Iranian Journal of Pediatrics
Volume:19 Issue: 2, 2009

It has been suggested that periodontal disease may be a risk factor for a number of multifactorial systemic conditions such as preterm deliveries. The aim of the present study was to examine the relationship between maternal periodontal disease and body size of newborns. After controlling traditional risk factors for premature child birth and low birth weight. One-hundred eighty mothers were selected: 17 were periodontally healthy, 77 had gingivitis, 72 had initial periodontitis and 14 suffered from established periodontitis. These mothers and their newborns formed the study population. The body size consisting of weight, height, and head and chest circumference, were taken from newborns'' hospital files. A decrease in the newborns'' body size was observed as the mothers'' periodontal disease severity increased. Birth weight, height, and head and chest circumference of babies born of mothers with established periodontal disease were significantly lower than those who were born of mothers with healthy periodontal condition, gingivitis and initial periodontal disease (P=0.006, P=0.016, P<0.001 and P<0.001, respectively). The data suggest that there is a considerable association between periodontal disease in pregnant women and body size of their newborns, this preliminary finding needs to be confirmed in more extensive studies.

This study was conducted to determine the hospital prevalence, clinical severity and treatment outcome of rotavirus versus non-rotavirus diarrhea in children attending a secondary level children hospital of Bangladesh. Total 601 children aged from 1 month to 5 years with watery diarrhea were enrolled and their stool samples were analyzed by ELISA for rotavirus antigen. Total 601 children aged from 1 month to 5 years with watery diarrhea were enrolled and their stool samples were analyzed by ELISA for rotavirus antigen. Despite high prevalence of Rotavirus diarrhea in Bangladesh, majority of this illness can be managed at home and/or in primary health care centers, since clinical severity and outcome of rotavirus diarrhea remains similar to that of non-rotavirus diarrhea. This message is expected to reduce frequent and sometimes un-necessary referral of diarrhea patients to higher centers thereby saving the working hours of the attending parents as well as disease burden to children hospitals having limited beds against the huge demand.

Early diagnosis of neonatal sepsis and appropriate treatment decreases the mortality and morbidity of these infants. The aim of this study was to assess the role of pro­calcitonin (PCT) as a marker in the early diagnosis, treatment and follow-up of neonatal sepsis. Thirty-eight neonates with clinical (n=8), suspected (n=19) and proven sepsis (n=11) were evaluated. The PCT levels were measured by immunoluminoassay before and on day 5 of treatment. PTC levels of 0.5-2 ng/ml, 2.1-10 ng/ml and >10 ng/ml were considered as weakly positive, positive, and strongly positive, respectively. The sepsis screen tests and cultures of blood or other sterile body fluids in these three groups of infants were recorded. The levels of PCT in proven sepsis group were higher than that in other groups. Strongly positive PTC level was seen in none of 8 cases of clinical sepsis, 4 of 19 suspected and in 10 of 11 cases with proven sepsis. PCT levels were dramatically decreased in three groups on day 5 of treatment. The results show that the serum procalcitonin levels seem to be significantly increased in proven sepsis and decrease dramatically in all types of sepsis after appropriate treatment.

The purpose of this study was to investigate the effect of traditional games on fundamental motor skills in seven to nine-year-old boys. Forty subjects of seven to nine-year-old boys selected randomly by a personal information questionnaire. After pretest by Test of Gross Motor Development- edition 2 (TGMD-2), gross motor skill, locomotor and object control motor skills, subjects were divided by random matching into two groups. The first group performed traditional games and the second group performed daily activities. Then children in first group played traditional game at 24 sessions. After 12 and 24 sessions, traditional game and daily activity groups participated in the mid and post tests. Data were analyzed by Variance Analyze of Repeated Measures. The results showed that traditional games with mean difference in fundamental motor skill development (17.12, P<0.001), and also with mean difference in locomotor (2.23, P=0.002), and mean difference) in object control skill development (2.27, P=0.002) significantly are more effective than daily activities. Traditional game program is appropriate for a fundamental motor skill development.

