Journal of Pediatric Perspectives
Year:2017 | Volume:5 | Issue:3 (39)|Papers Count:17

The ingestion of foreign bodies is a comprehensive problem affecting the pediatric population, especially under 5 years of age. The ingestion of 2 or more magnets may lead to their attraction over planes of intervening soft tissue with enough force to cause significant complications including obstruction, fistula formation or even perforation. This case series report have documented the cases of 4 children age 2-9 years, who have experienced a variety of complications from magnet ingestion. Included are the cases of a 2 years old boy and 9 years old girl with bowel perforation, a 7 years old boy with mucosal erosion, and a 4 years old boy who underwent magnet retrieval before complications arose.

Background Although exclusive breastfeeding (EBF) is highly emphasized by the experts, nulliparous women do not adhere to this behavior at a desirable level. Since it seems that mothers’ beliefs and values play an important role in their adherence to these behaviors, the present study, aimed to perform a careful analysis of the behavior and evaluation of factors associated with the EBF in nulliparous women referring to healthcare centers in Bushehr using theory of planned behavior. Materials and Methods This is a cross-sectional study, which was conducted on 400 nulliparous mothers with children less than six-months who referred to healthcare centers in Bushehr, Iran. Stratified random-sample was used and data were collected using a researcher-made questionnaire and were later analyzed using statistical tests, including Pearson, Spearman, linear regression and logistic regression in SPSS version 22. 0 Software. Results The results showed that 62. 5% of infants were exclusively breast-fed. Variables such as infant' gender, father's occupation and type of pregnancy were significantly related with EBF behavior. Constructs, including attitude (P< 0. 001, r=0. 295), subjective norms (P< 0. 001, r=0. 376) and perceived behavioral control (P< 0. 001, r=514) were significantly correlated with the EBF intention. Subjective norms, perceived behavioral control and behavioral intention predicted 13. 8% changes in mothers' breastfeeding behavior. Conclusion The theory of planned behavior is an appropriate framework to identify factors associated with the EBF behavior among nulliparous Iranian mothers. Therefore, designing interventions based on this theory seems to have the potential to improve the EBF practice.

Background Congenital heart diseases (CHD) are the most common congenital anomaly in children and also the leading cause of mortality from congenital anomalies. Various factors including smoking, drinking alcohol and addiction play role in development of congenital heart diseases. This study was conducted with the aim of investigation of the prevalence of addiction in parents of children with congenital heart disease compared with healthy children. Materials and Methods This was a case-control study conducted on 320 children with congenital heart disease aged 6 months to 16 years and 320 healthy children as control group. Children referring to Ali Asghar hospital or who were hospitalized in Imam Ali Hospital were included in the study and their demographic characteristics and their parents were collected. Data were analyzed using SPSS 20. Results Average age of diseased and healthy children was 4. 08 ± 4. 11 and 3. 59 ± 2. 36, respectively. The rate of addiction of father, mother and parents of children with congenital heart disease was higher than those of children in control group. The most common congenital heart disease was ventricular septal defect (VSD). Conclusion In overall, this study showed addiction rate of parents in children with congenital heart disease was higher.

Background: Although the efficacy of Bacillus Calmette-Guerin (BCG) vaccine in the prevention of tuberculosis has been noted consistently, the use of BCG vaccine is not without risk. In this study we aimed to evaluate immunologically, children with complication of BCG vaccination in North of Iran. Materials and Methods: This case-control study began in 30 Jan 2013 and was completed in 2 Jul 2015. In case group 35 patients with moderate to severe complications of BCG vaccination for Tuberculosis (TB), have been enrolled. The control group included 35 patients with mild complication and patients had no complications due to BCG vaccine. Routine and specific tests for evaluation of immunological function were performed. Results: Out of total number of 35 patients in case group, 3(8. 6%) patients had severe complication, also they diagnosed as BCG-osis; 32(91. 42%) cases had moderate symptoms. In the control group 25 (71. 4%) patients had mild complications and 10(28. 57%) patients had no complications. The mean of IL-23 level in the two groups had significant difference (P= 0. 027). There was a significant relationship about interleukin and interferon deficiency among patients with severe complications. Patients with mild to moderate complications of BCG vaccine were not associated with immunodeficiency. Patients with severe complications of BCG vaccine, were associated with Mendelian susceptibility to mycobacterial disease (MSMD) primary immunodeficiency (PID). Conclusion: Severe complications of BCG vaccine could be due to MSMD and it may be associated with immune deficiency in IL 12/23. BCG vaccination must be deferring in newborns in families with a history of death following presumed BCG or early death or recurrent infection, until suitable screening immunological tests exclude the PID.

