Effects of White Noise Sound on the Severity of Muscle Vaccination Pain in Children Under Two Years.

Objectives: Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old. Materials & Methods: This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05). Results: A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28). Conclusion: This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.

The effect of oral use of concentrated pomegranate juice by mothers on hyperbilirubinemia in neonates under phototherapy: A randomized clinical trial.

Background: Hyperbilirubinemia is a common problem in neonates that causes hospitalization. The aim of this study was to investigate the effects of concentrated pomegranate juice (CPJ) consumption by breastfeeding mothers on neonatal hyperbilirubinemia. Materials and Methods: In this open-labeled, add-on, randomized clinical trial, 86 breastfeeding mothers and their neonates were allocated into two groups. In the control group, neonates received phototherapy. Besides neonates' phototherapy in the intervention group, their mothers received CPJ (1 tablespoon [15 g] three times a day) up to discharge. The bilirubin level was the primary outcome. The duration of phototherapy, the duration of hospital stay, and the need for exchange transfusions were secondary outcomes. Results: CPJ reduced the bilirubin level of hospitalized neonates within 48 h after consumption (P = 0.048, standard mean difference = 0.648). It also resulted in reduced duration of hospital stay and faster discharge of the neonates. Furthermore, in 48 h after discharge, bilirubin was significantly lower in the CPJ group (P = 0.003, partial eta squared = 0.123). Conclusion: Compared to the control group, consumption of CPJ by lactating mothers whose infants underwent phototherapy resulted in lower bilirubin levels, shorter hospital stay, and faster discharge.

One-year prevalence and the association between SARS-CoV-2 cycle threshold, comorbidity and outcomes in population of Babol, North of Iran (2020-2021).

Background: The present study aimed to investigate the one-year prevalence of SARS-CoV-2, common comorbidities and demographic information among negative- and positive rRT-PCR in health care workers (HCW), hospitalized and outpatients. Also, the association between SARS-CoV-2 cycle threshold (Ct) and the outcomes of patients were analyzed in Babol, northern Iran. Methods: This large retrospective cross-sectional study was performed between March 2020 and March 2021. The records of 19232 hospitalized, outpatients and HCW suspected to COVID-19 were collected from teaching hospitals in the North of Iran. Results: Out of the 19232 suspected to COVID-19 patients, 7251 (37.7%) had a positive rRT-PCR result; 652 (9%), 4599 (63.4%) and 2000 (27.6%) of those were categorized as HCW, hospitalized and outpatients, respectively. Moreover, between the hospitalized and the outpatient group, 10.2 and 0.8% cases died, whereas no death cases were reported in the HCW. Furthermore, it seems that death rate was significantly different between the three groups of Ct value, the highest mortality in those with Ct between 21 and 30 (group B=7.6%) and the lowest in the group with the highest Ct (between 31 and 40 = 5.5%) (p<0.001). Conclusion: In summary, 37.7% of cases were positive for SARS-CoV-2; of which, 63.4, 27.6 and 9% were hospitalized, outpatients and HCW, respectively. With regard to the mortality rate in hospitalized patients and the significant association with Ct under 20 and 30, it seems that the early detection and the initial quantification of SARS-CoV-2 in the first week of the conflict and therapeutic considerations to reduce the relative load can reduce the mortality rate.

The effect of concurrent use of swaddle and sucrose on the intensity of pain during venous blood sampling in neonate: a clinical trial study.

BACKGROUND & OBJECTIVE: Infants undergo painful procedures while receiving care and treatment. Blood sampling is the most common painful procedure for infants. Pain control plays a significant role in preventing unwanted physical and psychological effects. Therefore, this study aimed to investigate the effect of concurrent use of swaddle and sucrose taste on the pain intensity during venous blood sampling in neonates. METHODS: In this clinical trial study, 60 infants admitted to the neonatal ward of Amirkola Hospital were randomly divided into four groups of 15 patients. In the first group, the infants were swaddled before blood sampling. In the second group, sucrose was administered to infants. In the third group, the neonates were swaddled and given sucrose simultaneously, and in the fourth group (control), blood sampling was performed routinely. PIPP pain scale and demographic questionnaire were used to collect the data. Data analysis was performed using SPSS23. RESULTS: The results showed a significant difference between the mean pain intensity in neonates in the sucrose-swaddle group (4.53 ± 1.30) and the sucrose (7.73 ± 2.73), swaddle (9.86 ± 33.33), and control (12.13 ± 2.06) groups during blood sampling (P < 0.001). Besides, after blood sampling, there was a significant difference between the mean pain intensity in neonates in the sucrose-swaddle group (4.33 ± 1.23) and the sucrose (8.13 ± 2.66), swaddle (7.73 ± 2.78), and control (10.00. ± 1.96) groups (P < 0.001). CONCLUSION: The present study showed that pain severity during and after venous blood sampling was lower in the swaddle-sucrose group than in other groups. Therefore, it is recommended that the combined method of swaddle-sucrose be used in infants as a better pain reliever when intravenous blood sampling is performed.

