International Journal of Pediatrics
Volume:8 Issue: 77, May 2020

Quality of life (QoL) is a complicated phenomenon in patients with thalassemia major. This study was conducted to clarify the concept of QoL in patients with thalassemia major.

This study was performed using Roger’s evolutionary method. Electronic databases: Cochrane Library, Web of Science, Scopus, Science Direct, ProQuest, and Medline. The inclusion criteria were papers published in English up to March 2017 with no time limit for publication. The keywords searched in titles, abstracts, and keywords of the studies included quality of life, health-relatedquality of life, thalassemia, thalassemia major, beta thalassemia, and beta thalassemia major.

67 studies were included. QoL in most studies had been evaluated using the SF-36 and PedsQL. The terms QoL, HRQoL, and QL were used interchangeably in most of the studies. In this concept analysis, HRQoL and well-being were recognized as surrogate terms for the QoL in patients with thalassemia major. The concepts related to the QoL in patients with thalassemia major included satisfaction, indicator of health care, individual’s own view of health, and health status assessment. Five antecedents identified in this concept analysis were: professional figure mainly involved, clinical-care interventions, medicinal and therapeutic approaches and response to them, disease characteristics and presence of comorbidities, ability and characteristics of patient. Seven attributes of the QoL in patients with thalassemia major were objective, subjective, multidimensional, measurable, dynamic, predictable, and processable.

Consequences of the concept were effects on physical functioning and improvement of psychological conditions, compliance with regular chelation therapy, iron overload, continuing education, having an appropriate job and marriage, patients’ economic and social status, and finally, motivation and life expectancy.

One of the most important methods of complementary medicine is music and phonotherapy and one of the most beautiful sounds is the sound from the recitation of the Quran. We aimed to investigate the effect of the sound of the Quran on physiological responses in preterm infants.

All clinical trials evaluating the Effect of the Sound of the Holy Quran on the physiological responses in premature infants were searched in the online databases of Scopus, EMBASE, Cochrane, Web of Science and Medline with no language or time restrictions up to the end of Feb. 2019, using the combination related keywords of Mesh. Two reviewers did study selection.

Five studies with a sample size of 360 were included in this review. In the first study, the mean of respiratory and heart rates significantly decreased and oxygen saturation levels increased in the Quran group compared to the control groups. In the second study, there was a significant difference in the oxygen saturation, respiratory rate, and heart rate between the two groups. In the third study, there was a significant difference in arterial blood oxygen levels and heart rates between the groups. In the fourth study, two groups (Quran recitation and control) were surveyed at minute 10 and 20 of intervention, also at minute10 post intervention; there were significant differences in respiratory rates and oxygen saturation levels at the three time points. In the fifth study, results did not indicate any significant differences in the mean of responses in four groups (Quran recitation, lullaby music, silence, and control groups). Conclusion Listening to recitation of the Quran can improve physiological parameters (reduced heart and respiratory rates, and increased oxygen saturation level) in preterm infants.

Breast engorgement is a postpartum problem in postpartum mothers;more than two-thirds of women develop it. Therefore, various complementary medicine techniques are used to decrease severity of breast engorgement. We aimed to determine the effect of massage and acupressure on severity of breast engorgement in lactating mothers.

In this review,the search process for clinical trials of massage and acupressure on breast engorgement in lactating mothers was carried out systematically on the databases of Medline, Web of Science, EMBASE, Cochrane and Scopus. The single and combined keywords of (Breast Hyperemia OR Breast Engorgement OR Treatment OR Therapeutics OR Therapy OR Lactating) AND (Acupressure OR Massage), without time restriction from inception up to February 10, 2019 were searched. Two reviewers did study selection.

Finally, six studies were included (with 581 participants). The findings of four studies showed that acupressure has positive effects on breast engorgement. In one study, an intervention protocol consisting of pamphlet and video preparation, massage (once a day for two days), breastfeeding training, counseling and support resulted in a greater reduction in breast size, lower sodium levels in breast milk, and greater breastfeeding than the control (no intervention) group. Another study showed that the decrease in breast engorgement intensity in the breast Oketani-massage group was significantly greater than the control group.

A supportive approach can be used to improve mild breast engorgement, and both acupressure and massage can be used to treat moderate and severe breast engorgement. Therapeutic measures can be accomplished alone or in combination with pharmacology.

Sleep disturbances among child patients are a commonly reported problem. We aimed to review the effectiveness of aromatherapy on sleep disorders of children and infants.

