Evaluation of QT Dispersion in Children with Breath Holding Spells

How to Cite This Article: Movahedian AH, Heidarzadeh Arani M, Motaharizad M, Mousavi GhA, Mosayebi Z. Evaluation of QT Dispersion in Children with Breath Holding Spells. Iran J Child Neurol. Winter 2016; 10(1):25-30.AbstractObjectiveBreath holding spells (BHS) are common involuntary reflexes in infancy and early childhood. Differential diagnosis should embrace Long QT Syndrome (LQTS) and paroxysmal abnormalities of rhythm. The aim of this study was to compare QT dispersion (QTd) in children with breath holding spells and normal controls.Materials & MethodsQT dispersion and Corrected QT(QTc) dispersion were measured in 12 lead surface electrocardiograms in 56 patients with BHS and compared with healthy children of the same age referred to the clinic for regular checkup visits.Results The most common type of BHS was cyanotic (83.9%). Seven patients (12.5%) had pallid and two patients (3.5%) had mixed spells. There was a history of breath holding spells in 33.9% of the children. QT dispersion was 61.6± 22.5 and 47.1±18.8 ms in patient and control groups, respectively. QTc dispersion (QTcd) was 104 ± 29.6 and 71.9 ±18.2 ms, respectively. There was a significant difference between patient and control groups in terms of QTd and QTcd (P<0.001).ConclusionQTd and QTcd were increased in children with BHS. Therefore, the evaluation of EKG for early diagnosis of rhythm abnormalities seems reasonable in these children

The Association between Neonatal Icterus or Neonatal Phototherapy and the Likelihood of Childhood Asthma among Iranian Children

Background: There might be a close link between neonatal icterus and/or neonatal phototherapy and childhood asthma. The present study aimed to assess the relationship between neonatal icterus and/or phototherapy and the likelihood of childhood asthma among Iranian population. Materials and Methods The present case-control study was performed on 102 consecutive asthmatic children hospitalized at Children’s Medical Center, Tehran, Iran. Asthma was diagnosed by a pediatric asthma and allergy specialist based on clinical manifestations and/or spirometry results for children older than 5 years. A total of 113 sex and age-matched children without asthma who were admitted to other wards during the same period of time were selected as the control group. Data were collected by a researcher-made checklist including data regarding participants’ age, gender, and gestational age, history of neonatal icterus and history and duration of phototherapy, filled by participants’ parents/guardians. Results: There was a significant difference between cases and controls with respect to preterm birth, history of phototherapy and duration of phototherapy. History of icterus was not associated with childhood asthma. In the multivariable logistic regression model, both history of phototherapy (P=0.029), and duration of phototherapy (P=0.03) were considered as determinants for occurrence of childhood asthma. Conclusion According to the results, history of neonatal icterus was not associated with childhood asthma, but history and duration of phototherapy were both determinants of childhood asthma

Arthrogryposis-renal Dysfunction-cholestasis Syndrome

Background: Arthrogryposis-renal dysfunction-cholestasis (ARC) syndrome is a rare autosomal recessive disorder mostly affecting the liver, kidney, skin, as well as central nervous and musculoskeletal systems. This multisystemic disease results from mutations in the vacuolar protein sorting 33B (VPS33B) or VPS33B- interacting protein, and apical-basolateral polarity regulator (VIPAR) genes. This is a lethal disorder from which few patients can survive at the first year of their life. This syndrome exhibits a wide range of phenotypes, such as ichthyosis, hypothyroidism, agenesis of the corpus callosum, and congenital cardiovascular anomalies. Case report: Here, we present the case of a 32-day-old male neonate with respiratory distress admitted to Children's Medical Center Hospital in Tehran, Iran, in August 2019. He had ichthyosis, cholestasis with arthrogryposis as bilateral clubfeet, developmental dysplasia of the hip, and flexion contractures in upper limbs. During hospitalization, he received Shohl’s solution for metabolic acidosis, intravenous antibiotics, fat-soluble vitamins, and levothyroxine. Other  presentations in our case included  ichthyosis, failure to thrive, congenital heart disease, and hypothyroidism. Conclusion: Timely diagnosis, supportive care and genetic counseling should be provided for better outcome.   Keywords

