Journal of Pediatric Perspectives
Year:2018 | Volume:6 | Issue:9 (57)|Papers Count:15

Background: Birth weight is one of the decisive factors in infant vulnerability and mortality. The impact of a full-body massage on the weight gain of preterm infants has been taken into account. Nevertheless, very few studies have been conducted on effects of abdominal massage. Hence, the current study was carried out to explore effects of abdominal massage on the weight gain of preterm infants hospitalized in neonatal intensive care units. Materials and Methods: This study was a single-blind randomized controlled clinical trial, conducted on 64 preterm infants hospitalized in neonatal intensive care units in selected hospitals of Isfahan. They were randomly categorized into two groups, namely control and intervention. The pre-feeding weight of the infants in the groups was recorded daily. They were fed using an orogastric tube every two hours. One hour after the feeding, a researcher (with a master’ s degree in Neonatal Intensive Care Nursing) gave abdominal massage to the infants in the intervention group twice a day, at 2. 00 p. m. and 8. 00 a. m., for 15 minutes, during a five-day period. However, the control group received the routine care in the unit. Data were analyzed using the SPSS software version 23. 0, and analytical as well as descriptive statistical methods. Results: Regarding their gender, 38 infants (59. 3%) were male; the mean and standard deviation (SD) of weight gain during five days were more in the intervention group (1480. 76± 31. 29) than in the control group (1365. 83± 41. 93). This difference was statistically significant (p < 0. 05). Conclusion According to the results of the present study, abdominal massage seems to improve weight gain in preterm infants and could be substituted for a full-body massage.

Background The literature reviews show that taking care of dying newborns for a nurse is associated with stress and anxiety, and nurses will be faced with many challenges, the present study aimed to explain the spiritual challenges experienced by nurses in neonatal end of life in the NICU. Materials and Methods The present study was conducted with a qualitative method and "purposive" sampling. The study environment was NICU in the hospitals of Zahedan, Iran. Semi-structured interviews used for interview and data collection. A number of 24 participants with inclusion criteria were interviewed. Qualitative content analysis method was used with the conventional approach and inductive method with Graneheim and Lundman approach. Results Data analysis explored were categorized in three main themes: spiritual challenge of neonatal care with two-categories (palliative care, and care with love and affection); psychological / spiritual support challenges of family with two categories (spiritual support of family, psychological support of family), and nurses' spiritual distress with one category (nurse's trauma in neonatal care). Conclusion In this study three themes were obtained: 1-Spiritual challenge of neonatal care with two-categories (palliative care, and care with love and affection); 2-Psychological / spiritual support challenges of family with two categories (spiritual support of family, psychological support of family), and 3-The nurses' spiritual distress with one category (nurse's trauma in neonatal care).

Background Attention deficit hyperactivity disorder (ADHD) is a common behavioral disorder that affects 8-12% of school-age children. Several environmental and genetic factors play a role in the etiology of this disease. One of the genetic factors involved is dopamine beta-hydroxylase (DBH) gene, which plays an essential role in catecholamine synthesis by converting dopamine into norepinephrine. Here we investigated DBH polymorphisms associated with ADHD in North West of Iran. Materials and Methods: This descriptive comparative study was performed on 130 children aged 5-14 years who were diagnosed with ADHD by child and Adolescent psychiatrist following a detailed psychiatric assessment and 130 matching healthy children were also selected from local children’ s Hospital in Tabriz city, Iran. Also, 2ml Peripheral blood sample was obtained from all the participants and RFLP-PCR technique was then used to study the polymorphism position rs5320 and allele and genotype frequency of DBH gene. Results: The results showed that the frequency of allele A (as the allele causing the disorder) was 15% in ADHD subjects and 6% in healthy subjects (p <0. 05). The genotype frequency in ADHD subjects was 4%AA, 26%AG, and 70%GG, and 0%, 12% and 88% for healthy children, respectively (p=0. 017, do=2, χ 2=3. 14). Conclusion: The results suggest that DBH polymorphism, position rs5320, plays a role in the pathogenicity of ADHD in the studied population and therefore can be considered as a candidate gene for future diagnosis.