Background: Maternal nutrition during pregnancy affects the birth weight of neonates. Some of the undesirable pregnancy outcomes are linked to lower birth weights. This study aimed to assess the relationship between maternal dietary patterns, weight gain during pregnancy and nitric oxide (NO), as an endothelial relaxing factor, and the possible effects on birth weight. Materials and Methods: At first, a pilot study was done, and finally a number of 233 mothers who referred to 4 public and private hospitals in Isfahan, the Central of Iran, during March 2014 to March 2015 via a convenience sampling method, were elected and participant in this study. Dietary patterns were assessed using a Persian version of Food Frequency Questionnaire (FFQ). Gestational weight gain was measured, too. Cord blood nitric oxide (NO) level, and neonate’ s anthropometric characteristics were measured after delivery. Results: The study participants consisted of 233 mother-neonate pairs. Overall, 4. 3% of boys and 11. 8% of girls, had low birth weight (< 2. 500 gr). Mean gestational weight gain was 12. 85 ± 4. 37 kg, and there was a statistically significant between three birth-weight categories (Low birth weight, normal birth weight and high birth weight) (P<0. 05). Gestational weight gain during pregnancy was associated with consumption of chicken, cereals, sugar, and birth weight of neonates, too (P<0. 05). Nitric oxide had an inverse correlation with birth weight; however, this association was not statistically significant (r =-0. 10, P >0. 05). Conclusion: Dietary patterns during pregnancy play as a main role in being low birth-weight neonates, in part by having impacts on gestational weight gain. In our samples among some Iranian mother-neonate pairs, endothelial function does not show a direct association with birth weight through releasing NO.

Background Feeding intolerance is one of the leading causes of weight loss in preterm infants. The present study aimed to evaluate the effects of abdominal massage on feeding tolerance in preterm infants hospitalized in neonatal intensive care units in Isfahan, Iran. Materials and Methods: In this randomized controlled clinical trial, 64 infants who had the inclusion criteria, were selected and randomly assigned to control and intervention groups. They were fed every two hours. The gastric residual volume, the abdominal circumference, the frequency of defecation, and the frequency of vomiting episodes, were measured before the feeding. One hour after the feeding, abdominal massage in the intervention group (massage), was given by a researcher twice a day for 15 minutes in a 5-day period. The control group received typical unit care. In order to analyze the data, the SPSS version 23. 0 software and analytical as well as descriptive statistical methods were used. Results: The abdominal massage affected the preterm infants’ feeding-tolerance criteria and significantly reduced the gastric residual volume, the abdominal circumference, and the frequency of vomiting episodes and significantly increased the frequency of defecation in the intervention group, as compared with the control group (P < 0. 05). Conclusion Abdominal massage could impact preterm infants’ feeding-tolerance criteria. Based on the above results, it is apparently essential to carry out more in-depth studies in this field.

Background Several beneficial effects of non-nutritive sucking in infants, including the physiological stability, relaxation, better transition from tube feeding to oral feeding have been reported. But its effect on oxygen saturation in neonates under the Nasal Continuous Positive Airway Pressure (NCPAP( وis not so clear. This study aimed to investigate the effects of non-nutritive sucking on transcutaneous oxygen saturation levels of neonates treated with NCPAP. Materials and Methods This quasi-experimental study was done on 25 preterm neonates, hospitalized with a diagnosis of respiratory distress, required NCPAP, in the neonatal intensive care unit (NICU) at the Ayatollah Rouhani Hospital and Babol Clinic, North of Iran. Non-nutritive sucking was elicited by a standard pacifier appropriate to their age one hour a day, and the mean oxygen saturation was measured before and after intervention by cardiopulmonary monitoring (Saadat Co., Iran). Data analyzed using SPSS-18. 0 software. Results In the 25 cases studied, the mean oxygen saturation values before performing non-nutritive sucking was 96. 31± 2. 88%, which was changed to 98. 35± 1. 6% after intervention, and this increase was statistically significant (P = 0. 004). Results showed that the gender, birth weight and gestational age of neonates had no effect on mean Blood oxygen saturation (SpO2) level. Conclusion According to the results, using the non-nutritive sucking in premature neonates under the NCPAP, can improve oxygenation.

