eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 1 1 article Rajithasundaran Annapoorneswary arar.puthiyedath04@gmail.com 1 Krishnaswami Devi meenakshi drdevi_1804@yahoo.in 2 Sridevi A Naaraayan childdoctorsri@yahoo.co.in 3 Junior Resident, Department of Pediatrics, Government Kilpauk Medical college, India Professor of Pediatrics, Department of Pediatrics, Government Kilpauk Medical college, India Associate Professor, Department of Pediatrics, Government Kilpauk Medical College, India Background and Objective: Neonatal sepsis is associated with high mortality and has a favourable outcome when recognized and treated in a timely manner. In resource-limited settings, there is need for an affordable test with a short turnaround time for timely diagnosis of sepsis. The study was aimed to find out the role of eosinopenia and neutrophil-to-lymphocyte ratio (NLR) in screening for early-onset sepsis (EOS) and to determine the cut-off point for absolute eosinophil count (AEC) and NLR to predict early-onset neonatal sepsis. Methods: This descriptive study was conducted on neonates with suspected EOS at Medical College Hospital, Chennai, Tamil Nadu, India. Complete blood count, C-reactive protein, blood culture, and antibacterial sensitivity were assessed, and neonates with laboratory evidence of sepsis were considered as EOS group. AEC and NLR were compared between groups. Specificity, sensitivity, positive predictive value (PPV) and negative predictive value (NPV) were calculated. Receiver operating characteristic (ROC) analysis was performed. The median value of AEC and NLR was compared with the Mann -Whitney test. Findings: Among the 140 neonates studied, 72(51.4%) had low birth weight. The absolute neutrophil count was higher (8954 vs. 7322) and the absolute lymphocyte count (3040 vs. 5593) and platelet count were lower in sepsis (126074 vs. 239151). Eosinopenia with cut-off point of 194.5 and NLR with a cut-off point of 1.565 had higher sensitivity than specificity and a high negative predictive value (NPV). Conclusion: It can be concluded that eosinopenia and NLR are useful tools in the diagnosis of early -onset sepsis. http://caspianjp.ir/article-1-190-en.pdf Eosinophils Neonatal sepsis Neutrophils Lymphocytes eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 2 2 article Ankur Joshi ankur2304joshi@gmail.com 1 Swati Mulye swatijoshimulye@gmail.com 2 Purti Agrawal Saini purtiagrawal@gmail.com 3 Garima Agrawal Varshney drgari.agr@gmail.com 4 NSCGMC Khandwa MP India SriAurobindo Medical College and PG Institute, Indore MP India NSCGMC Khandwa, MP India Department of Pediatrics, Nandkumar Singh Chouhan Government Medical College, Khandwa, India Background and Objective: Sickle cell disease is a chronic, inherited disease with many complications that worsen the quality of life (QoL) of patients. Although psychosocial problems are common in these patients, they receive the least attention from parents and caregivers. The aim of the present study was to evaluate the psychosocial problems and QoL of children and adolescents with sickle cell disease. Methods: A cross-sectional study was conducted on 30 patients with sickle cell disease in an Indian tertiary teaching hospital between September 2019 and April 2020. Social and psychological aspects were assessed using the PSC-35 scoring system. To assess the QoL, the current study used a self-designed questionnaire including main psychological, physical, and social domains of the World Health Organization Quality of Life Brief Version (WHOQOL-BREF) scale. Findings: The mean age of the participants was 8.86 (SD ± 4.54 years) with a range between 2 and 18 years. Among sociodemographic variables, older age, number of hospitalizations, blood transfusions and pain episodes per year were significantly associated with some QoL variables. Although none of the participants in the present study suffered from depression, higher scores on the PSC-35 score were significantly associated with some QoL variables. Conclusion: Multiple admissions, transfusions, and pain episodes negatively affect the QoL of children and adolescents with sickle cell disease. Because some QoL variables may serve as early predictors of depression, it is recommended to regularly assess the QoL in these children. http://caspianjp.ir/article-1-191-en.pdf Mental Health PSC score Psychological Problems Quality of life Sickle cell disease eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 3 3 article Amanollah Zarei Ahmady zarei-a@ajums.ac.ir 1 Neda Mohtasham mohtasham-n@ajums.ac.ir 2 Mitra Ahmadi ahmadi-mi@ajums.ac.ir 3 Nader Shakiba-Maram nader_shakiba@yahoo.com 4 Nader Shafiei nader_shafiee@ajums.ac.ir 5 Marine Pharmaceutical Sciences Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Department of Pediatric Clinical Toxicology, Abuzar’s Children Medical Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Department of Pediatric Gastroenterology, Jundishapur University of Medical Sciences, Ahvaz, Iran Nanotechnology Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran Department of Pediatric Gastroenterology, Jundishapur University of Medical Sciences, Ahvaz, Iran Background and Objective: Acute gastroenteritis in children is a major cause of morbidity in the world. This study investigated the effect of suspension prepared from date seed in reducing the severity and duration of diarrhea in gastroenteritis pediatrics. Methods: Participants in this clinical trial study comprised 140 gastroenteritis pediatrics referred to Abuzar Children’s Hospital in Ahvaz. Eligible patients were randomly assigned to experimental and control groups. The intervention group was given 5% date seed suspension in the amount of 12 mg/kg of body weight orally once every 8 hours for 7 days; the control group was administered a placebo three times a day. Then the two groups were compared for severity and duration of diarrhea as well as stool volume. Findings: The duration and severity of diarrhea were