Amirkola Children's Hospital Research Articles

Prognosis of Guillain-Barré Syndrome in Children.

Guillain-Barre Syndrome (GBS) is an acute polyradiculoneuropathy characterized by progressive motor weakness of limbs and areflexia. In this study, our aim was to evaluate the clinical pattern and prognosis of children with Guillain-Barre syndrome. This cross-sectional study was conducted in the Pediatric Neurology Unit of Amirkola Children's Hospital, Babol, Iran during the period of 5 years from October 2008 to September 2013. We assessed the clinical features, results of electrodiagnostic tests, functional status, treatment and outcome of 17 children diagnosed with GBS. Of 17 (male to female ratio = 1.6:1) children studied, all had motor weakness, 4 children (23.5 %) and cranial nerve palsies. Respiratory paralysis was found in one child requiring assisted ventilation. Antecedent illness preceding GBS was recorded in 7 (41.2%) children. The GBS subtype distribution as per electrodiagnostic studies was as follows: acute inflammatory demyelinating polyradiculoneuropathy (AIDP) in 12 (70.6%) acute motor axonal neuropathy (AMAN) in 3 (17.6%), acute motor sensory axonal neuropathy (AMSAN) in 2 (11.8%). IVIG constituted the treatment given in all of the patients. Complete recovery was observed in 16 children and the remaining one child was dependent to wheelchair. GBS in children is not poor prognostic disorder and our recommendation is administration of IVIG as soon as possible after clinical diagnosis. Except for one child who remained wheelchair bound, there was no mortality or morbidity in long-term observation. Besides, strong limitation of our study was the low number of subjects.

Intermittent Diazepam versus Continuous Phenobarbital to Prevent Recurrence of Febrile Seizures: A Randomized Controlled Trial.

Febrile seizure is the most common neurologic problem in children between 3 months to 5 years old. Two to five percent of children aged less than five yr old will experience it at least one time. This type of seizure is age dependent and its recurrence rate is about 33% overalls and 50% in children less than one yr old. The prophylactic treatment is still controversial, so we conducted a randomized controlled clinical trial to find out the effectiveness of continuous phenobarbital versus intermittent diazepam for febrile seizure. This clinical trial was conducted in the Department of Pediatric Neurology, Babol University of Medical Sciences, Babol, Iran between March 2008 and October 2010. All children from 6 month to 5 yr old referred to Amirkola Children's Hospital, Babol, Iran were enrolled in the study. Children with febrile seizure that had indication for prophylaxis but did not receive any prophylaxis previously were enrolled in the study. For prophylactic anti convulsion therapy, patients were divided randomly in two groups. One group received continuous phenobarbital and another treated with intermittent diazepam whenever the children experienced an episode of febrile illness for up to one year after their last convulsion. Of all 145 studied cases, the recurrent rate in children under prophylaxis with diazepam was 11/71 and in phenobarbital group was 17/74. There was no significant difference in the recurrence rate in both groups. There was no significant difference in the effectiveness of phenobarbital and diazepam in prevention of recurrent in febrile seizure and we think that in respect of lower complication rate in diazepam administration, it cloud be better choice than phenobarbital.

Evaluation of Filtration Rates in Radiology Devices Used in Hospitals Affiliated to Babol University of Medical Sciences, Iran

BACKGROUND AND OBJECTIVE: Filtration in radiology devices plays a pivotal role in weakening of soft X-ray photons and reduction of absorbed radiation dose by patients. This study aimed to evaluate the filtration rate of radiology devices at public hospitals affiliated to Babol University of Medical Sciences, Iran. METHODS: In this cross-sectional study, we used the DIAVOLT device to measure the level of radiology filtration. DIAVOLT was placed under the X-ray tube and exposed to radiation by applying multiple potential differences to the radiology device. After radiation, output potential differences were measured and recorded. FINDINGS: This study was performed at Ayatollah Rohani, Shahid Beheshti and Yahyanejad hospitals located in Mazandaran, Iran. Potential differences of 50-80 kilo-volts (kV) were applied to radiology devices, and output voltage of the DIAVOLT device was observed to be compatible with input potential at the standard error rate of ±5. In Amirkola Children's Hospital, level of filtration was 0.5 mm, while it was estimated at 2.5 aluminum mm in other hospitals. In addition, applied input time to the DIAVOLT device was compatible with output time. In Shahid Rajaee Hospital of Babolsar city, rate of input potential was higher than the output potential in the DIAVOLT device, which diverted from the standard level; however, filtration degree was adequate. CONCLUSION: According to the results of this study, kV examinations were accurate at all the hospitals affiliated to Babol University of Medical Sciences. Therefore, it could be concluded that rate of filtration is adequate in the

Prevalence of viral gastroenteritis in children with acute gastroenteritis in Babol, Iran

