Impact of Early Treatment With High-Dose Intravenous Immunoglobulin on Incidence of Kawasaki Disease Complications in Iranian Children.

Objective: Kawasaki disease (KD) occurs in five-year-old or younger children. This study aimed to evaluate the impact of high-dose intravenous immunoglobulin plus acetylsalicylic acid therapy on the prevention and treatment of coronary artery lesions and to evaluate the impact of high-dose acetylsalicylic acid (ASA) on the hearing of the patients. Materials and methods: In this retrospective cohort study, 31 patients with KD were followed from January 2012 to December 2015. The clinical, para-clinical, color Doppler echocardiogram and audiometry results were evaluated. Results: Overall, seven cases (22.6%) developed coronary artery aneurysm (CAA) in the acute phase of the disease, of whom only two still had CAA at the end of the treatment (6%). One of the five children with CAA recovery had a delay in the onset of treatment and one of two patients with persistent CAA at the end of treatment was admitted within the first 10 days. There was no evidence-based abnormal liver biochemical test. None of the patients developed sensorineural hearing loss (SNHL) on audiometry tests conducted before and after treatment. Conclusion: Recovery of coronary artery lesions was 71.43% after 28 days of the onset of treatment. The distribution of coronary artery aneurysm was not different in terms of the time of the treatment initiation (P-Value = 0.371). None of the children had a sensorineural hearing loss (SNHL) 48 hours and 4 weeks after treatment.

Cardiovascular Malformations in Infants of Diabetic Mothers: A Retrospective Case-Control Study.

Maternal diabetes has teratogenic effects on the evolution of the fetal cardiovascular system; as a consequence, cardiovascular malformations are the most common anomalies in infants of diabetic mothers. The present study focuses on the association of all types of diabetes in mothers with the incidence of congenital cardiovascular malformations in their infants. In this retrospective case-control study performed between the years 2008 and 2010, 35 infants of diabetic mothers were selected as a case group, and another 35 infants of mothers with normal blood glucose levels were selected as a control group. Data has been extracted from patients' files and registered. Finally, the association of data has been performed according to statistical analysis. According to the results, the prevalence of cardiovascular anomalies was significantly higher in infants of diabetic mothers (P=0.018). The most common malformations in the case group were PDA 10%, hypertrophic cardiomyopathy 9% and PFO 8%. Maternal diabetes type (overt or gestational diabetes), duration and control method did not correspond with any significant differences in the prevalence of cardiac anomalies. The results of this study indicate that diabetes in pregnant women plays an important role in the incidence of certain types of cardiac anomalies, such as PFO, HCMPT, and PDA. As a result, the performance of diagnostic procedures (like embryonic echo, before and after birth), provision of special prenatal care to diabetic mothers, and providing supportive and therapeutic care to symptomatic infants seems highly advisable in such cases.

Risk Factors for post-Cardiac Surgery Diaphragmatic Paralysis in Children with Congenital Heart Disease.

BACKGROUND: Injured phrenic nerve secondary to cardiac surgeries is the most common cause of diaphragmatic paralysis (DP) in infants. The aim of this study was to determine the risk factors for DP caused by congenital heart defect corrective surgeries in pediatrics. METHODS: This cross-sectional study, conducted in a 2-year period (2006-2008), included 451 children with congenital heart diseases admitted to the Pediatric Cardiac Surgery Ward of Imam Khomeini Hospital. The diaphragmatic function was examined via fluoroscopy, and the frequency of DP and its relevant parameters were evaluated. RESULTS: Of the 451 patients, comprising 268 males and 183 females at an age range of 3 days to 204 months (28.2 ± 33.4 months), 25 (5.5%) infants (60% male and 40% female, age range = 15 days to 132 months, 41.2 ± 28.1 months) had DP as follows: 48% unilateral right-sided and 36% unilateral left-sided. Additionally, 68% had cyanotic congenital heart disease and 84% had DP following total correction surgery. The highest prevalence rates of DP resulting in phrenic hemiparesis were observed after arterial switch operation, Fontan procedure, and Blalock-Taussig shunt surgery, respectively. Thirteen (52%) of the 25 DP patients underwent surgical diaphragmatic plication because of severe respiratory distress and dependency on mechanical ventilation, and most of the cases of plication underwent arterial switch operation. The rate of mortality was 24% (6 patients). CONCLUSION: DP with a prevalence of 5.5% was one of the most common complications secondary to cardiac surgeries in the infants included in the present study. Effective factors were age, weight, cyanotic congenital heart defects, and previous cardiac surgery. Diaphragmatic plication improved prognosis in severe cases.