Abstracts

Corporate assessment of behaviour adjustment in children with chronic renal failure

Aim: To describe behavioural problems in children with chronic renal failure (CRF).
Methods: Behavioural problems were studied in 19 patients on regular haemodialysis; 19 patients in predialysis stage; and 19 healthy children, using the Child Behavior Checklist (CBCL) and the Semi-structured Clinical Interview for Children and Adolescents (SCICA).
Results: For CBCL scales, the mean score on the internalizing scale was significantly higher in the dialysis than in the predialysis and healthy children. No significant differences in the mean scores of the Total Problem or Externalizing scales were found between the groups studied. The mean score of SCICA Observed Problems and Total Self-Reports were significantly higher in the healthy children than in CRF groups. The mean score on Total Self-Report was significantly higher in the healthy children than in the predialysis group. There were significant positive correlations between SCICA Self-Report and all CBCL scales. No significant correlations were found between these CBCL and SCICA scales and the age, severity of anaemia, duration of CRF or the efficacy or duration of haemodialysis in CRF patients.
Conclusion: Corporate assessment of child adjustment through different informants yields a comprehensive view of child psychopathology in CRF that calls for psychosocial support and early identification of maladjustment.

Paediatrics.me 2008; 13(1): 4-10

Quitting cigarette smoking among adolescent students in Mansoura, Egypt

Context: Recent trends indicate rising rates of smoking prevalence among children and adolescents and earlier age of initiation. Adolescents and school-age children should therefore be a primary focus for intervention strategies.
Objective: To establish and highlight the prevalence of cigarette smoking as well as the prevalence, causes, methods and predictors of quitting cigarette smoking.
Design, setting and participants: A cross-sectional followed by a nested case (quitters) control (current smokers) study of 1194 students enrolled in governmental secondary schools in Mansoura, Egypt. Their age ranged from 15 to 18 years (mean 15.9±1.1 years).
Results: The prevalence of current cigarette smoking was 16.7%. Among those who had ever smoked, 30.9% had tried to quit but failed and 35.5% intended to quit in future. The prevalence of quitters (ex-smokers) was 22.3%. Health hazards, disapproval from the family and religious prohibitions were the causes of quitting.
Logistic regression analysis showed that the greatest predictors of quitting smoking were students not being in paid employment; not smoking the whole cigarette; being female; smoking for less than one year’s duration; spending their free time alone or with their family; and not swallowing whole smoke.
Conclusion: There is a need for effective enforcement of tobacco control legislation in schools to protect students’ health. Through schools we can reach a sizeable segment of adolescents who are smokers. A school-based anti-smoking programme can approach those with a high probability of quitting smoking in the initial stage. Later on, the programme can target other students with a low probability of quitting smoking. The role of religion and family in prohibiting smoking should not be neglected in this programme.

Paediatrics.me 2008; 13(1): 12-17

Non-ketotic hyperglycinaemia as a cause of neonatal hypotonia

Non-ketotic hyperglycinaemia is a condition that causes serious functional disorders of the central nervous system (CNS) and the degradation of its structure. We present a case of a newborn who developed hypotonia and seizures within 24 hours of birth. Extensive investigations revealed elevated glycine levels in serum, CSF and urine. Diazepam and phenobarbitone were used to control the seizures but the infant remained ventilator-dependent and expired during the neonatal period.

Paediatrics.me 2008; 13(1): 19-21

Neonatal genital prolapse

This case describes a neonate who developed a genital prolapse on the third day of life, in obvious association with a meningocele. The prolapse in this case was reduced by gentle digital manipulation, although a minority of cases require surgical intervention. Neonatal genital prolapse is rare but is often associated with congenital spinal defects and meningocele. Now that more infants with these disabilities are surviving, cases of associated genital prolapse are likely to be seen more frequently.

Paediatrics.me 2008; 13(1): 22

Permanent neonatal diabetes associated with other anomalies: experience from the Southern Region of Saudi Arabia
Neonatal diabetes mellitus (both transient and permanent) is very rare, with an estimated incidence ranging from 1 in 400 000 to 1 in 500 000 neonates. It can be isolated, part of an association or part of a syndrome (e.g. Wolcott-Rallison syndrome). This paper reports five cases of permanent neonatal diabetes mellitus (PNDM), being the total number of cases of PNDM admitted to Aseer Central tertiary hospital from the Southern Region of Saudi Arabia over a four-year period from 2001-2005. Associations were found between PNDM and central hypothyroidism, haemolytic anaemia and microcephaly with brain dysgenesis. The parents of all the infants had made consanguineous marriages.