 This review was conducted with a systematic search of electronic resources in English such as Medline (via PubMed), Scopus, Web of Science, Cochrane Library, and EMBASE, with no time limit from inception up to February 2019; using the following keywords alone or in combination: (Aromatherapy OR Smell OR Olfactory OR Essential oil) AND (Sleep Disorders OR Sleep OR Sleep Paralysis OR Sleep Arousal Disorders) AND (Children OR Infant OR Baby OR Neonate OR Pediatric).

Four studies were included in the review. In the first study, a comparison of the nights with and without aromatherapy showed no significant difference regarding length of time the children were asleep, sleep onset time and number of interruptions during the night. In the second study, aromatherapy with Rosa damascena essential oil significantly improved sleep quality parameters in children except with daytime sleeping (p=0.059). In the third study, a significant decrease was observed in the sleep quality score in children with acute lymphoblastic leukemia in aromatherapy with oil of orange than in the controls (p<0.05). In the fourth study, the infants in the Lavender bath oil group spend  more time in deep sleep and less time crying prior to sleep onset than in the control group (p<0.05).

Aromatherapy with Lavender and Rosa damascena essential oil and orange oil can improve group sleep quality, deep sleep and time crying prior to sleep onset. However, it was not effectiveregarding sleep disorder in children with autism.

Background Beta thalassemiais a genetic blood abnormality identified through mutations, which reduce the synthesis of the ß-globin chain. Gene therapy through Lentiviral vectors have cured many of genetic disorders. The purpose of this study was to investigate the efficacy of lentiviral vectors in treatment of ß-thalassemia as a novel approach for sustained treatment and prevention of recurrent blood transfusion that has many adverse effects on the patients. Materials and Methods In this systematic review, a systematic search of online databases (Web of Science, Scopus, and Medline) with no language restriction between 2012 and 2020 using the combination related keywords of Mesh included (Thalassemia OR Beta thalassemia OR β_thalassemia OR BTM) AND (Lentivirus) AND (Genetic therapy OR Gene therapy). All valuable data was allocated, and two independent researchers considered all articles. Results Finally, 20 articles that met the criteria were selected. Articles were quantitative (n=16), and qualitative (n=4), their year of publication varied from 2012 to 2020. Results showed that the main outcome of the desired survey was therapeutic treatments for thalassemia worldwide. While highly compatible donors for allogeneic bone marrow transplantation are accessible to less than 30% of all patients, gene therapy has emerged as a holistic and practical approach for the remaining 70%. Conclusion Nowadays, with the development of gene therapy, there is hope for a cure for genetic diseases. The successes of gene therapy techniques can bring laboratory methods of gene therapy a step closer to clinical and general use as a common treatment for genetic defects.

Since preterm infants are subjected to numerous painful and stressful procedures, various strategies reducing the effects during and after painful procedures are required; we aimed to review the effectiveness of the use of different strategies as a primary or adjunctive treatment on the painful procedures, and the physiological parameters in preterm infants.

In this systematic review, English databases such as PubMed, Scopus, ISI Web of Science, Cochrane Library and EMBASE were systematically searched without any time limitation up to February 2019. The search keywords were (Aromatherapy OR Olfactory OR Amniotic Fluid OR Milk or odor) AND (Pain OR Venipuncture).

Finally, four articles were included. The first study conducted on four groups indicates that the pain profile score and the crying time slightly differed during and after the heel prick procedure. In the second study, having pricked the heel, the breast milk group in comparison with the formula milk group embodied the lower premature infant pain profile (PIPP) score. According to the third study, both the vanilla and the breast milk odors groups indicated soothing effects on the premature infants during sampling; and only the breast milk odor is the soothing factor affecting the infants after the sampling termination. The fourth study found that the infants, who were exposed to their own mother’s milk odor, when compared with the control group, encompassed the lowest median PIPP score during venipuncture.

Amniotic fluid, the mother’s milk, vanilla and the mother’s odor were determined as reduction and enhancement factors affecting painful procedures and physiological parameters in preterm infants, respectively.

