Lactate Level Is More Significant Than Carboxihemoglobin Level in Determining Prognosis of Carbon Monoxide Intoxication of Childhood.

OBJECTIVES: To evaluate the demographics, risk factors, correlation between carbon monoxide (CO) level and clinical findings, and laboratory findings determining the prognosis and ischemic myocardial injury due to CO intoxication in patients admitted to pediatric emergency department. MATERIALS AND METHODS: Six hundred seventy-four patients were admitted with CO intoxication between May 2007 and October 2009, 288 patients who required hospitalization were enrolled into the study prospectively. RESULTS: Incidentally, 144 (50%) of the patients were evenly distributed as girls and boys. Their age ranged between 7 months and 17 years; mean age was 8.6 years. The mean CO level was 26.8. The high levels were detected regarding lactate in 199 (90.1%) patients, creatine kinase (CK)-MB in 130 (45.1%) patients, CK in 80 (27.8%) patients, cardiac Troponin I in 35 (17.2%) patients, and lactate dehydrogenase in 34 (15.7%) patients. There was a significant positive correlation when symptoms like syncope, loss of consciousness, and convulsion were compared with carboxyhemoglobin, lactate, CK, CK-MB, and lactate dehydrogenase levels (P < 0.05), whereas there was no correlation when compared with cardiac Troponin I (P > 0.05). To determine the accuracy of predicting severe CO intoxication, sensitivity of 52.6% and specificity of 85.7% were found in receiver operating characteristic analysis when the lactate level was 3.85 mmol/L, whereas sensitivity of 70.5% and specificity of 59.6% were found when the carboxyhemoglobin level was 27.1%. One hundred forty-six (%50.8) of the patients had normal electrocardiographic findings, whereas 135 (46.8%) had sinus tachycardia, 6 (2%) had right branch block, and 1 (0.34%) had atrioventricular block. In 34 patients who had high CK-MB and Troponin I levels, only sinus tachycardia was detected in electrocardiography, and there were no ST changes. Hyperbaric oxygen was necessary in 2 patients admitted with coma. CONCLUSIONS: In children admitted because of CO intoxication, the blood lactate levels may give more accurate information in terms of loss of consciousness and convulsion, lactate level could be taken as a measure of severe poisoning and may help to decide for hyperbaric oxygen treatment.

Right middle lobe atelectasis in children with asthma and prognostic factors.

BACKGROUND: Although right middle lobe (RML)-atelectasis of the lungs is a common complication of asthma, the relevant data is limited. The aim of this study is to define the characteristics of RML atelectasis in asthma during childhood. METHODS: Children with asthma who had recently developed RML atelectasis were included; anti-inflammatory medications, clarithromycin, and inhaled salbutamol were prescribed, chest-physiotherapy (starting on the sixth day) was applied. Patients were reevaluated on the sixth, fourteenth, thirtieth, and ninetieth days, chest X-rays were taken if the atelectasis had not resolved at the time of the previous visit. RESULTS: Twenty-seven patients (6.8 (4.8-8.3) years, 48.1% male) with RML atelectasis were included. Symptoms started 15 (7-30) days before admission. The thickness of the atelectasis was 11.8 ± 5.8 mm; FEV1% was 75.9 ± 14.2 and Childhood Asthma Control Test scores were 11.8 ± 5.6 at the time of admission. The atelectasis had been resolved by the sixth (n = 3), fourteenth (n = 9), thirtieth (n = 10), and ninetieth days (n = 3). The treatment response of the patients whose atelectasis resolved in fourteen days was better on the sixth-day (atelectasis thickness: 4.7 ± 1.7 vs. 11.9 ± 7.3 mm, p = 0.021) compared to those whose atelectasis resolved later. Nearly half (54.5%) of the patients whose atelectasis had resolved by fourteen days were using controller medications at the time of admission. However, only two patients (13.3%) were on controller treatment in the latter group (p = 0.032). Regression analysis didn't reveal any prognostic factors for the early resolution of atelectasis. CONCLUSIONS: Early diagnosis and treatment of RML atelectasis prevents complications. Patients who had early resolution of atelectasis had already been on anti-inflammatory medications, and responded better to aggressive treatment within the first week.

Characteristics of Children with Acute Carbon Monoxide Poisoning in Ankara: A Single Centre Experience.

