فهرست مطالب
International Journal of Pediatrics
Volume:7 Issue: 65, May 2019
- تاریخ انتشار: 1397/12/21
- تعداد عناوین: 16
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Pages 9349-9362
Background
Incidence of polyhydramnios in various studies has been reported from 0.2 to 3.9%. Approximately, 50-60% of cases are idiopathic with no known etiology. We aimed to investigate perinatal outcomes of idiopathic polyhydramnios with a normal ultrasound.
Materials and MethodsIn this study, Persian and English databases including Barakatkns, SID, Magiran, Medline, Science Direct, Scopus, Cochran, Embase, and ProQuest were searched for articles published from 1950 to August 2018. The search procedure was conducted with keywords related to "idiopathic polyhydramnios", "perinatal outcomes", "normal ultrasound", and their equivalents in "Mesh" and PICO. In meta-analysis, first we quantified heterogeneity by using I2 statistics and tested using the Cochran’s Q test. Even when a low heterogeneity was detected, a fixed-effects model was applied, and for more than 75% of heterogeneity, random-effects model was used. The Forest Plot chart was drawn up and the relative risk (RR) estimate for each study (ES), the pooled estimate of "RR" by combining all the studies and its 95% CI, and the P-value associated with it, were indicated.
ResultsIn this study, 13 articles involving 325,426 pregnant women were included for the Meta-analysis. The RR and 95% CI of Caesarian Section (C.S), 1.61(1.25-2.07), macrosomia, 1.84(1.40-2.42), preterm delivery, 2.45(1.29-4.64), NICU admission, 2.90(1.77-4.74), Apgar score min 5 <7, 2.79(1.18-6.57), fetal distress, 1.69(1.02-2.80), and large for gestational age (LGA), 2.27(1.38-3.72), were determined. We found a higher RR of perinatal outcomes including NICU admission, Apgar score min 5<7, preterm delivery, and LGA. RR other perinatal outcomes such as macrosomia, fetal distress, and C.S. were lower.
ConclusionIdiopathic Polyhydramnios was significantly associated with adverse perinatal outcomes. Intensive intrapartum monitoring and further attention in the postpartum are warranted.
Keywords: idiopathic-polyhydramnios, Meta-analysis, normal ultrasound, Perinatal outcome -
Pages 9363-9367
Foreign body aspiration is a potentially life-threatening event especially in those who are younger than 5 years old. Aspiration could be presented as a spectrum, ranging from absolutely asymptomatic event to more sever events including choking, respiratory distress and cyanosis or even death. Although foreign bodies in lung may not be visualized on X-ray, X-ray radiography is considered as a first step in localizing aspirated foreign bodies. Bronchoscope as rigid or flexible optic fiber is the main device used in removing aspirated foreign bodies.
However, in some cases, as the present case report, previous foreign bodies which were localized in lung could travel back to the mouth and be ingested. In this report, we discussed a case of foreign body aspiration in a 10 year-old girl referred to Dr. Sheikh Hospital, Mashhad, Iran, whose foreign body located in the lower lobe of the left lung returned and was ingested before bronchoscopy after some episodes of sever coughingKeywords: Bronchoscopy, Children, Cough, Foreign body aspiration -
Pages 9369-9377BackgroundMothers and infants are considered as two vulnerable groups. Most problems occur during and immediately after delivery, which, if not addressed promptly, lead to death of mother, baby, or both. Maternal emotional support and midwifery care is one of non-pharmacologic methods of pain management during labor and delivery. Since the quality of midwifery care has an effective role in mothers' satisfaction with midwife's performance, this study was conducted to assess the quality of mothers' satisfaction with midwifery care.Materials and MethodsIn this cross-sectional study, 400 mothers admitted to the postpartum ward of Shahid Mobini Brothers Hospital of Sabzevar, Iran, were evaluated by simple convenience sampling. The research instrument was a questionnaire entitled "Satisfaction with quality of midwifery care in labor and delivery room", and was confirmed by content validity method and reliability was calculated by Cronbach's alpha coefficient (α = 0.92). Data were analyzed using SPSS software version 16.0.ResultsThe average age of mothers was 25.88 ± 5.70 years old. The mean maternal satisfaction was 104.72 ± 