Background Advances in the perinatal and neonatal cares have brought about considerable reductions in the neonatal mortality. The present study aimedto determine the disease patterns, outcomes and factors influencing the neonatal mortality in single neonatal intensive care unit. Materials and Methods This descriptive research was retrospective and cross-sectional in type. The study population enrolled all neonates who had been hospitalized in the neonatal intensive care unit (NICU) of the Besat hospital, Hamadan city, Iran, for a period of one year from October 1, 2015 to September 31, 2016 and the mothers and infants information (such as maternal diseases, delivery mode, neonatal age, birth weight, the causes and duration of hospitalization) were extracted from the Medical records and analyzed using SPSS software version 16. 0 Results The study population included 600 infants and 13% (78) of whom were died. The results of the multivariate logistic regression analysis for the risk factors associated to the neonatal deaths indicated that there was a significant relationship between neonatal deaths and the use of mechanical ventilation, gastrointestinal bleeding, birth weight less than 2500 grams, positive urine cultures, need for surgery, administration of dopamine, anticonvulsant drugs, and surfactant (P<0. 05). Conclusion The present study indicated that sepsis, surfactant administration and ventilator use significantly influence neonatal death; additionally, to underlying diseases, the occurrence of complications and their number increase the probability of neonatal deaths.

Background Adolescence is the transient period from childhood to adulthood and the beginning of physical, mental and social changes. Understanding and meeting adolescents’ needs may have important effects on reducing theirs dangerous behaviors and therefore, will result in a more health society. This study aimed to assess the reproductive health needs of Iranian adolescent. Materials and Methods This qualitative design study explored the reproductive health needs among Iranian adolescent boys and girls. Purposeful sampling method was used until data saturation was reached. Data was gathered using focus group for girls and face to face interviews for boys. The interviews used semi-structured questions. Data analysis was carried out using the method proposed by Altschuld for need assessment. Trustworthiness of the data was assessed using Guba and Lincoln Indicators. Results Participants were 10 adolescent girls (age range from 13-15) and ten 14-17 year age male adolescences. The reproductive health needs of girls included 4 categories: Menarche and puberty health, Discrimination in family and society, Sexual orientation, education and Consultation demands. The needs extracted from interviews of adolescent boys included adaptation with changes in puberty, sexual orientation, educational and consultation demands. Conclusion Despite some differences between males and females needs, their reproductive health needs are greatly similar. Adolescents need more Education and consultation support about puberty which will be possible with education of families and teachers.

Background Bleeding is one of the most common complications of craniosynostosis surgery, which its appropriate management is associated with better post-operative outcomes. The aim of this retrospective study was to evaluate the visual estimated blood loss in intraoperative management of infants with craniosynostosis surgery. Materials and Methods This retrospective study was performed on 200 patients who underwent craniocinostosis surgery and hospitalized in intensive care unit (ICU) at Mofid Hospital, Tehran, Iran, from July 2015 to June 2017. Data collecting was done using a self-made checklist and from patients' medical record. Required data include age, gender, method of anesthesia, and arterial blood gas (ABG), hemoglobin (Hb), and platelet (Plt) changes during surgery, volume of administered blood and fluid were recorded and evaluated. Data analysis using SPSS software (version 22. 0). Results Among the patients, 59% (n=118) were boys, the mean age of patients was 13. 3 ± 13. 52 months. Anesthesia technics were total intravenous anesthesia (TIVA) (15. 5%, n= 31), and inhalation or mixed (84. 5%, n=169). Patients received 992. 02 ± 468 ml fluid and 205. 86± 100 ml blood, before surgery. There was no significant difference between preoperative Hb and first Hb in pediatric intensive care unit (PICU) (p=0. 12). However, preoperative and first Plt in PICU were different (p=0. 000). Also, last Hb in ABG (10. 5± 1. 90), and the first Hb in PICU showed no significant difference (r=0. 088, p=0. 219). Conclusion According the results, visual assessment and correction of blood loss with hemoglobin measurement and by experienced anesthesiologist was a reliable and safe method in patients with craniosynostosis surgery and feasible in every operating room.

