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Background and Objective: Stress hyperglycemia (Transient rise of blood sugar during acute physiologic stress) has been reported in adults in conditions such as trauma, burns, stroke, myocardial infraction and patients admitted for any cause in intensive care unit. In pediatric age group stress hyperglycemia occurs in febrile illness and sever gastroenteritis. Prevalence and importance of stress hyperglycemia is not fully appreciated by physicians. This study was designed to find the frequency of stress hyperglycemia in children and infants admitted in Qaem Hospital and comparing it with other studies in Iran and other countries. Physicians’ knowledge about these phenomena prevents unnecessary and sometimes dangerous intervention. Patients with stress hyperglycemia due to acute clinical illness may be at risk of developing diabetes in future and their follow up is important matter. Materials and Methods: This descriptive cross-sectional study was conducted from March 2001 to May 201 on 334 patients admitted in Qaem Hospital who needed blood sampling for diagnostic tests. Known cases of diabetes mellitus and patients who received corticosteroids or beta-agonist agent and dextrose containing intravenous fluids were excluded from study. Blood sugar was determined by glucose oxidas method. On serum samples within 30 minute-1 hour after blood sampling. Hyperglycemia was defined in our study as blood sugar more than 150 mg/dl, fever as 37.5°C auxiliary temperature, and dehydration status defined as criteria of WHO. Results: 334 patients from age 2 days to 14 years had inclusion criteria, of these 59.5% were male and 40.4% were female. 26.3% of patients had variable degrees of dehydration. 23.7% of patients had auxiliary temperature?38.5°C to 40°C. blood sugar were in the range of 37 mg/dl-325 mg/dl and there was stress hyperglycemia in 17 patients (5.1%). Stress hyperglycemia was obviously more observed in patients with higher temperatures, more sever dehydration or clinical deterioration. There was no case of diabetes mellitus throughout 1-year follow up. Conclusion: Stress hyperglycemia is a relatively frequent clinical and laboratory finding in patients admitted in pediatrics and neonatal wards. There is no relation between the stress hyperglycemia and final diagnosis of patients, however the more serious the clinical condition, the higher the temperatures or more sever dehydration rises the likelihood of stress hyperglycemia.

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Background & Objective: Despite their very wide geographical distribution in the Mediterranean region, most Leishmania infantum strains belong to zymodeme MON-1. As different Leishmania species are known to cause different clinical symptoms and may require different treatment protocols, therefore this study was done to identify and characterize the leishmania agents causing visceral, Leishmaniasis (VL) in humans, reservoirs and vectors in the north-west of Iran by Isoenzyme analyses. Materials & Methods: In this descriptive and cross sectional study, The samples collected from 12 VL confirmed patients (bone marrow aspirates), 26 dogs (spleen and hepatic aspirates) and more than 100 sand flies from northwest of Iran between 2005 and 2006. All aspirated material from human, canine and sandflies demostrated growth of Leishmania parasite in NNN and αMEM media. The above species compared with WHO reference strains, Leishmania (Leishmania) donovani (DD8), L (L) infantum (IPT-1), L (L) tropica (K-27), and L(L) major (5-ASKH), using thin layer starch gel electrophoresis. The enzymes investigated in this study were ALAT, ASAT, SOD, ES,NH, MPI, GPI, MDH, 6PGD, PGM, PEPD, and PDK. Results: In this study L.infuntum. MON-1 was the only zymodeme present in all samples of dogs and human sandflies. Conclusion: We concluded that the visceral Leishmania (VL) focus in northwest of Iran is evidently Mediterranean type, which extends from Portugal and Morocco to Pakistan and the Central Asia and domestic doges act as the reservoir host in northwest of Iran, where the complete life cycle of zymodeme MON-1 has been identified.

