فهرست مطالب mahbod kaveh

COVID-19 caused chaos in healthcare globally, particularly among children. While they make up a smaller percentage of patients, it is essential to identify potential prognostic factors for disease severity considering their clinical status, age, and comorbidities. This study aims to investigate the clinical, laboratory, imaging, and prognosis of COVID-19 in children.

In this descriptive-analytical study, the clinical records of the patients were used to complete the information from the inpatient and outpatient records. Finally, the course of the disease was done by following up the patients on an outpatient basis, and the patients who suffered from the complications of COVID-19 or died were investigated. Finally, laboratory/radiology symptoms of patients were compared between three groups (definite, suspected, and probable).

A total of 65 patients were girls (38%) and 106 patients (62%) were boys. And no statistically significant difference was found between the age and sex of the patients (P=0.42). No statistical significance difference was found between lung involvement, respiratory distress, patients’ fever, gastrointestinal symptoms, leukopenia and lymphopenia, high C-reactive protein (CRP) and lactate dehydrogenase (LDH), skin involvement, underlying disease, elevated liver enzymes in three groups of probable, suspected, and definite patients (positive test result) (P>0.05).

The result showed that the symptoms of COVID-19 in the first stage are uncommon in children and these symptoms are non-specific, also a lower percentage of tests are reported positive in children and as a result, no significant statistical difference was observed between clinical and paraclinical findings with polymerase chain reaction (PCR) test results of patients in our study.

The neonate's Cardiopulmonary resuscitation (CPR) is the most important and common emergency condition in the delivery room. Approximately 10% of newborns are unable to initiate effective breathing and require assistance. The aim of this study was to evaluate the frequency of CPR levels of the neonates delivered during a year in Moheb Yas Hospital who were resuscitated.

This was a retrospective cross-sectional descriptive study. The sampling method in this study was census. In this study, all the live neonates born during the year (April, 2010 to April, 2011) in Moheb Yas Hospital who were resuscitated, were enrolled in the study. The information of these infants was recorded in separate checklists. This checklist included the following information: mother's age, gestational age, gender of the baby, method of the delivery, multiple births, complications of the placenta and umbilical cord, amount of amniotic fluid, fetal presentation, meconium excretion, fetal heart rate pattern, Apgar of the baby, resuscitation levels, underlying diseases of the mother, maternal diseases during pregnancy, drug use by the mother and premature rupture of the amniotic sac. Finally, the data were analyzed by SPSS software. P-values less than 0.05 were considered statistically significant.

There were 2,176 live births during the study. Of these infants , a total of 322 neonates (15.27%) underwent CPR. 51.8% were male. The mean gestational age was 36.08 weeks. The first minute Apgar was less than 5, between 5-7, and above 8 respectively in 10.5%, 33.4%, and 56% of neonates. About 42% of neonates needed initial resuscitation (warming, drying, and respiratory stimulation). 48% required respiratory ventilation with bag and mask, 5% endotracheal tube, 2.7% cardiac massage, and 1.3% needed medication. In 96.7% of cases, the CPR team was ready for resuscitation before delivery.

If resuscitation is performed in a timely and appropriate manner, very few of these infants will need advanced resuscitation. On the other hand, the high need for resuscitation by bags and masks can be secondary to the educational nature of this hospital.

Persistent pulmonary hypertension of the newborn (PPHN) is caused by the inability of the pulmonary arteries to dilate at birth, which leads to severe hypoxemia. Several risk factors have been identified in association with its occurrence and prognosis. The present study aimed to determine the incidence of PPHN, describe neonates’ characteristics, and evaluate the etiology, as well as mortality risk factors in newborns hospitalized due to PPHN at Bahrami Children’s Hospital, Tehran, Iran, from 2017 to 2020.

A total of 49 neonates were included in the present study. The PPHN diagnosis was based on clinical criteria and echocardiography provided by neonatologists. Therefore, a complete history, physical examination, and laboratory data were gathered. Afterward, PPHN etiology was determined, and the patients were followed up for six months. Finally, PPHN prevalence was calculated and probable risk factors for its complications were investigated by using logistic regression analysis.

