Pediatric arrhythmology deals with studying of frequency and regularity of heart rhythm disorders in childhood. Rhythm disturbances (dysrhythmias, arrhythmias) occur as a result of disturbances in the creation or conduction of stimuli in the specific or working musculature of the heart. Simplifying the knowledge of everyday work on pediatric arrhythmias, they can originate from the atria of the heart when we speak about supraventricular arrhythmias or from the heart chambers when we talk about ventricular arrhythmias. There are currently three major problems that burden pediatric cardiologists and pediatric arrhythmologists, and which are the focus of interest in pediatrics as a whole. These are primarily sudden cardiac death in children (SCD), fetal arrhythmias (FA) and postoperative-incisional arrhythmias (IA). The development of pediatric arrhythmology is imperative in the development of pediatrics and pediatric cardiology.

Cardiomyopathies (CMP) are very rare disease in newborn with a very poor uotcome. Only isolated case reports and small case series have been reported. CMP is a disease that affects the myocardium and causes mechanical or electrical cardiac dysfunction. Even cumulatively, these conditions account for only approximately 1% of childhood cardiac disease. CMP presents a therapeutic challenge for the clinician, as evidenced by the fact that 10% of all pediatric cardiac deaths can be attributed to this condition. The estimated incidence of pediatric CMP was determined to be 1,13 cases per 100.000 children. Incidence varied according to sex, region and racial origin.We concluded that the best approach for evaluating a neonate who has a potential CMP is to identify the possible type of CMP and subsequently determine the potential cause wich leads terapeutic issue. Aetiology and clinical course are especially heterogeneous in infants. The most commonly identified aetiologies are genetic syndromes and metabolic diseases. A multidisciplinary approach is recommended for defining the aetiology and developing individual treatment strategies.

Objective - The purpose of this investigation was to determine the frequencies and types of associated congenital heart disease and other cardiac lesions in children with congenital anomalies of the kidneys and urinary tract (CAKUT). Participants and method - This was a prospective cardiac evaluation of children with diagnosed CAKUT, conducted between January 2013 and December 2015 at the Department of Pediatrics of the University Clinical Hospital, Tuzla. All cases were reviewed for age, gender, consanguinity, occurrence of congenital heart disease (CHD) and CAKUT in family history. Cardiac examination included: physical examination, noninvasive blood pressure measurement, a twelve lead electrocardiogram and echocardiogram. Results - Complete cardiac examination was performed in 144 children with congenital anomalies of the kidneys and urinary tract. Clinically insignificant morphological or hemodynamical changes were noted in 13% or 9.0% children. Congenital heart disease was found in 32 (22.2%), hypertrophic cardiomyopathy in 2 and pulmonary hypertension in 1 of the 144 children. In 4 children congenital heart disease was part of other known genetic syndromes, and all of these cases had severe CHD. In twenty-six or 76.5% of the total of 32 patients it was already known, and in 6 (23.5%) CHD was discovered during this research. Ventricular septal defect was the most common malformation (13% or 40.6% of patients). Vesicoureteral reflux was the most frequent CAKUT associated with CHD. Conclusions - The results of this study showed a significant association between CAKUT and CHD. Therefore we suggest performing cardiac assessment of all children with CAKUT.

Background: Palivizumab is indicated for respiratory syncytial virus (RSV) prophylaxis in high-risk children. Methods: Observational study, based on 4 sites in Bosnia and Herzegovina (BH 365 (61.9%) infants in total were born before 33 weeks. Average gestational age of preterm infants enrolled for prematurity only was 30.2 ± 3.2 weeks; for preterm infants with BPD/CLD it was 28.3 ± 3.7 weeks. Overall average of palivizumab injections was 4.1 ± 1.0. Hospitalization rate related to severe lower respiratory infections (LRI) during the period of protection by palivizumab was 1.2%. Respiratory infections which deserved medical attention were observed in 3.7% infants included in palivizumab prophylaxis.Conclusion: RSV prophylaxis in B&H is provided systematically and successfully, following the national guidance established in 2009, with the aim of achieving a good cost-benefit ratio, with very low hospitalization rate for severe LRI in prophylaxed infants. New randomized controlled trials (RCTs) and American Academy of Pediatrics (AAP) guidance revised in 2014 will be taken into account in establishing a new national recommendation.

