فهرست مطالب

Comprehensive Pediatrics - Volume:9 Issue: 1, Feb 2018

Journal of Comprehensive Pediatrics
Volume:9 Issue: 1, Feb 2018

  • تاریخ انتشار: 1397/01/20
  • تعداد عناوین: 11
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  • Nakysa Hooman *, Mahnaz Sadeghian, Fariba Jahangiri, Soudabeh Hosseini Page 1
    Context: Hemolytic uremic syndrome (HUS), being more prevalent in infants and children, is recognized by a triad of acute kidney injury, microangiopathic hemolytic anemia, and thrombocytopenia. It is classified according to the underlying disorders, such as infection, systemic, metabolic disorder, or complement dysregulation. It has a high rate of morbidity and mortality. Many types of treatment, such as conservative management, plasma exchange, regular plasma infusion, and even a new expensive medication, “Ecluzimab”, have been suggested. The aim of this systematic review is to estimate the incidence and prevalence of HUS (according to diarrhea positive or negative samples). In addition, the study will investigate the clinical presentation and the outcome of Iranian patients.
    Evidence Acquisition: The following data bases will be explored for articles published between years 1985 and 2016, PubMed, EMBASE, OVID, SCOPUS, Web of Sciences, Google Scholar, Google, barakatkns.com, MagIran, SID, dociran, PDFiran, and ganj.irandoc. Besides, all online university databases will be searched for theses and abstracts of local or international congresses; a manual search will be performed to identify pertinent cross references. Systematic review or meta-analysis, longitudinal and cohort studies, cross-sectional, case-control, and epidemiological studies will be included in this review. Relevant conference proceedings, theses or unpublished data will also be considered. The retrieved data should comprise of proportions, incidence, prevalence, geographical distribution, mortality and morbidity rates (i.e. dialysis and central nervous system involvement). A meta-analysis will be performed if 3 similar studies are found. If sufficient data is extracted, subgroup analysis will be performed for age, gender, acute kidney injury, dialysis, and death.
    Results
    The results of the current study could have implications for health policies, practice, research, and medical education: The data could improve clinical and health care decisions, allow estimation of the number of patients that require new medication, and could direct future research design in this field.
    Keywords: Hemolytic, Uremic Syndrome, Atypical Hemolytic Uremic Syndrome, Diarrhea Prodrom Positive HUS
  • Leili Koochakzadeh, Kiavoosh Fekri, Reza Pakzad, Mehdi Khabazkhoob * Page 2
    Background
    This study aimed at comparing the therapeutic effect of anti-D immunoglobulin (anti-D IG) and Intravenous Immunoglobulin (IVIG) in children with acute immune thrombocytopenic purpura (ITP).
    Methods
    This Randomized double-blind, controlled clinical trial was conducted on 98 children attending a Children’s medical center during year 2008. The selected participants were allocated to IVIG and anti-D IG groups using the balanced-block randomization method. The platelet count, hemoglobin level, and side effects of the medications were evaluated on days 1, 3, 7, 14, and 21 after drug injection.
    Results
    After drug injection, the platelet count increased in both groups (P 0.05). The hemoglobin level also decreased after injection in both groups (P 0.05). Regarding the ability of the drugs to increase the platelet count, 56% of the patients in the anti-D IG group and 52% of the children in the IVIG groups had platelet counts of more than 20 000 during the 24 hours after drug administration with no difference between the 2 groups (P = 0.836). The incidence of drug adverse effects, including fever and chills (4.1% in the anti-D group versus 10.4% in the IVIG group), severe hemolysis (4.5% in the anti D group versus 0% in the IVIG group) and headache (6.25% in the anti-D group versus 4.1% in the IVIG group), had no significant difference between the two groups (P > 0.05).
    Conclusions
    Intravenous Immunoglobulin and anti-D have similar effectiveness in the treatment of children with acute ITP. Considering the fewer side effects of anti-D, it may be a suitable replacement for IVIG in ITP patients.
    Keywords: Anti, D IG, IVIG, Immune Thrombocytopenic Purpura, Platelet, Hemoglobin
  • Farid Imanzadeh_Naghi Dara_Pejman Rohani_Batool Emadi_Sara Sanii_Mohadeseh Mousavi - Khorshidi_Amir Hossein Hosseini * Page 3
    Objectives
    We aimed to evaluate the role of aspartate aminotransferase to platelet ratio in the diagnosis of liver fibrosis and its prognosis after surgery in infants with biliary atresia.
