International Journal of Pediatrics http://www.hindawi.com The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Genotyping of Methicillin Resistant Staphylococcus aureus Strains Isolated from Hospitalized Children Wed, 22 Oct 2014 07:54:31 +0000 http://www.hindawi.com/journals/ijpedi/2014/314316/ 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 http://www.hindawi.com/journals/ijpedi/2014/120686/ 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 http://www.hindawi.com/journals/ijpedi/2014/643689/ 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 http://www.hindawi.com/journals/ijpedi/2014/760654/ 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 http://www.hindawi.com/journals/ijpedi/2014/928529/ 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 http://www.hindawi.com/journals/ijpedi/2014/676023/ 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 http://www.hindawi.com/journals/ijpedi/2014/986716/ 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. Magnitude and Reasons for Harmful Traditional Practices among Children Less Than 5 Years of Age in Axum Town, North Ethiopia, 2013 Thu, 19 Jun 2014 06:00:12 +0000 http://www.hindawi.com/journals/ijpedi/2014/169795/ Background. In addition to beneficial traditional practices, there are around 140 harmful traditional practices affecting mothers and children in almost all ethnic groups of Ethiopia. Therefore this study might give a clue about their practice and associated factors. The objective of this study was to assess magnitude of harmful traditional practices among children less than 5 years of age in Axum Town, North Ethiopia. Methods. Community based cross-sectional study was conducted on 752 participants who were selected using multistage sampling. Simple random sampling method was used to select ketenas from all kebelles of Axum Town. After proportional allocation of sample size to eachketena, systematic random sampling method was used to get the study participants. Data was collected using interviewer administered questionnaire; it was entered and analyzed using SPSS version 16 and descriptive statistics was calculated. Results. Majority of the respondents (81.2%) were Orthodox, 78.2% of the mothers had no work, and majority of mothers had no formal education. Among the harmful traditional practices performed on children, uvula cutting alone was performed on 72.8% of children followed by milk teeth extraction and uvula cutting with eyebrow incision. Conclusion. The leading harmful traditional practice performed on children in this study was uvula cutting. Kahsu Gebrekirstos, Atsede Fantahun, and Gerezgiher Buruh Copyright © 2014 Kahsu Gebrekirstos et al. All rights reserved. Computer Game Use and Television Viewing Increased Risk for Overweight among Low Activity Girls: Fourth Thai National Health Examination Survey 2008-2009 Thu, 05 Jun 2014 13:15:12 +0000 http://www.hindawi.com/journals/ijpedi/2014/364702/ Studies of the relationship between sedentary behaviors and overweight among children and adolescents show mixed results. The fourth Thai National Health Examination Survey data collected between 2008 and 2009 were used to explore this association in 5,999 children aged 6 to 14 years. The prevalence of overweight defined by the age- and gender-specific body mass index cut-points of the International Obesity Task Force was 16%. Using multiple logistic regression, computer game use for more than 1 hour a day was found to be associated with an increased risk of overweight (adjusted odds ratio (AOR) = 1.4; 95% confidence interval: 1.02–1.93). The effect of computer game use and TV viewing on the risk for overweight was significantly pronounced among girls who spent ≤3 days/week in 60 minutes of moderate-intensity physical activity (AOR = 1.99 and 1.72, resp.). On the contrary, these sedentary behaviors did not exert significant risk for overweight among boys. The moderating effect on risk of overweight by physical inactivity and media use should be taken into consideration in designing the interventions for overweight control in children and adolescents. Tracking societal changes is essential for identification of potential areas for targeted interventions. Ladda Mo-suwan, Jiraluck Nontarak, Wichai Aekplakorn, and Warapone Satheannoppakao Copyright © 2014 Ladda Mo-suwan et al. All rights reserved. Interplay of T Helper 17 Cells with CD4+CD25high FOXP3+ Tregs in Regulation of Allergic Asthma in Pediatric Patients Wed, 04 Jun 2014 13:08:39 +0000 http://www.hindawi.com/journals/ijpedi/2014/636238/ Background. There is evidence that Tregs are important to prevent allergic diseases like asthma but limited literature exists on role of cells in allergic diseases. Methods. Fifty