ISRN Pediatrics The latest articles from Hindawi Publishing Corporation © 2014 , Hindawi Publishing Corporation . All rights reserved. Labor and Related Injuries among Schoolchildren in Palestine: Findings from the National Study of Palestinian Schoolchildren (HBSC-WBG2006) Thu, 03 Apr 2014 08:35:05 +0000 Background. Labor related injuries among Palestinian schoolchildren are a significant undocumented public health concern. This study aimed at documenting the prevalence and nature of work related injuries among schoolchildren as well as identifying sociodemographic factors that predict these injuries. Methods. A cross-sectional survey included 15,963 children of whom 6458 (40.8%) completed an optional package related to labor. Students aged 12–18 years self-completed the international WHO collaborative HBSC valid questionnaires between April and May of 2006. Results. Approximately 73.8% of the students who filled the optional package reported working during the last 12 months, of whom 79.1% sustained a work related injury. Work injuries were significantly higher among boys, younger children, and children enrolled in UNRWA schools and living in Gaza Strip . Children working ≥3 hours/day were more likely to experience injuries, 1.73 (95% CI, 1.53–1.95), than those working ≤3/day. About half of the children worked in retail trade (51.5%), agriculture (20.0%), and cleaning (11.4%). Injury type was related to the type of work performed. Conclusions. The high prevalence of injuries among working Palestinian schoolchildren confirms its severity as a public health problem. To reduce occupational injuries, policymakers and professionals should develop intervention programs that target the public and health providers. Christine Jildeh, Ziad Abdeen, Haleama Al Sabbah, Christopher Papandreou, Ibrahim Ghannam, Nancy Weller, and Anastas Philalithis Copyright © 2014 Christine Jildeh et al. All rights reserved. Prevalence of Congenital Anomalies: A Community-Based Study in the Northwest of Iran Wed, 26 Mar 2014 10:11:52 +0000 Background. Congenital anomalies are responsible for a remarkable proportion of mortality and morbidity in newborns. The aim of this study was to document the epidemiological features of congenital anomalies in rural areas, northwest of Iran. Method. The study population included live births born between 2004 and 2012 in rural areas of Tabriz district. All health records of the children under 8 years were assessed retrospectively. Results. Of 22500 live births, 254 cases were identified with a primary diagnosis of congenital anomalies giving a prevalence rate of 112.89 per 10 000 births (95% CI: 99.08 to 126.69). Anomalies of the nervous system were the most common defects, accounting for 24% of birth defects followed by the heart diseases anomalies. The highest prevalence rate for birth defects was observed in the south-western region with 386 per 10 000 births (95% CI: 215 to 556) compared to the similar rate in the north-western region with 15 per 10 000 births (95% CI: −14 to 45). Conclusion. The considerable geographic disparities in the prevalence of congenital anomalies in the region might be attributed to the highly polluted industrial zone in the area (including air and water pollution, etc.). This needs further etiological investigations in the region. Hossein Mashhadi Abdolahi, Mohammad Hassan Kargar Maher, Farzaneh Afsharnia, and Saeed Dastgiri Copyright © 2014 Hossein Mashhadi Abdolahi et al. All rights reserved. Predicators for Weight Gain in Children Treated for Severe Acute Malnutrition: A Prospective Study at Nutritional Rehabilitation Center Wed, 12 Mar 2014 11:27:17 +0000 Introduction. Despite being an important health problem in developing countries, there is little information available on factors affecting the severe acute malnutrition, especially nondietary factors. Objective. To study the impact of various factors, especially nondietary ones affecting directly or indirectly the weight gain in children with severe acute malnutrition. Method. A total of 300 children in the age group of 6 to 60 months meeting the WHO criteria for severe acute malnutrition were enrolled in the study. These children were provided special therapeutic diet as recommended by WHO/UNICEF protocol. Children were called for followup every 15 days up to 2 months after discharge to evaluate whether these children have achieved a final target weight gain of 15% of their admission weight. The impact of nondietary factors related to child, mother, and socioeconomic status was evaluated. Data collected through structured questionnaire were analyzed. Result. 172 (57.4%) of the total 300 children did not gain final target weight despite giving adequate diet. We observed that impact of various nondietary factors like mother’s educational status and her knowledge about feeding practices, socioeconomic status, previous history, and present evidence of infection in child was important in determining the weight of child. No association was found with gender of child, BMI of mother, and father’s educational status on the weight gain of child. Conclusion. The findings of this study confirm the association of many nondietary factors with weight gain in children treated for severe acute malnutrition. To reduce malnutrition emphasis should be given on these factors. Jyoti Sanghvi, Sudhir Mehta, and Ravindra Kumar Copyright © 2014 Jyoti Sanghvi et al. All rights reserved. Incidence of Retinopathy of Prematurity in Extremely Premature Infants Sun, 09 Mar 2014 09:51:01 +0000 Purpose. To investigate the incidence and the severity of retinopathy of prematurity (ROP) in extremely preterm infants born before 28 weeks of gestation in southeastern Turkey. Methods. A retrospective chart review was performed for infants born before 28 weeks of gestation. The