    Methods
    This retrospective study was conducted using the medical records of patients diagnosed with biliary atresia who underwent surgery and liver biopsy in Mofid Children’s Hospital from 2008 to 2016. The sampling method was complete enumeration and all patients admitted to the hospital in these 8 years were selected as the sample. In this study, an author - made checklist was used. According to data available in the archives of Mofid Children’s Hospital, a total of 100 patients with preoperative diagnosis of biliary atresia entered the study. The obtained data were analyzed using descriptive statistics and inferential statistics. The significance level in this study was considered to be 0.05.
    Results
    A total of 100 patients were enrolled in this study, with 64 male patients and 36 female. The patients gave birth at a minimum of 29 weeks and a maximum of 40 weeks. The gestational age was significantly related to the final diagnosis of the disease among children (p = 0.011). With a cut off value of aspartate aminotransferase to platelet ratio of 0.95, 25 patients (50%) with biliary atresia were in the group of significant fibrosis (F4, cirrhosis) and the others were in the non - significant fibrosis group (p value = 0.021).
    Conclusions
    In our study, aspartate aminotransferase to platelet ratio was calculated and showed significant relationship to the final diagnosis based on liver biopsy categorizations among infants with Biliary Atresia after Portoenterostomy.
    Keywords: Biliary Atresia, Prognosis, Liver Fibrosis, Aspartate Aminotransferase, Platelet Ratio Index
  • Milad Borji, Fatemeh Shahbazi, Shahin Nariman, Masoume Otaghi, Saeid Safari * Page 4
    Background
    Mother-child bonding is rooted in the affective relationship between mother and child that is shaped during pregnancy and leads to the mental growth of infants.
    Objectives
    This study was conducted to determine the relationship between mother-child bonding and maternal mental health in Ilam.
    Methods
    In this descriptive-analytical study, 300 mothers in Ilam were selected using a two-stage cluster sampling method. The demographic characteristics questionnaire, the mother-infant bonding scale, Spielberger anxiety inventory, and edinburgh postnatal depression scale constituted the data collection instruments in this study, which were completed in the eighth to tenth postnatal week. Data were analyzed in SPSS via descriptive statistics (means and standard deviations) and inferential tests (t tests and ANOVA).
    Results
    The results of this study revealed that the mean and standard deviation of the obtained mother-child bonding scores were 38.48 ± 12.86. Weakened mother-child bonding and risk of child abuse comprised the highest and lowest frequencies, respectively. Mother-child bonding had a statistically significant association with mothers’ state anxiety, trait anxiety, and depression, and these variables affected mother-child bonding (P
    Conclusions
    Considering the relationship between mother-child bonding and maternal mental health, proper screening is required to pursue secondary prevention in pregnant mothers. In addition, it is essential to perform necessary interventions to improve maternal mental health to facilitate better mother-child bonding.
    Keywords: Mother, Child Bonding, Stress, Anxiety, Depression, Postpartum
  • Touran Shahraki, Mansour Shahraki, Ghasem Miri-Aliabad * Page 5
    Background
    Upper gastrointestinal bleeding (UGIB) is recognized as a life-threatening emergency condition among children and parents, which requires prompt assessment. The purpose of this study was to determine the role of upper endoscopy in determining the cause of UGIB in a pediatric population.
    Methods
    In this retrospective study performed at Ali-Ibn-Abi-Taleb hospital, records of all children with UGIB (below 14 years) were evaluated. Subjects with incomplete information were excluded from the study.
    Results
    A total of 101 patients with the mean ± SD age of 6.8 ± 3.99 years were included in this study (45 females, 56 males). The clinical presentations included hematemesis in 77 (76%) cases, melena in 6 (5.9%) cases, and both in 18 (17.8) cases. The upper endoscopy showed a high diagnostic yield (90%) in determining the cause of UGIB. The most common source of bleeding was esophageal varices in 32 (31.7%) children, followed by peptic ulcer disease (n, 17; 16.8%), gastritis (n, 11; 10.9%), and hiatal hernia. No cause of UGIB was found in 10 (9.9%) cases.
    Conclusions
    Esophageal varices and peptic ulcer disease were the most common causes of UGIB in our center. Considering the valuable role of endoscopy in the diagnosis and treatment of UGIB, early referral to a hospital with pediatric endoscopy is recommended.
    Keywords: Gastrointestinal Bleeding, Children, Endoscopy
  • Zohreh Torabi, Mohammad Halvachi, Mehran Mohseni, Hamid Khederlou * Page 6
    Background
    Lead is an element, which can cross the placenta and enter the fetus during pregnancy if present in the blood of the expectant mother. Therefore, in this study, the level of lead in maternal and umbilical cord blood of neonates was determined, and its relationship with weight at birth, gestational age, height, and head circumference was investigated.
