Iranian Journal of Pediatrics
Volume:28 Issue: 5, Oct 2018

This review article will cover common congenital conditions affecting the hand with specific reference to etiology, diagnosis, and treatment. The congenital hand differences that are covered herein are syndactyly, amniotic constriction band, hypoplastic thumb, radial polydactyly, vascular anomalies, and radial longitudinal deficiency. The reader is provided with a brief review of each of these conditions.

Neonatal stroke (NS) is a common, severe central nervous system disease that is the main cause of death and disability in neonates. Therefore, great attention has already been paid to it by clinicians. However, much knowledge remains yet to be discovered about this disease. To understand the clinical features, increase awareness, reduce missed diagnoses or misdiagnoses, and improve the prognosis of NS. A retrospective analysis was conducted on clinical data from 51 patients with NS recording perinatal factors, clinical manifestations, imaging findings, and treatment outcomes. 1) Logistic multi-factor regression analysis showed that cesarean section, perinatal hypoxia, small for gestational age and maternal-fetal infection were the main risk factors of NS, 2) A total of 84.3% of the patients presented neurological symptoms or signs, of which 78.4% had convulsions as the primary symptom or major manifestation, and 67.5% had positioning significance, while 15.7% of the patients had no clinical manifestations, 3) Onset of symptoms: 76.7% within 24 hours after birth, 86.0% within 48 hours, 90.7% within 72 hours, and 7.0% after 3 days, with only 2.0% after 7 days, 4) Bilateral hemisphere involvement was present in 49.1% of cases, left hemisphere involvement in 31.4%, right hemisphere and basal ganglia involvement in 19.6% each, 5) The incidence of sequelae in living babies was 45.8%, and the overall rate of a poor prognosis was 49.1%. 1) Convulsion was the most common primary symptom of NS, 15.7% of the patients had no clinical manifestations. 2) The patients had an NS onset within several minutes to hours after birth, with > 75% having an onset within 24 hours, 85% within 48 hours, and > 90% within 72 hours after birth, 3) Caesarean section, perinatal hypoxia and small for gestational age were closely associated with NS, 4) Patients often exhibited bilateral hemisphere injury

The aim of this study was to examine the relationship between a foreign body in the nose of a child and the dominant hand, the educational level of the parents and the habits of the mother in cleaning the nose with tissues or tweezers etc.

There is a lack of evidence about the foreign body in the nose in children and association among dominant hand, parental behaviour and education level.

A retrospective examination was made of the records of 136 patients (78 male, 58 female) diagnosed with a foreign body in the nose in the period January 2014 - January 2017. A record was made of age, gender, the type of foreign body, treatment and complications, etc. Patients with a psychosomatic disorder were excluded from the study.

The vast majority of the patients were children aged 2-5 years (N = 124, 91.17%). The most common foreign bodies were a bead, a part of a plastic toy, a button, a safety pin, paper and paper tissues. The foreign body was removed from the same side as the dominant hand in 116 (85.29%) cases. The incidence of nasal foreign body was found to be statistically significantly higher in those with a parental level of education of primary school (P < 0.026).

There was a statistically significant relationship between the localisation of a nasal foreign body and the dominant hand, so the patient’s relatives must be asked about the side of the dominant hand. Taking into consideration that complications are greatly reduced with clinical experience, it is recommended that intervention for a nasal foreign body is made by an ear, nose and throat specialist