significantly less in children in the intervention group than in the control group (p<0.05). The mean duration of diarrhea in the intervention and control groups was 3.508±1.102 and 4.680±4.001 days, respectively. The mean severity of diarrhea, decreased at 24 hours (2.0857±0.607; 1.8571±0.747), 48 hours (1.7429±0.695; 1.2571±0.695), 72 hours (1.1000±0.695; 0.7857±0.814), and 96 hours (0.5429±0.629; 0.4143±0.577) after the intervention and was lower in the intervention group than the control group, and the difference between the two groups was significant (p=0.001). Moreover, stool consistency was higher in the intervention group than in the control group after the consumption of date seed suspension (p<0.05). Conclusion: Our results confirm the effectiveness of the herbal medicine prepared from date seed waste for control and treatment of gastroenteritis. http://caspianjp.ir/article-1-201-en.pdf Child Date seed Diarrhea Gastroenteritis eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 4 4 article Mohammad Gholami Mohammad.gholami.7mg@gmail.com 1 Sanaz Mehrabani s.mehrabani@mubabol.ac.ir 2 Mohammadreza Esmaeili Dooki esmaeilidooki@yahoo.com 3 Hoda Shirafkan hodashirafkan@gmail.com 4 Student Research Committee, Babol University of Medical Sciences, Babol, Iran. Mohammad.gholami.7mg@gmail.com Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R. Iran. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, I.R.Iran. Background and Objective: Ingestion of corrosive substances in children is associated with complications and costs to the health care system. The aim of this study was to determine the incidence and complications of ingesting corrosive substances in children. Methods: This cross-sectional study was conducted on children aged 6 months to 14 years who underwent upper endoscopy at Amirkola Children's Hospital during 2014-2021 for complaints of corrosive ingestion. Information studied included demographic information, type of corrosive substances, clinical symptoms, endoscopic findings, complications, and laboratory results. Findings: In the 79 children (mean age of 31.33±20.38 months), 65.8% were boys, the most common type of ingested substance was alkaline (86.1%) and the most common ingested substance was bleach (69.6%). Totally, 70.1% of children had symptoms. The most common clinical symptoms were vomiting (68.4%) and oral lesions (39.2%). The esophagus (59.5%) was more affected than the stomach, and the most common esophageal endoscopic finding was grade 1 esophagitis (45.6%). No significant relationship was found between clinical symptoms, the incidence of esophageal-gastric involvement, or the severity of esophageal involvement. Leukocytosis (p=0.009), the increase in C-reactive protein (CRP) (p=0.001), erythrocyte sedimentation rate (ESR) (p=0.007), and blood sugar (BS) (p=0.019) were significantly related to the severity of esophageal involvement. Conclusion: The results of the study showed that the rate of dangerous side effects caused by ingestion of corrosive substances was not high in children, but often caused by the use of alkaline drain openers, so attention and appropriate diagnostic measures are recommended, as well as preventive measures. http://caspianjp.ir/article-1-214-en.pdf Child Endoscopy Ingestion of corrosive substances eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 5 5 article Alireza Ganjali Ganjalipsych@yahoo.com 1 Gholamreza Soleimani drsoleimani@zaums.ac.ir 2 Elham Shafighi Shahri e.shahri@zaums.ac.ir 3 Alireza Teimouri alirezateimouri260@gmail.com 4 Saeedeh Yaghoubi s.yaghoubi@zaums.ac.ir 5 Department of Clinical Psychology, Health Promotion Research Center, School of Medicine, Zahedan University of Medical Science's, Zahedan, Iran Associate Professor, Pediatric infectious, Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Science's, Zahedan, Iran Assistant Professor of Zahedan University Medical Science, Fellow of Pediatric Endocrinology, Zahedan University of Medical Science, Zahedan, I.R.Iran PhD in Demography Children and Adolescents Health research center, Research Institute of Cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Science's, Zahedan, Iran Assistant Professor, Children and Adolescents Health Research Center, Research Institute of Cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Science's, Zahedan, Iran Background and Objective: Based on WHO, mask wearing may prevent coronavirus disease 2019 (COVID-19) transmission. The aim of the present study was to investigate the prevalence of mask wearing and its related factors in Zahedan, southeastern Iran. Methods: This cross-sectional study was carried out to investigate mask wearing in 408 children aged 2 to 18 years who were referred to specialized pediatric clinics at Zahedan University of Medical Sciences in Zahedan, Iran. The study ran in 2021-2022, and participants or their parents were asked about age, gender, number of children in the family, father's and mother's occupation, father's and mother's education, and family socioeconomic status. The SPSS 20 with a significance level of 0.05 was used to analyze the data. Findings: The rate of mask wearing was 61.52%. Of the children who adhered to wearing masks, 57.77 % wore three layers, 94.42% wore well-fitting masks, and 65.34 % changed their masks at least three times per day. About 53.50% of the parents of the children who refused to wear masks did not believe in this behavior, and the others had economic problems. Mask-wearing was significantly influenced by all socio-demographic factors (p< 0.001). Conclusion: It was found that 62% of the children wore masks. The majority of children who adhered to wearing masks used three layers, were adapted and changed masks at least three times per day. The majority of those who refused to wear masks did not believe in this treatment. Socio-demographic factors had a significant impact on mask wearing. http://caspianjp.ir/article-1-188-en.pdf Behaviors COVID-19 Mask-Wearing Pandemic eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 6 6 article Shiva Khanbabaie shivakhanbabaee@gmail.com 1 Masoud Kiani m.kiani@mubabol.ac.ir 2 Iraj Mohammadzadeh i.mohammadzadeh@mubabol.ac.ir 3 Hadi Sorkhi h.sorkhi@mubabol.ac.ir 4 Mahmoud Hajiahmadi hajiahmadi@yahoo.com 5 Kiarash Saleki kiarash_saleki@icloud.com 6 Student Research Committee, Babol University of Medical Sciences, Babol, Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran The Clinical Research Development Unit of Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, IR Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Student Research Committee, Babol University of Medical Sciences, Babol, Iran Background and Objective: Despite the self-limiting nature of bronchiolitis, its severe forms require hospitalization. Electrolyte imbalance during bronchiolitis is common, however, the relationship between bronchiolitis severity and serum sodium (Na) levels has not been well studied. The purpose of this study was to investigate the relationship between serum Na level and bronchiolitis severity. Methods: This cross-sectional study included hospitalized children with bronchiolitis at Amirkola Children’s Hospital, Babol, Iran, from May 2020 to May 2021. Diarrhea, underlying disease, glucocorticoid intake, and intravenous fluid therapy before admission were considered exclusion criteria. The Bierman-Pierson scale was used to evaluate the severity of the disease, and hyponatremia was divided into mild, moderate, and severe groups. Variables were analyzed using Statistical Packages for Social Sciences (SPSS) 26. A value of P<0.05 was considered significant. Findings: Sixty-one children (55.7% male) with a mean age of 5.19 ± 4.36 months were enrolled in the study, with most (50.8%) belonging to the mild form of the disease. The mean serum Na levels based on the severity of bronchiolitis were 136.22 (SD: 2.99), 133.76 (SD: 3.88), and 130.50 (SD: 11.45) in the mild, moderate, and severe groups, respectively. There was a statistically significant relationship between serum sodium level and severity of bronchiolitis (P-value = 0.013). Conclusion: The results showed that higher severity of bronchiolitis was associated with an increased risk of hyponatremia. Therefore, periodic monitoring and correction of hyponatremia in children with bronchiolitis, especially at younger ages, is necessary to improve the outcome of the disease. http://caspianjp.ir/article-1-208-en.pdf Bronchiolitis Child Electrolyte imbalance Prognosis Sodium eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 7 7 article Mohsen Ebrahimi dr.mebrahimi@goums.ac.ir 1 Seyed Ali Aghapour dr.aghapour@goums.ac.ir 2 Raheleh Rostami Yasuri rrostamiyasuri@goums.ac.ir 3 Azam Rashidbaghan rashidbaghan@yahoo.com 4 Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran Neonatal and Children’s Health Research Center, Golestan University of Medical Sciences, Gorgan, Iran Background and Objective: Asthma is the most common chronic disease in children and its prevalence has increased in the last three decades, so making the proper control of asthma is of great importance. The aim of this study was to evaluate asthma control in children in Gorgan, Iran. Methods: In this cross-sectional study, 80 asthma patients in Taleghani Hospital, Gorgan, Iran (2019-2020) were studied in two groups; one controlled (n=46) and another one uncontrolled (n=34). The age range of the patients was 5-15 years. Data with a diagnosis of asthma were extracted from the medical records. The asthma control test (ACT) questionnaire was used to assess asthma control. A checklist was also prepared for this purpose. Findings: Among the uncontrolled patients, 14 (31.10%) were female and 20 (57.10%) were male. A significant relationship was found between gender and disease control (P=0.02). Moreover, a positive association was found between asthma control and parents’ asthma history (P=0.03 for father and P=0.05 for mother/father). The duration of asthma showed no significant differences between the controlled and uncontrolled groups. Disease severity also had a positive effect on poor asthma control (P=0.001), resulting in 52.90% of patients in the uncontrolled group having severe asthma. Conclusion: The uncontrolled asthma seemed to be present in less than 50% of asthmatic children. Gender, parental history, and severity of asthma revealed a positive association with asthma control. The results could be useful to further overcome the problems of asthma control. http://caspianjp.ir/article-1-189-en.pdf Asthma Control Asthma Control Test Childhood Diseases eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 8 8 article Majid Naderi dr.naderi@zaums.ac.ir 1 Maryam Lashkaripour dr_lashkaripour@yahoo.com 2 Saeedeh Yaghoubi s.yaghoubi@zaums.ac.ir 3 Ilia Mirzaei 4 Associate Professor of Pediatric Hematology and Oncology, Genetics and Non-Communicable Disease Research Center, Zahedan University of Medical Sciences, Zahedan, Iran Associate Professor of Psychiatry, Department of Psychiatry, School of Medicine, Baharan Psychiatric Hospital, Zahedan University of Medical Sciences, Zahedan, Iran Assistant Professor of Zahedan University of Medical Sciences, Zahedan, Iran Faculty of Medicine, Zahedan University of Medical Sciences, Zahedan, Iran Background and Objective: Thalassemia is one of the most common genetic diseases that affect all aspects of quality of life (QOL). The present study was conducted to evaluate the QOL of children and adolescents with thalassemia major. Methods: This descriptive-analytical-cohort study was performed on patients with thalassemia major referred to Ali Asghar Hospital in Zahedan in 2017-2018. A 26-item World Health Organization Quality of Life questionnaire (WHOQOL-Bref) was used to assess patients' QOL. The questionnaire of this study had two major components; 1- General information like age, sex, education, numbers of transfusions and heart disease and 2- Questions regarding physical and mental