Paediatrics.me 2008; 13(2): 32-37

Age at menarche among adolescent schoolgirls in Mansoura, Egypt

Background: Menarche is the first indicator of women’s reproductive capacity. This biological event is the outcome of a number of social and biological factors.
Aim: This study was done on adolescent girl students in Mansoura, Egypt, to estimate age at menarche by recall and probit analysis of the status quo method and to study factors affecting its variation.
Subjects and method: A total of 668 female students was selected by cluster sampling techniques from public general and technical secondary schools in urban and rural areas. Data was collected through an anonymous self-administered questionnaire.
Results: A total of 642 girls were able to recall their age at menarche. It varied from 10 to 16 years with a mean of 12.9 years. Median age at menarche (MAM) estimated by probit analysis was 11.7 years. The recall age at menarche differed significantly with the socioeconomic characteristics of the family, as well as birth order and obesity status both at menarche and currently.
Conclusion: The implications of early menarche on sex education and family planning programmes need to be considered, especially with the tendency to early marriage in traditional communities.

Paediatrics.me 2008; 13(2): 38-43

A role for atypical infection in childhood asthma?
Two differing perspectives by two different authors are presented on the role of atypical infections and the use of antibiotics in childhood asthma. The first author suggests that Mycoplasma pneumoniae may be more commonly implicated in childhood asthma than is often recognized. M. pneumoniae infections can cause inflammatory changes in the lungs but are also linked to initiation, exacerbation and chronicity of asthmatic symptoms. Due to the difficulty in detecting mycoplasmas the association between these infections and childhood wheezing and asthma may be underreported. He discusses a possible rationale for using a macrolide antibiotic for children with atypical infection in asthma. The second author argues that most episodes of acute asthma triggered by infections are in very young children, yet this is the group in which infection with mycoplasma is rare. Macrolide antibiotics may have an anti-inflammatory effect but when one should be prescribing a potent anti-inflammatory steroid preparation, the effect of a macrolide seems redundant.

Paediatrics.me 2008; 13(2): 48-50

Adolescents’ sexual and reproductive health in the Middle East: issues and challenges
Despite a few national and local studies, the sexual and reproductive health of adolescents in the Middle East is relatively ignored in most of the countries in the Region. This paper reviews the sexual and reproductive health of adolescents (age 10-19 years) in the Middle East based on available published research.
Various sexual and reproductive health problems among adolescents in the Middle East are presented. Both the contributing factors and the protective elements relevant to the Region are briefly discussed. The challenges facing any prospective programme to improve the sexual and reproductive health of adolescents in the Region are numerous. However, many activities can be initiated to promote the sexual and reproductive health of a large segment of adolescents in the Arab population. The role of health care personnel, including paediatricians, is crucial to the success of any proposed activities. It is hoped that this paper will encourage the Ministries of Health in Middle Eastern countries, policy makers and the community as a whole to endorse culturally and religiously acceptable policies for adolescent sexual and reproductive health and to implement these in the near future.

Paediatrics.me 2008; 13(3): 60-64

Caesarean section and respiratory distress in late preterm infants: a local experience

Objective: To assess the incidence of respiratory distress (RDS) in infants born by Caesarean section between 34 and 37 weeks’ gestation.
Methods: The medical charts of mothers and their infants who were born by Caesarean section with a gestational age of between 34 and 37 weeks were reviewed. One hundred and forty-nine infants were identified. The rate of RDS was calculated among all studied subjects.
Results: Infants identified in this study were 25 (16.2%), 48 (31.2%), 54 (35.1%), and 22 (14.3) with a gestational age of 34, 35, 36, and 37 weeks respectively. RDS was confirmed in 35 (23.5%) infants and 14 of them required mechanical ventilation. The remaining infants were treated with continuous positive airway pressure and oxygen therapy. A comparison between those who developed RDS (35) and those who did not (114) showed no significant statistical differences in the rate of pregnancy-induced hypertension, diabetes, antenatal steroids and premature rupture of membranes.
Conclusion: The incidence of RDS in infants born between 34 and 37 weeks’ gestation by Caesarean section is significantly high. It is a potentially preventable condition and all possible measures have to be undertaken to avoid it.