This study was conducted to determine the eventual association between copper deficiency in newborns with neural tube defects (NTD) in Northern Iran. A high prevalence of neural tube defects has been reported from this region. This hospital based case control study was carried out on 13 newborns having neural tube defects and 35 healthy controls in Northern Iran during 2005-2006. Serum copper was measured by spectrophotometery. Serum copper level in newborns with NTD and healthy normal newborns was 16.5 (±7.2) μmol/l and 16.7 (±6.6) μmol/l, respectively. In case group 38.5% of newborns and in control group 28.6% had copper deficiency. Logistic regression analysis showed no association between the presence of NTD and copper deficiency (OR:1.6, 95% CI=0.3-7.1, P=0.5). This study showed no association between NTD and copper deficiency in newborns.

The aim of this study was to estimate the prevalence of overweight and obesity in 7 to 18-year-old children in Birjand (east Iran) in 2005-2006. Individuals selected using multistage stratified random sampling. This cross-sectional study was performed on 6093 students (2995 boys and 3098 girls) aged 7-18 years in Birjand (2005-2006). Subjects were selected via step-wised random sampling in four districts of the city. Body weight and height were measured directly. Percentiles were calculated for body mass index (BMI) Overweight and obesity was defined based on the 85th and 95th percentiles of body mass index for age and sex, respectively, as proposed by CDC in 2000. The overall prevalence rates of overweight and obesity were 4.8% and 1.8%, respectively. Overweight prevalence varied by age from 1.6% to 9.1% in girls and 0.5% to 7.8% in boys, with obesity rate from 0.8% to 2.5% in girls and 0.5% to 3.7% in boys. According to this study, prevalence rate of overweight and obesity in Birjandi children is lower than that in many other parts of Iran and some neighboring countries.

Allergic diseases are frequent in children and their prevalence and severity differ in different regions of the world. It has been hypothesized that antibiotic use, early in life, may increase the subsequent risk of asthma and other allergic disorders. The aim of this study was to investigate the association between the use of antibiotics in the first year of life and the subsequent development of asthma and other allergic symptoms. In our survey using standardized methods (International Study of Asthma and Allergies in Childhood), parents of 6-7 year-old children were questioned regarding asthma, allergic rhinitis and eczema symptoms in their children. The prevalence of ever wheezing, wheezing during past 12 months and exercise-induced asthma in the children who took antibiotics in the first year of life were not different statistically but the prevalence of asthma ever was significantly higher. No significant relationship was found between the use of antibiotics and hay fever or eczema. We found that the use of antibiotics in early childhood was not associated with an increased risk of developing allergic symptoms in children.

The aim of the study was to determine the etiology of Chronic Kidney Disease (CKD) among children attending the pediatric nephrology service at Abuzar children''s hospital in Ahvaz city, the referral center in Southwest of Iran. We reviewed the records of 139 children, diagnosed to have CKD over a 10-year period. CKD was defined a glomerular filtration rate (GFR) below 60 ml/1.73 m2/min persisting for more than 3 months. Among 139 children 81 (58%) were males. The mean age at diagnosis of CKD in the patients was 4.2 (±3.6) years. Mean level of serum creatinine at presentation was 1.9 (±1.4) mg/dl. The mean GFR at presentation was 33.5 (±15.4) ml/1.73m2/min while 22% of the patients were already at end stage renal failure indicating that these children were referred too late. Congenital urologic malformation was the commonest cause of CKD present in 70 (50.4%) children [reflux nephropathy (23.1%), hypo/dysplastic kidney (15.8%), obstructive uropathy (10.8%), and prune belly syndrome (0.7%)]. Other causes included hereditary nephropathies (17.2%), chronic glomerulo-nephritis (6.5%), multisystemic diseases (4.3%), miscellaneous and unknown (each one 10.8%). The mean duration of follow-up was 26 (±24.67) months. Peritoneal or hemodialysis was performed in 10 patients. Six patients underwent (4 live-related and 2 non-related) renal transplantation. The rest have died or received standard conservative management for CKD. The commonest causes of CKD were reflux nephropathy, hypo/dysplastic kidney, hereditary nephropathy and obstructive uropathy. Patients presented late, had severe CKD and were malnourished and stunted.

