Journal of Comprehensive Pediatrics
Volume:6 Issue: 4, Nov 2015

Visual problems in children contribute to learning disorders, which are one of the most influential factors in learning.. The aim of the present study was to determine the prevalence of refractive and binocular vision errors in children with learning disorders..Patients and In this cross-sectional study, 406 children with learning disorders with a mean age of 8.56 ± 2.4 years were evaluated. Examinations included the determination of refractive errors with an auto-refractometer and static retinoscopy, measurement of visual acuity with a Snellen chart, evaluation of ocular deviation, and measurement of stereopsis, amplitude of accommodation, and near point of convergence.. Of the 406 participants, 319 (78.6%) were emmetropic in the right eye, 14.5% had myopia, and 6.9% had hyperopia according to cycloplegic refraction. Astigmatism was detected in 75 (18.5%) children. In our study, 89.9% of the children had no deviation, 1.0% had esophoria, and 6.4% had exophoria. In addition, 2.2% of the children had suppression. The near point of convergence ranged from 3 to 18 cm, with a mean of 10.12 ± 3.274 cm. Moreover, 98.5 and 98.0% of the participants achieved complete vision with the best correction in the right and left eye, respectively. The best corrected visual acuity in the right and left eye was achieved in 98.5 and 98.0% of the children, respectively.. The pattern of visual impairment in learning-impaired children is not much different from that in normal children; however, because these children may not be able to express themselves clearly, lack of correct diagnosis and appropriate treatment has resulted in a marked defect in recognizing visual disorders in these children. Therefore, gaining knowledge of the prevalence of refractive errors in children with learning disorders can be considered the first step in their treatment..

The neonatal mortality rate is one of the most important indicators of health promotion. However, undoubtedly, the first step to decreasing this indicator is to identify the factors affecting neonatal mortality.. This study was designed and implemented in order to identify other factors, such as time and day of birth, personnel shift, and work experience, and their relationship with neonatal mortality..Patients and In this retrospective, cross-sectional study, the medical records of all deceased neonates hospitalized in Fatemieh hospital of Hamadan, during a 5-year period (2006 – 2011) were extracted. A questionnaire including sex, weight, gestational age, time of birth, delivery mode, maternal disease, and leading cause of death was filled out. The information was then analyzed using SPSS 19.. In this study, 974 neonatal deaths were registered, among which 57.2% were male. The mean birth weight of neonates was 1.548 g (ranging from 300 – 4.800), and the mean gestational age was 31.2 weeks. The leading causes of death were respiratory distress syndrome (49.6%), septicemia (26.2%), and disseminated intravascular coagulation (4.9%). In terms of the time of death, 63.1% had died during night shifts. The mean length of stay from birth to death was 3.1 and 2.3 days for morning and night shifts, respectively. In terms of the average work experience, the morning shift nursing personnel (seven individuals/shift) had 8.3 years of experience, while the night shift nursing personnel had 4.1 years of experience (five individuals/shift).. The mortality rate is higher in neonates born during night shifts and weekends. This is because, in addition to known factors affecting the mortality rate, human factors, such as taking advantage of fewer personnel with less work experience during night shifts, can increase the neonatal mortality rate.

Down syndrome (DS) is the most common chromosomal abnormality in newborns and is associated with other congenital malformations and health problems. The features of Down syndrome differ according to ethnicity and geographic region.. The main aim was to assess the clinical characteristics of DS patients in a referral pediatric cardiology department..Patients and In this cross-sectional study, we assessed the clinical characteristics of children with Down syndrome and heart defects in an educational hospital over 11 years (from September 2001 to September 2012) in Iran. All data were collected according to a checklist created by the researchers, which included the clinical information, genetic characteristics, cardiac and non-cardiac co-existing diseases, and parental variables of the children. An independent t-test and a chi-square test were used to compare qualitative variables such as birth weight and age of diagnosis. P < 0.05 was considered statistically significant.. 100 patients with Down syndrome and congenital heart disease were evaluated; 52 were female (52%) and 48 were male (48%). The average birth weight of the subjects was 2745 ± 523 (mean ± SD) grams. The mean age of the patients’ mothers was 32 ± 6 years, and the mean age of the patients’ fathers was 36 ± 6 years. Chromosomal analysis was performed for 61 patients, 60 of whom had free trisomy (98.4%), one of whom had translocation (1.6%), and none of whom had a mosaic pattern of chromosomal abnormality. The parents of 33 the patients in this study were consanguineous. All patients had cardiac disorders, but non-cardiac disorder also was recorded in 37 patients (37%). The most common non-cardiac disorder in patients was hypothyroidism, and the second most common was gastrointestinal problems.. Parents were blood relatives in 33 (33%) of the patient cases, which is a very high rate. Therefore, non-random mating is an important issue in developing countries that needs more attention.

