Amirkola Children's Hospital Research Articles

Comparison of the Volumetric Parameters of Platelets in Diabetic Children with and without Diabetic Ketoacidosis: A Case-Control Study in the North of Iran

Background: This study aimed to determine the volumetric parameters of platelets including MPV (Mean Platelet Volume) and PDW (Platelet Distribution Width) in diabetic children with and without diabetic ketoacidosis (DKA) and to evaluate their relationship with the severity of DKA. Materials and Methods: A case-control study was conducted on 112 children with type 1 diabetes mellitus (T1DM), with and without DKA, who referred to Amirkola Children's Hospital, Iran, in 2016-2021. Of them, 43 were boys, and 69 were girls. The diagnosis of diabetes was based on clinical symptoms and diagnostic criteria, and DKA was diagnosed through the analysis of arterial blood gas. The patients’ MPV and PDW were also evaluated, and the P values less than 0.05 were considered significant. Results: Out of 112 children with diabetes (with the mean age of 8.71 ± 3.22 years), 56 persons had DKA. In terms of DKA severity, 17 patients (30.4%) had mild, 29 (51.8%) had moderate, and 10 (17.8%) had severe DKA. The children with DKA had the mean blood glucose of 490.98±46.11mg/dL, MPV of 10.02± 1.19fl), and PDW of 13.07± 1.18flwere significantly higher (P<0.001). It was found that, an increase in the severity of DKA would raise the mean MPV (P = 0.006) and PDW(P<0.001) significantly. Conclusion: Based on the results of this study, as the severity of DKA increases in diabetic children, the mean levels of MPV and PDW increase significantly. Therefore, it is suggested that MPV and PDW be used to predict the severity of DKA in diabetic children.

Thyroid function tests in overweight and obese children and adolescents with and without non-alcoholic fatty liver disease.

Hypothyroidism can play an important role in the development of non-alcoholic fatty liver disease (NAFLD). This study compared the thyroid function tests in overweight and obese children and adolescents with and without NAFLD. This case-control study was conducted on 100 children and adolescents aged 4-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital, Babol, Iran in 2021. 42 obese and overweight children with NAFLD were considered as case group and 56 persons without NAFLD as control group. They were selected after physical examination and body mass index (BMI) assessment. Then, TSH, T4, FBS, lipid profile, 25(OH) vit D3 (VD), AST and ALT levels were measured. Abdominal ultrasound was performed to survey fatty liver. T-test and Chi-score were used for analysis and p< 0.05 was considered significant. The mean age in both group was 11.63±2.55 and 10.07±2.61 years, respectively (P=0.004). Hypothyroidism was not seen in the groups. Two groups in terms of mean TSH (P=0.92), T4 (P=0.87), FBS (P=0.33), cholesterol (P=0.44), LDL (P=0.35), VD (P=0.07) had no significant difference. However, difference was found between the two groups in terms of the mean level of AST (P=0.003), ALT (P=0.001), TG (P=0.02), HDL (P=0.01) and BMI (P0.001). This study showed that the mean level of thyroid hormones in both groups did not have significant difference and hypothyroidism was not seen. Other studies with larger sample size and longer periods of time are suggested.

Effect of Domperidone on Children with Functional Abdominal Pain: A Randomized Controlled Clinical Trial

Background: One of the most common functional problems in children is functional abdominal pain (FAP), and dysmotility is one of the possible causes of FAP. Domperidone is a prokinetic drug that increases gastrointestinal motility. Objectives: The aim of this study was to evaluate the effect of domperidone on the treatment of FAP in children. Methods: In this double-blind clinical trial study, FAP was diagnosed in 80 children aged 5 - 14 years, who were referred to Amirkola Children's Hospital in Babol for one year based on the criteria of the Rome IV. Then, they were randomly divided into two groups of 40 patients. Group A received domperidone tablets (0.25 mg/kg, three-time/day) for two months, and group B received a placebo. The primary outcome was at least a 50% reduction in both frequency and severity of pain, and the secondary outcome was a significant reduction in the duration, frequency, and intensity of pain according to the Wong-Baker scale compared to baseline. Results: A total of 80 children completed the trial (40 with domperidone). The recovery rate was higher in the domperidone group than in the placebo group after eight weeks (71.8% vs. 28.2%; P &lt; 0.0001), and domperidone had significant superiority over the placebo in reducing the duration (4.58 ± 7.71 vs. 24.5 ± 41.45, min/day, P &lt; 0.001), frequency (3.35 ± 3.99 vs. 10.63 ± 10.55, episode/week, P &lt; 0.001), and intensity (2.20 ± 2.16 vs. 5.05 ± 2.37, P &lt; 0.001) of the pain. Conclusions: Based on the results, domperidone can be useful in the treatment of FAP in children.