following data were reviewed: gender, gestational age (GA), birth weight (BW), zone and stage of ROP, presence of plus disease, and treatment for ROP if needed. Infants were divided into 2 groups according to GA as follows: group 1 included infants of GAs 25 weeks and under; group 2 included infants of GAs less than 28 weeks and over 25 weeks. Results. The incidence of any ROP in the whole cohort, in group 1, and in group 2, was 66.0%, 95.5%, and 58.6%, respectively. Incidence of any ROP was significantly associated with BW and GA ( and , resp.). The overall incidence of type 1 ROP was 35.8% (59.1% in group 1 and 29.9% in group 2). Development of type 1 ROP was independently associated with GA. Conclusion. Any ROP was significantly associated with BW and GA. Extremely premature infants with lower GA were found to be more likely to develop type 1 ROP. BW cannot predict the development of type 1 ROP. Alparslan Şahin, Muhammed Şahin, Fatih Mehmet Türkcü, Abdullah Kürşat Cingü, Harun Yüksel, Yasin Çınar, Şeyhmus Arı, and İhsan Çaça Copyright © 2014 Alparslan Şahin et al. All rights reserved. Heavy Metal Levels in Adolescent and Maternal Blood: Association with Risk of Hypospadias Tue, 04 Mar 2014 11:14:10 +0000 Background. Hypospadias is a part of testicular digenesis syndrome (TDS) which includes infertility, cryptorchidism, and spermatogenesis. Heavy metals act as endocrine disrupting compounds. Heavy metals such as cadmium, chromium, arsenic, and lead have been associated with male infertility, cryptorchidism, spermatogenesis, cancer, reproductive disorder, and neurological disorder. However, it remains an important issue to corroborate or refute the hypothesis that the role of heavy metals in male reproductive tract disorders. Hence, the present study was designed to investigate the possible association of heavy metal and risk of hypospadias by estimating the blood heavy metal levels. Methods. In this case control study, 50 hypospadias boys diagnosed and confirmed by a pediatric urologist and 50 randomly selected age-matched (1–5 years) healthy control boys not suffering from any clinically detectible illness and their mothers have been included and heavy metal levels in the blood of these subjects have been estimated by Atomic Absorption Spectrophotometer (AAS). Result. Significantly high levels of cadmium and lead have been observed in hypospadias cases; however, all heavy metal levels were present in higher concentration. Conclusion. Higher blood levels of cadmium and lead may be associated with the increased risk of hypospadias. Tusha Sharma, Basu Dev Banerjee, Chandra Shekhar Yadav, Piyush Gupta, and Sunil Sharma Copyright © 2014 Tusha Sharma et al. All rights reserved. Identification and Prevention of Antiepileptic Drug Noncompliance: The Collaborative Use of State-Supplied Pharmaceutical Data Wed, 19 Feb 2014 13:10:41 +0000 Background. Antiepileptic drugs (AEDs) noncompliance is associated with increased risk of seizures and morbidity in seizure disorder patients. Objective. To identify risk factors that correlated to higher levels of morbidity, measured by emergency room (ER) utilization by seizure disorder members taking AED. Methods. Patients with primary or secondary diagnosis of seizures, convulsions, and/or epilepsy and prescribed AEDs during an 11-month period were included in the study. Variables were analyzed using multivariate statistical analysis including logistic regression. Results. The study identified 201 members. No statistical significance (NS) between age, gender, number of tablets, type of drug, or other risk factors was associated with increased mortality. Statistical significance resulted with medication compliance review of 0–14 days, 15–60 days, and 61+ days between refills. 68% of patients with ER visit had noncompliance refill between 0 and 14 days compared to 52% of patients in non-ER group (). Contrastingly, 15% of ER group had refills within 15–60 days compared with 33% of non-ER group (). There was NS difference between two groups when noncompliance was greater than 60 days (). Conclusions. The study suggests that careful monitoring of pharmaceutical refill information could be used to identify AED noncompliance in epileptic patients. Joseph C. Hodges, Janet Treadwell, Amy D. Malphrus, Xuan G. Tran, and Angelo P. Giardino Copyright © 2014 Joseph C. Hodges et al. All rights reserved. Relation between Red Cell Distribution Width and Left Ventricular Function in Children with Heart Failure Mon, 10 Feb 2014 14:49:25 +0000 Background. Most of the studies done on adults showed that red cell distribution width (RDW) can be used as a prognostic marker in patients with chronic heart failure. However, RDW has not been tested in children with heart failure. Methods and Results. 31 children with heart failure admitted to Cardiology Unit, Tanta University Hospital, during the period of January 2012 to December 2012 were included in this study, RDW as a component of routine blood count was evaluated and correlated to the echocardiographic parameters of left ventricle. The mean age of our cohort was 16.16 ± 14.97 months, congenital heart disease with left-to-right shunt represented 58.1% of the underlying causes of heart failure while dilated cardiomyopathy made 41.9%. The mean hemoglobin level was 9.14 ± 1.18 gm/dL; RDW level ranged from 10.7% to 27.7% with a mean of 16.01 ± 3.34. Hemoglobin was significantly correlated with RDW at any level. For the echo parameters, at cutoff point of 16.4%, RDW was significantly correlated with fraction shortening (FS), and A, E/A ratio, but it was not correlated with LVEDD, LVESD, and E/É at the same cutoff level. Conclusion. RDW, a simple, available test, can be used as a marker for the left ventricular function in children with heart failure until an echocardiography