فهرست مطالب

Pediatrics - Volume:26 Issue: 1, 2016
  • Volume:26 Issue: 1, 2016
  • تاریخ انتشار: 1395/01/22
  • تعداد عناوین: 14
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  • Soichiro Kitamura Page 1
    Pediatric coronary artery bypass surgery gained wide acceptance with the introduction of internal thoracic arteries (ITAs) for bypass operations for post Kawasaki disease (KD) lesions. The technique is now established as the standard surgical choice, and its safety even in infancy, graft patency, growth potential, graft longevity and clinical efficacy have been well documented. In this article the author reviews the development of pediatric coronary bypass as the main indication for the treatment of coronary lesions due to KD. I believe that coronary revascularization surgery in pediatric population utilizing uni- or bilateral ITAs is the current gold-standard as the most reliable treatment, although percutaneous coronary intervention with or without a stent has been tried with vague long-term results in children.
    Keywords: Coronary Bypass, Pediatrics, Kawasaki Disease, ITA (Internal Thoracic Artery), Saphenous Vein Graft, Graft Patency, Long, Term Survival, Cardiac Events
  • Nushaba F. Panakhova* Page 2
    Background
    Infants with fetal growth retardation (FGR) are prone to intestinal disorders.
    Objectives
    Aim of the study was to determine the role of mucosal defense ability in formation of gut injury in infants with FGR.
    Materials And Methods
    44 premature infants who were admitted to the Neonatal Intensive Care Unit were divided into two groups: 20 infants with FGR (FGR group) and 24 appropriate-for-gestational age newborns (AGA group). Control group consisted of 22 premature infants who were delivered after uncomplicated pregnancy. Gut barrier function was evaluated by detecting serum intestinal trefoil factor (ITF) and intestinal fatty acid binding protein (IFABP). The level of serum IFABP and ITF was measured by using ELISA method.
    Results
    FGR group showed significantly higher ITF concentration than AGA group on the first days of life (P 0.01). High level of ITF in the FGR group significantly declines up to 7th - 10th day of life (P 0.01). This reduction was accompanied by increase of IFABP which is a marker of ischemic intestinal mucosal injury. Correlation analyses showed that ITF had a negative correlation with IFABP.
    Conclusions
    Infants with fetal growth retardation are characterized by a high level of ITF on the first days of life. This protects intestinal mucosa under hypoxic conditions. Its subsequent decline accompanied by an increase of IFABP reflects the depletion of Goblet cells to secret ITF causing damage to the integrity of intestinal mucosal barrier.
    Keywords: Perinatal Hypoxia, Fetal Growth Restriction, Intestinal Barrier, Mucosal Injury
  • Leily Mohajerzadeh*, Alireza Mirshemirani, Mohsen Rouzrokh, Naser Sadeghian, Ahmad Khaleghnejad, Tabari, Alireza Mahdavi, Sareh Poorhasan Page 3
    Background
    Hypospadias is one of the most common congenital genital anomalies in males that necessitates to be operated early in infancy (when 6 to 9 months old). On the other hand, hypospadias is a challenging field of pediatric urology with multiple reconstruction techniques. A perfect hypospadias repair is supposed to return urethral continuity with sufficient caliber, eradicate phallus curvature, and supply an acceptable appearance with low complications.
    Objectives
    This study aimed to evaluate the outcomes of using onlay island flap technique in the repair of hypospadias with shallow urethral plate.
    Patients and
    Methods
    In this prospective study within June 2012 to December 2013, we performed onlay island flap procedure to repair hypospadias with shallow urethral plate measuring less than 6 millimeter. This technique was selected for all types of hypospadiasis except subcoronal type. Nesbit’s dorsal plication procedure was established for chordee. In cases with very small glans, urethroplasty was performed without glansplasty.
    Results
    Twenty three patients with mean age of 30 (range 10 - 60) months underwent onlay island flap repair; all had a shallow urethral plate
    Conclusions
    This technique offers acceptable results regarding meatal stenosis, urethrocutaneous fistula and esthetic outcome.
    Keywords: Onlay Island Flap, Hypospadias, Urethroplasty
  • Ilker Ertugrul *, Selman Kesici, Benan Bayrakci, Omer Faruk Unal Page 4
    Background
    Tracheostomy was first observed in Egyptian drawings in 3600 BC and performed frequently during the 1800’s diphtheria epidemic.