The purpose of the study was to define characteristics of children with acute carbon monoxide poisoning. Eighty children hospitalized with acute carbon monoxide poisoning were recruited prospectively over a period of 12 months. Sociodemographic features, complaints and laboratory data were recorded. When the patient was discharged, necessary preventive measures to be taken were explained to parents. One month later, the parents were questioned during a control examination regarding the precautions that they took. The ages of the cases were between one month and 16 yr. Education levels were low in 86.2% of mothers and 52.6% of fathers. All families had low income and 48.8% did not have formal housing. The source of the acute carbon monoxide poisoning was stoves in 71.2% of cases and hot-water heaters in 28.8% of cases. Three or more people were poisoned at home in 85.1% of the cases. The most frequent symptoms of poisoning were headache and vertigo (58.8%). Median carboxyhemoglobin levels at admission to the hospital and discharge were measured as 19.5% and 1.1% (P < 0.001). When families were called for re-evaluation, it was determined that most of them had taken the necessary precautions after the poisoning incident (86.3%). This study determined that children with acute childhood carbon monoxide poisoning are usually from families with low socioeconomic and education levels. Education about prevention should be provided to all people who are at risk of carbon monoxide poisoning before a poisoning incident occurs.

Increased serum hepcidin and ghrelin levels in children treated for iron deficiency anemia.

BACKGROUND: The aim of this study was to determine the relation between iron deficiency anemia (IDA) and serum leptin, hepcidin, and ghrelin levels. METHODS: Thirty children with IDA and 28 healthy children between the ages of 6 months and 6 years admitted to our hospital were evaluated prospectively. IDA was diagnosed based on clinical and laboratory findings. All children with IDA were treated with iron II-glycine-sulphate complex for 3 months. Complete blood count; iron metabolism parameters; and serum leptin, hepcidin, and ghrelin levels were studied in all healthy children and in children with IDA before and after treatment. RESULTS: In children with IDA, the decrease seen in serum leptin levels after the iron treatment was not statistically significant. However, the increase seen in serum hepcidin levels after the iron treatment was statistically significant (P = 0.038). Hepcidin levels were significantly higher in children with IDA who received iron treatment compared to healthy children (P = 0.008). After the iron treatment, serum ghrelin levels in children with IDA were also significantly higher compared to the levels before treatment and healthy children (P = 0.019 and 0.000, respectively). CONCLUSION: Serum ghrelin and hepcidin levels increase with iron treatment in children with IDA. In view of the higher serum ghrelin and hepcidin levels after iron treatment when compared to pretreatment levels and the healthy children, we suggest that the iron treatment has an important role in serum hepcidin and ghrelin synthesis.

In-vitro platelet hyperaggregation and hypersecretion associated with the use of fish oil in healthy children.

OBJECTIVE: The aim of this study is to evaluate how fish oil supplementation in children affects platelet function tests in vitro. MATERIALS AND METHODS: The study included 62 children (20 healthy children without any medications and 42 healthy children who volunteered to take fish oil supplementation) aged between 2 and 12 years. In the group of children taking fish oil supplementation, the baseline, fourth week, and eighth week values for platelet function tests were obtained. RESULTS: In the platelet aggregation tests induced by high dose of ADP after 8 weeks, the values were significantly higher compared with the values measured before the use of fish oil. The fish oil-supplemented group's values showed an increase in the fourth-week measurements compared with the control group and the baseline measurements in terms of platelet secretion test induced by collagen, standard dose of thrombin, and high-dose thrombin. Platelet secretion tests induced by standard dose of ADP at the end of the eighth week showed an increase compared with baseline test values. CONCLUSION: This study was done in in-vitro conditions wherein the platelet function in the pediatric age group was analyzed and it was found that eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA) present in fish oil especially exhibit in-vitro hyperaggregation and increase the secretion of platelets. As a result of this, we consider that it is necessary to be careful while using fish oil supplementation in children as an antithrombotic agent and for a variety of other indications.

Iron deficiency anemia in infants: does it really affect the myocardial functions?