Paediatrics.me 2008; 13(3): 66-69

Tobacco smoking among adolescent students in Mansoura, Egypt
Objectives: To highlight the prevalence of different types of tobacco smoking as well as underlying factors associated with current tobacco smoking among adolescent students in Mansoura, Egypt.
Methods: This study was carried out on 1194 students enrolled in governmental secondary schools in Mansoura, Egypt. The two-stage, cluster sampling design used in the Global Youth Tobacco Survey (GYTS) in Egypt was utilized. An Arabic self-administered anonymous questionnaire was developed based on World Health Organization guidelines for monitoring tobacco use and core questions in GYTS.
Results: The study revealed that 18.5% of students were current smokers of any type of tobacco. The prevalence of current cigarette and shisha smoking were 16.7% and 10.4%, respectively. Nine per cent of students were current cigarette and shisha smokers simultaneously.
The logistic regression analysis revealed that the independent predictors of current tobacco smoking were having family members who smoke, male gender, having friends who smoke, and being in a single parent family, in that order.
Conclusions: The prevalence of tobacco smoking among secondary school students in Mansoura has not declined, but increased. The higher rate of shisha smoking is an emerging and alarming problem among adolescent students. To protect their health there is a need for effective enforcement of tobacco control legislation and the formulation of legislation for adolescent smoking. Through school health education we can reach a sizeable segment of smoking adolescents.

Paediatrics.me 2008; 13(3): 70-78

Research priorities for child health and well-being
Over the past few decades, the amount of research on child health has grown considerably. Many reports have reviewed the lessons of these research efforts and have developed recommendations for future research. This viewpoint highlights broad-based trends in research priorities, describes gaps in existing knowledge bases and suggests approaches for developing and implementing a national child health research agenda.

Paediatrics.me 2008; 13(4): 87-90

Does vesicoureteral reflux increase the risk of antibiotic resistance in paediatric urinary tract infections?
Objectives: To assess if the presence of vesicoureteric reflux (VUR) is associated with increased antibiotic resistance of uropathogens in children with urinary tract infections (UTI).
Materials and methods: In 154 children (2 months to 12 years) with culture-proven UTI (first or recurrent) we analysed the association between antibiotic resistance of urinary pathogens and VUR, adjusting for age, gender, renal scarring, prior antibiotic prophylaxis, fever and urinary symptoms.
Results: 250 episodes of UTI (145 first and 105 recurrent) were diagnosed, of which 81 episodes (32%) were associated with VUR. In the univariate analysis, only cefuroxime resistance was significantly higher in the presence of VUR (38% vs. 19%, crude OR 2.6, P=0.001). In the multivariable analysis, none of the antibiotics, including cefuroxime, showed a difference in resistance with or without VUR.
Conclusion: In our population, the risk of uropathogen resistance to antibiotics is not increased by the presence of VUR.

Paediatrics.me 2008; 13(4): 91-94

Acute laryngo-tracheo-bronchitis (“croup”)
The basic management of acute laryngo-tracheo-bronchitis is discussed, including indications for admission to hospital. The traditional principle of non-aggressive management supplemented by oxygen therapy still holds good. Treating mild croup with increased humidity is now redundant. Adrenaline provides symptom relief but steroid therapy for moderate to severe croup is indicated. Oral dexamethasone is still recommended.

Paediatrics.me 2008; 13(4): 95-97

External migration of a ventriculoperitoneal shunt tube through the vagina: a rare complication
Although external extrusion of the distal end of a ventriculoperitoneal shunt catheter is known to occur, it is extremely rare for this to happen through the vaginal wall. We report and discuss a case of vaginal extrusion of the distal end of a ventriculoperitoneal shunt catheter in a nine-month-female infant with dribbling of cerebrospinal fluid.