    Objectives
    The aim of this study was to elucidate the indications, complications, mortality rate, and the effect of pediatric tracheostomy on length of PICU or hospital stay.
    Materials And Methods
    Demographic characteristics, diagnosis at admission, duration of ventilation of 152 patients were analyzed retrospectively.
    Results
    The most common tracheostomy indication was prolonged intubation. The mean duration of mechanical ventilation before tracheostomy was 23.8 days. Forty five percent of the tracheostomy procedures were performed at bedside. Neither the place nor the age had any effect on the development of complications (P = 0.701, P = 0.622). The procedure enabled 62% of the patients to be discharged from hospital.
    Conclusions
    Tracheostomy facilitates discharge and weaning of mechanical ventilation. Although the timing of tracheostomy has to be determined for each individual patient, three weeks of ventilation seems to be a suitable period for tracheostomy. Tracheostomy can be performed at bedside safely but patient selection should be made carefully.
    Keywords: Pediatric, Intensive Care Unit, Tracheostomy, Complications, Timing
  • Mohammad Golshantafti, Tahereh Yavari, Mohammadhosain Afrand* Page 5
    Background
    The most common reason of respiratory distress in the newborn is transient tachypnea of the newborn (TTN). There are some reports saying that TTN is associated with increased frequencies of wheezing attacks.
    Objectives
    The aims of this study were to determine the risk factors associated with TTN and to determine the association between TTN and the development of wheezing syndromes in early life.
    Materials And Methods
    In a historical cohort study, we recorded the characteristics of 70 infants born at the Shohadaye Kargar Hospital in Yazd between March 2005 and March 2009 and who were hospitalized because of TTN in the neonatal intensive-care unit. We called their parents at least four years after the infants were discharged from the hospital and asked about any wheezing attacks. Seventy other infants with no health problems during the newborn period were included in the study as the control group.
    Results
    The rate of wheezing attacks in newborns with TTN was more than patients with no TTN diagnosis (P = 0.014). TTN was found to be an independent risk factor for later wheezing attacks (relative risk [RR] = 2.8).
    Conclusions
    The most obvious finding of this study was that TTN was an independent risk factor for wheezing attacks. So long-term medical care is suggested for these patients who may be at risk, because TTN may not be as transient as has been previously thought.
    Keywords: Asthma, Transient Tachypnea of the Newborn (TTN), Wheezing Attack
  • Hatem Hamed Elshorbagy*, Elsaeed R. Fouda, Naglaa M. Kamal, Mohammed M. Bassiouny, Waleed M. Fathi Page 6
    Background
    Epicardial fat has a role in cardiovascular diseases.
    Objectives
    To assess epicardial fat and its relation with carotid intima-media thickness (IMT) in obese adolescents with metabolic syndrome (MetS).
    Patients and
    Methods
    The study included 60 obese adolescents and 25 control subjects. According to the presence or absence of MetS, obese subjects were divided into two subgroups. We measured weight, height, calculated Body Mass Index, waist circumference, hip circumference, systolic blood pressure, diastolic blood pressure and biochemical parameters (fasting glucose, total cholesterol, triglycerides, high density lipoprotein cholesterol, and low density lipoprotein cholesterol, High sensitivity C-reactive protein, fasting insulin, a homeostasis model assessment index of insulin resistance. plus an echocardiographic examination with measurement of epicardial adipose tissue thickness (EATT).
    Results
    Left ventricular mass index measurements were significantly higher in MetS group than both non-MS and control groups. The MetS and non-MetS obese patients had significantly higher carotid IMT in comparison to the control group. Carotid IMT measurements were significantly higher in MetS group had than both non-MetS and control groups. Also, EATT was significantly increased in patients with MetS compared to control group. Among MetS obese group, EATT was positively correlated with body mass index-standard deviation score, waist circumference, fasting glucose, fasting insulin, insulin resistance, triglyceride levels, left ventricular thickness, left ventricular mass index and myocardial performance index. EATT was found to be the only predictor of carotid IMT.
    Conclusions
    EATT is closely related to carotid IMT and early cardiac dysfunction in obese adolescents with MetS.