Short Term Outcome of Neonates Born With Abnormal Umbilical Cord Arterial Blood Gases.

BACKGROUND: Umbilical arterial blood gas (UABG) analysis is more objective than other methods for predicting neonatal outcome. Acidemic neonates may be at risk for unfavorable outcome after birth, but all neonates with abnormal arterial blood gas (ABG) analysis do not always have poor outcome. OBJECTIVES: This study was carried out to determine the short term outcome of the neonates born with an abnormal ABG. PATIENTS AND METHODS: In a cohort prospective study 120 high risk mother-neonate pairs were enrolled and UABG was taken immediately after birth. All neonates with an umbilical cord pH less than 7.2 were considered as case group and more than 7.2 as controls. Outcomes like need to resuscitation, admission to newborn services and/or NICU), seizure occurrence, hypoxic ischemic encephalopathy (HIE), delayed initiation of oral feeding and length of hospital stay were recorded and compared between the two groups. P value less than 0.05 was considered as being significant. RESULTS: Comparison of short term outcomes between normal and abnormal ABG groups were as the fallowing: need for advanced resuscitation 4 vs. 0 (P = 0.001), NICU admission 16 vs. 4 (P = 0.001), convulsion 2 vs. 0 (P = 0.496), HIE 17 vs. 4 (P = 0.002), delay to start oral feeding 16 vs. 4 (P = 0.001), mean hospital stay 4 vs. 3 days (P = 0.001). None of the neonates died in study groups. CONCLUSIONS: An umbilical cord PH less than 7.2 immediately after birth can be used as a prognostic factor for unfavorable short term outcome in newborns.

Relation between Neonatal Icter and Gilbert Syndrome in Gloucose-6-Phosphate Dehydrogenase Deficient Subjects.

BACKGROUND AND AIM: The pathogenesis of neonatal hyperbilirubinemia hasn't been completely defined in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient newborns. The aim of this study was to detect the relationship between Gilbert's syndrome and hyperbilirubinemia in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient neonates. MATERIALS AND METHODS: This case-control study was conducted in Amirkola pediatrics teaching hospital, Babol, Iran. A total number of one hundred four infants were included in the study (51 infants with neonatal jaundice and Gloucose-6-Phosphate Dehydrogenase (G6PD) deficiency admitted to phototherapy or transfusion were selected as the case group and 53 infants with Gloucose-6-Phosphate Dehydrogenase (G6PD) deficiency admitted for other reasons than jaundice were selected as the control group). Exclusion criteria were ABO or Rh incompatibility or other reasons that made Coombs test positive, sepsis, hepatosplenomegaly, metabolic diseases, medical treatment and phototherapy. The promoter and coding regions of Uridine diphosphate Glucuronosyl Transferase 1A1 (UGT1A1) of genomic DNA were amplified by polymerase chain reaction (PCR) isolated from leukocytes. We used chi-square test and t-test to compare cases and controls. RESULTS: Distribution of Gilbert genome was not significantly different between the two groups; among cases, 33.3% were homozygote, 35.3% heterozygote, and 31.4% normal. Among controls, 22.6% were homozygote, 34% heterozygote, and 43.4% normal (p-value=xxx). Hyperbilirubinemia family history didn't differ significantly between these two groups. CONCLUSIONS: We showed that in Gloucose-6-Phosphate Dehydrogenase (G6PD) deficient neonates, there was no significant association between Gilbert's syndrome (promoter polymorphism) and hyperbilirubinemia.

Comparison of molecular mutations of G6PD deficiency gene between icteric and nonicteric neonates.