Background The present review study provides specific evidence to assess the impact of distraction techniques and hypnosis on the pain of bone marrow aspiration in children. Materials and Methods This review study aimed to determine the effects of distraction techniques and hypnosis on the controlling pain of bone marrow aspiration in children. Internal databases (SID, Magiran, IranMedex and Irandoc), and international databases (Google-Scholar, Medline, PubMed, Elsevier, ProQuest, Springer and Web of Science), were searched by using the Mesh key words including "cancer", "bone marrow", "aspiration", "distraction", "hypnosis", "pain", "children" and "pediatric", with no time limit since the foundation of these databases until December 2016. Results In overall review of the articles, based on the issues expressed, the effect of most of various distraction interventions and hypnosis on the pain severity of children under the bone marrow aspiration procedure was significant and positive (P<0. 05). Of course, pain severity variations in all studies, were different. Conclusion According to the results of the mentioned studies, we find that in order to reduce the pain of venipuncture in children most effectively, it is better that these techniques be done according to age and the children's mental and physical conditions.

Background Vitamin D deficiency is known as a one of the underlying causes of Idiopathic musculoskeletal pain (IMSP). This study aimed to evaluate the correlation between serum vitamin D (Cholecalciferol) status in patient with Non-specific Musculoskeletal Pain and healthy children. Materials and Methods Seventy-seven children (aged 3– 14 years), with IMSP were included as cases and 90 healthy subjects were selected for control group. Demographic characteristics and biochemical levels of vitamin D and Parathyroid hormone (PTH), were obtained. Data were analysis using SPSS version 17. 0 software. Results Results showed that vitamin D means levels of patients and healthy children were significantly different (19. 5 + 8. 84 ng/mL versus 12. 7 + 11. 89 ng/mL), respectively (P<0. 05). Also, there was a significant difference between PTH level in both healthy and patient subjects (P<0. 001). Mean levels of vitamin D in both groups were below the normal range, but lower in control group (P<0. 001). Conclusion Deficiency of vitamin D was suggested as the probable identified risk factors for IMSP in children. The results of our study did not reveal clear correlation between vitamin D deficiencies in children which suffer IMSP compared the healthy children.

Background: Although sleep disorders are common problems among families and they affect the learning, memory processes and academic performance of children, there is no evaluation of these disorders in Iran. The aim of this study was to assess the prevalence of sleep disorders and its association with academic performance of school age children. Materials and Methods: A cross-sectional study was conducted on 1, 100 middle school students of Isfahan city of Iran during 2012-2013. Multi-stage random cluster sampling method was performed and five girl’ s schools and five boy’ s schools were selected. The data gathered with a validated questionnaire to evaluate the academic performance and sleep disorders. Results: The mean duration of nocturnal sleep was 8. 38± 1. 17 which was significantly higher in the group with excellent academic performance (8. 86± 1. 18 hours), than the other two groups (8. 14± 1. 17 hours for average academic performance and 7. 90± 1. 15 hours for poor academic performance). Academic performance was significantly associated with age, gender, parental occupation, nocturnal sleep time, sleep latency and sleep disorders (P<0. 05). Conclusion: This study revealed that sleep disorders negatively affect the academic performance and highlighted the importance of proper sleep among children and students.

Background Complementary feeding practices play an important role in growth and development of the children. This study aimed to determine the complementary feeding practices status among children aged 6-23 months and its association with various socio-demographic factors. Materials and Methods This community based cross-sectional study was conducted at field practice area of Urban Health Centers in Khalkhal city, North West of Iran. In the preset study 576 mothers of children aged 6-23 months were selected with multistage random sampling method and interviewed using structured questionnaire for Infant and Young Child Feeding (IYCF) indicators (minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD). Data were analyzed with using SPSS-20. 0, Chi-square, bivariate and multivariate logistic regression tests. Results Findings showed that MDD, MMF and MAD were adequate in 42. 3%, 42. 7% and 30. 9%, respectively. MDD and MAD was significantly associated with gender of child, type of delivery, birth order of child, mothers literacy and health literacy (P<0. 001); MMF was significantly associated with health literacy and literacy status of mother, birth order of child (P<0. 001). Conclusion The study revealed that majority of mothers practiced inadequate complementary feeding. The feeding practices were found to be significantly associated with various socio-demographic factors which highlighted the importance of addressing these factors for improvement of feeding practices and prevention of various health related problems among children.