Background The weaning process is complex and needs to be done carefully. The success of extubation in premature babies is associated with brain maturity and adequate function of the lungs. We aimed to identify the ventilator parameters and clinical conditions related to extubation success and failure in premature infants. Materials and Methods This is an observational study, analytical and non-comparative cohort. We selected all premature infants, into inclusion criterion, admitted to the Neonatal Intensive Care Unit (NICU) of Hospital de Clí nicas, Curitiba, Brazil in Invasive mechanical ventilation (IMV). The fifty-one premature infants were evaluated every day until tracheal extubation and the data of the day of extubation were used. Results Thirty-nine premature infants had extubation success and the majority of them 32(82. 05%) were appropriated for gestational age (AGA). The parameters that showed a statistical difference between success and failure group were Positive end-expiratory pressure (p = 0. 03), plate pressure (p = 0. 03), Partial pressure oxygen (p = 0. 04), pH (p = 0. 04), end-tidal CO2 (p = 0. 01) and heart rate (p = 0. 04). The use of caffeine periextubation and the permanence in Continuous positive airway pressure (CPAP) during the post-extubation period was higher in the success group (46. 15% and 87. 18%, respectively). The presence of piratory distress syndrome (RDS) was high in both groups, success group, 82. 05% and failure group 100%. Conclusion The pressure values, the arterial blood gas analyses, and capnometry are important parameters to evaluate in the weaning process, checking these values closer to reference values. Supports before and after endotracheal extubation, such as the use of caffeine and CPAP, are important to avoid the need for reintubation.

Background: Prediction of adverse perinatal and postnatal outcomes could be possible by using ultrasound Doppler evaluation, however there are some controversies regarding this issue in the literature. The goal of present study was to evaluate predictive value of Doppler indices in single and twin pregnancies during second trimester. Materials and Methods: This prospective study was conducted in Yas Hospital, Tehran, between February 2015 and January 2016. The number of 71 singleton pregnancies and 59 twin pregnancies enrolled in this study. A single expert perinatalogist / sonographer did all Doppler ultrasound exams and followed up cases until the end of pregnancy. To compare Doppler indices and pre-postnatal outcomes between singleton and twin groups, the Student’ s t-test, Pearson χ 2 test and Fisher’ s exact test were used for continue and categorical variables, respectively. Results: Rates of preterm delivery and SGA were significantly higher in twin pregnancies compared with singletons (P<0. 001). Mean PI in singleton pregnancies was significantly higher than in twin pregnancies (1. 4± 0. 8 vs. 0. 6± 0. 2; P<0. 001). On the other hand mean RI in twin pregnancies was significantly higher than the counterpart group (0. 8± 0. 4, 0. 6± 0. 2; p=0. 002). Doppler ultrasound indices were not significantly different in singleton and twin pregnancies with and without complications (P>0. 05). Conclusion According the results, the mean PI of uterine arteries in twin pregnancies in the second trimester was significantly lower than singleton pregnancies. On the other hand this value did not differ between perinatal complicated and uncomplicated pregnancies.

Background: Febrile seizures are the most common convulsive disorder in children. There is growing evidence that vitamin D can affect gene expression and modulate various cell metabolisms. Also vitamin D may have a role in the etiology of febrile seizures. We aimed to explore vitamin D status in children with febrile seizure. Materials and Methods: This cross-sectional study was conducted on 40 children with first episode of febrile seizure referring to Children's Medical Center in Tehran, Iran. A 5 ml blood sample was taken from the peripheral veins of each participant. Serum levels of vitamin D, calcium, phosphorus, parathyroid hormone (PTH), and alkaline phosphates (ALP) was recorded. Other variables that were recorded from each case were gender, age, parental consanguinity and family history of febrile seizure. Patients’ skin color was categorized based on Fitzpatrick’ s scale. We asked the parents to complete a validated food frequency questionnaire including vitamin D sources in children. Results: The mean plasma calcium, phosphorous, PTH and ALP were in normal ranges; the mean vitamin D level was 24. 41± 11. 21 ng/ml )in insufficient range). In 7. 5% of patients, vitamin D level was in the deficient, 72. 5% was in the insufficient and 20% was in sufficient levels. There was no significant difference in vitamin D level between two sexes (P=0. 85). There was no significant correlation between vitamin D level and age (P=0. 34). There was no significant correlation between vitamin D level and its metabolites (P>0. 05). Conclusion There was a high prevalence of vitamin D insufficiency among our patients with febrile seizure. Further analytical studies are recommended to prove the relation between vitamin D deficiency and febrile seizure.

