International Journal of Pediatrics
Volume:9 Issue: 96, Dec 2021

In many cochlear implant users, even after some time following cochlear implantation and adequate central auditory stimulation, certain hearing processing capabilities remain unresolved. These difficulties for cochlear implant users have a very similar manifestation to the decoding sub-category of the buffalo model of auditory processing which has a direct role in accurate phoneme processing. The present study was designed to investigate phoneme processing abilities in cochlear implant users and to evaluate the efficacy of phonemic rehabilitations in this population.
This was an interventional study with single subject design. Six prelingually deaf children aged between 8 and 11 years were recruited in the study. The performance of the cochlear implant users during three phases of baseline, intervention and follow-up was investigated. Phonemic Training and Phonemic Synthesis programs were administered and the outcomes were compared based on performance of the children in phoneme recognition test, phonemic synthesis test and the phoneme error analysis form.
All findings demonstrated that test scores improved in all six cases after intervention in comparison to the baseline (p< .00).
This study suggests that phoneme-based rehabilitation strategies improve the performance of deaf children with cochlear implants and should be used in postoperative therapy batteries.

The prevalence of childhood obesity, which is associated with the health risk of OSA, is increasing. This study aimed to assess the polysomnographic findings of obese and non-obese children and adolescents with OSA. In this cohort retrospective study, all the obese and non-obese children and adolescents with OSA referring to Sleep Disorders Clinic, Qazvin Children Hospital, during 2014-2019 were included. The participants were 52 pediatrics within the age range of 1-16 years old and mean age of 6.47±3.59 years, 20 (38.5%) of whom were female and 32 (61.5%) were male. The number of samples was determined according to previous studies, and the patients’ case information was applied in this research. Obese children and adolescents were determined according to their BMI. PSG was performed for all the participants and its variables including sleep onset, sleep efficiency, sleep stages (N1, N2, N3, rapid eye movement (REM)), arousal index (AI), apnea hypopnea index (AHI), mean arterial oxygen saturation (SaO2), and total sleep time were determined and compared between the two groups. Mann-Whitney test showed a statistically significant difference in the percentage of REM sleep stage between the obese and non-obese groups (P=0.017). There was no statistically significant difference in the other polysomnographic variables between the two groups. In the obese group, linear regression showed significant correlation between body mass index (BMI) and AHI as well as mean arterial SaO2. the percentage of REM sleep stage in the obese group with OSA was lower than that in the non-obese group. There was a correlation (P≤0.05) between obesity and respiratory events in sleep. It is predicted that with increasing age, obese people are more likely to have severe sleep apnea.

Earthquake is the most catastrophic disaster that has harmful psychological, economic, social, political, and cultural effects on societies. Resilience or ability of a person for adapting to post-earthquake problems and crises is influenced by known and unknown factors. The present study aimed to explore experiences of Bam earthquake survivors about adolescents' resilience in that time. This is a qualitative study with a directed Content Analysis approach. The participants were a total of 34 individuals including; 10 teachers and 24 parents of the students who had earthquake experience in adolescent period. The subjects were selected based on a purposive method. The sampling was done until data saturation from the junior high schools in Bam city, Iran, in 2019. Data collected through in-depth and semi-structured interviews and analyzed by Granehim and Lundman method. Data analysis yielded 565 primary codes, 217 conceptual codes after integration, 25 subcategories, and 6 categories from the participants' experiences about their resilience against the disasters and earthquake. 6 categories include: disaster consequence, beliefs about resilience, beliefs about strengthening resilience, factors affecting resilience, consequences of facing disasters, the necessity of disaster preparedness. Participants stated different opinions and experiences about resilience and the factors that enhance or reduce it. They emphasized the necessity of preparedness and acquiring different skills for coping with disasters. Therefore, it is suggested that crisis management officials use these experiences to devise measures to prepare communities, before the occurrence of disasters, to support during and after disasters, to decrease the problems of future crises and to enhance resilience in communities, especially among adolescents as the next generation of society.

Children under five years of age are the primary victims of malnutrition. This study aimed to investigate risk factors of stunting among children less than 5 years in North-Western Iran.

This cross-sectional study was performed on 3300 children under 5 years of age in West Azerbaijan province. Selected households were visited by fifteen trained teams. Collected data were consisted of name, date of birth, height, weight, sex, breastfeeding status, age, stunting status (Without stunting, moderate, severe), place of residence, care quality, completion of growth curve and knowledge of mothers about heath cares. The data were analyzed using STATA version 20. Chi-square, binary logistic, and ordinal regression were used. P-values less than 0.05 were considered significant.