Background Access to appropriate images of fetal brain can greatly assist to diagnose of probable abnormalities. The aim of this study was to compare the suitability of T2-True Fast Imaging with Steady State Free Precession (T2-TRUFI), and T2-Half-Fourier Acquisition Single-Shot Turbo Spin-Echo (T2-HASTE( magnetic resonance imaging (MRI) to extract the fetal brain using the level set algorithm. Materials and Method: T2-TRUFI and T2-HASTE MRI of the uterus were performed. The fetal brain was cropped from the image manually, with an adequate margin of maternal tissues; and then the fetal brain was extracted using level set. The outcome was statistically analyzed to compare its success, error (Sensitivity and Specificity), and similarities (Dice and Jaccard), with those of images obtained by radiologist. Results: The mean values of statistical tests to evaluate the similarity (Dice and Jaccard) and the success and error (Sensitivity and specificity) between two T2-TRUFI and T2-HASTE were calculated as 97. 35%, 94. 98%, 95. 88%, 95. 88%, 99. 45%, 91. 10%, 83. 82%, 86. 44% and 99. 11%, respectively. However, the results from two images showed high scores to extract the fetal brain, but images from the T2-HASTE technique resulted in better visually output. Conclusion Based on our results, the T2-HASTE MR images are preferred to fetal brain extraction by level set algorithm compared to the T2-TRUFI MR images.

Background Attention deficit hyperactivity disorder (ADHD), is a multifactorial disorder and converging evidence has implicated abnormalities of dopamine neurotransmission. The aim of this study was to examine the association of-141 polymorphisms in DRD2 gene with ADHA among Iranian-Azeri population. Materials and Methods A case– control association study included 153 patients with attention deficit hyper activity disorder (case group), and 133 healthy subjects (control group). Genomic DNA was extracted peripheral blood samples by salting-out method. Single nucleotide polymorphism (SNP) genotyping was performed by Polymerase chain reaction-restriction fragment length polymorphism (PCR-RFLP) technique. The data analysis was performed through Chi-square, with a significance level of 0. 05. Results: There was not significant difference in the allele and genotype frequencies between ADHD and-141C Ins/Del polymorphism in cases and controls (P>0. 05). Ins/Ins homozygous dominants were more frequent in control group than the case group, but there was not significant difference observed (P>0. 05). Del/Del homozygous dominants were not observed. No significant difference was detected in the allele and genotype frequencies between ADHD and-141 Insertion/Deletion polymorphism in cases and control groups (P>0. 05). Conclusion Our results do not detected association between the-141C Ins/Del, rs1799732, polymorphism and ADHD disorder in population of Children in Iranian-Azeri.

Gentamicin is a bactericidal aminoglycoside antibiotic, it inhibits the protein synthesis. Gentamicin is active against the majority of aerobic gram-negative bacilli such as Pseudomonas, Klebsiella and Escherichia coli. The gentamicin doses are 3 mg/kg once-daily for preterm newborns < 35 weeks of gestation and 4 mg/kg once-daily for newborns > 35 weeks of gestation. The monitoring of gentamicin serum concentration is recommended when infants are treated for 48 hours or more. The gentamicin peak concentration must be at least 8 times the minimum inhibitory concentration (MIC) to be bactericidal and the gentamicin trough concentration must be < 2 μ g/ml to avoid ototoxicity and nephrotoxicity. Once-daily dosing of gentamicin (4 mg/kg), is preferred than twice-daily dose of 2. 5 mg/kg gentamicin. A gentamicin loading dose (4 mg/kg), followed by once-daily dosing of 2. 5 mg/kg yields safe and target range in neonates. An extended dosing interval of 48-hour (5 mg/kg gentamicin), was compared with twice-daily dose of 2. 5 mg/kg gentamicin. Infants in the 48-hour interval and in the twice-daily achieved peak gentamicin concentrations of 9. 43 μ g/ml and 6. 0 μ g/ml, respectively, (p<0. 001), and trough gentamicin concentrations were 1. 08 μ g/ml and 1. 54 μ g/ml, respectively, (p<0. 001). The infants born small for gestational age have a reduced gentamicin clearance, and a more prolonged gentamicin half-life than infants born appropriate for gestational age. Patent ductus arteriosus, extracorporeal membrane oxygenation, therapeutic hypothermia, and asphyxia reduce the gentamicin clearance.