The findings revealed that the prevalence of PPHN was 3.5% in the center under study, and the mortality rate, as well as complete recovery, were 24.5% and 63%, respectively. It was also found that factors, such as male gender, abnormal Apgar score at birth, and cesarean delivery, were high in a percentage of PPHN patients; however, they were not associated with PPHN mortality and morbidity. The only variable that had a significant association with mortality and morbidity was an abnormal white blood cell count.

The need for inotropic support was associated with poor outcomes. From the aspect of etiology, there exists higher mortality rates, complications, and poor prognosis among PPHN patients with underdevelopment, compared to the ones with maldevelopment.

The recent surge in coronavirus disease 2019 (COVID-19) cases has exposed health care workers (HCWs) to a wide range of psychological stressors and predisposed them to anxiety-related disorders. In this study, we observed the anxiety level in this population.

This multicenter, cross-sectional study was performed on 1,038 HCWs in 14 hospitals of Tehran during the COVID-19 pandemic. In May 2020, Beck Anxiety Inventory (BAI) was used to measure the level of anxiety in this population.

The mean±SD age of participants was 36.30±8.23 years old. Most participants were 31 to 40 years old (43.2), female (87.6%), and nurses (49.5%). The BAI scores of the participants were in a positive skew distribution, with a score range of 0-63, a median of 12, and a mean value of 15.30±11.43. Out of 1,038 hospital staff, 411 (39.6%) had moderate to severe anxiety. The anxiety level was significantly higher in HCWs ≤40 years old, women, and nurses. However, there was no significant relationship between stress levels among frontline workers compared to second-line workers (P=0.82).

It seems that HCWs experienced a high level of anxiety in the COVID-19 outbreak. One of the critical measures in every epidemic is to provide supportive care to maintain the mental well-being of HCWs, especially in high-risk groups, including younger HCWs, women, and nurses.

Intraventricular hemorrhage (IVH) is a major cause of brain injury in preterm infants. Considering the high prevalence of IVH in preterm infants and the importance of determining the risk factors, this study was done to evaluate the prevalence of various grades of IVH and identify the different associated factors and short-term complications.

In this retrospective study, the medical records of 54 preterm infants (26-37 weeks gestational age) admitted to the neonatal intensive care unit (NICU) of Bahrami Hospital, Tehran, Iran (2015-2018) were examined. Cranial ultrasonography was performed in all patients, and IVH was classified into 4 grades. A checklist was prepared and filled them out, and then the data were analyzed using SPSS-21.

Out of all subjects, IVH was found in 11 infants (20.4%). The most frequent IVH grades were 1 and 2. The most common Apgar scores in the fifth minute was 6. The mean weight of infants and Apgar score in patients with IVH was significantly lower than that of those without IVH. In multivariate logistic regression analysis of factors affecting IVH, Apgar score was the only significant independent predictor of IVH, such that with each number increase in Apgar score, the risk of IVH decreased (up to 100%).

Based on the results of this study, birth weight, gestational age and fifth-minute Apgar score were associated with IVH. Prevention of preterm birth and other preventive measures can reduce the complications of this disease.

 Nosocomial Infection (NI) is one of the leading causes of short- and long-term morbidity and mortality among neonates, especially in Neonatal Intensive Care Units (NICUs).

 We aimed to evaluate the epidemiology of NIs and associated factors.

 From March 2017 to September 2018, all the neonates who were admitted to the NICUs of Bahrami Children’s Hospital were enrolled. Nosocomial infections were identified based on the definition of CDC-NNIS. Demographic, clinical, and laboratory data of the patients were extracted from the medical records.

 A total of 979 neonates were admitted to the NICU, of whom 60 were diagnosed with NI. The incidence of NI was 6.1 per 100 hospitalized patients. The most prevalent NI was bloodstream infection (30%), followed by pneumonia (21.7%). The most frequent presentations were respiratory distress (31.7%) and poor feeding (26.7%). Major pathogens were Gram-positive bacteria such as Staphylococcus aureus (25.7%) and Coagulase-negative staphylococci (25.7%). The mean hospital stay was 25.2 ± 20.89 days. The mortality rate of patients with NI was 16.7%. The factors associated with an increased risk of mortality among patients with NI were a lack of ventilation support, low birth weight, and WBCs with an abnormal range.