health. The result of the questionnaire yielded a score depending on the answers provided by the patients. Data were analyzed using the independent t-test and ANOVA. Findings: Out of the 250 participants in the study, 123 and 127 ones were male and female, respectively. The mean QOL score was 262.735±13.785. There was no significant difference between boys and girls in the QOL score. But there was a significant difference in the QOL based on the education (P=0.000), heart disease (P=0.000) and number of blood transfusions (P=0.001). Conclusion: This study revealed that patients with thalassemia major required special attention to various aspects of their lives as their lower QOL negatively impacted them. Providing more and better medical and rehabilitation services to this group seems to be necessary. http://caspianjp.ir/article-1-155-en.pdf Children Quality of Life Thalassemia Major eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 9 9 article Mohammad Reza Khalilian khalilian-m@sbmu.ac.ir 1 Ramin Azizi Malmiri azizi-ramin@gmail.com 2 Tahmineh Tahouri tahmineh.tahouri@hotmail.com 3 Mohammad Ghazavi mo_ghazavi@yahoo.com 4 Assistant Professor of Pediatric Cardiology; Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Pediatric Neurology, Golestan Medical Educational and Research Center, Ahvaz Jundishapour University of Medical Sciences, Ahvaz, Iran Department of Pediatrics, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran Department of Pediatrics, Kashan University of Medical Sciences and Health Services, Kashan, Iran Background and Objective: A stroke is defined as an impairment of cerebral blood flow that results in neurologic symptoms and has ischemic and hemorrhagic forms. The ischemic type is more common in children. Congenital and acquired heart diseases are common causes of ischemic stroke in children. The aim of the present study was to describe the cardiac findings in pediatric patients younger than 14 years who were admitted with acute ischemic stroke. Methods: This cross-sectional study was conducted to evaluate the cardiac findings in 21 patients under 14 years of age admitted with acute ischemic stroke to Golestan General Hospital, Ahvaz, Iran, over a 5-year period between 2013 to and 2018. All patients underwent a thorough cardiac examination that included electrocardiography as well as echocardiography and, if necessary, contrast echocardiography. Patients also underwent MRI of the brain and hematologic laboratory tests. Descriptive data were analyzed using SPSS 23. Findings: Out of 21 patients, 5 (23.8%) had abnormal echocardiography, whereas 16 (76.2%) patients had normal echocardiography. The patients with normal echocardiography underwent contrast echocardiography, which was positive for patent foramen ovale in only one patient. Of the total of 5 patients with abnormal echocardiography, 2 patients had congenital heart disease, 2 patients had dilated cardiomyopathy, and one patient had left atrial myxoma. Conclusion: In any pediatric patient with acute stroke, cardiac causes should be considered as the main risk factor, and a thorough cardiologic examination would be necessary. http://caspianjp.ir/article-1-187-en.pdf Cardiac Disease Children Ischemic Stroke eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 10 10 article Sanaz Mehrabani mehrabanisanaz@gmail.com 1 Mohammadreza Esmaeilidooki esmaeilidooki@yahoo.com 2 Omid Reza Jamshidvand o.jmv@yahoo.com 3 Vanooshe Nezafati vanooshe.nzft@yahoo.com 4 Firuzeh Esmailzadeh esmailzadefiruze@yahoo.com 5 Associate Professor, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Professor, The Clinical Research Development Unit of Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, IR Iran Student Research Committee, Babol University of Medical Sciences, Babol, Iran Student Research Committee, Babol University of Medical Sciences, Babol, Iran Assistant Professor, Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Background and Objective: Bezoar is a mass or indigestible substance that accumulates in the gastrointestinal tract, especially in the stomach. The formation of gastric bezoars (especially phytobezoars) is rare in children; however, when they are formed, they present a therapeutic challenge due to their hard composition and consistency as well as their large size. Case Report: A 7-year-old boy with an abdominal mass was investigated in this case report. The patient had eaten a lot of persimmons and pomegranates in the past. Gastroduodenoscopy revealed a large phytobezoar in the stomach, which was removed and treated using a gastroduodenoscope. Conclusion: The gastroduodenoscopic technique is cost-effective in the treatment of gastrointestinal bezoars and has fewer complications for the patient than the surgery. http://caspianjp.ir/article-1-180-en.pdf Bezoar Child Gastroduodenoscopy Treatment eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 11 11 article Prathyush Modumudi Venkata Bhaskara pratyu.mvb@gmail.com 1 Rakesh Kotha dr.rakeshkotha@gmail.com 2 Alimelu Madireddy asvnrao@yahoo.com 3 Senior Resident, Department of Neonatology, Niloufer Hospital, Hyderabad, India Associate Professor of Neonatology, Niloufer Hospital Hyderabad, India Professor of Neonatology, Niloufer hospital Hyderabad, India Background and Objective: Previously, the coincidence of two different disease phenotypes in a single patient was considered to be a new phenotype or a phenotypic extension of a single known disease. However, with the advent of whole exome sequencing, it has become clear that in many cases it is a new phenotype or phenotypic extension. This case report represents a blended phenotype of Marfan and Larsen syndrome. Up to the time of reporting this case, we could not find a similar case in the sources. Case Report: A full-term male infant delivered vaginally by a primi-mother in a non-consanguineous marriage was transferred to the intensive care unit because of respiratory distress, meningomyelocele and