0.76. In satisfaction category, 1% were dissatisfied, 17.3% had moderate satisfaction, and 81.7% had high level of satisfaction. There was a significant relationship between the variables affecting the level of satisfaction including education, age, and number of maternal deliveries with satisfaction (P<0.05).ConclusionThe results of this study indicate that mothers have high satisfaction with the quality of midwifery care in the maternity ward. This care is mainly performed by midwives, and midwifery tutors and students. Therefore, it is recommended to apply midwives in other areas requiring specialized midwifery performance.Keywords: Iran, Midwife, Midwifery care, mothers, Satisfaction
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Pages 9379-9390BackgroundAttention deficit and hyperactivity disorder (ADHD) is a disorder of the brain characterized by periods of inattention, hyperactivity and impulsive behavior. We aimed to evaluate the role of MRI of the brain in children with ADHD.Materials and MethodsThis prospective study included 100 children with clinical diagnosis of attention deficit and hyperactivity disorder according to the criteria of IDC-10. There were 79 males and 21females. Their ages ranged between 3 and 14 years old. A cohort of patients were referred from pediatric neurology unit to radiology department in El Minia University hospital, El Minia, Egypt, in the period between January 2017 and December 2017. All of them underwent MRI evaluation of the brain after approval of the ethical committee of our institution and completion of informed consent.ResultsMRI examination was positive in 66/100 patients and negative in 34 /100 patients. Corpus callosum dysgenesis was the most common finding in 19/66 patients, followed by temporal lobe pathology in 14/66 patients. Fronto-parietal or cerebellar atrophy was found in 11/66 patients. Tuber cinereum lesions, hippocampus sclerosis, heterotopia, pachygyria, hemimegalencephaly, Joubert syndrome and pineal cyst were a spectrum of findings among the remaining positive patients.ConclusionMRI of the brain in children with attention deficit and hyperactivity disorder will be the pivot for diagnosis. Not all patients had cerebellar or fronto-parietal atrophy as presumed before. Temporal lobe, corpus callosum and tuber cinereum must be looked for carefullyKeywords: Attention deficit, hyperactivity disorder, Brain, Children, MRI
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Pages 9391-9397BackgroundKetamine is an antagonist receptor of N-methyl-D-aspartate (NMDA), and phencyclidine derivate sedative agent. Thus the aim of this study was to evaluate the effect of intravenous (IV) and intramuscular (IM) injection of Ketamine for sedation procedure of children.Materials and MethodsIn this randomized clinical trial the patients, 1-6 year-old children referred to Emergency Department of Ahvaz Golestan and Imam Khomeini Hospitals, Ahvaz city, Iran, were divided randomly into two groups (IV and IM groups). Patients in the IV group received ketamine with dose of 1.5 mg/kg intravenously and the patients in the IM group received ketamine with dose of 4 mg/kg intramuscularly. Then efficacy and side effects in both groups were performed every 5 minutes for the first for the first 15 minutes.Results222 patients with indication for sedation were enrolled. Results showed that in 1st min, most of the patients that received IM ketamine were in level 1 of sedation (67.6 %, n= 73); while the majority of patients that received IV ketamine were in level 1 to 3 of sedation (28.9%, 24.6% and 26.3%, respectively) (P<0.001). Moreover, in 5th min, most of the patients that received IV ketamine were in level 6 of sedation (62.3%), while those who received IM ketamine were in level 5 of sedation (52.8%) (P<0.001), which was better in IV group. While in 15th min, we did not find significant differences between the groups (P=0.057).ConclusionThe results of this study showed the beneficial effects of IV ketamine in making better sedation levels in pediatric patients for different purpose (medical and para-clinical procedures)Keywords: Children, Efficacy, Emergency Department, Sedation, Ketamine
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Pages 9399-9407IntroductionGlucose-Galactose Malabsorption (GGM) is an autosomal recessive and rare disorder of intestinal transport of glucose and sodium-glucose cotransporter type (SGLT1).