children with asthma and respiratory allergy (study group) and twenty healthy children (control group) were recruited in this study. Total IgE levels and pulmonary function tests were assessed. The expression of Tregs and cytokines was determined by flow cytometry. Results. The average level of total IgE in study group (316.8 ± 189.8 IU/mL) was significantly higher than controls (50 ± 17.5 IU/mL, ). The frequency of cells and culture supernatant level of IL-17 in study group (12.09 ± 8.67 pg/mL) was significantly higher than control group (2.01 ± 1.27 pg/mL, ). Alternatively, the frequency of FOXP3 level was significantly lower in study group [(49.00 ± 13.47)%] than in control group [(95.91 ± 2.63)%] and CD4+CD25+FOXP3+ to CD4+CD25+ ratio was also significantly decreased in study group [(6.33 ± 2.18)%] compared to control group [(38.61 ± 11.04)%]. The total serum IgE level is negatively correlated with FOXP3 level (, ). The FOXP3 expression is negatively correlated with the IL-17 levels (, ) and IL-4 levels (, ). Conclusions. Imbalance in /Tregs, elevated IL-17, and IL-4 response and downregulation of FOXP3 were associated with allergic asthma. Amit Agarwal, Meenu Singh, B. P. Chatterjee, Anil Chauhan, and Anuradha Chakraborti Copyright © 2014 Amit Agarwal et al. All rights reserved. Prevalence of Overweight and Obesity in Children and Adolescents from the Age Range of 2 to 19 Years Old in Brazil Tue, 03 Jun 2014 11:14:27 +0000 http://www.hindawi.com/journals/ijpedi/2014/583207/ Introduction. Infant juvenile obesity is currently a worldwide public health problem and it is increasing at alarming rate in the Brazilian population, showing its relevance in terms of public health. Objectives. Determine the prevalence of overweight and obesity in children and adolescents between 2 and 19 years old in different regions of Brazil. Methods. The following electronic databases were searched (from September through November 2013): Medline (PubMed), LILACS, and SciELO, using the descriptors and Boolean operators (obesity) and (overweight) and (child) and (prevalence) and (Brazil). Prospective and/or cross-sectional designs studies were found regarding the prevalence of overweight and obese children and adolescents in the five regions of Brazil. Results. A total of 191 scientific articles were found of which 17 met all inclusion criteria. A higher prevalence of overweight was found in the south (25.7%) and north (28.8%) of the country, and obesity in the southeast (15.4%) and south (10.4%). Conclusions. The scope of the studies was mostly based on municipal coverage, which resulted in limitations for conclusive analysis, showing the need for further studies of prevalence at the national level, with emphasis on public health in obese children and adolescents throughout the Brazilian territory. Janaina R. Niehues, Ana Inês Gonzales, Robson R. Lemos, Poliana Penasso Bezerra, and Patrícia Haas Copyright © 2014 Janaina R. Niehues et al. All rights reserved. Inflammatory Bowel Disease in Children of Middle Eastern Descent Mon, 02 Jun 2014 08:11:23 +0000 http://www.hindawi.com/journals/ijpedi/2014/906128/ Increasing rates of inflammatory bowel disease (IBD) are now seen in populations where it was once uncommon. The pattern of IBD in children of Middle Eastern descent in Australia has never been reported. This study aimed to investigate the burden of IBD in children of Middle Eastern descent at the Sydney Children’s Hospital, Randwick (SCHR). The SCHR IBD database was used to identify patients of self-reported Middle Eastern ethnicity diagnosed between 1987 and 2011. Demographic, diagnosis, and management data was collected for all Middle Eastern children and an age and gender matched non-Middle Eastern IBD control group. Twenty-four patients of Middle Eastern descent were identified. Middle Eastern Crohn’s disease patients had higher disease activity at diagnosis, higher use of thiopurines, and less restricted colonic disease than controls. Although there were limitations with this dataset, we estimated a higher prevalence of IBD in Middle Eastern children and they had a different disease phenotype and behavior compared to the control group, with less disease restricted to the colon and likely a more active disease course. Christina Mai Ying Naidoo, Steven T. Leach, Andrew S. Day, and Daniel A. Lemberg Copyright © 2014 Christina Mai Ying Naidoo et al. All rights reserved. Comparative Effect of Massage Therapy versus Kangaroo Mother Care on Body Weight and Length of Hospital Stay in Low Birth Weight Preterm Infants Sun, 25 May 2014 08:01:31 +0000 http://www.hindawi.com/journals/ijpedi/2014/434060/ Background. Massage therapy (MT) and kangaroo mother care (KMC) are both effective in increasing the weight and reducing length of hospital stay in low birth weight preterm infants but they have not been compared. Aim. Comparison of effectiveness of MT and KMC on body weight and length of hospital stay in low birth weight preterm (LBWPT) infants. Method. 