dysmorphism. On clinical examination, the baby had a heart murmur. The baby required oxygen support but no pressure. We slowly weaned off oxygen and gradually started feeding. An ultrasound and echocardiography were performed to rule out malformations. Using molecular and next-generation exome sequencing techniques, the infant was found to have heterozygous variations of the FBN1 gene c.6094A>T p.Thr2032Ser (depth -36x), a novel variant, and the FLNB gene c.2956C>Tp.Arg986Trp (depth -48x), suggesting for neonatal Marfan syndrome (nMFS) and Larsen syndrome phenotype,  which was compatible with the phenotypic findings of the neonate. Unfortunately, the infant died because of sepsis and aspiration. Conclusion: In extremely rare cases, there may be more than one syndrome. Under these circumstances, the prognosis is grim, as usual. When the syndromic phenotype varies, advanced genetic testing is preferred. http://caspianjp.ir/article-1-217-en.pdf Blended Phenotype Fibrillin-1 Genetic High Throughput Sequencing Analysis Larsen syndrome Neonatal Marfan syndrome Whole Exome Sequencing eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 12 12 article Jagadishkumar Kalenahalli kjagadishkumar@jssuni.edu.in 1 Prajwala Hassan Vasudev Prajwalahv@jssuni.edu.in 2 Manjunath Vadambal Gopalakrishna vgmanjunath@jssuni.edu.in 3 Nandish Huchhavanahalli Rudrappa nandishhr@jssuni.edu.in 4 MBBS., MD; Professor of Pediatrics, Jss Medical College, Jss Academy of Higher Education and Research, Mysore, India MBBS, MD; Assistant Professor of Pediatrics., Jss Medical College, Jss Academy of Higher Education and Research, Mysore, India MBBS.DCH., DNB.; Professor of Pediatrics, Jss Medical College, Jss Academy of Higher Education and Research, Mysore, India Senior Resident in Pediatrics, Jss Medical College, Jss Academy of Higher Education and Research, Mysore, India Background and Objective: Octreotide is a somatostatin analogue used to control upper gastrointestinal (GI) bleeding. Adverse effects observed include hyperglycemia, growth hormone deficiency, hypertension, Q-T interval prolongation, and ventricular fibrillation. In rare cases, mild bradycardia has been reported. Case Report: A 16-year-old boy was admitted with shock due to hematemesis and melena a bleeding duodenal ulcer. He was treated with an intravenous venous octreotide infusion at a dose of 1 microgram/kg/hour, and bleeding was controlled with coagulation forceps and adrenaline injection. Because of rebleeding, octreotide was increased to 2 micrograms/kg/hour because of bleeding again. After 24 hours, he developed severe bradycardia (pulse rate (PR) 45/minute). His PR increased to 66/minute by 12 hours after octreotide was discontinued. Conclusion: Octreotide can cause significant cardiovascular side effects. Bradycardia and cardiac conduction blocks may affect the hemodynamics of a child with acute GI bleeding. http://caspianjp.ir/article-1-209-en.pdf Bleeding Child Infusion Octreotide Severe Bradycardia eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 13 13 article Ketaki Kulkarni ketakikulkarni@mgims.ac.in 1 Ravi Varma ravivarma@mgims.ac.in 2 Anuragsingh Chandel anuragchandel@mgims.ac.in 3 Smita Jategaonkar jsmita@mgims.ac.in 4 Varsha Chauhan varsha@mgims.ac.in 5 Manish Jain manish@mgims.ac.in 6 Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Assistant Professor; Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Department of Pediatrics, Mahatma Gandhi Medical Institute of Medical Sciences, Sevagram, Maharashtra, India Background and Objective: Spinal muscular atrophy (SMA) type 1 is an autosomal recessive degenerative disease presenting early in life and progressing into neonatal and infancy. It is caused by a loss of function of the gene for surviving motor neuron 1, leading to degeneration of the anterior horn cells of the spinal cord and consequent to progressive muscle weakness and atrophy. The aim of this case report is to report an infant with SMA type 1which was presented with clinical sepsis. Case Report: This study reports a 1.5 months old male infant presenting with floppy limbs, poor nutrition, inadequate weight gain, and respiratory distress. The infant had tachypnea with paradoxical breathing, hypotonia, tongue fasciculations, bilateral wrist contractures, and absent deep tendon reflexes. He was tested for SMA by multiplex ligation-dependent probe amplification (MLPA). Reports were positive for a homozygous mutation of the SMN1 gene in exon 7 and exon 8, confirming the diagnosis of SMA type 1. Conclusion: SMA can be confused with neonatal sepsis due to similar clinical presentation; a high level of suspicion is required in children with respiratory distress in early infancy. It is important to alert clinicians to this differential diagnosis in children with failure to thrive, respiratory failure, and progressive muscle weakness, as the care of these patients presents unique challenges and ethical dilemmas. http://caspianjp.ir/article-1-202-en.pdf Floppy Hypotonia Poor Nutrition Respiratory Insufficiency Survival Motor Neuron Gene Werdnig-Hoffmann disease eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 14 14 article Houman Hashemian hashemian@gums.ac.ir 1 Fateme Ebrahimzadeh dr.fatemeebrahimzadeh@gmail.com 2 Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Pediatric Diseases Research Center, Guilan University of Medical Sciences, Rasht, Iran. Background and Objective: One of the leading causes of acquired heart disease in the world today is Kawasaki disease [KD], an acute systemic vasculitis in children. The purpose of this study was to identify the clinical and laboratory manifestations of children with KD admitted to the 17th Shahrivar Educational Hospital in Rasht, Iran. Methods: We retrospectively studied the cases of 75 children with KD who were admitted to the 17th Shahrivar Educational Hospital in Rasht between 2011 and 2018. The frequency distribution of age, sex, seasonal prevalence, clinical manifestations including