The aim was to assess the myocardial functions in infants with iron deficiency anemia (IDA). The findings of 22 infants with IDA and 16 healthy infants were compared. Complete blood count in all infants, serum iron level, total iron binding capacity (TIBC), and serum ferritin level in patients were evaluated. Echocardiography with tissue Doppler imaging (TDI) was performed in all infants. The mean hemoglobin was 8.5 versus 11 g/dL, hematocrit was 26.7 versus 33.1% and the mean corpuscular volume (MCV) was 59.8 versus 72.2 fL in patients and controls, respectively. The median serum iron level was 14.5 µg/dL, TIBC was 444 µg/dL, and serum ferritin level was 4.9 ng/mL in patients. There were significant differences between patients and controls for the myocardial performance indexes of the left ventricle (LV) (0.57 vs. 0.45, P < .05), interventricular septum (IVS) (0.56 vs. 0.48, P < .05), and the right ventricle (RV) (0.56 vs. 0.41, P < .05). The similar significances were also present for the ejection times (ET) of the LV (173.1 vs. 212.1 ms, P < .05), IVS (173.7 vs. 195.6 ms, P < .05), and RV (169.9 vs. 213.3 ms, P < .05). In spite of negatively significant correlations between hemoglobin, hematocrit, MCV and MPI, the correlations between these parameters and ET were positively significant. However, there were no correlations between serum iron level, TIBC, serum ferritin level, and the TDI parameters of patients. According to these findings, we could say that, the IDA affects the myocardial functions in a negative manner.

The effect of an anaphylaxis guideline presentation on the knowledge level of residents.

OBJECTIVE: To determine the effects of an anaphylaxis guideline presentation in residency training, which is an important period for having skilled and knowledgable doctors in the future and see how the residents' level of knowledge changes after presentation. The study is the first in Turkey to identify ways to integrate clinical practice guidelines (CPGs) in residency training. METHODS: In this interventional study to evaluate a continuous medical education (CME) intervention without a comparison group, a clinical practice guidelines on diagnosis and management of anaphylaxis was presented to the Family Medicine and paediatrics residents at the Ankara Training and Research Hospital, by a specialist in paediatric allergy. The presentation was done within routine training sessions. A test was applied before and 10 weeks after the presentation. Electronic sources and hard copies were used for dissemination. The results were analysed with SPSS 15.0. The categorical data was analysed with Fisher's Exact test and the Mann-Whitney U test was used to compare the groups. The threshold for statistical significance was set at P < 0.05. RESULTS: The post-test scores were 58.2/100 for family physicians and 71.7/100 for paediatricians. For both pre- and post-test, paediatricians had significantly higher scores than the family physicians (p < 0.05). On the other hand, the family physicians had significantly higher post-test scores than their own pre-test scores (p < 0.05), while there was no significant increase in the scores of the paediatricians (p > 0.05). CONCLUSION: The study adds to limited information on the effects of clinical practice guidelines in Turkey. It shows us that the awareness of CPGs is low among physicians, and further research is needed to determine the potential role of clinical practice guidelines in continuous medical education. Physicians need a better training about how to manage anaphylaxis, and the best methods to identify their training needs must be determined.

Evaluation of nocturnal blood pressure changes and urinary electrolyte excretion in children with enuresis.

BACKGROUND: Monosymptomatic nocturnal enuresis (MNE) is defined as involuntary nighttime urination of children over five years of age without any congenital or acquired defect in the central nervous system. Many factors, mainly nocturnal polyuria, sleep disorders, decreased bladder capacity, and bladder dysfunctions play a role in the etiology of MNE. METHODS: Eighty-three children diagnosed with MNE were included in the study. Complete blood cell count, blood biochemistry, renin, and aldosterone levels of all children were obtained. Twenty-four-hour urine samples were collected separately daytime and nighttime and urinary electrolytes were evaluated. Also, 24-hour ambulatory blood pressure monitoring (ABPM) was performed for each patient. The results were evaluated by comparing both enuretic children vs. control group and enuretic children with polyuria vs. without polyuria. RESULTS: When we compared the enuretic children and the control group in terms of urinary electrolytes, the fractional excretion of sodium (FENa) and fractional excretion of potassium (FEK) values of the enuretic group were higher than the control. The evaluation of the 24-hour ABPM findings revealed no significant difference in terms of the mean arterial pressure (MAP) and diastolic blood pressure (DBP) during the daytime and nighttime measurements. The daytime systolic blood pressure (SBP), however, was significantly lower in the enuretic group. When enuretic children with and without polyuria and the control group were compared, the nighttime, FENa, FEK, as well as nighttime urinary excretion of calcium and protein were significantly higher in enuretic children with polyuria. No difference was detected on the MAP, SBP, or DBP values. CONCLUSIONS: In conclusion, the nighttime urinary solute excretion of enuretic children was found to be higher and this condition may especially be associated with pathogenesis of nighttime polyuria. In enuretic children, nighttime blood pressure changes were not influential in the etiopathogenesis in all patient groups and multiple mechanisms may play a role in the pathogenesis of enuresis.