Among 3300 children, a total of 436 individuals (13.2%) had stunting (moderate: 302 children/severe: 134 children). The Mean weight, height, BMI, month of birth and breast feeding duration in children were 11.89±3.76, 86.26±15.05, 15.88±2.44, 6.23±3.47 and 4.13±5.20, respectively. No significant independency was found among children with/without stunting regarding having breast feeding or cow milk, using baby pacifier and number of under-5-year children in each family (p>0.05). Other qualitative variables were not homogenous (p<0.05). In binary logistic regression analysis, age and weight were presented as risk factors in the model, that is, by increasing one unit of the age, provided that the other variables remain constant in the model, the risk of stunting increases for approximately four times, because the odds ratio (OR = 4.034) is significant (p = 0.021 ). Weight variable also produced such a situation (OR = 4.437, p = 0.007). Assuming that other variables remain constant in the model, the risk of shifting to the higher order of the stunting variable is roughly doubled in the model, because the odds ratio (OR = 2.285) is significant (p = 0.005).  Height was a preventive variable in the model for developing stunting (OR = 0.204, p = 0.002). In ordinal regression analysis, weight was presented as a risk factor in the model (OR = 2.285, p = 0.005) and height was a preventive variable (OR = 0.450, p = 0.001).

According to the results of the study, prevalence of stunting is high indicating the necessary measures in this regard. Weight, height and age are appropriate predictors to predict stunting in children

Osteoporosis is one of the most common problems in health systems and a hidden epidemic in the modern world. The aim of the present study was to investigate osteoporosis-related nutritional behaviors based on the theory of planned behavior (TPB) in adolescent girls in Sari, Iran.

This cross-sectional study was performed on 341 12-16-year high school students who were selected by multi-stage random sampling method in Sari, Iran. Data collection was carried out using a TPB-based researcher-made questionnaire consisting of three parts; part A included questions on demographic characteristics and osteoporosis-related diseases, part B discussed osteoporosis nutritional behaviors based on TPB constructs, including behavioral attitudes, subjective norm, perceived behavioral control, and intention, and part C was the Food frequency questionnaire (FFQ).  Part A and B were completed by students and part C was completed through an interview, taking into account the number of food units based on the recommended standards of the Food Pyramid. Data analysis was also performed using regression analysis, Pearson correlation and ANOVA in SPSS ver. 20.

The present study demonstrated a significant relationship between perceived behavioral control and osteoporosis predisposing nutritional behaviors (P<0.05). Also, among TPB constructs, subjective norm (β=0.138) and intention (β=0.136) were the main determinants of osteoporosis-preventive behaviors; and subjective norm (β=0.182) and knowledge (β=0.155) played the most important roles in determining osteoporosis-predisposing nutritional behaviors.

Based on the results, there is a significant relationship between TPB constructs and osteoporosis-related nutritional behaviors. Considering the role of TPB constructs and lower consumption of the osteoporosis-preventing group, there is a need for educational interventions among adolescents, parents and other people influencing adolescents.

This study was performed to determine the relationship between vitamin D level and allergic factors in patients with asthma referring to asthma and allergy clinic in Gorgan.
In this observational study that was performed as a cross-sectional survey between April and September 2019, 84 patients with asthma were enrolled. The mean age of the participants was 9.05±2.65, and 46 (54.8%) of them were male. The IgE level of the children was determined using the MicroWell kit (USA) and by ELISA method, from the blood taken from the samples; and the serum concentration of 25-hydroxy vitamin D was measured using the DIA kit made in the United States and Enzyme linked ELISA Immunosorbent assay method. The data were entered into SPSS software version 18 to assess the relationship between the vitamin D level and allergic factors (IgE and eosinophil).
It was found that according to the Spearman test there was a significant reverse correlation (r=-0.77) between serum vitamin D with IgE and serum eosinophil (P=0.001). It was true for medium but not severe asthma patients.
According to the obtained results, it may be concluded that higher serum vitamin D is related to lower asthma severity in patients.

