International Journal of Pediatrics
Volume:3 Issue: 19, Jul 2015

Children with severe asthma attack are a challenging group of patients who could be difficult to treat and leading to significant morbidity and mortality. Asthma attack severity is qualitatively estimated as mild, moderate and severe attacks and respiratory failure based on conditions such as respiration status, feeling of dyspnea, and the degree of unconsciousness. Part of which are subjective rather than objective. We investigated clinical findings as predictors of severe attack and probable requirement for Pediatric Intensive Care Unit (PICU) admission. In a cross sectional and analytical study, 120 patients with asthma attack were enrolled from April 2010 to April 2014 (80 admitted in the pediatric ward and 40 in Pediatric Intensive Care Unit). Predictors of PICU admission were investigated regarding to initial Heart Rate (HR), Respiratory Rate (RR), Oxygen Saturation in Arterial Blood (SaO2) and Partial Pressure of Carbon Dioxide in Arterial Blood (PaCo2) and clinically evident cyanosis. Initial heart rate (P=0.02), respiratory rate (P=0.03), Arterial oxygen saturation (P=0.02) and PaCo2 (P=0.03) and clinically evident cyanosis were significantly different in two groups (Ward admitted and PICU admitted). There was a significant correlation between initial vital sign and blood gas analysis suggesting usefulness of these factors as predictors of severe asthma attack and subsequent clinical course.

The extended program of immunization (EPI) in Iran is started in 1984, and it played an important and effective role in controlling many infectious diseases in community. The objective of this study was to determine the time trends of vaccination coverage by the type of vaccine among children, in the age group of 0-24 months, in Iran from the beginning of EPI (1984) to 2013. This study has been conducted as a descriptive analytical research to evaluate the vaccines of extended program of immunization in Iran from 1984 to 2013. The data of this study have been obtained from the World Health Organization and UNICEF. The data of this study included the percentage of coverage for routine vaccines in Iran National immunization program in children, aged 0-24 months. The data analysis has been done by STATA, Version12. The coverage of all vaccines has been continuously increased from 1984 to 2013, and now the coverage for all of them is about 99 percent. All coefficients in the regression models are positive and statistically significant (P <0.05). Birth dose of Hepatitis B (HepBB) and third dose of diphtheria–tetanus–pertussis containing vaccine (DPT3) variables with coefficients of 1.52 and 1.34 had the highest rate of increasing during this period, respectively. The first dose of diphtheria–tetanus–pertussis containing vaccine (DPT1) with a coefficient of 0.65 had the lowest coefficient among other variables. According to the findings, maintaining the wide coverage, monitoring and updating the program can play an important role to improve children''s health, contagious disease prevention, and health promotion.

Children may be intentionally or unintentionally exposed to any substance. Substance poisoning is one of the most important emergency interventions in children that cause a great number of deaths each year. Regarding the importance of this issue and recent increase in number of poisoning cases, a study with the aim of investigating cases of substance poisoning and factors involved in emerging them was carried out in Children Hospital of Tabriz. The present descriptive cross-sectional study was carried out on hospitalized children with substance poisoning diagnosis during two years. The data was collected through referring to patients’ case and using demographic information questionnaire and symptoms checklist. The data was analyzed using SPSS-13, descriptive statistics, t- test, chi- square and spearman tests. During two years, 97 children with the mean age of 48.6± 32.3 months were hospitalized due to substance poisoning. 59.3% of the study population consisted of boys and 40.7% of girls. Drowsiness, decreased level of consciousness, vomiting and pin point pupil were the most common symptoms recorded in children. The relationship between the type of substance and parents’ addiction was statistically significant (P<0.05). There was no significant relationship between intentional and unintentional poisoning and parents’ addiction (P>0.05). Non-specific package, unsafe keeping, and shortage of people’s knowledge are among the most important factors involved in methadone poisoning in children. Delivering clear information about the fatal effect of this drug on children by health- care personnel especially doctors seems be necessary.