Jaundice is a common disorder in neonates and one of the provable causes of glucose-6-phosphate dehydrogenase (G6PD) deficiency, some mutation types of which may be associated with severe neonatal icter. The present study has been conducted to compare G6PD mutations in incteric and non icteric neonates. This case-control study was implemented in the NICU and Newborn Ward of Amirkola Children Hospital in 2007-2008. Available sampling approach was used and 50 icteric as well as 50 non-icteric newborns, both with G6PD deficiency, were selected as the case and the control group respectively. G6PD deficiency was diagnosed using FST (Fluorescent Spot Test) method. All samples were first evaluated in terms of Mediterranean mutation and the negative cases were then examined for Chatham mutation; all remaining samples were finally tested for Cosenza mutation. G6PD mutations were compared in the two groups and P-value less than 0.05 was considered significant. In icteric group, 76% were male and 24% were female and in non-icteric group, 70% were male and 30% were female. The mean weight of neonates was 3.2 ± 0.4 kg and 2.8 ± 0.8 kg in icteric and non-icteric groups respectively (p<0.05). In non-icteric group, 54% Mediterranean, 18% Chatham, and 28% Cosenza negative were observed and in icteric group, 56% Mediterranean, 32% Chatham, and 12% Cosenza negative were found; the distribution of Mediterranean and Chatham mutations was not significantly different between the two groups (p>0.05), however, the distribution of rare mutations (Cosenza negative) was significantly different between icteric and non-icteric groups with enzyme deficiency (p<0.05). The mean bilirubin level was not statistically different in Mediterranean (18.5±2.9), Chatham (18.8±2.1) and Cosenza negative (20±4.3) mutations (p> 0.05). Newborns with Chatham mutation have been less in need of exchange transfusions (p <0.05) indicating that rare mutations of G6PD gene may less likely lead to neonatal icter.

Cord blood -fetoprotein as a predictive index for indirect hyperbilirubinemia in term neonates.

BACKGROUND: Prediction of severe neonatal hyperbilirubinemia is very important for early treatment and prophylaxis of neurologic sequels. The aim of this study was to evaluate the predictive role of umbilical cord -fetoprotein (UCAFP) as a marker of an increased risk for neonatal hyperbilirubinemia in full term babies. METHODS: Umbilical cord blood was collected from 400 term singleton full term well newborn babies who met our inclusion criteria and stored in -20°C. Those who developed jaundice and admitted for phototherapy (34 newborns: 22 males and 12 females), considered as case group and 31 non-jaundiced infants (13 males and 18 females) gestational age-weight-matched considered as the control group. The serum level of UCAFP was checked in these 65 newborns and was compared between these two groups. RESULTS: Mean UCAFP in case group was 523.429±174.158 and in control group was 664.548±154.894 µg/L. In the non-jaundiced group, mean UCAFP values was higher than neonate with hyperbilirubinemia (664.548 vs. 523.429µg/L). The mean UCAFP in males was 519.023 µg/L and in females was 531.508 µg/L (p=0.066). Sixty (92.3%) babies delivered by cesarean section (CS) and 5 (7.7%) by normal vaginal delivery (p=0.566). CONCLUSION: According to our study, there was no significant positive association between UCAFP and subsequent neonatal indirect hyperbilirubinemia or serum bilirubin level.

Early surgical intervention for diaphragmatic paralysis in a neonate; report of a case and literature review.

BACKGROUND: Diaphragmatic paralysis in newborns is related to brachial plexus palsy. It can cause respiratory failure necessitating prolonged mechanical ventilation and subsequent extubation failure. CASE PRESENTATION: We present a two-hour-old male newborn with a birth weight of 4500 grams who had a right-sided brachial plexus palsy and right diaphragmatic paralysis due to shoulder dystocia. He developed respiratory distress due to isolated paralysis of the right hemi diaphragm. The clinical course was progressive, his condition worsening despite oxygen application. Physical examination, chest X-rays and M-mode ultrasonography of the diaphragm confirmed the diagnosis diaphragmatic paralysis. Surgical plication of diaphragm was done earlier than the usual time because of recurrent extubation failure. Diaphragmatic plication led to rapid improvement of pulmonary function and allowed discontinuation of mechanical ventilation in less than 3 days. CONCLUSION: Early diaphragmatic plication enhances weaning process and may prevent or minimize the morbidity associated with long-term mechanical ventilation in a neonate with diaphragmatic paralysis.

Acute Lymphoblastic Leukemia with Eosinophilia and Strongyloides stercoralis Hyperinfection.

BACKGROUND: Acute lymphoblastic leukemia (ALL) is the most common malignancy in children. Bone pain is an important symptom that can be severe. Eosinophilia without any other abnormal laboratory findings is rare in ALL. Strongyloides stercoralis in ALL causes disseminated fatal disease. CASE PRESENTATION: This 9-year-old girl presented with bone pain in lumbar region. Bone pain was the only symptom. The patient didn't have organomegaly. The BM samples were studied by flow cytometry, which showed pre-B cell ALL. Larva of Strongyloides stercoralis was found in fecal examination. Plain chest x ray showed bilateral para-cardiac infiltration. Strongyloidiasis was treated before starting chemotherapy. After two days treatment with Mebendazol the patient developed cough, dyspnea, respiratory distress and fever. The treatment changed to Ivermectin for 2 days. Chemotherapy started five days after diagnosis of leukemia. CONCLUSION: The patient complained merely of bone pain in lumbar region without any other signs and symptoms. Peripheral blood smear showed eosinophilia without any other abnormality. Stool examination showed Strongyloides stercoralis larvae. We suggest that all patients diagnosed as ALL in tropical and subtropical regions should be evaluated for parasitic infection especially with Strongyloides stercoralis.