Life-threatening intracranial bleeding in a newborn with congenital cytomegalovirus infection: late-onset neonatal hemorrhagic disease.

The authors present a case of a 36-day-old infant with intracranial and intramuscular hemorrhage due to vitamin K deficiency bleeding, who received intramuscular vitamin K prophylaxis at birth. In this case, laboratory tests showed anemia, liver dysfunction with cholestasis, and coagulopathy, consistent with vitamin K deficiency abnormality. Serological analyses showed that cytomegalovirus immunoglobulin (Ig)M and IgG avidity were both positive. The infant was treated successfully with intravenous ganciclovir and blood products. This case suggests that it is imperative to meticulously investigate the etiology in neonates with late-onset hemorrhagic disease of the newborn. Cholestatic liver disease caused by congenital cytomegalovirus infection should be in mind in term infants who presented with late-onset hemorrhagic disease.

An experience of oseltamivir phosphate (tamiflu™) in a pediatric patient with chronic idiopathic thrombocytopenic purpura: a case report.

We report a pediatric patient with chronic idiopathic thrombocytopenic purpura who suffered from an influenza A (H1N1) virus infection. A 13-year-old girl presented with fever, coughing, and generalized petechiae. The influenza A antigen was positive in her pharyngeal aspirate. She was successfully treated with neuraminidase inhibitor oseltamivir phosphate. Her platelet counts progressively increased with oseltamivir phosphate without another blood product or agent. We suggest that oseltamivir phosphate can be used in patients with immune thrombocytopenic purpura who present with influenza virus A infection. We also suggest that oseltamivir phosphate can be effective in patients with immune thrombocytopenic purpura. Large study groups are needed to confirm the relationship between idiopathic thrombocytopenic purpura and neurominidase inhibitors.

Childhood obesity-related cardiovascular risk factors and carotid intima-media thickness.

The purpose of this study was to investigate the relationship between childhood obesity and carotid intima-media thickness (IMT). This is a cross-sectional study in obese children and non-obese control subjects. This study included 75 obese children and 40 non-obese control children. Systolic and diastolic blood pressure (SBP, DBP) values and waist and hip circumferences were measured. Fasting blood glucose and insulin concentrations, total cholesterol, triglycerides (TG), low-density lipoprotein cholesterol (LDL-C), and high-density lipoprotein cholesterol (HDL-C) were assayed. The carotid IMT was measured by high resolution B-mode ultrasonography. Waist/hip ratios, SBP and DBP were significantly increased in the obese group compared to the non-obese children (all p < 0.001). The total cholesterol, LDL-C, HDL-C, and TG in the obese children were significantly different from values in the control subjects (all p < 0.001). Compared to the controls, the obese children demonstrated significant differences in a number of clinical risk factors including body weight, body mass index (BMI), BMI-standard deviation score (SDS), SBP/DBP, waist circumference, hip circumference, and waist/hip ratio (all p < 0.001). Compared to the controls, the obese children showed increased mean carotid IMT values [0.52 mm (95% confidence interval [CI], 0.40-0.64 mm) vs. 0.35 mm (95% CI, 0.24-0.38 mm), p < 0.001]. Univariate correlation analysis revealed that the carotid IMT was closely related to the BMI-SDS, SBP/DBP, waist and hip circumferences, serum TG, cholesterol, LDL-C, HDL-C, fasting serum insulin level, and insulin resistance indices including the homeostasis model assessment of insulin resistance (HOMA-IR), fasting glucose-to-insulin ratio (FGIR), and quantitative insulin-sensitivity check index (QUICKI). Multiple regression analysis showed that the BMI-SDS, TG and QUICKI were independent predictive risk factors for increased carotid IMT. Measurements of BMI-SDS, blood pressure, waist and hip circumferences, serum TG levels, the QUICKI insulin resistance index, and carotid IMT by ultrasonography are suitable in pediatric patients in a clinical setting and may be used for screening of obese children.

Interventions to reduce pain during vaccination in infancy.

