Comparison of developmental status of 5-year-old singleton children born through assisted and natural conceptions

Approximately one percent of current live births of the world are conceived via assisted reproductive technologies [ART]. The purpose of this study was to compare the developmental status of children born through assisted and natural conceptions at the age of five years. In a retrospective cohort study, developmental status of 5 years old children was evaluated via Persian version of 60-month Ages and Stages Questionnaires. Case group consisted of 61 singletons, term babies whom were born through ART in the Research and Clinical Center for Infertility, Yazd, Iran in 2005. Control group consisted of 61 term, first child, singleton and spontaneously conceived born five years old children whom were referred to Shahid Akbari primary health care center in 2010. 58 girls [47.5%] and 64 boys [52.5%] were evaluated. Frequency of developmental delay in domains of fine motor [47.5% vs. 24.6%, p=0.008] and problem solving [60.6% vs. 34.4%, p=0.004] were more in ART born children. On logistic regression, fine motor development state was independently affected by maternal educational level [OR: 5.3, 95% CI: 1.67-16.30, p=0.004] and developmental status in problem solving domains was independently affected by maternal educational level [OR: 4.88, 95% CI: 1.25-19.07, p=0.02] and birth weight [OR: 7.1, 95% CI: 1.78-29.01, p=0.006]. Maternal educational level and birth weight are important factors that influenced developmental outcome of ART born children.

Efficacy of chloral hydrate and promethazine for sedation during electroencephalography in children; a randomised clinical trial

The purpose of this study was to compare efficacy and safety of oral chloral hydrate [CH] and promethazine [PZ] for sedation during electroencephalography [EEG] in children. In a parallel single-blinded randomized clinical trial, sixty 1-10 year old children referred to EEG Unit of Shahid Sadoughi Hospital from January 2010 to February 2011 in Yazd, Iran, were evaluated. They were randomized to receive orally 70 mg/kg chloral hydrate or promethazine 1 mg/kg. The primary outcome was efficacy in adequate sedation and successful recording of EEG. Secondary outcome included clinical side effects, time from administration of the drug to adequate sedation, caregiver's satisfaction on a Likert scale, and total stay time in EEG Unit. Twenty four cases with mean age 2.9 +/- 1.9 years were evaluated. Adequate sedation [Ramsay sedation score of four] was obtained in 43.3% of PZ and 100% of CH group [P=0.00001]. Also in 70% of PZ and 96.7% of CH group, EEG was successfully recorded [P=0.006]. So, CH was a more effective drug. In CH group, EEG was performed in shorter time after taking the drug [32.82 +/- 9.6 vs 52.14 +/- 22.88 minutes, P<0.001] and the parents waited less in the EEG unit [1.29 +/- 0.54 vs 2.6 +/- 0.59 hours, P<0.001]. They were also more satisfied [4.6 +/- 0.6 scores vs 3.1 +/- 1.4 scores, P=0.001]. Mild side effects such as vomiting in 20% of CH [n=6] and agitation in 6.6% of PZ group [n=2] were seen. No significant difference was seen from viewpoint of side effects frequency between the two drugs. The results of the present study showed that chloral hydrate can be considered as a safe and more effective drug in sedation induction for sleep EEG in children

Effect of body massage on increase of low birth weight neonates growth parameters: a randomized clinical trial

Admission of low birth-weight [LBW] neonates in neonatal intensive care unit [NICU] causes their deprivation of tactile and sensory stimulation. The purpose of this study was to evaluate efficacy of body massage on growth parameters [weight, height and head circumference] gain velocity of LBW in Yazd, Iran. A randomized clinical trial study was conducted on LBW neonates whom were admitted to NICU of Shahid Sadoughi Hospital, Yazd, Iran from March to December 2011. Neonates were randomly assigned to two groups. In group one, 20 neonates were received massage three times in a day for consecutive 14 days by their mothers. In group two, intervention consisted of standard and routine care as control group. The primary endpoints were efficacy in increase of mean of weight, height and head circumference that were evaluated 14 days after intervention, at ages one and two months. Secondary outcome was clinical side effects. 17 girls and 23 boys with mean gestational age of 34.4 +/- 1.22 weeks were evaluated. In the body massage group, only weight at the age of two months was significantly higher than the control group [mean +/- SD: 3250 +/- 305 vs. 2948 +/- 121 gr, p=0.005]. No adverse events were seen in the two groups. Body massage might be used as an effective and safe non-medical intervention for increasing of weight gain velocity in LBW preterm neonates

Comparison of growth parameters of 5-year-old singleton children born in assisted versus natural conception

