Iranian Journal of Pediatrics
Volume:27 Issue: 5, Oct 2017

One of the benefits of delayed cord clamping is a reduction in the rate of intraventricular hemorrhage. The findings in this regard are controversial and some negative effects of the procedure have been reported.
The purpose of this study was to investigate the effects of delayed cord clamping on intraventricular hemorrhage in preterm infants.
This clinical trial was carried out on 70 preterm neonates delivered via cesarean section. Their gestational age was less than 32 weeks and the birth weight less than 1500 grams. Neonates were randomly assigned to two groups of early cord clamping (less than 10 seconds) or delayed clamping of the umbilical cord (30 - 45 seconds after birth). 3 to 7 days after birth, presence of Intraventricular hemorrhage (IVH) in both groups was checked by ultrasonography (Mindray machine, model m7) and. Rate and severity of IVH was compared between the two groups.
There was no significant difference in mean gestational age, birth weight, gender distribution and medications in both groups of delayed cord clamping and early clamping of the umbilical cord. The incidence of seizures in the early clamping was 8.6% and in the delayed clamping zero (P = 0.239). The incidence rate of IVH and periventricular leukomalacia (PVL) was 11.43% and 5.7%, respectively in the early clamping, while this rate was zero in the delayed clamping group. This difference was not statistically significant in both indicators (P = 0.12 and P = 0.493, respectively).
The results showed that intraventricular hemorrhage in premature neonates with delayed clamping was less prevalent than those with early clamping, and may be used as a reliable method.

Current changing lifestyles of Iranians, especially in childhood, may affect the risk of developing cardiovascular diseases.
The purpose of this study was to determine the effects of endurance, resistance, and combined training on cardiovascular risk factors in male obese children.
Sixty male obese children (age 8 - 12 years, BMI between 30 - 35 kg and Z-score above ) were chosen randomly divided into four groups of exercise training: group I, endurance exercise training (EET); group II, resistance exercise training (RET); group III, combined exercise training (CET); group IV, controls (C). Exercise training programs were performed for eight weeks, 4 sessions per week, with the same intensity and duration in all types of exercise training groups. Blood samples were collected 24 and 48 hours before and after exercise training, respectively. Data were obtained in all groups and analyzed by repeated measurement and one way ANOVA using SPSS software (version 21).
Results indicated that fasting glucose, BMI, TC, TG, LDL, VLDL, TC/HDL, and LDL/HDL ratio decreased significantly and HDL increased in three types of exercise training compared to the control group (P 0.05).
The three types of exercise training, especially endurance training method, decrease the risk factors for occurrence of cardiovascular diseases and health complications related to obesity in inactive male obese children.

The purpose of the study was to investigate the prevalence and associated factors of being in a physical fight in “association of Southeast Asian nations” (ASEAN) member states.
The total sample consisted of 30284 adolescents aged 13 - 15 years from seven ASEAN countries that were included in the cross-sectional “global school-based student health survey” (GSHS) between 2007 and 2013.
The prevalence of “being in a physical fight in the past 12 months” across seven ASEAN countries (excluding Brunei) was 30.1%, ranging from below 15% in Cambodia and Myanmar to more than 30% in Indonesia, Malaysia, Philippines and Thailand. In multivariate logistic regression analysis, sociodemographic factors (younger age, being male, the experience of hunger) and risk behavior (sedentary behavior, ever had sex, tobacco use, alcohol use, truancy, being bullied, and having sustained an injury) were found to be associated with “having been in a physical fight” in the past year. Lack of protective social-familial factors (low peer support and low parental or guardian support) were only associated with physical fighting in bivariate analyses.
A significant proportion of physical fighting was found in ASEAN calling for interventions aimed to prevent physical fighting considering identified associated factors.

The aim of the study was to evaluate the possible relationship of clinical severity during asthmatic exacerbation with the ventricular functions and the levels of vascular endothelial-related biomarkers endothelin-1 (ET-1) and platelet-derived growth factor-BB (PDGF-BB) in the condensed breathing air in the children with asthma.
The study included a total of 80 children with acute asthmatic episode; of these, 28 had a mild, 26 had a moderate, and 26 had a severe attack. Samples of condensed breathing air were obtained for being analyzed for ET-1 and PDGF-BB levels during the study. All patients were evaluated by echocardiography at the beginning of the study and two weeks after the treatment of asthmatic episode.
Before treatment, mPAP in moderate and severe asthma groups was significantly higher than in mild asthma group (21.6 ± 7.3, 30.1 ± 9.8 and 32.7 ± 7.8; P 0.05). Am and Em waves, and IVRT, IVCT, ET and RV MPI during the asthmatic attack and after treatment did not change significantly between the groups; pre- and post-treatment values of these parameters also did not show significant differences. In exhaled air samples of the group with severe asthma exacerbation ET-1 and PDGF-BB were higher than those in the moderate and mild group (0.80 ± 0.42, 0.58 ± 0.30, 0.50 ± 0.15; P = 0.002 and 281.7 ± 253.2, 167.3 ± 148.1, 135.9 ± 74.9; P = 0.008 respectively).
Our study results showed that mPAP in direct proportion with the increased inflammatory cytokines was significantly higher in asthma attacks and levels of ET-1 and PDGF-BB were significantly increased with severity of asthma, indicating a vascular response.