Background Scorpion stings are the most important health problems in tropical and subtropical countries. The aim of this study was to assess spatial distribution of scorpions and scorpionism in Ardabil province, Iran. Materials and Methods This descriptive– analytic study was carried out in all 10 counties of Ardabil province, Northwestern Iran. The clinical and demographic data of scorpion sting cases were collected from questionnaires belonging to an 8 year-period of 2010 to 2017. In addition, scorpions were captured using Ultra-violet (UV) light, Pitfall traps and digging methods. After species identification, Arc GIS 9. 3 software was applied for mapping spatial distribution of them. Data were analyzed by SPSS software (version 21. 0). Results A total of 958 scorpion sting cases were documented. One hundred ninety cases (19. 83%) of them were occurred in age group <19 years. Stings were mostly recorded in rural areas after midnight and in the early morning hours from April to September. Also, nocturnal envenomation was observed with the highest frequency (52. 50%). A total of 142 scorpions were collected and identified. The collected scorpions belonged to Butidae and Scorpionidae families. They were classified into two genera (Mesobuthus, Scorpio), and two species: Mesobotus eupeus (99. 29%), and Scorpio maurus (0. 71%). Conclusion There was a high prevalence of scorpion stings in rural areas in Ardabil province among age group less than 19 years old. This finding suggests the necessity of preventive programs for decreasing this higher incidence.

Background Allergic rhinitis (AR) is a common form of nose inflammatory disease that occurs when the mucosal immune system overreacts to environmental allergens especially in the air. It’ s absolutely clear that the prevalence of AR varies between different countries, and even between the various areas of a country. The purpose of present investigation is to determine the prevalence of AR, as most common allergic disorders, in the children of middle schools in Isfahan, Iran. Materials and Methods This investigation performed from February 2016 to July 2016, thoroughly, 1191 Junior high school children aged 13-14 years old were screened in our study. Authenticated ISAAC questionnaire was interviewer-administered to gather data on parentally informed symptoms, clinician diagnoses and environmental exposures. Results: The students were averagely 13. 57+ 0. 5 years old; 779 (65. 4%) of them had been suffering from AR and 696 (58. 4%) of them had the symptoms of rhinitis over the preceding year. Symptoms of conjunctivitis such as Itch and watery eyes have been reported in 35. 1% of cases. Among examined students, 644/1191 (54. 1%) were females (P= 0. 000). The relationship of allergic rhinitis and exposure to parental smoking, domestic and type of feeding in infancy were not significant (P= 0. 655, 0. 459, 0. 946, respectively), but exposure to house planting was statistically significant (P=0. 000). Daily activity was affected in 43(3. 6%). Conclusion Prevalence of allergic rhinitis was considerably high in Junior high school students of Isfahan and frequently is undiagnosed. In addition the association of allergic with gender and keeping house plants was significant.

Background Emotional bonding between mother and neonate is an extremely sensitive process in postpartum. Therefore, one of the important processes in the postpartum period is the development of maternal and neonatal bonding. This study was aimed to investigate the effect of family-based counseling on mother-child bonding at 4-6 weeks of postpartum in women referred to selected health centers of Urmia in 2017. Materials and Methods This clinical trial study was conducted on 330 women and their families who were selected in health care centers of Urmia in 2017. Data collection tools were personal information form, General Health Questionnaire (GHQ), Multidimensional Scale of Perceived Social Support (MSPSS), and Postpartum Bonding Questionnaire. The women were randomly divided into two groups: intervention (n = 165) and control (n =165). The intervention group received 4-6 counseling sessions based on family support and the control group received routine care. Data analysis was performed using SPSS software (version 20), non-parametric Mann-Whitney test, Wilcoxon and parametric t tests. P value less than 0. 05 was considered significant. Results Findings revealed a significant reduction in mean ± SD of total mother-child bonding (41. 17± 33. 37), general bonding difficulties (19. 17± 18. 04), threatened rejection (11. 95± 9. 86), infant-focused anxiety (6. 77± 5. 70) and incipient abuse (3. 27± 2. 90). Conclusion According to the obtained results, family-based counseling has deeply positive effect on mother-child bonding that can arise physical and mental health benefits originated from this bonding in childhood period and in all stage of puberty.