Infantile and Maternal Choriocarcinoma: A Case Report and Review of Literature

Background: Choriocarcinoma is a rare highly malignant trophoblastic neoplasm. It can be preceded by any form of gestation including a complete or a partial mole, miscarriage and normal pregnancy. Simultaneous intraplacental choriocarcinoma involving both mother and infant is extremely rare. Hepatomegaly, anemia, elevated ßHCG is the diagnostic triad. Here we report a 6 weeks old Afghan girl infant with intraplacental choriocarcinoma presented by severe anemia and widespread multiple metastatic lesions in liver, lung and brain with an elevated level of ßHCG . According to rarity of the disease, rapid progression and the high mortality rate with delay in diagnosis and intervation , choriocarcinoma should be one of the differential diagnosis in severe infantile and maternal anemia without any antecedent reason. According to highly vascular and friable nature of tumor, biopsy can be dangerous for diagnosis. As choriocarcinoma secrets ßHCG, measurement of serum ßHCG is the most common method used to diagnose choriocarcinom

Epidemiologic features of early onset sepsis in neonatal ward of Shabih Khani hospital in Kashan

Background and objective: Neonatal sepsis is defined as presence of clinical signs accompanied by positive blood culture in newborns less than one month of age. Sepsis is a common cause of hospital admission in neonates, and it is known as one of the main causes of mortality among them, not only in developed countries but in developing ones. Delay in diagnosis and appropriate antibiotic therapy would result in death. The aim of this study is to find the main pathogens of sepsis and evaluate sensitivity changes of organisms to antibiotics in comparison with the past. Method: In this descriptive study, 104 (files of) neonates, admitted to the neonatal ward of Shabih Khani Hospital, with positive blood culture over a 24-month period ( 2005-2007) were assessed. Data were extracted for analysis. Results: Over this 24-month study on 104 neonates with sepsis, the most common organisms included flavobacterium 43.3% , pseudomonas 33.3%, coagulase negative staphylococcus 17.3%, coagulase positive staphylococcus 5.9% followed by enterobacter , E.coli, beta-haemolytic streptococcus, klebsiella, diphtheriod and lysteria. Conclusion: In this study Flavobacterium is found to be the most common organism for early sepsis. Although infection with flavobacterium is rare, its rate of mortality is high and it is resistant to majority of common antibiotics. Therefore, early diagnosis and appropriate antibiotic prescription helps reduce its complications

Evaluation of Pulse Oximetry in the Early Detection of Cyanotic Congenital Heart Disease in Newborns

Background: Delayed or missed diagnosis of critical and cyanotic congenital heart disease (CHD) in asymptomatic newborns may result in significant morbidity and mortality. The aim of this study was to determine the accuracy of pulse oximetry screening  performed on the first day of life for the early detection of critical and cyanotic CHD in apparently normal newborns. Methods: This cross-sectional study used postductal pulse oximetry to evaluate term neonates born between 2008 and 2011 with normal physical examinations. Functional oxygen saturation < 95% was considered abnormal, and second measurement was done 2 hours later. If the second measurement remained < 95%, an echocardiogram was performed. On enrolment in the study, the following data for each neonate were recorded: gestational age, gender, birth weight, mode of delivery, and mother’s age. Results: During the study period, totally 3,846 newborns were evaluated. Of the whole study population, 304 (7.9%) babies  had a  postductal functional saturation < 95%. The second measurement was also < 95% in 104 (2.7%) neonates. The mean age of the neonates at the time of pulse oximetry was 18.91 ± 8.61 (min = 4.5 and max = 49) hours. Forty-nine percent of the subjects were female and 51% were male. Echocardiography was performed on 81 out of 104 newborns, and 14 (0.36%) of them had CHD. The types of CHD in our patients were tetralogy of Fallot (3 cases), transposition of the great vessels (2 cases), double-outlet right ventricle (2 cases), truncus arteriosus, total anomalous pulmonary venous return, atrioventricular septal defect, pulmonary atresia, persistent pulmonary hypertension, ventricular septal defect, and atrial septal defect (1 case for each type). The best time for pulse oximetry was within 8-24 hours of the newborns’ life. Conclusion: Pulse oximetry screening along with clinical examination may be able to assist in the early detection of critical and cyanotic CHD in asymptomatic newborns