Viral gastroenteritis is considered a significant cause of death and is a common cause of hospitalization worldwide. This study was performed to assess the role of rota, adeno and astrovirus in children with acute diarrhea in one main children's hospital in Amirkola, Babol North of Iran. In this cross-sectional study, stool specimens from 208 children suffering from acute diarrhea referred to Amirkola children's hospital were tested for the presence of rota, adeno and astrovirus by a monoclonal antibody-based enzyme immunoassay. Demographic data were gathered by a questionnaire. The prevalence of viral causes of acute gastroenteritis was reported by relative frequency. Rota, adeno and astrovirus antigens were detected in 61.1%, 2.9% and 2.4% of patients respectively. Infants between 6 and 12 months of age were most frequently affected by rotavirus (29.8%) ( P< 0.03). Rotavirus infection was significantly less frequent in summer and spring than winter and autumn ( P< 0.0001). No significant difference was observed in rotavirus infection between male and female but the prevalence of adenovirus in girls was significantly higher than boys ( P< 0.05). Rotavirus can be regarded as a major etiologic agent of acute diarrhea in children less than two years old at Amirkola children's hospital, Babol. Immunization may protect the children before their first symptomatic infection.

Correlation between hyperglycemia and retinopathy of prematurity.

Several risk factors are attributed to retinopathy of prematurity (ROP). This study was done to determine any association between hyperglycemia and ROP in premature infants. In a retrospective case-control analysis, all infants with a gestational age (GA) < 34 weeks and a birthweight (BW) < 2000 g admitted and treated in the Neonatal Intensive Care Unit at Amirkola Children's Hospital, Iran, during March 2007-September 2010 were included. Hyperglycemia was defined as a plasma glucose level of >150 mg/dL during the hospital stay. The duration of being hyperglycemic was also recorded. All of these neonates were examined for ROP by a retinologist unaware of group assignment. The difference in the ROP incidence and also the severity of ROP was compared between the hyperglycemic and non-hyperglycemic infants. Matching was done for GA, BW, and also Clinical Risk Index for Babies score. The data were analyzed by t-test, χ(2) -test and logistic regression test and a P < 0.05 was considered significant. In total, 155 neonates were examined. Seventy (45.2%) of them developed ROP but 85 (54.8%) did not show any evidence of ROP. The frequency of hyperglycemia in patients with ROP was 33 (47.2%), but in those without ROP, hyperglycemia occurred in five (5.9%) (P = 0.0001). The severity of ROP showed no significant differences between the two groups (P = 0.35). The logistic regression for GA and BW showed a significant correlation between hyperglycemia and ROP (P = 0.0001). Hyperglycemia is an important risk factor for ROP that can be prevented along with other risk factors by accurate supervision.

Implementation of mother-training program to improve parenting in pre-school age children: a randomized-controlled trial.

Background:Preventing child abuse is an area of evaluation that should be deeply considered. The enhancing skill of maternal child care is also useful in this field.Aim:The aim of this study was to assess the impact of a training strategy to improve parenting in the families identified as at risk of child maltreatment.Materials and Methods:This randomized and controlled trial was conducted in 60 mothers allocated in the experimental and controlled group by a simple random allocation in Amirkola Children's Hospital in North Iran from January 2009 to December 2009. Mean score of maternal child abuse before and after intervention has been assessed by Conflict Tactics Scale for Parent and Child. Data analysis was based on the independent t-test, the paired t-test and one way analysis of variance.Results:The mean and standard deviation of maternal child abuse score in the experimental group before and after intervention were 30.21 ± 1.21 and 23.31 ± 1.52, respectively, (P < 0.001, t = 6.63), but no difference was found in the control group.Conclusions:The training program on maternal skills to prevent child abuse was a powerful resource. Therefore, healthcare providers in the field of pediatric about parenting skills should be taught with a specific consideration.

Short-term outcome of premature neonates admitted to NICU & newborn services at Amirkola children hospital in 2010

Introduction: Improvements in newborn intensive care led to decreased mortality, but increased the morbidity rates of preterm infants. This study have designed to evaluate the short- term outcome in premature infants admitted to NICU at Amirkola Children Hospital(ACH) , northern Iran from Mar20,2010- Mar21,2011 Methods: All the premature infants admitted to NICU and newborn services from Mar20, 2010- Mar21, 2011 entered to the study .Data like Death, NEC, IVH, and ROP were gathered. Gestational of age determined based on New Ballard Score.IVH and NEC diagnosed with brain ultrasonography and radiology. ROP diagnosed by indirect ophthalmoscopic exam made by a retinologist and if it was advanced then referred for therapy. Hearing test done with ABR technique and then if it was failed, referred to repeat ABR and any patients with hearing loss referred for rehabilitation with hearing aid. We followed up patients for hearing loss and blindness until the 2-2.5 years of age. Results: In 159 premature neonates who admitted in this period 63.5% were boy and 36.5% was girl. Seventy nine percent delivered by C/S and 21% through NVD .The most frequent GA group was 34-37 week (56%).The mean CRIB score of the babies was 5.6±2.4. The mortality premature neonates were %9.7. The rate of IVH, NEC and threshold ROP were 9.5%, 3.1%, and 10.3% respectively. We have 1 neonate with blindness and 3 neonates with hearing loss. Conclusion: The finding of this study reveals an improvement in the short-term outcome in premature infants' admitted to NICU at ACH, although there is some distance between the present condition and the real favorable outcome.