    Keywords: Metabolic Syndrome, Epicardial Adipose Tissue Thickness, Echocardiography
  • Ayten Ozmen, Semiha Terlemez*, Fatma Sedef Tunaoglu, Sebnem Soysal, Ayhan Pektas, Erman Cilsal, Ulker Koca, Serdar Kula, Ayse Deniz Oguz Page 7
    Background
    The rate of congenital heart disease is 0.8% in all live births. The majority of this, however, is acyanotic congenital heart disease. The survival rate of children with cardiac disease has increased with the developments provided in recent years and their lifetime is extended.
    Objectives
    This study aims to evaluate neurodevelopment of children with uncomplicated acyanotic congenital heart disease in preschool period and determine the factors affecting their neurodevelopmental process.
    Patients and
    Methods
    132 children with acyanotic congenital heart disease aged 6 - 72 months were involved in the study. Mental development and intelligence levels of patients under 2 years old were assessed by using Bayley Development Scale-III, and Stanford Binet Intelligence test was employed for patients over 2 years old. Denver Developmental Screening Test II was applied to all patients for their personal-social, fine motor, gross motor and language development.
    Results
    The average age of patients (67 girls, 65 boys) included in the study was 35.2 ± 19.6 months. It was determined that there were subnormal mental level in 13 (10%) patients and at least one specific developmental disorder in 33 (25%) patients. Bayley Mental Development Scale score of patients who had received incubator care in perinatal period was found significantly low (88 ± 4.2) compared to those with no incubator care (93.17 ± 8.5) (P = 0.028). Low educational level of father was established to be linked with low mental development scores at the age of 2 and following that age (P
    Conclusions
    Neurodevelopmental problems in children with acyanotic congenital heart disease were found higher compared to those in society. Mental development and intelligence levels of patients were determined to be closely associated with receiving incubator care, father’s educational level and iron deficiency anemia.
    Keywords: Acyanotic Congenital Heart Disease, Psychometric Assessment, Mental Development
  • Mitra, Azra Aldaghi, Seyed, Mohsen Dehghani*, Mahmood Haghighat Page 8
    Background
    Celiac disease is an immune-mediated inflammation of the small intestine caused by sensitivity to dietary gluten in genetically sensitive individuals.
    Objectives
    In this study, we aimed to evaluate the predictive value of tissue transglutaminase (tTG) antibodies for the diagnosis of celiac disease in a pediatric population in order to determine if duodenal biopsy can be avoided.
    Patients and
    Methods
    The subjects were selected among individuals with probable celiac disease, referring to a gastrointestinal clinic. After physical examinations and performing tissue transglutaminase-immunoglobulin A (tTG-IgA) tests, upper endoscopy was performed if serological titer was higher than 18 IU/mL. Therapy started according to pathologic results.
    Results
    The sample size was calculated to be 121 subjects (69 female and 52 male subjects); the average age of subjects was 8.4 years. A significant association was found between serological titer and pathologic results; in other words, subjects with high serological titer had more positive pathologic results for celiac disease, compared to others (P
    Conclusions
    As the results indicated, a single serological test (tTg-IgA test) was not sufficient for avoiding intestinal biopsy.
    Keywords: Celiac Disease, Diagnostic Accuracy, tTG, IgA, Small Bowel Biopsy
  • Kokab Namkin, Mahmood Zardast, Fatemeh Basirinejad* Page 9
    Background
    Helicobacter pylori infects around 50% of the human population and is asymptomatic in 70% of the cases. H. pylori eradication in childhood will not only result in peptic symptoms relief, but will also prevent late-term complications such as cancer. Today, probiotics are being increasingly studied in the treatment of gastrointestinal infections as an alternative or complement to antibiotics.
    Objectives
    In this study we aimed to assess the effect of S. boulardii supplementation on H. pylori eradication among children in our region.
    Patients and
    Methods
    In this randomized double-blind placebo-controlled clinical trial 28 asymptomatic primary school children with a positive H. pylori stool antigen (HpSA) exam were randomly allocated into the study group, receiving Saccharomyces boulardii, and the control group receiving placebo capsules matched by shape and size, for one month. The children were followed up weekly and were reinvestigated four to eight weeks after accomplished treatment by HpSA testing. The significance level was set at P
    Results
    24 children completed the study. The mean HpSA reduced from 0.40 ± 0.32 to 0.21 ± 0.27 in the study group, indicating a significant difference (P = 0.005). However, such difference was not observed in the control group (P = 0.89). Moreover, the HpSA titer showed a 0.019 ± 0.19 decrease in the study group whereas the same value was 0.0048 ± 0.12 for the controls, again stating a significant difference (P = 0.01).
