Journal of Comprehensive Pediatrics
Volume:10 Issue: 1, Feb 2019

Previous studies have indicated that 24 - 53% of children admitted to pediatric intensive care units (PICUs) suffer from acute or chronic malnutrition at admission. Furthermore, a large number of them undergo deterioration in nutritional status during hospitalization. Critically ill children are at an increased risk of malnutrition because of altered metabolism, and baseline nutritional assessment helps identify those patients at risk of developing malnutrition or further nutritional deterioration. This leads to an early nutritional intervention, which is the ultimate goal of nutrition support therapy. This review was conducted to describe three main steps of nutritional management (baseline nutritional assessment, nutritional intervention, and monitoring) in PICU admitted patients and discuss the importance and considerations of each step. According to the fact that early and proper nutritional support is seriously important in intensive care medicine, considering a stepwise approach toward nutrition management in pediatric intensive care units might be so useful. The assessment of nutritional status, identifying patients at risk of further nutritional deterioration, accurate measurement of energy and nutrient need for each patient, initiating nutrition support based on the nutrition support team (NST)-approved protocols, and regular assessment of anthropometry and nutritional parameters during the admission period are the stepwise phases of nutritional management in PICU patients. Following these steps might reduce the number of PICU patients who deteriorate mainly due to the poor or late nutritional support.

The most common complications of Bacillus Calmette-Guérin (BCG) vaccine are lymphadenopathy, lymphadenitis, abscess, and fistula. These occur in less than one percent of vaccinated individuals. The aim of this study was to determine the frequency of these side-effects in Iranian neonates at a university hospital. The researchers decided to study the new results of BCG vaccine complications at the university center and compare them with previous results from Iran and other countries until the relative position of Iran was identified. In a prospective, descriptive-analytical study with the census method, 214 neonates at Golestan Hospital of Tehran, Iran from May 2015 to Jan 2018 were studied. Bacillus Calmette-Guérin vaccination was performed for all these neonates at the hospital. The neonates were examined on a monthly basis by a physician and the questionnaires were completed. In this study, the rate of lymphadenopathy, lymphadenitis, and fistulization of the abscess after BCG vaccination were 2.5%, 0.5%, and 0%, respectively. No significant difference was observed between gender and age of the infants and the occurrence of the complications (P > 0.05). This study showed a higher rate of lymphadenopathy and lymphadenitis after BCG vaccination compared with other studied countries. Various factors are involved in making this difference, such as inaccuracy in the injection site and injection method, improper dilution and type of vaccine manufacturer, and a more immunogenic vaccine (Pasteur Company, Tehran). Therefore, health authorities should help reduce the incidence of complications of BCG vaccination with continuous education of the vaccination unit personnel, monitoring the preservation and method of vaccine preparation and change of the vaccine strain.

Diagnosis of pediatric sinusitis with puncturing as an invasive technique and culturing of the microorganisms may be substituted with less invasive imaging methods. Computerized tomography scanning as the gold standard of sinusitis diagnosis may not be a generalized method due to its devastating radiation effects; therefore, ultra-sonography and radiography seem to be methods to be evaluated in the diagnosis of maxillary sinusitis. There are limited and conflicting studies found in the literature that have evaluated the role of ultra-sonography in the diagnosis of maxillary sinusitis. The purpose of this study was to compare ultra-sonography with Water’s view radiography in the diagnosis of maxillary sinusitis in children. In this prospective study, 60 children aged over four years old with clinically diagnosed maxillary sinusitis, admitted to Lung Clinic of Mofid Children’s Hospital, were enrolled. Water’s view X-ray and ultra-sonography were performed by two expert radiologists on the same day. Data and interpretations were collected and entered in the SPSS 21 software. The patient’s mean age was 6.8 ± 1.8 years. Overall, 120 maxillary sinuses were analyzed by ultra-sonography and radiology. There was diagnostic agreement between the two techniques regarding 59 sinus sites, 49.2%. Compared to standard X-ray, ultra-sonography had a sensitivity of 56.4% and specificity of 91.7%. The diagnosis rate for normal interpretation via the ultrasound technique compared to the standard X-ray was 8.3% and considered acceptable. This method underestimated the diagnosis of fluid collection (30.4%), yet overestimated the rate of mucosa thickening (62.3%). This study revealed that ultra-sonography is not a suitable technique for detection of mild mucosal thickening yet may come to represent an alternative substitution to the more invasive methods for diagnosis of acute sinusitis with moderate to severe mucosal thickness and fluid collection in the maxillary sinuses.

The first aid educational mobile app (Khadem) developed by the Iranian Red Crescent Society provides the most important and simplest training of the first aids in crises for people. The present study aimed to investigate the impact of this mobile application on improving high school students’ awareness of first aids. In this quasi-experimental study (before and after using the mobile application), 51 students studying at high schools of Ahvaz city in the southwest of Iran were selected as the sample using simple random sampling method. Before the intervention, their awareness and mastery of the first aids were measured by a pre-test. Then, the mobile software was offered to them and one month later, they were asked to give another test. The scores obtained before and after the intervention were evaluated. Descriptive and inferential statistics were used for data analysis using SPSS V.22. Overall, the students' awareness of first aids was very low. In the intervention group, the mean score of the students’ awareness significantly increased after the intervention (offering mobile app) (P < 0.01). According to Spearman, Kruskal-Wallis, and Mann-Whitney tests, age, gender, and school grade had no impact on the mean scores obtained before and after the intervention (P < 0.05). Due to the various advantages and capabilities of smartphones and their popularity among students, they can provide a good opportunity to teach the students vital subjects such as the first aids, although this technology is yet to be officially included in the curriculum.