Urinary tract infections (UTIs) are one of the most important bacterial infections among children throughout the world. The study aimed to assess the cost of hospitalization associated with pediatrics UTIs in Kermanshah province between 20 April 2013 and 20 February 2015. This survey was a cross sectional and descriptive study. The study subjects included all those aged 20 years and younger who were admitted to the Imam Reza hospital, a referral hospital in Kermanshah, with the diagnosis primary of the UTI in the studied period. The data on age, gender, Length of stay (LOS), and cost of hospitalization were collected from the medical records. The data analysis was performed by Stata V.12. Overall average of age and length of stay was 2.7+ 3.9 years and 6.2+ 4.4 days, respectively. The study showed the average cost per patient and per one day hospitalization was 9,206,699 and 1,484,951 Iranian Rials (IRR), respectively. Patient’s share of total cost of hospitalization in before and after Health Sector Evolution Program (HSEP) was 1,565,710 and 982,619 IRR, respectively. In addition, there are a significant positive relationship between age, being boy and length of stay with total cost of hospitalization. Our finding implies that the total cost of pediatric UTIs is substantial; at about 877,719,440 IRR before HSEP and 1,734,770,576 IRR after HSEP. The study also indicates that Health Sector evolution program causes considerable decrease the patient’s share of total cost of hospitalization (8.7 % vs. 23.4 %).

Diabetes mellitus (DM) is a major public health problem. Objective of current study was to know the demography, clinical characteristics and etiology of youth diabetes mellitus in Kashmir, North India. A prospective hospital based study, carried out in the Department of Endocrinology, SKIMS Srinagar, Kashmir- India, in a two-year period. All the new youth onset diabetes patients whose age were less than twenty five years and were admitted in endocrinology ward for various reasons over the period from July 2008 to September 2010 were enrolled in this study. Variables recorded were demographics, clinical presentation, laboratory tests. A total of seventy two patients of youth onset diabetes mellitus with a mean age of 16.7 + 5.7 years were studied. There were 33 males (45.8%) and 39 females (54.2%). Fifty nine patients (81.9%) presented with osmotic symptoms; hypoglycemic episodes were present in forty one (56.9%) patients. Family history of type 1 diabetes mellitus was present in nineteen (26.4%) patients; fourteen were less than 20 years and five more than 20 years. Sixteen (22.2%) patients had nephropathy. Diabetic ketoacidosis (DKA) at initial presentation was diagnosed in thirteen (18.1%) of the patients and nine (12.5%) had retinopathy. Osmotic symptoms, hypoglycemic episodes and family history of diabetes were the most common presenting symptom. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients.

The preservation and promotion of the health in children who are one of the most vulnerable parts in any society has an important role in the health system of each country. In this study, the socioeconomic factors affecting the infant mortality in Eastern Mediterranean Regional Office (EMRO) countries have been examined during the time period from 2000 to 2013. This study was a panel data type estimated by using the method of random effects. The Likelihood ratio (LR) and Wooldridge tests have been applied to investigate the hetereoskedasticity and autocorrelation. The data used in this study have been collected from the websites of the World Bank and the World Health Organization (WHO). The studied panel has been evaluated by Feasible Generalized Least Squares (FGLS) method due to the existence of hetereoskedasticity. The results showed that the variables of per capita national income logarithm, vaccination coverage of Measles, the education level of 15 to 24-year-old women, per capita health expenditures, and the accessibility of improved health facilities, had an inverse association with the mortality rate of children. All variables except vaccination coverage for Measles had significant association. The per capita national income also had the greatest impact in decreasing the mortality rate of children. The findings indicate that socioeconomic inequality in infant mortality in EMRO countries is determined not only by health system functions but also by factors beyond the scope of health authorities such as education system, and economic variables.

