Journal of Pediatric Perspectives
Year:2020 | Volume:8 | Issue:1 (73)|Papers Count:17

Background: Chronic kidney disease is a global health concern, its detection and diagnosis in earlier stages is also a great challenge that can alleviate this burden. Kidney biopsy is important to establish histopathological patterns. But, it is invasive. We aimed to evaluate the correlation of renal resistive index (RI) measured by Doppler ultrasound with the progression of chronic kidney disease and to evaluate its significance as non-invasive marker of renal histological damage. Materials and Methods: This is a prospective cross sectional study conducted at El Minia Pediatric University Hospital, El Minia, Egypt, and included a total of 57 children: 38 patients with different stages of chronic kidney disease (group I), and 19 healthy children served as controls (group II). Full history, examinations and some laboratory investigations as 24 protein in urine, serum urea and creatinine concentrations were done. All participants underwent renal Doppler ultrasonography and a kidney biopsy was taken from CKD patients. th Results: Resistive index was significantly higher in patients group (group I) compared to control group. In CKD patients there was a significant positive correlation between RI and stages of CKD (r=0. 47, p<0. 05). Also, there was a significant positive correlation between RI and histological indices. However, significant negative association was found between RI and both eGFR (r=-0. 49, p<0. 05), and renal length (r=-0. 40, p<0. 05). Conclusion: Resistive index increases with the progression of CKD and it is correlated with the histological indices. So, RI as a non-invasive technique could be considered as a marker of renal function and histological damage in CKD patients and it could be a non-invasive indicator for monitoring the progression of renal disease.

Background: The first hours and days of birth are considered as the most sensitive time for mothers and newborns which require complete and high-quality care and services. To improve the quality of cares, recognizing the needs of service receivers is considered one of the most important approaches. We aimed to identify the unmet needs of healthy newborns' mothers in hospitals. Materials and Methods: This qualitative study was carried out through recording and implementing 14 in-depth, semi-structured interviews at the discharge time with healthy newborns' mothers about their most important expectations and unmet needs in terms of newborns' care in several hospitals in Tehran, Iran. Purposeful sampling was used. Then, directional content-analysis was performed using the Grundheim and Lundman approach and the main research themes were identified. Results: Unmet needs of mothers in terms of cares provided for their newborns in hospitals were included in two main themes: 1) Unmet services required for mothers of healthy newborns including three categories: mental, and psychological services and cares, the continuous presence of companion patience and the need for proper and timely services; and 2) Required information for healthy newborns' mothers including two categories of the need for receiving complete information about health status of the newborn and the need for receiving additional information and more training related to healthy newborn care. Conclusion: According to the study, healthy newborns' mothers have unmet needs in hospital including support services and sufficient information. Therefore, appropriate services and information should be provided to mothers to care for their healthy newborns. This not only increases the satisfaction of mothers but also improves the quality of healthy newborn care in hospital.

Background: Advances in medical science and nursing care today have led to the survival of preterm infants. Therefore, it is important to address methods to reduce the duration of hospitalization of preterm infants. Aim of the systematic review on the efficacy of aromatherapy on reducing the duration of hospitalization of preterm infants. Materials and Methods: Systemic search of online databases (Medline (via PubMed), Web of Science, Cochrane, International Registry Platform for ongoing trials and clinical trails. gov, and EMBASE complete for randomized control trial and non-randomized prospective or retrospective clinical studies published with no time limit till Feb 2019. Study selection was done by two reviewers. Results: Five studies were included into systematic review. In the first study, 50 infants were divided into odorless and odor-stimulated (by anise or cinnamon) groups. The mean duration of discharge in the olfactory stimulation group was 3. 4 days earlier than the odorless group (p=0. 12). In the second study, the time spent in the hospital was significantly shorter in the milk-odor (43 days) than control group (55. 5 days). In the second study, length of stay in hospital was shorter in premature infants in neonatal intensive care units exposing impregnated pad than control in the fourth study, the result of their study showed olfactory stimulation with vanilla but not rose decreased length of stay in hospital than control group. In the last study, duration of hospitalization was shorter in the Odor of breast milk group in comparison with control group. Conclusion: According to the results of the present study, the olfactory stimulation of preterm infants can be effective in reducing the duration of hospitalization.