The mucopolysaccharidoses (MPSs) are a group of rare inherited metabolic disorders caused by lack or insufficient activity of lysosomal enzymes. Although no cure has been identified until now, Enzyme Replacement Therapy (ERT) can reduce symptoms of some types of MPSs. providing ERT for patients is a challenge for health systems due to expensivity of the medicines. In this study, we aimed to examine the average annual cost of medicines used for ERT per patient in Iran healthcare system.
Data on patients were consolidated from different sources of Iran Food and Drug Administration’s (IFDA). After collecting data, patients with MPS I, IV, and VI were categorized into five age groups (5-years interval). The number of vials distributed monthly was used for the estimation of the annual medication cost for each patient and compared against the Gross Domestic Product (GDP) per capita.
Data on 185 patients with MPS was analyzed. The frequency of patients with MPS I, IV, and VI was 27, 40.6, and 32.4%, respectively. The average annual expenditure on ERT medications per patient was estimated at 206.07 United States Dollars. The average annual cost has shown to be about 38 times the current GDP per capita of the country.
The medication cost of ERT for MPS disease is substantial to the health system. To ensure the best clinical effectiveness and efficient use of financial resources, it is highly recommended that healthcare policymakers use an evidence-based clinical practice guideline and improve the data quality in rare diseases registry.

It has been believed that infants are at a lower risk for the severe symptoms and complications that arise from COVID-19. This report represents details on a newborn with sepsis that has been diagnosed with COVID-19 and, unfortunately, did not survive.

The case was a 1-day-old female newborn, admitted to the surgical intensive care unit in Namazee Hospital, Shiraz, Iran, for a bladder exstrophy operation. She gradually started to deteriorate on the fourth day after the surgery, diagnosed with sepsis based on the results of her blood culture. Progressively, her vital signs and blood tests fell within normal ranges after being treated with broad-spectrum antibiotics. Without any fever, the neonate became severely irritable on the 16th day after her birth and hospitalization. Considering lymphopenia, high CRP, and abnormal chest x-ray, pharyngeal swab sampled for COVID 19. The newborn died from multi-organ failure on the 18th day of life. Reverse transcription-polymerase chain reaction (RT-PCR) confirmed the COVID 19 infection in the dead newborn. The parents’ pharyngeal sample, however, was negative for COVID 19.

Growing awareness of sepsis as a risk factor for the severity of the COVID-19 infection in the neonatal period can be a form of knowledge for physicians to begin early treatment and reduce odds of mortality in this group of patients.

The present study aimed to translate the cystic fibrosis questionnaire-revised (CFQ-R) for children with cystic fibrosis (CF) into Persian and evaluate the reliability and validity of the instrument.
About eighty individuals including children and their parents were enrolled in this cross-sectional study. Demographic characteristic and disease severity parameters of the subjects were recorded. After translation of the CFQ-R to Persian, the participants completed the parent or child translated version of the CFQ-R, as well as the PedsQL 4.0. Reliability and validity analyses were, then, carried out.
The forward-backward translation was employed in this study. The total content validity ratio (CVR) and content validity index (CVI) were above 0.8 and at least 0.49, respectively. The internal reliability of each domain was acceptable (Cronbach alpha coefficients 0.65-0.91). Appropriate domains of the CFQ-R and pediatric quality of life inventory (PedsQL 4.0) were correlated, indicating the acceptable concurrent validity (r=0.5-0.7). In addition, test-retest reliability was assessed using correlation-coefficients, which were considered significant for both the child version (r=0.88; P˂0.001) and parent version (r=0.78; P˂0.001). Moreover, the CFQ-R scales showed significant correlations with the clinical indices and the construct of disease severity in the child and parent version.
According to the results, the Persian version of the child and parent CFQ-R has acceptable reliability and validity indices; and may be suggested to be used in clinical trials for the clinical evaluations and follow-ups of Iranian children with CF.