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Background & Objective: Health evaluation and growth monitoring of the infant is a visual diagram of growth and primary health services are based on it. In the best option, these indices must be provided separately for each community. This study was done to evaluate growth indices of newborns in Gorgan- Northern Iran. Materials & Methods: In this observational descriptive study which was carried out during (Oct-Nov 2003), all healthy infants without any major abnormality born within 25-42 weeks of gestational age were evaluated in Dezyani Hospital, Gorgan growth indices (head circumference, length and height) were measured in 1011 infants. Gestational age was defined by Balard scoring and delivery type was recorded, too. After entering data into SPSS-10 software, data were analyzed using chi-square, t-test and correlation bivariate. Results: Mean gestational age (±SD) was 39.86±1.72 weeks and most of them were born by vaginal delivery. Amongst them, 3.2% were premature (less than 37 weeks), 4.4% were low birth weight and 0.69% were very low birth weight. Correlation between growth indices and gestational age was significantly positive in all cases (p<0.05). Conclusion: This study showed that growth indices are lower than other parts of Iran. Further investigations needed, especially longitudinally and cross-sectional, to determine the growth indices in this region and in other parts of country.

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Background and Objective: Patent ductus arteriosus (PDA) is a common problem in preterm infants which can result in serious hemodynamic changes causing respiratory and cardiac morbidities if not treated in the first week of life. The treatment options available are pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The cyclo-oxygenase inhibitors approved for use are indomethacin and ibuprofen which have been used with different routes of administration and dosages. This study was conducted to evalute the lower and standard dose of oral ibuprofen in patent ductus arteriosus closure in preterm infants. Materials and Methods: In this clinical trial study, 44 preterm infants (<35 weeks gestational age) were randomly assigned to receive either a low dose (0.2mg/kg/dose for 3 doses, 24 hours apart) ibuprofen or a standard dose (10mg/kg/dose for the first dose, followed if needed, at 24hours interval by one or two additional doses of 5mg/kg each). These premature neonates either had clinical signs of patent ductus arteriosus or were diagnosed by echocardiography before stabilization of clinical signs. Patent ductus arteriosus closure was confirmed by echocardiography. They were under observe for drug's side effects (oliguria/anuria, GI bleeding, serum creatinin, intraventricular hemorrhage) and their clinical course was recorded. Results: The patent ductus arteriosus closure rates were the same with both doses (74% in case group vs.76% in control), 5 infants in the case group (22%) and 3 infants in the control group (14%) did not respond to the first course of therapy and needed a new course. There was a significant more rate of reducing renal output with the standard dose 33% vs. 4% (P<0.05), but the serum creatinin level was not different between two groups. One infant (4%) in the case group and 3 infants (14%) in the control group had GI bleeding. There was not any difference in intraventricular hemorrhage grading between two groups. Conclusion: This study showed that inspit of lower renal side effect, the low dose oral ibuprofen in comparison to standard dosage did not have any meaningful difference in closure of PDA in preterm infant.

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Background and Objective: Child obesity is increased in developing countries. This study assessed the prevalence of obesity on children which are exclusively on breast feeding and its duration among children aged 24-59 months in Bandar Turkmen district Northern, Iran.

Materials and Methods: In this descriptive- analytical study, 343 in children aged 24-59 months were selected with stratified random sampling. Obesity was defined as >+2SD NCHS (National Center for Health Surveys) reference. Data were collected by questionnaire, interview with mothers and were analyzed with Chi-Square and Fisher tests and multiple regression logistic models.

Results: In this study, 6.4% of children were obese. Prevalence of obesity was not significantly different between boys and girls (5.4% and 7.4% respectively). Breast feeding duration<18 months (P<0.005) and formula or cow’s milk plus breast feeding up to 6 months old (P<0.01) was significantly correlated with children’s obesity. Breast feeding duration more than 18 months reduced the obesity risk factor with 64%.

Conclusion: This study demonestrated that exclusively breast feeding in the first 6 months of life and breast feeding duration more than 18 months reduce the child obesity.