Background Each year about 32. 4 million of children are born with low birth weight, which is below the 10th percentile for their gestational ages; moreover, about fifteen million of them are premature. Actually, about 60% of neonatal deaths occur in low birth weight neonates related to their prematurity. This study aimed to determine the neonatal death rate and the most common causes of the hospital inborn admissions to the Neonatal Intensive Care Unit (NICU). Materials and Methods A descriptive cross sectional study was conducted in NICU, during two separated periods one in 2007 and the other during 2015. All consecutive live born babies from 1st of January to 31st of December of 2007 were included as 1st period studied and the second period from 1st of January to 31st of December 2015. The neonatal mortality rate (NMR), and causes of deaths in two years, were studied and compared. Results In 1st period, the neonatal death rate in NICU was 27. 2 %, while in 2nd period; it was 33. 9%, which was higher. The commonest causes of neonatal death were the same but, the percentages were different and the leading causes of death from the higher frequencies down were hyaline membrane syndrome, birth asphyxia, congenital anomalies, meconium aspiration and others. Conclusion The neonatal death rate in the NICU was higher in 2015, compared to 2007. This needs special efforts for strengthen the strategies of neonatal care and management at the time of delivery and even before and during intrauterine life through good antenatal care to improve the NICU outcome.

Background Body image is a determinant of individual attractiveness and physical activity among the young people. This study was aimed to assess the association of Trans-theoretical model based exercise behavior change with body image evaluation among the female Iranian students. Materials and Methods This cross-sectional study was conducted in Sanandaj city, Iran in 2016. Using multistage sampling method, a total of 816 high school female students were included in the study. They completed a three-section questionnaire, including demographic information, Trans-theoretical model constructs and body image evaluation. The obtained data were fed into SPSS version 21. 0. Results The results showed more than 60% of participants were in the pre-contemplation and contemplation stages of exercise behavior. The means of perceived self-efficacy, barriers and benefits were found to have a statistically significant difference during the stages of exercise behavior change (P<0. 05). Moreover, there was a significant correlation between the stages of exercise behavior change and fitness evaluation, fitness orientation, subjective weight and body areas satisfaction subscales (P<0. 05). The interaction effect of self-efficacy and body image on exercise behavior were reported to be statistically significant (P<0. 05). Conclusion The findings of this study indicated poor physical activity and effect of body image on doing exercise. Body image and designing interventions to promote exercise behavior are suggested to be taken into account.

As host to some of the world’ s biggest emergencies and protracted crises, the Eastern Mediterranean Region carries the largest burden of displaced populations globally. Out of 58 million displaced persons worldwide, almost 30 million (52%) come from the Region. Syria is currently the world’ s biggest producer of refugees and internally displaced persons, with more than 40% of the population now displaced. Afghanistan and Somalia face two of the longest-spanning refugee situations, with Afghanis constituting the second-largest refugee group in the world after Syrians, and Somalia facing one of the world’ s most complex refugee situations. The Region is also witness to massive internal displacement. More than 4 million people in Iraq are now displaced inside the country. In Yemen, one of the world humanitarian crises in the world, more than 2. 4 million people have relocated to safer areas to escape the violence. Countries in the Eastern Mediterranean Region have shown generous hospitality towards displaced populations. Lebanon, a country of four million people, is now the highest per capita host of refugees in the world, with refugees comprising almost a third of the total population. In Jordan, Syrians make up 10% of the population. Iran is host to 3 million Afghan refugees, during the last thirty years. Pakistan, a country with more than 1. 5 million internally displaced persons, is also host to more than 1. 5 million refugees from Afghanistan. With the majority of refugees and internally displaced persons across the region living outside camp settings, both displaced populations and host communities, are exposed to increased public health risks. These include infectious diseases due to overcrowded living conditions, limited access to safe water and sanitation, and varying degrees of access to primary health care services.