assessment for the patients is done. Wegdan Mawlana, Amr Donia, and Doaa Elamrousy Copyright © 2014 Wegdan Mawlana et al. All rights reserved. Influence of the Type of Basal Insulin and Other Variables on Clinical Outcomes in Children with Newly Diagnosed Type 1 Diabetes Thu, 06 Feb 2014 11:12:16 +0000 Background. Basal insulin detemir and glargine each have characteristics that may make them a superior choice in children and adolescents with type 1 diabetes, but there is a paucity of data on glycemic results in this population. Objective. Examination of variables associated with achievement of HbA1c goal in children and adolescents with newly diagnosed type 1 diabetes. Methods. The primary outcome, factors associated with achievement of HbA1c goal, was examined in a retrospective chart review. Variables, including type of basal insulin, were collected during the first year of diagnosis of patients in a pediatric diabetes clinic. Secondary outcomes included change in HbA1c, severe hypoglycemic events, and episodes of DKA. Results. 94 patients were included in the study. HbA1c at diagnosis was found to be a significant predictor of achievement of goal at 3 months () and of change in HbA1c at 3 and 12 months ( for each). Severe hypoglycemia and episodes of DKA were uncommon. Conclusions. Choice of basal insulin was not found to be a predictor of achieving HbA1c goal or of change in HbA1c over the course of the first year of diagnosis with type 1 diabetes. Ruth M. Garrison, Jeremy L. Johnson, Michelle E. Condren, Kevin C. Farmer, and David H. Jelley Copyright © 2014 Ruth M. Garrison et al. All rights reserved. Role of Electrical Impedance Tomography in Clinical Practice in Pediatric Respiratory Medicine Wed, 25 Dec 2013 15:54:08 +0000 This paper summarizes current knowledge about electrical impedance tomography (EIT) and its present and possible applications in clinical practice in pediatric respiratory medicine. EIT is a relatively new technique based on real-time monitoring of bioimpedance. Its possible application in clinical practice related to ventilation and perfusion monitoring in children has gaine increasing attention in recent years. Most of the currently published data is based on studies performed on small and heterogenous groups of patients. Thus the results need to be corroborated in future well-designed clinical trials. Firstly a short theoretical overview summarizing physical principles and main advantages and disadvantages is provided. It is followed by a review of the current data regarding EIT application in ventilation distribution monitoring in healthy individuals. Finally the most important studies utilizing EIT in ventilation and perfusion monitoring in critically ill newborns and children are outlined. Wojciech Durlak and Przemko Kwinta Copyright © 2013 Wojciech Durlak and Przemko Kwinta. All rights reserved. Vitamin D Supplementation for the Treatment of Acute Childhood Pneumonia: A Systematic Review Thu, 19 Dec 2013 15:26:12 +0000 Background. Studies have found an increased incidence of vitamin D deficiency in children with pneumonia; however, there is no conclusive data regarding the direct effect of vitamin D supplementation in acute pneumonia. Methods. A comprehensive search was performed of the major electronic databases till September 2013. Randomized controlled trials (RCTs) comparing treatment with vitamin D3 versus placebo in children ≤5 years old with pneumonia were included. Results. Out of 32 full text articles, 2 RCTs including 653 children were eligible for inclusion. One trial used a single 100,000 unit of oral vitamin D3 at the onset of pneumonia. There was no significant difference in the mean (±SD) number of days to recovery between the vitamin D3 and placebo arms (). Another trial used oral vitamin D3 (1000 IU for <1 year and 2000 IU for >1 year) for 5 days in children with severe pneumonia. Median duration of resolution of severe pneumonia was similar in the two groups (intervention, 72 hours; placebo, 64 hours). Duration of hospitalization and time to resolution of tachypnea, chest retractions, and inability to feed were also comparable between the two groups. Conclusions. Oral vitamin D supplementation does not help children under-five with acute pneumonia. Rashmi Ranjan Das, Meenu Singh, Inusha Panigrahi, and Sushree Samiksha Naik Copyright © 2013 Rashmi Ranjan Das et al. All rights reserved. Effect of Women’s Decision-Making Autonomy on Infant’s Birth Weight in Rural Bangladesh Thu, 12 Dec 2013 18:25:07 +0000 Background. Low birth weight (LBW), an outcome of maternal undernutrition, is a major public health concern in Bangladesh where the problem is most prominent. Women’s decision-making autonomy is likely an important factor influencing maternal and child health outcomes. The aim of the study was to assess the effect of women’s decision-making autonomy on infant’s birth weight (BW). Methods. The study included data of 2175 enrolled women (14–45 years of age) from the Maternal and Infant Nutritional Intervention in Matlab (MINIMat-study) in Bangladesh. Pearson’s chi-square test, analysis of covariance (ANCOVA), and logistic regression analysis were applied at the collected data. Results. Women with lowest decision-making autonomy were significantly more likely to have a low birth weight (LBW) child, after controlling for maternal age, education (woman’s and her husband’s), socioeconomic status (SES) (odds ratio (OR) = 1.4; 95% confidence interval (CI) 1.0, 1.8). BW was decreased significantly among women with lowest decision making autonomy after adjusting for all confounders. Conclusion. Women’s decision-making autonomy has an independent effect on BW and LBW outcome. In addition, there is a need for further exploration to identify sociocultural attributes and gender related