International Journal of Children and Adolescents
Volume:4 Issue: 2, May 2018

To assess the effectiveness and safety of oral amiloride for the treatment of edema in pediatric patients with idiopathic nephrotic syndrome.

Methods and subjects:

A randomized trial of amiloride vs hydrochlorthiazide was done in 34 patients. The mean age was 4.3±0.7 years old. After a 2 weeks washout of diuretic therapy, nephrotic children with edema were randomized into two groups receiving amiloride vs  hydrochlorthiazide. The effect of diuretics was assessed by the amount of weight reductionand the measurement of urinary fractional excretion of sodium during the first three days of diuretic therapy.

Results:

34 patients were enrolled for this trial (17 patients in amiloride group and 17 patients in hydrochlorthiazide group). The mean weight loss during the first three days of diuretic therapy was 1.3±0.65 kg in amiloride group and 1.19±0.4 kg in hydrochlorthiazide group (PV=0.55). The mean of maximum urinary fractional excretion of sodium during the first three days of diuretic therapy was 2.1±0.65% in amiloride group and 1.8±1% in hydrochlorthiazide group.

There  was not any difference between amiloride and hydrochlorthiazide medications in reducing weight and increasing urinary fractional excretion of sodium in children with nephrotic syndrome.

Nonsteroidal anti-inflammatory agents are the treatment of choice for ductal closure in premature newborn.This study was conducted to determine early and late outcome, as well as the effectiveness of oral ibuprofen in the treatment of patent ductus arteriosus (PDA) in premature infants.

 In this clinical trial, all preterm infants below 37 weeks, with documentation of PDA were enrolled. Infants were divided into two groups.The case group (19 patients) was treated with three doses of oral ibuprofen. Control group (19 patients) were under restriction of fluids (serum level of ⅔ maintenance).
The rate of ductal closure, presence of pulmonary hypertension were determined at the age of one week, one month ,3 months and 6 months  and  intraventricular hemorrhage and periventricular leukomalacia (PVL) were detected at the age of one week and one month. The presence of retinopathy was checked at the time of hospital discharge and at the age of one month.

Ductal closure was achieved in all newborn of the ibuprofen group whereas in control group ductal closure rate was16/19(84.2%). (p=0.23) No case of pulmonary hypertension, PVL or retinopathy was observed in oral ibuprofen group. Regarding to other criteria such as hospital stay, intraventricular hemorrhage, sepsis, ventilator time dependence, pulmonary hemorrhage and mortality rate, no significant difference between the two groups was observed.

Oral ibuprofen suspension may be an effective and safe alternative for PDA closure in premature infants. However larger studies are warranted.

Attention Deficit/Hyperactivity Disorder (ADHD) occurs concurrently with many psychiatric disorders.  Considering lack of information about comorbid psychiatric disorders in Iranian children, this study was performed to evaluate the prevalence and pattern of psychiatric disorders comorbidity in the children with ADHD.

In a cross sectional study, frequency of comorbid psychiatric disorders in a randomly selected sample of children with definitive ADHD referred to child and adolescent psychiatry clinic of Kashan University of Medical Sciences, IRAN, was determined through clinical interview using Kiddie's Schedule for Affective Disorders and Schizophrenia.

The mean age of participating children was 7.35±1.23 years and 132(66%) children were boy.  Among 200 children, 107 (53.5%) had at least one comorbid psychiatric disorder which Obsessive-Compulsive Disorder was most prevalent psychiatric disorders following with Enuresis, and Oppositional Defiant Disorder respectively.  There were statistically significant relationships between age and the type of comorbid psychiatric disorders.

Considering the high prevalence of psychiatric disorders comorbidity such as OCD, Enuresis and ODD in children with ADHD, precise diagnosis and proper treatment is essential. More studies are recommended for detection and proper treatment of these psychiatric disorder comorbidities.

We present the case of a 7 year old boy with a history of aggressive behavior, speech delay and progressive neurodevelopmental regression. Mucopolysaccharidosis was suspected based on skeletal and behavioral symptoms and confirmed by whole exone sequencing.

Children interstitial lung (ChILD) disease is a large group of disorders with damage in alveolus and capillary. Although these disorders resemble ILD of adult in nomination, ChILD represents different pathologic and clinical patterns.
A 2.5 months old girl, with failure to thrive and grunting and dyspnea, complained of staccato coughs without association with feeding, since she was 15 days old and FTT.The patient appeared ill on admission, with central cyanosis, respiratory distress and hypoxemia (SpO2: 80%).she was admitted in PICU, and empirical antibiotic therapy was started, She was intubated.The chest radiography showed haziness in upper zone and parahilar of both lungs and left retro cardiac region. Barium swallow and bronchoscopy were normal. Echocardiography was normal. Chest CT scan showed haziness in posterior zone of bilateral lower lobes, and compensatory hyper aeration of upper lobe of right lung.
The patient was undergone the lung biopsy which included nonspecific interstitial pneumonia fibrotic variant which was most compatible with Interstitial Lung Disease.

Necrotizing enterocolitis is one of the serious complications of prematurity. Eosinophilia has not been proposed as a classical laboratory abnormality in NEC. Previous studies suggest that eosinophilia during NEC may be a sign of allergic enterocolitis.

We present a premature neonate with birth weight of 1280 grams with abdominal distention, bilious gastric residue and bloody stool, severe eosinophilia and pneumatosis intestinalis in abdominal X-ray that treated as necrotizing enterolitis and fully recovered without the management of allergic enterocolitis.

 severe eosinophilia may be encountered during the episodes of NEC and it may propose the diagnosis of allergic enterocolitis but further studies is needed to clarify this association.

Neonates weighing less than 1500 grams (VLBW) consider nearly 4-7% of live births.  VLBW infants are more likely to be hospitalized due to their complications. The aim of this study is  to determine the rate of recovery, complications and predictive factors of VLBW neonate’s mortality.
A cross-sectional study in NICU of Shahidakbar-Abadi Hospital in Tehran during the year 1395 was performed on all infants born with birth weight less than 1500 grams. Neonates were examined for one month from birth to discharge or expulsion or death. And information about mother and baby was extracted from medical records.
Of the 9903 live births in Akbarabadi Hospital in Tehran in 1395, 264 VLBW newborns were included in the study. The survival rate was 75% (198) in this study. This study evaluated the prevalence of morbidities such as RDS, PDA , ROP , IVH, NEC, BPD, sepsis and pneumothorax. The most important morbidity in this study considered RDS.
The most important factors of mortality in this study were RDS (P <0.001), PDA (P = 0.006), sepsis (P <0.001), IVH (P = 0.02), and pneumothorax (P <0.001), respectively. Considering the higher rate of survival in this study comparing with previous studies in Iran, this study shows improvement in neonatal care of VLBW infants in NICU.