HIV infected children are at risk of growth and developmental disorders.
We assessed growth and neurodevelopment outcomes in 0 - 5 years old HIV infected children.
A cohort study was carried out in a referral HIV clinic. Twenty eight HIV infected children and 47 healthy children aged 0 - 5 years were compared with regard to growth and neurodevelopmental status within two consecutive 6 months. During this period, some parent based interventions were achieved and antiretroviral treatment was optimized in case of necessity.
Among the growth parameters measured, the only significant difference between case and control groups at the beginning of the study was the head circumference percentile (P = 007) and for the developmental variables, abnormality in speech and language ability were more common in case group than in control group (P = 0.04). The difference between controlled and uncontrolled HIV patients at enrollment was marginally significant in gross motor function (P = 0.059) and a significant difference was seen in social ability (P = 0.01). The score changes among parameters before and after intervention between case and control groups were significant in language ability (P = 0.01), fine motor (P = 0.001) and social ability (P = 0.02). The score changes among parameters before and after intervention were also significant in head circumference percentile (P = 0.02) between the two groups, and for weight percentile (P = 0.04) and length percentile (P = 0.04) between well and poorly HIV controlled patients.
The growth and developmental disorders could be preventable with antiretroviral treatment and some simple parent based interventions.

Postoperative mechanical ventilation is required in patients undergoing congenital heart surgery. However, the duration of mechanical ventilation may be extended as a result in some patients. Inflammation is a normal and expected process following surgery and the intensive care process. However, increased and prolonged inflammation increases the risk of mortality and morbidity. The neutrophil lymphocyte ratio (NLR) can be used as a new marker of inflammation in cardiovascular diseases. The aim of our study was to evaluate the association between NLR and successful extubation in pediatric patients undergoing cardiovascular surgery with prolonged intubation.
Pre-extubation blood samples were used for the baseline data. Extubation failure was defined as reintubation within 24 hours of extubation for study purposes. Total white blood cell (WBC), neutrophil and lymphocyte count were recorded pre-extubation, and the NLR was calculated.
Ninety-nine patients who had undergone congenital heart surgery were classified. Statistically significant differences were observed with regard to the blood results for the two groups for WBC (P = 0.001), neutrophil count (P = 0.001), lymphocyte count (P = 0.003), and NLR (P = 0.001). Following multivariate logistic regression analysis, the NLR, WBC, neutrophil count, lymphocyte count remained significant predictors of successful extubation.
The NLR was found to vary significantly in children in whom extubation failed compared to that in children in whom extubation was successful (following prolonged intubation) and was also predictive of successful extubation in our study.

Transient tachypnea of the newborn (TTN) is a common cause of respiratory distress in the neonatal period. There are few data regarding the pharmacotherapy for the management of TTN. Previous studies documented the therapeutic role for the beta2 agonists in TTN by accelerating the clearance of excessive fluid from the alveolar space. The aim of present study was to assess the effect of salbutamol on major clinical outcomes including duration of oxygen therapy and improvement of respiratory symptoms.
This double blinded randomized clinical trial was conducted in 2014 in three urban tertiary care centers of Babol, North of Iran. Patients were assigned to receive either inhalational salbutamol (35 patients) or placebo (35 patients), and clinical outcomes were compared Before and after treatment in interval of 30 minutes, one, four and six hours from the beginning of the study.
There was no significant difference between the clinical findings of salbutamol and placebo group before and 24 hours after the initiation of the study. After the exclusion of the neonates with retraction silverman anderson scor Inhaled salbutamol resulted in shorter duration of respiratory support and hospitalization and earlier initiation of enteral feeding in TTN patients with moderate to severe respiratory symptoms. Further RCT studies with a larger study population and higher retraction score are suggested to achieve valid data in the management of TTN.