determinants of women decision-making autonomy in this study setting. Arpana Sharma and Manzur Kader Copyright © 2013 Arpana Sharma and Manzur Kader. All rights reserved. Role of Organochlorine Pesticides in Children with Idiopathic Seizures Tue, 03 Dec 2013 14:27:17 +0000 Background. Organochlorine pesticides (OCP) are persistent organic pollutants that have been implicated in causing several deleterious effects in humans. These are known neurotoxins in high doses, but the role of environmentally acquired OCPs in the body to induce seizures in children has not been investigated yet. Objectives. To assess the serum levels of OCPs in children aged 2–12 with idiopathic seizure and to find out any association between the two are our objectives. Methods. It was a cross-sectional pilot study. Twenty developmentally normal children aged 2–12, presenting with idiopathic generalized seizures, were recruited. Twenty age-matched controls without any history of seizures were also taken. Their serum levels of , , and hexachlorocyclohexane (HCH); and aldrin; dieldrin; p,p-dichlorodiphenyltrichloroethane (DDT), o,p-DDT, and p,p dichlorodiphenyldichloroethylene (DDE); and and endosulfan were analysed using gas chromatography (GC). Mann-Whitney test was used to compare OCP levels between the groups. Spearman correlation was used to find the correlation between individual pesticide levels with age and seizure duration. Results. Levels of , , and total HCH were significantly higher among cases as compared to the control group (). Conclusion. There exists a possible association between idiopathic seizures and high serum levels of OCPs, especially HCH. Shilpa Khanna Arora, Prerna Batra, Tusha Sharma, Basu Dev Banerjee, and Sushan Gupta Copyright © 2013 Shilpa Khanna Arora et al. All rights reserved. Development of Dengue Infection Severity Score Tue, 12 Nov 2013 15:54:47 +0000 Objectives. To develop a simple scoring system to predict dengue infection severity based on patient characteristics and routine clinical profiles. Methods. Retrospective data of children with dengue infection from 3 general hospitals in Thailand were reviewed. Dengue infection was categorized into 3 severity levels: dengue infection (DF), dengue hemorrhagic fever (DHF), and dengue shock syndrome (DSS). Coefficients of significant predictors of disease severity under ordinal regression analysis were transformed into item scores. Total scores were used to classify patients into 3 severity levels. Results. Significant clinical predictors of dengue infection severity were age >6 years, hepatomegaly, hematocrit 40%, systolic pressure <90 mmHg, white cell count >5000 /μL, and platelet ≤50000 /μL. The derived total scores, which ranged from 0 to 18, classified patients into 3 severity levels: DF (scores <2.5, , 58.1%), DHF (scores 2.5–11.5, , 35.5%), and DSS (scores >11.5, , 6.4%). The derived score correctly classified patients into their original severity levels in 60.7%. An under-estimation of 25.7% and an over-estimation of 13.5% were clinically acceptable. Conclusions. The derived dengue infection severity score classified patients into DF, DHF, or DSS, correctly into their original severity levels. Validation of the score should be reconfirmed before application of routine practice. Surangrat Pongpan, Apichart Wisitwong, Chamaiporn Tawichasri, Jayanton Patumanond, and Sirianong Namwongprom Copyright © 2013 Surangrat Pongpan et al. All rights reserved. Ethnic Background and Overweight among 5-Year-Old Children: The “Be Active, Eat Right” Study Thu, 10 Oct 2013 10:19:47 +0000 Introduction. This study investigates the association between ethnic background and overweight (obesity included) among 5 year olds. Methods. We used baseline data from 5 year olds () and their parents collected for the “Be active, eat right” study. A child was considered to be of non-Dutch ethnic background when at least one of the parents was born abroad. Odds ratios (ORs) were adjusted for sociodemographic characteristics. Results. Compared to children of Dutch ethnic background, for children with a Moroccan ethnic background the OR for being overweight (obesity included) was 2.27 (95% CI 1.48–3.47), for Turkish children the OR was 3.63 (95% confidence interval (CI) 2.46–5.35), for Antillean children the OR was 1.97 (95% CI 1.01–3.86), and for Surinamese children the OR was 0.47 (95% CI 0.20–1.06). Addition of parental overweight decreased the ORs for Moroccan and Turkish children by 10.2% and 12.5%, and addition of watching TV and having breakfast by the child decreased the ORs by 7.9% and 12.2%. Conclusion. Already at a young age, children of Moroccan and Turkish ethnic background are at increased risk for being overweight compared to Dutch children. Parental overweight, watching TV, and not having breakfast by the child are contributing factors in this association. Lydian Veldhuis, Mara van Dooremaal, Willemieke Kroeze, Carry M. Renders, Remy A. HiraSing, and Hein Raat Copyright © 2013 Lydian Veldhuis et al. All rights reserved. Primary Immunodeficiency May Be Misdiagnosed as Cow’s Milk Allergy: Seven Cases Referred to a Tertiary Pediatric Hospital Mon, 30 Sep 2013 15:27:38 +0000 Introduction. The presence of eczema and gastrointestinal manifestations are often observed in cow’s milk allergy (CMA) and also in some primary immunodeficiency diseases (PID). Objective. To describe 7 patients referred to a tertiary allergy/immunology Center with a proposed diagnosis of CMA, who were ultimately diagnosed with PID. Methods. This was a retrospective study based on clinical and laboratory data from medical records. Results. Seven patients (6 males) aged between 3 mo and 6 y were referred to our clinic with a proposed diagnosis of CMA. They presented with eczema and/or gastrointestinal symptoms. Five were receiving