ComplementaryPediatricsITO-0

COMPLEMENTARY PEDIATRICS Edited by Öner Özdemir 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com COMPLEMENTARY PEDIATRICS Edited by Öner Özdemir 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Complementary Pediatrics Edited by Öner Özdemir Published by InTech Janeza Trdine 9, 51000 Rijeka, Croatia Copyright © 2012 InTech All chapters are Open Access distributed under the Creative Commons Attribution 3.0 license, which allows users to download, copy and build upon published articles even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. After this work has been published by InTech, authors have the right to republish it, in whole or part, in any publication of which they are the author, and to make other personal use of the work. Any republication, referencing or personal use of the work must explicitly identify the original source. As for readers, this license allows users to download, copy and build upon published chapters even for commercial purposes, as long as the author and publisher are properly credited, which ensures maximum dissemination and a wider impact of our publications. Notice Statements and opinions expressed in the chapters are these of the individual contributors and not necessarily those of the editors or publisher. No responsibility is accepted for the accuracy of information contained in the published chapters. The publisher assumes no responsibility for any damage or injury to persons or property arising out of the use of any materials, instructions, methods or ideas contained in the book. Publishing Process Manager Irena Voric Technical Editor Teodora Smiljanic Cover Designer InTech Design Team First published February, 2012 Printed in Croatia A free online edition of this book is available at www.intechopen.com Additional hard copies can be obtained from orders@intechweb.org Complementary Pediatrics, Edited by Öner Özdemir p. cm. ISBN 978-953-51-0155-0 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Contents Preface IX Part 1 Pediatric Ophtalmology 1 Chapter 1 Pediatric Ophthalmology / Eye and Disorders 3 Hikmet Basmak, Nilgun Yildirim, Seyhan Topbas, Ahmet Ozer, Nazmiye Erol, Huseyin Gursoy and Afsun Sahin Part 2 Pediatric Surgery 31 Chapter 2 Acquired Cryptorchidism: What Should We Know? The Results of a Systematic Review 33 N. Zavras, A. Charalampopoulos, K. Velaoras and E. Iakomidis Chapter 3 Merits and Arguments Related to Circumcision 43 Hosni Khairy Salem Chapter 4 Nifedipine Gel with Lidocaine in the Treatment of Anal Fissure in Children: A Pilot Study and Review of the Literature 53 Baruch Klin, Ibrahim Abu-Kishk, Yigal Efrati and Gad Lotan Part 3 Special or Interdisciplinary Care 71 Chapter 5 Oxidative Stress of Newborn 73 Eloisa Gitto, Gabriella D’Angelo, Erika Cusumano and Russel J. Reiter Chapter 6 Pain Management and Nursing Approaches in Pediatric Oncology 97 Nejla Canbulat and Ayşe Sonay Kurt Chapter 7 Snake Bites in Pediatric Patients, a Current View 123 M.E. De la O. Cavazos, C. Treviño Garza, G. Guajardo-Rodríguez, B.A. Hernández-Montelongo and F.F. Montes-Tapia 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com VI Contents Chapter 8 What is the Role of Pediatricians on Oral Health? 137 Cigdem Elbek Cubukcu Chapter 9 Interdisciplinary Model of Attention for Children Undergoing Hospitalized Surgical Procedures 165 Renata Panico Gorayeb, Maria de Fátima Galli Sorita Tazima, Flávio de Oliveira Pileggi, Maria Angela Marchini Gorayeb, Ricardo Gorayeb and Yvone A.M.V. Vicente Part 4 Psychosocial Issues 177 Chapter 10 Adolescent Psychosocial Development and Evaluation: Global Perspectives 179 Fadia AlBuhairan, Rosawan Areemit, Abigail Harrison and Miriam Kaufman Chapter 11 Comparisons of Bully and Unwanted Sexual Experiences Online and Offline Among a National Sample of Youth 203 Michele L. Ybarra, Kimberly J. Mitchell and Dorothy L. Espelage Chapter 12 A New Approach in Adolescent Alcohol Intoxication – Clinical Pediatric Experience and Research Combined 217 E. Van Zanten, J.J. Van Hoof and N. Van der Lely Chapter 13 Infantile Hospitalisation and Chronic Disease 235 Camila Aloisio Alves and Rosa Maria de Araújo Mitre Chapter 14 How to Accompany Children and Parents During the Different Phases of a Severe Chronic Disease 253 Momcilo Jankovic and Giuseppe Masera Part 5 Professional Liability 267 Chapter 15 Risk Management in Obstetrics and Neonatal-Perinatal Medicine 269 Jonathan Muraskas, Lindsay Ellsworth, Eric Culp, Gretchen Garbe and John Morrison Part 6 Frequently Used Medications Guide 287 Chapter 16 Administration and Dose of the Most Frequently Used Drugs in Paediatrics 289 Şenay Çetinkaya 