30 LBWPT infants using convenience sampling from Neonatal Intensive Care Unit, V.S. hospital, were randomly divided into 2 equal groups. Group 1 received MT and Group 2 received KMC for 15 minutes, thrice daily for 5 days. Medically stable babies with gestational age < 37 weeks and birth weight < 2500 g were included. Those on ventilators and with congenital, orthopedic, or genetic abnormality were excluded. Outcome measures, body weight and length of hospital stay, were taken before intervention day 1 and after intervention day 5. Level of significance was 5%. Result. Data was analyzed using SPSS16. Both MT and KMC were found to be effective in improving body weight (P = 0.001, P = 0.001). Both were found to be equally effective for improving body weight (P = 0.328) and reducing length of hospital stay (P = 0.868). Conclusion. MT and KMC were found to be equally effective in improving body weight and reducing length of hospital stay. Limitation. Long term follow-up was not taken. Priya Singh Rangey and Megha Sheth Copyright © 2014 Priya Singh Rangey and Megha Sheth. All rights reserved. Validation of the Breastfeeding Experience Scale in a Sample of Iranian Mothers Mon, 19 May 2014 08:59:53 +0000 http://www.hindawi.com/journals/ijpedi/2014/608657/ Objectives. The aim of this study was to validate the breastfeeding experience scale (BES) in a sample of Iranian mothers. Methods. After translation and back translation of the BES, an expert panel evaluated the items by assessing the content validity ratio (CVR) and content validity index (CVI). 347 of mothers visiting health centers completed the Farsi version of the BES in the first month postpartum. Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) were performed to indicate the scale constructs. Reliability was assessed by Cronbach's alpha coefficient. Results. CVR and CVI scores for the BES were 0.96 and 0.87, respectively. Cronbach's alpha coefficient for the BES was 0.83. The results of the EFA revealed a new 5-factor model. The results of the CFA for the BES indicated a marginally acceptable fit for the proposed model and acceptable fit for the new model (RMSEA = 0.064, SRMR = 0.064, /df = 2.4, and CFI = 0.95). Mothers who were exclusively breastfeeding at the first month postpartum had less breastfeeding difficulties score (30.3 ± 7.6) than mothers who were on partial breastfeeding (36.7 ± 11.3) (). Conclusions. The Farsi version of the BES is a reliable and valid instrument to assess postpartum breastfeeding difficulties in Iranian mothers. Forough Mortazavi, Seyed Abbas Mousavi, Reza Chaman, and Ahmad Khosravi Copyright © 2014 Forough Mortazavi et al. All rights reserved. Bacterial Pathogens and Antimicrobial Resistance Patterns in Pediatric Urinary Tract Infections: A Four-Year Surveillance Study (2009–2012) Mon, 19 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2014/126142/ The aims of this study were to assess the common bacterial microorganisms causing UTI and their antimicrobial resistance patterns in Bandar Abbas (Southern Iran) during a four-year period. In this retrospective study, samples with a colony count of ≥105 CFU/mL bacteria were considered positive; for these samples, the bacteria were identified, and the profile of antibiotic susceptibility was characterized. From the 19223 samples analyzed, 1513 (7.87%) were positive for bacterial infection. UTI was more frequent in male (54.9%). E. coli was reported the most common etiological agent of UTI (65.2%), followed by Klebsiella spp. (26%), Pseudomonas aeruginosa (3.6%), and Staphylococcus coagulase positive (3.7%). Results of antimicrobial susceptibility analysis for E. coli to commonly used antibiotics are as follows: Amikacin (79.7%), Ofloxacin (78.3%), Gentamicin (71.6%), Ceftriaxone (41.8), Cefotaxime (41.4%), and Cefixime (27.8%). Empirical antibiotic selection should be based on awareness of the local prevalence of bacterial organisms and antibiotic sensitivities rather than on universal or even national guidelines. In this study, Amikacin and Gentamicin were shown to be the most appropriate antibiotics for empiric therapy of pyelonephritis, but empirical therapy should only be done by specialist physicians in cases where it is necessary while considering sex and age of children. Seyed Reza Mirsoleymani, Morteza Salimi, Masoud Shareghi Brojeni, Masoud Ranjbar, and Mojtaba Mehtarpoor Copyright © 2014 Seyed