replacement formula. All patients presented with other clinical features, including severe/recurrent infections unrelated to CMA, and two of them had a positive family history of PID. Laboratory tests showed immune system dysfunctions in all patients. Hyper-IgE and Wiskott-Aldrich syndromes, CD40L deficiency, severe combined immunodeficiency, X-linked agammaglobulinemia, transient hypogammaglobulinemia of infancy, and chronic granulomatous disease were diagnosed in these children. In conclusion, allergic diseases and immunodeficiency are a result of a different spectrum of abnormalities in the immune system and may be misdiagnosed. Educational programs on PID among clinical physicians and pediatricians can reduce the occurrence of this misdiagnosis. Karina Mescouto Melo, Ellen Dantas, Maria Isabel De Moraes-Pinto, Antonio Condino-Neto, Isabela G. S. Gonzalez, Marcia C. Mallozi, Jackeline M. Franco, and Beatriz T. Costa-Carvalho Copyright © 2013 Karina Mescouto Melo et al. All rights reserved. Proximal Aortic Stiffness Is Increased in Systemic Lupus Erythematosus Activity in Children and Adolescents Thu, 19 Sep 2013 11:27:35 +0000 Patients with systemic lupus erythematosus (SLE) are prone to premature atherosclerosis and are at risk for the development of cardiovascular disease. Increased arterial stiffness is emerging as a marker of subclinical atherosclerosis. Purpose. To measure proximal aortic stiffness in children and adolescents with SLE. Methods. We studied 16 patients with SLE in activity (mean age years; 16 females), 14 patients with SLE not in activity (mean age years; 4 males, 10 females), and 16 age- and sex-comparable healthy children and adolescents ( years; 4 males, 12 females). Disease activity was determined by the SLE disease activity index (SLEDAI). All subjects underwent echocardiography for assessment of proximal aortic pulse wave velocity (PWV) [Ao distance/Ao wave transit time in the aortic arch]. Venous blood samples were collected for ESR. Results. Patients in activity had significantly higher PWV values than controls (), while no significant difference was found between patients not in activity and controls. Conclusions. SLE patients with disease activity demonstrate increased PWV and arterial stiffness of the proximal aorta, while patients without disease activity do not. This suggests that inflammation secondary to SLE activity, and not subclinical atherosclerosis, is the major underlying cause for increased arterial stiffness in this age group. Yehia Mohamad El Gamal, Ola Abd Elaziz Elmasry, Iman Saleh El Hadidi, and Ola Kamel Soliman Copyright © 2013 Yehia Mohamad El Gamal et al. All rights reserved. Targeted versus Universal Neonatal Hearing Screening in a Single Egyptian Center Thu, 12 Sep 2013 09:55:21 +0000 Aim. To compare targeted neonatal hearing screening (TNHS) and universal neonatal hearing screening (UNHS) since many developing countries, including Egypt, implement selective screening for high-risk neonates. Methods. 150 neonates were assessed; 50 full terms consecutively admitted to the well-baby nursery and 100 neonates consecutively admitted to neonatal intensive care unit (NICU), Ain Shams University. Patients were further subdivided into high-risk group which included 50 neonates with multiple risk factors for hearing loss and low risk group which included 50 neonates with only one risk factor. Transient evoked otoacoustic emissions (TEOAEs) were used for hearing screening. Auditory brain response (ABR) was performed 3 months later for failed TEOAEs. Results. The most frequent risk factor was consanguinity (46%). In the well-baby population, 16% failed TEOAEs. In the NICU, 30% of the low risk and 38% of the high risk groups failed TEOAEs. Regarding ABR, failed results were 12%, 10%, and 8% in the high-risk, low-risk, and healthy groups, respectively. Conclusion. The use of TNHS would have missed 8% of neonates from the well-baby group who actually had PCHL (permanent congenital hearing loss). The use of UNHS would identify all cases with PCHL, allowing for early intervention and follow-up. Safaa S. Imam, Rania A. El-Farrash, Hesham M. Taha, and Helbees E. Bishoy Copyright © 2013 Safaa S. Imam et al. All rights reserved. N-Terminal proBNP Levels and Tissue Doppler Echocardiography in Acute Rheumatic Carditis Wed, 11 Sep 2013 10:48:50 +0000 Background. Rheumatic heart disease (RHD) is a leading cause of heart failure in children and young adults worldwide. B-type natriuretic peptide (BNP) is a useful marker of critical pediatric heart disease, and its N-terminal peptide, NT-proBNP, is elevated in congenital and acquired heart disease in children. Aim. To measure NT-proBNP levels as a marker of carditis in children with acute rheumatic carditis, as compared to children with quiescent RHD and healthy controls. Methods. 16 children with acute rheumatic carditis, 33 children with quiescent RHD, and a cohort of 30 healthy children were studied. Transthoracic echocardiography was performed to assess valve and cardiac function. Tissue Doppler echocardiography was performed for E/E′ (ratio between mitral inflow E wave and lateral mitral annulus E′ wave) and systolic strain. Results. NT-proBNP levels were significantly higher in children with acute rheumatic carditis and dropped with its resolution. Strain and E/E′ values were comparable among the three groups. Conclusion. NT-proBNP is significantly elevated in children with acute rheumatic carditis in the acute stage compared to children with quiescent RHD and healthy subjects, in the presence of comparable echocardiographic indices of LV systolic and diastolic function. Alyaa A. Kotby, Ghada S. El-Shahed, Ola A. Elmasry, Iman S. El-Hadidi, and Rowaida N. S. El Shafey Copyright © 2013 Alyaa A. Kotby et al. All rights reserved. Maternal Vitamin A