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Preface It is a great honor for me to be editor of the book Complementary Pediatrics. Currently; there is a lot of classical pediatric text books describing various topics. In these kinds of text books, there have always been similar topics with the same styles. In this book volume, beyond classical themes, a different approach was made to current pediatric issues and topics. This book volume covers complementary issues of pediatric subspecialties consisting of ophthalmologic, surgical, psychosocial and administrative issues of frequently used medications. Book consists of 16 chapters which will help get us and patients enlightened with the new developments on these subspecialties’ area. First section of the book is pediatric ophthalmology, which concisely explains most common eye disorders encountered during childhood until adolescence. Pediatric Surgery section discusses very classical but unsettled approaches for issues related to circumcision and cryptorchidism. An interesting approach also has been defined for the treatment of anal fissure. Section of special and interdisciplinary care entails pain management, snake bites, oral health, oxidative stress and a model of specialized interdisciplinary management. Oxidative stress of newborn is described in detail and therapeutic options are explained. In addition, the use of melatonin is mentioned as a useful tool to combat oxygen toxicity in newborns. Section on psychosocial issues is usually not mentioned in old pediatric textbooks, but it is not forgotten in this book volume. This section starts with adolescent psychosocial development and continues with commonly encountered problems such as alcohol intoxication and unwanted sexual experience. Moreover, as a paramedical issue, professional liability section describes liability in detail in this book. Frequently used medications section, lists the administration and dose of most frequently used pediatric drugs as a directory. This manual will help decrease administrative medication and calculation errors. 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com X Preface In conclusion; with these 16 chapters, this book volume completes knowledge on pediatric subspecialties including psychosocial and special / interdisciplinary issues. Before I finish my last words, I feel obliged to my father Orhan and father-in-law Hasan Baş for their support during this period time. Öner Özdemir, MD Assoc. Prof. of Pediatrics İstanbul Medeniyet University Göztepe Research/Training Hospital 3rd Clinic of Pediatrics, Division of Pediatric Allergy/Immunology Kadıköy, İstanbul, Turkey 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Part 1 Pediatric Ophtalmology 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 1 Pediatric Ophthalmology / Eye and Disorders Hikmet Basmak, Nilgun Yildirim, Seyhan Topbas, Ahmet Ozer, Nazmiye Erol, Huseyin Gursoy and Afsun Sahin Eskisehir Osmangazi University Medical Faculty, Department of Ophthalmology, Turkey 1. Introduction 1.1 Growth and development of child’s eye The growth and development of eye harbors many challenging anatomical and physiological alterations starting from the intrauterine life until the early puberty. After the early puberty, the axial length of eye, which is defined as the anterior posterior diameter of the eye, remains unaltered in healthy subjects. However, the refractive status of the eye may still change in adults due to aging processes. The eye development starts in the 3-week embryo, from the optic vesicles. The eye is an organ which derives from all three of the germ layers (ectoderm, endoderm and mesoderm). The initial 3 years of life is the critical period for eye development, and rapid increase in dimensions of the organ takes place in these years. Clear vision is mandatory for the development of visual cortex in this critical period. It is accepted that normal adult visual capacity develops at 3 years of age (Fredrick, 2004). The coordinated growth of eye’s refractive components to reach a plano refraction is called emmetropization. If any failure happens in this process, refractive errors develop. The axial length is either too short, causing hypermetropia, or too long, causing myopia. Astigmatism is due to abnormal shapes in cornea. Very high degrees of hypermetropia (>5D) is not normal in newborns. The cornea and lens may flatten normally within years, but the axial length often pauses behind. This causes permanent hyperopia, which is called nanophthalmos. Generally, eyes with hyperopia of greater than 5 diopters have little chance of emmetropization (Mutti, 1992). All