fever, skin rash, changes in the lips and oral cavity, conjunctivitis, changes in the extremities, and cervical lymphadenopathy; laboratory findings including platelets and leukocyte count, erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]; and response to treatment were studied. The obtained data were analyzed using descriptive statistical methods. Findings: Out of 75 patients, the most common clinical manifestations were fever [100%], skin rash [78.67%], alterations to the lips and mouth [74.67%], bilateral non-purulent conjunctivitis [64%], changes in the extremities [46.67%], and cervical lymphadenopathy [38.67%], respectively. Among 75 patients, 70 [93.33%] had ESR above 40 mm/h, and 63 patients [84%] had high C-reactive protein [CRP]. Sixty percent of children had incomplete Kawasaki disease. Eight of our patients [10.6%] developed coronary heart disease. Conclusion: In this study, the most frequent principal clinical manifestations were fever, skin rash, and alterations in the oral cavity and lips. Cervical lymphadenopathy had the lowest prevalence. Increased ESR and CRP were also the most common laboratory findings. http://caspianjp.ir/article-1-210-en.pdf Child Coronary Aneurysm Kawasaki Disease eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 15 15 article Maryam Yahyapour Azad maryamyahyapour2020@gmail.com 1 Tahereh Hamzehpoor Haghighi Dr.Hamzehpoor@liau.ac.ir 2 Somayeh Khosravaniyan somaye_kh94@miau.ac.ir 3 Shafa Hospital, Guilan University of Medical Sciences, Rasht, Iran Department of Psychology, Lahijan Branch, Lahijan Islamic Azad University, Lahijan, Iran Family Counseling, Faculty of Educational Sciences, Marvdasht Islamic Azad University, Marvdasht, Iran Background and Objective: The increase in self-injurious behaviors is a concern about adolescents and is related to people's attachment styles. The present study used the descriptive-correlation method to predict self-harm based on attachment styles with the mediating role of emotion dysregulation in high school female students. Methods: The statistical population of this study included all the female high school students in autumn and winter 2022-2023 in Pasargad City, Fars province, of which 337 students aged 13 to 18 years participated in the convenience sampling. In this research, three questionnaires were used including the self-harm Inventory (SHI), the attachment scale of Collins and Read (1990), and the difficulty in emotion regulation scale (DERS). Data analysis was conducted in SPSS-24 and Amos-24 software with Pearson correlation coefficient and bootstrap statistical tests. Findings: The findings showed that there was a significant correlation between attachment styles and self-harm, difficulty in emotion regulation and self-harm, and finally between attachment styles and emotion dysregulation at the 0.01 level. The chi-squared value was significant with 56.29 at the 0.001 level. Conclusion: The results demonstrated that emotion dysregulation played a mediating role between attachment styles (secure and avoidant) and self-harm, and their path coefficient was negative, and the anxious attachment style had a positive effect on self-harm due to the difficulty in emotion regulation. http://caspianjp.ir/article-1-216-en.pdf Attachment Styles Emotional Regulation Female Students Self-Injurious Behavior Self-Harm eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 16 16 article Kurosh Riahi riahi-k@ajums.ac.ir 1 Babak Najibi najibi-b@ajums.ac.ir 2 Mehrdad Razmara razmara.m@ajums.ac.ir 3 Thalassemia and Hemoglobinopathy Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Deparment of Pediatric Cardiology, Golestan Medical Educational Hospital, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran. Department of Pediatrics, Faculty of Medicine, Ahvaz Jundishapur university of Medical Sciences, Ahvaz, Iran. Background and Objective: Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease. Hypercyanotic spells are one of the major complications of TOF which call for a prompt intervention to resolve hypoxic conditions. The aim of this study was to evaluate the effect of intranasal midazolam on the control of spells in children with hypercyanotic TOF. Methods: This semi-experimental study was conducted on TOF children referring to the pediatric emergency department of Golestan Hospital, Ahvaz, Iran from April 2017 to February 2018. The children were knee-chest positioned by the mother, and if the spells were not resolved, 0.2 mg intranasal midazolam was introduced into the nasal cavity. Three minutes after the child’s recovery, measurement of heart rate and respiratory rate as well as pulse oximetry was done. Data were analyzed by SPSS version 17. Findings: Of the 10 patients studied, 6 (60%) were boys and 4 (40%) were girls. The age of patients ranged from 6 months to 3.5 years. Sixty percent of the children were in recovery, 20% were crying, and 20% were fearful. Examination of before and after intervention showed that heart rate and respiratory rate were significantly reduced (P <0.001). There was a significant increase in arterial blood oxygen (P <0.001). Conclusion: According to the results of this study, intranasal midazolam is effective and safe in controlling spells in patients with TOF. http://caspianjp.ir/article-1-183-en.pdf Cyanosis Heart Diseases Midazolam Nasal Absorption Tetralogy of Fallot eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 17 17 article Yaseena Bhanu byaseena@gmail.com 1 Linga Reddy Kasula drklreddy1966@gmail.com 2 Rakesh Kotha dr.rakeshkotha@gmail.com 3 Alimelu Madireddy asvnrao@yahoo.com 4 Niloufer Hospital, Hyderabad, India. Niloufer Hospital, Hyderabad, India. Niloufer Hospital, Hyderabad, India. Niloufer Hospital, Hyderabad, India. Background and Objective: Niemann-Pick type C is a rare lysosomal storage disorder causing cholesterol intracellular transport deficiency. Typically found in children, it causes neurological deterioration and age-related symptoms. In