Deficiency during Pregnancy and Its Relation with Maternal and Neonatal Hemoglobin Concentrations among Poor Egyptian Families Wed, 21 Aug 2013 14:06:05 +0000 Background. Vitamin A deficiency (VAD) during pregnancy represents a major public health problem in developing countries. Anemia is a common consequence of VAD. We aimed to measure serum retinol concentrations of a sample of poor Egyptian mothers and correlate it with their Hb% and cord Hb%. Methods. This cross-sectional study included 200 healthy mothers and their healthy full term newborns. Maternal and cord blood samples were collected for CBC and measurement of serum retinol concentrations. Results. Forty-seven mothers (23.5%) had VAD and 50% were anemic. Mothers with VAD had a significantly lower mean Hb% and a significantly higher frequency of anemia (95.7%) compared to mothers without VAD (35.9%). The relative risk for anemia among mothers with VAD was 2.7 (CI = 2.12–3.3). Newborns of mothers with VAD had a significantly lower mean cord Hb% compared to newborns of mothers without VAD. Maternal serum retinol concentrations were positively correlated with maternal Hb% and cord Hb%. Conclusion. Maternal VAD during pregnancy among poor mothers is associated with maternal anemia and lower Hb% of newborns at birth. Vitamin A supplementation is highly recommended for this vulnerable group. A. M. Hamdy, M. M. Abdel Aleem, and A. A. El-Shazly Copyright © 2013 A. M. Hamdy et al. All rights reserved. Natal and Neonatal Teeth: An Overview of the Literature Sun, 18 Aug 2013 13:55:34 +0000 The occurrence of natal and neonatal teeth is an uncommon anomaly, which for centuries has been associated with diverse superstitions among different ethnic groups. Natal teeth are more frequent than neonatal teeth, with the ratio being approximately 3 : 1. It must be considered that natal and neonatal teeth are conditions of fundamental importance not only for a dental surgeon but also for a paediatrician since their presence may lead to numerous complications. Early detection and treatment of these teeth are recommended because they may induce deformity or mutilation of tongue, dehydration, inadequate nutrients intake by the infant, and growth retardation, the pattern and time of eruption of teeth and its morphology. This paper presents a concise review of the literature about neonatal teeth. Shubhangi Mhaske, Monal B. Yuwanati, Ashok Mhaske, Raju Ragavendra, Kavitha Kamath, and Swati Saawarn Copyright © 2013 Shubhangi Mhaske et al. All rights reserved. A Comparative Study on Diadochokinetic Skill of Dyslexic, Stuttering, and Normal Children Tue, 06 Aug 2013 07:50:17 +0000 Objective. Previous studies have shown some motor deficits among stuttering and dyslexic children. While motor deficits in speech articulation of the stuttering children are among the controversial topics, no study on motor deficits of dyslexic children has been documented to date. Methods. 120 children (40 stuttering, 40 dyslexia, and 40 normal) 6–11 years old were matched and compared in terms of diadochokinetic skill. Dyslexia symptoms checklist, reading test, and diadochokinetic task were used as measurement instruments. Results. The data analysis showed that there are significant differences () in reaction time and the number of syllables in accomplishing diadochokinetic tasks among stuttering children, dyslexics, and the control group. This indicates that stuttering children and dyslexics have poor performance in reaction time and in the number of monosyllable articulation and long syllable articulation. Furthermore, there are significant differences () in these indices between stuttering children and dyslexics, so that the latter group have better performance than the former one. Conclusion. The findings indicate that stuttering children and dyslexics have deficits in diadochokinetic skill which suggests their low performance in the motor control of speech production and articulation. Such deficits might be due to the role of the tongue in the development of stuttering and dyslexia. Ayyoub Malek, Shahrokh Amiri, Issa Hekmati, Jaber Pirzadeh, and Hossein Gholizadeh Copyright © 2013 Ayyoub Malek et al. All rights reserved. Selected Health Status Measures of Children from US Immigrant Families Mon, 08 Jul 2013 13:15:52 +0000 Using the 2007 National Survey of Children's Health (N = 91,532), we studied the relationship between the joint effects of immigrant family type (foreign-born children, US-born children/one foreign-born parent, US-born children/both foreign-born parents, and US-born children/US-born parents) and race/ethnicity on various health measures (parent-reported physical and dental health, obesity/overweight, breast-feeding, school absence, injury, and chronic condition). We used weighted logistic regression to examine the independent effects of the 12-level joint variable on various health status measures while controlling for confounding factors. Overall, nearly one-third of families with both foreign-born parents were poor, and one-quarter of the parents in these households did not complete high school. Compared with non-Hispanic White US-born children, multivariable analyses indicate that all Hispanic children have higher odds of obesity, poor physical and dental health, with Hispanic foreign-born children 7 times as likely to report poor/fair physical health. Most children of immigrant parents were more likely to have been breast-fed and less likely to miss school more than 11 days. Child age and household poverty status were independently associated with most of the health status measures. Combined race/ethnicity and immigrant family type categories have heterogeneous associations with each health outcome measure examined. Culturally competent interventions and policies should be developed to serve these