Clinical outcome and cost of treatment and care for neonates less than 1000 grams admitted to Vali-e ASR Hospital

Background: The aim of this study is to estimate the cost of care and treatment for extremely low birth weight (ELBW) neonates admitted to a teaching and referral hospital. This cost estimation project can help health policy makers and planners make decisions and develop plans for perinatal service staging programs and better management of NICUs (Neonatal Intensive Care Units). Methods: This cohort study performed on 50 extremely low birth weight neonates (w . 1000gr) born in Vali-e Asr Hospital, Tehran-Iran in the period of March 2012 to September 2013. This teaching and referral hospital had 15 NICU beds as well as an active neonatal growth and development follow-up clinic with a pediatric neurodevelopment specialist during the period of the study. Cases would undergo initial developmental visits and preventative measures immediately after being admitted to the ward. Also after discharge, they were followed up monthly for six months and then every two months, during first year of life. Results: Overalls, 23 newborns -46% of ELBW and 40% of total neonatal mortality rate (that amounted 55) died during hospital stay. Beside hospitalization, the major part of expenses was related to medication and medical supplies. All neonates needing rehabilitation underwent this type of intervention for one year. The mean cost of rehabilitation in neonates with no insurance coverage was 6700 US Dollars per year, which is reduced by half (3350 US Dollars) when covered by insurance. Conclusion: Medication, medical supplies and equipment cost was significantly high. This is especially due to the fact that the present types of insurances do not cover such expenses very well, forcing parents to pay themselves. Insurance systems are expected to take this issue into immediate account

Eosinophilic Granuloma of the Skull Base: Patient with Unique Clinical Moreover, Radiographic Presentation

This case report presents an eight-year-old girl having periauricular swelling and severe pain during mouth opening on the right-side temporomandibular joint (TMJ). CBCT showed extensive destruction of the base of the skull and the roof of the glenoid fossa on the right side. The findings based on CT and MRI images with and without contrast are discussed herein. This report highlights a skull base eosinophilic granuloma that mimics TMJ disorder and the importance of proper evaluation of CBCT images to make an early diagnosis

Autoimmune Polyglandular Syndrome Type 2: An Unusual Presentation

"nAutoimmune polyglandular syndrome (APS) type 2 is characterized by the presence of Addison's disease, in association with autoimmune thyroid disease and/or type 1 diabetes mellitus. APS type 2 occurs most often in middle aged females and is rare in children. Here an 11 year old boy is reported with Addison's disease who developed symptom's of diabetes mellitus, goiter, malabsorption, macrocytic anemia and keratitis. APS type 2 occurs most often in middle aged females and is quite rare in children but one should think to autoimmune poly glandular syndrome type II in patient at any age especially in patients with Addison's disease

Determination of Optimum Performance Strategy of Energy Storage in Power System

Determination of optimal capacity for today energy storages has been specially noticed. The delay in increasing storage production capacity is one of the applications for energy storage supplies in which utilization from energy storage supplies along with improvement in the power status at peak hours of consumption may postpone the demand for installation of a new power plant module. In this essay, the optimal capacity of energy storage is determined in order to reduce exploitation costs by second-order non linear programming. This method expresses this problem with a target quadratic function based on the produced power of units and capacity of energy storage supply. The requirements have been modeled as linear equality and inequality equations. The related constraints for produced power and incremental and decremental power ratio in generators have been considered as well

Lamotrigine Effects on Breastfed Infants

Lamotrigine is a safe anti-epileptic drug among pregnant and lactating women. Some concerns exist regarding the safety of lamotrigine during breastfeeding and related neonatal complications. In this brief review, this matter was evaluated and discussed. In this review study, the medical literature available in search databases such as Embase, Scopus, PubMed, and Medline and even also local medical search engines were evaluated. The results indicated that lamotrigine is a safe anti-epileptic drug for breastfeeding women with rare and usually mild adverse effects among neonates exposed to high milk concentration of this drug and its metabolites. However, close periodical monitoring for infants whose mothers are utilizing lamotrigine is recommended to decrease the probability of severe side effects among them

Ursodeoxycholic Acid Can Improve Liver Transaminase Quantities in Children with Anticonvulsant Drugs Hepatotoxicity: a Pilot Study

The present study has been directed to investigate Ursodeoxycholic Acid (UDCA) effect in children, to reduce the high Liver transaminases induced by Anticonvulsant drugs (drug induced hepatitis). This idea has been driven from Cytoprotective and antioxidant properties of UDCA to be used in drug induced inflammation in Liver. Twenty two epileptic patients aged between 4 mo - 3 yr whom were under anticonvulsant therapy with drugs such as valperoic acid, primidone, levetiracetam, Phenobarbital or any combination of them and had shown Liver transaminases rise , after rule out of Viral-Autoimmune, Metabolic and Anatomic causes, have been prescribed UDCA in dose of 10-15 mg/kg/day, at least for 6 months. Any patient who have shown confusing factors such as genetic disorders with liver involvement or spontaneous decline in enzymes or had not treatment compliance has been excluded from the study. Transaminases range changes as well as Probable side effects of the drug have been monitored. The results indicated that UDCA is effective and well tolerable in the children with drug induced hyper transaminasemia. No side effect has been seen and recorded in this study. Based on this study and its results, we recommend UDCA as a safe and effective choice in drug induced hepatotoxicities