Acute kidney injury (AKI) is a serious, common and occasionally under-recognized condition. To date, the clinical and some laboratory parameters are routinely applied to distinguish between functional and structural AKI which can be challenging in certain occasions. In the present paper, we investigate the accuracy of urinary calprotectin as a diagnostic biomarker in this dubious situation.
This is a cross-sectional study among 75 children with AKI defined by Acute Kidney Injury Network (AKIN) and 20 healthy children as controls which was carried out for about six months (September 2014 to March 2015). Random urinary calprotectin concentration was assessed by ELISA in both groups within 48 hours after diagnosis. Patients with obstructive uropathy, malnutrition, renal transplantation, chronic renal failure, urinary tract infection, and malignancy were excluded. Receiver-operating characteristic (ROC) curves were drawn to determine the accuracy of urinary calprotectin to detect children with structural AKI. P value less than 0.05 was considered significant.
Median urinary calprotectin was 1240 ng/mL in structural AKI, 28.5 in functional, and 33 in controls. Receiver operating curve analysis revealed high levels of accuracy for measuring calprotectin in predicting structural AKI. A cutoff level of 230 ng/mL for urinary calprotectin showed high sensitivity and specificity. The urine calprotectin/creatinine ratio indicated the same accuracy as urinary calprotectin in diagnosing structural AKI. The ROC curve function was better for urine calprotectin and its ratio in comparison to fractional excretion of sodium (FENa).
Calprotectin is a biomarker that can rapidly and easily recognize structural from functional AKI with high sensitivity and specificity in comparison to traditional most accurate diagnostic test; FENa.

Early and late surgical complications of peritoneal dialysis (PD) come along with important and sometimes devastating morbidity, interference of medical care, decreased performance of dialysis, eventually increase the rate of mortality. The aim of our study was to evaluate the changes in the rate of surgical complications and the outcome of PD catheter insertion in a tertiary center in Iran since starting PD program.
This was a retrospective cohort study conducted between 1993 and 2012. Inclusion criteria were all children aged 14 years or younger with chronic kidney disease who underwent peritoneal dialysis. Patients with acute peritoneal dialysis and those who were followed up for less than six months were excluded. eGRF was calculated using Schwartz formula. The surgical complications including catheter malfunction, leak, Dacron sheet extrusion, and hernia were considered. Catheter survival, rate of catheter changes, and rate of peritonitis were calculated in two time period. P value less than 0.05 was considered as statistically significant.
During a 19 year interval, 86 PD catheters were inserted in 50 patients, with a median (range) age of 22.5 (1 - 192) months. The most common underlying diseases were CAKUT (congenital anomaly of kidney and urinary tract, 32%), cystic kidney disease (26%), congenital nephrotic syndrome (16%), and hemolytic uremic syndrome (14%). Median eGFR at the time of operation was 7.8 (4 - 31.4 mL/min/1.73 m2). Catheters were inserted laparoscopically in 4.6%. Among surgical complications, 39% of patients developed hernia in median of five months after surgery, in addition catheter malfunction, dislocation, adhesion, or cuff extrusion developed in 22% of cases. The most common reasons for removal were catheter related (outflow failure, adhesion, cuff extrusion) (21%) and infection (peritonitis, tunnel infection) (17.4%). Reoperation for catheter related complication was required in 21 (42%) patients. However, the number and the cause of catheter exchange and the outcome of patients were not statistically significant in two time periods; The rate of outflow failure (77% vs. 25%), peritonitis rate (1 per 7.5 vs. 56.9 patient-months) and catheter reinsertion rate (1 per 30.8 vs. 63.7 patient-months) improved significantly from the time period before 2005 and afterward. The median (range) follow up of patients was 29 (6 - 126) months. Almost 20% transplanted, -26% were still on CAPD, 6% switched to hemodialysis, renal function recovered in 10%, and 38% died.
This study shows that although improvement in our technique has been accomplished and complications related to technique of insertion are declining; catheter and patient outcomes still are far from standard.

Premature infants undergo several painful procedures in the neonatal intensive care units leading to many short-term and long-term detrimental effects on their health. Identifying pain in infants is complex because they are not able to express pain verbally. Hence, using a validated tool to assess pain in infants is essential to ensure effective control of pain.
The present study aimed to validate the Persian Premature Infant Pain Profile-revised (PIPP_R) in preterm and term infants hospitalized at neonatal intensive care units.
This methodological cross-sectional study recruited 145 infants in four gestational age groups Irrespective of gestational age, PIPP-R scores were significantly higher during painful procedures (9.59 ± 2.55) compared to non-painful procedures (3.34 ± 1.48). A comparison of pain scores among four infant groups showed a significant difference in pricking scores among the groups (P value The results showed that the Persian version of PIPP-R has a high construct validity and reliability and can be used as a valid tool to assess pain in preterm and term infants by physicians and nurses in clinical practices. The applicability of the tool by nurses must be assessed.

