Zinc and Copper Concentrations in Human Milk and Infant Formulas

Objective

Available accurate data on the concentrations of copper (Cu) and zinc (Zn) in human milk throughout lactation and infant formulas is important both for formulating nutritional requirements for substances and to provide a base line for the understanding the physiology of their secretion. The objective of this study was to analyze the concentrations of zinc and copper in infant formulas and human milk during prolonged lactation. Levels of these metals were examined in relation to selected parameters such as age, weight, height, education and occupation of mothers.

Methods

Thirty mothers referred to the selected clinics in Tehran entered the study. Human milk samples were collected at 2 months postpartum. Zinc and copper concentrations were determined by atomic absorption spectrophotometer.

Findings

The mean values of Zn and Cu in human milk were 2.95±0.77mg/L and 0.36±0.11 mg/L. The mean values of Zn and Cu in infant formulas were 3.98±0.25 mg/L and 0.53±0.17mg/L.

Conclusion

No significant relationship was found between levels of trace elements in human milk and evaluated parameters such as age, weight, height, education and occupation of mothers. The concentrations of zinc and copper in breast milk were lower than those reported in the literature.     

Cardiac Troponin T Levels of Umbilical Cord in Neonates with Abnormal Fetal Heart Rate

Objective

Most neonatal encephalopathic disorders appear to be caused by perinatal events. Persistent myocardial ischemia leads to cellular necrosis and release of troponin from cardiac muscles. Fetal distress during labor may be detected by monitoring the fetal heart rate. However little is known about the relationship, if any, that exists between fetal heart rate abnormalities and the fetal cardiac musculature and its function. The aim of this study was to investigate the relationship, if any, of umbilical cord serum levels of cardiac troponin T with fetal bradycardia or late deceleration.

Methods

In this cross sectional study, troponin T level in umbilical cord blood of 80 neonates are measured. There were 23 versus 57 fetuses with and without late deceleration or bradycardia.

Findings

Level of cardiac troponin T in umbilical blood of neonates with fetal bradycardia or late deceleration was elevated in comparison to neonates without bradycardia or late deceleration. There was no relation between umbilical troponin T level and mode of delivery.

Conclusion

Infants with fetal bradycardia or late deceleration during labor had significantly higher cord cardiac troponin T levels. If troponin level is normal, the probability of hypoxia will be very low.     

Malondialdehyde Level in the Cord Blood of Newborn Infants

Objective

In this study, we aim to demonstrate that measurement of the malondialdehyde (MDA) level in the umbilical cord blood of newborn infants born via cesarean section (C/S) and normal vaginal delivery (NVD) is indicative of oxidative stress during the perinatal period.

Methods

The study was conducted at Bakirkoy Training and Research Hospital between January 2006 and April 2006 on 15 newborns born via elective C/S, 15 newborns born via emergency C/S, and 15 newborns born via normal vaginal delivery. Complete blood count, total bilirubin, glucose, creatinine phosphokinase (CPK), uric acid, iron, blood gas, and malondialdehyde levels were measured in the umbilical cord blood

Findings

Malondialdehyde levels in the umbilical cord blood in the emergency C/S and NVD groups were found to be statistically and significantly higher than those in the elective C/S group. In the emergency C/S group, it was determined that the malondialdehyde level increased as the oxygen saturation of the umbilical cord blood increased. In the NVD group, a positive correlation was detected between the total bilirubin and malondialdehyde levels in the umbilical cord blood. In the emergency C/S group, the malondialdehyde level was recorded to be high in the infants with high level of uric acid in the umbilical cord blood.

Conclusion

We concluded that the malondialdehyde level in umbilical cord blood could serve as an indication of perinatal oxidative stress and that it could thus help in preventing permanent damage.     

Resistin in Cord Blood of Small for Gestation Age and Appropriate for Gestation Age Term Neonates

Objective

Placental hormones such as resistin, adiponectin, ghrelin and leptin are known to have considerable role in fetal growth and there are some articles published in this area recently. Nevertheless there is a shortage of data showing association between resistin level and fetal growth; that was why we decided to conduct a study to evaluate this association.