Background Combined Methylmalonic Aciduria (MMA), and homocystinuria CblC type is the most common inborn error of cobalamin metabolism with 77 mutations identified till date in the MMACHC gene. The disease has early and late presentations with varied clinical features. Case report A pair of preterm monochorionic twins was born to non-consanguineous parents with history of 2 previous infant deaths with suspected MMA. The twins became symptomatic in second week with severe neutropenia, thrombocytopenia, progressive encephalopathy and eczema without anemia, metabolic acidosis or hyperammonemia. Investigation revealed elevated plasma Complement 3 (C3) acyl carnitine and very high MMA levels in urine. Genetic testing revealed a novel large deletion mutation in chromosome 1 which comprised of the whole MMACHC gene confirming the diagnosis of CblC type of MMA. The mutation was homozygous despite parents being unrelated and was identified in both parents later. Both twins responded transiently to treatment with hydroxycobalamin. Conclusion Large deletion in the MMACHC gene which was identified in a homozygous state in our twins is previously unreported. The phenotypic features are described.

Background Intussusception is the main cause of bowel obstruction and one of the most common surgical emergencies that can occur during childhood. That is why this study investigates the effective factors for non-surgical reduction in patients who have experienced successful reduction in intussusception to determine the effective factors. Materials and Methods This retrospective study was performed between 2011 and 2017. The following subjects, including age, gender, degree of reduction, leukocyte level, symptom onset interval, Appearance of Signs and the Visit of Children, presence of blood in stool, free abdominal fluid in ultrasound, and length of the intestinal tract involved in ultrasonography, were extracted. Results A total of 217 patients with intussusception had visited the emergency department. The average of the leukocyte level of children with successful intussusception non-surgical reduction was lesser the children with unsuccessful intussusception non-surgical reduction and there was a significant difference (P<0. 0001). The average distance between the appearance of signs and the visit of children was 1. 66± 0. 4 days for successful intussusception non-surgical reduction and 4. 31± 0. 6 days for unsuccessful intussusception non-surgical reduction. There were 30 instances (21. 6%) of blood in stool positive and 109 (78. 4%) instances of blood in stool negative. Conclusion The success rate of non-surgical reduction is relatively high and has a significant relationship with age, leukocyte level, and the distance between the beginning of signs and visit, the existence of blood in stool, and the length of the involved intestine.

Background: Transient tachypnea of the newborn (TTN) is one of the most common neonatal respiratory disease and its symptoms usually begins in the first few hours after birth. The volume of fluid intake according to the neonate's conditions varies. We aimed to compare the restricted fluids volume with standard fluids volume in treatment of neonates with TTN. Materials and Methods: This clinical trial was performed on 80 neonates with a diagnosis of TTN admitted in the Neonatal intensive care unit (NICU) of Fatemiyeh Hospital and Beasat Hospital of Hamadan Medical University in Iran. Patients were randomly divided to standard fluids volume (control = 40), and restricted fluids volume treatment groups (case = 40). The hospitalization duration, oxygen therapy duration as well as the number of days need for oxygen with hood; Nasal continuous positive airway pressure (NCPAP), and mechanical ventilation therapy was recorded. After data collection, the data were statistically analyzed via SPSS software (version 21. 0). Results: The subjects were 30 (37. 5%) females and 50 (62. 5%) males (62. 5%) with an average gestational age of 38. 12 (± 1. 07) weeks. The main aim from this interventional study was effect of restricted fluid therapy on management of TTN in NICU section. The hospitalization duration, oxygen therapy duration and need for oxygen therapy with hood in the intervention group were significantly lower than the control group (P<0. 05), but need for mechanical ventilation and need for NCPAP were not significantly different between the two groups (P>0. 05). Conclusion TTN treatment with restricted fluids volume, compared with standard volume of fluids, significantly reduces the need for respiratory supports as well as the duration of hospitalization in the NICU section.