Case Report
Our patient is a 32-day-old boy who was examined for severe diarrhea and acidosis and was treated with GGMdiagnosis. A number of laboratory tests were performed on this patient as well as positive test for reduced substance of stool and positive hydrogen breath test. On the other hand, the improvement of diarrhea with fasting and the initiation of a glucose and galactose free formula (fructose-basedformula [galactomin B-19]) was instructed. He was treated and followed with diagnosis of GGM.ConclusionIn summary, careful clinical observation, laboratory tests, and the character of the external cues may provide indications of GGMKeywords: case report, Child, Diarrhea, Glucose-Galactose Malabsorption -
Pages 9405-9411BackgroundPreeclampsia is a specific pregnancy syndrome. Early diagnosis and proper administration of preeclampsia can lead to improved maternal and neonatal outcome. We aimed to investigate the uterine artery Doppler ultrasound in predicting the preeclampsia in women with a high-risk pregnancy.Materials and MethodsThis analytic study was conducted on 160 primigravida women with gestational age of 18 to 26 weeks referring to Ali-IEbne Abi Taleb hospital of Zahedan (Iran). The uterine artery Doppler was considered as abnormal if mean Pulsatility Index (PI) was higher as 95% for gestational age or bilateral notching was observed. All uterine artery sonography was performed by one expert sonographer and with one machine. Then the pregnancy outcomes (such as placenta abruption, postpartum hemorrhage, death, Neonatal Intensive Care Unit admission, low birth weight, preterm labor, etc.) were compared between the two groups.ResultsThe mean age of pregnant women was 25.4±5.6 years old. Preeclampsia was seen in 37 (24.7%) of the women and healthy was seen in 113 (75.3%) of the women. A statistically significant difference was seen between the women with normal and abnormal Doppler sonography (P=0.001). The sensitivity of Doppler ultrasonography in predicting early onset, late onset and severe preeclampsia was 73.3 %, 62.5 %, and 100%, respectively. The specificity of Doppler ultrasonography in predicting early onset, late-onset, and severe preeclampsia was 64.4%, 66.1%, and 74.3%, respectively.ConclusionThe findings of the study showed that uterine artery Doppler (Pulsatility Index) is useful in predicting the occurrence of preeclampsia in second trimester.Keywords: Preeclampsia, pregnancy, Uterine artery Doppler
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Pages 9413-9422BackgroundThe high prevalence of overweight and obesity in children is closely correlated with the increasing consumption of sugar-sweetened beverages (SSBs).The purpose of this study was using the theory of planned behavior(TPB) to explain intent to consume SSBs among secondary school students.Materials and MethodsThis descriptive-analytical (cross-sectional) study wasconducted on 416 secondary school students selected using multi-stage cluster sampling. Data collection instrument was a three-part questionnaire including students' characteristics with 4 items; students' beliefs toward SSBs based on the TPB with 13 items; and the amount of daily consumption of SSBs and water with 2 items. The collected data were analyzed using descriptive and analytical tests, Pearson’s correlation coefficient and linear regression in the SPSS (version 22.0).ResultsThe results showed that the average age of the participants was 13.91 ± 0.78 years. The prevalence rate of overweight and obesity in students was reported 21.6%. The amount of SSB use among students was unsatisfactory (3.87 glasses per day), while daily water consumption was reported 1.75 glasses per day. In addition, the findings indicated that students' attitude and perceived behavioral control (P<0.001) had a statistically significant association with intent to reduce consumption of SSBs, and those constructs explained 27% of variance of students' intention.ConclusionAmong the variables related to the TPB, attitude and perceived behavioral control were effective factors on students' intention toward consumption of SSBs. Hence, by using the present findings, health care providers can plan, implement and evaluate suitable interventions to reduce the consumption of SSBs in studentsKeywords: Obesity, Student, Sugar, Sweetened Beverages, theory of planned behavior
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Pages 9423-9427Acalvaria defined as absent skull bones, is an extremely rare congenital anomaly with only a handful of cases reported in literature. In this report we presented a male newborn case of acalvaria referred to our hospital (Shahid Motahari hospital of Urmia, Iran). The condition per se has been described as having high mortality rate. Very few living cases, less than ten, have been reported till now.Keywords: Acalvaia, bone defect, Child, Skull malformation
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Pages 9429-9441Background
Some controversy exists about the role of cecostomy in the management of fecal disorders. The present meta-analysis aims provide a comprehensive evaluation on the role of cecostomy on management of fecal incontinence and constipation in children.
Materials and Methods
An extensive search was performed on the Medline, Embase, Scopus, and Web of Science until July 2017. Two independent researchers screened the title and abstracts of the studies and then relevant studies were included. Finally, pooled effect size was presented as standardized mean difference (SMD) or pooled prevalence with 95% confidence interval (95% CI).
Results
14 articles were entered (740 children). The success rate of cecostomy in management of fecal disorders was 90.6% (success rate=90.6%; 95% CI: 86.4 to 94.2). The most common side effects of this technique include granulation tissue formation (29.6%), cecostomy tube leakage (8.5%), tube dislodgement (7.0%), and tube site infection (2.3%).