Methods

This study was approved by ethic committee of pediatric health research center and research vice chancellor of Tabriz University of Medical Sciences. In this case-control study we measured the insulin, glucose and resistin in the cord blood of neonates with gestational age of 37 weeks or more in Al Zahra tertiary hospital from March 2011 to March 2012. Thirty-nine appropriate for gestation age (AGA) neonates and 41 small for gestation age (SGA) neonates were studied.

Findings

The umbilical cord blood resistin level was not found to have significant correlation with the type of delivery [normal vaginal delivery (NVD) or cesarean-section (C-S)], neonate’s gender, maternal age or body mass index (BMI). There was no significant difference in the levels of Insulin and glucose between AGA and SGA groups. Resistin level of blood cord in AGA group was 613.76±180.10 (range: 132.6-983.80 ng/ml) and in SGA group it was 1303.47±537.07 (range: 800.9-3001 ng/ml) (P<0.001). Neonates’ weight in AGA group was 3162.82±407.92 g and in SGA group it was 2425.85±32.84 g (P<0.001).

Conclusion

In this study resistin level had reverse correlation with fetal weight in term neonates. The SGA neonates with growth insufficiency have higher resistin levels in their cord blood than AGA neonates with same gestational age. It is recommended to conduct more studies in future with larger population of patients to clarify the resistin role in neonatal birth weight.     

Early versus Late Trophic Feeding in Very Low Birth Weight Preterm Infants

Objective

Improved survival of preterm infants, beneficial effects of trophic feeding and limited data on timing management of enteral feeding for very low birth weight preterm infants requires more researches to determine the exact starting time and increased volumes. This study aims to compare early (<48 h) versus late (>72h) trophic feeding with respect to important neonatal outcomes.

Methods

In a cohort study from September 2007 to October 2008, a total of 170 preterm infants (1000-1500 gram, 26-31 weeks) consisting of 125 who received trophic feeding enterally within the first 48 hours of birth (early group) and 45 fed enterally after 72 h0urs (late group), without major congenital birth defects and severe asphyxia entered the study. Bolus feeding was started in both groups at 1-2 cc/kg every 4-6 hours of human milk or preterm infant formula and was advanced 1-2 cc/kg/day if tolerated along with parenteral nutrition. Feeding intolerance, possibility of necrotizing entrocolitis (NEC), episodes of sepsis, body weight, length of NICU stay, and duration of parenteral nutrition were assessed serially.

Findings

There were no statistically significant differences in the clinical and maternal characteristics of infants in the two groups. The time to gain birth weight (13.75±5.21 vs 20.53±6.31 (P < 0.001)), duration of parenteral nutrition (9.26±4.572 days vs 14.11±6.415 days (P < 0.001)), hospital stay (12.14±8.612 vs 21.11±1.156 (P < 0.001)) were significantly shorter in early compared to late feeding group; none of the two groups experienced a high incidence of late onset sepsis (P = 0.73). There was 1 case of confirmed NEC in every group.

Conclusion

The benefits of early trophic feeding shown by this study strongly support its use for the preterm infants without adding to complications.     

Cord Blood Alkaline Phosphatase as an Indicator of Neonatal Jaundice

Background:

Management of hyperbilirubinemia remains a challenge for neonatal medicine because of the risk of neurological complications related to the toxicity of severe hyperbilirubinemia.

Objectives:

The purpose of this study was to examine the validity of cord blood alkaline phosphatase level for predicting neonatal hyperbilirubinemia.

Patients and Methods:

Between October and December 2013 a total of 102 healthy term infants born to healthy mothers were studied. Cord blood samples were collected for measurement of alkaline Phosphatase levels immediately after birth. Neonates were followed-up for the emergence of jaundice. Newborns with clinical jaundice were recalled and serum bilirubin levels measured. Appropriate treatment based on serum bilirubin level was performed. Alkaline phosphatase levels between the non-jaundiced and jaundiced treated neonates were compared.

Results:

The incidence of severe jaundice that required treatment among followed-up neonates was 9.8%. The mean alkaline phosphatase level was 309.09 ± 82.51 IU/L in the non-jaundiced group and 367.80 ± 73.82 IU/L in the severely jaundiced group (P = 0.040). The cutoff value of 314 IU/L was associated with sensitivity 80% and specificity 63% for predicting neonatal hyperbilirubinemia requiring treatment.