<p><b>INTRODUCTION</b>At present, about 1% of newborns are delivered through assisted reproductive technologies (ART) worldwide. This study aimed to evaluate and compare the growth parameters of children born in assisted and natural conception at 5 years of age.</p><p><b>MATERIALS AND METHODS</b>In a cross-sectional case control study, weight, height and head circumference of 5-year old children were assessed. The case group consisted of term, singleton babies who were products of ART in the Center for Infertility of Shahid Sadoughi University, Yazd, Iran in 2005. The control group consisted of term, fi rst child, singleton and spontaneously conceived 5-year-old children who were referred for vaccination to primary health care center of Shahid Akbari in 2010.</p><p><b>RESULTS</b>Fifty-eight girls (47.5%) and 64 boys (52.5%) "with equal numbers in each of the 2 groups" were evaluated. Sex distribution, mean ages of fathers and mothers were not statistically significant different in both groups. Children born after ART tend to have lower birth weight, smaller birth head circumference and lower weight at 5 years of age. Having low birth weight (<2500 g), being underweight and having short stature at the age of 5 were more common in babies born through ART.</p><p><b>CONCLUSION</b>Growth retardation is more prevalent in babies born through ART. Thus, growth assessment, parents' knowledge about child physical development, and timely and accurate follow-up of these children are necessary for early detection of any growth disorders.</p>

Effect of adenotonsillectomy on adhd symptoms of children with adenotonsillar hypertrophy

Adenotonsillar hypertrophy and obstructive sleep disordered breathing can lead to attention deficit/hyperactivity disorder [ADHD]. The purpose of this study was to evaluate effect of adenotonsillectomy on improvement of ADHD symptoms in a quasi-experimental [before and after] study. The efficacy of adenotonsillectomy on improvement of ADHD symptoms of 35 children aged 5-12 years with adenotonsillar hypertrophy and ADHD was evaluated six months after surgery. Diagnosis of ADHD was based on the DSM-IV criteria in three subtypes [predominantly inattentive type, predominantly hyperactiveimpulsive type and combined type]. Seventeen boys [49%] and eighteen girls [51%] with mean [ +/- SD] age of 7.4 +/- 3.8 years [range: 1-10 years] were evaluated. Frequency of combined type of ADHD decreased significantly six months after adenotonsillectomy [54.3% versus 22.9%, P=0.003]. ADHD inattention score [2.26 +/- 1.93 versus 0.96 +/- 0.45, P=0.005], hyperactivity score [4.23 +/- 3.57 versus 3.57 +/- 8, P=0.03] as well as ADHD combined score [9.66 +/- 2.58 versus 7.2 +/- 3.67, P=0.0001] improved significantly after surgery. Upper air way obstruction due to adenotonsillar hypertrophy might be an important and treatable cause of ADHD and should be considered in evaluation of affected children. Adenotonsillectomy in these children is associated with improvements in ADHD symptoms.

Afebrile seizure subsequent to initial febrile seizure

<p><b>INTRODUCTION</b>Febrile seizure (FS) is the most common paediatric neurological problem. The purpose of this study was to determine the frequency of afebrile seizures subsequent to FS in children with initial FS and to evaluate its risk factors.</p><p><b>METHODS</b>A prospective study was conducted on all children (age 6 months to 6 years) referred with initial FS to the Shahid Sadoughi Hospital, Yazd, Iran, between August 2004 and March 2006, who were followed up for at least 15 months for the occurrence of subsequent afebrile seizures.</p><p><b>RESULTS</b>161 boys and 120 girls (mean age 2.12 ± 1.33 years) were followed up for 34.1 ± 7.8 months. 87 (31%) patients had complex FS and 19 (6.7%) patients had subsequent afebrile seizure, with a mean occurrence time of 10.6 ± 6.4 months. Univariate analysis using chi-square test showed that initial FS within one hour of developing fever (p = 0.0001), neurodevelopmental delay (p = 0.0001), family history of epilepsy (p = 0.0001), recurrent FS (p = 0.003) and focal FS (p = 0.04) were risk factors for subsequent afebrile seizure. On multivariate analysis, neurodevelopmental delay (odds ratio [OR] 2.6, 95% confidence interval [CI] 2.3-3.4), initial FS within one hour of developing fever (OR 1.7, 95% CI 1.2-2.1) and family history of epilepsy (OR 1.5, 95% CI 1.1-1.9) were significant factors.</p><p><b>CONCLUSION</b>Special attention should be paid to children with FS during history-taking and developmental assessments to identify high-risk patients and those who might need prophylactic anticonvulsants.</p>