Background: Wayfinding involves behavior in order to navigate between the two points of origin and destination. The importance of this issue is considerable; because facility of wayfinding is directly related to improving the efficiency of space, and its psychological effects on human life. This study focuses on the effective physical factors in the wayfinding of educational spaces for children. Materials and Methods: The research method has been applied qualitatively and quantitatively. Data collection was done using sketch maps in January 2019. So that, from two primary schools in Rasht, which had a total of 299 primary students 168 sketch maps were collected from the students of different sections using the Cochran formula. It should be noted that for analysis of the research findings, MAXQDA 10 and SPSS 24 software were also used. Results: The findings of this research indicate that in the age group of 7-8 years-old parks and playgrounds, in the age group 9-10 years-old green space, and in the age group of 11-12 year-old, entrance signage and navigation boards, were the most important signs in the wayfinding of children into educational spaces. Also, the results showed that there was no significant difference between different groups and the variances are homogeneous. Conclusion: Components such as scale changes, the use of cheerful colors, architectural distinctions, the use of textures that fit children's character for materials, such as hearts, stars, or animation characters, graphic and fantasy signs and symbols are suitable stimulants for wayfinding of children aged 7-12 year-old into educational spaces.

Background: Considering the important role of understanding the childbearing motivations in counseling services about childbearing behavior, and need for applying a valid and reliable instrument to assess it in Iranian society, this study was conducted to determine Childbearing motivation. Questionnaire was validated in two versions including Persian and English. The review aimed to comprehensively review the validity and reliability of Childbearing Motivation Questionnaire to provide comprehensive information to health providers. Materials and Methods: We conducted an extensive search on online databases (Medline, EMBASE, Web of Science, Scopus, Cochrane Library, and CINAHL) from inception until September 2019. The following keywords were used: ("Childbearing Questionnaire" OR "CBQ") AND ("Factor Analysis" OR "Exploratory Factor Analysis" OR "Confirmatory Factor Analysis" OR "Reliability" OR "Psychometric" OR "Cronbach's alpha" OR "Test-retest Reliability" OR "Intra-class Correlation Coefficient" OR "ICC"). COSMIN checklist was used to assess the methodological quality of studies. Results: Three studies were included in review. Intra-class correlation coefficient (ICC), Cronbach's alpha coefficient and the test-retest reliability indicated satisfactory reliability of the CBQ. Original version of Childbearing Motivation Questionnaire was developed by Miller (1995). In Persian version, original model did not show the 'acceptable' fit. After removing eight factors with low loading and two correlated error terms, modified model was found to have "adequate" fitness (Comparative Fit Index (CFI=. 91), Tucker-Lewis Index (TLI=. 90), Root Mean Square Error of Approximation (RMSEA=. 04), and Chi-square to degree of freedom x2/df=1. 92). Conclusion: The Persian and English version of childbearing motivation has good construct validity and reliability. Future research needs to test six-factor model with 49 total items and modified model with 43 items in various populations.

Background: Preterm birth with a prevalence of about 10% causes 75-95% of prenatal mortality, and one of the effective factors of it is hormonal factors. This study aimed to investigate the effect of oral medroxy progesterone on reducing preterm labor in women with a history of preterm labor. Materials and Methods: This double-blinded clinical trial was performed on 214 pregnant women with the history of at least one preterm labor referred to midwifery clinic of Fatemieh Hospital, Shiraz, Iran, during 2017 to 2018. One hundred and seven women underwent treatment with oral medroxy progesterone (100 mg per day), and 107 individuals were prescribed placebo, and prenatal care was performed routinely. Recent pregnancy course and delivery time were compared in two groups. Data were analyzed by SPSS software version 16. 0. Results: Gestational age with a mean of 30 ± 3. 89 and 36± 2. 11 weeks, respectively in control and intervention groups differed significantly (P <0. 05). The number of referrals to hospital due to preterm labor, the age of patients at first referral due to preterm labor, and age of delivery in both groups of receiving progesterone and placebo were significantly different (P <0. 05). Conclusion: Based on the results of the current study using 100 mg oral progesterone per day in weeks 16-36 of pregnancy was effective in reduction of preterm labor, and caused improved gestational age in mothers.