    Methods
    In this cross sectional study, a total of 70 pregnant women and their newborns were selected at Mousavi Hospital of Zanjan, Iran, based on the inclusion criteria. The level of lead in the umbilical cord blood of newborns and mothers was evaluated, and its correlation with birth weight, gestational age, height, and head circumference was assessed.
    Results
    The average level of lead in the maternal and cord blood was 11.01 μg/dL and 9.54 μg/dL, respectively, which indicates a significant difference (P
    Conclusions
    In this study, the average lead level of pregnant women was 11.01 μg/dL in Zanjan, which is higher than the global standard (10 μg/dL). The birth weight of newborns, whose mothers had higher blood lead levels, was lower than that of other neonates. Therefore, more attention should be paid to the level of lead by the healthcare system in order to take effective measures and reduce lead pollution.
    Keywords: Umbilical Cord, Neonates, Lead, Birth Weight, Maternal
  • Fariba Noori, Shahin Nariman, Hanieh Rahmiaan, Akram Sadat Sadat-Hoseini *, Aida Ravarian Page 7
    Objectives
    Effective interventions such as non-nutritive sucking (NNS) improve neonatal development. The current study aimed at assessing the effect of NNS intervention by mothers on physiological factors, duration of full oral feeding attainment, and the length of hospital stay.
    Methods
    The current clinical trial was conducted in the neonatal care unit (NICU) of Arash hospital affiliated to Tehran University of Medical Sciences, Tehran, Iran. The study was conducted on 2 groups of 38 preterm neonates. Neonates had gestational age of 26 - 34 weeks and received gavage feeding. They did not have assisted ventilation. Control neonates received routine care, whereas the intervention neonates received 3 NNS sessions done by mothers during the first 10 minutes of tube feeding per day. Data collection instrument included a mother-infant demographic form and an observation checklist of infant’s physiological features. The date of full feeding and length of hospitalization were recorded.
    Results
    Findings did not show any statistically significant correlation between groups in physiological features. Duration of full oral feeding attainment in the intervention and control groups were 22 ± 14.51 and 30.05 ± 18.58 days, respectively. The length of hospital stay in the intervention and control groups were 31.26 ± 16.89 and 41.82 ± 23.07 days, respectively. Then, non-nutritive sucking by mother’s finger sped up the duration of full oral feeding attainment and reduced the hospitalization.
    Conclusions
    Since NNS does not require skill and expertise, participation of mother is recommended. Then, infants benefit from not only the positive effects of NNS, but also mother-infant interaction.
    Keywords: Preterm Infant, Non, Nutritive Sucking, Full Oral Feeding, Mothers, Stay in Hospital, Oral Feeding
  • Shiva Shayestefar, Marjan Mardani- Hamooleh, Marjan Kouhnavard, Maliheh Kadivar * Page 8
    Background
    Some ethical challenges have emerged along with advances within the field of pediatrics. Meanwhile, the residents of pediatrics face particular ethical challenges, since they have different roles in their professional career as educators, students, advocators, and clinicians.
    Objectives
    The aim of the present study was to identify ethical challenges in the field of pediatrics from the viewpoints of Iranian pediatric residents
    Methods
    This cross-sectional study was conducted during 9 months. The studied population consisted of 90 residents of pediatrics studying at Tehran University of Medical Sciences in Tehran, capital of Iran. Sampling was conducted in the form of census counts of a 32-item instrument that evaluated ethical challenges in the field of pediatrics. Validity and reliability of this questionnaire were evaluated by experts in the field of medical ethics and pediatrics. Data were analyzed using the SPSS software using descriptive-analytic statistic methods.
    Results
    The most serious ethical challenges in the field of pediatrics were providing enough information to obtain informed consent (4.74 ± 0.22), dealing effectively with the conflicts of decision-making by the sick children and their families (4.68 ± 0.14), giving bad news to the sick children or their parents as appropriately as possible (4.64 ± 0.18), and taking necessary actions in dealing with cases of child maltreatment (4.62 ± 0.16), respectively. In addition, based on linear regression analysis, there was a significant correlation (P = 0.03, r = 0.059) between the residents’ gender and their views towards ethical conflicts; female residents paid more attention to these challenges than male residents.
    Conclusions
    Paying attention to ethical challenges in the field of pediatrics helps the authorities provide favorable conditions in clinical settings. Therefore, resulting in less ethical challenges in similar situations.