Outcomes of very‐low‐birthweight infants after discharge with a discharge weight of 1500 grams

Discharge of very-low-birthweight (VLBW) neonates from hospital is an important issue and has a standard criterion worldwide. According to this criterion, VLBW infants will be discharged from hospital when weighing 1800-2100 g but in the newborn services at Amirkola Children's Hospital (ACH), VLBW neonates are discharged when reaching 1500 g. The aim of this study was to determine the safety of this policy. In this analytic-prospective study, 100 premature neonates with discharging weight (DW) of 1500 g and a control group of 150 neonates with DW of 1600-2500 g were included. Both groups showed similar socioeconomic, perinatal and postnatal conditions. They were admitted and treated in the newborn services at ACH. The outcome variables, including death after discharge, readmission and need for emergency visit for an acute problem up to 3 months after discharge, were studied. The information was analyzed by SPSS-16 software and a P-value < 0.05 was considered significant. Need for emergency visit after discharge reached a significant difference between the two groups (31 in the case group vs 21 in the control group, P= 0.000), but there were no significant differences in the readmission rate and death after discharge (two deaths and 15 readmissions in the case group vs two deaths and 21 readmissions in the control group, P= 0.855) In order to decrease the need for emergency visits, we suggest a program of early hospital discharge with home nursing visits and neonatologist support.

The Effect of Anticonvulsant Drugs (Phenobarbital and Valproic Acid) on the Serum Level of Cholesterol, Triglyceride, Lipoprotein and Liver Enzymes in Convulsive Children

Objective on the effect of various antiepileptic drugs on serum lipids show contradictory results. We aimed to find the effect of Phenobarbital and Sodium Valproate monotherapy on serum lipid profile and liver function tests in epileptic children. Materials & Methods This cohort study was conducted in Amirkola Children Hospital. One hundred and ten children with epilepsy were included in this study. Children with hepatic or renal disease, those receiving medications which could alter liver function tests or serum lipid profile were excluded from the study. Patients were allocated into two groups. The first group, including 63 patients, received Phenobarbital and the second group, including 47 patients, received Sodium Valproate, both in divided doses. A venous blood sample was collected after overnight fasting to evaluate serum triglyceride, total cholesterol, LDL, HDL, and liver function tests. Data was analyzed with SPSS version 17. Results receiving Phenobarbital, total cholesterol, LDL, HDL, ALP, SGOT and SGPT increased significantly after treatment, but TG level showed no significant changes. In children receiving Sodium Valproate, HDL, ALP, SGOT, SGPT significantly increased after treatment but there were no statistically significant changes in total cholesterol, LDL and TG. In our study, the plasma levels of LPa elevated significantly after treatment with Phenobarbital and Sodium Valproate (P Value=0.0001). This increase was more significant in patients receiving Sodium Valproate. Conclusion results suggested a need for monitoring serum total cholesterol, HDL, LDL, and TG levels in patients receiving Phenobarbital and Valproic Acid.

IRON STATUS IN FEBRILE SEIZURE: A CASE-CONTROL STUDY

Objective Data on the relationship between iron deficiency anemia and febrile convulsions are controversial. The aim of this study was to determine the association between iron deficiency anemia and febrile convulsions among children. Materials & Methods This case-control study was conducted during 2006-2007, on 90 children with febrile seizures (case) and 90 febrile children without seizures (control) referred to the Amirkola children hospital (a referral hospital in the north of Iran). Two groups were matched for age and sex. In all children hemoglobin (Hb) level, hematocrit (Hct), mean corpuscular volume (MCV), mean corpuscular hemoglobin (MCH) and plasma ferritin (PF) were determined and the data collected were analyzed statistically using the t-test. Results The mean PF and TIBC levels were not significantly different in the febrile seizure compared to the reference group; neither were differences in Hb levels statistically significant between two groups. However MCV and MCH were significantly higher in the febrile seizure group (p Conclusion Plasma ferritin levels were not significantly lower in children with febrile seizures in comparison with the children in control group. It seems that iron insufficiency does not play a role in pediatric febrile seizures.