Conclusions:

The cord blood alkaline phosphatase level can be used as a predictor of severe neonatal jaundice.     

Measurement of the Urinary Lactate/Creatinine Ratio for Early Diagnosis of the Hypoxic–Ischemic Encephalopathy in Newborns

Objective

Hypoxic ischemic encephalopathy (HIE) is a major cause of permanent neurological disabilities. Perinatal asphyxia may induce neonatal mortality after birth or neurological impairment among survivors. There are no reliable methods for identifying infants at risk for this disorder.

Methods

We measured the ratio of lactate/creatinine (L/C) in urine by proton nuclear magnetic resonance spectroscopy within 6 and 24 hours after birth in 50 normal infants and 50 infants with asphyxia who developed hypoxic–ischemic encephalopathy. The study was performed from September 2006 to May 2007. For statistical analysis, the SPSS software was used. Group comparisons were performed with chi-square and t-test(1, 5).

Findings

L/C ratio was 3.3±2 among asphyxiated neonates in the first six hours after birth which was 11 folds greater than in normal neonates (0.3±0.08, P=0.0001). This ratio decreased to 1.5±0.55 for asphyxiated cases in the first 24 hours after birth, which was 5 folds greater than in control group (P=0.0001). Asphyxiated neonates were subdivided into Group A with mild asphyxia and L/C ratio 2.5±0.5; Group B with moderate asphyxia and L/C ratio 4.2±1.5; and Group C with severe asphyxia and L/C ratio 3.4±3.3. The severity of asphyxia correlated with the greater L/C ratio among our cases and was significant (P=0.0007). The sensitivity and specificity of L/C ratio in cut off point of 0.48, was 96.1% and 100% respectively.

Conclusion

Measurement of the urinary L/C ratio soon after birth maybe a promising tool to identify asphyxiated neonates and also to predict the severity of asphyxia.     

T-Peak to T-End Abnormality in Pediatric Patients with Syncope

Objective

The purpose of this study was to examine the relationship between T-peak-to-T-end interval and its dispersion in children with syncope to detect possible repolarization abnormalities in these patients.

Methods

We enrolled 19 patients with a positive tilt test for syncope (7 boys, 12 girls) and 35 participants with normal results on the test.

Findings

Mean age was 11.4±3.1 years in patients and 10.0±5.1 years in controls (P =0.27). The T-peak-to-T-end interval in lead V1 was significantly longer in patients with a positive tilt test (0.36±0.062 vs. 0.32±0.071, P=0.007). T-peak-to-T-end interval dispersion was significantly greater in the group of patients (0.15±0.07 vs. 0.11±0.04, P±0.003).

Conclusion

The T-peak-to-T-end interval in lead V1 and T-peak-to-T-end dispersion were significantly larger in patients with a positive tilt test. Our findings suggest a depolarization abnormality in children with syncope.     

The Role of Zinc Sulfate in Acute Bronchiolitis in Patients Aged 2 to 23 Months

Objective

Evaluating the effect of zinc sulfate in improving the clinical manifestations of acute bronchiolitis in children younger than 2 years.

Methods

This was a double blind pilot trial on 50 patients aged 2 to 23 months at Ghaem and Dr. Sheikh Hospitals in Mashhad from January 2008 to March 2009. Patients were randomly divided into two groups: a case group received oral zinc sulfate and to the control group was given placebo.

Findings

Mean age of case group was 168.0±108.6 days and control group 169.2±90.4 days (P=0.98) with male predominance in both groups. At first there was no statistically significant difference between the two groups in reducing the symptoms. But 24 hours after treating, improvement of some important manifestations including tachypnea, subcostal and intercostal retraction, wheezing and cyanosis revealed statistically significant difference in control group in comparison with case group (P=0.04).

Conclusion

Zinc sulfate has no benefit in improving clinical manifestations of acute bronchiolitis.     