expanding communities. Stella M. Yu, Sue C. Lin, and Terry Adirim Copyright © 2013 Stella M. Yu et al. All rights reserved. Determinants of Oxygen Therapy in Childhood Pneumonia in a Resource-Constrained Region Sun, 02 Jun 2013 16:35:40 +0000 Childhood pneumonia is a leading cause of morbidity and mortality among underfives particularly in the resource-constraint part of the world. A high proportion of these deaths are due to lack of oxygen, thereby making oxygen administration a life-saving adjunctive when indicated. However, many primary health centres that manage most of the cases often lack the adequate manpower and facilities to decide which patient should be on oxygen therapy. Therefore, this study aimed to determine factors that predict hypoxaemia at presentation in children with severe pneumonia. Four hundred and twenty children aged from 2 to 59 months (40% infants) with severe pneumonia admitted to a health centre in rural Gambia were assessed at presentation. Eighty-one of them (19.30%) had hypoxaemia (oxygen saturation < 90%). Children aged 2–11 months, with grunting respiration, cyanosis, and head nodding, and those with cardiomegaly on chest radiograph were at higher risk of hypoxaemia (). Grunting respiration (, 95% CI 2.287–7.482) and cyanosis (, 95% CI 5.248–355.111) were independent predictors of hypoxaemia in childhood pneumonia. We conclude that children that grunt and are centrally cyanosed should be preferentially commenced on oxygen therapy even when there is no facility to confirm hypoxaemia. Bankole Peter Kuti, Samuel Ademola Adegoke, Benard E. Ebruke, Stephen Howie, Oyeku Akibu Oyelami, and Martin Ota Copyright © 2013 Bankole Peter Kuti et al. All rights reserved. The Type of Anesthesia Used during Cesarean Section Is Related to the Transient Tachypnea of the Newborn Wed, 24 Apr 2013 13:43:14 +0000 Aim. To demonstrate whether transient tachypnea of the newborn (TTN) is found more frequently in women undergoing general or combined epidural-spinal (CES) anesthesia during Cesarean section. Methods. This study was done retrospectively. A total of 1447 Cesarean sections (C/S) were performed in our clinic between January 2008 and December 2011. General anesthesia was performed in 1078 (74.5%) of the Cesarean cases. CES anesthesia was performed in 369 cases (25.5%). The International Classification of Diseases,Tenth Revision code of P22.1, was used to identify the infants with TTN. Stratified multivariate analysis was undertaken on subgroups to assess the effect modification by factors known to influence the incidence of TTN: maternal age, maternal systolic-diastolic artery pressure, heart rate, Apgar score at 1 and 5 minutes, sex, time interval from spinal block to skin incision, and time interval from skin incision to umbilical cord clamping. Results. The rate of TTN diagnosis was found to be higher in parturients who had a cesarean section with combined epidural-spinal anesthesia, but no statistical differences were found. (odds ratio = 1.471 and 95%CI: 0.92–2.35). Conclusions. The incidence of TTN was found related to C/S but independent from the type of anesthesia. However, studies with a wider spectrum of patients and a lower quantitative difference between the groups are needed in order to draw firm this conclusions. Esengül Keleş, Hamza Yazgan, Arzu Gebeşçe, and Emine Pakır Copyright © 2013 Esengül Keleş et al. All rights reserved. Heart Rate and Arterial Pressure Changes during Whole-Body Deep Hypothermia Thu, 11 Apr 2013 16:50:32 +0000 Whole-body deep hypothermia (DH) could be a new therapeutic strategy for asphyxiated newborn. This retrospective study describes how DH modified the heart rate and arterial blood pressure if compared to mild hypothermia (MH). Fourteen in DH and 17 in MH were cooled within the first six hours of life and for the following 72 hours. Hypothermia criteria were gestational age weeks; birth weight  g; clinical signs of moderate/severe hypoxic-ischemic encephalopathy. Rewarming was obtained in the following 6–12 hours (0.5°C/h) after cooling. Heart rates were the same between the two groups; there was statistically significant difference at the beginning of hypothermia and during rewarming. Three babies in the DH group and 2 in the MH group showed HR < 80 bpm and QTc > 520 ms. Infant submitted to deep hypothermia had not bradycardia or Qtc elongation before cooling and after rewarming. Blood pressure was significantly lower in DH compared to MH during the cooling, and peculiar was the hypotension during rewarming in DH group. Conclusion. The deeper hypothermia is a safe and feasible, only if it is performed by a well-trained team. DH should only be associated with a clinical trial and prospective randomized trials to validate its use. Giacomo Cavallaro, Luca Filippi, Genny Raffaeli, Gloria Cristofori, Federico Schena, Elisa Agazzani, Ilaria Amodeo, Alice Griggio, Simona Boccacci, Patrizio Fiorini, and Fabio Mosca Copyright © 2013 Giacomo Cavallaro et al. All rights reserved. Prevalence and Clinical and Immunoviralogical Profile of Human Immunodeficiency Virus-Hepatitis B Coinfection among Children in an Antiretroviral Therapy Programme in Benue State, Nigeria Wed, 03 Apr 2013 11:26:37 +0000 Background. Nigeria has the world largest burden of paediatric HIV and is also highly endemic for Hepatitis B virus (HBV). However, relatively little is known regarding the prevalence of HBV-HIV coinfections among Nigerian children. Methods. A retrospective study among treatment naive HIV-infected children attending the pediatric clinic of the APIN Plus/Harvard PEPFAR program of the Federal Medical Centre, Makurdi, between June 2008 and June 2012. Results. The mean age of the 395 subjects studied was years. Thirty-one subjects (7.8%) were positive for HBV. No subject was HIV-HBV-HCV triply