Journal of Pediatric Perspectives
Year:2019 | Volume:7 | Issue:7 (67)|Papers Count:14

Background: Postpartum depression has negative effects on mother, child and family. Regarding the side effects of antidepressants and because of contradictory results on the effects of herbal medicines, the present meta-analysis was conducted to evaluate the efficacy of herbal medicines in treatment of postpartum depression and maternal-infant attachment. Materials and Methods: An extensive search was done in databases of Medline, EMBASE, Scopus, Cochrane, and Web of Science in English databases as well as IranDoc, Magiran, Medlib and SID, in Persian databases with no time limitations until November 2018. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: The meta-analysis of five trials showed score of depression was lower in herbal medicines group compared to placebo (Standardized Mean Difference [SMD=-0. 648], 95% confidence interval [CI]:-0. 849 to-0. 446). Heterogeneity was non-significant (I2=0%, p=0. 476). Meta-analysis of compounds containing lavender decreased score of depression significantly compared to control group. Heterogeneity was non-significant (SMD=-0. 629, 95%CI:-0. 847 to-0. 411, I2=9. 8%, p=0. 34). The lavender meta-analysis of three studies showed a significant effect in comparison to control group (SMD=-0. 570, 95%CI:-0. 799 to-0. 341; I2=9. 8%, p=0. 34). The aromatherapy meta-analysis showed that aromatherapy with or without massage could lead to a significant decrease in score of depression compared to control group (SMD=-0. 637, 95%CI:-0. 924 to-0. 333; I2=66%, p=0. 084). Some herbal medicines showed a significant effect on maternal-infant attachment and feelings toward baby scale. Conclusion: Herbal medicines can be considered as an alternative option in treatment of postpartum depression. Also, maternal-infant attachment and feelings toward baby scale were affected by herbal medicines.

Background Dysmenorrhea is an important disease that affects physical, social and psychological functioning such as social, emotional and health performance. The lavender essential oils are being used in both combined and mere forms. The purpose of this meta-analysis is to investigate the effects of lavender alone and in combination with other aromatic plants on the attenuation of dysmenorrhea. Materials and Methods The previously published articles were searched on only English databases of Medline, Cochrane library and scouts. Headings (MeSH) using the main keywords of (Lavandula OR lavender) AND (Dysmenorrhea) since inception until March 15 2019. We also searched all Iranian Databases with the same English keywords. Results Meta-analysis of lavender alone ‘ showed that dysmenorrhea intensity was lower in patient treated with lavender in comparison to control: standardized mean difference [SMD] =-1. 17, 95% confidence interval:-1. 72 to-0. 629. Heterogeneity was 85% and significant (p<0. 001). Our meta-analysis showed dysmenorrhea intensity was lower in patients treated with compound containing lavender in comparison to control: SMD =-1. 04; (p<0. 001). Conclusion Given the patient's interest in complementary medicine and the low cost of this therapeutic approach, this technique can be used as a useful way to improve dysmenorrhea. The findings of these studies should be interpreted with caution because of the high heterogeneity between studies and the small number of studies and small sample size.

Background Computed tomography (CT) scan is one of the most frequent tests among children in which they should be completely calm and immobilized for a correct patient test. In this study, we aimed to investigate the effects of intramuscular dexmedetomidine (DEX) with intramuscular ketamine in children undergoing CT imaging. Materials and Methods This double-blind clinical trial study was conducted in Golestan and Imam Khomeini hospitals of Ahvaz, Iran, in 2017 and 2018. In the first and second groups, intramuscular ketamine and intramuscular DEX were injected with doses of 4 mg/kg and 3 μ g/kg, respectively. The objective of the drug injection was to reach the patient at a level of sedation of 4. During the entire period of sedation, heart rate and blood pressure were measured and recorded at the start of the study as well as after 5, 10, 15, 20, 25, 35, 45, and 55 minutes. Results In this study, 94 children needing sedation in CT-scan were included. The mean age of the children was 3. 87 ± 1. 70 years old and 54. 3% of them were girls. Mean time of onset of sedation in ketamine group (8. 82 ± 3. 86 minutes) was significantly lower compared to that of the DEX group (20. 46 ± 10. 9 minutes) (p < 0. 001). In addition, the mean duration of sedation effect in ketamine group was significantly lower than that of the DEX group (p = 0. 002). There was no significant difference in the mean discharge time in the two groups. In the ketamine group, 8 cases had side effects, however, no side effects were observed in the DEX group (p = 0. 006). Conclusion Based on the results, although DEX has a slower onset of effect and a longer duration of effect compared to ketamine, due to its lower side effects, it can be an appropriate alternative to commonly used sedative medications.