Background: Antibiotic resistance in Cystic Fibrosis (CF) patients has been a serious issue in their survival. The objective of this study was to investigate the antibiogram trend in serial admissions among CF patients. Materials and Methods: In this retrospective descriptive-analytical study, from 2014 to 2019, 95 known cases of CF patients with repeated admissions at Masih Daneshvari Hospital, Tehran, Iran, were evaluated. Demographic data and para-clinical parameters were evaluated. Fourteen antibiotic disks were used to determine antibiotic resistance. Resistance trend in 2014 and 2018 was compared. Results: Out of 95 patients, 48 patients (52. 2%) were female. The mean age of patients was 19. 43 ± 6. 7 years. Pseudomonas positive culture in the first admission was 68. 4%; while it was 45. 3% in the second admission and 28. 4% in the third admission (p> 0. 05). Staph positive culture was 20%; 18. 9%, and 16. 8%, respectively (p> 0. 05). Pseudomonas aeruginosa was the most sensitive to vancomycin (93. 8%), followed by colistin (93. 3%) and ceftazidime (65. 2%). There was no correlation between patients' age and multidrug resistance (MDR). FEV1 was significantly lower in both the patient with positive pseudomonas (p-value: 0. 01), and culture and MDR (p= 0. 023). Furthermore, in terms of antibiotic resistance over time, resistance to colistin statistically decreased from 25% in 2014 to 2% in 2018 (p= 0. 02). Conclusion: Vancomycin, Colistin, Ceftazidim, Imipenem, Amikacin, and Gentamycin had the highest drug sensitivity; while Cefotaxime, Clindamycin, and Chloramphenicol antibiotics had a low sensitivity. From 2014 to 2019, resistance to Colistin dramatically decreased.

Background: Sigmoid volvulus (SV) in pregnancy is a very rare entity, which can be associated with extremely high rates of mortality and morbidity for both mother and fetus. Care Report: A 22-year-old female patient with a first pregnancy with a gestational age of 27 weeks was referred to the Omolbanin hospital, Mashhad, Iran, and presented with generalized pain, abdominal swelling, and abnormal bowel movements from a week ago. Intestinal loops with thick wall and fluid content decreased with decrease in peristalsis was seen in abdominal and pelvic ultrasound. In addition, abdominal and pelvic X-ray examination showed enlarged bowel with bent inner tube view. Due to severe abdominal pain and available evidence, she underwent laparotomy for suspected intestinal obstruction. A dilated sigmoid colon rotated about two times around its mesentery was seen adjacent to the pregnant uterus. The sigmoid was detorted and was fixed to the pelvic floor through its mesentery. The patient was discharged 4 days after surgery in good general condition, and her baby was born at 38 weeks of gestation by natural vaginal delivery. Conclusion: Sigmoid volvulus during pregnancy is a rare complication. Its timely diagnosis will prevent intestinal gangrene and reduce maternal and fetal damage.

Background: The placental calcification is often considered as a physiologic aging process of the placenta but it may be accompanied with the altered levels of vitamin D (vit D). The aim of this study was to evaluate association between placental calcification and vit D in low risk pregnant women. Materials and Methods: In a case-control study eighty otherwise healthy pregnant women with a gestational age between 37-41 weeks were recruited and divided into the case (n=40), and control (n=40) groups (based on the result of the ultrasonography and according to the Grannum grading). The serum of calcium in pregnant women and vit D level in cord blood were measured by high performance liquid chromatography (HPLC). Neonatal anthropometric values were measured after birth, too. Results: Most of the pregnant women (n=74, 92%) showed either insufficiency or deficiency of vitamin D in cord while calcium levels were normal in both groups. Serum calcium showed a significant difference between two groups [p=0. 042, odds ratio (OR): 2. 006, 95% confidence interval (CI): 1. 024-3. 928], but vitamin D did not (p=0. 144, OR: 1. 048, 95%CI: 0. 984-1. 115). Vitamin D level had a significant relationship with calcification of the placenta as well as maternal age, gestational age, and birth weight. Conclusion: It is better to measure calcium and vitamin D in mothers with calcified placenta because the vitamin D level had a significant relationship with placental calcification and we recommend the administration of vitamin D in pregnant women.

