International Journal of Pediatrics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Neonatal Septicemia in Nepal: Early-Onset versus Late-Onset Mon, 16 Nov 2015 14:10:12 +0000 Introduction. Neonatal septicemia is defined as infection in the first 28 days of life. Early-onset neonatal septicemia and late-onset neonatal septicemia are defined as illnesses appearing from birth to three days and from four to twenty-eight days postnatally, respectively. Methods. In this cross-sectional study, blood samples from the suspected infants were collected and processed in the bacteriology laboratory. The growth was identified by standard microbiological protocol and the antibiotic sensitivity testing was carried out by modified Kirby-Bauer disk diffusion method. Results. Among total suspected cases, the septicemia was confirmed in 116 (12.6%) neonates. Early-onset septicemia (EOS) was observed in 82 infants and late-onset septicemia (LOS) in 34 infants. Coagulase-negative staphylococcus (CoNS) (46.6%) was the predominant Gram-positive organism isolated from EOS as well as from LOS cases followed by Staphylococcus aureus (14.6%). Acinetobacter species (9.5%) was the predominant Gram-negative organism followed by Klebsiella pneumoniae (7.7%). Conclusions. The result of our study reveals that the CoNS, Staphylococcus aureus, Acinetobacter spp., and Klebsiella pneumoniae are the most common etiological agents of neonatal septicemia. In particular, since rate of CoNS causing sepsis is alarming, prompting concern to curb the excess burden of CoNS infection is necessary. Shamshul Ansari, Hari Prasad Nepal, Rajendra Gautam, Sony Shrestha, Puja Neopane, and Moti Lal Chapagain Copyright © 2015 Shamshul Ansari et al. All rights reserved. Danger Signs of Childhood Pneumonia: Caregiver Awareness and Care Seeking Behavior in a Developing Country Wed, 21 Oct 2015 13:59:34 +0000 Background. Efforts to reduce child mortality especially in Africa must as a necessity aim to decrease mortality due to pneumonia. To achieve this, preventive strategies such as expanding vaccination coverage are key. However once a child develops pneumonia prompt treatment which is essential to survival is dependent on mothers and caregiver recognition of the symptoms and danger signs of pneumonia. Methods. This community based cross-sectional study enrolled four hundred and sixty-six caregivers in Enugu state. It aimed to determine knowledge of caregivers about danger signs of pneumonia and the sociodemographic factors that influence knowledge and care seeking behaviour of caregivers. Results. There is poor knowledge of the aetiology and danger signs of pneumonia among caregivers. Higher maternal educational attainment and residence in semiurban area were significantly associated with knowledge of aetiology, danger signs, and vaccination of their children against pneumonia. Fast breathing and difficulty in breathing were the commonest known and experienced WHO recognized danger signs while fever was the commonest perceived danger sign among caregivers. Conclusion. Knowledge of danger signs and health seeking behaviour among caregivers is inadequate. There is need for intensified public and hospital based interventions targeted at mothers to improve their knowledge about pneumonia. Ikenna K. Ndu, Uchenna Ekwochi, Chidiebere D. I. Osuorah, Kenechi S. Onah, Ejike Obuoha, Odutola I. Odetunde, Ikenna Nwokoye, Nnenne I. Obumneme-Anyim, Ifeyinwa B. Okeke, and Ogechukwu F. Amadi Copyright © 2015 Ikenna K. Ndu et al. All rights reserved. Improving ECG Services at a Children’s Hospital: Implementation of a Digital ECG System Mon, 14 Sep 2015 11:35:41 +0000 Background. The use of digital ECG software and services is becoming common. We hypothesized that the introduction of a completely digital ECG system would increase the volume of ECGs interpreted at our children’s hospital. Methods. As part of a hospital wide quality improvement initiative, a digital ECG service (MUSE, GE) was implemented at the Children’s Hospital at Montefiore in June 2012. The total volume of ECGs performed in the first 6 months of the digital ECG era was compared to 18 months of the predigital era. Predigital and postdigital data were compared via -tests. Results. The mean ECGs interpreted per month were 53 ± 16 in the predigital era and 216 ± 37 in the postdigital era (), a fourfold increase in ECG volume after introduction of the digital system. There was no significant change in inpatient or outpatient service volume during that time. The mean billing time decreased from 21 ± 27 days in the postdigital era to 12 ± 5 days in the postdigital era (). Conclusion. Implementation of a digital ECG system increased the volume of ECGs officially interpreted and reported. Frank A. Osei, Gregory J. Gates, Steven J. Choi, Daphne T. Hsu, Robert H. Pass, and Scott R. Ceresnak Copyright © 2015 Frank A. Osei et al. All rights reserved. Safety of a Bioactive Polyphenol Dietary Supplement in Pediatric Subjects with Acute Diarrhoea Mon, 07 Sep 2015 07:55:20 +0000 The hematological and clinical chemistry profile for children aged 6 months to 5 years with acute diarrhoea was measured in a double blind clinical trial. Subjects were randomized to the study group () given a bioactive polyphenol dietary supplement in oral rehydration solution (ORS) or to the control group () given distilled water as a placebo in ORS twice daily for up to 4 days. All subjects received 10 mg zinc daily for the 4 days in the study. Venous blood was collected for complete blood count, electrolytes, liver function, and creatinine upon enrollment (baseline) and at the end of 4 days (end of