Evaluation of Vitamin D Level in Children With Febrile Seizure Referred to Amirkola Children's Hospital, Babol.

Objective. This study aim to evaluate the level of vitamin D with the incidence of febrile seizure. Method. This case-control study was conducted on 90 febrile children referred to Amirkola Children's Hospital from 19 February to 21 August 2021. Febrile children with and without seizures were considered as case and control groups, respectively. Vitamin D, calcium, phosphorus, and alkaline phosphatase were evaluated. Results. The mean level of vitamin D was not significant between the 2 groups (P = .62), but the mean level of alkaline phosphatase was higher in the case group, statistically (P = .04). 46.75% and 15.6% of case group, 28.9% and 26.7% of control group had deficiency and insufficiency levels of vitamin D, respectively (P = .17). Conclusion. In this study the mean level and deficiency of Vitamin D were not significant between the 2 groups. No correlation was also found between Vitamin D levels and the incidence of Febrile Seizure.

Complications of patients with hematologic malignancies in a selected Iranian population.

Hematologic malignancies in childhood and their treatments can cause dental anomalies and jaw bone abnormalities; therefore, the aim of this study was to assess the prevalence of these disorders in children. This cross-sectional study was conducted on all children diagnosed with hematologic malignancies that referred to in Amirkola Children's Hospital from 2011 to 2018. All of children underwent clinical evaluation in a Dental Radiology Clinic and panoramic imaging was performed. The radiographs were examined for dental anomalies and jaw bone abnormalities. The data were analyzed by descriptive analysis using chi-square, Mann-Whitney and Kruskal-Wallis with a 95% confidence interval. The study population consisted of 32 children and 9.46% of these patients showed intraoral signs in clinical evaluations. Panoramic radiographs indicated dental anomalies in 12 (63.9%) and jaw bone abnormalities in 17 (89.4%) patients. The most common dental anomaly and bone abnormality were taurodontism and changes in lamina dura, respectively. By measuring the mandibular cortical index (MCI), it was revealed that 13 had osteopenia, in which 4 of them had severe osteopenia (osteoporosis). The statistical analysis demonstrated that there was a significant difference between the incidence of osteoporosis and changes in lamina dura with the gender (p<0.05). Due to early onset of osteopenia and osteoporosis and the presence of dental and bone abnormalities in half of study population, early assessment of their clinical and radiographic condition can be helpful in the prevention and the early treatment of their oral complications.

13-year Old Male Child Patient with a known Case of Necrotizing Encephalopathy

ANCE (Acute necrotizing encephalopathy of childhood) is a disease that affects children with a high fever, a respiratory or gastrointestinal infection, rapid changes in awareness, and seizures. Almost all Asian newborns and children who were previously in good health are affected by this illness. According to serial magnetic resonance imaging studies, the thalami, cerebellum, brainstem, and white matter all showed symmetric lesions in this disease. The condition has a poor prognosis with high morbidity and mortality rates. Amir Kola Children's Hospital is evaluating an A.N.E.C. in a 22-month-old kid Missense mutations were also detected in the gene that codes for the nuclear pore protein- Ran Binding Protein 2 (RANBP2). Though the clinical course and prognosis of ANE differ, the characteristic of neuro radiology manifestation of ANE is multifocal symmetric brain lesions visible on computed tomography (C.T.) or magnetic resonance imaging (M.R.I.).The treatment of ANCE is still under particular observation. We provide the most up-to-date information on ANCE, emphasizing early detection and successful consultation and treatment of this rare but deadly disease.

Determination of serum alkaline phosphatase reference in healthy children aged 1-18 years.