Background: Conventional echocardiography and tissue Doppler imaging have been highlighted to diagnose diastolic and systolic heart dysfunction. We aimed to compare tissue Doppler imaging with conventional echocardiography to diagnose heart dysfunctions in diabetes mellitus type 1 (DMT1) patients. Materials and Methods: This case-control study was conducted in the Ali Asghar Clinic, Zahedan, Iran. The study lasted from 2017 to 2018 on 140 participants aged from 4-18 years, and consisted of 70 patients with DMT1, and 70 children who referred to hospital for checkup as control group. The participants went under tissue Doppler imaging and conventional echocardiography (M mode and 2D) by an invariable cardiologist. The 5 ml blood samples were taken to test blood leptin and ferritin. The data were analyzed using SPSS software (version 18. 0). Results: Conventional findings such as left and right deceleration time, left, and right peak E velocity, left ejection time, left Myocardial performance index and TDI findings such as left, and right ET’ , right S’ , right E’ , left MPI’ , right MPI’ , and left E/E’ were different in patients and the control group (p<0. 05). Left and right deceleration time, and LV Mass index in conventional and left ET’ , right ET’ in TDI were different in age groups of patients (p<0. 05). In sex groups, left deceleration time, left peak A velocity, right acceleration time, right deceleration time and right E/A in conventional and left ET’ , left ICT’ , left IRT’ , right ICT’ , right IRT’ , right S’ and right MPI’ in TDI were different (p<0. 05). Conclusion: This study concluded that both conventional and TDI were different between DMT1 patients and the control group, but TDI was stronger in discrimination.

Background Cochlear implantation is an approved treatment which can be used to treat severe to profound hearing loss. Imaging before cochlear implant surgery is very important in decision making and assessing the temporal bone anatomy for surgery. We aimed to assess the diagnostic value of high resolution CT scan (HRCT), and MRI of temporal bone in candidate patient for cochlear implantation and compared with surgical results. Materials and Methods The present cross-sectional study was conducted on 34 patients aged under 5 years with sensorineural hearing loss (SNHL) undergoing cochlear implantation (CI) in Ahvaz cochlear implant center, Ahvaz, Iran. All patients were assessed via temporal bone HRCT and MRI before surgery. In addition, the radiological findings were analyzed and compared with surgical results. Results Obstruction of cochlear patency was found in 7 patients. The mean sensitivity/specificity of CT and MRI assessments were 100/94% and 100/96. 3%, respectively. Associated anomalies were found in 4 patients. The mean sensitivity/specificity of CT and MRI assessments were 50/100% and 75/100%, respectively. Conclusion Based on the results, since CT scans are more accessible and cost less for the patient, it is recommended to perform CT scan as a primary method for assessment before surgery, while the MRI is only applied when the initial findings are unclear.

Cystic fibrosis (CF) is a common progressive genetic disorder among children which involves lungs, kidneys, intestine and liver. Apart from the significance of genetic factors, various environmental factors particularly bone mineral density are directly associated with CF. Remarkably, bone disease is appeared as a routine and common trait in long term CF survivors which implies that environmental parameters including calcium and vitamin D intake as well as drug inducement are the most important risk factors causing low bone mineral density. Conspicuously, absolute and notable treatment of cystic fibrosis associated to bone disorder must involve investigating the risk factors including the reduced intake of certain vitamins and minerals due to pancreatic inadequacy, modified hormone production, severe and chronic lung infection with increased ranges of bone function cytokines for a weak bone health situation. In this review, focus is on these considerable factors alongside the genetic factors in cystic fibrosis.