case report of camptomelic dysplasia

Camptomelic Dysplasia [CMD] is a rare autosomal dominant congenital dwarfism characterized by shortness and bowing of long bones [camptomelia] and other severe skeletal and extra skeletal malformations. CMD is generally considered to be lethal and the majority of cases die in the neonatal period due to respiratory insufficiency. We hereunder report a term male neonate with characteristic clinical and radiological findings of CMD, hydrocephaly, no sex reversal, and a negative family history of skeletal problems who was born to non-consanguineous healthy parents and was admitted to Shahid Sadoughi Hospital, Yazd, Iran, immediately after birth due to respiratory distress. The patient required continuous mechanical ventilation support and all attempts to reduce respiratory support failed and the patient died on the 21th day of his life. Camptomelic Dysplasia is a terrible experience for parents; thus, prenatal diagnosis of CMD by ultrasound is essential and mandatory for a better therapeutic intervention

Efficacy and safety of topiramate as the first - line drug in the treatment of infantile spasms

Infantile Spasms [IS] is one of the catastrophic epileptic syndromes of infancy. The purpose of this study was to evaluate clinical efficacy and safety of to piramate [TPM] as the first -line drug in the treatment of infantile spasms. In a quasi- experimental study, efficacy and safety of TPM in treatment of forty children with IS who were referred to pediatric neurology clinic of Shahid Sadoughi University of Medical Sciences in Yazd, Iran, from September 2008to 2010 was evaluated. Twenty two girls [55%] and 18 boys [45%] with a mean age of 9.2 +/- 3.9 months [range= 3-20 months] were evaluated. Ninety percent of the patients had symptomatic IS. At the end of three months of TPM treatment, 40% of the patients became seizure free, 27.5% had more than 50% reduction in seizure frequency, 27.5% had no notable change in seizure frequency and 5% had an increased frequency of seizures. Transient and mild side effects, which were seen in 32.5% of the patients, included drowsiness in 15%, hypotonia and hyperthermia [each one] in 7.5%and anorexia and weight loss in 2.5%. All side effects disappeared in two or three weeks of treatment. Topiramate is an effective and safe drug in the treatment of IS and could be considered as the first line of treatment

Developmental status of NICU admitted low birth weight preterm neonates at 6 and 12 months of age using ages and stages questionnaire

Low birth weight [LBW or birth weight<2500g] can be one of the serious problems in children. The purpose of this study was to evaluate the developmental status of LBW preterm neonates admitted to neonatal intensive care unit [NICU] at the corrected ages of six and 12 months via the Persian version of Ages and Stages Questionnaires [ASQ]. In a follow up study, fifty LBW preterm neonates admitted to Shahid Sadoughi Hospital NICU in 2008 were evaluated for developmental status at 6 and 12 months of age using ASQ. Twenty four boys and 26 girls with a mean gestational age of 31.3 +/- 2.7 weeks and a mean birth weight of 1480.3 +/- 422.8 grams were evaluated. Developmental delay in gross motor and personal social skills domains were the most prevalent abnormal developmental status at 6 and 12 months of age. Mean score in gross motor skills, personal social skills and problem solving domains at 12 months of age were significantly higher in neonates with birth weight >/= 1500 grams. Mean score in fine motor skills, communication and problem solving domains at 12 months of age were significantly higher in neonates who were exclusively breast fed. LBW and preterm infants admitted to the NICU showed degrees of developmental delay at the ages of 6 and 12 months, especially in the gross motor and personal-social developmental domains on the ASQ. So, evaluation and monitoring of development status of LBW should be emphasized for early and timely diagnosis, investigation, and management

Evaluation of excessive pregnancy weight gain effect in non-diabetic women with normal pre-pregnancy BMI on macrosomia of neonates

The objective of this study was evaluation of excessive pregnancy weight gain effect in non-diabetic women with normal pre-pregnancy BMI on macrosomia of neonate. In a descriptive cross-sectional study, neonate weighs of all term pregnancy in non-diabetic women with normal pre-pregnancy BMI delivered from 2002 to 2004 in Shaheed Sadoughi Hospital in Yazd, were evaluated. Compared with mothers with normal pregnancy weight gain, the risk of macrosomia in offsprings was significantly elevated in women who had excess weight gain. The odds ratio [OR] was 3.3 [95% confidence interval [CI] = 2.2 - 5.1, P = 0.0001]. Given the complications associated with delivering large babies, women may benefit from not gaining excess weight in pregnancy

prevalence of speech disorder in primary school students in Yazd-Iran

Communication disorder is a widespread disabling problems and associated with adverse, long term outcome that impact on individuals' families and academic achievement of children in the school years and affect vocational choices later in adulthood. The aim of this study was to determine prevalence of speech disorders specifically stuttering, voice, and speech-sound disorders in primary school students in Iran-Yazd. In a descriptive study, 7881 primary school students in Yazd evaluated in view from of speech disorders with use of direct and face to face assessment technique in 2005. The prevalence of total speech disorders was 14.8% among whom 13.8% had speech-sound disorder, 1.2% stuttering and 0.47% voice disorder. The prevalence of speech disorders was higher than in males [16.7%] as compared to females [12.7%]. Pattern of prevalence of the three speech disorders was significantly different according to gender, parental education and by number of family member. There was no significant difference across speech disorders and birth order, religion and paternal consanguinity. These prevalence figures are higher than more studies that using parent or teacher reports