Outcome of Very Low Birth Weight Infants Over 3 Years Report From an Iranian Center

Objective

Very low birth weight (VLBW) infants are at high risk for morbidity and mortality. This article determines the frequency of disease, rate od survival, complications and risk factors for morbidity and mortality in VLBW neonates admitted to a level III neonatal intensive care unit (NICU) at Mahdieh Hospital in Tehran.

Methods

This cross-sectional retrospective study was performed from April 2007 to March 2010 on all hospitalized VLBW neonates. Relevant pre- and peri-natal data up to the time of discharge from the hospital or death, including complications during the course of hospitalization, were collected from the case notes, documented on a pre-designed questionnaire and analyzed.

Findings

Out of 13197 neonates, 564 (4.3%) were VLBW with 51.4% males. Mean gestational age was 29.6±2.5 weeks; mean birth weight 1179±257 grams. Mean birth weight, gestational age and Apgar scores were significantly higher in babies who survived than in those who died, (1275±189 vs. 944±253 grams; 30.5±2.2 vs. 27.5±2 weeks and 6.9±1.7 vs. 5±2.1 respectively, P<0.001 in all instances). Overall survival was 70.9%; in extremely low birth weight (ELBW) newborns this figure was 33.3% rising to 84.1% in infants weighing between 1001-1500 grams. Respiratory failure resulting from RDS in ELBW babies was the major factor leading to death. Need for mechanical ventilation, pulmonary hemorrhage and gastro-intestinal bleeding were also significant predictive factors for mortality.

Conclusion

Birth weight and mechanical ventilation are the major factors predicting VLBW survival.     

Outcomes of Second Look Exploration in Testicular Torsion of Children

Background:

Testicular torsion (TT), or twisting of the testicle resulting in a strangulation of the blood supply, occurs in men whose tissue surrounding the testicle is not well attached to the scrotum. It is important to emphasize that testicular torsion is a medical emergency.

Objectives:

The aim of this study is to evaluate the second look exploration and outcomes in TT.

Patients and Methods:

Seventy boys out of 124 patients underwent early exploration and 48 hours later second look exploration due to TT. All patients were checked with preoperative color-doppler ultrasonography (CDU) and intraoperative bleeding test. Data included age at admission, side of pathology, relation of TT with season of year, duration of preoperative history, degree of testicular torsion, CDU findings, and degree of bleeding; results of second look exploration, follow-up, and outcomes were analyzed.

Results:

Totally 70 patients were included in this study within five years, of which mean age was 28.6 ± 32.9 months (range 1 to 144), 48% of our patients had nausea and vomiting. Preoperative CDU showed absent/weak flow in 50 (71%) cases. Winter showed most frequently (44%) referred cases of testicular torsion. Orchidopexy was performed in 44 (63%) and orchidectomy in 26 (37%) cases after second look exploration. Mean follow-up duration was 3.1 ± 1.4 years. 4 (9%) cases in orchidopexy group developed testicular atrophy during follow-up, all four cases had a history of longer than 12 hours and grade II testicular bleeding test intra-operatively. Other orchidopexy patients salvaged. 26 patients, who were in grade III, underwent orchidectomy in second look exploration.

Conclusions:

TT requires emergency attention. The ischemia time of the testis is traditionally after 6 hours, and imaging or other diagnostic modality should not be a cause of delay. Early surgical exploration is modality of choice, and second look exploration after 48 hours can be more effective and salvageable in these patients.     

The Effect of Clofibrate on Decreasing Serum Bilirubin in Healthy Term Neonates under Home Phototherapy

Objective

This study was designed to determine the effect of clofibrate on neonatal uncomplicated jaundice treated with home phototherapy.

Methods

This clinical trial study was performed on 60 newborns with jaundice that received home phototherapy. Inclusion criteria were body weight between 2500 to 4000 gr, breastfed, total serum bilirubin (TSB) between 14 to 20 mg/dl, aged over 72 hours. The neonates were randomly divided into two groups. All received home phototherapy. Group I received a single dose of 50 mg/kg clofibrate and the other group served as control group. Total serum bilirubin level was measured every 24 hours.