The growth and development of children affect biochemical variables. This population-based study was designed to evaluate the reference interval for alkaline phosphatase (ALP) routinely measured in the clinical laboratory. For this examination, 873 cases were selected among the healthy children and adolescents aged 1-18 years who referred to the endocrinology clinic of Amirkola Children's Hospital for growth evaluation. After overnight fasting, early morning blood samples were obtained to measure the ALP level and other biochemical parameters using an automatic biochemical analyzer. Subjects were categorized by age, sex, and body mass index (BMI) values. The age groups were categorized as follows: 1-4 years, 5-8 years, 9-13 years, and 14-18 years. There was a significant difference among the age and sex categories; on the contrary, there was no meaningful variation between the two groups categorized by BMI. The reference range for ALP was 474.14-517.71 U/L for children aged 1-4 years, 273.47-871.44 U/L for 5-8 years, 215.04-893.69 U/L for 9-13 years, and 228.9-739.22 U/L for 14-18 years. Also, significant positive correlation was found between ALP with length (P=0.000, r=0.134), weight (=0.04, r=0.073), phosphorus (P) (P=0.001, r=0.122), and alanine aminotransferase (SGPT) (P=0.000, r=0.142) respectively. This project's data established a reference interval for ALP in healthy children and adolescents, which will prepare a basis for diagnosis and monitoring liver- or bone-related disorders.

Evaluation of the developmental outcome in children with congenital hypothyroidism.

Background:Congenital hypothyroidism (CH) is one of the most common endocrine diseases and one of the major causes of mental retardation in children. So we aimed to evaluate the developmental outcome of children with CH.Methods:This case-control study was performed on two 3-6-year-old groups of 100 patients. The case group was children with CH, referred to Endocrine Clinic of Amirkola Children's Hospital (2011-2017) and the control group was healthy children and normal from other states. The Denver developmental screening test-II (DDST_II) was used to assess the developmental factors and disorders in four areas of gross motor, fine motor, personal-social and language. Data were analyzed by SPSS 21 using descriptive statistics, t-test and chi-square, and a p<0.05 was considered significant.Results:The mean age of 200 children in the case and control groups was 54.62±15.72 and 59.68±15.64 months, respectively. In the case group, 45% and 55% of them had transient and permanent CH, respectively. All four criteria of DDST_II in the control group as well as gross motor in the case group were normal, but fine motor, personal-social and language were reported normal in 94, 95 and 93% of the case group, respectively. All subjects with abnormal DDST_II, had a negative neonatal screening tests.Conclusion:The results obtained from DDST_II indicated that 6% of children with CH had an abnormal development, all who had an onset of medical treatment over 30 days, which makes it important to screen the neonatal thyroid disease and diagnose this disease timely.

Impact of Peer Education on Breastfeeding Self-Efficacy in Primiparous Women

Background: Peers are influential people who can enhance self-efficacy (SE) factors by verbal encouragement and common experience sharing and affect maternal SE in promoting and maintaining breastfeeding (BF). This study aimed to determine the effect of peer education on BF SE among primiparous mothers. Methods: This randomized clinical trial study was conducted on nulliparous mothers with hospitalized neonates in the neonatal ward of Amirkola Children's Hospital, Mazandaran Province, Iran, within May-September 2018. The statistical population of this research (n=120) was selected using the convenience method and randomly divided into two groups of intervention and control (n=60 each). The control group received the usual and standard center's education. However, the mothers in the intervention group received, two one-hour sessions of BF education from peers in addition to the usual training. These peers were qualified and experienced in two years of successful BF. The tools used for data collection were the demographic form and Breastfeeding Self-Efficacy (BE SE) Scale. The BE SE questionnaire was completed at the time of enrollment and the eighth week after primiparous delivery. The collected data were analyzed in SPSS software (version18) using an independent t-test and paired t-test. A p-value of less than 0.05 was considered significant. Results: The two groups were similar in demographic variables. The mean score of BF SE after the education in the control and intervention groups were obtained as 48.38±7.85 and 60.25±8.32, respectively, which was significant (P<0. 001). Conclusion: Based on the results, breastfeeding through peer education increased SE in primiparous women. Therefore, it is recommended to adopt it as an appropriate educational method to improve the quality of BF education among mothers with newborns hospitalized in the neonatal ward.