Infections include an important cause of neonatal death. The gold standard of diagnosis is a culture that should be obtained from suspected sites. The basis of treatment is antibiotic therapy. It should start as soon as possible for preventing any subsequent complications. Choosing the appropriate antibiotic for empirical treatment is important. In this study, patients who were admitted to the neonatal wards of a Children’s Hospital Medical Center for infections with positive blood, CSF, or urine culture were studied during a two-year period. Ninety-two newborns that had positive cultures were included in the study. Concerning the site of infection, 27.9% of positive blood cultures and 54.1% of urinary tract infections were sensitive to aminoglycosides (P value = 0.026). However, there was no significant relationship between the infection site and sensitivity to cephalosporins. Based on the bacterial species, 76.1% of Gram-negative infections were sensitive to aminoglycosides but 40.4% to cephalosporins (P value = 0.052). According to the relationship found in the study, aminoglycosides can safely start in case of a higher probability of urinary tract infections and Gram-negative infections as empirical treatment.

The cancer was considered the second cause of death from early infancy to 14 years of age after the inadvertent damage. Also, leukemia was reported as the most common type of cancer in infants. The current study was aimed to evaluate the epidemiology, incidence, and mortality rates of leukemia from early infancy to 14 years of age in South-Central Asia. This is a descriptive cross-sectional study. In the current study, the incidence and mortality rates of leukemia in South-Central Asia were determined. The data were extracted from a Cancer Global Project in 2012 available at http://globocan.iarc.fr/Default.aspx. In South-Central Asia, 1514027 cases of cancer were recorded in 2012 in which 480267 cases (3.2%) were related to leukemia. The highest incidence rates of leukemia were reported for Iran, Kazakhstan, Sri Lanka, and Uzbekistan with the ratio of 3.6, 3.2, and 3 cases per 100000 people, respectively compared with the lowest incidence rates in Bangladesh, and Bhutan with the ratio of 0.8 and 0.9 cases per 100000 people, respectively in under14-year-old infants. Leukemia was reported as the most common type of cancer in infants, providing important information about possible changes of risk factors considering that its trend might help us to find critical ways so as to decrease the rate of cancer in infants.

Triage nurses are the first people in the emergency department providing care to patients. Their knowledge is very important in efficient triage. According to the few studies on the factors affecting triage, the current study aimed at investigating the nurses and nursing students’ knowledge about the triage of children. Accordingly, the current study aimed at determining the level of knowledge of nursing students and nurses about pediatric triage and the impact of knowledge on the triage performance, in Guilan University of Medical Sciences, Iran. The current descriptive, cross sectional study was conducted on 88 nurses and 88 nursing students selected through a census sampling from a selected hospital. The data were collected over one month in 2017, by means of a researcher-made questionnaire that included: Demographic characteristics (age, gender, degree, etc.) and knowledge level of staff. The validity of the questionnaire was determined by content validity and its reliability was measured by a test-retest method. After transferring the data into SPSS, statistical analysis was performed by descriptive and inferential statistical tests such as the Wilcoxon and Kruskal-Wallis. The level of significance was P < 0.05. A total of 176 questionnaires were completed. A review of the responses given in the knowledge section revealed that 94.3% of the nurses and students were within the weak range. There was no significant relationship between demographic characteristics and triage knowledge in nurses and nursing students (P > 0.05). According to the current study results, knowledge of nurses and nursing students should be reinforced to better accomplish patient’s triage. Since emergency nurses are among the most important staff in providing the prioritizing triage, therefore, nursing education programs should include triage courses that retain mastery in this scope.

Jaundice is one of the most common problems in the neonatal period. Phototherapy is one of the most commonly used treatments for jaundice that can be used as a simple, practical home-based treatment. Hospitalization during the first days of birth to conduct phototherapy may result in problems like nosocomial infections and mother separation from the baby. The aim of this study was to evaluate the efficacy of home phototherapy in the duration of treatment, mean bilirubin level, and complications. This clinical trial was performed on newborns with jaundice in Isfahan health centers. The sample was randomly divided into two groups: Phototherapy at home (32 patients) and phototherapy at the hospital (32 patients). A demographic questionnaire and a researcher-made checklist were used to collect data on variables such as the duration of treatment, the frequency of treatment failure, mean bilirubin, and phototherapy complications. The mean duration of phototherapy in both groups was two days, which showed no significant difference (P = 0.32). The most common complication in both groups was skin rashes and restlessness, which also showed no significant between two groups (P > 0.05). There was no significant difference in terms of treatment failure (P = 0.246). Statistical tests also revealed that bilirubin reduction was the same in both groups. Home phototherapy can be suggested as a safe treatment with no complication to the patients.