OBJECTIVE: To investigate interventions that affect pain reduction during vaccination in infants and children attending a well-child unit. STUDY DESIGN: A consecutive sample of 243 children between age 0 and 48 months receiving their routine vaccinations was randomly assigned to 1 of the study groups. A total of 158 infants under age 6 months were randomly assigned to breast-feeding or no breast-feeding during immunization, and 85 children age 6 to 48 months were randomly assigned to receive 12% sucrose solution, lidocaine-prilocaine cream, or no intervention. All children were evaluated for crying time and pain score by a pediatrician using the Neonatal Infant Pain Scale (NIPS) for those under age 12 months and the Children's Hospital of Eastern Ontario Pain Scale (CHEOPS) for those over age 12 months. RESULTS: Breast-feeding in infants under age 6 months and use of sucrose or lidocaine-prilocaine in children age 6 to 48 months significantly reduced crying time and pain scores compared with controls. No difference in outcome was seen between the sucrose and lidocaine-prilocaine treatment groups. CONCLUSIONS: Here we expand on previous findings by demonstrating that breast-feeding may have an analgesic effect up to age 6 months and that in older children, both sucrose and lidocaine-prilocaine reduce vaccination pain.

A rare presentation of central nervous system in a pediatric patient with Hodgkin disease: cavernous sinus syndrome.

Intracranial involvement by Hodgkin disease is rare. We report a pediatric patient with Hodgkin disease who had intracranial disease at presentation. The patient was referred to our hospital with a suspicion of central nervous system tumor. Although the most common presenting feature of intracranial Hodgkin disease is cranial nerve palsy with brain parenchyma being the most common intracranial site of involvement, to our best knowledge no pediatric case of Hodgkin disease presented with isolated cavernous sinus syndrome reported. We report this rare case because of its unusual presentation, in which Hodgkin disease presented with cavernous sinus syndrome. Physicians should consider the probability of Hodgkin disease in children of all ages who present with cavernous sinus syndrome.

Influence of high bladder pressure on vesicoureteral reflux and its resolution.

OBJECTIVES: Voiding dysfunction may result in lower urinary tract symptoms in children and is associated with urinary tract infection, renal damage and vesicoureteral reflux (VUR). The aim of this study was to assess the relationship between detrusor pressure, VUR and abnormal renal scintigraphy findings in children with dysfunctional voiding. PATIENTS AND METHODS: Between 2004 and 2007, 30 children with VUR and voiding dysfunction, 22 girls and 8 boys, median age 8.2 years, were evaluated. Urodynamic study, renal scan and voiding cystourethrography were performed in all patients. RESULTS: The degree of the renal scarring was found to be associated with the detrusor pressures (p = 0.018). The highest detrusor pressure was shown in the group of urge syndrome. The degree of the VUR was found to be correlated with the detrusor pressures (p = 0.038). In our study group, VUR had resolved in 11 (37%) patients, had improved in grade in 10 (33%) patients and remained unchanged in 9 (30%) patients after anticholinergic therapy. No significant relationship was found between the duration of therapy and the voiding patterns (p = 0.389). CONCLUSION: Every child with VUR should undergo a careful evaluation of its bladder function. The patients who have high detrusor pressures should be evaluated carefully for the presence of VUR and renal damage.

Hepatitis A seroprevalence and demographics in Turkish children in Ankara.

BACKGROUND: Hepatitis A virus (HAV) is the most common cause of hepatitis in childhood and an important public health problem. The objective of the present study was to determine the seroprevalence of hepatitis A and patient demographics in children between 1 and 15 years old who were admitted to a pediatric outpatient clinic in Ankara, Turkey. METHODS: Hepatitis IgM and G antibodies were determined in the sera of children who attended the outpatient clinic. Informed consent was obtained from all subjects or their parents. RESULTS: The mean age of the children (n = 335) was 7.9 +/- 2.1 years; 47.5% of them were girls. The overall anti-HAV IgG prevalence in children aged 1-15 years was 47.2%. The positivity of hepatitis A IgM was highest in the 6-10 years age group (22.7%; P < 0.001). HAV IgG was highest in the 11-15 years age group (69.4%; P < 0.001). A total of 95.6% of the children had social insurance, 49.3% were living in poverty. The socioeconomic level of 82.4% of subjects was low. The history of hepatitis in their families was 6.9%. CONCLUSIONS: Hepatitis A is intermediate endemic in Ankara and children must be vaccinated before school age, in addition to health education and improved sanitation.

Efficacy and safety of Saccharomyces boulardii in amebiasis-associated diarrhea in children.