study); mean values were compared by 95% confidence intervals. Overall, blood factors measured either remained the same over the 4 days or increased or decreased at the same levels between the two groups during the study period. All values were within accepted ranges for paediatric subjects except serum AST (SGOT), where the mean value of the study group approached the upper bound of the range on day 4 but was comparable to the value of the control group. Consumption of this supplement twice daily for 4 days is safe for children and infants. Shafiqul A. Sarker, Shamima Sultana, Mark Pietroni, and Arthur Dover Copyright © 2015 Shafiqul A. Sarker et al. All rights reserved. Perceptions of Weight and Health Practices in Hispanic Children: A Mixed-Methods Study Tue, 25 Aug 2015 10:01:30 +0000 Background. Perception of weight by parents of obese children may be associated with willingness to engage in behavior change. The relationship between parents’ perception of their child’s weight and their health beliefs and practices is poorly understood, especially among the Hispanic population which experiences disparities in childhood obesity. This study sought to explore the relationship between perceptions of weight and health beliefs and practices in a Hispanic population. Methods. A cross-sectional, mixed-methods approach was used with semistructured interviews conducted with parent-child (2–5 years old) dyads in a primarily Hispanic, low-income population. Parents were queried on their perceptions of their child’s health, health practices, activities, behaviors, and beliefs. A grounded theory approach was used to analyze participants’ discussion of health practices and behaviors. Results. Forty parent-child dyads completed the interview. Most (58%) of the parents of overweight and obese children misclassified their child’s weight status. The qualitative analysis showed that accurate perception of weight was associated with internal motivation and more concrete ideas of what healthy meant for their child. Conclusions. The qualitative data suggest there may be populations at different stages of readiness for change among parents of overweight and obese children, incorporating this understanding should be considered for interventions. Byron Alexander Foster and Daniel Hale Copyright © 2015 Byron Alexander Foster and Daniel Hale. All rights reserved. Corrigendum to “High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI” Tue, 02 Jun 2015 11:57:22 +0000 Sheikh Sohail Ahmed, Tamara Unland, James E. Slaven, and Mara E. Nitu Copyright © 2015 Sheikh Sohail Ahmed et al. All rights reserved. High Risk Infants Follow-Up: A Case Study in Iran Tue, 02 Jun 2015 07:34:03 +0000 Background. A follow-up program for high risk infants was initiated in Alzahra Maternity Hospital in Tabriz city, Iran, in 2013. The aim of this paper is to give a brief report of the program. Material and Methods. Two groups of high risk neonates were studied. The first group comprising 509 infants received services in Alzahra Maternity Hospital implemented by the follow-up program. This included a full package for family to look after high risk infant and periodic clinical evaluation at two and four weeks after birth and then two, three, four, five, and six months later again. The second group including 131 infants in Taleqani Maternity Hospital received routine services after birth with no specific follow-up care. Results. Some anthropometric indices showed a significant improvement in the intervention hospital compared to control group. These included the following: head circumference at first and second months; weight in the first, fourth, fifth, and sixth months; and height in sixth month only. Clinical evaluation of infants showed an improvement for some of the medical conditions. Conclusion. Follow-up care program for a minimum of six months after discharge from maternity hospitals may help to avoid adverse and life threatening consequences in high risk infants. Mohammad Heidarzadeh, Behzad Jodeiry, Mohammad Baqer Hosseini, Kayvan Mirnia, Forouzan Akrami, Abbas Habbibollahi, Sara Moazzen, and Saeed Dastgiri Copyright © 2015 Mohammad Heidarzadeh et al. All rights reserved. Increased Body Mass Index during Therapy for Childhood Acute Lymphoblastic Leukemia: A Significant and Underestimated Complication Mon, 25 May 2015 13:07:45 +0000 Objective & Design. We undertook a retrospective review of children diagnosed with acute lymphoblastic leukemia (ALL) and treated with modern COG protocols to determine longitudinal changes in body mass index (BMI) and the prevalence of obesity compared with a healthy reference population. Results. At diagnosis, the majority of patients (77.5%) were in the healthy weight category. During treatment, increases in BMI -scores were greater for females than males; the prevalence of obesity increased from 10.3% to 44.8% for females but remained relatively unchanged for males (9.8% to 13.7%, ). Longitudinal analysis using linear mixed-effects identified associations between BMI -scores and time-dependent interactions with sex , disease risk , age , and BMI -score at diagnosis and total dose of steroid during maintenance . Predicted mean BMI -scores at the end of therapy were greater for females with standard risk ALL irrespective of age at diagnosis and for males younger than 4 years of age at diagnosis with standard risk ALL. Conclusion. Females treated on standard risk protocols and younger males may be at greatest risk of becoming obese during treatment for ALL. These subgroups may benefit from intervention strategies to manage BMI during treatment for ALL. Helen C. Atkinson, Julie