 The results of the present study showed that the incidence of NI was high, and the cultures collected from body fluids had a particular role in the diagnosis and treatment of NI. Standard infection control practices should be applied to reduce the incidence of NI and subsequent morbidity and mortality.

Bilious vomiting is highly suggestive of an acute and emergent condition among neonates. The aim of this study was to investigate the non-surgical causes of bilious vomiting in neonates admitted to a tertiary center and to compare them with the surgical causes.

This cross-sectional study was performed on 80 infants with bilious vomiting who were admitted at the neonatal intensive care unit of a pediatric tertiary center over 2 years. The demographic characteristics, clinical symptoms and signs, diagnostic assessments and therapeutic approaches were recorded.

The mean age of neonates was 9.07 ± 8.84 days and 55% of them were males. The most common final diagnosis was: Necrotizing Enterocolitis (NEC), duodenal atresia, Hirschsprung’s disease, gastroesophageal reflux disease (GERD), volvulus, sepsis, meconium plug, isolated mal-rotation, metabolic abnormalities, imperforate anus, and Ladd’s bands, respectively. Abnormal findings in ultrasound and X-rays were detected in 35% and 46.3%, respectively. About half of the affected neonates were treated non-surgically. Overall, 17.5% of the patients died.  Most deaths were seen in infants with NEC. Using multivariable logistic regression analysis, the presence of NEC as an underlying etiology was the only predictor of neonatal death in neonates with bilious vomiting (OR = 12.455, 95%CI: 1.365 – 113.618, P = 0.025).

The most common cause of bilious vomiting was NEC followed by duodenal atresia. Half of the neonates with bilious vomiting were treated medically without operation

Neonatal jaundice is a common condition among neonates in the first few days of life and is a leading cause of admission among neonates. The aim of this study was to investigate the most common risk factors associated with severe neonatal hyperbilirubinemia (NNH) and short-term complications of the exchange transfusion (ET).

In this retrospective study, the medical records of newborns <28 days with severe hyperbilirubinemia who underwent ET during 2015-2018 were analyzed. Medical records and files were searched using the keyword “exchange transfusion”. The clinical and demographic characteristics of the study population as well as the short-term complications of ET were descriptively analyzed.

Totally, 74 newborns with the mean age of 5.6 ± 3.4 days were included in the current study. The baseline mean peak total serum bilirubin (TSB) was 25.8 ± 5.7 mg/dl.  In neonates, the ABO incompatibility was the most frequent cause of severe hyperbilirubinemia requiring ET (54.1%), followed by sepsis (39.2%). Moreover, 57.7% of neonates developed complications secondary to ET. The most common complication was hyperglycemia (71.6%), followed by thrombocytopenia (48.6%).

Hemolysis and sepsis are common causes of NNH; therefore, the extensive screening and identification of the at-risk population can help decrease the incidence of severe NNH. Frequent monitoring of blood sugar and screening of thrombocytopenia before and after ET procedures are necessary to reduce adverse events.

Background The esophageal atresia (EA) is the most common esophageal congenital anomaly. The aim of this study was to evaluate the predictive factors in the survival of newborns with esophageal atresia. Materials and Methods This was a descriptive-analytic cross-sectional study performed on newborns with esophageal atresia who were admitted at Bahrami children’s hospital, Tehran-Iran, during 7 years (2009-2015). The patient’s information was collected from their medical records and recorded in a checklist. The variables of the checklist included: age, sex, gestational age, birth weight, congenital anomalies, duration of mechanical ventilation, duration of hospitalization, respiratory distress syndrome (RDS), and age at surgery, complications, and cause of death. Then, the relationship between different variables was evaluated with mortality and morbidity and the factors that had the greatest impact on patients' prognosis were identified. The study included 95 neonates with EA. Fifty-three (55.8%) were male. The most common anomalies were cardiac (38.9%), renal (15.8%), and skeletal (9.5%). The most common postoperative complication was pneumothorax (31.6%), pneumonia (25%), and stenosis at the site of anastomosis (21.1%). In this study, 15 children died (mortality rate 15.7%), and the most common cause was sepsis. There was a significant relationship between birth weight and death, pneumothorax (P=0.008, and P=0.037, respectively). There was no significant relationship between gestational age and mortality (P>0.05). There was a significant relationship between major cardiac anomalies and duration of mechanical ventilation and mortality (P= 0.043, and P<0.001, respectively). Conclusion This study showed that neonates with esophageal atresia, low birth weight, major cardiac anomalies and the need for prolonged mechanical ventilation are poor prognosis predictor factors.

