Journal of Comprehensive Pediatrics
Volume:4 Issue: 2, Dec 2013

Context: Respiratory tract infections are the main cause of children’s morbidity and mortality both in the developing and the developed countries. An accurate understanding of the epidemiology of these diseases, identification of risk factors, etiology and seasonality are critical for successful treatment and/or prevention program.Evidence Acquisition: This article aims at offering clinicians a brief update on the recent epidemiology of respiratory infections in pediatrics. It also underlines the fact that any evidence-based recommendation needs more research in different areas. Almost 150 million new episodes of pneumonia are identified per year worldwide more than 90% of which occur in developing countries. Nearly 30% of total annual deaths occur in children younger than 5 years old. Viruses remain the most common cause of RTIs. S. pneumonia and HIB are the main causes of bacterial pneumonia in the world; however, infections due to many of these pathogens can be prevented. Widespread immunization against influenza, measles, bacilli calmette-guerin (BCG) and now pneumococcus have been related to the decline of the LRTIs in children..

It has been shown that trend of achieving to Millennium Development Goal 4 (MDG 4), varies by region and between countries, indicating the possibility of existing different barriers and/or facilitators. This study aimed to evaluate the trend of Under Five Mortality Rate (U5MR), and Infant Mortality Rate (IMR) and explore the main challenges to reach MDG 4 by 2015.Patients and In 2009, we have reviewed the latest countries’ MDG reports. The key stakeholders, from both governmental and international organizations in the country have been visited, and interviewed by the research team as a part of the data triangulation process. The last data on U5MR and IMR has been explored, and the achievements were tracked. The U5MR and IMR varied from 257 and 165 deaths per 1000 live births in Afghanistan, to 24 and 17 in Turkey, respectively. Turkey has already reached the U5MR and IMR goals. Afghanistan, Uzbekistan, and Pakistan were at risk of not reaching the goals, and Iran and Tajikistan were a little beyond the time schedule. Turkmenistan, Kirghizstan and Azerbaijan were on the track on MDG on U5MR. Regarding IMR, Afghanistan, Uzbekistan, Pakistan and Iran were at the risk of not reaching the MDGs in 2015, and Turkmenistan, Kyrgyzstan and Azerbaijan were on the track. Adult literacy, Expenditure on Health and Out-of-Pocket Expenditure on Heath had a strong association with both U5MR and IMR. it is optimistically expected that few of ECO countries would reach the target millennium goals. More focus on the basic needs of communities through a comprehensive primary health care system, and improving health financing are experiences worked in the region, and could help the ECO countries to improve more in MDGs health related achievements.

Undernutrition is the most common cause of growth retardation in developing countries. We aimed to assess the effect of undernutrition on cognition, intelligence quotient, and impulsivity index of 7-11 year-old children in Shiraz, southern Iran. Our objective was to determine the association between chronic moderate undernutrition and poor Intelligence Quotient and Impulsivity Index..Patients and In this case-control study, two groups of school-aged children with the mean age of 9 ± 0.98 years were enrolled. After controlling the confounding variables, 24 children with moderately chronic undernutrition (group 1) were compared to 17 normal children (group 2). We selected children based on growth parameters, evaluation of intensity, history, and by excluding underlying diseases. Intelligence quotient and draw-a-person tests were performed. We described data as mean and standard deviations, and used the t test for independent groups. Data was analyzed using SPSS software, version 11.5. Significance level was considered as 5%. Only P5 (omissions) and P7 (relativities) parameters in the DAP test were significantly different. The Mean ± SD in the undernourished and normal groups were respectively 0.91 ± 0.28, 0.70 ± 0.46 for p5 (P = 0.030), and 0.64 ± 0.49, 0.35 ± 0.49 for p7 (P = 0.024), and 17.8 ± 1.89, 19 ± 1.80 (P = 0.050) for spelling. For verbal intelligence quotient, (VIQ) were 115 ± 9.7, and 113 ± 10.6 (P = 0.528). For performance intelligence quotient, (PIQ) were 117 ± 14.1, and 116 ± 11.3 (P = 0.864). For total intelligence quotient, (TIQ) were 117 ± 10.3, and 116 ± 10.2 (P = 0.715). For impulsivity index were 5.3 ± 2.8, and 4.3 ± 2.6 (P = 0.256). Chronic and moderate malnutrition did not influence the cognitive function, the intelligence quotient, and the impulsivity index..