The aim of this study was to determine if there is any correlation between patent ductus arteriosus (PDA) dimensions measured by two dimensional echocardiography (2DE) and three dimensional echocardiography (3DE) in comparison with angiographic data as the gold standard technique. Such correlation may help us to immediately detect ductal spasm and select the proper device according to echocardiographic assessments. In this comparative study, we successively selected 26 pediatric patients with isolated PDA, who referred for elective percutaneous PDA closure at Nemazee Hospital, affiliated to Shiraz University of Medical Sciences (SUMS) since January 2016 till March 2017. All patients underwent full 2DE and 3DE before device closure at the day of angiography (less than 5 hours before catheterization). We emphasized the dimension of pulmonic and aortic end diameter and length of PDA by these modalities and comparison of our data. The study population had a mean age of 28.7 months and a mean weight of 10.67 Kg; the majority of our patients were female (84.6%). The difference in pulmonic end of PDA was not significant statistically by all modalities. The difference in aortic end of PDA was significant and there was no correlation between 2DE and 3DE with angiographic data. Comparison of data obtained from 2DE and 3DE revealed that the length of PDA in 2DE, 3DE angiography well correlated with each other. One case developed ductal spasm during angiography. The ductus pulmonic end and length dimensions measured by echocardiography and angiography well correlated with each other and were interchangeable. Such findings may be helpful during percutaneous transcatheter occlusion if any ductal spasm happens. Thus, we may recommend the use of a suitable device according to the maximum size of PDA that was measured either by echocardiography or angiographic studies

It is reported that there is increasing prevalence of autism spectrum disorder (ASD) in the world. Early recognition, diagnosis and intervention are known to be vital to improve the prognosis in children with ASD. In China, little research has been conducted on the knowledge of autism prevalence by child healthcare workers, or their attitude towards the traditional Chinese medical treatment of childhood ASD. This study assessed the knowledge of autism prevalence and attitudes towards traditional Chinese medical treatment among child healthcare workers in grassroots health organizations in China. A total of 265 child healthcare workers were randomly selected in Chongqing, China. A socio-demographic questionnaire was administered to assess knowledge about autism prevalence as well as the attitudes towards the traditional Chinese medical treatment of childhood ASD. The correlations between socio-demographic variables and knowledge of childhood ASD were examined using univariate and multivariate analyses. Out of 12 possible scores of knowledge about autism, mean score was 7.3 ± 2.19. Knowledge about childhood ASD was statistically associated with the education level, geographic region, the area of specialty and level of work experience with ASD. 38% of participants believed that ASD could be treated by traditional Chinese medicine. 79% of participants did not agree that the prevalence of childhood ASD in China was approximately 1%. The scores among child healthcare workers reflect deficits in knowledge about ASD. Therefore, education about childhood ASD is needed. Further studies on the effects of traditional Chinese medical treatment and a relatively accurate prevalence of ASD in China are needed

Advances in medical science and success in increasing the survival rate of vulnerable infants have raised the future evolution issues of these children. Developmental and behavioral disorders are the most common problem in children after discharge from NICU. A lot of factors are involved in the occurrence of developmental disorders. According to the importance of the subject and lack of accurate regional information, this study aimed to investigate the developmental disorders and related factors in low weight infants. This retrospective cohort study was performed on 76, 4 - 12 month-old infants with a history of hospitalization in NICU of Shiraz Hazrat Zeinab Hospital with an average weight of 1800 grams. These infants were evaluated developmentally by ASQ (Age and stage questionnaire). The data was analyzed by statistical tests. Using ASQ, 17% of children were detected as having developmental disorders. The percentages of developmental disorders for fine and gross motor domains, problem solving ability, communication and personal-social behaviors were 14.5%, 23.7%, 19.7%, 17.6% and 14.5%, respectively. The correlation coefficient statistical test did not show any significant relationship between developmental disorder with mechanical ventilation, duration of hospitalization, surfactant and betamethasone injection, and final diagnosis of diseases (r < 1). Although improvement in respiratory therapy, monitoring system, non-invasive procedures and developmental care have decreased neonatal mortality rate and prematurity complications, but we cannot find any relationship between related risk factors and neurological outcomes. Developmental delay of low birth weight infants must be detected and rehabilitation started soon after discharge from NICU