Preterm and very low birth weight (VLBW) infants are at great risk of hyperbilirubinemia and bilirubin-associated brain damage.. The aim of this study was to compare the efficacy of prophylactic versus therapeutic phototherapy in VLBW infants..Patients and Fifty VLBW infants were randomly assigned to receive either phototherapy from the first day of life regardless of their serum bilirubin level for up to five days (prophylactic group) or phototherapy when their bilirubin level reached half the exchange transfusion level (therapeutic group). All data, including gestational age, gender, birth weight, serum bilirubin level on the first day, peak serum bilirubin concentration, the age at which the peak serum bilirubin level was reached, duration of phototherapy, and the number of exchange transfusions, were studied and analyzed.. The mean bilirubin level on the first day in both groups exhibited no significant difference. The peak serum bilirubin was 7.7 ± 1.4 and 8.5 ± 2.1 mg/dL in the prophylactic and therapeutic group, respectively, and there was no significant difference in the age at which the peak serum bilirubin levels were reached in both groups (2.4 ± 1.2 vs. 2.1 ± 1 days in the prophylactic and the therapeutic group, respectively). The mean duration of phototherapy in the prophylactic group was 84 ± 43 hours, while for the therapeutic group it was 72 ± 39 hours, and hence the difference was not significant. The need for an exchange transfusion was lower in the prophylactic group compared to the therapeutic group (33% vs. 7%), although the difference was not statistically meaningful (P < 0.112).. According to our study, phototherapy should not be used as prophylactic therapy for all VLBW infants, but rather it should be individualized in order to maintain low bilirubin levels..

Stimulants are first-line agents for the treatment of attention-deficit/hyperactivity disorder (ADHD). Despite the impressive track record of stimulants in the treatment of ADHD, they fail in 25% of patients due to lack of efficacy or the emergence of unwanted side effects.. In this study, we investigated the efficacy and safety of duloxetine, a serotonin and norepinephrine reuptake inhibitor, in the treatment of children with attention-deficit hyperactivity disorder (ADHD)..Patients and In an open label clinical trial, 13 children aged 6 – 11 years diagnosed with ADHD were prescribed 30 mg/day duloxetine once daily by oral administration for six weeks. Conners Parent Rating Scale-Revised-Short form (CPRS-R-S) and the ADHD Rating Scale were used to assess the efficacy of the treatment.. Ten children with a mean age of 8.40 ± 1.67 years terminated the trial. A significant reduction in CPRS-R and its subscales was evident from week four of the study. In terms of side effects, duloxetine was generally safe and well tolerated.. This preliminary assessment suggests that duloxetine may be a medication of interest in the treatment of children with ADHD. Further controlled studies with larger samples are required to evaluate the efficacy of duloxetine in treatment of children with ADHD..

Although asymptomatic hypophosphatemia is a common finding in diabetic ketoacidosis (DKA), severe symptomatic hypophosphatemia is an uncommon complication.. We report a 16-year-old female child with DKA, who developed thrombocytopenia, rhabdomyolysis, muscle weakness, and acute renal failure due to severe hypophosphatemia. She was managed with intravenous fluids, insulin infusion, phosphate therapy, and dialysis. After two weeks of hospitalization, the patient was discharged home with no squeal.. In critically ill patients, the symptoms of hypophosphatemia may not be apparent, but clinicians should be vigilant about this complication during therapy. In cases of severe symptoms (e.g., cardiopulmonary distress, anemia and thrombocytopenia, or rhabdomyolysis), phosphate therapy under close surveillance is warranted.

The use of topical corticosteroids in children and adults, especially in covered areas and for a prolonged duration, may result in Cushing’s syndrome and suppression of the hypothalamic-pituitary-adrenal axis.. The present report describes the cases of three children and a 25-year-old man who presented with clinical features of Cushing’s syndrome and adrenal insufficiency following prolonged use of clobetasol cream. Two of the children continued with hypertension even after discontinuation of clobetasol, and were treated with angiotensin-converting enzyme inhibitors. One of these two children had developed acute renal failure, hypertensive encephalopathy, and permanent visual loss prior to admission.. Whenever a cushingoid appearance is accompanied by adrenal insufficiency, the exogenous use of steroids, especially topical creams, should be explored. Hypertension may persist even after cessation of use and may result in life threatening complications..

Infective endocarditis (IE) causes serious complications in patients. Congenital heart disease (CHD) is an important underlying condition in children. Septic pulmonary embolism is an uncommon syndrome, and pulmonary valve IE is rare. The current study presented a case of right-sided IE with pulmonary valve involvement and its complications as pulmonary septic emboli in a child with CHD.. A 6-year-old girl with a ventricular septal defect (VSD) was presented. Echocardiography revealed large vegetation in the right ventricular outflow tract near the pulmonary valve. The patient showed clinical symptoms of lung involvement, and radiologic investigation was compatible with a diagnosis of septic pulmonary emboli. She had good response to antibacterial therapy and underwent a successful surgical closure of the heart defect.. Children with CHD are at risk of severe complications with the involvement of other organs. long-term febrile illness should be taken seriously in these children. They need hospitalization and careful evaluation..