A. Marsh, Shoshana R. Rath, Rishi S. Kotecha, Hazel Gough, Mandy Taylor, Thomas Walwyn, Nicholas G. Gottardo, Catherine H. Cole, and Catherine S. Choong Copyright © 2015 Helen C. Atkinson et al. All rights reserved. Two Oral Midazolam Preparations in Pediatric Dental Patients: A Prospective Randomised Clinical Trial Wed, 20 May 2015 12:57:17 +0000 Pharmacological sedation is an alternative behavior management strategy in pediatric dentistry. The aim of this study was to compare the behavioral and physiologic effects of “commercially midazolam syrup” versus “orally administered IV midazolam dosage form (extemporaneous midazolam (EF))” in uncooperative pediatric dental patients. Eighty-eight children between 4 to 7 years of age received 0.2–0.5 mg/kg midazolam in this parallel trial. Physiologic parameters were recorded at baseline and every 15 minutes. Behavior assessment was conducted objectively by Houpt scale throughout the sedation and North Carolina at baseline and during injection and cavity preparation. No significant difference in behavior was noted by Houpt or North Carolina scale. Acceptable behavior (excellent, very good, and good) was observed in 90.9% of syrup and 79.5% of EF subjects, respectively. Physiological parameters remained in normal range without significant difference between groups and no adverse effect was observed. It is concluded that EF midazolam preparation can be used as an acceptable alternative to midazolam syrup. Katayoun Salem, Shaqayegh Kamranzadeh, Maryam Kousha, Shahnaz Shaeghi, and Fatemeh AbdollahGorgi Copyright © 2015 Katayoun Salem et al. All rights reserved. Midline Cervical Cleft: Review of an Uncommon Entity Thu, 23 Apr 2015 10:26:01 +0000 Introduction. Midline cervical cleft is a rare congenital malformation which nonetheless has a classic presentation. This study presents one of the largest single series of new patients with MCC and provides an exhaustive review and catalogue of publications from the international literature. Materials and Methods. Retrospective chart review performed in two academic medical centers and literature review performed with primary verification of all quoted references. Results. Ten patients with MCC were identified (8 boys and 2 girls). All patients presented with the classic findings of this congenital anomaly, and the length of the skin defect correlated with an increase in the patient’s age. Surgical excision was complete in all cases. Thorough international literature review yielded only 195 verifiable previously reported cases. Conclusions. This is one of the largest series of new patients with midline cervical cleft presented in the world literature. Although rare (with less than 200 cases published to date) this entity does have a reliable presentation that should lead to rapid and accurate diagnosis. Complete surgical excision at an early age is appropriate since the anomaly increases in length commensurate with the patient’s age. Liana Puscas Copyright © 2015 Liana Puscas. All rights reserved. The Impact of Ethnicity on Wilms Tumor: Characteristics and Outcome of a South African Cohort Thu, 26 Mar 2015 08:42:40 +0000 Background. Nephroblastoma is the commonest renal tumour seen in children. It has a good prognosis in developed countries with survival rates estimated to be between 80% and 90%, while in Africa it remains low. Method. Retrospective study of patients diagnosed with nephroblastoma who are seen at 4 paediatric oncology units, representing 58.5% of all South African children with nephroblastoma and treated following SIOP protocol between January 2000 and December 2010. Results. A total of 416 patients were seen at the 4 units. Over 80% of our patients were African and almost 10% of mixed ethnicity. The most common stage was stage 4. The median survival was 28 months after diagnosis with the mixed ethnicity patients recording the longest duration (39 months) and the white patients had the shortest median survival. The overall 5-year survival rate was estimated to be 66%. Stage 2 patients did significantly better (85%). Conclusions. Our patients are similar with regard to gender ratio, median age, and age distribution as described in the literature, but in South Africa the more advanced stage disease seen than in other developed countries is translated into low overall survival rate. D. K. Stones, G. P. Hadley, R. D. Wainwright, and D. C. Stefan Copyright © 2015 D. K. Stones et al. All rights reserved. Posttransfusion Haematocrit Equilibration: Timing Posttransfusion Haematocrit Check in Neonates at the National Hospital, Abuja, Nigeria Sun, 15 Mar 2015 13:45:46 +0000 Anaemia is a common morbidity in the NICU and often requires transfusion of packed red blood cells. Haematocrit equilibration following red cell transfusion occurs over time ultimately resulting in a stable packed cell volume (PCV). Knowledge of this equilibration process is pertinent in the accurate timing of posttransfusion (PT) PCV. We conducted a prospective study to determine an appropriate timing for PT PCV estimation on 47 stable anaemic babies at the Neonatal Unit of National Hospital, Abuja. Values of PCV were determined before transfusion and at 1, 6, 12, 24, and 48 hours posttransfusion. Forty of the recruited neonates and young infants were analyzed. Their gestational age range was 26 to 40 weeks. 