Background Physical activity in asthmatic children may be useful. But there is not adequate knowledge about it. In present study the effect of selective exercise on motor competency and pulmonary function in asthmatic pediatrics was evaluated. Materials and Methods In a randomized clinical trial study, fifteen asthmatic children aged 6 to 18 years were included. Patients were randomly divided into the experimental or control group. There was no difference in the routine pharmacotherapy. The aerobic group had an exercise program consisting of 45-minute sessions three times per week for 8 weeks. The outcome measures were the difference between the pre-and post-exercise program and also the experimental and control groups. Spirometry parameters (such as FEV1and FVC) were measured. Motor competency was measured by the Ozeretski test. Quality of life was evaluated by St. George's questionnaire. The data were analyzed using SPSS software (version 16. 0). Results: A significant effect was observed for spirometry parameters, quality of life and the Ozeretski test in two studied groups. Aerobic exercise had a significant effect in improving FEF 25-75%, quality of life and the fine and gross motor performance in the experimental group (P< 0. 05). A significant difference was observed between two groups for FEF, FEF25-75% and quality of life (P< 0. 05). Conclusion Regular exercise improves the spirometric parameters and quality of life in studied asthmatic children. In present study, aerobic exercise and strength training were useful complementary means for the treatment of asthmatic children.

Background: Fungal infections with high morbidity and mortality in neonatal intensive care unit are usually preceded by colonization. We aimed to investigate the prevalence of fungal colonization, determine the risk factors and health outcome such as any change in the patient's improvement in hospitalized infants of Neonatal Intensive Care Unit (NICU). Materials and Methods: This prospective cohort study was conducted on all newborns who were hospitalized in Namazee NICU which is the largest neonatal center in Southwestern Iran during the six-month period from January to July 2018. The eye, urine, perineum, nose, throat, umbilicus and blood were sampled within 72 hours following NICU admission and repeated one week later. Each newborn with at least one positive fungi culture from surveillance site was defined as fungal colonization. All newborns were categorized into two groups based on results of fungal colonization; they were evaluated for baseline perinatal and neonatal characteristic data, probable risk factors (such as prior antibiotics, presence of an endotracheal tube and neonatal disease) and health outcomes (cure, improvement or death). Statistical analysis was done using SPSS software (version 22. 0). Results: From a total of 105 (37 girls, 68 boys) hospitalized newborns in NICU, forty-eight (45. 7%) of them were colonized by Candida spp. which was the only fungus isolated from the cultures. There were significant differences for the level of hemoglobin (p= 0. 04) and cardiac diseases (p= 0. 04) between the two groups of fungal colonization and non-colonized newborns. One-third of the newborns that had fungal colonization passed away vs. one-tenth without fungal colonization. Conclusion Based on the results, there was a 45. 7% rate of fungal colonization in hospitalized newborns in NICU. Hemoglobin level and cardiac diseases were a risk factor for fungal colonization in these patients. The rate of death was approximately three-fold in hospitalized infants with fungal colonization vs. non fungi infected.

