A new therapeutic strategy for gastroesophageal reflux disease resistant to conservative therapy and monotherapy in preterm neonates: a clinical trial

Background: Gastroesophageal reflux disease (GERD) is one of the most common problems in neonates. The main clinical manifestations of GERD are frequent regurgitation or vomiting associated with irritability, anorexia or feeding refusal, failure to thrive, Sandifer posturing, apnea, bradycardia and stridor in infants. Since the clinical manifestations of GERD are often non-specific in preterm infants, it has been described as the clinical syndrome responding to anti-reflux treatment. Aims: To our knowledge, no clinical trial has compared the efficacy of histamine-2 receptor antagonists (H2RAs) and proton pump inhibitors (PPIs) in preterm infants, nor has any study assessed the effect of adding a prokinetic agent to an acid suppressant and compared them together in these infants, so the present study was conducted. Study design: This study was performed on 58 preterm newborns (mean age, 9.72 ± 6.78 days, 43.2% boys and birth weight of 1,571.9 ± 596.59 grams) with GERD resistant to conservative therapy and monotherapy hospitalized in neonatal wards and NICUs of Shariati and Bahrami Children Hospitals during 2014-2016. Neonates were randomly assigned to a double-blind trial with either oral metoclopramide plus omeprazole (group A) or oral metoclopramide plus ranitidine (group B). After one week and one month, their symptoms and signs were evaluated again. The response rate in each group was the primary outcome and the side effect of drugs in each group was the secondary outcome. Results: Our study showed that both regimens were effective in the treatment of GERD resistant to conservative therapy and monotherapy in premature infants. The response rate of “omeprazole plus metoclopramide” was significantly higher than the response rate of “ranitidine plus metoclopramide” (91.37 ± 7.5 vs. 77.06 ± 3.38, respectively; p = 0.04) (primary outcome). There were no drug-related complications of drugs in both groups in our study (secondary outcome). Conclusion: This study showed that combined therapy led to the response rate of > 70% in each group, but it was significantly higher in group A (> 90%). Both combination therapies led to higher response rate in comparison with conservative therapy and monotherapy used before intervention

a case of acute leukemia with multiple complications due to leukemia and it\'s treatment: case report

Background: Acute leukemia is one of the most common types of childhood malignancies and one fourth of malignancies in this age group is acute leukemia. Acute leukemia may be myeloid or lymphoid. Acute lymphoblastic leukemia is characterized with abnormal proliferation of lymphoid cells and symptoms related to this are acute and if disease is not treated appropriately, it progresses rapidly and end up to death. Diagnosis of these types of malignancies is easily made with evaluation of bone marrow and peripheral blood cells by an expert hematologist. One of the primary sites of leukemic involvement in childhood is oral cavity which is caused by infiltration of leukemic cells in this area. This causes signs and symptoms, for instance, oral lesions gingival hemorrhage and swelling. Case presentation: We present a 13-year-old girl who was referred to local physician due to toothache and gingival lesions. Some medications were prescribed for her without any improvement. Then excision of this painful gingival lesion was done and diagnosis of acute lymphoblastic leukemia was confirmed. After diagnosis and start of appropriate medical therapy, patient developed many different complications of acute lymphoblastic leukemia and its related therapies. What make this presented case as an outstanding and interesting one is the mentioned complications which were more significant with multiple organ involvement in comparison with similar cases. These complications were treated by appropriate managements. Conclusion: With new advance in treatment of ALL, survival rate of patients is increased but unfortunately morbidity rate is significant. These complications may be managed by appropriate therapies and close follow-up

Severe anemia and hydrops in a neonate with parvovirus B19 infection: a case report

Background: Anemia at the time of birth may cause some problem like asphyxia, heart failure shock or even death in a neonate. Different etiologies can be considered for this problem. Parvovirus B19, as a viral organism, can cause hydrops fetalis and neonatal anemia and consequent complications. We present here a case of newborn infant with severe anemia who had human parvovirus B19 infection.Case Presentation: A male newborn with gestational age of 36 week was born from a mother with poor prenatal care and history of contact with domestic animal. The neonate was very pale with Apgar score 2 at 1 min and received resuscitation, mechanical ventilation and repeated blood transfusion The hemoglobin level was significantly low. Analysis was made based on the clinical presentations. According to the case history, physical and laboratory findings, neonatal severe anemia induced by parvovirus B19 infection was suggested and Laboratory work up documented his infection with parovirus B19.Conclusion: Parvovirus B19 (B19 virus) is the smallest single strand linear DNA virus in animal viruses, which is the only strain of parvovirus that is pathogenic in humans. Human parvovirus B19 may cross the placenta and result in fetal infection, morbidity and death. Parvovirus is an uncommon cause of neonatal anemia and hydrops fetalis so this etiology must be considered in differential diagnosis of anemia at birth