Reza Mirsoleymani et al. All rights reserved. Early Blood Gas Predictors of Bronchopulmonary Dysplasia in Extremely Low Gestational Age Newborns Thu, 15 May 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2014/210218/ Aim. To determine among infants born before the 28th week of gestation to what extent blood gas abnormalities during the first three postnatal days provide information about the risk of bronchopulmonary dysplasia (BPD). Methods. We studied the association of extreme quartiles of blood gas measurements (hypoxemia, hyperoxemia, hypocapnea, and hypercapnea) in the first three postnatal days, with bronchopulmonary dysplasia, among 906 newborns, using multivariable models adjusting for potential confounders. We approximated NIH criteria by classifying severity of BPD on the basis of the receipt of any O2 on postnatal day 28 and at 36 weeks PMA and assisted ventilation. Results. In models that did not adjust for ventilation, hypoxemia was associated with increased risk of severe BPD and very severe BPD, while infants who had hypercapnea were at increased risk of very severe BPD only. In contrast, infants who had hypocapnea were at reduced risk of severe BPD. Including ventilation for 14 or more days eliminated the associations with hypoxemia and with hypercapnea and made the decreased risk of very severe BPD statistically significant. Conclusions. Among ELGANs, recurrent/persistent blood gas abnormalities in the first three postnatal days convey information about the risk of severe and very severe BPD. Sudhir Sriram, Joy Condie, Michael D. Schreiber, Daniel G. Batton, Bhavesh Shah, Carl Bose, Matthew Laughon, Linda J. Van Marter, Elizabeth N. Allred, and Alan Leviton Copyright © 2014 Sudhir Sriram et al. All rights reserved. Lipid Profile and Correlation to Cardiac Risk Factors and Cardiovascular Function in Type 1 Adolescent Diabetics from a Developing Country Mon, 12 May 2014 10:07:07 +0000 http://www.hindawi.com/journals/ijpedi/2014/513460/ Objective. The adverse role of dyslipidemia in predicting cardiovascular outcomes has not been elucidated extensively among type 1 diabetics in the literature. Methods. We assessed dyslipidemia and its correlation to other cardiac risk factors in adolescents with type 1 diabetes. Total thirty type 1 adolescent diabetics were evaluated for their metabolic profile, including serum lipids and echocardiography was performed. Results. The average age of the cohort was 14.3 ± 3.09 yr with disease duration of 5.35 ± 2.94 yr. The mean HbA1C was 8.01%. The mean serum cholesterol, LDL, HDL, and triglyceride were normal. Serum cholesterol was high in patients with longer disease duration (, ), high systolic blood pressure (, ), and elevated HbA1C > 8% (, ). Higher lipid values were associated with poorer carotid artery distensibility () and higher carotid artery intimomedial thickness (cIMT) ( for cholesterol and LDL). Hyperglycemia adversely affected ejection fractions, though serum lipids did not show any significant effect on left ventricular parameters. Conclusions. Dyslipidemia and hyperglycemia can serve as biomarkers for cardiovascular dysfunction in at-risk adolescents with type 1 diabetes. Carotid artery parameters are adjunctive tools which may be affected early in the course of macrovascular disease. Aashima Dabas, Sangeeta Yadav, and V. K. Gupta Copyright © 2014 Aashima Dabas et al. All rights reserved. Population-Based Placental Weight Ratio Distributions Tue, 06 May 2014 12:55:31 +0000 http://www.hindawi.com/journals/ijpedi/2014/291846/ The placental weight ratio (PWR) is a health indicator that reflects the balance between fetal and placental growth. The PWR is defined as the placental weight divided by the birth weight, and it changes across gestation. Its ranges are not well established. We aimed to establish PWR distributions by gestational age and to investigate whether the PWR distributions vary by fetal growth adequacy, small, average, and large for gestational age (SGA, AGA, and LGA). The data came from a hospital based retrospective cohort, using all births at two London, Ontario hospitals in the past 10 years. All women who delivered a live singleton infant between 22 and 42 weeks of gestation were included . Nonparametric quantile regression was used to fit the curves. The results demonstrate decreasing PWR and dispersion, with increasing gestational age. A higher proportion of SGA infants have extreme PWRs than AGA and LGA, especially at lower gestational ages. On average, SGA infants had higher PWRs than AGA and LGA infants. The overall curves offer population standards for use in research studies. The curves stratified by fetal growth adequacy are the first of their kind, and