Background Drugs used by patients with sickle cell anemia to relieve pain have side effects, so the use of non-pharmacological palliative methods (such as massage, muscle relaxation, heat, drinking fluids, etc. ) can be considered. We aimed to determine effect of non-pharmacological palliative methods training among adolescents with sickle cell anemia. Materials and Methods In this clinical trial, 60 adolescents with sickle cell anemia attending Shafa Hospital in Ahvaz, Iran, in 2018 participated. After obtaining informed consent and expressing the objective of the research, patients were randomly divided into two equal groups of intervention and control. The intervention group received three 90-minute sessions training about non-pharmacological relief methods. Both groups completed the pain care form in the 4th, 6th and 8th week after the intervention. Data was analyzed using SPSS software (version 23. 0). Results Results showed that the mean of pain severity in the studied periods was significantly different between the two intervention and control groups (p<0. 05). Overall, the mean pain intensity in the intervention group in the 4th, 6th and 8th weeks after the intervention was lower than the control group (p<0. 05). Rate of referrals in the intervention group significantly decreased after intervention, while in the control group, it increased significantly (p<0. 05). Conclusion Based on the results, non-pharmacological palliative methods (such as respectively, massage, muscle relaxation, heat, drinking fluids, thought deviation and guided imagery), can be used as a safe method for reducing pain.

Background: Apnea can be associated with many complications such as bradycardia, cyanosis, hypotension, hypotonia, hydrocephalus, neurologic complications, and even death. Pharmacological treatment is associated with many side effects. We aimed to investigate the effect of aromatherapy on Apnea in premature newborns. Materials and Methods: An extensive search was done in databases of Medline, Embase, Scopus, Cochrane, and Web of Science until February 2019. Two independent researchers screened articles, in the next step, full texts of probably relevant articles were summarized and categorized based on the evaluated outcomes and overall effect size was presented. Results: Three studies were included in the systematic review (including 110 preterm infants). Aromatherapy with breast milk odor not with vanilla odor, caused variability of premature infants’ heart rate blood oxygen saturation during and after venipuncture. Calming effects were observed when preterm newborns were exposed to either vanilla or breast milk odors during venipuncture; however, only breast milk odors had a calming effect on subjects after sampling. Breast milk odor was more effective regarding calming effects on premature infants. Infants in olfactory stimulation with anise or cinnamon were discharged from hospital 3. 4 days earlier than the control group (p = 0. 12). A subgroup analysis of subjects with a body weight of 2, 000 grams or more showed a shorter hospitalization period. When compared by gender, better effect was observed in boys than girls with shorter hospitalization in NICU. Conclusion Aromatherapy can be effective for apnea in preterm infants. Due to the small number of participants and low number of articles, the conclusion should be interpreted with caution.

Every year, some 3. 9 million girls aged 15 to 19 years undergo unsafe abortions (1). Approximately 16 million girls aged 15 to 19 years and 2. 5 million girls under 16 years give birth each year in developing regions (2, 3). Complications during pregnancy and childbirth are the leading cause of death for 15 to 19 year-old girls globally (4). Adolescent mothers (ages 10 to 19 years) face higher risks of eclampsia, puerperal endometritis, and systemic infections than women aged 20 to 24 years (5, 6). The term "adolescent" is often used synonymously with "teenager". In this sense "adolescent pregnancy" means pregnancy in a woman aged 10– 19 years (2, 7). Pregnant teenagers face many of the same pregnancy related issues as other women. There are additional concerns for those under the age of 15 as they are less likely to be physically developed to sustain a healthy pregnancy or to give birth (8). For girls aged 15– 19, risks are associated more with socioeconomic factors than with the biological effects of age (9). Risks of low birth weight, premature labor, anemia, and pre-eclampsia are connected to biological age, being observed in teen births even after controlling for other risk factors (such as accessing prenatal care etc. ) (5, 6).

Background Suicidal attempt is an important phenomenon among pregnant women in Iran. This study was designed to determine the epidemiological status and risk factors of suicidal attempts by poisoning in pregnant women. Materials and Methods All pregnant women who were referred to the poisoning department of Imam Reza Hospital (Mashhad, Iran) from November 2016 to November 2017, were evaluated in terms of suicidal attempts. Cases of poisoning with a suicidal intent were included in the study after obtaining informed consent. A checklist, including the baseline characteristics, risk factors, and underlying causes of suicide, was completed for every participant anonymously. After regaining consciousness, the participants were interviewed by a psychiatrist in the consultation room for 20 minutes, and the underlying psychiatric disorders, mood disorders, stressors, and suicidal thoughts were evaluated. Finally, the collected data were analyzed using SPSS software (version 16. 0). Results Among 40 pregnant women evaluated in this study, 87. 5% did not have a stable job or income, 55% had difficult living conditions, 45% suffered from sleep disorders, 45% had suicidal thoughts, and 42. 5% reported addiction in husband. In addition, 32. 5% of women had a history of depression, 32. 5% had previous suicidal attempts, 32. 5% had abortion thoughts, 20% had a family history of suicide attempt, 17. 5% were addicts, and 17. 5% had a history of self-injury. Conclusion This study indicated that the most important factors associated with suicidal attempts by poisoning in pregnant women include lack of job and income, difficult living conditions, and history of psychiatric problems and addiction.