    Conclusions
    Saccharomyces boulardii has a positive effect on reducing the colonization of H. pylori in the human gastrointestinal system but is not capable of its eradication when used as single therapy.
    Keywords: Probiotic, Helicobacter Pylori Stool Antigen, Saccharomyces Boulardii, Helicobacter Pylori
  • Wei Li, Yu-Jie Liu, Xiao-Le Zhao, Shi-Qiang Shang, Lang Wu, Qing Ye, Hui Xu* Page 10
    Background
    The levels of Th1/Th2 cytokine can alter in pathogenic infection in children with pneumonia.
    Objectives
    To evaluate Th1/Th2 cytokine profile and its diagnostic value in M. pneumoniae pneumonia in children.
    Patients and
    Methods
    Children with M. pneumoniae mono-infection and 30 healthy children were tested with cytokines assay. We used real time PCR to detect M. pneumoniae in children with pneumonia.
    Results
    M. pneumoniae test was positive in 2188 (16.62%) out of 13161 pneumonia children. Children aged 5 - 9 years had the highest rate and summer was a season with high rate of M. pneumoniae incidence in Zhejiang province. During the course of study, in 526 pneumonia children with M. pneumoniae mono-infection and 30 healthy children cytokines assay was performed. IL-2 level of M. pneumoniae pneumonia children was lower than that of healthy children (median levels, pg/mL: IL-2: 3.2 vs. 5.7, P = 0.00), while IL-4, IL-10 and IFN-γ were higher than in healthy children (median levels, pg/mL: IL-4: 3.2 vs. 1.5, P = 0.00; IL-10: 5.6 vs. 2.5, P = 0.001; IFN-γ: 20.4 vs. 4.8, P = 0.001).
    Conclusions
    IL-2 decreases and IL-4, IL-10 and IFN-γ increase in children with M. pneumoniae pneumonia, which has a promising prospect in diagnosis of this disease in clinical practice.
    Keywords: Cytokines, Pneumonia, Children, M. pneumoniae
  • Mohammad Esmaeili, Marjan Esmaeili*, Fatemeh Ghane, Ali Alamdaran Page 11
    Background
    Ureteropelvic junction obstruction (UPJO) is one of the most common causes of urinary tract obstruction in children. Several methods are used to diagnose upper urinary tract obstruction including renal ultrasonography (US), intravenous pyelogram (IVP), diuretic renography (DR), magnetic resonance urography (MRU) and antegrade or retrograde pyelography. Nowadays it is suggested to use diuretic renography as the best method for diagnosing of UPJO. There is no comparative study between IVP and DR scan for diagnosis of UPJO in children.
    Objectives
    The aim of the present study was to compare IVP with furosemide injection and diuretic renography in diagnosis of clinically significant UPJO.
    Patients and
    Methods
    This was a cross sectional study performed in 153 UPJO suspected children (121 boys, 32 girls) based on US findings in cases presented with urinary tract infection (UTI), prenatal hydronephrosis, abdominal/flank pain, abdominal mass and hematuria. Renal ultrasound was used as an initial screening tool for detection of urinary tract abnormality. Vesicoureteral reflux (VUR) was ruled out by voiding cystourethrography (VCUG). Serum creatinin, blood urea nitrogen, urinalysis and urine culture was screened in all cases. IVP with furosemide and DR were performed as soon as possible after the mentioned workup.
    Results
    During a five year period, 46 out of 153 patients were diagnosed as UPJO based on diuretic renography: the age ranged from 4 months to 13 years (mean: 3.1 ± 0.78 years). There was a significant higher (76%) proportion of UPJO in the boys and in the left side (78%). The sensitivity of IVP with furosemide injection in diagnosis of UPJO was 91.3% whereas DR was accepted as standard for diagnostic procedure in diagnosis of UPJO.
