Fontanel Size from Birth to 24 Months of Age in Iranian Children

How to Cite This Article: Esmaeili Mo, Esmaeili Ma, Ghane Sharbaf F, Bokharaie Sh. Fontanel Size from Birth to 24 Months of Age in Iranian Children. Iran J Child Neurol. Autumn 2015;9(4):15-23.AbstractObjectiveDiagnosis of abnormal fontanel size, a potential clue to recognition of different disorders, requires an understanding of the wide variation of normal fontanel size. The anterior fontanel is the largest, prominent and most important for clinical evaluation. The aim of this study was to establish and define normal range of fontanel size from birth to 24 months of age in healthy Iranian children that might be generalized to other populations.Materials & MethodsTotally, 550 subjects enrolled randomly in this cross sectional study. They were apparently normal healthy children, from birth to 24 months of age, including 208-term newborn and 342 infant from birth to 2 yr old. Fontanel size was measured and recorded as the mean of the length (anterior- posterior dimension) and width (transverse dimension). Mean anterior fontanel sizes in our samples were classified for periods of 3 months. Nomograms and statistical analyses were performed and depicted by Excel Microsoft Office 2007 and two-tailed t-test respectively.ResultsThe mean ±2SD of anterior fontanel size was 2.55±1.92 cm in newborns, 3.37±2.48 (largest size) in 3 months of age. It was closed in all cases in 15-18 months of age. The mean posterior fontanel size was 0.8 cm in newborns and closed in all infants in 2 months of age. There was no significant difference in anterior fontanel size between two genders except in newborn and 6-9 months old (P>0.05).ConclusionAbnormal fontanel can indicate a serious medical condition. Therefore, it is important to understand normal variations, to utilize standardized techniques for measurement and appropriate standards of normal range in different age groups and populations. This study provides a normal range of mean fontanel size in Iranian infants as a local reference. It might be generalized to other populations.

Renal Amyloidosis Due to Juvenile Rheumatoid Arthritis Occurring in Early Childhood

Renal amyloidosis is a late manifestation of chronic juvenile rheumatoid arthritis (JRA) and usually manifests during the first 10 to 15 years after the onset of JRA. We hereby report a boy with JRA-related renal amyloidosis who presented with nephrotic syndrome in early childhood. Amyloidosis was associated with a 6-year history of juvenile rheumatic arthritis (JRA). Diagnosis of renal amyloidosis was confirmed by the deposition of Congo red positive amyloid fibrils within the glomeruli. Polarized light microscopy showed the classic green birefringence appearance.Key words: Arthritis, Juvenile; Amyloidosis, familial renal; Chil

Comparison of the Voiding Cystourethrogram Results One and Three weeks after the First Urinary Tract Infection in 1-Month to 15-Year-Old Children

Introduction: To determine whether the timing of voiding cystoureterogram (VCUG) in the first or the third week after a diagnosis of urinary tract infection (UTI) is important in the diagnosis and severity of VUR.Materials and Methods: In this case-control study, 72 children between 1 month and 15 years old diagnosed with their first episode of UTI were investigated over one year. The study population was divided into 2 groups of 36, early (VCUG in the first week after UTI) and late (VCUG 3 weeks after UTI), and compared the severity and incidence of reflux in both groups.Results: The prevalence of VUR was 66.6%. Twenty-two cases in the first group (61%) and 26 cases in the second group (72.2%) presented with VUR. The peak age of the disease in both groups was 1-3 years with a female predominance. The most common germ detected was E-Coli and the most common presentations were fever (87.5%) and dysuria (26.3%).Conclusions: As VUR following UTI is very common in children and is one of the most important risk factors of early hypertension and chronic renal failure, early diagnosis by VCUG seems to be useful in all UTI patients before discharge. Keywords: Urinary Tract Infection; Vesico-Ureteral Reflux; VCUG; Child

The Relationship between Chronic Constipation and Urinary Tract Infection in Children: A Case-Control Clinical Study

Background Urinary tract infection (UTI) is one of the most common bacterial infections in children, if not diagnosed leads to serious complications such as hypertension, chronic renal failure and renal scar. Constipation is one of the main risk factors for recurrent UTI. The aim of present study was to investigate the relationship between chronic constipation and urinary tract infection in children. Materials and Methods In this case-control study 105 patients with functional chronic constipation as case group, compared with 104 children without chronic constipation as control. The control group was matched according to gender and age. The prevalence of UTI in children with and without constipation as well as their improvement was compared after treatment. Results The prevalence of UTI in case and control groups was 13.3% and 6.7%, respectively (P=0.17). The prevalence of UTI in case group decreased to 3.8% after treatment of constipation. Escherichia coli (E coli) was the most commonly isolated organism in both groups. Conclusion Results of present study showed that despite of no significant urinary tract infection incidence between children with constipation and those without constipation, the constipation should still be considered as a predisposing risk factor for the UTI occurrence

One-Year Follow-Up of Radiologic and Clinical Findings in Children with Prenatal and Neonatal Hydronephrosis

