Journal of Comprehensive Pediatrics
Volume:8 Issue: 2, May 2017

In the diagnostic evaluation of urinary tract infection (UTI) in children, dipstick urinalysis and urine microscopy/culture are the initial steps. Although these investigations are not without their drawbacks, urine culture remains the gold standard. Biomarkers may also be used as diagnostic tools, predictors of complications, and renal parenchymal injury. This paper aims to review the studies reporting the utility of biomarkers in the diagnosis and prognostication of UTI. Using the key words- ‘urinary tract infection’, ‘children’, and ‘biomarkers’- the PubMed database was searched for systematic reviews/meta-analyses and original studies, which were published within the past 25 years. Information was also gathered from relevant textbooks published within the same period. Serum procalcitonin, urine/serum interleukin 6 (IL-6) and 8 (IL-8), as well as urine neutrophil gelatinase-associated lipocalin (NGAL) are the major biomarkers of febrile UTI. In addition, procalcitonin and these cytokines are reported to be early predictors of vesico-ureteric reflux (VUR) and renal parenchymal injury, while procalcitonin and IL-6 can also help to differentiate between lower UTI and upper UTI (pyelonephritis). Despite the wide range in the sensitivity and specificity of these biomarkers reported in the reviewed studies, the values are still acceptable. Some of these biomarkers may, in the future, obviate the need for invasive radiological tests, although their utility still require validation by further research. However, given the ability of imaging studies to detect structural abnormalities of the urinary tract, their use still remains relevant in the investigation of UTI despite the radiation risks associated with majority of them.

Circumcision is the most common surgical procedure throughout the world today and is usually performed in children for medical, cultural, or religious reasons. In most countries, nonsurgeons or traditional circumcisers perform this procedure, however, there is still a debate regarding the proper age of circumcision.

To determine the best and appropriate time for circumcision, we compared the late complications of this procedure between patients who are circumcised in different age groups.

This is a retrospective and descriptive study that was performed on patients who were referred for late circumcision complications. The patients were divided according to the age range of circumcision as well as the performed age, which were divided into 4 groups (neonate, infant, child, and adolescent) by the author, during the period of May 2010 to December 2013 at an urology clinic. All late complications that were obtained were analyzed and compared between these groups.

Overall, 120 cases of patients were enrolled. The mean age of neonates, infants, children, and adolescent were 14 ± 2.5 days, 4 ± 1.5 months, 6 ± 0.5 years, and 14 ± 1.8 years, respectively. All of them have been circumcised by the classic method. The most common complication (15 patients) was meatal stenosis (12.5%) and was more prevalent in neonates 8 (29.62%).

The ratio of late complications of circumcision is significantly higher in neonates and infants as compared to children as well as adolescents. The results of this study showed that for prevention of developing postoperative complications, the appropriate age of circumcision is to be a child as well as adolescent. For prevention of debilitating and prolonged complications, it should only be performed in medical institutions by suitably trained surgeons.

According to the American academy of pediatrics, there is a high correlation between the length of exclusive breastfeeding and increased benefits of mothers and preterm infants. Evidence shows that breastfeeding support programs are effective in prolonging the lactation period, but the effect of these programs on the length of exclusive breastfeeding is not clear.
The present study aimed at evaluating the effect of education on exclusive breastfeeding continuation in mothers with late- preterm infants.
In this randomized experimental study, 124 mothers of hospitalized late- preterm infants at Fatemiyeh hospital (Hamedan, Iran) were randomly assigned into 2 groups (intervention or control). The data collection instruments included a demographic questionnaire, BASNEF, and checklist for lactation visits, which were required to be completed by mothers in both groups. Moreover, weight gain in infants was measured by researchers before the treatment, and then once a month for a period of 2 months. For mothers in the intervention group, 5 sessions of breastfeeding education on BASNEF model was held during 5 consecutive days. Analyses were conducted using the SPSS 21.0; and a P value less than 0.05 was considered significant.
Based on the results at the end of the first- and second- month follow-up, there were statistically significant differences between the intervention and control groups in lactation performance, knowledge, attitude, subjective norm, assessment of results, and enabling factors of the mothers (P The results of this study revealed that breastfeeding instructional sessions were effective in encouraging mothers to continue exclusive breastfeeding the infants by breast milk; thus, it is suggested to encourage mothers to breastfeed based on the BASNEF model.