Primary school can lead to compatibility problems in children without an early childhood education because they experience separation from their families for the first time. In order to detect developmental delays that may arise at the school and to plan the necessary support, it was aimed to determine primary school readiness levels of the children aged 66 - 72 months. This study included 91 children aged 66 - 72 months who were admitted to the Pediatric Outpatient Clinic of Beyhekim State Hospital between June 2016 and August 2016. The Denver Developmental Screening Test II which consists of 134 items was performed. The Test items are divided into four main sections and surveys whether the chilren are ready for the first grade of primary school. The test results were interpreted as normal, suspect and abnormal. 36 (39.6%) of 91 patients were female and 55 (60.4%) were male. There was no statistically significant difference between the test results in terms of gender. When examining the distribution of children according to months, there was no statistically significant difference. Data for the child's age, the mother's age, the father’s age, duration of breastfeeding, the age (month) at which the child started talking, walking or completed toilet training was expressed as mean ± standard deviation. When these values were examined and also the mean values containing normal and abnormal results were compared, there was a statistically significant difference only between the months when the children started talking. When examining the results of the Denver II test, it was found that 64 (70.3%) children had abnormal development and 27 (29.7%) normal development. In the study evaluating primary school readiness levels of the children aged 66 - 72 months, the substantial proportion of the children who were admitted to the hospital, had a developmental delay. In light of this study, all pre-school children should be evaluated before admission to primary school

This study reports frequency of different causes of infant cholestasis diagnosed by clinical and biochemical parameters as well as liver biopsy.

Cholestasis persisting beyond two-weeks of age in 46 infants less than 6 months old was evaluated. A checklist including signs and symptoms, as well as laboratory, imaging and liver biopsy results was prepared. According to diagnosis, patients were classified into two groups: biliary atresia (BA) and non-biliary atresia (Non-BA) and results were compared between two groups. P value < 0.05 was considered significant.

Forty six infants (25 girls, 21 boys) with cholestasis and mean age of 65 ± 99 days were included in the study. Most of the infants (42%) were referred at the age of > 91 days. The most common symptoms and signs were jaundice in 100% followed by hepatomegaly (78%), splenomegaly (52%), acholic stool (35%) and dark urine (37%). There were no significant differences between the two groups for age, gender, onset of jaundice and organomegaly. Patients in BA group experienced more acholic stool, abnormal AST, ALT and bilirubin (P < 0.05). The most common underlying causes of liver disease in study group were BA (30.4%) and idiopathic neonatal hepatitis (INH) in 30.4% followed by metabolic disorders.

Sixty one percent of infants with cholestasis in present study had BA and INH. A systemic approach is the key for rapid diagnosis to rule out BA and other treatable disorders for a better outcome

Growth charts have been used to record and evaluate an infant’s growth condition at birth and during infancy. The current study was undertaken to explore the anthropometric indices of growth in Iranian newborn infants to draw growth charts and compare them with charts in use.

Data of singleton births was extracted from the Iranian national data centre ministry of health database between March 2014 and 2015. Newborns with ill conditions, stillbirth, congenital anomalies such as neural tube defects (NTDs), and multiple births were excluded. Our study included 1277169 singleton live births. Growth curves were created for boys (51.7%) and girls (48.2%) for birth weight, length, and head circumference. Smoothening of the curves was accomplished by using gamlss package under R.3.0.1 software.

The average GA was 38.5 ± 1 weeks. The average birth weight was 3242 ± 422 gram and 3125 ± 422 gram for boys and girls respectively. Length of body at birth was 50 ± 2.2 cm in boys and 49.5 ± 1.2 cm in girls and as for head circumference, the average was 35 ± 1.4 cm and 34.2 ± 2.3 cm respectively for studied boys and girls. Female newborns had lower weight, length and head circumference in comparison to male newborns.

we observed differences between age-gender specific growth chart in Iranian newborn infants with Fenton growth chart that may be attributed to ethnicity, regional and socioeconomic factors, mother-fetus health and nutrition status during pregnancy