Abstract: Background & Aims: Hydronephrosis is a common problem in prenatal and newborn infants diagnosed by ultrasonography. Bladder to ureter reflux, the upper or lower urinary tract obstruction, and neurogenic bladder are the most common causes of hydronephrosis in newborns and infants. Methods: In this study, 100 neonates and infants with hydronephrosis were observed clinically and laboratorically for one year. Patients were allocated to two groups of fetal and newborn infants by the time of detection of hydronephrosis. Classification of the severity of hydronephrosis was based on the anterior-posterior diameter of renal pelvis including: mild hydronephrosis (5-9 mm), moderate (10-15 mm), and severe (more than 15 mm). Results: Fifty four patients were boy and 46 were girl. Mean age of patients in first visit of fetal and newborn infants hydronephrosis were respectively 2.5 (79% asymptomatic) and 5 month (100% symptomatic). Causes of fetal hydronephrosis were: bladder to ureter reflux (45%), idiopathic hydronephrosis (41%), ureteropelvic junction obstruction (UPJO) (3.11%), physiological hydronephrosis (7.5%), and posterior urethral valve (8.3%). Bladder to ureter reflux was the most common cause of hydronephrosis in all of the patients (57%). The most common causes of mild and severe hydronephrosis were bladder to ureter reflux and ureteropelvic junction obstruction, respectively. In patients with fetal hydronephrosis, 100%, 30% and 6% of cases of severe, moderate, and mild hydronephrosis need surgery, respectively. Conclusion: Using ultrasonography in pregnancy led to the discovery of most asymptomatic fetal hydronephrosis more than infant hydronephrosis. Keywords: Prenatal hydronephrosis, Neonatal hydronephrosis, Vesicouretral reflux, Obstructive uropathy, Voiding cystourethrogram (VCUG

Prevention of chemotherapy-induced nephrotoxicity in children with cancer

Children with cancer treated with cytotoxic drugs are frequently at risk of developing renal dysfunction. The cytotoxic drugs that are widely used for cancer treatment in children are cisplatin (CPL), ifosfamide (IFO), carboplatin, and methotrexate (MTX). Mechanisms of anticancer drug-induced renal disorders are different and include acute kidney injury (AKI), tubulointerstitial disease, vascular damage, hemolytic uremic syndrome (HUS), and intrarenal obstruction. CPL nephrotoxicity is dose-related and is often demonstrated with hypomagnesemia, hypokalemia, and impaired renal function with rising serum creatinine and blood urea nitrogen levels. CPL, mitomycin C, and gemcitabine treatment cause vascular injury and HUS. High-dose IFO, streptozocin, and azacitidine cause renal tubular dysfunction manifested by Fanconi syndrome, rickets, and osteomalacia. AKI is a common adverse effect of MTX, interferon-alpha, and nitrosourea compound treatment. These strategies to reduce the cytotoxic drug-induced nephrotoxicity should include adequate hydration, forced diuresis, and urinary alkalization. Amifostine, sodium thiosulfate, and diethyldithiocarbamate provide protection against CPL-induced renal toxicity

Primary Vesicoureteral Reflux In Iranian Children:A Follow-Up Of 330 Cases

Background: Experience with vesicoureteral reflux (VUR) differs in differ-ent centers and there are plenty of controversies. The aim of this study was to evaluate the outcome of primary VUR complications and the rate of recurrence of UTI. Methods: The medical charts of all infants and children with primary VUR who were followed up by two nephrologists were reviewed. During 19 years (1985-2004), 330 patients (271 females, 59 males) with 496 refluxing ureters were followed up as primary VUR. Results: The patients' age at diagnosis was 4 days to 16 years (mean: 4.1 years) and the mean duration of follow-up was 4.5 years. Urinary tract infec-tion (UTI) was the presenting symptom in 95% and fever was recorded in 35% of cases. Frequencies of different grades of VUR at initial investigation were 10%, 35%, 30%, 13% and 12% for grades I to V, respectively. Recurrence of UTI in VUR of grades I to V were 22.2%, 18.1%, 20%, 23.4% and 17.9%, re-spectively. Follow-up voiding cystourethrogram revealed resolution of VUR in 55%, improvement in 27.5%, no change in 12%, and deterioration in 5.5%. Complications such as chronic renal failure and hypertension were observed in 13 and 13 patients, respectively. Renal scarring was present in 52% of boys and 29% of girls. Conclusion: The present study indicates that symptomatic primary VUR is more common and has better prognosis in girls. Recurrence of UTI is not re-lated to the grade of VUR

Urine alpha-1-microglobulin reliability in the diagnosis of pyelonephritis: a systematic review

Introduction:Pyelonephritis is known as kidney inflammation due to bacterial infection which should be diagnosed and treated promptly. In this article, we decided to systematically review the diagnostic value and reliability of evaluating urine excretion low molecular weight protein alpha-1-microglobulin (A1M). Methods: PubMed and Scopus were searched for the relevant articles about the efficacy of urine alpha-1-micriglobulin assays in the diagnosis of pyelonephritis in children. The search strategy was microglobulin AND pyelonephritis. No language and date limitations were included in this review. Results: A total of 16 articles were retrieved from PubMed and 23 articles from Scopus. After studying the abstracts, only 5 articles were selected, which specifically studied the efficacy of alpha-1-micrglobulin in the diagnosis of pyelonephritis in children.Discussion: A1M is not an acute phase protein but its concentration alters in several clinical conditions. Conclusion: Evaluating the urine concentration of A1M is a noninvasive and cost effective strategy with the diagnostic capability for urinary tract disorders such as early recognition of tubular damages during pyelonephritis