Pattern of febrile illnesses in children seen at a pediatric ambulatory care setting.

BACKGROUND: Fever is the most common sign of childhood illnesses and febrile children constitute a substantial proportion of the practice of pediatrics and family medicine. OBJECTIVES: To highlight the pattern of febrile illnesses in children attending pediatric ambulatory health-care settings. METHODS: A one-year prospective study was conducted on febrile children who were consecutively seen and managed at two walk-in primary-care clinics in Sulaimania Children's Hospital, Riyadh. Data collection and analysis were structured around the principal study objectives. RESULTS: Among the 16,173 children seen, 4086 (25.3%) were identified as having a fever and evaluated to determine the aetiology of their febrile illness. Boys outnumbered girls and a significant increase in the frequency of febrile illnesses was noted in children 4 to 24 months of age. Upper respiratory tract infections were the commonest cause of fever (75%) and most of these infections were viral rhinopharyngitis. Viral gastroenteritis and pneumonia were prominent diagnoses, each accounting for 5% of febrile illnesses. Notably of low frequency were serious bacterial infections, such as meningitis (0.5%), cellulitis and bone or joint infection (1.8%) and urinary tract infection (0.7%). Only 9% of the febrile children required hospitalization. The ambulatory management of the other febrile children included the prescription of oral antibiotics to 64% of them. CONCLUSION: The proper clinical assessment of these febrile children and the prudent use of laboratory tests and antimicrobials remain the most important management strategies in primary health-care practice.

Acute rheumatic fever in Saudi Arabia: mild pattern of initial attack.

Fifty-one children with the initial attack of acute rheumatic fever (ARF) were studied prospectively to verify the sociodemographic and clinical profile and to compare results with those from other countries. Most children belonged to large families who lived in an urban setting with ready access to medical care. Unlike reports from many developing countries, the clinical manifestations in this study paralleled data from the West and included arthritis in 76% of the cases, carditis in 43%, and chorea in 8%. Among the 22 cases with carditis, 18 had mitral regurgitation, three developed combined mitral and aortic regurgitation, and one had aortic regurgitation. This study demonstrates the mild nature of ARF in Saudi Arabia and supports the concept that climate and geography appear to bear little relationship to the incidence and severity of ARF.

Antecedents and outcome of simple and complex febrile convulsions among Saudi children.

Of 215 Saudi children seen with their first febrile convulsion (FC) at the King Khalid University Hospital, Riyadh, between January 1984 and December 1988, the index FC was simple for 133 children and complex for the remaining 82. History of adverse antecedent factors, particularly perinatal asphyxia, birth injuries and pre-existing neurological deficits, were significantly more associated with complex FC, as was occurrence of first FC before the age of 12 months. Recurrence of FCs and development of epilepsy were also more common among the group of children with complex FC. Complex FCs were less benign in the present study population than has been reported in some Western studies.

Birth order, socioeconomic status and birth height of Saudi infants.

A survey of 4498 singleton births of Saudi infants provided information on birth height, gestational age, birth order and socioeconomic status. The average birth height for the Saudi infant was 49.8 centimeters. The study results indicated a linear relationship between birth order and birth height significant at the probability level 0.001. The relationship between birth height and socioeconomic status was not statistically significant.

PIP: Data on 4498 randomly selected infants delivered at 4 hospitals in Riyadh, Saudi Arabia were examined to determine the relationship between birth order and socioeconomic status on birth height. Sex, gestational age, weight (g), height (cm), and head circumference (lcm) data were collected fore each single liveborn infant within 24 hours of birth. A Harpenden Infantometer was used for height measurement, and the Dubowitz chart for corroborating gestational age calculated from the self report of menstrual history. Prior viable pregnancies delivered determined birth order. Excluded were infants born to diabetic mothers, and infants with marked malnutrition or abnormalities. The results of average height in this sample were 49.8 cm with a range of 27.5-62.8. There was a linear relationship between birth height and birth order at the .001 level of significance. The shortest infants were born 1st; i.e., 49.3 cm average. The tallest heights were in the highest birth order group at 50.3 cm. There was no significant relationship found between birth height and socioeconomic status. 55.4% were born at 40 weeks gestation, and only 4.4% were 37 weeks. 20.5% were 1st borns, 15.9% 2nd born, 13.9% 3rd born, 12.0% 4th born, 10.8% 5th born, and 26.9% 6th born or higher. Income level determined socioeconomic status. 47.5% were middle income families earning SR5000-9999/month. 9.4% were higher income, and 36.2% had low monthly income of SR 2500-4999., 5.1% earned SR2500/month. 1.8% provided no information on income.

Prevalence of iron deficiency in Saudi children from birth to 15 months of age.

A cross-sectional study was carried out to determine the prevalence of iron deficiency among healthy Saudi children from birth to 15 months of age. The groups studied were: newborns, 3-4 months, 5-6 months, 7-8 months, 9-10 months and 12-15 months of age. The age groups were dictated by the vaccination schedule. Serum ferritin was measured and transferrin saturation calculated in each subject. The lower limits of normal were taken as a transferrin saturation of less than 10% and a serum ferritin of less than 12 micrograms/l. A total of 333 serum samples was adequate for analysis. None of the newborns or the 3-4-month-old infants had evidence of iron deficiency. At 5-6 months only 3.3% of subjects had iron deficiency. In the subsequent older age groups the prevalence of iron deficiency increased significantly with age from 9.3% to 12.7% and reached 14.5% in the oldest age group. Screening for iron deficiency in children attending well-baby clinics and hospitals at ages of 12-15 months is recommended.