One of the most common urological disorders in childhood is vesicoureteral reflux (VUR) that can lead to kidney injury, scarring and chronic kidney disease. VUR is diagnosed by radiological methods, which are often invasive. We evaluated the possibility of diagnosing VUR by measuring urinary NGAL (Neutrophil gelatinase-Associated Lipocalin) in this study.
This prospective cohort study was conducted on children aged 1-5 years old with recurrent urinary tract infections in 2017- 2018 in Sannandaj, Iran. After ruling out other causes of recurrent urinary tract infections, urinary levels of NGAL and creatinine (Cr) were measured in random urine simultaneously with voiding cystourethrography (VCUG). Then the patients were divided into 2 groups with and without VUR based on VCUG and the collected data were statistically analysed.
In this study, 71 children (12-60 months) with a mean age of 23±36.35 months were studied, among whom 34 children had VUR and 37 children did not have VUR. The mean urinary NGAL/Cr ratio in the group with VUR (3.45 ± 3.8 ng/mg) was significantly higher than that in the group without VUR (1.18± 0.8 ng/mg) (P: 0.002). The best cut-off point for urinary NGAL/Cr ratio was 1.27 ng/mg, with a sensitivity of 76.5% and specificity of 73% (ROC area: 0.76, P <0.001).
Urinary NGAL/Cr ratio is higher in children with VUR and may be used as a rapid and non-invasive method in the diagnosis of VUR.

Congenital adrenal hyperplasia (CAH) is a potentially life-threatening form of primary adrenal insufficiency characterized by cortisol, aldosterone, and epinephrine deficiencies, as well as overproduction of androgens. Infertility is one of the most important complications in male patients with CAH, and testicular adrenal rest tumors (TARTs) are known to be the most important cause of infertility in these patients. The prevalence of TART is considered to be high in patients with classic type of CAH, and poor hormonal control is known as a factor associated with tumor development. In the present study, the prevalence of TART and factors associated with its development were evaluated in pediatric patients with CAH. This is a descriptive cross-sectional study evaluating 30 males (6 month -18 years) with the classical 21-hydroxylase deficiency (21-OHD) through testicular ultrasonography. Data including age, bone age, puberty status, 21-OHD phenotype (salt wasting (SW) or simple virilizing (SV)) and serum levels of 17- hydroxyprogesterone (17-OHP), androstenedione and adrenocorticotropic hormone (ACTH) were recorded. The prevalence of TART was determined as 56.7%, which increased with age with a higher prevalence in children >12 years old (52.9%). The mean age in patients with TART was 12.4 ± 4.18 years. No association was found between TART and 21-OHD phenotype, androstenedione, or 17OHP levels, but an association was found between TART and elevated levels of ACTH (p= 0.049), advanced bone age (p= 0.030) and puberty (p= 0.003). According to the results, TART is very common and can occur in pre-pubertal and young patients, and the disease control could be a factor associated with its development. Therefore, it is suggested to investigate the TART development early in childhood, mainly in poorly controlled 21-OHD patients.

There is disagreement about the use of zinc and synbiotics in improving the effectiveness of antibiotics in the treatment of bacterial pneumonia in children or reducing the side effects of this treatment. The aim of this study was to evaluate the interventional effects of synbiotics and zinc sulfate on reducing clinical symptoms and the average duration of treatment in children suffering from bacterial pneumonia.
This study was a randomized clinical trial with a parallel-group. The participants included 1 month to 18 years children who were admitted to Sabzevar Heshmatieh Hospital with fever, cough, and respiratory distress with a diagnosis of bacterial pneumonia. They were assigned to the three groups of antibiotic only, antibiotics/synbiotics and antibiotics/zinc, randomly. Clinical symptoms including fever, faster respiration rate per minute (Tachypnea), retraction (subcostal, intercostal, suprasternal, and nasal flaring), crackles, wheezing, cough, and gastrointestinal side effects (diarrhea) were recorded on arrival and daily until discharge and compared at a significance level of 0.05.
Overall, there was no significant difference between the patients' clinical symptoms (fever, respiration rate per minute, subcostal, intercostal and suprasternal retraction, and nasal flaring), crackles‎, wheezing, cough, and gastrointestinal side effects (diarrhea) in the three groups.
The results of this study could not show any clinical benefit for prescribing zinc or synbiotics in combination with standard antibiotic therapy in the treatment of children and infants, and they could not reduce the side effects of this treatment.

Multiple sulfatase deficiency (MSD) is a very rare Lysosomal Storage Disease (LSD) caused by mutations in the SUMF1 gene. So far, about 143 patients with MSD have been reported in previous studies, although this figure is likely an underestimation due to under-reporting and under-recognition. The present report shows the genetic and clinical aspects of a patient with MSD in comparison to the previously reported patients.