Background: Learning is the most important human attribute. Cognition plays an important role in it and metacognition is another form of cognition that monitors cognitive processes and plays an important role in motivating one to learn. This study aimed at investigating the relationship between metacognition skills with academic motivation and academic achievement in high school students in Kerman, Iran. Materials and Methods In this cross-sectional descriptive-analytic study, 332 first-grade high school students in Kerman city, Iran, in 2018-19 were selected using stratified random sampling method (160 girls and 172 boys). The data were collected using the McClelland Academic Achievement Scale, O'Neill's Metacognition Skills (1996), and students' first semester average point to measure their academic achievement. Data were analyzed by SPSS software (version 16. 0) using multivariate regression. Results Findings showed that among the metacognition components, only planning had a significant effect on students' academic motivation (P<0. 05). Furthermore, among the metacognition components, cognitive awareness and strategy had a significant effect on students' academic achievement (P<0. 05). Findings also showed a significant positive relationship between students' academic motivation and academic achievement (r = 0. 128, P<0. 001). Conclusion The results of this study showed a positive and significant relationship between academic motivation and academic achievement in high school students.

Background: Cisplatin is a common platinum based chemotherapy drug that is commonly used for the treatment of the solid tumors. It is believed that this drug has nephrotoxic effects due to its oxidative action. Therefore, it is believed antioxidant agents such as vitamin E can prevent this nephrotoxic effect; however, the human studies are not sufficient. We aimed to assess the effect of vitamin E against cisplatin induced nephrotoxicity. Materials and Methods: In a randomized controlled trial, the patients were grouped into two control and target group. Both groups should receive cisplatin with a dose of 50 mg/m as single dose or in 3 to 5 divided doses. The target group received 400 IU of vitamin E daily until two days after discontinuing cisplatin and the control group received only cisplatin. Patients' serum urea, creatinine, and Kidney injury molecule-1 (KIM-1) levels were measured and compared between the two study groups and in a before-after manner. 2 Results: Totally, 29 patients were grouped into 17 controls and 12 patients in target group. The KIM1biomarker was statistically higher in control group at the end of study (p=0. 040). When assessing the before-after results, KIM-1 biomarker showed a significant decrease (1. 10± 0. 32 pg/mL to 0. 71± 0. 09 pg/mL; p<0. 05). Conclusion: Based on the results, it seems vitamin E can help to protect kidney against cisplatin toxicity; however, further clinical trials are needed to support our findings.

Background: Breath-holding spells (BHS) is a sudden and reflexive phenomenon that is common in infancy and early childhood. Despite the harmless nature of BHS, being subjected to this phenomenon is very stressful for parents and sometimes requires treatment. In this study, we evaluated the efficacy of fluoxetine therapy (as an anxiolytic medication) on pediatric BHS. Materials and Methods: The present clinical trial study was carried out on 30 patients with BHS referring to Neurology Clinic of Ghaem Hospital, Mashhad, Iran, in 2018. The subjects were randomly divided into control (n = 15), and intervention (n= 15) groups. The control group was then treated with iron and the intervention group with iron and fluoxetine for 3 months. The frequency and duration of BHS before and after treatment were compared in both groups. The results were later analyzed using SPSS version 16. 0. Results: The present study was carried out on 30 children. The mean of infants’ age in the control and intervention groups was 20. 26 ± 5. 8 and 22. 46 ± 5. 2 months, respectively (P>0. 05). The mean frequency and the duration of BHS decreased from 8. 2 ± 4. 3 to 1. 6 ± 2. 4 times per week (p = 0. 000), and from 50. 66 ± 26. 26 to 5. 4 ± 6 seconds (p = 0. 000) in the control group; and from 7. 2 ± 3 to 2. 06 ± 2. 7 times per week (p = 0. 001), and 50. 66 ± 38 to 8. 8 ± 7. 9 seconds (p = 0. 002) in the intervention group, which was indicative of a statistically significant difference. However, the difference in the mean frequency and duration of BHS in the intervention group, which represents the effect of fluoxetine, was not statistically significant (p = 0. 411 and p = 0. 792, respectively). Conclusion: The results of the present research confirm the effect of iron therapy on decreasing the mean frequency and duration of BHS, but also indicate the ineffectiveness of synergistic administration of fluoxetine and iron on decreasing mean frequency and duration of BHS.