Conclusion
The results of the present meta-analysis show that the cecostomy is safe and an effective technique in the management of fecal disorder in children. However, the findings presented on the eligible articles have have shown a low level of evidence and it is suggested that clinical trials should be conducted in this field.Keywords: Antegrade Colonic Enema, Constipation, Fecal Incontinence, Pediatrics -
Pages 9443-9451BackgroundThere is a lack of information regarding anaphylaxis that is triggered by the peanut and nuts in countries with emerging economies. We aimed to identify the factors that are related to the prevalence of secondary anaphylaxis that results from ingesting peanuts or nuts.Materials and MethodsA cross-sectional, population-based study was conducted in which we applied a structured questionnaire to a random sample of 1992 adolescents, aged 15 to 18 years. After identifying those subjects with presence of adverse symptoms after food intake, we then asked if this was due to the ingestion of the peanuts or nuts. Factors associated with anaphylaxis were identified through the odds ratio estimation using logistic regression in a multivariate analysis model.ResultsThe prevalence of global anaphylaxis caused by the peanuts and nuts was 0.9%, n=17 (95% CI: 0.5% to 1.4%); 0.6%, n=12 (95% CI: 0.3% to 1.1%) with any type of nut, and 0.3%, n=7 (95% CI: 0.2% to 0.7%) with the peanut; anaphylaxis caused exclusively by the peanut was recorded at 0.2% (95% CI: 0.1% to 0.6%). Notably, one case of anaphylaxis was triggered by five types of nuts (almond, pecan, Brazilian nut, cashew, and pistachio), another by 4 types (hazelnut, peanut, walnut, pecan, and cashew), there were 9 cases that were prompted by only one food (5 peanut, 2 cashew, 1 chestnut, 1 almond). The only factor found to be associated with anaphylaxis was a personal history of pollen allergy, odds ratio: 10.12 (p = 0.046).ConclusionThe prevalence of anaphylaxis induced by peanuts or nuts in the Mexican population varies from 0.5 to 1.4%; and the personal history of pollen allergy was the only associated factor with anaphylaxis.Keywords: Anaphylaxis, Adolescents, Allergy, Prevalence
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Pages 9453-9459
McCune-Albright Syndrome (MAS) is a rare sporadic disease characterized by bone fibrous dysplasia, Café au lait spots and a variable association of hyperfunction endocrine disorders. There is not any certain treatment available for this syndrome, and both physical and emotional disability in these patients is still a major concern for physicians. In present report we have described a 10- year-old girl, presented with precocious puberty, multiple Café au lait macules and fibrous dysplasia, successfully treated with pamidronate in a four-year follow-up period.Keywords: Children, Iran, Fibrous dysplasia, McCune-Albright syndrome, Precocious puberty -
Pages 9461-9469
BackgroundDiaper dermatitis is one of the most prevalent skin disorders in neonates and children. The purpose of this study was to compare the effects of Aloe Vera and chamomile ointment on the degree of diaper dermatitis in children.Materials and MethodsIn this double-blinded randomized clinical trial, 90 children below two years of age, who had diaper dermatitis and were hospitalized in the Tabriz Pediatric Hospital, Tabriz city- Iran, were included in the study using random sampling. The children were divided into three equal groups, with one group receiving routine treatments and the other two receiving chamomile and Aloe Vera ointment three times a day. The samples were examined on the first, third, and sixth day of the study using a diaper rash five-point scale. The data were analyzed by descriptive and analytical tests in SPSS software version 22.0.ResultsBaseline criteria such as age, gender, and education of mothers were similar in all the groups (P>0.05). Moreover, the dermatitis extent recovery was achieved over time (P<0.001) in all the three groups; however, comparison among the three groups showed no significant difference in all the types of treatment (P>0.05).ConclusionThere was no difference between the Aloe Vera, chamomile, and routine treatments in dermatitis extent recovery.Keywords: Aloe vera, Chamomile, Children, Diaper dermatitis -