this article, two cases of Niemann-Pick type C1 with cholestasis and another case with a compound heterozygous mutation that included Niemann-Pick type D are presented. Although neonatal diseases are the most common cause of early cholestasis, this report emphasizes the importance of considering storage disease in cholestasis. Case Report: A 34-day-old female baby born to a third-degree married couple at 38 weeks gestation presented with cholestatic jaundice. Whole-exome sequencing suggested an NPC1 gene mutation and Niemann-Pick type C. A 35-day-old female baby born at 39 weeks gestation presented with ecchymotic patches, decreased feed acceptance, greenish discoloration of the eyes, high-color urine, and firm hepatosplenomegaly. The child was worked up for conjugated hyperbilirubinemia and a liver biopsy in favor of Niemann-Pick disease. Whole exome sequencing showed an NPC1 gene heterozygous mutation, suggesting Niemann-Pick disease types C and D. Conclusion: Pediatricians should consider Niemann-Pick disease in neonates with persistent cholestasis. http://caspianjp.ir/article-1-220-en.pdf Cholestasis Lipid Storage Disorders Neonate Niemann-Pick Disease eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 18 18 article Angela Hamidia angela_7633@yahoo.com 1 Farzan Kheirkhah drfarzankh@yahoo.com 2 Soraya Khafri khafri@yahoo.com 3 Sanaz Azadforouz sanaz.a23@yahoo.com 4 Maryam Dadashi maryam.dadashi@gmail.com 5 Nasim Palizban Palizban@gmail.com 6 Sakineh Javadian Javadian1939@yahoo.com 7 Armon Massoodi armonmassoodi@gmail.com 8 Assistant Professor of Psychiatry, Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Department of Statistic and Epidemiology, School of Medicine, Babol University of Medical Sciences, Babol, Iran. Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran. Student Research Committee, Babol University of Medical Science, Babol, Iran. Student Research Committee, Babol University of Medical Science, Babol, Iran Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Social Determinants of Health Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, Iran Background and Objective: Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental disorders in childhood. The aim of this study was to compare the efficacy of methylphenidate (Ritalin) and atomoxetine in improving ADHD symptoms and also their side effects. Methods: The randomized clinical trial included 60 children aged 6-14 years with ADHD who were referred to the psychiatric clinic of Yahyanejad Hospital. They were randomly divided into two groups, one of which received methylphenidate and the other atomoxetine. The patients were followed up by a psychiatrist after treatment. Improvement in symptoms was measured by examining the ADHD Rating Scale (RS) scores. The results were analyzed using an independent t-test and a value of p≤0.05 was considered significant. Findings: The mean ADHD RS score decreased in both groups in the fourth- and eighth-week intervals after the intervention, with a statistically significant difference in the eighth week compared to pre-treatment and the fourth week for both groups (P-value=0.001). However, no statistically significant difference was observed in the mean scale score between the two groups (P-value=0.48). In the fourth week, the mean complication rate was significantly lower with atomoxetine than with methylphenidate (P-value=0.001). Even in the eighth week, no significant difference was found in the side effects of methylphenidate and atomoxetine (P-value=0.553). Conclusion: The efficacy and tolerability of atomoxetine and methylphenidate were described as similar. However, there was no significant treatment difference between the two drugs. The frequency of side effects was similar for both drugs after eight weeks of treatment. http://caspianjp.ir/article-1-203-en.pdf ADHD Atomoxetine Drug Efficacy Methylphenidate eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 19 19 article Swapna Lingaldinna dr.swapnalingaldinna@gmail.com 1 Greeshma Gunapati greesh201095@gmail.com 2 Rakesh Kotha dr.rakeshkotha@gmail.com 3 Sadiqua Anjum sadiqua_anjum@yahoo.com 4 Alimelu Madireddy asvnrao@yahoo.com 5 associate professor of neonatology junior resident in pediatrics Department of Neonatology, Niloufer Hospital, Osmania Medical College, Hyderabad, India assistant professor of neonatology professor f neonatology Background and Objective: When vulnerable infants are admitted to the neonatal intensive care unit (NICU), they often encounter barriers to breastfeeding that make the transition to oral feeding difficult. To increase the rate of early breast milk expression rate among mothers of infants admitted to the NICU, we have launched a Quality Improvement (QI) project. Methods: A QI study with a quasi-experimental pre- and post-test design was conducted in the NICU between June 2020 and November 2021 at Niloufer Hospital in Hyderabad, India. All mothers who gave birth to babies younger than 35 weeks or 2 kg participated in the study. Mothers with certain health conditions, mastitis, or cytomegalovirus infection were not included. The rate of early breast milk expression within six hours of birth and the rate of exclusive breastfeeding at discharge were the main outcome indicators. Mothers and birth attendants were counseled immediately after delivery, posters were displayed in the maternity wards, and breast pumps and milk containers were distributed. A fishbone analysis was used to investigate the potential barriers to early expression of breast milk. Findings: A total of 1359 mother-baby pairs were included in the study. During the study period, the rate of exclusive breastfeeding at the time of discharge increased (63% to 85%), and the expression of breast milk within 6 hours improved (29.7% to 74.39%). Conclusion: Simple QI initiatives like lactation counseling, tags, posters, breast pumps, and provision of milk containers can promote early expression of breast milk and exclusive breastfeeding