Hemophagocytic Lymphohistiocytosis in a Neonate: Case Report

  Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of pathologic immune activation, occurring as either a familial disorder or a sporadic condition, in association with a variety of triggers. This article will introduce a neonate with HLH in Iran. We report a case of HLH presenting with respiratory distress and fever, hepatosplenomegaly, jaundice and pancytopenia on the second day of life. Typical clinical and laboratory findings were detected in the neonate. HLH was diagnosed according to HLH-2004 guidelines. In spite of initiating the treatment, the disease did not cure. Post-mortem, extensive hemophagocytosis was found in multiple organs. No specific genetic defect was identified. Since HLH is a potentially lethal childhood illness, early diagnosis of this disorder and commences the therapy is important for pediatricians

Bronchogenic Cyst: A Rare Cause of a Retroperitoneal Mass in a Neonate

Background: Bronchogenic cysts (BCs) are congenital abnormalities of the primitive foregut, which are commonly found in the lung and mediastinum; however, they may rarely occur in the retroperitoneal region. Case report: We present a case of 20-day-old male newborn with a prenatal diagnosis of an abdominal mass who was referred and admitted to our hospital for further evaluation. Abdominal ultrasound and computed tomography scan demonstrated a retroperitoneal ill-defined solid mass locating on the upper ridge of the left kidney in close contact with the posterior wall of the stomach and pressure effects on the spleen hilum. Concerning presumptive diagnosis of neuroblastoma, less likely Wilms tumor, and subdiaphragmatic sequestration, surgery was carried out, and the mass removed completely. Pathological examination revealed a multiloculated cystic-solid mass with cystic spaces which was lined by respiratory epithelium, and the underlying fibrotic stroma contained islands of mature cartilage consistent with the diagnosis of bronchogenic cyst. Conclusion: Although BCs rarely occur, they should be considered in the differential diagnosis of a retroperitoneal mass in the neonates.   Keyword

High Flow Nasal Cannulae versus Nasal Continuous Positive Airway Pressure in Neonates with Respiratory Distress Syndrome Managed with INSURE Method: A Randomized Clinical Trial

Background: In recent years, various noninvasive respiratory support (NRS) of ventilation has been provided more in neonates. The aim of this study was to compare the effect of HFNC with NCPAP in post-extubation of preterm infants with RDS after INSURE method (intubation, surfactant, extubation). Methods: A total of 54 preterm infants with RDS (respiratory distress syndrome) were enrolled in this study. Using a randomized sequence, they were assigned into two groups after INSURE method. The first group received HFNC while the second group received NCPAP for respiratory support after extubation. A comparison was made between these two groups by the rate of reintubation, air leak syndrome, duration of oxygen therapy, hospitalization, the rate of bronchopulmonary dysplasia (BPD), intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and mortality. Data were analyzed by using the SPSS version 18 software. The statistical analyses included Student’s t-test for continuous data and compared proportions using Chi-squared test and Fisher‘s exact test for categorical data. Result: The rate of reintubation was higher in the HFNC compared with the NCPAP group. The rate of either IVH or ROP had no significant differences between the two groups. In addition, duration of oxygen requirement and hospitalization were not statistically different. There was no case of BPD or mortality among these patients. Conclusion: This study showed that preterm infants with RDS could manage post-extubation after INSURE method with either NCPAP or HFNC. However, in this single-center study, the rate of reintubation was higher in the HFNC group while further multicenter study might be assigned. Trial Registration Number: IRCT201201228800N