they demonstrate that PWR differs for SGA and LGA infants. Erin M. Macdonald, John J. Koval, Renato Natale, Timothy Regnault, and M. Karen Campbell Copyright © 2014 Erin M. Macdonald et al. All rights reserved. PeristeenⒸ   Transanal Irrigation System for Paediatric Faecal Incontinence: A Single Centre Experience Tue, 06 May 2014 12:44:26 +0000 http://www.hindawi.com/journals/ijpedi/2014/954315/ Aim. To evaluate the efficacy of the PeristeenⒸ transanal irrigation system when treating faecal incontinence in children due to chronic idiopathic constipation. Methods. A retrospective study was conducted of the first cohort of patients affected with faecal incontinence and referred to our centre for PeristeenⒸ transanal irrigation treatment between January 2010 and December 2012. Patients with neurogenic bowel disturbance were excluded. A previously described and validated faecal continence scoring system was used to assess bowel function and social problems before and after treatment with PeristeenⒸ. Results. 13 patients were referred for PeristeenⒸ transanal irrigation during the study period. Mean time of using PeristeenⒸ  was 12.6 months (±0.6 months) and mean length of follow-up was 21.2 months (±0.9 months). All patients were noted to have an improvement in their faecal continence score, with a mean improvement from 9.7 ± 1.4 to 14.8 ± 2.7 () and a reduction in episodes of soiling and increasing in quality of life scores. Conclusion. In this initial study, PeristeenⒸ appears to be a safe and effective bowel management system, which improves bowel function and quality of life in children affected with faecal incontinence as a result of chronic idiopathic constipation, Hirschsprung’s disease, and anorectal malformations. Omar Nasher, Richard E. Hill, Riyad Peeraully, Ali Wright, and Shailinder J. Singh Copyright © 2014 Omar Nasher et al. All rights reserved. Evaluation of Heart Rate Assessment Timing, Communication, Accuracy, and Clinical Decision-Making during High Fidelity Simulation of Neonatal Resuscitation Wed, 30 Apr 2014 06:41:11 +0000 http://www.hindawi.com/journals/ijpedi/2014/927430/ Objective. Accurate heart rate (HR) determination during neonatal resuscitation (NR) informs subsequent NR actions. This study’s objective was to evaluate HR determination timeliness, communication, and accuracy during high fidelity NR simulations that house officers completed during neonatal intensive care unit (NICU) rotations. Methods. In 2010, house officers in NICU rotations completed high fidelity NR simulation. We reviewed 80 house officers’ videotaped performance on their initial high fidelity simulation session, prior to training and performance debriefing. We calculated the proportion of cases congruent with NR guidelines, using chi square analysis to evaluate performance across HR ranges relevant to NR decision-making: <60, 60–99, and ≥100 beats per minute (bpm). Results. 87% used umbilical cord palpation, 57% initiated HR assessment within 30 seconds, 70% were accurate, and 74% were communicated appropriately. HR determination accuracy varied significantly across HR ranges, with 87%, 57%, and 68% for HR <60, 60–99, and ≥100 bpm, respectively (). Conclusions. Timeliness, communication, and accuracy of house officers’ HR determination are suboptimal, particularly for HR 60–100 bpm, which might lead to inappropriate decision-making and NR care. Training implications include emphasizing more accurate HR determination methods, better communication, and improved HR interpretation during NR. Win Boon, Jennifer McAllister, Mohammad A. Attar, Rachel L. Chapman, Patricia B. Mullan, and Hilary M. Haftel Copyright © 2014 Win Boon et al. All rights reserved. Do Maternal Quality of Life and Breastfeeding Difficulties Influence the Continuation of Exclusive Breastfeeding? Mon, 28 Apr 2014 07:37:19 +0000 http://www.hindawi.com/journals/ijpedi/2014/156049/ Objectives. This study was conducted to determine whether maternal quality of life (QOL) and breastfeeding difficulties influence the continuation of exclusive breastfeeding (EBF). Methods. In a survey, 358 consecutive pregnant women filled out a quality of life questionnaire in the third trimester of pregnancy and the breastfeeding experience scale at 4 weeks postpartum. We assessed breastfeeding practices every month up to 6 months postpartum. Results. Only 11.8% of women continued EBF at six months. Mothers who continued EBF at 2 and 4 months postpartum had better QOL in late pregnancy than mothers who discontinued it (). There were no significant differences between the two groups in QOL scores at 6 months postpartum. Mothers who continued EBF at 2 months postpartum experienced less breastfeeding