Studies on various adult cancer types showed that there are changes in levels of protein types that are related to iron metabolism. In our study, proteins related to iron metabolism are examined for the first time in childhood malignancies and results are presented.
Between January 2013 and December 2014, 58 patients 17 healthy children were included in the study. Blood samples were taken from patients at diagnosis and in remission and serum ferritin heavy chain (FTH-1), ferritin light chain (FTL), LCN-2, soluble transferrin receptor (sTFR), transferrin receptor-2 (TFR-2), hepcidin and ferroportin levels were examined using ELISA method.
Levels of FTH-1 were found higher in all patient groups than in control group (P

Tandem MS analysis of dried blood spots is a widely used method for diagnosis of inborn errors of metabolism. Clinical laboratories performing this test for clinically suspected children at different ages are faced with the challenge of using appropriate reference ranges for the diagnostic markers.
Retrospective evaluation of laboratory data was performed to establish the disease spectrum and clinically relevant reference ranges for the diagnostic markers.
The results of clinically suspected 4800 patients were extracted from laboratory information system and correlated with clinical data. Relevant reference ranges for the analytes in dried blood spots was determined using nonparametric statistical methods.
Forty four patients were diagnosed with 12 different inborn errors of metabolism. There were 23 patients with organic acid disorder, 13 patients with amino acid or urea cycle disorder and 8 patients with fatty acid oxidation disorder. The reference ranges were significantly different between the children under and over 1 year of age for some acylcarnitines (C0, C2, C3, C5OH, C14, C16 and C18) and amino acids (citrulline, arginine, tyrosine, valine and leucine).
The interpretation of the Tandem MS analysis results showed that the difference in the reference ranges for children under or over one year of age did not affect the diagnosis for most frequent inborn errors of metabolism.

Juvenile marriage is a violation of human rights. Previous studies state that female children are both subjected to more problems compared to male children and are at more risk in terms of mortality and morbidity. Violence towards woman is a universal problem that is common in every culture and society in the world. It has been reported that domestic violence is higher in juvenile marriages and that it continues during pregnancy. However, there was no study in the literature that researched domestic violence towards married juveniles who are pregnant.
To assess situation regarding domestic violence towards married pregnant juveniles.
This research was conducted a sectional, descriptive study. The population of the research was formed of females who were pregnant, between the ages of 10 and 19 between January and July 2016, and had married as juveniles. The population of the research consisted of pregnant girls who were between the ages of 10 and 19 between January and July 2016 and who had entered into a juvenile marriage. We planned to reach the entire population without sampling in this study. The research was formed of 79 pregnant juvenile brides in total; (n = 54) registered in twenty family health centers (ASM’s) in the Yenisehir, Kayapinar, Baglar and Sur provinces of Diyarbakir and (n = 25) of them were not registered. percentages, averages, the Fisher exact test and Pearson chi-square tests were used in the analysis of the data.
The average age of the pregnant married girls/adolescents who were included within the research was 17.86 ± 1.00. It was found that 26.0% of the pregnant juveniles had been subjected to violence during their pregnancy. They stated that they were subjected, respectively, to verbal (51.9%), physical (26.6%), emotional (27.8%), sexual (11.4%) and economic (11.4%) violence. It was established that exposure to violence was affected by whether the marriage was involuntary or voluntary (P = 0.011) and whether they perceived their relationship status to be good or bad (P = 0.00).
Nurses, who encounter individuals face-to-face more than other workers because of the very nature of their roles, have a significant responsibility in this regard.