Background: Small for gestational age (SGA) refers to newborns whose birth weight is less than the 10 percentile for gestational age. The aim of this study was to provide a comparative assessment of ultrasound placental findings in SGA and normal-weight fetuses in singleton pregnant women. th Materials and Methods: In this cross-sectional study, a total number of 112 singleton pregnant women who were in their second trimester and referred to Shariati and Imam Khomeini hospitals, Tehran, Iran, during 2016-17 were selected. Ultrasound placental findings were assessed in SGA and normal-weight fetuses. Fetal and maternal indices were also assessed. Data were analyzed using SPSS software (version 16. 0). Results: There was a significant relationship between maternal age and IUGR (0. 026); while no significant relationship was found between gestational age and IUGR (p=0. 185). No statistically significant difference existed between male and female fetuses in terms of IUGR (p=0. 542). The highest artery Doppler systolic-diastolic pressure ratio was found in EFW<5th percentile which showed a statistically significant difference with other groups (p<0. 01). Uterine artery resistance indices (UARI) in <5th percentile and >90th percentile groups were the highest and lowest respectively with a statistically significant difference with other groups (p<0. 01). Amniotic fluid index was the lowest in 5-10th percentile and <5th percentile groups (p<0. 01). Conclusion: Based on the results, SGA incidence was significantly related to maternal pregnancy age, artery Doppler systolic-diastolic pressure ratio, UARI, AFI, and placental thickness. As such, ultrasound methods can be employed during pregnancy to detect SGA incidence.

Background: Non-suicidal self-injury (NSSI) refers to the intentional damage of one's own body without a suicidal intent, which involves common behaviors such as cutting, burning, scratching, and hitting the body. Identifying factors associated with the development and continuity of NSSI is a research priority, as prevention is crucial. The aim of the current study was to determine factors associated with NSSI in Iran. Materials and Methods: In this systematic review, Persian databases including Barakat Knowledge Network System, Magiran, SID, and international databases including Scopus, Medline, and Web of Science were searched for relevant publications in English and Persian by using the following Medical Subject Headings search terms: "behavior self-injurious" OR "deliberate self-harm" OR "deliberate self-harm" OR "self-destructive behavior" OR "non-suicidal self-injury" AND "Iran": from 1983 until September 2019. Two independent reviewers studied the full text of the articles and extracted the main results. The results of studies were classified and presented descriptively with a narrative approach. Results: A total of 334 articles were found of which 18 articles (n= 17343) met the inclusion criteria and were reviewed. More than half of the reviewed articles were cross-sectional (n=16). Three main themes were identified: factors associated with baseline characteristics (such as age and gender); mental disorders (such as depression); and psycho-social factors associated with mental disorders (such as self-concept disturbance). Conclusion: The meaning of identified main themes shows that the most important factor in occurrence of NSSI in Iranian patients is mental health status. Since the majority of studies were cross-sectional, the data do not yet justify risk factors. Therefore, longitudinal studies with adequate methodological qualities are recommended in future studies.