difficultties during one month postpartum than mothers who discontinued it (). Conclusion. In attempts to promote EBF, mothers with poor QOL or breastfeeding difficulties in early postpartum should be identified and helped. Forough Mortazavi, Seyed Abbas Mousavi, Reza Chaman, and Ahmad Khosravi Copyright © 2014 Forough Mortazavi et al. All rights reserved. Critical Analysis of PIM2 Score Applicability in a Tertiary Care PICU in Western India Sun, 27 Apr 2014 13:23:45 +0000 http://www.hindawi.com/journals/ijpedi/2014/703942/ Objective. Children have limited physiological reserve that deteriorates rapidly. Present study profiled patients admitted to PICU and determined PIM2 score applicability in Indian setting. Patients and Methods. Prospective observational study. Results. In 742 consecutive admissions, male : female ratio was 1.5 : 1, 35.6% patients were ventilated, observed mortality was 7%, and 26.4% were <1 year. The profile included septicemia and septic shock (29.6%), anemia (27.1%), pneumonia (19.6%), and meningitis and encephalitis (17.2%). For the first year, sensitivity of PIM2 was 65.8% and specificity was 71% for cutoff value at 1.9 by ROC curve analysis. The area under the curve was 0.724 (95% CI: 0.69, 0.76). This cutoff was validated for second year data yielding similar sensitivity (70.6%) and specificity (65%). Logistic regression analysis (LRA) over entire data revealed various variables independently associated with mortality along with PIM2 score. Another logistic model with same input variables except PIM2 yielded the same significant variables with Nagelkerke R square of 0.388 and correct classification of 78.5 revealing contribution of PIM2 in predicting mortality is meager. Conclusion. Infectious diseases were the commonest cause of PICU admission and mortality. PIM2 scoring did not explain the outcome adequately, suggesting need for recalibration. Following PALS/GEM guidelines was associated with better outcome. Vivek V. Shukla, Somashekhar M. Nimbalkar, Ajay G. Phatak, and Jaishree D. Ganjiwale Copyright © 2014 Vivek V. Shukla et al. All rights reserved. Utility of Gastric Lavage in Vigorous Neonates Delivered with Meconium Stained Liquor: A Randomized Controlled Trial Thu, 24 Apr 2014 12:08:32 +0000 http://www.hindawi.com/journals/ijpedi/2014/204807/ Objective. To determine the incidence of feed intolerance in vigorous babies with meconium stained liquor (MSL) who received prophylactic gastric lavage as compared to those who were not subjected to this procedure. Design. Randomized controlled trial. Setting. Tertiary care teaching hospital. Participants/Intervention. 330 vigorous babies delivered with MSL and satisfying the predefined inclusion criteria were randomized either to receive gastric lavage (group A, ) or to not receive gastric lavage (group B, ). Clinical monitoring was subsequently performed and recorded in prestructured proforma. Results. There was no significant statistical difference () in incidence of feed intolerance in “lavage” and “no lavage” groups. Secondary Outcome. There was no evidence of secondary respiratory distress in either group. None of the patients in the lavage group exhibited adverse effects owing to the procedure. Conclusions. There is no role of prophylactic gastric lavage in neonates born with MSL. Jatin Garg, Rupesh Masand, and Balvir Singh Tomar Copyright © 2014 Jatin Garg et al. All rights reserved. Parental Involvement in the Preoperative Surgical Safety Checklist Is Welcomed by Both Parents and Staff Sun, 13 Apr 2014 13:44:43 +0000 http://www.hindawi.com/journals/ijpedi/2014/791490/ We involved the parents of paediatric patients in the first part of the three-stage WHO Surgical Safety Checklist (SSC) process. Forty-two parents took part in the study. They came to the theatre suite with their child and into the induction room. Immediately before induction of anaesthesia they were present at, and took part in, the first stage of the three-stage SSC process, confirming with staff the identity of their child, the procedure to be performed, the operating site, and the consent being adequately obtained and recorded. We asked parents and theatre staff later whether they thought that parental involvement in the SSC was beneficial to patient safety. Both parents and staff welcomed parental involvement in the WHO Surgical Safety Checklist and felt that it improved patient safety. Martin T. Corbally and Eamon Tierney Copyright © 2014 Martin T. Corbally and Eamon Tierney. All rights reserved. The Effect of Probiotics on Childhood Constipation: A Randomized Controlled Double Blind Clinical Trial Wed, 09 Apr 2014 14:27:33 +0000 http://www.hindawi.com/journals/ijpedi/2014/937212/ Background. Inconsistent data exist about the role of probiotics in the treatment of constipated children. The aim of this study was to investigate the effectiveness of probiotics in childhood constipation. Materials and Methods. In this placebo controlled trial, fifty-six children aged 4–12 years with constipation received randomly lactulose plus Protexin or lactulose plus placebo daily for four weeks. Stool frequency and consistency, abdominal pain, fecal incontinence, and weight gain were studied at the beginning, after the first week, and at the end of the 4th week in both groups. Results. Forty-eight patients completed the study. At the end of the fourth week, the frequency and consistency of defecation improved significantly ( and , resp.). At the end of the first week, fecal incontinence and abdominal pain improved significantly in intervention group ( and , resp.) but, at the end of the fourth week, this difference was not significant ( and , resp.). A significant weight gain was observed at the end of the 1st week in the treatment group. Conclusion. This study showed that probiotics had a positive role in increasing the frequency and improving the consistency at the end of 4th week. M. Sadeghzadeh, A. Rabieefar, P. Khoshnevisasl, N. Mousavinasab, and K. Eftekhari Copyright © 2014 M. Sadeghzadeh et al. All rights reserved. Fall in Vitamin D Levels during Hospitalization in Children Sun, 30 Mar 2014 07:17:34 +0000 http://www.hindawi.com/journals/ijpedi/2014/291856/ Plasma levels of 25-hydroxyvitamin D [25(OH)D] were measured by competitive Electrochemiluminescence Immunoassay (ECLIA) in 92 children (67 boys, 25 girls) aged 3 months to 12 years at admission to hospital (timepoint 1, T1) and at discharge (timepoint 2, T2). There was a significant fall in the mean 25(OH)D from T1 (71.87 ± 27.25 nmol/L) to T2 (49.03 ± 22.25 nmol/L) (mean change = 22.84 nmol/L, value = 0.0004). Proportion of patients having VDD (levels <50 nmol/L) at admission (25%, 23/92) increased significantly at the time of discharge (51.09%, 47/92) (). There was a trend towards longer duration of hospital stay, requirement of ventilation and inotropes, development of healthcare-associated infection, and mortality in vitamin D deficient as compared to nondeficient patients though the difference was statistically insignificant. In conclusion, vitamin D levels fall significantly and should be monitored during hospital stay in children. Large clinical studies are needed to prospectively evaluate the effect of vitamin D supplementation in vitamin D deficient hospitalized children on various disease outcome parameters. Devi Dayal, Suresh Kumar, Naresh Sachdeva, Rakesh Kumar, Meenu Singh, and Sunit Singhi Copyright © 2014 Devi Dayal et al. All rights reserved. Free Radicals and Antioxidant Status in Protein Energy Malnutrition Thu, 27 Mar 2014 08:53:07 +0000 http://www.hindawi.com/journals/ijpedi/2014/254396/ Background/Objectives. The aim of this study was to evaluate oxidant and antioxidant status in children with different grades of Protein Energy Malnutrition (PEM). Subjects/Methods. A total of two hundred fifty (250) children (age range: 6 months to 5 years) living in eastern UP, India, were recruited. One hundred and ninety-three (193) of these children had different grades of PEM (sixty-five (65) children belong to mild, sixty (60) to moderate, and sixty-eight (68) to severe group). Grading in group was done after standardization in weight and height measurements. Fifty-seven (57) children who are age and and sex matched, healthy, and well-nourished were recruited from the local community and used as controls after checking their protein status (clinical nutritional status) with height and weight standardization. Redox homeostasis was assessed using spectrophotometric/colorimetric methods. Results. In our study, erythrocyte glutathione (GSH), plasma Cu, Zn-superoxide dismutase (Cu,Zn-SOD,EC 1.15.1.1), ceruloplasmin (Cp), and ascorbic acid were significantly () more decreased in children with malnutrition than controls. Plasma malondialdehyde (MDA), and protein carbonyl (PC) were significantly () raised in cases as compared to controls. Conclusion. Stress is created as a result of PEM which is responsible for the overproduction of reactive oxygen species (ROSs). These ROSs will lead to membrane oxidation and thus an increase in lipid peroxidation byproducts such as MDA and protein oxidation byproducts such as PC mainly. Decrease in level of antioxidants suggests an increased defense against oxidant damage. Changes in oxidant and antioxidant levels may be responsible for grading in PEM. M. Khare, C. Mohanty, B. K. Das, A. Jyoti, B. Mukhopadhyay, and S. P. Mishra Copyright © 2014 