To evaluate association between polymorphism rs1670533 in RNF212 gene with the risk of Down syndrome in young women. In a case control study, one hundred pregnant women were evaluated in both group. The case group consisted pregnancy with diagnosis of Down syndrome in women younger than 35 years old. The control group consisted pregnancy with normal neonate. Fifty pregnant women in each group were allocated.one hundred blood samples were collected. Genomic DNA was extracted by salting – out method and polymorphism of rs1670533 were detected by PCR.PCR products were detected on 2% agarose gel electrophoresis. The TTrs1670533 haplotype was present in 36% of pregnant women with Down syndrome versus 14% of normal pregnant women, (p = 0.003 e-12; CI 95%1.665-5.305, OR = 3.107); TC haplotype was present in 56% of normal pregnancy regarding of16% of pregnancy with Down syndrome (p = 4.288 e = 12; CI 95%: 0.145-0.25; OR = 0.126). It seems that TTrs1670533 haplotype is a risk factor for pregnancy with Down syndrome in young women and TC haplotype has protective effect.

To assess the association between intrapartum intrathecal opioid use and breastfeeding and weight gain following cesarean section.
The prospective double-blinded study was conducted on term pregnant women, undergoing elective cesarean section under spinal anesthesia. They divided into two groups. In the first group, intrathecal Morphine was used to achieve analgesia during or after the operation. The remainder divided into two subgroups, those who did not receive any opioid or those received systemic opioids. Following labor breastfeeding accessed in a follow-up, two month latter.
There was no difference between the demographic variables of the mothers and newborns APGAR score and weight at the time of birth. Breastfeeding rate was similar in intrathecal group in compare with other patents (P value = 0.518). While, the infants’ weight at the end of second month was lower in spinal opioid group (P value = 0.036).
The present study was the first to suggest that spinal (intrathecal) opioids do not have any impact on breastfeeding. However the relationship between spinal anesthesia on weight gaining needs more investigation.

This study compared neonatal outcome and maternal complications in multiple pregnancies after assisted reproductive technologies (ART) to spontaneous pregnancies. In this cross-sectional study, we reviewed medical records of 190 multiple pregnancies and births conceived by ART or spontaneous conceptions between 2004 and 2009 in Women Hospital. Obstetric history and outcomes were recorded and compared between these two groups. SPSS version 13 was used for data analysis. The results were analyzed using student’s t test, chi square and logistic regression (p<0.05). There were 106 deliveries from spontaneous conceptions and 84 that resulted from ART. Parity history and mode of delivery significantly differed between the two groups (p<0.001). The ART group had significantly higher preterm labor and premature rupture of membranes (PROM) whereas pregnanc-induced hypertension (PIH) was higher in the spontaneous group (p=0.01). Newborn intensive care unit (NICU) admission, duration of hospitalization, still birth and low gestational age were significantly higher in the ART group while neonatal jaundice was higher in the spontaneous group. Logistic regression analysis by considering neonatal complications as the dependent variable showed that respiratory distress syndrome (RDS), NICU admission and Apgar score were independent predictors for neonatal complications. Obstetric and neonatal outcomes must be considered in multiple pregnancies conceived by ART.

Elevated nucleated red blood cell (NRBC) count is introduced as a potential marker of intra-uterine growth restriction (IUGR). To investigate the probable association regardless of any known underlying disease, we aimed to study disturbances in NRBC count in infants experiencing idiopathic IUGR. Twenty three infants regarded IUGR without any known cause were chosen to be compared to 48 normal neonates. Blood samples were collected instantly after birth and the same measurements were done in both groups. NRBC count/100 white blood cells was significantly higher in the IUGR group (P value<0.001). pH measurements did not reveal any significant difference. Increased NRBC count in cases of idiopathic IUGR in absence of chronic hypoxia could strengthen its predictive value suggested in previous studies. It could help early IUGR detection and beneficial intervention.