Neurogenic bladder is a term referred to many urinary conditions in persons with uncontrolled state of bladder due to brain, spinal cord, or nerve disorder. Children with congenital anomalies of the spinal cord, such as spina bifida, may also have neurogenic bladder.
The study aimed to find a possible link between neurogenic bladder and prenatal risk factors.
In this case-control study, 60 infants with neurogenic bladder and 60 infants without neurogenic bladder, who referred to the Amir-Kabir hospital, were evaluated. Both groups completed preset questionnaires. Maternal information was assessed, and statistical analysis was done by SPSS version 19
The results showed that male gender, maternal age > 35 years, family history of kidney disease, low education level of parents, low family income, low birth weight (LBW), smoke exposure, chronic hypertension in mothers, gestational hypertension, chronic diabetes mellitus in mothers, gestational diabetes mellitus, maternal BMI The data suggest that prenatal factors may affect the risk of neurogenic bladder. Adequate prenatal care and good maternal support can be effective in the prevention of neurogenic bladder.

Asthma is one of the chronic diseases that could affect quality of life (QOL). Therefore, one of the goals of healthcare interventions for this disease is improving the QOL. The current study aimed at determining the effect of the Orem self-care model on QOL in adolescents with asthma.
The current prospective study assigned 64 adolescents with asthma referring to Shariati Hospital into 2 groups of control and intervention by the simple random sampling method. Then, the Orem-based training was implemented through 8 sessions of 2 hours and the asthma QOL questionnaire was presented to both groups prior to and 2 months after completion of the training. The data were analyzed by descriptive and analytical statistics consisting of the paired and independent t tests with SPSS version 20.
There was a significant change in the mean score of different QOL dimensions before and after the training in the intervention group by respiratory status (P = 0.001), mood functioning (P = 0.03), social functioning (P = 0.005), physical activity (P = 0.006), and general understanding of health (P = 0.004), but there was no significant difference in the mean score of different QOL dimensions before and after the training in the control group (P > 0.05).
Based on the contribution of the Orem self-care model to increase QOL in the adolescents with asthma, it seems better to use this model as a healthcare intervention to improve asthma control and patient adherence.

Leptin is a pro-inflammatory cytokine produced by adipose tissue. Considering the association between obesity and asthma, the current study aimed at investigating if leptin was in the pathway of obesity-asthma relationship in children and if it played a distinctive role in children with asthma and obesity versus the ones with obesity but without asthma.
The current case-control study was conducted on 23 children with asthma and obesity and 13 children with obesity but without asthma (body mass index ≥ 95%) aged 6 to 15 years from October 2011 to October 2012 in Mofid Children’s Hospital, Tehran, Iran. Group 1 included 23 children with asthma and obesity with a mean BMI of 24.3 kg/m2, while group 2, included 13 cases with obesity but without asthma and a mean BMI of 26.6 kg/m2. Both groups were evaluated for their serum leptin, triglyceride, cholesterol, and IgE mean levels. The serum leptin levels were measured by the enzyme-linked immunosorbent assay (ELISA) technique. The results were analyzed with SPSS version 19. The Mann-Whitney test was employed to compare the results.
The mean serum leptin level in the children with asthma and obesity was 2.19 ng/mL and in the ones with obesity but without asthma was 2.85 ng/mL (P = 0.006). The mean serum triglyceride and cholesterol levels in the group 1 were 175.4 mg/dL and 189 mg/dL, respectively, while in the group 2 were 175.4 mg/dL and 226.2 mg/dL, respectively. A significant difference was observed in serum leptin levels between the children in groups 1 and 2 (P = 0.006), but surprisingly the increased leptin was detected in the group 2 subjects.
The current study findings indicated that serum levels of leptin were significantly higher in the cases with obesity but without asthma. Therefore, other cytokines appeared to play a role in the children with asthma and obesity.

Apnea denotes temporary cessation of breathing. It is an ominous symptom in children beyond neonatal period. Central apnea results from a lack of respiratory effort due to either a cessation of output from the brainstem respiratory centers or the inability of the efferent nerves and respiratory muscles to receive or process the signals from the brain. This can be due to the immaturity of the system as seen in premature infants or secondary to different disease processes.
A 13-month-old girl child presented with frequent apneic spells following a major neurosurgical intervention for occipital encephalocele. Marked improvement was seen after the institution of caffeine citrate therapy resulting in complete resolution of apnea along with appreciable growth and development.
Recurrent apnea is a potential complication in infants following the repair of occipital encephalocele. Caffeine citrate may be effective in central apnea beyond the neonatal period especially in the treatment of apnea related to neurosurgical procedures.