M. Khare et al. All rights reserved. Characteristics of US Health Care Providers Who Counsel Adolescents on Sports and Energy Drink Consumption Mon, 24 Mar 2014 07:58:03 +0000 http://www.hindawi.com/journals/ijpedi/2014/987082/ Objective. To examine the proportion of health care providers who counsel adolescent patients on sports and energy drink (SED) consumption and the association with provider characteristics. Methods. This is a cross-sectional analysis of a survey of providers who see patients ≤17 years old. The proportion providing regular counseling on sports drinks (SDs), energy drinks (EDs), or both was assessed. Chi-square analyses examined differences in counseling based on provider characteristics. Multivariate logistic regression calculated adjusted odds ratios (aOR) for characteristics independently associated with SED counseling. Results. Overall, 34% of health care providers regularly counseled on both SEDs, with 41% regularly counseling on SDs and 55% regularly counseling on EDs. On adjusted modeling regular SED counseling was associated with the female sex (aOR: 1.44 [95% CI: 1.07–1.93]), high fruit/vegetable intake (aOR: 2.05 [95% CI: 1.54–2.73]), family/general practitioners (aOR: 0.58 [95% CI: 0.41–0.82]) and internists (aOR: 0.37 [95% CI: 0.20–0.70]) versus pediatricians, and group versus individual practices (aOR: 0.59 [95% CI: 0.42–0.84]). Modeling for SD- and ED-specific counseling found similar associations with provider characteristics. Conclusion. The prevalence of regular SED counseling is low overall and varies. Provider education on the significance of SED counseling and consumption is important. Nan Xiang, Holly Wethington, Stephen Onufrak, and Brook Belay Copyright © 2014 Nan Xiang et al. All rights reserved. Factors Associated with Acute Malnutrition among Children Admitted to a Diarrhoea Treatment Facility in Bangladesh Tue, 11 Mar 2014 00:00:00 +0000 http://www.hindawi.com/journals/ijpedi/2014/267806/ To assess the risk factors for acute malnutrition (weight-for-height -score (WHZ) < −2), a case-control study was conducted during June–September 2012 in 449 children aged 6–59 months (178 with WHZ < −2 and 271 comparing children with WHZ ≥ −2 and no edema) admitted to the Dhaka Hospital of icddr,b in Bangladesh. The overall mean ± SD age was 12.0 ± 7.6 months, 38.5% (no difference between case and controls). The mean ± SD WHZ of cases and controls was −3.24 ± 1.01 versus −0.74 ± 0.95 (), respectively. Logistic regression analysis revealed that children with acute malnutrition were more likely than controls to be older (age > 1 year) (adjusted OR (AOR): 3.1, ); have an undernourished mother (body mass index < 18.5), (AOR: 2.8, ); have a father with no or a low-paying job (AOR: 5.8, ); come from a family having a monthly income of <10,000 taka, (1 US$ = 80 taka) (AOR: 2.9, ); and often have stopped predominant breastfeeding before 4 months of age (AOR: 2.7, ). Improved understanding of these characteristics enables the design and targeting of preventive-intervention programs of childhood acute malnutrition. Connor Fuchs, Tania Sultana, Tahmeed Ahmed, and M. Iqbal Hossain Copyright © 2014 Connor Fuchs et al. All rights reserved. Impact of an Educational Film on Parental Knowledge of Children with Cerebral Palsy Wed, 05 Mar 2014 15:53:45 +0000 http://www.hindawi.com/journals/ijpedi/2014/573698/ Parents of children with cerebral palsy (CP) must have knowledge about the disease and its management to improve the outcome. This uncontrolled interventional trial was carried out to evaluate the parental knowledge of CP and assess the impact of an educational programme on it. Preset questionnaires were filled before and 1 week after a single session educational programme using an educational film. Out of a total of 53 subjects, majority (75.5%) were from lower socioeconomic status. Initially, none knew the correct name of child’s illness; afterwards 45.3% could name it. When compared to previous status, there occurred significant improvement in the knowledge of parents after viewing the film with regard to knowing the cause of CP, knowing that motor involvement was predominant in CP, knowledge regarding curability of the disease, and knowledge about special schooling (). Change in knowledge was not related to socioeconomic or educational status (). Majority (94.3%) found the film useful and 96.2% learned how they could help in the management of their children. Parental knowledge of CP is inadequate which can be improved by incorporating such educational programmes in special clinics to improve management. Shilpa Khanna Arora, Anju Aggarwal, and Hema Mittal Copyright © 2014 Shilpa Khanna Arora et al. All rights reserved.