Background There is limited study and a lack of systematic review in the field of aromatherapy with orange, and storytelling and their positive effects as a safe, simple and low-cost. The present study is aimed to provide a comprehensive review of the alleviating effects of aromatherapy with orange and therapeutic storytelling on anxiety during dentistry. Systemic search of online databases (Medline, Web of Science, Cochrane, EMBASE and Scopus), for randomized control trial and non-randomized prospective or retrospective clinical studies without time and language limitation, using related keyword combinations were searched up to Mar 2019. Two reviewers did study selection and the evaluation of studies was conducted by Jadad scale. Finally,three studies were included in a systematic review. In the first study, salivary cortisol and pulse rate improved significantly in both aromatherapies with and without orange aroma. In the second study, there was no significant difference in the mean of blood pressure, oxygen saturation, and pulse rate between groups (orange essential oil and without aroma) of children during dental treatment; anxiety level was assessed with Venham’s picture scale. Comparison between groups regarding Venham’s picture test was significant. In the third study, there was significant decrease of anxiety, pain and anger in the storytelling psychotherapy group compared with, the placebo and control groups of children receiving treatment by the dentist. Conclusion Both methods, orange odor and storytelling, were effectiveness in decreasing the anxiety level of children receiving dental treatment.

Asthma is a growing problem worldwide and the limitations of the current therapy for allergic asthma highlight the need for novel therapeutics. We conducted a systematic review and meta-analysis to find out the role of probiotics in the treatment of Asthma.

 In this systematic review, a comprehensive search of the major electronic databases was done till October 2017. Clinical trials comparing the effect of probiotics versus placebo on treating asthma were included. Trials focusing on prevention of asthma were not included. A predefined set of outcome measures was assessed. Continuous data were expressed as standardized mean difference with 95% confidence interval (CI). Dichotomous data were expressed as odds ratio with 95% CI. P-value < 0.05 was considered as significant.

11 studies with 2,027 participants were included. Probiotic intake was associated with a significant improvement in pulmonary function test and slight benefits in asthma control test. Probiotics did not reduce asthma exacerbation and wheezing episodes although there was a high degree of heterogeneity in studies. It also has no significant effect on viral respiratory infection in asthmatics and no improvement in quality of life. Probiotic intake improved the following parameters: longer time free from episodes of asthma. Adverse events were not significant.

Although trials showed promising effects of probiotics as an additive on therapy on some parameters of asthma, as this evidence was generated from only a few trials with high degree of heterogeneity, routine use of probiotics as an additive on therapy of asthmatic patients cannot be recommended at this time.

Background Gastroesophageal Reflux is a physiological phenomenon, which occurs in infants, children, and normal adults. Various studies have shown that Baclofen is a potent inhibitor of lower esophageal sphincter and has beneficial effects in adult reflux disease. We aimed to evaluate the Baclofen effect in pediatric Gastroesophageal disease.

Children 6 months to 12 years old, with Gastroesophageal reflux disease were enrolled in this Clinical trial study. Patients referred to Taleghani Children’s Center in Gorgan, Golestan province, Iran from May to August 2019.  Patients were randomly divided into two intervention group and control group. The controls received only proton pump inhibitor 1 mg per kg treatment, and intervention group received proton pump inhibitor (PPI) plus baclofen 0.25 mg per kg two times per day. Patient data including age, gender, family history, growth status, reflux symptoms, previous drug treatment history, and symptoms in two groups, were compared.

Fifty-four patients in the baclofen treatment group and 58 patients in the non-baclofen treatment group were included. The mean age of the patients was 6.61+ 3.55 years. The most common symptoms of all patients were abdominal pain (73.2%), nausea (73.2%), regurgitation (64.3%), and dental erosion (55.4%). The rate of recovery was significantly related to gender, with 69.9% of patients having moderate to full recovery (p = 0.017). Weight gain in baclofen treated group was significantly higher.

The results suggest that baclofen along with routine Gastroesophageal reflux treatments in children can help reduce or improve symptoms of the disease. Due to limited studies, further studies are needed to confirm the positive effect of this drug with higher sample size.

Adolescents who have overweight and obesity face many physical and psychological problems and this condition may extend to adult life. The aim of this study was to compare factors related to health promotion lifestyle based on Pender Health Promotion Model (HPM) among high school students with and without overweight and obesity. Materials and Methods This was a comparative cross-sectional study conducted on high school students in Deyyer city, Bushehr province, Iran. 353 students (180 students with overweight and obesity and 173 without overweight and obesity) were studied. The data collection tool consisted of three sections (baseline characteristics, HPM constructs and Health-Promoting Lifestyle Profile II). Data were analyzed using SPSS software version 22.0.