B-cell lymphoma presenting as acute pancreatitis symptoms in a child

Lymphoma which has a wide range of manifestations is the third malignancy in pediatrics. Nearly, 50% of patients have extranodal involvement. Pancreas can be affected secondarily more than primarily. A 10-year-old boy with recurrent abdominal pain in the epigastric region for six weeks was referred to Amirkola Children's Hospital, affiliated to Babol University of medical sciences (north of Iran). The patient was icteric with elevated levels of amylase and lipase. A hypoechoic mass near the head of the pancreas was detected by ultrasound examination. Pathology of stomach polyps revealed small blue round-cell tumor compatible with a lymphoma. In children with acute pancreatitis symptoms and palpable abdominal mass, the non-Hodgkin lymphomas (NHL) should be considered as an important, though rare possible cause.

Molecular investigation of extended-spectrum β-lactamases (ESBLs) genes in the Salmonella isolates obtained from children with acute diarrhea

Salmonellosis is an important public health concern among children in worldwide. Extended-spectrum β-lactams (ESBLs) cause resistance to clinically important beta-lactams which are generally used to treat invasive Salmonella infections. Therefore, the aim of this study was to investigate the presence of SHV , TEM and CTX-M genes in different strains of Salmonella isolated from children with acute diarrhea and to determine their resistance profile. In this cross-sectional study, 300 fecal samples were collected from children referred to the Amirkola Children's Hospital, Babol, Iran. Antibiotic susceptibility testing was done according to the CLSI guideline. ESBLs-producing strains were identified using double disk synergy test method on the Mueller-Hinton agar plates. Multiplex-PCR was performed using oligonucleotide specific primers to detect of SHV , TEM and CTX-M genes. In total, 7% (n; 21/300) salmonella were isolated, which 61.9%, 28.6% and 9.5% were Salmonella typhimurium , Salmonella enteritidis and Salmonella typhi , respectively. The prevalence of the ESBL-producing isolates were 52.4%. M-PCR results showed that 42.8%, 38.1% and 14.3% of isolates were carried CTX-M , TEM and SHV genes, respectively. Also, 18.2% of isolates harbored CTX-M , and TEM genes, simultaneously. The high rate of ESBLs-producing Salmonella strains in the pediatric patients is an alarm. It is also recommended that alternative drugs be used with less resistance, which requires further investigation.

Effect of Vitamin D Therapy on Hashimoto's Thyroiditis in Children with Hypovitaminosis D

Background Hashimoto's thyroiditis (HT) is a common cause of thyroid diseases in children and the role of vitamin D (VD) is controversial. Therefore, the aim of this study was to investigate the influence of VD therapy on HT in children with hypovitaminosis D. Materials and Methods This randomized clinical trial study was conducted on 30 patients referred to Endocrine Clinic of Amirkola Children's Hospital (ACH) of Babol in Iran. The serum levels of calcium, T4, TSH, Anti thyroid peroxidase antibody (TPOAb), and Anti thyroglobulin antibody (TgAb) were checked, and ultimately the HT was diagnosed based on thyroid sonography and these findings. According to normal range of calcium>8.4 mg/dl and low level of VD, the patients were divided into deficient ( Results The mean of anti-Tg and anti-TPO statistically decreased was 801.63±1172.29 vs. 492.38±1021.48 (p=0.01), and 728.21±1004.28 vs. 441.57±603.26 (p=0.01) before and after intervention, respectively so that this reduction was higher in 2-12 year-old patients. Moreover, the mean of thyroid volume in both right and left lobes statistically reduced was 3.97±3.18 vs. 3.21±2.67 (p=0.002), and 3.32±2.94 vs. 3.21±3.96 (p=0.008) before and after intervention, respectively so this decrease was higher in≥13 year-old children (p<0.05). Conclusion This study showed that the level of autoantibodies and thyroid volume were decreased, after VD intervention. Thus, it is suggested that the serum VD level should be routinely checked in these patients and when observing hypovitaminosis, an appropriate treatment and prevention with VD should be carried out to avoid recurrent VD deficiency.