The efficacy and safety of adding Saccharomyces boulardii to antibiotic treatment for amebiasis-associated acute diarrhea in children were assessed in this study. Forty-five children in Group I received only metronidazole per oral for 10 days while 40 patients in Group II received S. boulardii in addition to the same medication. The major outcomes investigated were duration of acute and bloody diarrhea, frequency and consistency of stools, resolution time of the symptoms, and the tolerance and side effects of the treatment regimens. The median duration of acute diarrhea was 5 (1-10) days in Group I and 4.5 (1-10) days in Group II (p=0.965). The median number of stools on follow-up and duration of bloody diarrhea, fever, abdominal pain and vomiting were similar in the two groups. S. boulardii was well tolerated by the children and no side effects were recorded. Addition of S. boulardii to antibiotic treatment of amebiasis-associated acute diarrhea in children does not seem to be more effective than metronidazole treatment alone.

Early and severe presentation of vitamin D deficiency and nutritional rickets among hospitalized infants and the effective factors.

Nutritional rickets is re-emerging as a significant health problem among children. We determined the frequency of nutritional rickets and vitamin D deficiency among hospitalized children and the effective factors. During a one-year period, 305 hospitalized children (ages between 0 to 3 years) were evaluated for clinical and biochemical markers of vitamin D deficient rickets and related factors. Twenty-one of them (6.8%) were diagnosed as nutritional vitamin D deficiency and rickets. Most of the children diagnosed were under one year old (16/21, 76.2%). Fourteen vitamin D deficient rachitic children were admitted to the hospital with infectious conditions, and most of them were respiratory tract infection. The rachitic group was compared for statistical significance with the non-rachitic control patients for the data collected. Rachitic children had a lower rate of vitamin D intake. The frequency of malnutrition and anemia and the percentage of covered mothers were higher in the rachitic group than in the control group. Vitamin D deficiency-related rickets is still a common and serious health problem especially in the infancy period. To address this problem, a specific attention should be given to women of reproductive age and in the early infancy period. Initiation of vitamin D supplementation could be offered very early (perhaps after the birth) in children with risk factors.

A novel mutation of the GLUT2 gene in a Turkish patient with Fanconi-Bickel syndrome.

Fanconi-Bickel syndrome is a rare inherited disorder of carbohydrate metabolism. The disease is characterized by the association of a massive hepatomegaly due to glycogen accumulation, severe hypophosphatemic rickets and marked growth retardation due to proximal renal tubular dysfunction. Fanconi-Bickel syndrome is a single gene disease and is caused by defects in the facilitative glucose transporter 2 (GLUT2) gene (SLC2A2) on chromosome 3q26.1-26.3, which encodes for the glucose transporter protein 2 expressed in hepatocytes, pancreatic beta-cells, enterocytes, and renal tubular cells. Several mutations in a gene encoding a glucose transporter have been reported in patients with Fanconi-Bickel syndrome. Here we report a Turkish child who had a novel mutation that has not been described before and we discuss the knowledge regarding genetic mutations in this rare disease.

Prolonged hungry bone syndrome in a 10-year-old child with parathyroid adenoma.

We report a case of primary hyperparathyroidism associated with prolonged hungry syndrome (HBS) after parathyroid adenomectomy in a 10-year-old girl. Bone mineral density (BMD) revealed severe loss of cancellous BMD. Overt bone disease, high alkaline phosphatase, decreased cancellous BMD and a large adenoma can be used as preoperative predictive risk factors of HBS in children.

Do different vaccination regimens for BCG and hepatitis B affect the development of allergic disorders in early childhood?

AIM: To determine whether age at bacilli Calmette-Guérin (BCG) and hepatitis B vaccination has an effect on the development of atopy and allergic disorders in early childhood. METHODS: This was a cross-sectional study of 109 children aged between 24 and 36 months with respiratory system diseases. The study population was divided into two groups according to vaccination regimens: group 1, beginning hepatitis B vaccination at birth and receiving BCG vaccine at two months of age; group 2, receiving BCG vaccine at birth and beginning hepatitis B vaccination at two months of age. Atopic status was assessed by skin-prick tests (SPTs). RESULTS: There was no statistically significant difference in atopy between two groups (p = 0.27). However, the prevalence of recurrent wheezing was higher in group 1 (36.4%) than group 2 (16.3%) (p = 0.04). Logistic regression analysis identified receiving BCG vaccine at birth and beginning hepatitis B vaccination at the age of two months were protective for recurrent wheezing (odds ratio 0.5; confidence interval: 0.3-0.8; p = 0.01). CONCLUSION: We believe that the administration of BCG vaccine at birth and hepatitis B vaccine at two months may be protective against recurrent wheezing but doesn't prevent atopy.