The mean score of health promoting lifestyle behaviors in spiritual-growth (p<0.029), responsibility (p<0.02), stress-management (p<0.002), physical-activity (p<0.001), healthy-eating (p<0.002), in students with overweight and obesity were significantly lower than those without overweight and obesity. According to the results of regression analysis, predictors of health promoting lifestyle between two groups of students were different. The only predictor construct of healthy lifestyle in adolescents without overweight and obesity was perceived self-efficacy (p<0.001), and in students with overweight and obesity in addition to perceived self-efficacy (p=0.030), perceived barriers (p=0.015), also predicted students' health promoting lifestyle.

The results of this study showed that students with overweight and obesity had a poor health promoting lifestyle compared to those without overweight and obesity. In general, to improve the health-promoting lifestyle, implementation of educational interventions based on the HPM with emphasis on self-efficacy for normal weight students and self-efficacy and perceived barriers constructs for obese and overweight students are recommended.

Background Neurofibromatosis is an autosomal dominant disease. It affects one in 2,700 to 3,300 people. The main gene mutated in the disease is a tumor suppressor protein called neurofibromin. There are several categories, the most important of which is divided into two types of type I and type 2 neurofibromatosis. Here, we aimed to identify the underlying genetic defect in eleven Iranian families with Neurofibromatosis type 1. Materials and Methods In this cross-sectional descriptive study, 18 patients were studied in 11 Iranian families. After clinical examination by the relevant specialist, DNA extraction was performed on the affected individuals, and then whole exome sequencing was used for accurate diagnosis. Results 11 individuals (4 males and 7 females) with average age 26± 1.18 year participated in the study. Precise diagnosis of type 1 neurofibromatosis was made. The location of the gene and even the type of mutation was also determined. These mutations, reported in eleven families include 4 deletions (c.747_75 del ATTTG, c.1458.1459delAA, c.1186-13delT, c.2804_2804delA), 3 nonsense mutations (Arg1306x, R1276X, L276X,), 2 splice site mutation (c.1261-2A>G, c.1185+1G>T), a silent mutation (c.3395G>A), and an Insertion mutation (c.4446_4447insT). Conclusion In conclusion, owing to the complexity of the diagnosis and, in some cases and the need to better- understand the molecular mechanisms of the disease, determining the genetic mutation profile of the disease may be of great help in better understanding the disease and Whole Exome sequencing is an extremely efficient method to identify possible disease-causing mutations.

Today, most of the information related to the health system is provided by the mass media. Learning about health issues requires understanding and recognizing their influence on health behavior and critical analysis of media content by the target audience, especially the most frequent and the most vulnerable one, adolescents. We aimed to determine the relationship between media literacy and health literacy in adolescents. In this descriptive-analytical study, 217 students in the first year of high school, eligible for inclusion in the study, were randomly selected from six districts of education in Isfahan and completed the media literacy and the health literacy Measure for Adolescents questionnaires. Data were analyzed using SPSS software version 16.0. The mean score of media literacy and health literacy in adolescents was 70.26 ± 9.88 (total score= 100) and 152.20 ± 25.78 (total score= 205), respectively. Among the dimensions of media literacy, the two dimensions of media message content perception (15.07 out of 20), and conscious choice of media messages (15.08 out of 20) had the highest mean score and the dimension of media message analysis (12.44 out of 20) had the lowest one. The multiple linear regression model showed that among the media literacy dimensions, the best predictors for health literacy scores were the two dimensions of media message content perception and awareness of the hidden purposes of media messages. Conclusion The results of the present study showed that there was a direct correlation between the media literacy with the health literacy and all of its dimensions except for the critical look at media messages.

Congenital hypothyroidism (CH) is one of the preventable causes of intellectual disability. The aim of this study was to compare intelligence quotient (IQ) in early treated children with CH and healthy children. This cohort study was conducted on 78 early treated children with CH (patient group) identified in screening program in Qazvin, Iran, started in 2006 and 90 age and sex matched healthy children (control group). The Persian version of Wechsler scale was performed to assess IQ (full scale, verbal, performance). Full-scale score among 70 and 80 were defined as borderline IQ and score among 50 and 69 were defined as mild mental retardation. Data were analyzed using SPSS software version 16.0. Mean age was 6.57±1.92 in patients group and 6.94±1.57 in control group (P>0.05). 46/78 of the patient group and 51/90 of the control group were male (P>0.05). Mean full scale (87.01±13.47 vs. 107.45±10.49; P< 0.001), verbal (85.73±13.54 vs. 106.86±10.18; P< 0.001), and performance (89.44±13.66 vs. 110.62±9.82; P< 0.001) IQ in the patients group were significantly lower than the control group. 73.1% of the patients group had average and above IQ. Borderline IQ (14.1% vs. 0) and mild mental retardation (12.8% vs. 1.1%, P<0.001) in the patients group were significantly higher than the control group (P<0.001). Based on the results, although mean IQ in treated children with congenital hypothyroidism was lower than the control group, 73.1% of them had normal IQ. Early diagnosis and treatment of congenital hypothyroidism with high doses of thyroid hormone as well as patients' compliance can prevent mental retardation.