Nurses' strategies for managing pain in pediatric units: A qualitative study in Iran

Context: Pain management is one of the main clinical challenges that health-care jobs encounter with it. The nurses play a pivotal role in providing pediatric pain management. Aims: This study was conducted to determine nurses' strategies for managing pain in pediatric units in Iran. Settings and Design: This qualitative study was conducted with a content analysis approach at one teaching hospital in Amirkola Children's Hospital in Babol, Iran. Materials and Methods: Data were collected from 16 nurses, using semi-structured interviews during the year 2015–2016. The inclusion criteria were the nurses with at least 3 years of work experience in children's departments. Sampling was purposeful with maximum variation. Immediately after each interview and recording, the content was transcribed using Word software. Interviews were individually conducted in the hospital nurses restroom. Statistical Analysis Used: Data analyzed by conventional content analysis method simultaneously data collection based on five steps of Granheim and Lundman. To ensure the accuracy and reliability of data were used according to Lincoln and Guba's criteria. Results: The data analysis showed that the main them was nurses' undeveloped clinical judgment. The contents included sixth subthemes such as “incomplete investigation of the presence and severity of real pain,” “priority to pain pharmacological actions,” “inadequate understanding of nurse to the time and lack of analgesics,” “nurse's inadequate attention to the conditions of the use of nonpharmacological and pharmacological interventions,” “inappropriate assignment of nonpharmacological pain to the mother,” and “incomplete evaluation and record of pain relief.” Conclusions: Nurses use the strategy of underdeveloped clinical judgment to manage pain in pediatric units. Due to this determined fact, it is necessary to design a practical model for improving the clinical judgment of nurses in pediatric pain management.

Effects of Lactose-Restricted Regimen in Breastfeeding Children with Acute Diarrhea.

Background:Acute diarrhea is a major cause of mortality in children. Few studies have addressed the administration of lactose-restricted diets in breastfed children with acute diarrhea. The present study was conducted to investigate the effects of a lactose-restricted regimen on breastfed children with acute diarrhea treated with zinc supplements.Methods:The present single-blind randomized clinical trial was conducted on children aged 6-24 months in Amirkola Children's Hospital (2015-2017). 90 children were randomly assigned to two groups. Group A was daily treated with 20 mg of zinc and a lactose-restricted diet and breast milk for two weeks. Group B received 20 mg of zinc and breast milk and an age-appropriate diet for two weeks. The data collected in all the subjects included the frequency of diarrhea and the mean duration of hospitalization and recovery from diarrhea.Results:The two groups were not significantly different in terms of mean age, weight and ratio of males to females. The mean duration of hospitalization was found to be 3.1 ± 0.8 days in group A and 3.2 ± 0.6 in group B (P = 0.3), the mean duration of recovery to be 2.9 ± 0.8 in group A and 2.6 ± 1.1 in group B (P = 0.2) and the mean frequency of diarrhea 2.9 ± 0.7 in group A and 2.8 ± 0.8 days in group B (P = 0.5), suggesting no significant differences between the two groups. No adverse effects associated with zinc therapy were reported.Conclusions:A lactose-restricted regimen was found not to be beneficial for children with acute diarrhea under continuous breastfeeding and zinc therapy.

The incidence of hyperglycemia during the induction phase of chemotherapy in patients with acute lymphoblastic leukemia

Background: Hyperglycemia is one of the most complications of corticosteroid and asparaginase during induction phase of chemotherapy in children suffering from acute lymphoblastic leukemia (ALL). This study was carried out to evaluate the incidence of hyperglycemia and associated risk factors during chemotherapy induction phase at Amirkola Children's Hospital. Materials and Methods: In this cross-sectional (retrospective) study, 150 children (mean age: 79.16±42.68 months) with ALL were evaluated (2000- 2011). Hyperglycemia was described as random blood glucose level more than 200mg/dl in patients less than 2 years old. In patients older than 2 years, fasting blood glucose level more than 110-125 mg/dl was considered as impaired glucose level and fasting blood glucose level more than 126 mg/dl was defined as diabetes mellitus. The data were analyzed using SPSS (version 18) and running chi square test, pearson Ccorrelation, and logistic regression. P-values less than0.05 was considered statistically significant. Results: Out of 150 children with ALL, 21 (14%) of them had hyperglycemia, but none of them had diabetic ketoacidosis. Hyperglycemia was significantly associated with gender (P=0.014) and age. (P=0.000) which was more likely in patients older than 10 years. The incidence of hyperglycemia was also related to BMI (P=0.000). Relapse rate for ALL was 14.7%, which was not significantly associated with hyperglycemia. Conclusion: Hyperglycemia was common and transient during induction phase of chemotherapy and it was correlated with age, sex, and weight.

