Background: The present study was conducted to investigate and compare the effectiveness of the minimally invasive surfactant therapy (MIST) and the INSURE technique (Intubation, Surfactant administration, and extubation) in spontaneously breathing preterm infants. Methods: Preterm infants (28-34 weeks of gestation) born with respiratory distress syndrome between April 2013 and February 2014 were randomly selected to receive 200 mg/kg of surfactant (Curosurf) using either MIST or INSURE techniques. In the MIST group, surfactant was instilled via a thin tracheal catheter (5-f) that was then removed. In the INSURE group, the infants were first intubated, administered surfactant through passing a feeding tube through the endotracheal tube, and then extubated after 30 seconds of positive pressure ventilation. Nasal CPAP for respiratory support continued in both groups after performing the procedures. The amounts of supplemental oxygen required, intensive care requirements, and outcomes were compared between the two groups. Results: The present study examined 27 infants in the MIST group and 26 in the INSURE group. The amount of oxygen required by

The implementation of empowerment program is an effective strategy to promote the readiness of mothers of premature infants at discharge time.

Introduction:Fournier’s gangrene is an infective necrotizing fasciitis of external genital and perineal region. Hematologic malignancies and immunocompromised status are predisposing factors. Simultaneous occurrence of Fournier’s gangrene and congenital leukemia in neonates is extremely rare.Case Presentation:We present a case of Fournier’s gangrene in a 4-day-old female infant with a necrotic lesion in perineum and no history of trauma or other predisposing condition. Focusing on high blast percentage in blood cell count she was affected by acute myeloid leukemia (M4 type). Pseudomonas aeruginosa was isolated from the blood and wound culture. She was treated with broad spectrum antibiotics and supportive care. The parents refused chemotherapy and the patient was discharged from hospital. Bleeding and DIC was the cause of death in a local hospital few days later.Conclusions:High index of suspicion is essential for diagnosis and appropriate treatment. Congenital leukemia should be considered in the differential diagnosis of a newborn with clinical features of sepsis and necrotizing fasciitis.

Background: Since the intraventricular hemorrhage (IVH) is still a serious problem in premature infants associated with poor neurodevelopmental outcomes, there is a need for an accessible tool in order to identify these at high risk neonates. Objectives: To determine if high mean platelet volume (MPV) within 24 hours of birth can identify preterm infants prone to IVH as a simple accessible test. Methods: One hundred premature infants with gestational age (GA) of < 34 weeks with respiratory distress syndrome (RDS) were eligible in this study and were divided into two groups based on the diagnosis of IVH. Measurements of MPV and platelet counts

Pediatric tumors differ markedly from adult tumors in their nature, distribution, and prognosis. In this 10-year retrospective study, we present our experience with fine-needle aspiration (FNA) in pediatric patients 18 years of age and younger and correlate relationship between gender with organ, diagnosis, malignancy, and age. In our study, FNA material of pediatric tumors or masses with 18 years aged and younger were analyzed retrospectively.All FNAs in pediatric patients during this time period were identified and analyzed for age, gender, cytologic diagnosis, and site of aspiration. A total 1000 FNAs were performed from January 2007 to October 2015 in 499 children. Regardless the gender, the most frequently aspirated organ was lymph node, comprising 129 of the 499 cases followed by thyroid (112), neck cyst (79), and parotid (35) cases. The majority of the cases were diagnosed as benign lesions (436 of 499 cases). Other 63 cases comprising 40 female and 23 male cases had malignant lesions. There was significant age difference between people with or without malignancy. In malignant cases, there was a significant difference between the age on males and females. In regard to gender and diagnosis, cytologic diagnosis was stratified into 9 broad diagnostic categories: lymphadenitis, benign and malignant thyroid, cyst contents, benign breast, benign and malignant salivary, and negative for malignancy.In conclusion, our study supports the use of FNA cytology (FNAC) in lesions of various anatomic sites in the children less than 18 years old. As a simple, minimally invasive, and rapid procedure, cytopathologists can reliably utilize FNAC in children. The mean age of children receiving a malignant diagnosis was significantly higher than that of benign lesions. The mean age of malignancy in boys is significantly lower than that of girls with malignancy.

Background: Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography. Objectives: We compared the effectiveness of sonography with radiography for confirmation of the line tip placement. Methods: This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests. Results: A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%. Conclusions: Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

Background:The heel-lancing procedure is a common tissue damaging procedure routinely performed in premature neonates and causes pain. Therefore, efforts should be made to relieve this pain. Objectives: This study aimed to assess the effect of kangaroo mother care (KMC) for a brief duration of 15 minutes on pain intensity of heel lance in preterm newborns admitted to neonatal intensive care units. Patients and Methods:In this clinical trial with crossover design, 64 vitally stable preterm neonates between 30-36 weeks of gestational age, who needed at least two heel lances, were randomly allocated to two groups. In group A, neonates received KMC 15 minutes before, during, and two minutes after the first heel lancing procedure. In group B, neonates were kept in prone position in incubator 15 minutes before lancing. For second heel lancing, the neonates in group A were put in incubator and group B received KMC. Premature Infant Pain Profile (PIPP) was scored during and within two minutes after finishing the procedure in both conditions. Results: The mean score of pain intensity during the intervention was significantly lower in the KMC position (P < 0/000). Mean score of pain intensity at two minutes after intervention was also significantly lower in the KMC position (P < 0/000). Conclusions: KMC before and during heel lancing is a natural, easy to use, and cost-effective method to decrease pain in premature neonates. It is consistent with modern strategy of family-centered care in neonatal units.

Retinopathy of prematurity (ROP) remains a painful examination, despite the common application of local anesthetic eye drops. This study aimed at examining the analgesic effects of 25% glucose in a premature infant pain profile (PIPP) in the first eye examination of infants with ROP. This three-group, randomized clinical trial was conducted from March to February 2017. One oral dose of 25% glucose solution (1 cc/kg) was administered one minute before the first examination of ROP. Mydriatic and anesthetic eye drops were locally instilled in the eyes before the examination for each group. Then, comparisons were made with the control group, which did not receive oral glucose (B), as well as the group which received 1 ml/kg of distilled water (C). The main investigator, who was blinded to the groups, evaluated pain using PIPP at one minute before, during, and one and five minutes after the procedure (ethics code: IR.TUMS.MEDICINE.REC.1396.3130). The baseline characteristics were comparable between the groups. During the procedure, the group receiving oral 20% glucose showed significantly lower PIPP scores (13.8±1.39) compared to the other groups (group B: 15.95±1.27 and group C: 15.10±1.19) (P=0.001). The positive effects persisted for five minutes in this group after the procedure (7.6±1.26), compared to the other groups (P=0.034). During and after ROP screening, oral 25% glucose in combination with local anesthetic eye drops can cause a significant reduction in pain.