Dicephalic parapagus tribrachius conjoined twin is a very rare condition.We present a case of 5-days-old male dicephalic parapagus conjoined twins. The conjoined twins were diagnosed in 4th month of pregnancy by ultrasonography. The pregnancy terminates at 36 weeks by cesarean section and triplets were born. The babies were male conjoined twins and another healthy male baby. Many congenital defects of interest can now be detected before birth. Sever form of this malformation precludes postpartum life. It is supposed that with advances in screening methods for prenatal diagnosis these cases are terminated in first or second trimester of pregnancy.

To determine the association between polymorphism of UGT1A1 gene and idiopathic hyperbilirubinemia in Iranian neonates. Fifty neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) more that 15mg/dl and 50 neonates with idiopathic hyperbilirubinemia and Serum total bilirubin (STB) less than 15mg/dl enrolled in this study. Thymine-adenine (TA) repeats in the promoter region of UGT1A1 gene investigated by means of polymerase- chain reaction (PCR) DNA sequencing. Demographic characteristics did not differ significantly between groups while STB was higher in case group (17.5±1.9 vs. 10.4±1.8, p value <0.001). Among one hundred neonates evaluated in this study, TA6/6, TA6/7 and TA7/7 genotypes found in 52%, 42% and 6%, totally. TA6/7 and TA7/7 genotypes observed in case group more than the control group (P<0.001). STB levels were significantly higher in cases with TA6/7 and TA7/7 genotype pattern (P<0.001). Heterozygous and variant homozygous genotypes of the promoter region of UGT1A1 gene in healthy Iranian neonates with idiopathic hyperbilirubinemia should be considered.

To determine the effect of paternal age on preterm births in Iranian neonates. From January 2005 to January 2006, two hundred eighty one preterm neonates born in Mirza Kuchakkhan Hospital enrolled in this cross-sectional study. A structured questionnaire was applied for recording following data: birth weight, sex, gestational age, maternal age and paternal age. The study was limited to neonates whose maternal age was between 20 and 30 years to eliminate its confounding effect. Near 50% of fathers were between 30-39 years old and more than half of neonates had gestational age between 35-37 weeks. There were no relation between either paternal age (p= 0.1) or birth weight (p=0.5) and neonatal gestational age. In women with parity one, there was not significant difference between gestational age among different paternal age levels (p= 0.6) as well as women with parity two and three (p=0.2, p=0.3). Paternal age has no effect on gestational age and birth.

Considering the 50% mortality rate of neonatal septicemia associated with neutropenia and increasing resistance to antibiotics, simultaneous antibiotic therapy strategies are becoming more important. However, few studies have been performed to evaluate effectiveness of RhG-CSF in the treatment of neutropenia in neonates. This randomized clinical trial was performed on 40 neutropenic neonates with septicemia who were hospitalized in Vali-e-Asr and Mirza Koochak Khan Hospitals (Tehran, Iran). The neonates were randomly divided into two equal groups RhG-CSF was administered as a subcutaneous single dose of 10μg/kg/s.c. to neonates in group A and as 10μg/kg/s.c./day once daily for 3 days to neonates in group B. CBC and differential count was checked 6, 24 and 48 hours after the last dose. There was no significant difference in mean birth weight, gender, age, and risk factors between two groups. Neutropenia was improved 48 hours after the last dose, whilst there was no significant statistical difference between two groups (P>0.05). The final outcome including death, duration of hospitalization and duration of antibiotics therapy after RhG-CSF administration did not differ between two groups (P>0.05). The results of this study showed that administration of a single dose of RhG-CSF (10μg/kg) was effective in treating neonatal septicemic neutropenia.