Pages 9471-9480BackgroundHeart failure (HF) in infants and children with congenital heart disease (CHD) is a crucial complication with different outcomes. Many biomarkers are used as prognostic indicators. Soluble ST2 (sST2) is one of these markers studied in adults with HF. We aimed to study the prognostic value of sST2 in CHD children with HF.Materials and MethodsIn current case-control study, thirty-six CHD infants and children with HF (20 males and 16 females) with mean age of 20.3±11.2 months were included in this study. Another 20 (12 males and 8 females) healthy children with mean age of 20.9±9.1 months served as controls. Clinical evaluation, echocardiography and sST2 levels assessment were done for all subjects.ResultsOur results showed that sST levels were significantly higher in diseased group than controls (30.85±2.48 ng/ml vs. 22.12±1.50ng/ml, respectively), and we recorded higher levels in more severely diseased children, according to Ross clinical classification and in those with poor prognosis than those with good prognosis. ROC curve for sST2 levels in diseased group showed that at cutoff point of more than 29.8 ng/ml, sensitivity of sST2 to predict poor prognosis of HF children was 95% with a specificity of 88%. Area under the curve (AUC) was 0.94. We found significant negative correlations between sST2 levels, and left ventricular ejection fraction (LVEF), and fractional shortening (LVFS), and significant positive correlations with heart rate (HR) respiratory rate (RR), cardio-thorathic (CT) ratio, left ventricular end diastolic, and systolic dimensions (LVEDd and LVESd).ConclusionIncreased sST2 levels in infants with CHD complicated with HF can be used as a good predictive indicator to unfavorable outcome in those patients.Keywords: Children, Congenital Heart, heart failure, Soluble ST2
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Pages 9481-9496BackgroundThe growing prevalence of chronic diseases in children has increased their need for palliative care. We aimed to compare pediatric palliative care and home care training in Iran and in the selected countries.Materials and MethodsThis comparative study was conducted based on the classifications of palliative care for children and using databases such as Scopus, Science Direct, Ovid, ProQuest and Medline, websites affiliated with communities and associated with palliative care and home care services and according to the framework of World Health Organization’s Public Health Road Map. The selected countries consist of England, Canada, Australia and South Africa, where home care services are provided for children in addition to palliative care.ResultsThere is a pediatric palliative care training program for doctors in the selected countries. Home care is part of these programs in these countries. Despite the lack of an independent nursing course in postgraduate education in England, Canada, and Australia, community health nurses are responsible for providing care responsible to provide care for children with life-threatening diseases in the community and at home. In South Africa, a home-based palliative care training and support package for children was designed for community care workers. In Iran, pediatric palliative care is in the early stages and home care is evolving as a need.ConclusionEducation is the most important factor for integrating home care and pediatric palliative care into the health system. In countries with advanced pediatric palliative care, the knowledge and skills of care providers have been considered. In Iran, revising medical and nursing curriculums and the integration of palliative care and home care programs into the curriculum are essential.Keywords: Education, Home care, Pediatric, Palliative care
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Pages 9497-9505BackgroundRegarding adverse effects of postpartum depression on maternal mental health and the reduction of mother-infant attachment, there is a need to comprehensively understand Edinburgh Postnatal Depression Scale (EPDS). We aimed to review the validity and reliability of the EPDS in Iranian population to provide comprehensive information for the health providers.Materials and MethodsThe search procedure was fulfilled on the databases of Medline (via PubMed), Scopus, Cochran Library and Web of Science from inception to April 2018. The quality of studies was assessed by COSMIN checklist. Search keywords include (Edinburgh Postnatal Depression Scale) AND (Psychometric Properties).ResultsThree studies identified a two-factor structure and one study found a three-factor structure. Discriminant validity of the EPDS was able to differentiate three groups (minor depression, major depression, and healthy women); but failed to distinguish between women with caesarean section, and women with normal delivery. Internal consistency was reported by four studies. Cronbach’s alpha ranged from 0.7 to 0.79 for total EPDS score. Test-retest reliability was reported only in a study with Intraclass Correlation Coefficient (ICC) > 0.80. In terms of convergent validity, the EPDS was significantly positively correlated with General Health Questionnaire (GHQ) (r=0.76; p<0.001), and Hamilton Depression Rating Scale (HDRS) (r=0.62, p<0.001), and negatively with Short Form Health Survey (SF-36). Sensitivity was almost 0.74%, and specificity ranged from 0.80% to 0.93% at the cut-off point ofConclusionEvidence to support the validity and reliability of the EPDS in Iranian population is sufficient as a screening tool for postnatal depressionto decrease damage to the mother and the baby.Keywords: Edinburgh Postnatal Depression Scale, Iranian Population, Systematic review