Chemotherapy-induced peripheral neuropathy (CIPN) is frequent in children with acute lymphoblastic leukemia (ALL). Neurological manifestations can be grouped into one of the three functional divisions of the peripheral nervous system (PNS): sensory, motor and autonomic. One of the chemotherapeutic agents used in ALL is vincristine which has been associated with neuropathy in these children. This type of neuropathy can be transient but also leave permanent sequels that decrease patient’s quality of life.
To know the frequency and type of neuropathy induced by chemotherapy in a subpopulation of Mexican pediatric patients with acute lymphoblastic leukemia.
A cross-sectional study was conducted. There were included all pediatric patients with ALL diagnosed de novo from 2010 to December 31, 2013 who met the selection criteria. Descriptive statistics were used to determine the frequency and type of CIPN and information was described according to different clinical variables, type of treatment, risk classification, and ALL subtype according to the immunophenotype.
A total of 32 patients with acute lymphoblastic leukemia were included, mainly of early pre-B immunophenotype (93.8%), being 59.4% classified as high risk patients at the time of diagnosis. CIPN of sensory type was 78.1%, motor 34.3% and autonomic 40.6%. A significant proportion of patients (46.9%) were examined during maintenance phase.
To our knowledge, this is the first study to report the frequency and type of CIPN in a subpopulation of Mexican children with acute lymphoblastic leukemia. Frequency of CIPN was higher than that reported in other populations. By considering that prognosis of a patient presenting CIPN could be considered as favorable after treatment suspension (in most cases), it is not always reversible and affects patient’s quality of life. Therefore, it is necessary for all patients with ALL to be periodically monitored during treatment through neurological examination for detecting and immediately initiating their rehabilitation treatment.

Positioning is a part of routine neonatal care in most neonatal intensive care units. Optimal positioning has been controversially advocated as a practice for providing better neuro-developmental outcomes in prematures.
To evaluate by near-infrared spectroscopy (NIRS) the effect of changing posture on regional saturation of oxygen (rSO2) in the brain in mechanically ventilated preterm newborns during first 3 days after delivery.
Twenty stable ventilated preterm newborns were studied by NIRS in four different positions sequentially including supine, right-side-lying, prone, and left-side-lying, as well as in 3 intermediate periods between the four main positions.
About 45 percent of the sample of 20 neonates was under 30 weeks with a mean gestational age of 30.985 ± 6.459. Also, 50 percent were less than 1500 grams, with a mean weight of 1638.75 ± 623.04 grams. No statistically significant changes in rSO2 were found in the 4 main positions but we found significant difference between the rSO2 values of the “intermediate period between the right-side-lying and the prone position” with all other main positions and intermediate periods.
The four main postures utilized in the practice of positioning infants, do not differ in terms of cerebral oxygenation. However, it seems that wide ranges of spatial mobilization in ventilated preterm neonates may be a potential cause of fall in brain oxygenation.

Vitamin B12 cannot be synthesized in the body and it is essential for growth and development in humans.
To evaluate the vitamin B12 levels between the mothers and their infants who presented to the Pediatric Hematology outpatients department due to the symptoms of vitamin B12 deficiency. We also compared the effects of low B12 levels in both the mother and the child, compared to the effects of normal B12 levels in the mother and low levels in the child.
We enrolled 303 children aged 2 - 18 months between January 2013 and September 2015. Patients with a vitamin B12 level The birth weight of the children was low in the group where the B12 level of both the mother and the child (n = 163) was low and presentation to the clinic with neurologic signs and symptoms such as tremor, restlessness, seizure, hypotonia, and macrocephaly not related to another etiologic reason was common (P It is difficult to explain such complicated clinical pictures due to malnutrition especially in developing countries. Detecting and treating vitamin B12 deficiency early in mother and child is very important in prevention of potential irreversible neurological problems.

Wiskott–Aldrich syndrome (WAS) is characterized by microthrombocytopenia, eczema, recurrent infections, and an increased incidence of autoimmunity. Commonly, classic WAS is presented with severe clinical symptoms.
We report a new phenotype of classic Wiskott–Aldrich syndrome with mild symptoms in two cousins who were 7 years old. They had not severe infections or hemorrhage, in spite of having genetic mutation in WAS gene. The symptoms and infections of the patients responded to treatment with IVIG and antibiotics.
This report is presenting a novel clinical phenotype of classic WAS with milder symptoms.

Chronic recurrent multifocal osteomyelitis (CRMO) is a rare migratory skeletal disorder with non-infectious inflammatory etiology which usually causes bone pain in children and adolescents. Intermittent periods of exacerbation and remission are usually noted during the course of the disease. It is a multifocal bone disease usually involving the metaphyses of long bones. The clinical and Paraclinical findings are non-specific, and indeed CRMO is a diagnosis of exclusion based on multiple criteria.
We present a 6-year-old boy with multiple periods of fever, systemic inflammation and bone pain since he was 2 years old, hospitalized multiple times, received antibiotics and finally diagnosed as a CRMO case.
CRMO should be diagnosed according to a variety of clinical and paraclinical findings. In children and adolescents with multiple bone lesions and lytic lesion, one of the differential diagnoses that should be considered is CRMO.