To compare maternal complications and labor outcome in obese and non-obese women. It is a retrospective comparative study conducted at the Department of obstetrics and gynecology, Unit 1, Civil Hospital, Karachi from December 2008 to December 2009. A sample size of 220 gravid women is selected by Non Probability Convenience sampling technique. In these 110 obese women as cases was compared with 110 non-obese women as controls, booked at <20 weeks of gestation. Data were collected regarding maternal complication, mode of delivery and neonatal outcome by trained medical officers. Data were entered and analyzed by SPSS version 11.0 through descriptive analysis, chi-square test and independent sample t test. The p-value of <0.05 was considered significant. Pregnancy induced hypertension was present in 9 (8.2%) women in control group and 21 (19.1%) in cases (p=0.01). Gestational diabetes was seen in one (0.9%) in control compared to 8 (7.3%) in obese women (p=0.01). Obese women were found to be at increased risk of caesarean section [17 (15.5%) Vs. 39 (35.4%), p=0.002]. Apgar score at 1 and 10 minute were lower in cases compared to controls (p=0.0001). Obese women are at increased risk of pregnancy induced obesity and associated with an increased risk of hypertension, gestational diabetes mellitus, thromboembolic disease and urinary tract infection.

The purpose of this study was to investigate the incidence, type, location, and risk factors of accidental fetal lacerations during caesarean delivery. Total deliveries, caesarean deliveries, and neonatal records for documented accidental fetal lacerations were reviewed retrospectively in four university hospital. The gestational age, the presenting part of the fetus, the type of incision, and maternal age and parity were recorded. Caesarean deliveries were divided into elective and emergency procedures. Fetal lacerations were grouped according to the location and the need for surgical intervention. Of 19217 deliveries, 8840 women were delivered by caesarean birth (46%). Neonatal records documented 87 accidental fetal lacerations. Of these accidental lacerations, 16 needed surgical repair and 62 recovered by dressing. Head and neck was the most common site of laceration (64.1%). The overall rate of accidental fetal laceration per caesarean delivery was 0.88%. The rate of emergency caesarean was 45 (56.69%) and for elective procedures was 33 (42.4%). The risk for fetal accidentallaceration was higher in foetuses who underwent emergency caesarean birth (P<0.001). Fetal accidental laceration may occur during caesarean delivery and its incidence is significantly higher during emergency caesarean delivery. The patient should be counselled about the occurrence of fetal laceration during caesarean delivery to avoid litigation.

Spinal muscular atropies are common (genetically determined) disorders. They are heterogeneous both in genetic and phenotypic characteristics. Prevalence of disease was reported between 1 in 6000 to 1 in 25000 in different populations. So, carrier frequency should be 1 in 40 to 1 in 80 in those people. Deletion of both copies of SMA, gene was detected in more than %90 of SMA patients. According to present data there were not any epidemiological study and data in Iran regarding SMAs. So, we do not have accurate information about prevalence, incidence of disease and its carrier frequency. Because of high rate of consanguinity it should be high. With this background, we decided to carry this pilot study out, to determine prevalence, incidence, carrier rate, along with consanguinity rate, clinical spectrum, and molecular abnormality in the affected cases. In a 2 years period, 30734 live-born babies followed, 4 patient affected to SMA type I were detected. Prevalence of SMA I in this population was 1 in 7683, and carrier frequency was 1 in 43. At least 2 third of the newborn babies were product of consanguineous marriages.

Preterm labor (delivery after 20 weeks and before 37 weeks of gestation) is the leading cause of prenatal mortality in developed countries. Many women who have pre term labor have abnom1ally high plasma levels of a-fetoprotein in early pregnancy. This study was designed to evaluate the ability of this biochemical test and a clinical risk factor scoring system to prospectively discriminate pregnancies at high risk for preterm delivery. In nested case control study six~hundred women were studied prospectively from the early second trimester until delivery. There were sixty women in the study group (those with preterm delivery) and sixty women in the control group (those with term delivery). A plasma level sample was collected during the second trimester, between 17 and 30 week''s gestation. Then a-fetoprotein was determined in both groups. The mean AFP level was 196.75± 151.48 IU/mL in the study group and 85.98±55.90 IU/mL in the control group, both of which were statistically significant (p 10 in 17% of women in the study group and in 8% of women in the control group. The sensitivity, specificity, PPV and NPV of this test was 78%, 65%,69.10 and 75% respectively. The accuracy of the test, LR+ and LR- were 71%,2.24 and 0.333 respectively. The combination of measurement ofmatemal serum AFP in the second trimester associated with a risk factor scoring system provides a more accurate indicator ofthe1iskofpretenndeliveryand therefore may be of use in targeting prevention strategies.