anatomical alterations occur in order to achieve emmetropization. The corneal diameter at birth is about 9.5-10.5 mm. The average adult size is 12 mm. The corneal refractive power is 52 diopters at birth and 42-44 diopters in adulthood. Axial length is 17 mm at birth. It enlarges to 20 mm by the end of 12 months with continued rapid growth until 2 years old, then a slow increase to 24 mm by adulthood. The most rapid eye growth occurs within the first two years. At birth the power of the crystalline lens is 34 diopters. By 6 months of age power averages 28 diopters. By the adulthood the lens power reaches about 20 diopters. As cornea, lens, and axial length grow and change rapidly over the first months and years of life, the harmonization between these three components become crucial. 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Complementary Pediatrics 4 Normal infant eyes are 2 diopters hyperopic. This increases slightly to around age 7, then decreases to age 9-12 years when emmetropia is reached. Normal eyes have diminutive refractive changes after 13 years (Mutti, 1992). 2. Congenital eye anomalies The congenital eye anomalies may appear in isolation or as part of a systemic syndrome. It may be genetically proven in some cases. Either germ line or somatic mutations can cause eye abnormalities. They may result from disruption, deformation, intrauterine infection or teratogenic exposure. Some anomalies significantly affect visual acuity. On the other hand, there are some anomalies which are noticed incidentally on routine eye check with no significance to the patient (Kherani & Robb, 2008). 2.1 Infantile hemangiomas Infantile hemangiomas are the most common eyelid tumors in infancy. They have a bright red or purple appearance. Superficial ones typically blanch with pressure. At birth, they may be clinically undetected. However, they typically enlarge in the first 12 months followed by a slow involution during the first decade. Vision loss is related to amblyopia because of induced astigmatism or visual deprivation due to ptosis. Steroid treatment (intralesional and/or oral) is the first line of therapy (Levin, 2003). Fig. 1. Capillary hemangioma 2.2 Epibulbar dermoids Choristomas (congenital dermoids) are masses of normal tissue found in an abnormal location. They induce astigmatism and cause refractive amblyopia. They may be excised to improve cosmetic appearance and avoid amblyopia. 2.3 Microphthalmia A variety of disorders in which axial length is at least two standard deviations below normal is called microphthalmia. It is frequently associated with secondary orbital and ocular deformity including cataract and coloboma. It is frequently associated with various genetic conditions such as trisomy 13, Goldenhar’s syndrome (Kherani & Robb, 2008). 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Pediatric Ophthalmology / Eye and Disorders 5 2.4 Colobomas It results from failure of the embryonic fissure to close along the inferonasal side of the optic cup during embryogenesis. It is frequently associated with microphthalmia. The visual prognosis is linked to the degree of optic nerve and macular involvement. 2.5 Persistant fetal vasculature (persistant hyperplastic primary vitreus) It occurs sporadically and unilaterally in full-term health infants. The affected eye is microphthalmic with a shallow anterior chamber. A vascularized membrane behind the lens is typical. If the eye is not severely microphthalmic, surgical intervention may have a good prognosis (Levin, 2003). 3. Optic nerve disease in children The optic nerve is approximately 50 mm long from the globe to the chiasm. It can be subdivided into four segments: Intraocular (optic disc, optic nerve head), intraorbital, intracanalicular and intracranial segment. Optic nerve is surrounded by the vascular pia, arachnoid and dura mater. The subarachnoid space is continuous with the cerebral subarachnoid space and contains the cerebrospinal fluid. The optic nerve carries approximately 1.2 million afferent nerve fibres which originate in the retinal ganglion cells (Kanski 2011). Common congenital optic disc anomalies are present as follows: Tilted disc, optic disc pit, optic disc drusen (hyaline bodies), optic disc coloboma, morning glory anomaly, hypoplastic optic nerve and myelinated nerve fibres (Nicholson et al., 2011). Optic disc drusen is a common anomaly with a prevalence of 0.3% of the population. In buried drusen which are the most commonly encountered type, they mimic papilloedema. Exposed optic disc drusen are rare types and more easily diagnosed. They are usually innocent, but rarely may lead to visual field defects or