rates at discharge. http://caspianjp.ir/article-1-226-en.pdf Counselling Early Expression of Breast Milk Lactation Neonate Quality Improvement eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 20 20 article Devesh Yerrapragada deveshyerra@gmail.com 1 Rashmi N dr.rashminagaraj@gmail.com 2 Junior Resident, department of Pediatrics, JSS Medical College Hospital, JSSAHER, Mysuru, India Associate Professor, Department of Pediatrics, JSS Medical College Hospital, JSSAHER, Mysuru, India Background and Objective: To our knowledge in our country not many studies have been done regarding the iron status and cognitive function in children. Therefore, the aim of this study was to investigate the relationship between serum iron levels and cognitive function in children aged 1 month to 5 years in our institution. Methods: This study was conducted for 18 months in the pediatric population of a tertiary care hospital in Mysore, India, after obtaining approval from the Ethics Committee of the institution. A total of 255 subjects aged between 1 month and 5 years were selected as per the eligibility criteria. From these children, a venous blood sample was sent for determination of iron levels and total iron binding capacity. Cognitive abilities were assessed using the age-appropriate Ages and Stages Questionnaire (ASQ -3). Findings: The mean age of the study population was 22.87±14.83 months and the male-to-female ratio was 1.7:1. Totally, 230 out of 255 children were iron deficient (90.2%), 91.3% boys and 88.3 % girls. Anemia was found in 55.7% of the children, with 94.3% of those with anemia suffering from ID. ID was found to have a negative significant effect on fine motor skills (p < 0.0001) and problem-solving ability (p=0.01). Gross motor skills were significantly impaired by ID (p<0.0001). Conclusion: This study re-emphasizes that ID and IDA have a negative impact on cognitive development and performance, with more severe effects in the last stage of ID –IDA. http://caspianjp.ir/article-1-227-en.pdf Ages and Stages Questionnaire Cognitive Development Cognitive Skills Iron Iron Deficiency Iron-Deficiency Anemia eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 21 21 article Mousa Ahmadpour-kacho mousa_ahmadpour@hotmail.com 1 Yadollah Zahedpasha zypasha@gmail.com 2 Samira Pournajaf samirapournajaf@yahoo.com 3 Shahla Rahbar sh.rahbar93@gmail.com 4 khadijeh Ebrahimi kiasari khadijeebrahimi46@gmail.com 5 Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran The Clinical Research Development Unit of Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, IR Iran The Clinical Research Development Unit of Amirkola Children's Hospital, Babol University of Medical Sciences, Babol, IR Iran Background and Objective: Gestational alloimmune liver disease (GALD) is a rare hepatic disorder that begins during the intrauterine period with alloimmune mechanisms. The newborn shows signs of hyperbilirubinemia, hypoalbuminemia, and signs of liver failure. Because of the alloimmune mechanism, exchange transfusions and intravenous immunoglobulins are used as the treatment of choice. Case Report: We present a 15-day-old male newborn with conjugated hyperbilirubinemia, mild skin darkening and poor feeding that progressed to coagulopathy, increased serum ferritin and liver failure. On clinical suspicion and after a biopsy, the patient was treated but died and the diagnosis of the disease was confirmed by autopsy. The baby died despite exchange transfusion in combination with intravenous immunoglobulin and necropsy confirmed the presence of blue granules in the panlobular and also within the Kupffer cells, in a specific iron staining consistent with the diagnosis of GALD. Conclusion: Despite the fact that slightly darker skin in direct hyperbilirubinemia is due to phototherapy, a diagnosis of GALD should be considered in any infant with cholestasis and liver failure. http://caspianjp.ir/article-1-235-en.pdf Gestational Alloimmune Liver Disease Hemochromatosis Hyperbilirubinemia Neonate eng Non-Communicable Pediatric Diseases Research Center, Babol University of Medical Sciences, Babol, IR Iran Caspian Journal of Pediatrics 2423-4729 2383-3106 2023-06 9 1 22 22 article Saeedeh Firouzbakht dr.firouzbakht@gmail.com 1 Sahar Naderi sahar.naderi83@gmail.com 2 Department of Pediatrics, Bushehr University of Medical Sciences, Bushehr, Iran Department of Pediatrics, Bushehr University of Medical Sciences, Bushehr, Iran Background and Objective: While Kawasaki disease (KD) is common in Asia, the incidence of lymph-node-first presentation of Kawasaki disease (NFKD) in infants is unusual. We present the case of a nine-month-old boy with NFKD. Case Report: A previously healthy nine-month-old boy presented with symptoms including fever, tenderness, erythema, and severe edema. Physical examination revealed neck swelling and restricted mobility due to lymph node enlargement on the left side of his neck. The initial diagnosis of antibiotic-resistant bacterial lymphadenitis was made. Additional signs and symptoms included bilateral non-exudative bulbar conjunctivitis, erythema of the oral and pharyngeal mucosa accompanied by a reddened tongue and lips, erythema of the hands and feet, and the progressive development of a maculopapular rash. Laboratory tests revealed elevated levels of C-reactive protein (CRP) and erythrocyte sedimentation rate (ESR). An echocardiogram indicated a coronary artery abnormality. The patient was diagnosed with NFKD after meeting the diagnostic criteria for KD. Treatment was initiated with intravenous immune globulin (IVIG), aspirin and methylprednisolone. Following IVIG administration, his fever subsided and his symptoms improved. Conclusions: KD should be considered as a differential diagnosis in febrile infants with cervical adenopathy; patients meeting these criteria should be evaluated for this condition. http://caspianjp.ir/article-1-236-en.pdf Case Report Infant Node-first Mucocutaneous Lymph Node Syndrome