Nutrition in Pediatric Nephrotic Syndrome

Nephrotic Syndrome is a collection of symptoms due to glomerular damage, characterized by proteinuria ≥3.5g/day or a protein-creatinine ratio ≥2. From an etiological point of view, there are three forms of nephrotic syndrome, including congenital, primary, and secondary. The first sign of the disease is periorbital edema, especially in the morning. Diagnostic confirmation is done through evaluation of urine protein, serum electrolytes, BUN, Cr, Albumin, and cholesterol. The main treatment goals of nephrotic syndrome are decreasing proteinuria, preventing complications, and protecting the renal function via appropriate drugs and diet.The main objective of this study was to review diets required in nephrotic syndrome in children: Protein at a diose of 0.8 mg/kg/day is the most effective diet in nephrotic patients. Low-fat diets (calorie intake <30% and cholesterol ≤200mg/day) can improve hyperlipidemia. Salt and water intake should be restricted in the range of less than 2 gr/day and 1-1.5 liters/day, respectively. Nephrotic syndrome patients have iron, copper, zinc, and calcium deficiency due to increased urine protein excretion or concomitant metabolic disorders. Keywords: Nephrotic syndrome; Diet; Pediatrics; Nutrition. 

Pseudohypoaldosteronism type I in patient admitted with neonatal abstinence syndrome: A case report and review of literature

Pseudohypoaldosteronism (PHA) type 1 is a rare genetic disorder affecting one in 47,000-80,000 newborns. An autosomal dominant type which is restricted to the kidney (also known as rPHA1) and an autosomal recessive type which is more severe and presents with systemic symptoms were reported. A 3-h-old male infant was admitted to the neonatology ward due to high pitch cries, jitteriness, mild tremors, and excessive sleep with a positive history of maternal addiction. For the 1st time, after 9 days, the infant developed hyperkalemia (7 mEq/L) with mixed respiratory alkalosis, and metabolic acidosis (PH: 7.42, Pco2: 22 mm-Hg, Hco3: 12 mmol/L) and blood pressures of 84/44 mm-Hg were recorded. Even after initial treatment, once again the patient developed hyperkalemia resistant to therapy. Hyponatremia was also noted. Hormonal assays were collected, and congenital adrenal hyperplasia (a common differential diagnosis in neonatal hyperkalemia) was ruled out. Elevated renin and aldosterone levels were reported. On the 20th day, hyperkalemia-induced cardiac arrhythmia was demonstrated in the 2nd lead (K+ - 7.5 mEq/L). We report that this case as PHA type 1 is the rare but life-threatening cause of neonatal hyperkalemia. Initial therapy can prevent the possible occurrence of sudden death

The Prevalence of Risk Factors for the Development of Bacteraemia in Children

AIM: The objective of this study was to evaluate the frequency of risk factors for bacteremia in children less than 15 years of age was determined in Bahrami Hospital during 2013-2016. METHODS: This study conducted on 84 children aged 3 months’ to15 years old, who hospitalised in the pediatrics ward and the PICU in Bahrami Hospital from 2012 to 2016. Our study consisted of 46 boys (54.2%) and 38 girls. Moreover, 24.1% of subjects (20 patients) were entered in the study as young as three months old, followed by three months to three years (49.4 %; 41 subjects), and 3 to 15 years of age (26.5%; 22 individuals). RESULTS: The average hospitalization duration was determined to be 15.30 ± 8.75 days. Moreover, our results revealed that a history of blood transfusion in 11.2% of patients. On the other hand, 35.7% of cases were determined to be positive for blood cultures. The microorganisms reported from positive blood cultures include Enterobacter (81.48%), Escherichia coli (11.11%) and Klebsiella (3.70%). Also, 50% of patients were hospitalised in the internal ward, 12% received immunosuppressive drugs, and 96.4% of the patients had a history of vaccination. CONCLUSION: Pediatric severe sepsis remains a burdensome public health problem, with prevalence, morbidity, and mortality rates similar to those reported in critically ill adult populations. International clinical trials targeting children with severe sepsis are warranted

Risk Factors Associated with Neonatal Jaundice: A Cross-Sectional Study from Iran

BACKGROUND: Neonatal jaundice is one of the main causes of the patient's admission in the neonatal period and is potentially linked to morbidity.AIM: This study aimed to determine the possible risk factors for neonatal jaundice.METHODS: We investigated the case of infants who were admitted to the neonatal department of Ziyaeian hospital and Imam Khomeini Hospital for jaundice. Simple random sampling was used to evaluate variables related to maternal and neonatal predisposing factors based on the medical records and clinical profiles. All variables in this study were analysed using SPSS software.RESULTS: In this study, about 200 mothers and neonates were examined. Our findings depicted that mother's WBC, Hb, PLT, and gestational age were associated with jaundice (P < 0.05). Furthermore, there were significant relationships between different degrees of bilirubin with TSH, T4 levels and G6PD (P < 0.05). In fact, TSH, T4 levels and G6PD were found to be linked to neonatal hyperbilirubinemia. The risk factors for jaundice in our study population comprise some predisposing factors such as WBC, Hb, PLT, gestational age, TSH, and T4 levels, as well as G6PD. Neonates at risk of jaundice are linked to some maternal and neonatal factors that can provide necessary interventions to reduce the burden of the disease. Therefore, identification of associated factors can facilitate early diagnosis, and reduce subsequent complications.CONCLUSION: Neonatal jaundice should be considered as the main policy in all health care settings of the country. Therefore, identification of factors affecting the incidence of jaundice can be effective in preventing susceptible predisposing factors in newborns and high-risk mothers