Seizures are classified as febrile or afebrile in children according to the body temperature and age. The hormone irisin is known to increase with exercise and thermogenesis. The purpose of this study is to investigate the effect of type and duration of seizures involving muscular contraction due to neuronal stimuli in children with seizures on irisin levels. The physical, demographic and seizure characteristics of 45 patients and 40 control cases were recorded. Sera were collected from patients and control cases, initially during application for admission to hospital and then secondly within 8 - 24 hours while subjects were experiencing seizures. Twenty of the patients with seizures were febrile and 25 were afebrile. There was no difference between the patient and control groups in terms of sex or weight and height percentiles. There was no statistically significant difference in irisin levels between the patient and control groups (P > 0.05) but a significant difference was observed between initial and second irisin values in the patient group (P = 0.03). Irisin has been reported to increase after aerobic exercise lasting 45 minutes. The mean duration of seizure was 9.3 minutes in our patient group and the suggestion that lactate elevation in patients undergoing seizures is used by the anaerobic pathway may explain why irisin did not increase in these patients. Irisin does not increase in the early stage in patients undergoing seizures, but significant increases occur in 8 - 24 hours. More comprehensive studies are needed on this subject.

Obesity increases the risk of many pathologies, including cardiovascular and renal diseases. This study aimed to determine the association between obesity and proteinuria as well as glomerular hemodynamic changes (an early marker of kidney damage) in obese children and its relationship with metabolic syndrome.

This case-control study included 112 overweight and obese male and female patients aged 7 - 16 years, and 35 age- and gender-matched healthy controls. The obese patients were divided into 4 subgroups according to BMI:normal weight (control group), overweight, obese, morbidly obese. The glomerular filtration rate was estimated using classical and adjusted formulas based on the various body size descriptors of Leger, Schwartz, Filler, and Zappitelli, and chronic kidney disease formulas in all patients and controls. Creatinine, cystatin C, 24-hour urine protein, and the estimated glomerular filtration were compared between groups.

Blood pressure, creatinine, and 24-hour urine protein values were significantly higher in the overweight and obese patient subgroups (P < 0.05). The estimated glomerular filtration rate, which was calculated using creatinine or cystatin C, was higher in the obese patients and subgroups than in the control group (P < 0.05). In contrast, the estimated glomerular filtration rate measured using both classical and adjusted formulas was significantly lower in the obese patients than in the controls (P < 0.05).

Early indicators of renal damage are elevated urine protein and renal function test results compatible with impaired renal function. As such, obese pediatric patients should be routinely monitored for blood pressure, renal function, and proteinuria

To develop body mass index (BMI) cut-offs for overweight and obesity based on international obesity task force (IOTF) definition, in children in Tehran, and to compare these values with those of center for disease control (CDC) for local pediatric subjects in discriminating cardiometabolic risk factors. Anthropometric and biochemical information of 1555 participants, aged 5 - 18 years, from phase IV of the Tehran lipid and glucose study (TLGS), were used to obtain local IOTF and CDC cut-offs. We used the LMS method to develop BMI curves matching the adult cut-offs at the age of 18 years for defining obesity and overweight based on the IOTF definition. Using the CDC growth curves, overweight was defined as 85th ≤ BMI < 95th percentile, and obesity as a BMI ≥ 95th percentile. The overall prevalence of overweight was 22.2, 23.9 and 10.5%; and that of obesity was 7.8, 9.0 and 4.2% using international IOTF, local IOTF and local CDC criteria, respectively. IOTF curves better discriminated the presence of all cardiometabolic risk factors, compared with local CDC curves. Local IOTF cut-offs for children in Tehran are in agreement with international IOTF values and better discriminate the cardiometabolic risk factors in children compared with local CDC cut-offs.

A 30-month-old girl was referred to our clinic because of a large ASD secundum and severe pulmonary valve stenosis. Due to her clinical and paraclinical situation we decided to perform the surgery. The patient had no other symptoms except for those related to ASD. During the surgery we found a mass with its satellite nodule on the tricuspid valve. Histopathological examination of the mass revealed larval elements and infiltration of eosinophils.