The aim of this study was to evaluate preoperative and postoperative growth in children with congenital heart disease (CHD) when cardio-surgical treatment is delayed. Growth data were analysed on 116 children with various types of CHD (cyanotic lesions (Group 1), left to right shunt (Group 2) and obstructive lesions (Group 3)), who underwent cardiac surgery after a certain period of waiting. Preoperatively, during the time (median 1.13 (0.55-2.39)) years of waiting for surgery, their mean weight z-score decreased from -1.38 (+/- 1.19) to -1.41 (+/- 1.28), and their mean height z-score from -0.65 (+/- 1.41) to -0.81 (+/- 1.36). Children in Group 1 developed a significant linear growth deficit, in Group 2 weight was more affected than height, while in Group 3 both growth parameters were gradually slowly, but not significantly reduced. Postoperatively weight and height z scores, although they showed a linear trend of improvement for all three groups, remained significantly reduced for two years after surgery. At the time of the last examination at the age 9.11 (5.66-13.10) years, the mean height z score -0.16 (+/- 1.28), was significantly reduced p < 0.0001, than predicted height 0.23 (+/- 0.82). Growth catch-up was related to age at surgery and preoperative growth deficit. Delayed cardiac surgery in children with CHD aggravated growth deficit and caused slow and incomplete postoperative growth catch-up.

AIM This study was to evaluate the impact of the family socioeconomic status (SES) on health-related quality of life (HRQOL) in children with type 1 diabetes mellitus (T1DM). METHODS The cross-sectional study included 65 consecutive children T1DM between ages 5 and 18 years and their mothers. The control group was formed by random selection by matching each patient with one or two healthy control subjects. To evaluate generic HRQOL in children with T1DM we used the PedsQL™ 4.0 Generic Core Scales which include both a parent proxy-report and a child self-report with age-appropriate versions. To categorize the families' SES, the parents' education level and current employment were recorded and analyzed using the Hollingshed two-factor index of social position. None of the diabetic children in the sample came from families of upper social classes, so we categorized our diabetic children into the lower and middle social classes. RESULTS Physical health (P=0.02), social functioning (P=0.04), and school activities (P=0.0003) were lower in T1DM children with middle SES families than in controls from middle SES families. Parental reports revealed statistically significantly poorer HRQOL in children from low SES families in total scale score (P=0.005) and in terms of physical (P=0.0126), and psychosocial health (P=0.0246) as compared with the control group with lower SES. Also the parental proxy reports for middle scores of family SES were statistical significantly lower in the total score (P=0.0001), psychosocial health (P=0.0001), emotional functioning (P=0.0006), and school functioning (P=0.0001) compared with the middle group of the control. CONCLUSION The current findings suggest that low and middle SES of families in children with T1DM is associated with lower generic HRQOL as compared to control children with similar SES of families.

The primary objective of the study was to examine the relationship between generic and disease-specific HRQOL scores and metabolic control in children with Type 1 Diabetes Mellitus (T1DM). This cross-sectional study included 65 consecutive children between ages 5 and 18 years with T1DM. According to their values of glycosylated hemoglobin (HbA(1C)), the children were assigned to one of two groups. In Group 1 (N = 21) were the children with HbA(1C) values < 8% (good to moderate metabolic control) and Group 2 (N = 44) were children with > 8% (poor metabolic control). To evaluate generic and disease-specific HRQOL scores in children with T1DM in relation to metabolic control, we used the PedsQL 4.0 Generic Core Scales and the PedsQL 3.0 Diabetes Module. The patients in Group 1, by pediatric patient self-report and parent proxy-report, had statistically better disease-specific HRQOL scores on the diabetes symptoms, treatment barriers, treatment adherence and worry domains in comparison with Group 2. We also found significant correlations between the total generic HRQOL scores and HbA(1C) for both parent proxy-reports' Spearman's coefficient of rank correlation rho = -0.257; p = 0.0412 and pediatric patients' Spearman's coefficient of rank correlation rho = -0.269; p = 0.0313. The current findings suggest that poor glycemic control in children with T1DM is associated with lower generic and disease-specific HRQOL scores in developing and transitional countries.

The aim of this study was to assess the quality of life children after cardiac surgery for congenital heart disease (CHD) and to compare these results with healthy children. To assess the quality of life children after surgery for CHD we performed a cross-sectional study of 114 patients who were patients at the Department of Paediatrics in Tuzla, between the ages of 2 and 18 years, of both sexes, and with one of their parents. We used the "PedsQL 4.0 Generic Core Scales", with both child self-report and parent proxy-reports. By self assessment, the PedsQL total scores for quality of life were statistically significantly different between children after cardiac surgery for ages 13 to 18 years and healthy children, while by parent report PedsQL total scores were statistically significantly different between children after cardiac surgery for ages 5 to 7 years and healthy children. By self assessment, children after cardiac surgery for ages from 5 to 7 and 13 to 18 years reported that they have a statistically significantly lower quality of life in the segment school functioning compared to the healthy children. By parental assessment, children after cardiac surgery for ages 2 to 4, 5 to 7 and 8 to 12 years have a statistically significantly lower quality of life in the segments of physical and psychosocial health, emotional, social and school functioning. The results of our study indicate that children after cardiac surgery for CHD by self and parent assessment have a lower quality of life than healthy children.

A 6.6-year-old girl presented for leftsided cardiac enlargement on chestradiography (Panel A). Th ree yearsearlier she had undergone a lobectomyof the lower lobe of the leftlung for extraction of an echinococcalcyst.