Background: Few studies assessed the association of weight of premature infant and aromatherapy as a secondary outcome. Aim of study was to evaluate all clinical trials on the association of weight of premature infant and aromatherapy. Materials and Methods: All clinical trials evaluating the association of weight of premature infant and aromatherapy with the alleviation of pain were searched on the electronic databases of Scopus, EMBASE, Cochrane, Web of Science and Medline (via PubMed) with no language or time restrictions till December 26, 2019. Jadad scale as a valid and reliable tool was applied to assess the quality of included studies. Results: Finally, five studies with a total of 367 participants were enrolled in this systematic review. In the first study over that time interval, the mean daily weight gains did not differ significantly between the infants in the milk versus water-exposure conditions. In the second study the evaluation of the mean weight of subjects at discharge and the mean weight gained between hospitalization and discharge showed that there were no significant differences between the study and control groups. In third study, the infants' weight did not differ significantly among three groups: vanilla, placebo and rose. In the fourth study, the mean weight of preterm infants at discharge and between hospitalization and discharge showed no significant difference between two groups' impregnated pad with breast milk and control. In the fifth study, combining milk odor and nonnutritive sucking (NNS) than single NNS were effect in achieving oral feeding and earlier discharge from the hospital. Conclusion: Aromatherapy with a single oil or a combination of two or more aroma oils, were not effective on weight among high-risk and vulnerable infant, such as preterm infant and very low birth weight, there is a need for more accurate and robust future studies.

Background: Internet has played an increasingly important role in people's lives; however, there is a global concern that it may cause negative effects on health. The purpose of this study was to assess the prevalence of Internet addiction (IA), and its relationship with general health status among high school students. Materials and Methods: A cross-sectional study using a multistage proportionate sampling technique conducted among 10-15 year-old students in Isfahan, Iran. Data were collected from 721 students in 5 educational areas of Isfahan. A total of 721 students filled out a self-report questionnaire consisted of two parts; the first was Young Internet Addiction Test and the second was General Health Questionnaire (GHQ28). Data was analyzed using SPSS software version 16. 0. Results: Of the 721 students, 52% (375 students) were male. The average age of students was 15. 75± 1. 5 years old. The prevalence rate of Internet addiction among adolescents was 41. 2% nonaddicts, 53. 7% exposed to IA, and 5. 1% Internet addicts. Whereas there was a significant difference between boys and girls in IA (P=0. 004). In this study, Internet addiction was found to have an independent relationship with parent education and household income but it had a significant negative relationship with the general health aspect including physical health (r=0. 3, P<0. 001), depression (r=0. 4, P<0. 001), sleep (r=0. 4, P<0. 001), and social function (r=0. 25, P<0. 001). Conclusion: Based on the results, the prevalence of Internet addiction was high among high school students and overuse of the Internet by students may cause depression, decreased mental health and academic performance. Therefore, education about the proper use of the Internet is necessary for high school students.

Background: Complications caused by low birth weight (LBW) are among the most common causes of neonatal mortality and future problems during adulthood. This study aimed to identify the risk factors for LBW. Materials and Methods: This cross-sectional study was conducted in Mashhad University of Medical Sciences from 2017 to 2018 on 7, 382 LBW neonates and 36, 911 healthy neonates. Data were collected from the SINA electronic health record system. Data analysis was performed in STATA version 12. 0. Bivariate and multivariate logistic regression were applied to determine the association between independent variables and LBW. Results: The prevalence of low birth weight was 5. 88 infants per 100. In this study, the risk of LBW was increased in people living in rural areas, compared to urban areas, by 9% (95% CI: 1. 01-1. 18), in illiterate individuals by 4. 60% (95% CI: 4. 05-5. 23), in employed individuals by 2. 40% (95% CI: 2. 202. 62), in female newborns (95% CI: 1. 04-1. 16), in mothers with a history of miscarriage by 74% (95% CI: 1. 09-2. 75), in women with premature delivery by 34. 09% (95% CI: 29. 17-39. 84), in women with a history of multiple gestations by 22. 30% (95% CI: 18. 71-26. 59), in women with a history of drug consumption by 2. 01% (95% CI: 1. 83-2. 21), in mothers not consuming folic acid and iron by 24% (95% CI: 1. 10-1. 39) and 9% (95% CI: 1. 00-1. 19). On the other hand, it decreased by lack of consumption of multivitamins and vitamin D by 1% (95% CI: 0. 88-1. 11), and 29% (95% CI: 0. 610. 82), respectively. Conclusion: According to the results, educating mothers, increasing prenatal care, having an appropriate diet and taking supplements can play an important role in reducing the risk of LBW.