Recurrence of febrile seizures in Yazd shahid Sadoughi hospital

Febrile seizure is the most common problem in pediatric neurology that occurs in 3-4% of children. The purpose of this study was to determine febrile seizure recurrence frequency and to evaluate its risk factors. In a descriptive prospective study, 139 children [6 months to 6 years] with first febrile seizure were admitted to Yazd Shaheed Sadoughi Hospital between March 2004 and August 2005 and were followed up for at least 15 months for febrile seizure recurrence. Seventy six boys and 63 girls with a mean age of 2.03 +/- 1.21 years were followed up for 25.1 +/- 5.5 months. About 30% of them had complex febrile seizures and 37.4% had febrile seizure recurrence with a mean recurrence time of 6.7 +/- 5.9 months. About 65% of the children younger than one year and 30% of those older than one year had febrile seizure recurrence. [P value= 0.0001] Recurrence of seizure was seen in 63% of those who had seizure within an hour from the onset of fever and in 33% of those who had seizure after one hour from the onset of fever. [P value = 0.0005]. Seizures in children younger than one year old and seizures occurring in association with a fever lasting less than an hour were risk factors of febrile seizure recurrence. Febrile seizure is more disturbing in children younger than one year old. Antipyretic usage was not effective in preventing seizure recurrence but may reduce discomfort and is reassuring

efficacy and safety of zonisamide as an add-on drug in the treatment of Lennox-Gastaut syndrome

The Lennox-Gastaut syndrome [LGS: the triad of intractable seizures of various types, a slow spike-wave pattern in EEG and mental retardation] is one of the most difficult epilepsy syndromes to treat. The aim of this study was to evaluate the efficacy and safety of zonisamide [ZNS] as add-on therapy in seizures of children with LGS. In a quasi-experimental study, seizure frequency and side effects of 40 children with LGS who were referred to the pediatric neurology clinic of Shaheed Sadoughi University of Medical Sciences, Yazd, Iran, between September 2008 and November 2009 and were on ZNS for six months were evaluated. Twenty one boys and 19 girls with a mean age of 6.6 +/- 3.6 years were evaluated. At the end of six months of treatment with ZNS, 25% became seizure free, 25% had >50% reduction in seizure frequency while 35% did not have a notable change in seizure frequency and 15% experienced an increase in seizure frequency. Drug was effective in 62.5% of the myoclonic and generalized tonic-clonic, 50% of the atonic, 43% of the mixed type and 33.4% of the tonic seizures. Transient side effects were seen in 25% of the patients: drowsiness in 10%, hyperthermia in 5% and irritability, fatigue, ataxia and anorexia [each one] in 2.5% of the patients. No serious side effects were reported. ZNS could be considered as an add-on therapy in the management of intractable epilepsy in LGS

[Relationship between delivery type and successful breastfeeding]

Exclusive breastfeeding has a major effect on decreasing the mortality of the children, particularly in developing countries. The aim of this survey was to study the effect of type of delivery on success of exclusive breastfeeding. In a case-control study; 344 women including two equal groups of 172 cases were chosen based on the type of delivery, vaginal or by cesarean section, and followed for 6 months the way of feeding their infants and the rate of exclusive breastfeeding among them. The rate of exclusive breastfeeding was significantly lower in the mothers delivered by cesarean section than who delivered vaginally [13.4% vs. 41.8%]. The average duration of breastfeeding among the women with vaginal delivery was significantly longer than the cases with cesarean delivery [4.5 +/- 1.7 months vs. 4.0 +/- 1.5 months]. The rate of the onset of breastfeeding in the first hour of delivery was significantly higher among the group with vaginal delivery than the group with cesarean section [82% vs. 38%] and finally the rate of formula feeding among the infants of the mothers with cesarean section was higher than in the infants of the mothers with vaginal delivery [33% vs. 22%]. Cesarean section decreases the exclusive breastfeeding and hence attempts should be made to encourage the mothers for vaginal delivery and breastfeeding as well. Besides, discussing the benefits of breastfeeding for both mother and infant, supports the fact that mothers should be advised to attain executive breastfeeding