Effect of Vitamin D Supplementation on Pancreatic Β -Cell Function in Patients with Type 1 Diabetes Mellitus and Vitamin D Deficiency: A Clinical Trial Study

Background Considering the increasing prevalence of type 1 diabetes mellitus (T1DM) as an autoimmune disease in recent years and the positive effects of vitamin D (VD) on this disease, especially the preventive effect of VD on progressive reduction of pancreatic β-cells, we aimed to investigate the effect of VD on pancreatic β-cell function in T1DM patients. Materials and Methods From Sep 2016 to Nov 2017, this single-blind clinical trial study was performed on patients who have affected with T1DM in the last five years, referred to Endocrinology Clinic of Amirkola Children's Hospital in Babol city of Iran. The patients with VD level less than 30 ng/mL were treated with 50, 000IU Pearl VD for 9 months. The patients' C-peptide, 25 (OH) D, HbA1C and total daily dose(TDD) insulin were compared at the beginning and end of the study. Data were analyzed using SPSS software version 22.0. Results By examining all 30 randomly selected children meeting the inclusion criteria, it was found that VD increased the C-peptide level (0.06 nmol/L), slightly improved the pancreatic β-cell function as well as decreased their HbA1c (0.64%), and TDD insulin levels (0.05 unit) although none of the relationships was significant. However, a significant decrease in HbA1c level was found in the female group (p=0.04) as well as in the age group less than 10 years (p=0.007). Conclusion VD intake had no significant effect on serum C-peptide levels and reduction of HbA1c and TDD insulin though a significant decrease in HbA1c level was observed in the female group and in the patients less than ten years.

Effect of levothyroxine on cardiac function in children with subclinical hypothyroidism: A quasi-experimental study.

Background:Because of the importance of thyroid function and its effect on different organs, such as the heart, this study was aimed to evaluate the effect of levothyroxine on cardiac function in children with subclinical hypothyroidism.Methods:This quasi-experimental study was performed on children aged 4-12 years old with diagnosis of subclinical hypothyroidism in Amirkola Children's Hospital during 2018-2019. Cardiac functional parameters, including ejection fraction (EF), fractional shortening (FS), ratio of early filling velocity to early diastolic mitral annulus velocity (E/E'), myocardial performance index (MPI), left ventricular end-diastolic diameter (LVEDD), and left ventricular end-systolic diameter (LVESD), were measured by echocardiography at baseline and 6 months after levothyroxine treatment.Results:Out of the 30 subjects, 19 (63.3%) were boys and 11 (36.7%) were girls. The mean age was 6.60±2.13 years old. The mean EF index was 63.13±3.01 percent before treatment, which increased to 69.07±4.50 percent after treatment (p<0.001). Also, the mean FS was 31.83±1.62 percent before treatment, which improved to 35.10±1.13 percent after treatment (p<0.001). The mean MPI was 0.28±0.02 before treatment, which increased to 0.33±0.03 after treatment (p<0.001). On the other hand, no significant difference was found in the mean E/E' before and after treatment. The mean LVEDD decreased from 3.47±0.46 cm before treatment to 3.05±0.40 cm after treatment (p<0.001), whereas LVESD non-significantly decreased after treatment versus before treatment.Conclusion:The results showed that treatment with levothyroxine may improve cardiac functional parameters in children with subclinical hypothyroidism.