Working pregnant women are exposed to numerous occupational exposures, some of which may adversely affect their reproductive health. We aimed to review the effects of maternal occupational exposures and adverse effects on the infants. In this overview, searches were done on the online databases of Scopus, EMBASE, Cochrane, Web of Science and Medline; with no language or time restrictions (up to December 2019) to find studies that assess the relationship between maternal occupational exposures and adverse pregnancy outcomes. Two independent researchers performed the search process and a supervisor judged any disagreement in this regard. Women occupationally exposed to anaesthetic gases had increased risk of spontaneous abortion. Second study reported specific birth defects including limb defects, cleft lip and cleft palate neural tube defects, urinary tract defects and congenital heart defects. In the third study, increased risk of childhood brain tumors was seen following maternal occupational exposures to chlorinated solvents. In the fourth study, a positive relationship between maternal exposures to ambient air pollution with autism spectrum disorder. In the fifth study, a significant relationship between anesthetic gases and congenital malformation, chemotherapy agent and spontaneous abortion and between shift work and spontaneous abortion. In the sixth study, exposure to endocrine-disrupting chemicals, group at work showed an increased risk of LBW with the odds ratio of 1.25, 95% CI: 1.04, 1.49. In the seventh study, exposure to ambient air pollution increases the risk of stillbirth. In eight, a statistically significant association between childhood leukemia and parental occupation. Maternal occupational exposures can be can be leading risk factors for many adverse pregnancy outcomes and birth defects.

Massage therapy has been commonly practiced as a traditional complementary therapy in neonates. This study was designed to evaluate the effects of massage on decreasing bilirubin levels in infants undergoing phototherapy. Materials and Methods A total of 60 term icteric infants without known risk factors who were admitted to the neonatal intensive care unit of Ghaem Hospital, Mashhad, Iran from 2016 to 2018 were involved in this preliminary clinical trial. The infant participants were randomly divided into the massage + phototherapy (intervention group, n=30) who received massage therapy (with field technique) thrice daily (every 8 hours) for 30 minutes each, and phototherapy alone (control group, n=30) who received phototherapy and routine care. Serum bilirubin samples were obtained at different time points in both groups.

The mean feeding time in the intervention and control groups were 22.5 and 21.4 min, respectively. The mean birth weights in the intervention and control groups were 3052 and 3187 gr, respectively. No significant differences were found between the two groups in age, sex, Apgar score, maternal profile, and previous history of jaundice (P>0.05). Rates of bilirubin loss were 0.81±0.19 mg/dl/h and 0.59±0.18 mg/dl/h in the intervention and control groups, respectively (P=0.043), in the first 8 hours of admission which dropped to 0.46±0.16 and 0.37±0.22, respectively (P=0.958), in the first 30 hours of admission. Conclusion Based on the results, massage is suggested as a complementary method for phototherapy, especially in the first eight hours of treatment during toxic high bilirubin levels and at the peak risk of kernicterus.

Background Tay-Sachs disease is an autosomal-recessive lysosomal storage metabolic disorder. The typical symptoms of the disease include ataxia, muscle weakness, and mental disorders. The severity of the clinical symptom relies on the enzymatic activity of residual Hexosaminidase-A. Case Presentation The patients were two Iranian (Tabriz city, East Azerbaijan Province, Iran) 22-month-old male identical twins of distant consanguineous parents with a high Apgar who score referred to Tabriz Children Hospital, Tabriz, Iran. Both twins had normal growth until 7 months of age. They started regression after 7 months of age and became hypotonic so that they could not keep their neck and control their head. The enzyme analysis of the patients showed the low-level activity of Hexosaminidase-A. A considerable delay in normal myelination process was discovered by brain Magnetic Resonance Imaging in the patients. Conclusion It can be determined that Tay-Sachs disease can occur in twins of distant consanguineous parents. Further studies are needed for detecting the mutations relating to the disease in the patients as well as their families.