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Background and Objective: Irrational consumption of blood products leads to unwanted side effects in patients and imposes additional financial burdens on society and patients. This study was done to determine the pattern of consumption of packed red blood cells (PRBC) in hospitalized newborns and children.
Methods: This prospective descriptive-analytic study was conducted on 80 newborn (less than 4 months age) 36 children (more than 4 months to 16 years old) who used PRBC in Sari Bu-Ali Sina hospital, north of Iran. Demographic characteristics of patients and parameters of blood product were recorded and compared with standard guideline.
Results: During the study period, administration of 116 units of PRBC (28.5%) was studied. Totally, in 24 % of cases PRBC consumption did not follow the guideline. PRBC consumption was inappropriately prescribed for patients with hemoglobin higher than 12 g/dL (12%) and for patients with hemoglobin higher than 10 g/dL (12%). Both of the consumption volume to weight ratio (P<0.05) and rate of infusion (P<0.05) were significantly higher in children less than or equal to 4 months, than in children older than 4 months. The most commonly indications were respiratory distress syndrome in neonates (62.1%) and bone marrow suppression (14.7%).
Conclusion: A significant percentage of patients were received PRBC out of guideline recommendations.  It seems, for rational use of PRBC in children and neonates the existing guidelines should be more considered to reduce the cost and side effects.
 

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Background and Objective: Infantile colic which can cause nervousness and anxiety in parents by fussing and restlessness in babies. This study was done to determine the prevalence and associated risk factors of infantile colic in Babol, the North of IRAN.
Methods: This descriptive-analytical study was done on 591 breastfeeding babies (321 females, 270 males) born with birth weight 2500-4000 grams and gestational age ≥37 weeks without any medical problem during 2016-18. They visited in age 2, 4, 8, 12 weeks by neonatologist. On the basis of parents complain and Wessel's criteria babies were divided into three groups: Cramp with crying (colicky group), Cramp without crying and normal group. Then possible risk factors of infantile colic have been compared in three groups.
Results: 45.5% of babies presented cramp with crying as colic group. Time of restlessness was significantly more than morning during night and afternoon (P<0.05). Colic was higher in infants born by cesarean section (P<0.05), and in the first-born child (P<0.05). However, there was not significant relation with gender, mothers’ education, parents smoking and taking dairy product.
Conclusion: According to this study’s findings, nearly half of infants had the symptoms of colic, which was higher in first children, infants born by cesarean section and during night.

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Background and Objective: Iron deficiency anemia lead to a decrease in intelegence question (IQ) and a decrease in learning and mental and physical abilities. This study was done to determine the status of iron intake in infants aged 6 to 24 months under the cover of comprehensive health centers in Miandorood city, Mazandaran province, Iran during 2019.
Methods: This descriptive-analytical study was carried out on 400 infants aged 6-24 months who were enrolled in comprehensive health centers in Miandorood city, Mazandaran province, Iran during 2019. The status of iron drop consumption and mothers' awareness in this field were evaluated.
Results: The mean age of the infants was 13.8±4.8 months. The range of the mother’s age was 28.8±5.6 years. Of these, 274 (68.5%) of infants used iron drops regularly, 106 case (26.5%) often, and 20 case (5.0%) never. The mother's knowledge score was significantly correlated with the type of iron intake, height percentile, and maternal education level (P<0.05). Evaluation of the possible causes of irregular iron intake shows that the most frequent cases were forgetting (28.8%), 9.5% for nausea and vomiting, and ‎‎9.0% for teeth color changing.‎
Conclusion: Mothers' awareness of iron drops consumption was good. The most important barriers to regular iron intake in the present study were forgetfulness, vomiting, and tooth discoloration.
 

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Kawasaki disease is a medium-size vasculitis with peak incidence among infants of 9 to 11 month age. This case report represents a female infant of 18-month age whom was admitted to the Taleghani Pediatric Center of Gorgan, Iran; with referral for admission due to persistent fever for roughly 2 weeks despite various outpatient treatments. Upon the admission, Echocardiographic study was performed to assess whether the patient fulfils cardiac criteria of Kawaski disease which was consistent with the diagnosis and also positive for serious coronary complications in the infant. General condition of the patient improved as the treatment with both IVIG and Corticosteroids was initiated and carditis seemed to vanish in echocardiographic studies but as expected aneurysmal growth can last for over 80 days and in this case serial echocardiographic studies confirmed the formation of giant coronary aneurysms. Diagnosis of Kawasaki disease is based on persistent fever and consistency with clinical criteria and the main purpose of this case report was to emphasize the need to consider this disease in cases of persistent fever to avoid the serious following complications.