1-hour PT PCV (48.5% ± 5.5%) was similar to the 6-hour PT PCV (47.8% ± 5.6%) , but both were significantly different from the 12-hour (46.8% ± 5.9%), 24-hour (45.9 ± 5.8%), and 48-hour (45.4% ± 6.2%) PT PCVs. The 12-hour PT PCV was similar to the 24-hour and 48-hour PT PCVs ( and 0.063, resp.). We concluded that, in stable nonhaemorrhaging and nonhaemolysing young infants, the estimated timing of haematocrit equilibration and, consequently, posttransfusion PCV is 12 hours after red blood cell transfusion. L. I. Audu, A. T. Otuneye, A. B. Mairami, L. J. Mshelia, and V. E. Nwatah Copyright © 2015 L. I. Audu et al. All rights reserved. Enteral L-Arginine and Glutamine Supplementation for Prevention of NEC in Preterm Neonates Thu, 12 Mar 2015 11:58:53 +0000 Objective. Evaluating the efficacy and safety of arginine and glutamine supplementation in decreasing the incidence of NEC among preterm neonates. Methods. Prospective case-control study done on 75 preterm neonates ≤34 weeks, divided equally into L-arginine group receiving enteral L-arginine, glutamine group receiving enteral glutamine, and control group. Serum L-arginine and glutamine levels were measured at time of enrollment (sample 1), after 14 days of enrollment (sample 2), and at time of diagnosis of NEC (sample 3). Results. The incidence of NEC was 9.3%. There was no difference in the frequency of NEC between L-arginine and control groups (). NEC was not detected in glutamine group; L-arginine concentrations were significantly lower in arginine group than control group in both samples while glutamine concentrations were comparable in glutamine and control groups in both samples. No significant difference was found between groups as regards number of septic episodes, duration to reach full oral intake, or duration of hospital stay. Conclusion. Enteral L-arginine supplementation did not seem to reduce the incidence of NEC. Enteral glutamine may have a preventive role against NEC if supplied early to preterm neonates. However, larger studies are needed to confirm these findings. This work is registered in ( Identifier: NCT01263041). M. S. El-Shimi, H. A. Awad, M. A. Abdelwahed, M. H. Mohamed, S. M. Khafagy, and G. Saleh Copyright © 2015 M. S. El-Shimi et al. All rights reserved. Recent Advances in the Diagnosis and Treatment of Niemann-Pick Disease Type C in Children: A Guide to Early Diagnosis for the General Pediatrician Mon, 16 Feb 2015 13:33:17 +0000 Niemann-Pick disease (NP-C) is a lysosomal storage disease in which impaired intracellular lipid transport leads to accumulation of cholesterol and glycosphingolipids in various neurovisceral tissues. It is an autosomal recessive disorder, caused by mutations in the NPC1 or NPC2 genes. The clinical spectrum is grouped by the age of onset and onset of neurological manifestation: pre/perinatal; early infantile; late infantile; and juvenile periods. The NP-C Suspicion Index (SI) screening tool was developed to identify suspected patients with this disease. It is especially good at recognizing the disease in patients older than four years of age. Biochemical tests involving genetic markers and Filipin staining of skin fibroblast are being employed to assist diagnosis. Therapy is mostly supportive and since 2009, the first specific therapy approved for use was Miglustat (Zavesca) aimed at stabilizing the rate of progression of neurological manifestation. The prognosis correlates with age at onset of neurological signs; patients with early onset form progress faster. The NP-C disease has heterogeneous neurovisceral manifestations. A SI is a screening tool that helps in diagnostic process. Filipin staining test is a specific biomarker diagnostic test. Miglustat is the first disease-specific therapy. Hanna Alobaidy Copyright © 2015 Hanna Alobaidy. All rights reserved. Corrigendum to “Population-Based Placental Weight Ratio Distributions” Mon, 02 Feb 2015 13:03:06 +0000 Erin M. Macdonald, John J. Koval, Renato Natale, Timothy R. H. Regnault, and M. Karen Campbell Copyright © 2015 Erin M. Macdonald et al. All rights reserved. High Dose Dexmedetomidine: Effective as a Sole Agent Sedation for Children Undergoing MRI Thu, 29 Jan 2015 12:26:55 +0000 Objective. To determine the efficacy and safety of high dose dexmedetomidine as a sole sedative agent for MRI. We report our institution’s experience. Design. A retrospective institutional review of dexmedetomidine usage for pediatric MRI over 5.5 years. Protocol included a dexmedetomidine bolus of 2 μg/kg intravenously over ten minutes followed by 1 μg/kg/hr infusion. 544 patients received high dose dexmedetomidine for MRI. A second bolus was used in 103 (18.9%) patients. 117 (21.5%) required additional medications. Efficacy, side effects, and use of additional medicines to complete the MRI were reviewed. Data was analyzed using Student’s t-test, Fisher’s exact test, and Analysis of Variance (ANOVA). Main Results. Dexmedetomidine infusion was associated with bradycardia (3.9%) and hypotension (18.4%). None of the patients required any intervention. Vital signs were not significantly different among the subgroup of patients receiving one or two boluses of dexmedetomidine or additional medications. Procedure time was significantly shorter in the group receiving only one dexmedetomidine bolus and increased with second bolus or additional medications (). Discharge time was longer for children experiencing bradycardia (). Conclusion. High dose Dexmedetomidine was effective in 78.5% of cases; 21.5% of patients required additional medications. Side effects occurred in approximately 25% of cases, resolving spontaneously. Sheikh Sohail Ahmed, Tamara Unland, James E. Slaven, and Mara E. Nitu Copyright © 2015 Sheikh Sohail Ahmed et al. All rights reserved. Abnormal Blood Glucose as a Prognostic Factor for Adverse Clinical Outcome in Children Admitted to the Paediatric Emergency Unit at Komfo Anokye Teaching Hospital, Kumasi, Ghana Sun, 28 Dec 2014 