This study aimed to determine the effect of speed-strength exercises on the vestibular stability of schoolchildren with different nervous systems. The pedagogical experiment was conducted from January 12 to March 20, 2020 in Kirov, Russia, school number 60. The study involved children aged 13-14, 20 students from grade 7a and 20 students from grade 7b. The participants from class 7a were considered as the control group, being engaged in the usual program; and those from class 7b additionally performed speed-strength exercises. Children from grade 7b were divided into two subgroups taking into account the strength of their nervous systems, determined based on a «tapping test». Vestibular stability of schoolchildren was measured using the test of «Turns on the gymnastic bench». The data was analyzed using the Student's T-test. After the end of the pedagogical experiment, the indicators of vestibular stability in schoolchildren in all subgroups were improved, but in different ways. In the control group, the indicators were improved slightly, only by 6-7% (p>0.05). However, in the experimental groups the indicators improved significantly. In children with a strong nervous system, the indicators improved by 21% (p>0.05), and in children with a weak nervous system, by 18% (p>0.05). If at each physical education lesson at school children will additionally perform speed and strength exercises, then the indicators of vestibular stability will improve. Physical activity should be differentiated taking into account the strength of the nervous system of schoolchildren

Supracondylar fractures are common in children with the average age of is 5-8 years. It is especially important to pay attention to pain control in these children because of the severe pain they experience. This study was designed to compare the analgesic effects of oral ibuprofen with those of the acetaminophen in children with supracondylar fractures undergoing a non-surgical treatment. This triple-blind clinical trial was conducted on children with supracondylar fracture referred to the Emergency Department of Imam Reza and Hasheminejad Hospital. Children’s pain was assessed 2, 4 and 12 hours after taking the drug by VAS (Visual Analog Scale) criteria, which was explained by the researcher to their parents. In this study, 64 children with a mean age of 5.7±1.7 years were studied. 31 children in the acetaminophen group and 33 children in the ibuprofen group were evaluated. The mean score of pain reduction within 12 hours of drug administration showed no difference between the two groups (P = 0.710). After 12 hours of drug administration, 5 and 7 children became painless in the acetaminophen and ibuprofen, respectively, with no difference between the two groups. During the 12 hours after ibuprofen and acetaminophen, all children, similarly, felt analgesia and there was no significant difference between the two drugs in terms of pain relief and side effects; thus, both drugs are safe and effective for pain-control in children

One of the most common food allergies in infants is cow’s milk allergy (CMA). There is no available effective therapeutic strategy for this issue. It's important to develop effective approaches to reduce the risk of cow’s milk allergy. The purpose of this study was to investigate the effect of probiotics on the infants with cow’s milk protein intolerance. This study was a randomized clinical trial in full-term infants with CMA diagnosis. These patients were divided into case and control groups (receiving placebo and probiotics). Clinical symptoms such as diarrhea, abdominal pain, etc. were evaluated in 2, 4, 8, 12 and 16 weeks after receiving probiotics. During the 16 weeks of the study, a significant decrease was observed in the clinical and paraclinical findings in both groups. There was a statistically significant decrease in times of mucosal, bloody and daily defecation of the patients on the 4th, 8th and 12th weeks. Also, a significant difference was found between the groups in diarrhea and abdominal cramps from the 4th week. The consumption of probiotics for a short time in infants with CMA significantly decreased the clinical and paraclinical symptoms.

This study aimed at evaluating how the patient’s clinical manifestations and his/her anti TTG level are correlated with the intensity of histological damage based on the classification of Marsh Oberhuber.
This cross-sectional study was performed on 186 children suspected of celiac disease who referred to gastroenterology clinics between 2014 and 2015 and had Anti TTG >20. All patients underwent upper gastrointestinal endoscopy and multiple biopsies of duodenum were taken; histological classification was performed based on Marsh Oberhuber criteria. Finally, the relationship between serum levels of Anti TTG and histologic findings was assessed based on Marsh Oberhuber criteria.
There was a statistically significant difference between Anti TTG and different classes of grading March (P=0.01). Moreover, the intensity of intestinal damage based on Marsh Oberhuber criteria was significantly higher in children who had gastrointestinal complaints, the classic form of celiac disease and growth disorder. Anti TTG level of 148 IU/ml was the best positive cutoff point suggested by the ROC. For anti TTG levels of 148 IU/ml, sensitivity, specificity, positive predictive value and negative predictive value were 46.8%, 82.4%, 91.7%, and 27.2%, respectively.
Anti TTG level of 148 IU/ml has a high positive predictive value and a low negative predictive value for histologic changes more than grade 1 in Marsh classification