Comparing the Hospital Costs of the Neonates Admitted to NICU of Amirkola Children's Hospital Before and After the Implementation of the Health Sector Reform in Iran

Background: The cost-effective strategies are of paramount importance in the improvement of neonatal health services. Regarding this, the present study aimed to evaluate the health sector reform of the Islamic Republic of Iran and its impact on hospital costs related to the admission of neonates in Amirkola Children's Hospital.Methods: This observational analytic study was conducted in 2015 to evaluate the hospital records of all neonates admitted to Amirkola Children's Hospital during late 2013 (before the implementation of health sector reform in Iran) and late 2014 (after the implementation of this reform).Results: According to the results, the number of the neonates admitted to this center has increased by 11% after reform. Furthermore, the mean total hospital cost and share of insurance organizations have elevated by 2.2 and 2.5 fold, respectively. Mean of the cost paid by the patients has reached to 2.7 million Rials, which has had a 33% decrease, compared to that of the pre-reform stage. Additionally, 5.8% of the total expenditures related to neonatal inpatient cares were paid out-of-pocket.Conclusion: As the findings of the present study indicated, the health sector reform in Iran has increased the rate of neonatal admission and decreased the amount of direct payment by the people.

Experience of nurses about barriers to pain management in pediatric units: A qualitative study

Context: Children's pain in hospital settings has not yet been managed well. Although nurses play an important role in pain management, its extent is limited with respect to clinical nurses in Iran. Aims: This study was conducted to explore the experience of nurses' barriers to pain management in pediatric units. Settings and Design: This qualitative study was conducted at two teaching hospitals in Amirkola Children's Hospital in Babol and Children's Medical Centers in Tehran, Iran. Data were collected from 19 nurses, using unstructured and deep interviews during 2014–2015. Material and Methods: Sampling was purposeful with maximum variation. Data analyzed by conventional content analysis method simultaneously data collection based on five steps of Granheim and Lundman (2004). To ensure about the accuracy and reliability of data, four criteria namely credibility, confirmability, dependability, and transferability, were used according to Lincoln and Guba's criteria. Before the interviews, participants were ensured about the confidentiality of their information and voluntarily nature of the study. In addition, written informed consents of the nurses were obtained. Results: Data analysis extracted five themes of barriers to pain management, including: Inappropriate organizational structure, interruption in pain relief activities, inadequate competency of the nurses, individual characteristics of child and parents, and inefficacy of companions. These themes indicated the barriers to pediatric pain management based on research conditions and experience of nurses in the pediatric ward. Conclusions: Therefore, modification of organizational structure, elimination of causes of delay in pain relief measures, promotion of nursing competencies, paying attention to child and parents' characteristics, and improvement of companions' effectiveness should be prioritized to achieve an optimal pain management

Comparison Between the Cassia Fistula`s Emulsion With Polyethylene Glycol (PEG4000) in the Pediatric Functional Constipation: A Randomized Clinical Trial.

BackgroundThere are few effective drugs for pediatric functional constipation (FC).ObjectivesComparing the effectiveness of Cassia fistula’s emulsion (CFE) with Polyethylene glycol (PEG4000) in FC; and evaluation of safety of both drugs in the treatment of FC.Materials and MethodsA randomized open label, prospective, controlled, parallel-group clinical trial was carried on 109 children (M/F: 63/46; mean age ± SD: 59.7 ± 28.8 months) in Amirkola children’s hospital, Babol, Iran. The inclusion criteria were based on diagnosis of FC according to the Rome III criteria and age range between 2 - 15 years. They received CFE or PEG randomly for 4 weeks. Frequencies of defecation, severity of pain, consistency of stool, fecal incontinence and retentive posturing were compared between the two groups and with baselines. Children were counted as improved when they exited from Rome III criteria of FC.ResultsFifty seven patients were assigned to receive PEG and 52 patients received CFE. After 4weeks of medication, 86.5% of children in CFE group and 77.1% in PEG group (RR = 1.121, CI95%:0.939 - 1.338) exited from the criteria of FC. All measurable criteria improved in both groups without any significant difference, except in the frequency of defecation that in CFE group (10.96 ± 5.7) was significantly more than PEG group (6.9 ± 3.5) (P < 0.0001). Compliances of PEG were significantly better in the 2 first weeks (P = 0.002, 0.008) but not in third and fourth week (P = 0.061, 0.062). None of these two drugs cause clinically significant side effects.ConclusionsCFE can be as effective as PEG in the 4-weeks treatment of children with FC.