UTI was found in 12.5% of the asymptomatic jaundiced neonates with the onset of unconjugated hyperbilirubinemia in the first week of life. Therefore, we suggest that urine culture should be considered as a part of the diagnostic evaluation of jaundiced neonates older than 3 days with an unexplained etiology.

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It can be concluded that among the cytokines associated with Th17, the two cytokines of IL-21 and TGF-β play a more critical role in peptic ulcer and gastritis in the individuals infected with H. pylori. Furthermore, inflammation varies depending on the type of the cytokine and its secreted level.

INTRODUCTIONSpontaneous bacterial peritonitis (SBP) is defined as an ascitic fluid infection without a demonstrable intraabdominal cause [1] . It is a well known complication of cirrhosis in adults, occurring in 8% to 13% of patients [2][3][4][5] . The diagnosis is established by a positive ascitic fluid bacterial culture and an elevated ascitic fluid absolute polymorphonuclear leukocyte (PMN) count (≥ 2.5 × 10 5 /L). In adults, the organisms of SBP are usually gramnegative bacteria [2][3][4]6] , but they may differ in children [5,7] . The aim of the present study was to deter mine the causative agents of SBP in children with liver disease and ascites in our center. MATERIALS AND METHODSDuring a period of 2.5 years, from September 2003 to March 2006, 63 children with liver disease and ascites were prospectively studied in the Department of Pediatric Gastroenterology in Nemazee Hospital affiliated with Shiraz University of Medical Sciences, the major referral center in Southern Iran. Written consent was obtained from all parents after informing them about this study which was approved by the Ethics Committee of the University.Of the children involved in this study 12 had met the criteria for SBP (polymorphonuclear leukocyte count greater than 2.5 × 10 5 /L and positive ascitic fluid culture). In total 13 episodes of SBP were documented, of which two occurred with one patient, 4 mo apart. The patients and their parents answered a structured questionnaire, which included name, age, sex, clinical history, underlying liver diseases, history of antibiotic and diuretic use, history of previous variceal bleeding and episodes of SBP. All children had undergone a thorough physical examination.Serum albumin and glucose, urinalysis and urine culture were done in all patients. CONCLUSION: S. pneumoniae is the most common cause of SBP in the pediatric age group and we recommend a third generation cephalosporine (e.g., Ceftriaxione or Cefotaxime) for empirical therapy in children with SBP.

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