Background: Stunting and wasting, as two key health indexes in any society, are two major factors in children’ s physical and mental growth in the future, especially in developing countries. We aimed to investigate some factors affecting stunting and wasting among the under-five children in Eastern Mediterranean Region (EMR). Materials and Methods: The statistical population of the present study consisted of the under-five children suffering from stunting and wasting in the EMR and natural factors from the website of World Meteorological Organization (WMO), based on the secondary data in the period 2005-2016. After that, the maps were extracted using the Geographical Information System (GIS). Finally, for data analysis, the regression, path analysis and cluster analysis techniques were employed in the SPSS Statistical Software (version 23. 0). Results: The highest rates of stunting were in Yemen, Afghanistan, Pakistan, and Sudan, whereas Djibouti, Yemen, Somalia and Sudan had the highest rates of wasting. Accordingly, the children’ s stunting was affected by their wasting (Beta=0. 918), and reproductive, maternal, newborn and child health interventions economic status (Direct Impact=-0. 323, R= 0. 865, R2= 0. 748, ADJR2=0. 720, P<0. 05). It was also observed that life expectancy at birth (Beta=-0. 829, indirect impact=-0. 323), average wind speed (Beta=-0. 403, Indirect Impact=-0. 369), prevalence of anemia in pregnant women (Beta=0. 335, Indirect Impact= 0. 307), births attended by skilled health personnel (Beta=0. 226, Indirect Impact= 0. 207), had indirect effects on the wasting of children. Conclusion Based on the results, five variables affected the children’ s stunting and wasting including reproductive, maternal, economic status, life expectancy at birth, average wind speed, prevalence of anemia in pregnant women, and births attended by skilled health personnel.

Background The use of opioid drugs for controlling pain during and after surgery is a common but complicated procedure in neonatal anesthesia. This study compared the analgesic effect of acetaminophen with fentanyl after abdominal and chest surgery in Iranian newborns. Materials and Methods This randomized, double-blind clinical trial was conducted in two hospitals; in the NICU of Shahid Motahari hospital in Urmia and Namazi hospital in Shiraz, Iran. Sixty-six patients were randomized sequentially and assigned in two groups. One group of patients received acetaminophen dose of 10 mg/kg every six hours, and another group received fentanyl 6 μ g/Kg every six hours for 48 hours (9 doses). For all patients, pain was assessed using the "Neonatal Infant Pain Scale (NIPS)" at first time, 6, 12, 18, 24, 30, 36, 42 and 48 hours (9 measurements). If necessary, fentanyl 1 μ g/Kg was injected to the patients. Finally, all the information was recorded and analyzed using SPSS software (version 21. 0). Results The mean age of the fentanyl group was 16. 79 ± 15. 57 days and 16. 67 ± 15. 77 days in the acetaminophen group (P>0. 05). The mean weight in the fentanyl group was 3460 ± 737 gr and in the acetaminophen group was 3228. 548 ± 32. 28 gr (P>0. 05). Results showed that the mean scores of pain in all periods of time were not significantly different between the two groups (P>0. 05). No drug complications were seen in the acetaminophen group. Conclusion Based on the results, mean score of pain in fentanyl and acetaminophen groups was not statistically significant. Acetaminophen did not control pain as well as fentanyl in neonatal surgeries.