The aim of this study was to assess the incidence of thrombocytopenia and changes in various platelet parameters in neonates with blood culture positive sepsis. This was prospective study conducted over a period of one year in Neonatal Intensive Care Unit of Deen Dayal Upadhyay Hospital (DDUH), in Delhi, North India. All babies who were admitted during the study period were evaluated prospectively for evidence of sepsis. Among 560 neonates, 80/560 (14.28%) had culture positive sepsis. Gram- positive sepsis occurred in 21/80 (26.25%), gram- negative sepsis in 54/80 (67.5%), and fungal sepsis in 5/80 (6.25%). Incidence of thrombocytopenia in gram- negative sepsis was (35/54) 64.81%, in gram- positive sepsis (15/21) 71.41%, and in fungal sepsis was (3/5) 60%. Mean platelet count at the onset of sepsis in all the patients was 123287.5± 49428.68. The mean duration of thrombocytopenia in gram- positive sepsis was 4.66 ±2.6 days, in gram- negative sepsis 4.39 ± 2.22 days and in fungal sepsis 5.2±1.3 days. Mean platelet volume (MPV) at the time of onset of sepsis was high in gram- positive sepsis than in gram- negative sepsis (11.57±0.88 Vs 11.29 ± 0.76). The MPV of thrombocytopenic neonates was significantly higher than of non-thrombocytopenic neonates (P< 0.01). In this study, incidence of culture positive sepsis in neonates was 14.28%; thrombocytopenia was present in 66.25% of neonates with sepsis. Thrombocytopenia had 66.25% sensitivity and 87% specificity in predicting sepsis among culture positive patients.

Proximal displacement of stomach and gastro-esophageal junction into the thoracic cavity results in a condition known as Hiatal Hernia (HH). Sometimes this entity is overlooked in practice and patients are managed as non-surgical diagnoses such as gastroesophageal reflux disease or asthma.Case Report: A 6 month-old female infant has presented with bloody emesis for four months. She was evaluated and diagnosed with gastritis and treated with proton pump inhibitors accordingly. She later developed respiratory symptoms and a chest x-ray was ordered. It showed a retro cardiac shadow by which the correct diagnosis was reached. In the primary work up of patients with gastrointestinal or respiratory symptoms anatomical abnormalities should be considered. HH is an example of these abnormalities that is frequently missed by primary care physicians especially in the pediatric population.

Primary vision care is recommended for infants and young children. Childhood is critical time to prevent loss of vision and to optimize treatment so some eye disorders in children must be diagnosed at this time. To detect risk factors and visual abnormalities, the eye screening done by pediatricians and other primary care providers is necessary. The process that should be occur at each child visit to identify those patients who require referral to ophthalmologist and can be a preventative health measure. Thus, it is important that pediatricians increased knowledge about the eye conditions that may affect their youngest patients. This article reviews the most important pediatric eye condition that primary care providers may encounter.

The age of criminal responsibility of children in the Islamic Penalties Act has been determined as religious Bulugh (puberty) Nasab. According to this, criminal authorities hold girls criminally liable and punishable at 9 complete lunar years and boys at 15 complete lunar years. Unfortunately, our legislator has set criminal responsibility of children based on sexual maturity; therefore, thousands of newly born infants who are unable to think have been liable to punishment, while in the realization of criminal responsibility, there is a need for intellectual maturity (growth) in addition to sexual maturity; that is, in the realization of criminal responsibility of children, there are two necessary conditions: «attainment of puberty boundary» and «achieving growth and attainting intellectual maturity»; otherwise, the child has no criminal responsibility and we cannot hold him liable for his action and punish him. In this research, an attempt is made to address the problems of the Act by drawing on the Islamic sources.

Acute respiratory infections, diarrhea and fever are very common in children below the age of five years. All children suffer from these illnesses several times each year. However, during natural disasters like floods children are even more vulnerable to these diseases and death. Pneumonia, diarrhea, measles and malaria, and associated malnutrition, are responsible for over 60% deaths in children under five. During an emergency the proportion of children dying of the above mentioned diseases may be higher. It is possible for health workers to treat most sick children at health camps or in the community and save them from dying. This survey describes the steps to be followed by a health worker when managing a sick child in emergency situations.