Incidence of Intraventricular Hemorrhage and Post Hemorrhagic Hydrocephalus in Preterm Infants

"nGerminal matrix-intraventricular hemorrhage (IVH) is the most common variety of neonatal intracranial hemorrhage and is characteristics of the premature infant. The importance of the lesion relates not only to its high incidence but to their attendant complications (IC: hydrocephalus). Brain sonography is the procedure of choice in diagnosis of germinal matrix- intraventricular hemorrhage and hydrocephalus. In this study we have used brain sonography for detection of intraventricular hemorrhage and post hemorrhagic hydrocephalus and their incidences. The studied population was consisted of premature neonate (birth weight equal or less than 1500g and gestational age equal or less than 37 weeks) who admitted in Mofid Hospital NICU (Tehran, Iran) during a one year period. For all neonate (including criteria) brain sonography in first week of life was done and in presence of IVH, serial Brain sonography was done weekly for detection of hydrocephalus. A total of 57 neonate entered the study. Intraventicular-germinal matrix hemorrhage was seen in 64.4% (35 patients). Forty percent of patients with intraventricular-germinal matrix hemorrhage had grade I, 11% grade II, 25.7% grade III, 2.8% grade VI. Hydrocephalus was detected in 20 percent of patients who had intraventricular-germinal matrix hemorrhage. That incidence of IVH in our study in comparison with other area and situation is higher. Hydrocephaly had direct relation with severity of IVH. This shows that with control of risk factor of IVH, we can control Post hemorrhagic hydrocephalus

Relationship Between Birth Weight and Time of First Deciduous Tooth Eruption in 143 Consecutively Born Infants

Deciduous teeth play an important role in the proper alignment, spacing and occlusion of permanent teeth. The calcification of deciduous teeth begins during the fourth prenatal month, and calcification of all deciduous teeth begin by the end of the sixth prenatal month. The eruption date varies and is genetically influenced. Delayed eruption of deciduous teeth, especially the first teeth, causes nutritional problems for the infants. It also results in parental concerns. In this study, we compared the timing of eruption of the first deciduous teeth in infants in relation to their birth weight. Methods: A total of 143 infants born at Shariati Hospital in Tehran from December 2004 to December 2005 were included in the study. Data on sex, birth weight, gestational age, and time of first tooth eruption were collected. Results: The mean birth weight was 3220 ± 420 g with 5.5% of infants weighing less than 2500 g, and 19.9% weighing more than 3500 g. Patients were monitored weekly from the third month of age until the time of first tooth eruption. The mean age of first tooth eruption was 7.68 ± 1.84 months. Conclusion: There was a negative linear correlation between the time of first deciduous tooth eruption and birth weight, suggesting that delayed tooth eruption may be related to lower birth weight

Prophylactic Effect of Low Dose Vitamin D in Osteopenia of Prematurity: a Clinical Trial Study

Osteopenia of prematurity (OOP) is a preventable disease. Improved survival of premature newborns is associated with an increased incidence of OOP. The purpose of this study was to compare the prophylactic effects of two low doses of vitamin D (200 and 400 IU/Day) on the clinical, biochemical and radiological indices of the rickets of prematurity. In a randomized clinical trial, 60 preterm newborns with birth weight < 2000 g & gestational age < 37 weeks were randomly divided in two groups. Thirty newborns received 200 IU/d of vitamin D in group one and 30 ones received 400 IU/day of vitamin D in group two. On the 6th to 8th weeks of life, serum calcium, phosphate, alkaline phosphates, and 25-hydroxy vitamin D concentrations were measured and x- ray of left wrist and physical examination were performed. Both groups had no difference in biochemical, radiological or clinical presentation of rickets. Current study indicated that low dose vitamin D (200 IU/Day) is enough for prevention of OOP

Relation of Birth Weight with Time of First Deciduous Tooth

The deciduous teeth play a very important role in proper alignment, placing and occlusion of permanent teeth. Calcification of deciduous teeth begins during the fourth month of fetal life, and by the end of sixth month all of the deciduous teeth have begun calcification. Eruption date is variable and timing of eruption "runs in families". Delay of deciduous teeth eruption, especially the first teeth cause nutritional problem for infant and some worries for family. In this study we compare the time of eruption of first deciduous teeth in infant with their birth weight. A total of 148 infant who born at Shariati Hospital in Tehran in 2004- 2005 consecutively entered the study. Other data such as sex, birth weight, gestational age and time of first tooth eruption were collected. The mean birth weight was 3220 &amp;plusmn; 420 grams. 5.5% of cases were less than 2500 grams and 19.9% were over 3500 grams. The patients were followed weekly since third month of birth till the time of their first tooth eruption and the data was analyzed. The mean age of eruption of first tooth was 7.68 &amp;plusmn; 1.84 months. The results showed a reverse linear relationship between first deciduous tooth eruption and birth weight. So delayed tooth eruption may relate to birth weight