Efficacy of clofibrate on severe neonatal jaundice associated with glucose-6-phosphate dehydrogenase deficiency (a randomized clinical trial).

Glucose-6-phosphate dehydrogenase (G6PD) deficiency may cause severe hyperbilirubinemia with bilirubin encephalopathy unless intervention is initiated. The aim of this study was to assess the efficacy of clofibrate in full term G6PD deficient neonates with jaundice. A randomized clinical trial study was performed in two groups of full-term G6PD deficient jaundiced neonates (clofibrate treated group, n = 21; control group, n = 19). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate, whereas control group received nothing. Both groups were treated with phototherapy. Serum total and direct bilirubin levels were measured at the onset of treatments, 16, 24 and 48 hours later. On enrollment, the mean total serum bilirubin (TSB) level in the clofibrate treated group was 18.40 +/- 2.41 and in the control group was 17.49 +/- 1.03 (p = 0.401). At 16, 24 and 48 hours of treatment, the mean TSB in the clofibrate group were 15.2 +/- 1.9, 12.6 +/- 2.4, and 10.1 +/- 2.4 and in the control group were 16.5 +/- 1.2, 13.3 +/- 2.2 and 11.4 +/- 2.4, respectively (p = 0.047). At 48 hours, 7 (33%) cases in the clofibrate group and one (5%) case in the control group were discharged with a TSB < 10 mg/dl (p = 0.031). No side effects were observed on serial examinations during hospitalization, or on the 1st and 7th days after discharge. The results show that clofibrate induces a faster decline in serum total bilirubin level, a shorter duration of phototherapy, and hospitalization with no side effects in full-term G6PD deficient neonates with jaundice.

Effect of clofibrate in jaundiced full-term infants:a randomized clinical trial.

BACKGROUND: Hyperbilirubinemia is a common problem in newborn infants. It can progress to kernicterus in severe forms, unless an intervention is initiated. The objective of this study was to determine the therapeutic effect of clofibrate in full-term neonates with nonhemolytic jaundice. METHODS: A randomized clinical trial was performed on two groups of full-term jaundiced neonates: the clofibrate-treated group (n = 30) and the control group (n = 30). Infants in the clofibrate group received a single oral dose of 100 mg/kg clofibrate while the neonates in the control group received distilled water (same color and volume); both groups received phototherapy. Serum total and direct bilirubin levels were measured at the beginning, 16, 24, 48, and 74 hours, after the start of the trial. RESULTS: The mean+/-SD total serum bilirubin level of the control and clofibrate groups at enrollment was 17.5+/-2.3 and 18.2+/-1.9 mg/dL, respectively (P = 0.199). The mean+/-SD total serum bilirubin in the control and clofibrate groups after 48 hours was 11.4+/-2.4 and 10.1+/-2.4 mg/dL, respectively (P = 0.047). After 72 hours of intervention, 25 (83%) neonates of the clofibrate group and 16 (53%) of the control group were discharged with a total serum bilirubin of <10 mg/dL (P = 0.026). No side-effect was observed on serial examination during hospitalization, and on the first and seventh day after discharge. CONCLUSION: Clofibrate results in a faster decline in TSB, shorter duration of hospitalization and had no side effects in jaundiced full-term neonates.

The effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants.

BACKGROUND: Several agents have been used for neonatal umbilical cord care, but we did not find any study evaluating the effect of human milk on umbilical cord separation time. The purpose of this study was to compare the effect of topical application of human milk, ethyl alcohol 96%, and silver sulfadiazine on umbilical cord separation time in newborn infants. This study was undertaken place at a primary-level newborn nursery at a university teaching hospital and a private hospital. Of 373 singleton near- to full-term newborns enrolled in the study, 312 completed the study. METHODS: Newborns from birth were randomized to either: 1) mother's milk group, 2) alcohol group, 3) silver sulfadiazine group, and 4) control (no treatment) group. Mother's milk for group 1, ethyl alcohol for group 2, and silver sulfadiazine ointment for group 3 were applied to the umbilical stump three hours after birth and continued every eight hours until two days after umbilical cord separation. The time to umbilical cord separation and any discomfort such as infection, hemorrhage, and granuloma formation were reported by mothers. Nothing was applied to the umbilical stump of the control group and they received dry cord care only. RESULTS: It was observed a significant difference in the mean cord separation time among the four group. No significant complications were observed in any group. CONCLUSION: Breast milk could be substituted for other topical agents for umbilical cord care, but a multicenter study is required in order to advise it for routine umbilical cord care.