Paediatrics.me 2008; 13(4): 99-100

Epidural haematoma: a rare presentation in a patient with sickle cell disease. A case report and review of the literature
A case of spontaneous epidural haematoma in a 10-year-old Saudi girl with sickle cell disease (SCD) is described. SCD is common in children in the south of Saudi Arabia. The authors emphasize the need to recognize skull infarction and epidural haematomas as rare but potential complications of SCD, especially when there is no history of trauma. Bone scanning and MRI were useful in the diagnosis. The development of focal neurological signs led to surgical intervention which proved successful.

Paediatrics.me 2008; 14(1): 101-103

The decision not to resuscitate infants born at limit of viability in Saudi Arabia: an Islamic legal opinion
Advances in the technological and clinical care of preterm infants have led to improved survival rates for extremely low birth weight infants, but significant morbidity and disability persist. Physicians and parents have to make difficult decisions, often within a short time of birth, about whether to resuscitate and give intensive care to neonates born at ≤25 weeks’ gestational age. The decision to remove life-sustaining care from a critically ill baby is difficult and often distressing for parents and health care providers. This paper considers religious and ethical aspects of such decisions in the context of Islamic law. Relevant verses from the Holy Quran are reviewed, as well as a fatwa issued in Saudi Arabia in 2008. These offer guidance on end-of-life decisions for premature infants born at less than 6 lunar months’ gestation. The fatwa indicates that decisions can be based on the opinion of two specialist physicians who have studied the infant’s clinical condition. If full resuscitation is not considered beneficial to the infant, intervention need not be offered and the infant could be allowed to die but he or she should not be deprived of nutrition and fluid. This legal opinion is in accordance with the general view among paediatricians and other professional caregivers. The fatwa could be regarded as the first step in encouraging Islamic leaders to discuss this important topic with consultant paediatricians to establish guidelines for practising physicians to follow throughout the Islamic world.

Paediatrics.me 2009; 14(1): 8-10

Unintended pregnancy and child health: adverse effects and methodological issues
Despite the fact that unintended pregnancy is not a direct cause of child morbidity and mortality, it deserves awareness by the health care provider because of its high prevalence and potential impact on the health and well-being of children. This viewpoint is intended to provide primary health care workers as well as paediatricians with points of liaison with obstetricians. Available research, mostly in Western countries, has revealed that unintended pregnancy is associated with adverse effects on child health and well-being. However, the situation may differ in the Middle East, as revealed by the few studies available. Methodological issues and research needs are discussed.

Paediatrics.me 2009; 14(1): 12-15

Morbidity in large-for-gestational-age neonates unidentified by standard growth charts
Objective: Large-for-gestational-age (LGA) neonates, defined by a birth weight above the 90th percentile on growth charts based on population norms, are at increased risk of adverse perinatal outcome. We compare the association between neonatal morbidity and LGA as determined either by currently used percentiles based on population standards or by customized birth weight percentiles.
Study design: Retrospective cohort study of 6125 consecutive neonates delivered after 24 completed weeks in a large level 3 hospital in the United Kingdom. Using the customized method the weight percentile was calculated by adjusting for maternal height, booking weight, parity, ethnic origin, gestational age at delivery, and sex. Neonatal mortality and morbidity were the outcomes analysed in function of the method used to diagnose LGA.
Results: LGA occurred in 21% of pregnancies, of which 11.4% were diagnosed by the customized method alone. Although this group had a higher rate of complications than those diagnosed by the standard method, including hypothermia (P=0.01), hypoglycaemia (P=0.04), respiratory distress syndrome (P=0.05), intraventricular haemorrhage (P<0.001) and necrotizing enterocolitis (P=0.05), the association with these complications was confounded by preterm birth and maternal diabetes and disappeared after adjusting for those factors.
Conclusion: Although customized growth charts identified an extra 11.4% LGA infants who would not otherwise have been recognized, it is reassuring that they were not at increased risk of mortality or of complications associated with LGA.

Paediatrics.me 2009; 14(1): 16-18, 20-22

Pharmacy.me • Grocer.me • Paediatrics.me • Terms and conditions

Publisher: Pharmedia • Contact: Russ Finnerty • Email: pharmedia@btconnect.com

6 Tobin Close, Epsom, Surrey, KT19 8AE, UK • Tel: +44 (0)1372 742347 • Fax: +44 (0)1372 745187