Urinary calcium excretion is different in various geographical regions. Therefore, we decided to evaluate the urinary calcium excretion in pediatric inhabitants of residential districts in the Desert of Iran and to determine the frequency of hypercalciuria. This study was carried out from 2004 to 2005 on healthy children aged 7-12 years in Kashan (Central Desert of Iran). By proportional cluster sampling 95 rural and 305 urban cases were selected. The second non fasting morning urine sample was collected for measuring sodium, creatinine and calcium. Children whose urine calcium to creatinine ratio was more than 0.2 and urine sodium more than 200 meq/l were considered as hypercalciuric and hypernatriuric. Water samples were collected by health worker from 9 regions of the city and 9 villages for chemical analysis. The differences between frequencies were assessed by chi square test. P values less than 0.05 were considered significant. A total of 362 (175 females, 187 males) with a mean age of 9.5 (±1.4) years were studied. Mean urinary calcium/creatinine concentration ratio was 0.2 (±0.17). The 95th percentile value for urine calcium/creatinine concentration was 0.53 and prevalence of hypercalciuria was found as 37.8%. The contents of water were similar in Kashan city and the villages, only the mean of total water density was higher in water supply of the city (P<0.05). By regression analysis we found only direct but weak correlation between urine calcium and urine sodium excretion (r=0.37, P=0.0001). Urinary calcium excretion is high in desert of Kashan; thus it is important to conduct more studies to determine the risk factors and its untoward effect such as nephrolithiasis.

The requirement of vitamin D for breast-fed term infants remains an area of controversy. Different dosage is needed according to environmental factors such as sunlight exposure. Reception of more than 400 I.U. of vitamin D daily produces hypercalcemia. A random urine calcium/creatinin ratio (UCa/Cr) is a screening test for detection of hypercalciuria. Setting adequate values of vitamin D3 prophylaxis by random UCa/Cr in infant population of Yazd city in Iran, is the aim of present study. A total of 90 healthy, full term newborns of both genders were enrolled in the study. They were divided equally into three receiving vitamin D3 prophylaxis groups as follow: (I) 200 IU/daily, (II) 400 IU/daily and (III) 50000 IU two times in fifteen and sixty days after birth. A random urine specimen from each subject was analyzed for calcium, creatinin and serum 25-hydroxy-vitamin D at the end of three months of life. From all 90 studied infants, 25 (83.3%) infants with 200 IU/daily vitamin D3, 23 (76.7%) infants with 400 IU/daily vitamin D3 and 28 (93.3%) who received 50000 IU two times (76 infants, 84.4%) had hypercalciuria and 14 (15.6%) infants remained with low values of Ca/Cr ratios. According to high prevalence of hypercalciuria in this survey, it is recommended to evaluate the vitamin D level in infants and use proper amount of supplemented vitamin D. It seems that 200 IU/daily could be used in infants in our area.

Recently, studies reported the emergence and increasing popularity of the alternate use of acetaminophen and ibuprofen. The aim of the present study was to compare the clinical effectiveness of acetaminophen alone with an alternative regimen of acetaminophen and ibuprofen in hospitalized infants aged 9-24 months with fever of non bacterial origin. The study was performed between March 2006 and December 2007, in pediatric center of two hospitals in Urmia. Patients were randomly separated into two groups. Eligible cases were febrile hospitalized patients aged between 9 and 24 months; whose rectal temperature was ≥38.5oC. Infants of case group received 10 mg/kg ibuprofen alternating with 15 mg/kg acetaminophen every four hours. Infants of control group received 15 mg/kg acetaminophen every four hours. Temperature of patients in the two groups was registered 2, 4, 5, 7, and 8 hours after drug administration. The study was completed when each group received 35 cases. Seventy infants were divided into two groups. The case group consisted of 19 males and 16 females, in control group there were 18 males and 17 females. The results revealed significant difference between the two groups in lowering fever at 4, 5, 7 and 8 hours after treatment was initiated, but there was no significant difference at 2 hours after drug administration. An alternating treatment of acetaminophen (15 mg/kg) and ibuprofen (10mg/kg) 4 hours later is more effective than acetaminophen in lowering fever in 9 to 24 month old infants.