    Conclusions
    Although DR is accepted as the best method for diagnosis of UPJO, we found a small sensitivity difference between IVP and DR in kidneys with normal or near normal function. In many settings such as small cities lacking facilities for advanced isotope imaging technology, use of IVP with diuretic maybe an acceptable procedure for diagnosis of UPJO.
    Keywords: Ureteropelvic Junction Obstruction, Intravenous Urography, Diuretic Renography, Diruretic Urography, Excretory Urography, Children
  • The Outcome of Infantile Onset Pompe Disease in South of Iran
    Hossein Moravej*, Zohre Karamizadeh, Maryam Paran Page 12
    Background
    Infantile Onset Pompe Disease (IOPD) is a rare autosomal recessive neuromuscular disorder. It is associated with cardiomegaly, hypotonia, paresis, and death in the first year of life. Since 2006, following the use of Alglucosidase alfa as Enzyme Replacement Therapy (ERT), the patients’ survival is improved to a noticeable extent.
    Objectives
    The purpose of this study is to examine the outcome of IOPD patients in South of Iran and the degree of responsiveness to ERT.
    Patients and
    Methods
    All patients who were diagnosed with IOPD on the bases of clinical symptoms, and enzyme assay on dried blood spot, were included in the study; and were followed up regarding cardiac function, locomotor activity, and cognition.
    Results
    Six patients with IOPD were identified. All these six patients suffered from Hypertrophic Cardiomyopathy (HCM). Four (67%) of them also had generalized hypotonia. Three patients expired during the first weeks due to severe respiratory infection. One of them also got involved with Acute Cardiopulmonary Failure while receiving the fifth dose of ERT; and expired. However, the remaining two patients had a significant improvement after the maximum of 117 weeks of following up both cardiac and locomotor findings. These two patients were the same patients who showed cardiac symptoms from the beginning but did not have generalized hypotonia.
    Conclusions
    Although ERT has a significant effect on enhancing the survival of IOPD patients, it should be associated with meticulous heart-respiratory cares during the first months of treatment and preventing infection especially nosocomial infections.
    Keywords: Glycogen Storage Disease Type II, Alpha, Glucosidase, ERT, GAA Protein, Inborn Error of Metabolism
  • Yogesh Mehta*, Charudatta Shitole, Maninder Singh Setia Page 13
    Background
    Neonates and infants with hypomagnesemia present with seizures and psychomotor delay.
    Objectives
    The present study evaluated the changes in magnesium (Mg) levels and factors associated with these in the first three days of life.
    Materials And Methods
    We monitored 50 clinically asymptomatic neonates; they were not given any magnesium supplements even if they had hypomagnesemia at baseline. The variables analysed were: serum Mg; gestational age; birth weight; length; and the ponderal index. We used random effects (RE) models for longitudinal analysis of these data.
    Results
    The mean standard deviation (SD) gestational age was 36.3 (3.6) weeks and the mean (SD) weight was 2604.2 (754.4) grams. About 31% of the neonates had hypomagnesemia (
    Conclusions
    Asymptomatic neonates may have a high prevalence of hypomagnesemia; however, the levels become normal without any magnesium supplementation. Even though regular monitoring of magnesium levels is useful, no supplements are required - particularly in clinically asymptomatic neonates.
    Keywords: Magnesium, Supplementation, Hypomagnesemia
  • Jungwha Choi, Soo Ah Im, Jee Young Kim* Page 14
    Introduction
    Infantile hemangiomas of the airway are diagnosed at bronchoscopy as part of the investigation of stridor or other respiratory symptoms. Here, we present three-dimensional computed tomography (3D-CT)/bronchoscopy findings of submucosal subglottic hemangioma missed at bronchoscopy.
    Case Presentation
    We report on the clinical usefulness of 3D-CT/bronchoscopy as the primary diagnostic tool and follow-up method in the evaluation of suspected airway infantile hemangiomas, especially when the hemangioma is the submucosal type.
    Conclusions
    3D-CT/bronchoscopy will reduce the need for invasive laryngoscopic studies and help to diagnose submucosal hemangiomas undetected on laryngoscope. Additionally, 3D-CT/bronchoscopy will help evaluating the extent of the lesion, degree of airway narrowing, and treatment response.
    Keywords: Hemangioma, Trachea, CT, Bronchoscopy