Maternal risk factors for neonatal jaundice: a hospital-based cross-sectional study in Tehran

Diagnosis and timely treatment of neonatal jaundice is critical to preventing its dangerous side effects. Knowing the predisposing factors of neonatal jaundice is still a serious debate, which can be effective in controlling jaundice and the primary problem. The aim of this study was to evaluate maternal risk factors that contribute to the Hyperbilirubinemia among newborns admitted to Imam Khomeini and Ziaeean hospitals during 2015. We collected random samplings for the current study. Medical records for all newborns with jaundice were examined for risk factors associated with Hyperbilirubinemia. All variables were analyzed by SPSS software, version 19. Chi-square test and T-test were applied to evaluate qualitative and quantitative data, respectively. Our findings revealed that maternal age, weight, BMI, WBC, Hb, PLT, birth in the first pregnancy, numbers of pregnancies and prolonged delivery were significantly associated with bilirubin levels. Preventing the risk correlated with maternal factors or identifying neonates with these risk factors is important in effective management of infants. Therefore, the evaluation of neonatal jaundice in health care services should always be considered as a fundamental policy

Urinary antigene and PCR can both be used to detect Legionella pneumophila in children's hospital-acquired pneumonia

Legionella pneumophila is the causative agent of more than 95% cases of severe Legionella pneumonia. Nosocomial pneumonias in different hospital wards is an important medical and pharmaceutical concern. This study aimed to detect Legionella with two methods: polymerase chain reaction [PCR] and detection of urine antigenic test [UAT] in patients suffering from nosocomial pneumonia admitted to pediatric intensive care unit [PICU] of children hospitals. This study was conducted in PICU wards of Rasool Akram and Bahrami children hospitals, Tehran, Iran during 2013 - 2014. In patients diagnosed with hospital-acquired pneumonia, intratracheal secretion samples for PCR and urine sample for urinary antigen test [UTA] were taken. Simultaneously, PCR and urinary antigen test were conducted using commercial kits. The results of urinary antigen test and PCR were analyzed by SPSS v.19 for statistical comparison. In this study, 96 patients aging 2.77 years on average with two age peaks of less than 1 year and 7-8 year were enrolled. More than half of the patients were under 1 year old. The most common underlying diseases were seizure, Acute Lymphoblastic Lymphoma, Down syndrome and metabolic syndromes. The positivity rate of Legionella urinary antigen test was 16.7% and positivity rate of PCR test was 19.8%. There were no significant associations between the results obtained by both assays with age, gender or underlying diseases. In conclusion, PCR is a better detection method for Legionella infection than urinary antigen test, but the difference between the two methods was not significant

Evaluation of Knowledge, Attitude, and Practice of Mothers Presenting to Pediatric Clinic Regarding Urinary Tract Infection Prevention in Children

Introduction: Urinary tract infection is one of the most common bacterial infections in children. It is preventable in many cases and appropriate health behaviors can protect a child from the disease or minimize its risk. Considering the relatively high prevalence of urinary tract infections in children and with regard to the important role of healthy behaviors in preventing this infection, we decided to evaluate the knowledge, attitude and practice of mothers regarding the prevention of urinary tract infections.Materials and Methods: This cross-sectional descriptive-analytic study was performed in the Pediatric Clinic of Imam Khomeini Hospital to determine the knowledge, attitude, and practice of mothers about UTI in children and to evaluate its relationships with some demographic features. The data collection tool was a researcher-made questionnaire based on the literature review. The collected data were analyzed using SPSS 22 software and P-values less than 5% were considered significant.Results: One hundred and fifteen mothers who presented to the Pediatric Clinic of Imam Khomeini Hospital participated in this study. The average knowledge, attitude, and practice score in the first part and the practice score in the second part was 6.21, 47.85, 13.86, and 10.66, respectively.A statistically significant relationship was found between the score of knowledge and attitude. The knowledge score had a significant relationship between maternal employment status, household income, and household location. There was also a significant relationship between access to information and both the knowledge and attitude scores.Conclusions: The significant relationship between access to information resources and the maternal knowledge and attitude scores confirms the importance of awareness in improving the knowledge of mothers in preventing urinary tract infection.Keywords: Knowledge; Attitudes; Practice; Urinary Tract Infections; Pediatrics

Kawasaki Disease and Pyelonephritis: A Case Report: Kawasaki disease, and pyelonephritis

Kawasaki disease is a form of vasculitis, mainly in small and medium-sized arteries ofunknown origin, and often occurs in childhood. It is the leading form of heart disease acquiredin childhood in developed countries. Pyelonephritis is not usually associated with Kawasaki,but hereby we represent a case of Kawasaki disease associated with pyelonephritis; however,we can’t say whether pyelonephritis had a role in stating Kawasaki and it could be a properand valuable topic for research