Screening of kidney diseases by urinalysis in preschool children was approved in many parts of the world with inexpensive tools such as urinary dipsticks. In this study the researchers investigate the prevalence of hematuria and proteniuria in 4 to 6-year-old children in daycare centers of Rasht (Iran). The researchers examined proteinuria and hematuria in 1520 healthy children in daycare centers of Rasht. Urine strips were employed to examine the urine which was already collected from the subjects. Another urine sample was collected from those children with abnormal findings in the first samples with dipstick of the same brand a month later. If any positive result was found again, the urine was analyzed with dipstick and microscope concurrently. In the first dipstick samples, the prevalence was 3.2% for hematuria, 5.8% for proteinuria, and 0.13% for a mixture of proteinuria and hematuria. In the second urinalysis in patients with positive findings, hematuria, proteinuria as well as mixed proteinuria and hematuria were 20.4%, 52.0%, and 2.0% correspondingly. In the third analysis of samples, the abnormal findings in all patients were 13 (0.85%) isolated hematuria, 24 (1.57%) isolated proteinuria and one (0.06 %) mixed hematuria and proteiuria. This study showed that the prevalence of proteinuria and hematuria during pre-school period (4 to 6 year-olds) may reveal relatively similar frequencies of some other studies.

Penile agenesis (PA) is an extremely rare anomaly with profound urological and psychological consequences. The opening of the urethra could be either over the pubis or at any point on perineum or most frequently in anterior wall of the rectum. The aim of treatment is an early female gender assignment and feminizing reconstruction of the perineum.Case(s) Presentation: We report 8 cases of penile agenesis with urination and defecation through the rectum, apparently normal scrotum, bilateral descended testis, normally located anus, urethral opening in anus, 46xy karyotype and associated anomalies. In 2 cases parents refused any surgical interventions, but in 6 cases we did perform different operations (transforming five cases to females and one case to male gender). We recommend feminizing operations in newborns or infants, but in older patients, regarding the child''s psychology, it is advised to perform masculinizing operations, and finally, no surgical intervention should be undertaken before counseling the parents.

Hemihydranencephaly is a rare disorder of the brain characterized by complete or almost complete unilateral absence of cerebral cortex with preservation of meninges, basal ganglia, pons, medulla, cerebellum, and falx. Thirteen year-old male child presented with left sided upper and lower limb weakness with facial asymmetry since the age of six months. His magnetic resonance imaging (MRI) scans demonstrated a nearly complete absence of the right cerebral hemisphere including basal ganglion, which was replaced by cerebrospinal fluid with a small residual rim of the occipital cortex. The imaging features were suggestive of right-sided hemihydranencephaly. Patients with hemihydranencephaly provide an experiment of nature with potential implications for normal cognitive development and illustrate how much there is still to be learned about human development.

Aplasia cutis congenital (ACC) is a congenital absence of skin most commonly affecting the scalp. No definite etiology is available but multiple causes such as intrauterine infection, fetal exposure to cocaine, heroin, alcohol or antithyroid drugs, vascular disruption, genetic causes, syndromes and teratogens have been suggested. We present an infant with symmetrical type of aplasia cutis on the trunk and proximal limbs. She was product of triple pregnancy with two fetuses papyraceous at 12th week of gestational age and at birth. She is treated by non surgical management despite remarkable extent of the lesion. ACC of the trunk is less common than of scalp. Lesion often is symmetric and seen after fetus papyraceous in multiple pregnancies.

Waardenburg syndrome (WS) is a rare, autosomal dominant disorder characterized by congenital hearing loss; dystopia canthorum; broad nasal root; depigmantation of hair, skin or both; and heterochromic iris. WS is classified into four types, WS1, WS2, WS3 and WS4. In this paper, we report a new case of Waardenburg syndrome type I in an Iranian female. This report describes a two-year-old female with Waardenburg syndrome type I with features such as unilateral profound sensorineural hearing loss, white forelock, dystopia canthorum, broad nasal root, hypopigmentation of skin and scalp defect. As no treatment is available for patients with WS1, conservative treatments such as skin graft and referral to a hearing specialist are crucial for the normal development of patients.

Cystic fibrosis is a hereditary disease of mucus and sweat glands characterized by respiratory infections and pancreatic insufficiency. We describe a girl infant with cholestasis as of the first clinical presentation at the age of 1 month. She developed severe anemia which required transfusion for several times. High level of direct bilirubin, low level of albumin and positive sweat tests were detected in laboratory tests. Histopathology report of liver biopsy indicated giant cell neonatal hepatitis. Although neonatal hepatitis is common cause of neonatal cholestasis, such condition is quite rare in cystic fibrosis, which easily could be misdiagnosed. Early diagnosis and appropriate treatment could prevent further complications of the disease.