Background: Neonatal sepsis is one of the major causes of morbidity and mortality in newborns. Since early diagnosis of neonatal septicemia is important for timely initiation of correct antimicrobial therapy and considering the existence of variability in nonspecific clinical laboratories, we assessed the role of clinical manifestations and laboratory findings to find the right diagnosis. Objectives: The aim of this study was to evaluate, record and rank the clinical manifestations and lab data of neonates with clinical sepsis. Methods: In a cross sectional descriptive prospective study in 2013, a total of 110 consecutive infants with clinical manifestations of sepsis were studied in two groups including early onset sepsis (EOS) taking place at 72 hours of age or younger, and late onset sepsis (LOS) occurring after 72 hours. Check list of infant's data, presenting symptoms or signs and laboratory data in both groups were evaluated and recorded. Significant differences were set at as P < 0.05. Results: Overall, 81.8% of infants had EOS while 18.2% of infants had LOS. The mean age at the time of EOS and LOS presentation was one to two days and four to twelve days, respectively. The most common clinical manifestations were respiratory distress in 49 (44.5%), jaundice in 28 (25.5%), vomiting in 26 (23.6%) and poor feeding in 23 (20.9%) of the infants. Other clinical manifestations were lethargy (weakness), decreased sucking reflex, fever, tremor, abdominal distention and seizure, found in 12 (10.9%), 10 (9.1%), 4 (3.6%), 4 (3.6%), 3 (2.7%) and 2 (1.8%) neonates, respectively. Early Onset Sepsis was considerably associated with respiratory distress (P < 0.001), while LOS in neonates was followed by jaundice (P < 0.001), seizure (P = 0.02) and fever (P < 0.001). Anemia, leukocytopenia, leukocytosis, thrombocytopenia and C-reactive protein (CRP) positive results and blood culture was detected in 36 (32.7%), 2 (1.8%), 0 (0%), 2 (1.8%), 19 (17.3%) and 110 (100 %) neonates, respectively. Cerebrospinal Fluid (CSF) cultures were negative in all infants. Positive urine culture was seen in 10 (9.1%) infants. Conclusions: Respiratory distress is more common in EOS whereas jaundice, fever and seizure are more likely to be observed in LOS infants. Considering the results, clinical manifestations should be regarded as an important part of early diagnosis of sepsis.

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Background: Vitamin D has an essential role in bone growth and metabolism. Currently, its role has been investigated in different diseases. It is high prevalence of vitamin D deficiency in the world, particularly in developing countries. Objectives: The aim of this study is to investigate the prevalence of vitamin D deficiency in children of 1 -6 years old and its relation with their age, sex and body mass index. Methods: This study was conducted in pediatric clinic of Javaheri Hospital in Tehran, from 2016 to 2017. The study population was children of 1 -6 years old presenting to the pediatric clinic for routine examination or treatment. The collected data included age, gender, height, weight, and serum 25-hydroxy vitamin D level. Results: Of the total population of 288 children, 47.2% were female and 52.8% were male. The prevalence of vitamin D deficiency was 51%, while 4.51% had severe deficiency (level of vitamin D < 10 ng/mL). The relation between the level of vitamin D and variables of gender, height, weight, and body mass index was not statistically significant. Nonetheless, the level of vitamin D had a statistically significant relation with age such that, serum level of 25(OH) vitamin D reduced by 3.47 ng/mL for every one year of age (P < 0.001). Conclusions:The prevalence of vitamin D deficiency is increasing with increasing age. Therefore, adoption of preventive and therapeutic measures is necessary to reduce its prevalence and side effects.One billion people worldwide suffer from vitamin D deficiency, with a high prevalence in the Middle East countries such as Iran, especially in children under 12, with a prevalence range of 25 to 85% (1,2,8,12,13,(17)(18)(19)(20).Since Iran has adopted the policy to prevent vitamin D

Objective: To compare the different diagnostic criteria for gestational diabetes mellitus (GDM) proposed by the American Diabetes Association (ADA), World Health Organization (WHO), and Australian Diabetes in Pregnancy Society (ADIPS) in a 75-g, 2-hour oral glucose tolerance test (OGTT) and to investigate their effects on neonatal birth weight. Methods: Healthy pregnant women were enrolled in a cohort study to undergo a 75-g OGTT during 24 to 28 weeks of pregnancy and then followed up to delivery. ADA criteria and recommendations were used for the management of patients. Results: Among 670 pregnant women, GDM was diagnosed in 41 (6.1%), 81 (12.1%), and 126 (18.8%) on the basis of ADA, WHO, and ADIPS criteria, respectively. The kappa value was 0.38 (P<.0001) for the agreement between ADA and WHO criteria, 0.41 (P<.0001) for agreement between ADA and ADIPS criteria, and 0.64 (P<.0001) for agreement between WHO and ADIPS criteria. WHO-only "positive" women had significantly lower fasting plasma glucose (87.9 versus 102.2 mg/dL; P<.0001) and 1-hour plasma glucose levels (146.4 versus 200.5 mg/dL; P<.0001) but higher 2-hour plasma glucose levels (150.1 versus 109.1 mg/dL; P<.0001) than women diagnosed with GDM by only ADA criteria. The correlation coefficient between 1-hour glucose level and neonatal birth weight was 0.09 (P<.02). The adjusted odds ratio of macrosomia associated with GDM according to ADA criteria was 1.34 (95% confidence interval, 0.15 to 12). Conclusion: The frequency of occurrence of GDM was 6.1% in a 75-g OGTT based on ADA criteria, and there was fair agreement between ADA and WHO criteria, moderate agreement between ADA and ADIPS criteria, and strong agreement between WHO and ADIPS criteria. A modest correlation was found between the 1-hour serum glucose value and neonatal birth weight.

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