10:15:38 +0000 Dysglycaemia (hyper- or hypoglycaemia) in critically ill children has been associated with poor outcome. We compared the clinical outcomes in children admitted to Pediatric Emergency Unit (PEU) at Komfo Anokye Teaching Hospital (KATH) for acute medical conditions and presenting with euglycaemia or dysglycaemia. This is a prospective case matching cohort study. Eight hundred subjects aged between 3 and 144 months were screened out of whom 430 (215 with euglycaemia and 215 with dysglycaemia) were enrolled. The median age was 24 months (range: 3–144 months). In the dysglycaemia group, 28 (13%) subjects had hypoglycemia and 187 (87%) had hyperglycemia. Overall, there were 128 complications in 116 subjects. The number of subjects with complications was significantly higher in dysglycaemia group (, 46%) compared to euglycaemia group (, 8%) (). Forty subjects died out of whom 30 had dysglycaemia (). Subjects with dysglycaemia were 3 times (95% CI: 1.5–6.0) more likely to die and 4.8 times (95% CI: 3.1–7.5) more likely to develop complications (). Dysglycaemia is associated with increased morbidity and mortality in children with acute medical conditions and should lead to intensive management of the underlying condition. Emmanuel Ameyaw, Kwame Amponsah-Achiano, Peter Yamoah, and Jean-Pierre Chanoine Copyright © 2014 Emmanuel Ameyaw et al. All rights reserved. The Effects of Skin-to-Skin Contact on Temperature and Breastfeeding Successfulness in Full-Term Newborns after Cesarean Delivery Thu, 25 Dec 2014 06:05:27 +0000 Background. The skin-to-skin contact (SSC) of mother and newborn is uncommon full-term newborns after delivering via cesarean section due to the possibility of hypothermia in the infants. The aim of this study was to compare mothers’ and infant’s temperatures after delivering via cesarean section. Material and Methods. In this randomized clinical trial, 90 infant/mothers dyads delivered via cesarean section were randomized to SSC () and routine care (). In experimental group, skin-to-skin contact was performed for one hour and in the routine group the infant was dressed and put in the cot according to hospital routine care. The newborns’ mothers’ temperatures in both groups were taken at half-hour intervals. The data was analyzed using descriptive statistics, t-tests, and chi-square tests. Results. The means of the newborns’ temperatures immediately after SSC (), half an hour (), and one hour () after the intervention did not show statistically significant differences between the two groups. The mean scores of the infants’ breastfeeding assessment in SSC () and routine care () groups did not show significant differences (). Conclusion. Mother and infant’s skin-to-skin contact is possible after delivering via cesarean section and does not increase the risk of hypothermia. Shourangiz Beiranvand, Fatemeh Valizadeh, Reza Hosseinabadi, and Yadollah Pournia Copyright © 2014 Shourangiz Beiranvand et al. All rights reserved. Effectiveness of Palivizumab in Preventing RSV Hospitalization in High Risk Children: A Real-World Perspective Thu, 04 Dec 2014 12:26:04 +0000 Infection with respiratory syncytial virus (RSV) is one of the major causes globally of childhood respiratory morbidity and hospitalization. Palivizumab, a humanized monoclonal antibody, has been recommended for high risk infants to prevent severe RSV-associated respiratory illness. This recommendation is based on evidence of efficacy when used under clinical trial conditions. However the real-world effectiveness of palivizumab outside of clinical trials among different patient populations is not well established. We performed a systematic review focusing on postlicensure observational studies of the protective effect of palivizumab prophylaxis for reducing RSV-associated hospitalizations in infants and children at high risk of severe infection. We searched studies published in English between 1 January 1999 and August 2013 and identified 420 articles, of which 20 met the inclusion criteria. This review supports the recommended use of palivizumab for reducing RSV-associated hospitalization rates in premature infants born at gestational age < 33 weeks and in children with chronic lung and heart diseases. Data are limited to allow commenting on the protective effect of palivizumab among other high risk children, including those with Down syndrome, cystic fibrosis, and haematological malignancy, indicating further research is warranted in these groups. Nusrat Homaira, William Rawlinson, Thomas L. Snelling, and Adam Jaffe Copyright © 2014 Nusrat Homaira et al. All rights reserved. Off-Label Medicine Use in Pediatric Inpatients: A Prospective Observational Study at a Tertiary Care Hospital in India Tue, 25 Nov 2014 17:23:13 +0000 Background. In the absence of standard pediatric prescribing information, clinicians often use medicines in an off-label way. Many studies have been published across the globe reporting different rates of off-label use. There is currently no study based on Indian drug formulary. Methods. The prospective observational study included pediatric patients in ages between 0 and 12 years admitted in a tertiary care hospital. Off-label use was assessed using the National Formulary of India (NFI). Predictors of off-label use were determined by logistic regression. Results. Of the 1645 medications prescribed, 1152 (70%) were off-label based on 14 possible off-label categories. Off-label medicines were mainly due to dose difference and use in restricted age limits as indicated in NFI. Respiratory medicines (82%), anti-infectives (73%), and nervous system medicines (53%) had higher