Ureaplasma urealyticum (U. urealyticum) and Mycoplasma hominis (M. hominis) are two important pathogens in neonatal respiratory tract infections. As low gestational age and birth weight increase the colonization rate with these pathogens, and they are also risk factors of chronic lung disease (CLD), it is difficult to establish a statistically significant relation between these two factors. To determine the colonization rate of preterm ventilated neonates with U. urealyticum and M. hominis, and the relationship between infection and chronic lung disease in these neonates, a prospective study was performed.Patients and Determining tracheal colonization rate of preterm neonates with ureaplasma and mycoplasmsa and its relation to CLD. In a cohort prospective study in Hazrat Rasoul Akram Hospital, with 62 ventilated neonates (< 35 weeks) in the first 24 h of life, where tracheal secretions were aspirated, transported, and cultured in a specific media. CLD was diagnosed as oxygen requirement at 28 days or 36 weeks post conceptional age. From 62 cultures, 7 were positive for U. urealyticum (11.3%, CI95%: 3.4-19.2%) and 3 were positive for M. hominis (4.8%, CI95%: 0-10.2%). From 53 neonates who were alive at 28 days after birth, 11 neonates needed oxygen (20.8%, CI95%: 9.8-31.7%). From 10 neonates with positive cultures, 2 (20%, CI95%: 0-44.8%) died, and from 8 alive neonates, 3 (37.5%, CI95%: 4.0-71.0%) survived without CLD. From 52 neonates with negative cultures, 7 (13.5%, CI95%: 4.2-22.7%) died, and from 45 alive neonates, 39 (86.7%, CI95%: 76.7-96.6%) survived without CLD, and there was a significant difference between neonatal groups with positive and negative tracheal culture progressing to CLD (62.5% vs. 13.3%) (P < 0.001) (Figure 1). Intrauterine infection with U. urealyticum and M. hominis leads to negative neonatal outcome and increased rate of chronic lung disease in preterm neonates (< 35 weeks).

Lower gastrointestinal bleeding (LGIB) in infants and children is a common problem in medical centers; however, its epidemiologic properties have not been studied well. Due to the fact that LGIB has various causes in different geographical places, considering the importance of etiology in decision making for diagnostic techniques and treatment and since the lack of comprehensive database related to this issue, the main purpose of the current study was to determine the main causes of LGIB in children in a single center from Southern Iran.Patients and The study was conducted on all the patients less than 18 years old with LGIB who referred to Pediatric Gastroenterology Ward affiliated with Shiraz University of Medical Sciences between 2005 and 2009. The data, including the patients’ sex, age, and endoscopic as well as pathological findings, were collected and analyzed. Overall, our series included a total of 309 patients with LGIB (185 males and 124 females) below 18 years old. The most common causes of LGIB included colorectal polyps (n = 90; 29.1%), lymphoid nodular hyperplasia (n = 62; 20%), solitary rectal ulcer (n = 31; 10%), and inflammatory bowel disease (n = 20; 6.5%). Nevertheless, no obvious causes were identified in 30.7% of the patients. The prevalence of lymphoid nodular hyperplasia in less than 2 years old patients and colorectal polyps in the 2-6 years old patients were significantly higher than the other causes (P = 0.001). The most cases with inflammatory bowel diseases and solitary rectal ulcer were more than 2 years old. On the other hand, no statistically significant differences were observed between males and females as well as different age groups regarding the means of the underlying causes of LGIB (P > 0.05). The results of present study could be used by the Iranian physicians in order to gain an overall picture of LGIB in Iran and guide the management of the patients with LGIB.

Despite improvements in medical care provided during pregnancy to diabetic mothers, the cardiac complications in their infants are still more frequent than in the infants of general population. The primary objective of this study was to explore the spectrum of cardiovascular complications in infants of diabetic mothers (IDMs). The study was also aimed at investigating probable relations between infants’ heart lesions, the type of maternal diabetes, and the neonatal somatic data.Patients and Between July 2010 to June 2011, two-dimensional/M-mode and Doppler echocardiography evaluations were performed in IDMs at the out-patient clinic of the pediatric cardiology ward of a University hospital in Tehran. A total of 32 IDMs (18 male and14 female) were studied. Congenital heart disease (CHD) was found in 6 (18.7%) neonates and 3 of them suffered from conotruncal malformations. Hypertrophic cardiomyopathy (HCM) was observed in 15(46.9%) cases. There were 22 (68.8%) large for gestational age (LGA) infants. Gestational diabetes was found in 21(65.6%) mothers. We did not find a significant relation between the types of maternal diabetes and the frequency of CHD (P = 0.9), and the frequency of HCM in their infants (P = 0.9). Also a significant relation could not be found between LGA and the rate of CHD (P = 0.6) or the rate of HCM (P = 0.4). Our data showed a high prevalence of CHD in IDMs in our pediatric cardiology clinic. Neither the types of maternal diabetes nor the somatic findings of newborns were related to the occurrence of cardiac complications.