Despite the paramount importance of feeding preterm infants, it is not yet known which feeding method works best. Therefore, the aim of this study was to determine and compare the effect of cup and finger feeding methods on weight gain and feeding tolerance of preterm infants.
This study is a randomized clinical trial that was performed on 83 preterm infants admitted to the neonatal intensive care unit of Shahid Sadoughi Hospital in Yazd. Eligible infants were randomly divided into two experimental groups of Cup feeding (28 cases) and Finger feeding (27 cases) and a control group (28 cases). The duration of the study was one week; and the cases were fed four times a day, each time 15 to 20 minutes. Infants’ weight and feeding tolerance were recorded daily. Data was analyzed using SPSS 21 software and inferential tests (Chi-square, analysis of variance with repeated measures, paired t-test).
The mean weights of the infants in the three groups had not significantly changed after the intervention; and also the trend of changes in mean weight were not significantly different among the three groups (p = 0.25). The percentage of feeding tolerance was 85.7% in the experimental group with cup, 63% in the experimental group with finger, and 64.3% in the control group, which were not significantly different (p = 0.11).
According to the results, it seems that the three feeding methods with cup, finger and dropper have similar effects on weight and feeding tolerance of premature infants; though cup feeding resulted in slightly higher weight gain and higher feeding tolerance. However, to confirm it definitively, a study with a larger sample size and longer intervention time is required.

Physical activity is one of the key factors in children and teenagers’ health. The first step of planning based on social marketing is to conduct qualitative research. The present study follows a qualitative approach to identify the participants’ viewpoints about regular physical activity and determine approaches to promote it based on social marketing framework.
The social marketing theory served as the framework of the study. The study was carried out as a qualitative directed content analysis in 2020 in Kermanshah city, Iran. Data gathering was done through individual semi-structured interviews. Totally, 23 students (aged 12–15) as the main participants along with five mothers and four physical education teachers were selected through purposive sampling.
After data analysis and extracting initial codes, they were all categorized in four predefined categories of social marketing model (product, price, place and promotion) and related sub-categories. The majority of participants emphasized on the advantages of physical activity, namely prevention of chronic diseases, physical fitness, increased concentration, better learning performance, and a decrease in depression. They noted that they preferred a happy and friendly environment for doing physical activity. The teenagers listed fitness clubs, the media, and social media as preferred places to receive educational messages. The majority of participants mentioned that face-to-face education, social media, and the internet are the best communication channels.
The results gave an insight and a deeper knowledge about values and motivations in teenagers that affect their decision to perform regular physical activity. Moreover, researchers can use the findings to design and implement interventional programs to promote regular physical activities for teenagers

Echocardiography currently represents a significant proportion of cardiac medical expenditure, while many researchers believe that it would be wise to limit the use of this technique, through the enhancement of diagnosis techniques contributing to clinical auscultation. Hence, this study was conducted to evaluate the efficiency of detection of the newly invented Doppler Phonolyser Machine (DPM) compared to the findings by the conventional stethoscope in detecting heart murmurs. In a cross-sectional study, a total of 112 patients referred to the pediatric cardiology clinic were enrolled between Jan. 2017 and Jan. 2018. In step one, the patients were initially examined by a pediatric cardiologist, and then in step two, they were randomly divided into two groups (A and B) and were blindly re-examined by a 2nd-year pediatric resident. In Group A (Statoscope group), heart auscultation was performed using only a conventional Statoscope whereas, in Group B (Statoscope + DPM), heart sounds were detected and analyzed using a stethoscope and DPM. In the third step, the diagnostic results made by the pediatric cardiologist and the pediatric resident in groups A and B were compared with the final diagnostic echocardiography made by a pediatric cardiologist. Heart murmurs as one of the most common reasons for cardiologist referrals comprise about 65% of referrals to pediatric cardiologists. There was only a moderate correlation between a stethoscope and echocardiography to identify cardiac abnormality based on heart murmurs (56%), while there was a significant correlation between the diagnoses made by Doppler Phonolyser accompanied with the conventional statoscope when compared with the echocardiography results (٪85). Doppler Phonolyser is an innovative smart machine that could efficiently detect and analyze abnormal heart sounds and might play a key role in more accurate and earlier diagnosis of congenital and structural heart defects by general physicians and non-cardiologist specialists, and may potentially reduce the cost of treatment as well as anxiety of the patient's family.