off-label use. Important predictors of off-label prescribing were pediatric patients in age of 0 to 2 years (OR 1.68, 95% CI; ) and hospital stay of six to 10 days (OR 1.91, 95% CI; ). Conclusion. Off-label prescribing is common among pediatric patients. There is need to generate more quality data on the safety and efficacy of off-label medicines to rationalize pediatric pharmacotherapy. Mohd Masnoon Saiyed, Tarachand Lalwani, and Devang Rana Copyright © 2014 Mohd Masnoon Saiyed et al. All rights reserved. Geographical Differences in the Population-Based Cross-Sectional Growth Curve and Age at Peak Height Velocity with respect to the Prevalence Rate of Overweight in Japanese Children Mon, 24 Nov 2014 13:46:38 +0000 The School Health Examination Survey is a nationwide examination carried out annually in Japan, and the results are entered into a prefectural-level physical measurement database. We used this database to determine the geographical differences in a population-based cross-sectional growth curve and investigated the association between age at peak height velocity (PHV) and the prevalence rate of overweight in children among Japanese prefectures. Mean prefectural-level age at PHV was estimated by the cubic spline-fitting procedure using cross-sectional whole-year prefectural mean height data (5–17 years, 2006–2013), and 8-year (2006–2013) means of the standardized prevalence rates of overweight children and other anatomical data (8-year standardized weight and height) were recalculated. Mean prefectural age at PHV was more strongly correlated with the mean prefectural prevalence rate of overweight (age 5–8 years) than with other weights or heights in both sexes. On the basis of these findings and their confirmation by multiple regression analysis, the prevalence rate of overweight was selected as a primary factor to explain the geographical difference in age at PHV. These findings suggest that childhood overweight is a dominant factor responsible for the observed geographical differences in onset of puberty in Japan. Masana Yokoya and Yukito Higuchi Copyright © 2014 Masana Yokoya and Yukito Higuchi. All rights reserved. A Novel Algorithm in the Management of Hypoglycemia in Newborns Wed, 12 Nov 2014 06:55:41 +0000 Study Objective. To evaluate the safety of a new protocol in comparison to the standard protocol for managing hypoglycemia in neonates. Methods. Open label RCT-pilot study. Neonates admitted to NICU with hypoglycemia and requiring intravenous fluids were included. Fifty-seven eligible neonates were randomly allocated to either intervention group (starting fluids with 10% dextrose and increments of 1.5%) or standard protocol group (GIR of 6 mg/kg/min with increments of 2 mg/kg/min) till control of hypoglycemia. Primary outcome of the study was to know proportion of infants with subsequent hypoglycemia and hyperglycemia after enrolment. Results. The initial GIR (6 ± 0 mg/kg/min versus 4.8 ± 1.4 mg/kg/min, P < 0.001), the mean maximum GIR (6.7 ± 1.6 mg/kg/min versus 5.6 ± 2 mg/kg/min, P = 0.03), the maximum concentration of glucose infused (13.8 ± 2.9% versus 10.9 ± 1.9%, P < 0.001), and the total amount of glucose infused were significantly lower in the intervention group. The mean maximum blood sugar was significantly higher (129 ± 57 mg/dL versus 87 ± 30 mg/dL, P = 0.001) and there was a trend towards high proportion of infants with Hyperglycemia in the standard protocol group (n = 10, 39% versus n = 5, 16%, P = 0.07). The median difference between the highest and the lowest recorded sugar for any infant was significantly higher in the standard protocol group (median 93 mg/dL, IQR 52 to 147 mg/dL versus median 50 mg/dL, IQR 38 to 62.5 mg/dL, P = 0.03). Conclusion. A new and novel algorithm in the management of hypoglycemia in neonates is as safe as the standard protocol and requires further testing before routine implementation. Swapna Naveen, Chikati Rosy, Hemasree Kandraju, Deepak Sharma, Tejopratap Oleti, and Srinivas Murki Copyright © 2014 Swapna Naveen et al. All rights reserved. What Parents Think about Giving Nonnutritive Sweeteners to Their Children: A Pilot Study Tue, 04 Nov 2014 09:35:42 +0000 Objective. To evaluate parental attitudes toward providing foods and beverages with nonnutritive sweeteners (NNS) to their children and to explore parental ability to recognize NNS in packaged foods and beverages. Methods. 120 parents of children ≥ 1 and ≤18 years of age completed brief questionnaires upon entering or exiting a grocery store. Parental attitudes toward NNS were assessed using an interviewer-assisted survey. Parental selection of packaged food and beverages (with and without NNS) was evaluated during a shopping simulation activity. Parental ability to identify products with NNS was tested with a NNS recognition test. Results. Most parents (72%) disagreed with the statement “NNS are safe for my child to consume.” This was not reflected during the shopping simulation activity because about one-quarter of items selected by parents contained NNS. Parents correctly identified only 23% of NNS-containing items presented as foods or beverages which were sweetened with NNS. Conclusions. The negative parental attitudes toward providing NNS to their children raise the question whether parents are willing to replace added sugars with NNS in an effort to reduce their child’s calorie intake. Our findings also suggest that food labeling should be revised in order for consumers to more easily identify NNS in foods and beverages. Allison C. Sylvetsky, Mitchell Greenberg, Xiongce Zhao, and Kristina I. Rother Copyright © 2014 Allison C. Sylvetsky et al. All