infected. Significantly higher HIV-HBC coinfections were found, in older subjects (11–15 years), subjects that did not receive nor complete Hepatitis B vaccinations, and subjects that had a severe immunosuppression of < 15% with respective values of 0.00, 0.01, and 0.00. HIV-HBV co-infection did not significantly impact on other baseline characteristics including, gender, WHO clinical stage, median absolute CD4 count, mean viral load, median ALT, and hepatotoxicity. Conclusion. A high seroprevalence of HBV among this cohort of HIV-infected children contributes to the calls for pre-ART screening for HBV and the necessary paradigm shift in the ART nucleoside backbone to include agent(s) more dually effective against HIV and HBV. Emmanuel Ademola Anigilaje and Ayodotun Olutola Copyright © 2013 Emmanuel Ademola Anigilaje and Ayodotun Olutola. All rights reserved. Clinical Asthma Phenotypes and Therapeutic Responses Sun, 31 Mar 2013 11:26:56 +0000 Asthma is a heterogeneous disease that means not all asthmatics respond to the same treatment. We hypothesize an approach to characterize asthma phenotypes based on symptomatology (shortness of breath (SOB), cough, and wheezy phenotypes) in correlation with airway inflammatory biomarkers and FEV1. We aimed to detect whether those clinical phenotypes have an impact on the response to asthma medications. Two hundred three asthmatic children were allocated randomly to receive either montelukast (5 mg at bed time) or fluticasone propionate (100 ug twice daily) for 8 consecutive weeks. Serum concentrations of IL-2Rs, ICAM-1, VCAM-1, total IgE, eosinophilic %, eosinophil cationic protein (ECP), and FEV1 were done before and after treatment to patients and once to controls. Children who have SOB were found to have higher levels of total sIgE, older age, and longer disease duration, and they responded to fluticasone alone. Cough group was found to have higher levels of eosinophilic % and sECP, younger age, shorter disease duration and responded to montelukast alone. Wheezy group showed mixed pattern and responded to both medications. Conclusion. Although there is variability in response to ICS and LTRAs, we did identify characteristics of patient that should guide the clinician in the choice of asthma medications. M. Zedan, G. Attia, M. M. Zedan, A. Osman, N. Abo-Elkheir, N. Maysara, T. Barakat, and N. Gamil Copyright © 2013 M. Zedan et al. All rights reserved. Erratum to “The Comparative Study of the Effectiveness of Cimetidine, Ranitidine, Famotidine, and Omeprazole in Treatment of Children with Dyspepsia” Thu, 28 Mar 2013 11:24:35 +0000 Seyed Mohsen Dehghani, Mohammad Hadi Imanieh, Roya Oboodi, and Mahmood Haghighat Copyright © 2013 Seyed Mohsen Dehghani et al. All rights reserved. Automatic Tube Compensation versus Pressure Support Ventilation and Extubation Outcome in Children: A Randomized Controlled Study Tue, 26 Feb 2013 10:13:47 +0000 Background. Automatic tube compensation (ATC) has been developed to overcome the imposed work of breathing due to artificial airways during spontaneous breathing trials (SBTs). Objectives. This study aimed to assess extubation outcome after an SBT (spontaneous breathing trial) with ATC compared with pressure support ventilation (PSV) and to determine the risk factors for extubation failure. Methods. Patients ready for extubation were randomly assigned to two-hour spontaneous breathing trial with either ATC or pressure support ventilation. Results. In the ATC group (), 11 (65%) patients passed the SBT with subsequent extubation failure (9%). While in PSV group (), 10 (53%) patients passed the SBT with subsequent extubation failure (10%). This represented a positive predictive value for ATC of 91% and PSV of 90% (). Five (83%) of the patients who failed the SBT in ATC group were reintubated. This represented a higher negative predictive value for ATC of 83% than for PSV which was 56%. None of the assessed risk factors were independently associated with extubation failure including failed trial. Conclusion. ATC was equivalent to PSV in predicting patients with successful extubation. A trial failure in ATC group is associated with but does not definitely predict extubation failure. Ahmed Saad El-din El-beleidy, Asser Abd EL-Hamied Khattab, Seham Awad El-Sherbini, and Hebatalla Fadel Al-gebaly Copyright © 2013 Ahmed Saad El-din El-beleidy et al. All rights reserved. To Evaluate Serum Eosinophil Cationic Protein and Total IgE Concomitantly May Predict the Persistence of Wheezing in Young Children Mon, 24 Dec 2012 10:45:27 +0000 Background. We investigated the predictive value and the relative risk of the evaluation of serum eosinophilic cationic protein (sECP) and total IgE levels concomitantly in relation to the persistence of wheezing in young children. Methods. The study was conducted prospectively between January 2007 and December 2010. A hundred and eight children, aged between three months and four years, with three or more episodes of wheezing, were studied to evaluate the role of eosinophil inflammation and its relation to persistence of wheezing two years later. Results. A statistically significant difference in terms of total IgE and sECP values was observed between the groups (). When measurement of IgE and sECP was assessed concomitantly, the sensitivity was found to be 92.68%, the negative predictive value was found to be 71.43%, accuracy rate was found to be 84.26%, and the relative risk was found to be 3.06 in group 1. Conclusions. In this study, we aimed to emphasize the importance of the assessment of sECP and total IgE concomitantly, as being two noninvasive and easily applicable tests, useful in predicting persistent wheezing in early childhood. Esengül Keleş, Hamza Yazgan, and Arzu Gebeşçe Copyright © 2012 Esengül Keleş et al. All rights reserved.