    Keywords: Ethical Challenges, Iran, Medical Ethics, Pediatrics, Resident
  • Milad Borji, Asma Tarjoman, Hamid Taghi Nejad, Mehdi Meymizade, Shahin Nariman, Saeid Safari * Page 9
    Background
    A careful, timely, and accurate examination of patients by nurses provides grounds for maintaining and improving patients’ safety in hospitals. Proper examination of the health status of children and, consequently, an accurate nursing diagnosis can accelerate their recovery and can have positive effects on the family.
    Objectives
    This study aimed to determine the relationship between knowledge-skill and the importance of physical examination of children admitted to infectious wards from the perspective of nurses working in Ilam hospitals in 2017.
    Methods
    In this descriptive cross-sectional study, 150 nurses were selected using purposive sampling. To collect data, the demographic information questionnaire, physical examination knowledge-skill scale, and physical examination importance questionnaire were employed. Data were analyzed using the SPSS version 18. In addition, descriptive statistics (mean, standard deviation, frequency, and percentage) and inferential tests (independent and paired sample t-tests) were used.
    Results
    The findings revealed that the acquired knowledge-skill mean score was 100.86 out of 200. The nurses exhibited higher levels of knowledge-skill with regard to controlling vital signs, assessment of respiratory effort, observation of skin color, and touching the extremities to check the body temperature. In contrast, they exhibited lower levels of knowledge-skill in terms of examination of the breast to assess lumps, examination of the spine, assessing how the patient is talking, and listening to lung sounds. Additionally, there was a significant positive correlation between knowledge-skill and the importance of pediatric physical examinations (P
    Conclusions
    Considering that the mean score of nurses in terms of the knowledge-skill required for conducting pediatric physical examination was low, appropriate interventions should be planned by nursing managers to improve the status of nurses’ knowledge-skill in this field, in order to ensure the use of the necessary procedures for effective nursing practice.
    Keywords: Physical Examination, Nurses, Children, Pediatric Ward, Knowledge, Skill
  • Elie Aramouny, Robert Sacy *, Imad Chokr, Bassam Joudy Page 10
    Background
    Globally, there is a trend towards consumption of energy-dense, nutrient-poor foods leading to dietary imbalances in toddlers. Nutrient deficiencies are associated with the risk of obesity and other health risks. NutricheQ is an 18-item questionnaire that can quickly identify these risks based on dietary patterns in healthy toddlers.
    Objectives
    This study aimed to validate the NutricheQ tool, describe the dietary intake of toddlers and classify them into risk groups.
    Methods
    This was a national, multi-center, observational, validation study conducted at 21 medical centers in Lebanon. Data was collected from NutricheQ administered to the parents of toddlers during a single outpatient visit, and food diary filled by parents during a 4-day follow-up. The validation process of NutricheQ was done using Pearson’s and Spearman’s correlation, ANOVA and ANCOVA. The accuracy of NutricheQ in the Identifying categories of nutritional risk was evaluated using the receiver operating characteristic (ROC) curves. All analyses were performed using IBM-SPSS version 24 and P value of ≤ 0.05 was considered to be statistically significant.
    Results
    Of the 487 toddlers enrolled, 467 had full data on NutricheQ and food diary data was available for 247 only. Majority of toddlers in Lebanon (80% - 88%) were categorized in the moderate or low-risk groups of dietary intake indicating good eating habits. There was a significant positive association between the total NutricheQ score and both, age (r = 0.11, P = 0.021) and BMI Z-score (r = 0.11, P = 0.021). ROC fitting showed a very low discriminatory ability of the scores to correctly classify toddlers into the high-risk group based on their BMI Z-score. Significant positive correlation was obtained between the NutricheQ total score and exchangeable fat and meat with high fat, in the food diaries (R = 0.170, P = 0.045), indicating risk. Also, there was a negative association between the total NutricheQ score and soluble and insoluble fiber (Rs = 0.181, P = 0.004).
    Conclusions
    Results from this study showed that NutricheQ has reasonable validity in the Lebanese context to assess the dietary quality of toddlers in Lebanon and in identifying those at increased nutritional risk.
    Keywords: NutricheQ, Toddlers, BMI, Food Intake, Pre, Schoolers, Dietary Quality, Nutritional Risk
  • Ehsan Aghaei Moghadam, Azin Ghamari *, Maryam Nikoufar Page 11
    The prevalence of fetal arrhythmia is about 1% to 3% of all pregnancies and they are mostly benign. This report describes fetal ectopic atrial tachycardia (EAT) diagnosed in 31 weeks of gestation. The arrhythmia did not respond to transplacental therapy; therefore, cesarean section was done and arrhythmia was controlled by propranolol. This case showed effectiveness of rate control strategy by administration of propranolol.
    Keywords: Ectopic Atrial Tachycardia, Propranolol, Sotalol, Amiodarone, Fetal Therapy