Hemophagocytic Lymphohistiocytosis in a Neonate: Case Report

  Hemophagocytic lymphohistiocytosis (HLH) is a syndrome of pathologic immune activation, occurring as either a familial disorder or a sporadic condition, in association with a variety of triggers. This article will introduce a neonate with HLH in Iran. We report a case of HLH presenting with respiratory distress and fever, hepatosplenomegaly, jaundice and pancytopenia on the second day of life. Typical clinical and laboratory findings were detected in the neonate. HLH was diagnosed according to HLH-2004 guidelines. In spite of initiating the treatment, the disease did not cure. Post-mortem, extensive hemophagocytosis was found in multiple organs. No specific genetic defect was identified. Since HLH is a potentially lethal childhood illness, early diagnosis of this disorder and commences the therapy is important for pediatricians

Comparison of Fecal Calprotectin in Exclusively Breastfed and Formula or Mixed Fed Infants in the First Six Months of Life

We conducted this study to compare fecal calprotectin between exclusively breastfed and formula or mixed fed infants aged one month and six months. Sixty term infants were enrolled from the labor ward of Valiasr Hospital between Oct 2011 and July 2015 and their fecal calprotectin was checked by the ELISA method and Hycult biotech kits. The enrolled infants had a birth weight of 2500-4000 g and no perinatal insults or hospitalization. Stool sampling was done at 1±1 week and at 6n±1 months. The six-month infants had no recent disease, antibiotic use or vaccination. The mean fecal calprotectin was higher in exclusively breastfed infants at first and sixth months than formula and mixed fed infants (368.85±204.49 and 283.21±381.41 µg/g versus 152.59±139.13 and 113.62±92.75 µg/g respectively). (P=0.0001 and 0.018) Fecal calprotectin was higher in infants with GERD than healthy babies in the first and sixth months (P=0.0001 and 0.004). Based on the role of calprotectin in inflammation, its higher levels in exclusively breastfed infants is contrary to breast milk benefits and may be a sign of enhanced mucosal immune maturity in them

Frequency of “Nursing Strike” among 6-Month-Old Infants, at East Tehran Health Center and Contributing Factors

Objective:An abrupt refusal by the infant to breastfeed is often called “nursing strike”. In fact a common reason for cessation of nursing is infant’s refusal to breast feed. This problem can often be overcome. This paper has aimed to identify the causes of “breast feeding refusal” or “nursing strike” in 6 month old infants visiting the East Tehran health center for their scheduled vaccination of 6 months old. Materials and methods:Totally 175 six month old infants were enrolled in this study. A questionnaire was filled by mother for each child and later the infants with “nursing strike” were compared with all others. Results:In this study prevalence of breast feeding refusal in infants was 24%.There was significant relation between the “breastfeeding refusal” and maternal academic education or working status. In this study mothers reported various reasons associated with “refusal breast feeding. According to the mothers playful infant and nasal obstructions were the probable causes for refusal. Conclusion:There is a diverse variety of factors influencing nursing strike. Most of these factors can be prevented by identifying the background reasons and proper training

A Single Center Study of the Effects of Trained Fathers' Participation in Constant Breastfeeding

Constant breastfeeding that depends on the family support. Fathers' involvement is as an important factor of successful breastfeeding. The aim of this study was to evaluate the influence of fathers' participation in constant breastfeeding in Vali-E-Asr Hospital, Tehran, Iran. This interventional study was piloted on spouses of pregnant women participating in pregnancy courses. The case group consisted of fathers attending training courses of breastfeeding during pregnancy (Group A), and the control group was made up of fathers who did not take part in training courses (Group B). The courses were held three times from the 30th week of gestation to the end of pregnancy in a family health research center. Fathers attended three training sessions where they were trained by brochures. After delivery newborns were weighted and examined for jaundice (3-5 days, 30 days, three and six months after birth). According to mothers' views, spouses' participation, encouragement and support in group A, was 11 times more than group B. It means that 47 (94%) of spouses in the group A participated in mothers' constant breastfeeding, but fathers' participation in group B was 60% (30 spouses). This study showed that breastfeeding was more constant in the group that fathers participated in breastfeeding training course. One of the reasons for such a significant difference was spouses' participation, encouragement and support in the trained group. This study showed that fathers' involvement in training programs may influence constancy of breastfeeding