optic disc neovascularisation. Ultrasound is important for the differential diagnosis by showing calcific deposits associated with drusen (Kanski 2011). Optic neuritis is an inflammatory, infective or demyelinating process affecting the optic nerve. It can be classified both ophthalmoscopically and etiologically as follows. Papillitis is characterized by hyperemia and edema of the optic disc, associated with peripapillary flame-shaped hemorrhages. Neuroretinitis is characterized by papillitis in association with inflammation of the retinal nerve fibre layer and a macular star. The optic nerve head is normal in retrobulbar neuritis, because the optic nerve head is not involved. Optic neuritis may be seen due to demyelinating disease, parainfectious, infectious such as sinus-related, or associated with cat-scratch fever, syphilis, Lyme disease, cryptococcal meningitis and non-infectious such as sarcoidosis, systemic lupus erythematosus, polyarteritis nodosa and other vasculitides (Dale et al., 2009). Papilloedema is swelling of the optic nerve head secondary to raised intracranial pressure. It is nearly always bilateral, although it may be asymmetrical. Systemic findings such as headaches, deterioration of consciousness, nausea and vomiting, may be seen in patients with papilloedema. Transient obscurations lasting a few seconds are frequent in 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Complementary Pediatrics 6 patients with papilloedema. Horizontal diplopia due to 6th nerve palsy may accompany the clinical picture. Optic nerve glioma is the most common primary neoplasm of the optic nerve. A low-grade form of this neoplasm, called benign optic glioma, occurs most often in the pediatric patients. On the other hand, the aggressive form of optic glioma, is most common in adults. Many children with optic nerve glioma are also known to have neurofibromatosis type 1. Another optic nerve tumor is meningioma. Meningiomas are believed to arise from arachnoid cap cells, and they are usually attached to the dura. Optic atrophy is the final common morphologic endpoint of any disease process that causes axonal degeneration in the optic nerve. There are two types; primary and secondary. Primary optic atrophy may be caused by lesions affecting the visual pathways from the retrolaminar portion of the optic nerve to the lateral geniculate body. Secondary optic atrophy is preceded by long-standing swelling of the optic nerve head. 4. Retinitis pigmentosa Retinitis pigmentosa (RP) is a heterogeneous group of diffuse retinal dystrophies characterized by a progressive dysfunction affecting the rod more than the cone photoreceptors (a rod-cone dystrophy). It is the most common hereditary fundus distrophy with a prevalence of approximately 1:5000. All forms of RP can present in the first or second decade of life (Kanski, 2011). 4.1 Inheritance and systemic associations RP can be inherited as an autosomal dominant (ADRP), autosomal recessive (ARRP) or X- linked recessive (XLRP) pattern. RP can occur as an isolated sporadic disorder with no family history. The age of onset, rate of progression, eventual visual loss and associated ocular/systemic features are related to the type of inheritance (Khani, 2011). Approximately 20% of these cases are ADRP, and 6% to 9% are XLRP. The remaining 71% to 84% are either ARRP or isolated simplex cases. Up to 40% of recessive cases are associated with other systemic pathologies or syndromes and 18% have associated hearing loss. The most common forms of ADRP appear to have a later onset and less severe clinical course than XLRP. Significantly reduced visual function usually occurs at a younger age in XLRP than in other forms of RP. Most patients with XLRP are legally blind by age 30. Important systemic associations are Basen-Kornzweig syndrome (abetalipoproteinaemia), Refsum disease, Bardet- Biedl syndrome and Usher syndrome (Drack, 2006). 4.2 Symptoms and diagnosis Typically patients present with night blindness and visual field constriction. Central vision may or may not be involved. Classical retinal signs include bone-spicule pigmentation, arteriolar narrowing and disc pallor. Cystoid macular edema may occur. The fundus may be normal in the early stages of disease and this is often the case in young children. Electroretinography (ERG) is essential in the workup of inherited retinal dystrophies. Bright flash scotopic ERGs show a reduced a-wave, indicating rod photoreceptor dysfunction with 收费资料需者请发邮件：wzxidian@gmail.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Pediatric Ophthalmology / Eye and Disorders 7 less severe photopic ERG abnormalities. Perimetry is u