was noted in the dose administered to patients in the on-label versus off-label groups. Patients in the on-label group received a median dose of 113.6 mcg/kg (IQR 54.5 mcg/kg - 172.7 mcg/kg) versus a median dose of 74.4 mcg/kg (IQR 20.0 mcg/kg - 128.8 mcg/kg) in the off-label group. Prospective pediatric studies are needed to evaluate rFVIIa efficacy and safety in populations receiving the medication for off-label indications given increasing concerns involving the potential adverse effect profile of the medication as well as to develop evidence based dosing parameters for these indications.

Obesity has a permanent effect on childrens’ health and acts as a major risk factor for chronic diseases. Therefore considering children BMI is a vital parameter at each visit. This study was performed to assess the prevalence of obesity and its determinants in school children of Zahedan in Iran. Zahedan is the capital of Sistan-and-Balouchestan province known to have the highest prevalence of underweight in Iranian children.Patients and This cross-sectional study was performed on 3582 school children, among which 1786 were girls and 1796 boys in 2012. The students aged 6 to 13 years old and selected based on a stratified random method. The body mass index (BMI) was measured for each student and being overweight/obesity was determined based on CDC 2000 definitions. Prevalence proportions were estimated by weighing the sample. The study was performed at primary and guidance schools of Zahedan. Samples were stratified from two geographic regions of Zahedan (Zone 1 and 2). In the sample, 78.9% were under 85th percentile, 11.8% were overweight (85th - 95th percentile) and 9.3% were obese (> 95th percentile). Weighted estimate for the prevalence of obesity/overweight in girls, boys and all 6 - 13 years old students were 16.2%, 18.4% and 17.4%, respectively. Presence of overweight/obesity was related to school type (private to public schools OR = 2.13, 1.80 - 2.52) and increasing age (OR = 1.12, 1.04 - 1.20). A high prevalence of obesity was found in Zahedan students. Concurrent high prevalence of obesity/overweight and underweight demonstrates amplitude of weight problems in school children. There is an urgent need for special health programs to conduct proper diagnosis and management of obesity in Zahedan.

Neonatal mortality is one of the main indicators of health and welfare of population. Prematurity is one of the most important causes of neonatal mortality. We determined mortality rate and its main indicators among premature neonates in our region with the aim of making good decisions to improve public health and reduce neonatal mortality. We aimed to determine mortality rate and its main indicators among premature neonates in our region with the aim of making good decisions to improve public health and reduce neonatal mortality.Patients and Four-hundred and ninety-two consecutive premature neonates hospitalized in neonatal intensive care unit entered this cross-sectional study. The study information was extracted from hospital recorded files. Neonatal death rate was overall 27.4%, which was significantly higher in gestational age subgroup of less than 28 weeks compared with other gestational age subgroups. The most prevalent etiologies of neonatal death were respiratory distress syndrome (73.8%), congenital abnormalities (13.8%) and sepsis (5.4%), respectively. Preeclampsia and history of multiple pregnancies were more prevalent in non-survived neonates. According to multivariable regression modeling, low gestational age, low birth weight, low Apgar scores, need for intensive supports, history of disease in mother, occurrence of pneumothorax, multiple gestation and preeclampsia could all strongly predict occurrence of death in premature infants. Approximately one quarter of premature neonates had early mortality, which can be predicted by low gestational age, low birth weight, low Apgar score, need to intensive supports, postpartum complications, multiple gestation and history of maternal illnesses.

Type 1 diabetes mellitus (T1DM) is one of the most common chronic pediatric conditions, with potentially life-threatening sequels. However, good metabolic control can protect the patients against sequels. The aim of this study was to examine the relationship between awareness of the mothers about this disease on improving diabetic children metabolic control and also, to examine the relationship between socioeconomic situations of families and control of diabetes in this group of patients.Patients and This is a cross-sectional descriptive analytic study on 80 diabetic children and their mothers, who were registered in the diabetes association of Iran, for outpatient control of disease. Diabetes knowledge was measured by Michigan diabetes knowledge test and glycemic control was assessed by glycosylated hemoglobin (HbA1c). To assess the socio-economic status of a diabetic child’s family, educational level, occupational and marital status of parents were asked and the socioeconomic status (SES) was evaluated with Hollingshed four-factor index of SES. Mothers’ mean knowledge score was 17.72, children’s mean HbA1c was 7.77 and mean of SES was 27.89. There was no significant correlation between children’s HbA1c and mother’s SES. Also, there was an inverse linear relationship between mothers’ knowledge score and children’s HbA1c and there was a direct linear relationship between the mothers’ knowledge score and SES. Finally, based on the results obtained in this study, it can be concluded that the awareness of mothers of T1DM children has a good impact on blood sugar control, whereas the SES of families has no direct effect on blood sugar control. Additionally, SES can indirectly impact on the consciousness of mothers and lead to the reduction of HbA1c.