rights reserved. Genotyping of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Children Wed, 22 Oct 2014 07:54:31 +0000 Community associated methicillin resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen increasingly reported to cause skin and soft tissue infections for children. The emergence of highly virulencet CA-MRSA strains in the immunodeficiency of young children seemed to be the basic explanation of the increased incidence of CA-MRSA infections among this population. The subjects of this study were 8 patients hospitalized in the Pediatric Department at the University Hospital of Monastir. The patients were young children (aged from 12 days to 18 months) who were suffering from MRSA skin infections; two of them had the infections within 72 h of their admission. The isolates were classified as community isolates as they all carried the staphylococcal cassette chromosome mec (SCCmec) IV and pvl genes. Epidemiological techniques, pulsed-field gel electrophoresis (PFGE) and multilocus sequence typing (MLST), were applied to investigate CA-MRSA strains. Analysis of molecular data revealed that MRSA strains were related according to PFGE patterns and they belonged to a single clone ST80. Antimicrobial susceptibility tests showed that all strains were resistant to kanamycin and 2 strains were resistant to erythromycin. Mouna Ben Nejma, Abderrahmen Merghni, and Maha Mastouri Copyright © 2014 Mouna Ben Nejma et al. All rights reserved. Prevalence of Nocturnal Enuresis and Its Associated Factors in Primary School and Preschool Children of Khorramabad in 2013 Sun, 12 Oct 2014 07:05:28 +0000 Background. Nocturnal enuresis refers to an inability to control urination during sleep. This study aimed to determine the prevalence of nocturnal enuresis and its associated factors in children in the city of Khorramabad. Materials and Methods. In this descriptive-analytic, cross-sectional study, 710 male and female children were divided into two groups with equal numbers. The samples were selected from the schools of Khorramabad using the multistage cluster and stratified random sampling methods based on the diagnostic criteria of DSM-IV. The data was analyzed using the logistic regression. Results. The results showed that 8% of the children had nocturnal enuresis, including 5.2% of primary nocturnal enuresis and 2.8% of secondary nocturnal enuresis. The prevalence of nocturnal enuresis in the boys (10.7%) was higher compared with that in the girls (5.4%) (). There were statistically significant relationships between nocturnal enuresis and history of nocturnal enuresis in siblings (), respiratory infections (), deep sleep (), corporal punishment at school (), anal itching (), and history of seizures (). Conclusion. This study showed that the prevalence of nocturnal enuresis in the boys was higher compared with that in the girls. Katayoun Bakhtiar, Yadollah Pournia, Farzad Ebrahimzadeh, Ali Farhadi, Fathollah Shafizadeh, and Reza Hosseinabadi Copyright © 2014 Katayoun Bakhtiar et al. All rights reserved. Effects of Whole Body Therapeutic Hypothermia on Gastrointestinal Morbidity and Feeding Tolerance in Infants with Hypoxic Ischemic Encephalopathy Mon, 25 Aug 2014 05:26:53 +0000 Objective. This retrospective cohort study evaluated the effects of whole body therapeutic hypothermia (WBTH) on gastrointestinal (GI) morbidity and feeding tolerance in infants with moderate-to-severe hypoxic ischemic encephalopathy (HIE). Study Design. Infants ≥ 35 weeks gestational age and ≥1800 grams birth weight with moderate-to-severe HIE treated from 2000 to 2012 were compared. 68 patients had documented strictly defined criteria for WBTH: 32 historical control patients did not receive WBTH (non-WBTH) and 36 cohort patients received WBTH. Result. More of the non-WBTH group infants never initiated enteral feeds (28% versus 6%; ), never reached full enteral feeds (38% versus 6%, ), and never reached full oral feeds (56% versus 19%, ). Survival analyses demonstrated that the WBTH group reached full enteral feeds (median time: 11 versus 9 days; ) and full oral feeds (median time: 19 versus 10 days; ) sooner. The non-WBTH group had higher combined outcomes of death and gastric tube placement (47% versus 11%; ) and death and gavage feeds at discharge (44% versus 11%; ). Conclusion. WBTH may have beneficial effects on GI morbidity and feeding tolerance for infants with moderate-to-severe HIE. Kimberly M. Thornton, Hongying Dai, Seth Septer, and Joshua E. Petrikin Copyright © 2014 Kimberly M. Thornton et al. All rights reserved. Neonatal Thrombocytopenia after Perinatal Asphyxia Treated with Hypothermia: A Retrospective Case Control Study Thu, 21 Aug 2014 10:49:38 +0000 Our objective was to estimate the effect of therapeutic hypothermia on platelet count in neonates after perinatal asphyxia. We performed a retrospective case control study of all (near-) term neonates with perinatal asphyxia admitted between 2004 and 2012 to our neonatal intensive care unit. All neonates treated with therapeutic hypothermia were included in this study (hypothermia group) and compared with a historic control group of neonates with perinatal asphyxia treated before introduction of therapeutic hypothermia (2008). Primary outcome was thrombocytopenia during the first week after birth. Thrombocytopenia was found significantly more often in the hypothermia group than in the control group, 80% (43/54) versus 59% (27/46) (). The lowest mean platelet count in the hypothermia group and control group was and (), respectively, and was reached at a mean age of 4.1 days in the hypothermia group and 2.9 days in the control group (). The incidence of moderate/severe cerebral hemorrhage was 6% (3/47) in the hypothermia group versus 9% (3/35) in the control group (). In conclusion, neonates with perinatal asphyxia treated with therapeutic hypothermia are at increased risk of thrombocytopenia, without increased risk of cerebral hemorrhage. N. Boutaybi, F. Razenberg, V. E. H. J. Smits-Wintjens, E. W. van Zwet, M. Rijken, S. J. Steggerda, and E. Lopriore Copyright © 2014 N. Boutaybi et al. All rights reserved. Rotavirus Diarrhea among Children in Taiz, Yemen: Prevalence—Risk Factors and Detection of Genotypes Tue, 12 Aug 2014 11:38:21 +0000 Diarrheal diseases are a great public health problem; they are among the most causes leading to morbidity and mortality of infants and children particularly in developing countries and even in developed countries. Rotavirus is the most common cause of severe gastroenteritis in infants and young children in both developed and developing countries. The purpose of this study was to determine the incidence rate of Rotavirus infection, its genotypes, and risk factors among children with diarrhea in Taiz, Yemen. 795 fecal samples were collected from children (less than 5 years old), suffering from diarrhea and attending the Yemeni-Swedish Hospital (YSH) in Taiz , Yemen, from November 2006 to February 2008. Rotavirus was detected by enzyme linkage immunosorbent assay (ELISA) on stool specimens of children. Genotypes of Rotavirus were characterized by reverse transcriptase-polymerase chain reaction (RT-PCR) and polyacrylamide gel electrophoresis (PAGE). The results showed that 358 (45.2%) were Rotavirus-positive and the most prevalent genotypes were G2P[4] (55%), followed by G1P[8] (15%). In addition, Rotavirus was found through the whole year; however, higher frequency during the summer season (53.4%) and lower frequency during the winter season (37.1%). Abdulmalik Al-Badani, Leena Al-Areqi, Abdulatif Majily, Saleh AL-Sallami, Anwar AL-Madhagi, and Mohammed Amood AL-Kamarany Copyright © 2014 Abdulmalik Al-Badani et al. All rights reserved. Decision Making in the PICU: An Examination of Factors Influencing Participation Decisions in Phase III Randomized Clinical Trials Mon, 04 Aug 2014 09:12:45 +0000 Background. In stressful situations, decision making processes related to informed consent may be compromised. Given the profound levels of distress that surrogates of children in pediatric intensive care units (PICU) experience, it is important to understand what factors may be influencing the decision making process beyond the informed consent. The purpose of this study was to evaluate the role of clinician influence and other factors on decision making regarding participation in a randomized clinical trial (RCT). Method. Participants were 76 children under sedation in a PICU and their surrogate decision makers. Measures included the Post Decision Clinician Survey, observer checklist, and post-decision interview. Results. Age of the pediatric patient was related to participation decisions in the RCT such that older children were more likely to be enrolled. Mentioning the sponsoring institution was associated with declining to participate in the RCT. Type of health care provider and overt recommendations to participate were not related to enrollment. Conclusion. Decisions to participate in research by surrogates of children in the PICU appear to relate to child demographics and subtleties in communication; however, no modifiable characteristics were related to increased participation, indicating that the informed consent process may not be compromised in this population. Laura E. Slosky, Marilyn Stern, Natasha L. Burke, and Laura A. Siminoff Copyright © 2014 Laura E. Slosky et al. All rights reserved. Challenges and Frugal Remedies for Lowering Facility Based Neonatal Mortality and Morbidity: A Comparative Study Tue, 22 Jul 2014 07:07:14 +0000 Millennium development goal target on infant mortality (MDG4) by 2015 would not be realised in some low-resource countries. This was in part due to unsustainable high-tech ideas that have been poorly executed. Prudent but high impact techniques could have been synthesised in these countries. A collaborative outreach was initiated to devise frugal measures that could reduce neonatal deaths in Nigeria. Prevailing issues of concern that could militate against neonatal survival within care centres were identified and remedies were proffered. These included application of (i) recycled incubator technology (RIT) as a measure of providing affordable incubator sufficiency, (ii) facility-based research groups, (iii) elective training courses for clinicians/nurses, (iv) independent local artisans on spare parts production, (v) power-banking and apnoea-monitoring schemes, and (v) 1/2 yearly failure-preventive maintenance and auditing system. Through a retrospective data analyses 4 outreach centres and one “control” were assessed. Average neonatal mortality of centres reduced from 254/1000 to 114/1000 whilst control remained at 250/1000. There was higher relative influx of incubator-dependent-neonates at outreach centres. It was found that 43% of mortality occurred within 48 hours of presentation (d48) and up to 92% of d48 were of very-low birth parameters. The RIT and associated concerns remedies have demonstrated the vital signs of efficiency that would have guaranteed MDG4 neonatal component in Nigeria. Hippolite O. Amadi, Akin O. Osibogun, Olateju Eyinade, Mohammed B. Kawuwa, Angela C. Uwakwem, Maryann U. Ibekwe, Peter Alabi, Chinyere Ezeaka, Dada G. Eleshin, and Mike O. Ibadin Copyright © 2014 Hippolite O. Amadi et al. All rights reserved.