Pediatr. Rep., Volume 9, Issue 4 (November 2017) – 7 articles

We present a 10-year old boy with recurrent swelling of the right mandibular region. Based on the diagnosis of chronic recurrent parotitis, he received only supportive treatment. Because of frequent relapses, the diagnosis was reconsidered. Magnetic resonance imaging, scintigraphy and biopsy were compatible with chronic osteomyelitis. This lead to a diagnosis of mandibular primary chronic osteomyelitis, an uncommon non-suppurative inflammatory disease of unknown origin. After decortication of the mandible, the patient recovered well. Because there were no further complaints, the follow-up was ended 18 months after the operation. Full article

Zinc supplementation in children in endemic area of zinc deficiency had been reported of growth enhancement; however, the results were inconsistence. This study aimed to evaluate the efficacy of zinc supplementation on growth of school-aged children. A randomized double-blinded controlled trial was conducted in 140 Thai school children. Placebo or zinc bisglycinate (15 mg element zinc) were taken on school day for 6 months. Pre- and posttreatment anthropometric parameters were recorded. Changes in height from the baseline was considered as the primary outcome whereas, changes in other anthropometric parameters were considered as the secondary outcomes. The mean age was 8.9 years; baseline anthropometric data were not significant different between groups. At the end of study, children in zinc group had significantly higher gain in height (5.6±2.4 vs 4.7±1.4 cm, respectively; P=0.009) and height Z-score (0.45±0.37 vs 0.37±0.27, respectively; P=0.048) than children in control group. No significant differences of other anthropometric parameters were observed. In conclusion, zinc supplementation increased linear growth in Thai schoolaged children over a 6-month period but it had no effects on other anthropometric parameters. Full article

Congenital chest wall or pectus deformities including pectus excavatum (funnel chest) and pectus carinatum (pigeon chest) affect a significant proportion of the general population and up to 70% of patients with Marfan syndrome. Patients often experience significant morbidity and psychological distress, which can worsen with age. Here we discuss new techniques for both operative and non-operative treatment of pectus deformity, the importance of a welltimed intervention and special considerations in patients with Marfan syndrome. Full article

Zika virus (ZIKV) is a mosquito-borne flavivirus, which has been related to severe neurological complications in neonates. However, many clinical aspects of the infection remain unclear, especially in pediatric patients. In this case report we describe the uncommon presentation of ZIKV infection in a pediatric patient with acute gastrointestinal involvement hospitalized in a Brazilian Emergency Unit. Dengue hemorrhagic fever was initially suspected, however, the molecular result for Dengue was negative. Molecular testing for other arboviruses (ZIKV and Chikungunya), revealed positive for ZIKV RNA result in both blood and saliva. The ZIKV load in saliva (6.947 copies/mL) was higher than the vetected ZIKV RNA in plasma (1.945 copies/mL). Additionally, the performed abdominal ultrasound revealed mesenteric lymphadenitis without abdominal retention of fluids. The presentation of this case demonstrates that ZIKV can be involved in a broader range of clinical conditions than currently assumed, including pediatric emergencies, especially in regions with extensive ZIKV outbreaks. Full article

Timely introduced complementary foods, which are appropriate for age, safe and nutrient dense are vital for child growth and development. The aim of the study was to identify associated factors that hampered timely introduction of complementary feeding practices among children 6-23 months. A community-based cross-sectional study was carried out. The data were collected from March 02-20, 2015 in seven-selected Kebeles of Wolaita Sodo town. Systematic sampling technique was employed to select 623 mothers/caregivers with children. The analysis was done using SPSS version 21. Principal component analysis was used to measure household economic status. Binary logistic regression was used to identify predictors of timely initiation of complementary feeding practice. The proportion of timely (at six months) introduction of complementary feeding was 71.2% [95% CI: 66.4%-75.3%], and 25.5% [95% CI: 21.7%- 30%] of children were experienced delayed introduction of complementary feeding. Variables like maternal education [AOR=0.33; 95% CI (0.14-0.78)], household economic status [AOR=0.40;95% CI(0.17-0.85)], history of child medical illness [AOR= 0.63; 95% CI (0.40-0.98)], early initiation of breastfeeding [AOR=2.59; 95% CI (1.02-7.35)] and having source of information about child feeding practices [AOR=0.41; 95% CI (0.24- 0.73)] were identified as independent predictors of introduction of complementary foods at the age of six months. The study came up with nearly three-fourth of children were initiated complementary food just at six months of age. It is not much higher than the target of the current national health sector development program. Maternal illiteracy, low socioeconomic status, presence of medical illness and lack of source of information about complementary feeding practices were associated with timely initiation of complementary feeding. Unreserved support and encouragement should be made to raise level of timely introduction of complementary foods and to diminish delayed introduction of complementary food. Full article

46,XY ovotesticular disorder of sex development is extremely rare and indicates the presence of both testis and ovary in the same patient. Gender assignment in newborns represents a therapeutic challenge. We describe and comment on our multidisciplinary approach, ten years after the Chicago consensus meeting on disorder of sex development. Full article

Medium-chain acyl-CoA dehydrogenase deficiency (MCADD) is identified by newborn screening (NBS). The natural history of MCADD includes metabolic decompensation with hypoglycemia, hyperammonemia, seizures, coma, and death. NBS enables expectant management thus severe symptoms are rare in managed patients. We report premature birth of an MCADD affected infant and resultant management challenges. Nutritional support advanced from parenteral nutrition at 24 hours to enteral feeds. A NBS sample was collected day 2, positive results for MCADD was reported day six, and diagnostic tests were performed day seven. Lab results confirmed MCADD; however, representation of pathologic analytes was so extreme that ingestion of medium chain triglycerides was suspected and subsequently confirmed. Diet was adjusted and reflected in moderation of pathologic analytes. This case emphasizes the need for prompt review NBS results in premature infants. Implementing informatic intervention within electronic medical records, when a disorder requiring special nutritional intervention is identified, will protect premature infants in this vulnerable setting. Standard of care management provided premature infants may be contraindicated in the context of a comorbid inborn error of metabolism. Full article