Leukemia is the most common cancer in children. We aimed to evaluate the association between exposure to magnetic fields and childhood leukemia.

In this overview,the relevant articles evaluating the association between exposure to magnetic fields and childhood leukemia are screened on the electronic databases of Scopus, EMBASE, Cochrane, Web of Science, and Medline until February 10, 2019.

The first meta-analysis showed a statistical association between the magnetic field intensity of ≥0.4 μT and ≥0.2 μT and childhood leukemia. The second meta-analysis based on wiring configuration codes resulted in a pooled relative risk estimate of 1.46 (95% CI=1.05-2.04 μT, P=0.024) and 1.59 (95% CI=1.14-2.22 μT, P=0.006) for exposure to 24-h measurements of magnetic fields, indicating a potential effect of residential magnetic field exposure on childhood leukemia. In the third meta-analysis, the odds ratios of exposure categories of 0.1-0.2 μT, 0.2-0.3 μT, and ≥0.3 μT over

Three meta-analyses showed a statistical association between magnetic field intensity and childhood leukemia (ranged 0.1-2.36 μT). The results of one study also showed that there was no relationship between exposure to ≥ 0.1 μT and childhood leukemia.

Eruption hematoma is a macular elevation in the soft tissue of alveolar mucosa seen nearly during the tooth eruption. Commonly, it does not have any clinical symptoms. In most cases, the black dome shape appearance of eruption hematoma worries parents about malignancy. Since the physicians are often the firsts who examine the affected child, this letter aims to provide clinical characteristics, etiology, pathology, and treatment of eruption hematoma to these care providers.

Background Low birth weight is one of the most important health indicators in evaluating pregnancy care worldwide. We aimed to evaluate the effect of cell phones used in pregnancy on fetal growth and preterm labor. Materials and Methods The search process included screening the relevant articles on electronic databases of Scopus, EMBASE, Cochrane, Web of Science, and Medline to analyze the association of maternal exposure to magnetic fields with fetal growth, birth weight, small-for-gestational-age (SGA), and preterm labor. Results In the first study, the duration of pregnancy was shorter for mothers using cell phones for more than one hour per day than those use shorter than one hour. In the second study, the intermediate use of cell phones by mothers indicated an increased risk of preterm birth. In the third study, the birth weight were lower in excessive cell phone users than normal status. In the fourth study, low, medium, and high cell phone exposure during the six months before conception had no effect on low birth weight, preterm birth, and SGA.In the fifth study, a negative correlation was observed between magnetic fields expose during pregnancy and the birth week, birth weight, and birth length of the newborn. In the sixth study, the risk of low birth weight, preterm birth, and SGA was close to null. In the seventh study, dental radiography during pregnancy was associated with low birth weight, specifically with term low birth weight. Conclusion In general, there are contradictory findings on the impact of cell phone exposure during pregnancy. These results should be interpreted with caution because of the small sample size and recall bias.

Background Kawasaki disease (KD) also known as mucocutaneous lymph node syndrome is the febrile and self-limited vasculitis that occurs in children of all ages, especially younger than five years of age. Here, we describe a case of Kawasaki disease with coronary artery aneurysm and a big clot in LV with a diameter of 1.5 cm. Case Presentation In February 2019, a 10-month-old boy with a complaint of weakness and lethargy was referred to Imam Reza hospital in Mashhad (Iran). The patient has had coughs with no response to drug treatment for the past four months. Gallop rhythm was present in heart auscultation. Hepatomegaly was observed in physical examination. No lymphadenopathy was seen, but scalded skin was observed. On the second day of hospitalization in our center, he developed non-purulent bilateral conjunctivitis, strawberry tongue, and maculopapular rashes on the body and distal parts of the limbs. Echocardiography showed dilation of the heart chamber, blood clot in the left ventricle (LV) with the size of 1.5 cm, moderate to severe tricuspid regurgitation (TR), giant aneurysm (0.8 cm) in the left anterior descending coronary artery (LAD), right coronary artery (RCA) aneurysm (0.6 cm), and decreased ejection fraction (EF). Conclusion Kawasaki disease must be considered in the differential diagnosis of patients presenting symptoms of infection including fever and weakness, especially in infants. Early diagnosis of Kawasaki disease can lower the chance of complication including coronary artery aneurysms. Therefore, this disease must be permanently considered in patients (especially in infants) with long-term fever without a typical presentation of Kawasaki to avoid severe heart complications.