Findings

Two groups were matched regarding weight, sex, age and first TSB. At 24 and 48 hours of treatment, the mean values of TSB in the clofibrate group were 13.72 (1.56), 9.5 (0.56) and in the control group 15.30 (1.44), 12.6 (1.44). The results show that TSB was significantly decreased after 24 and 48 hours in clofibrate group (P<0.001). The mean duration of phototherapy in group I was 72(0.0) hours and in the control group 76.80 (±9.76) hours. The duration of phototherapy was significantly shorter in clofibrate group (P<0.001).

Conclusion

Clofibrate is effective for outpatients with neonatal hyperbilirubinemia who are under home phototherapy. Of course, further studies are needed for approved routine use of this drug in the treatment of neonatal jaundice.     

The Effect of Performing Preoperative Preparation Program on School Age Children's Anxiety

Objective

The purpose of this study was to examine effects of performing preoperative preparation program on children''s anxiety.

Methods

This study was performed in Amirkola Pediatrics Hospital, Mazandaran. A randomized controlled trail was performed on 122 children (7–12 years of age) admitted for elective surgery during 15 months. The researcher randomly assigned eligible participants in to the experimental and control groups, after pre-test baseline measurement had been taken. Analyzing was performed through independent t-test and χ² test. P<0.005 was considered statistically significant. The experimental group received therapeutic play and the control group received routine preoperative information preparation.

Findings

The mean and standard deviation of the state anxiety scores of children in experimental and control groups before intervention were 35.52±6.99 and 34.98±6.78, after intervention 31.44±5.87 and 38.31±7.44 respectively. The state anxiety score was lower significantly in the experimental group prior to preoperative surgery than in the control group (P=0.000).

Conclusion

Performing preoperative program with using therapeutic play intervention is effective for preparing children before surgery and decreases their anxiety.     

Efficacy of Chloral Hydrate and Promethazine for Sedation during Electroencephalography in Children; a Randomised Clinical Trial

Objective

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.

Methods

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.

Findings

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.

Conclusion

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.     

Comparison of Two Phototherapy Methods (Prophylactic vs Therapeutic) for Management of Hyperbilirubinemia in Very Low Birth Weight Newborns

Objective

Preterm and low birth weight (LBW) infants are at greater risk of developing bilirubin-associated brain damage compared with term infants. Certainly, phototherapy, if used appropriately, is capable of controlling the bilirubin levels in LBW infants; but there is not a unique phototherapy treatment strategy in LBW infants. This study was designed to compare the prophylactic phototherapy and late treatment of jaundiced newborns weighing 1000-1500 grams.

Methods

Sixty newborns with birth weight 1000–1500 g were studied. They were divided into two groups: the “Prophylactic” group, in which phototherapy started within six hours after birth and continued for at least 96 hours, and the "Treatment" group, which received phototherapy when indicated according to birth weight and suspended when bilirubin level fell below 50% of bilirubin level for blood exchange. Mean value of daily transcutaneous bilirubin (TCB), duration of phototherapy, the need for blood exchange, and the highest TCB value in both groups were analyzed.

Findings

In the prophylactic group, the highest daily mean rate of TCB was 7.71±1.84 mg/dl, which happened on the third day. In the treatment group, it was 8.74±1.72 mg/dl on the fourth day after birth. The TCB values in prophylactic group were significantly less than those of the treatment group only on the fourth and fifth days after birth (P<0.001). Although the median duration of phototherapy in the treatment group was shorter than that of the prophylactic group (137.60±57.39 vs 168.71±88.01 hours, respectively), this difference was not statistically significant. Only one neonate needed blood exchange in the treatment group.

Conclusion

The prophylactic phototherapy treatment for babies weighing 1000–1500 g significantly decreases bilirubin levels on the fourth and fifth days after birth but the clinical course of hyperbilirubinemia does not alter in LBW infant, as indicated by the non-significant change in the duration of phototherapy.     

Female Sex as a Risk Factor for Glycemic Control and Complications in Iranian Patients with Type One Diabetes Mellitus

Objective

The aim of this study was to evaluate the influence of sex on glycemic control, diabetes complications and associated abnormalities in patients with type one diabetes mellitus.

Methods

In a cross-sectional study in 309 patients (156 females and 153 males within the age range of 3-16 years) with type one diabetes mellitus referred to endocrinology clinic in Children''s Medical Center in Tehran from March 2005 to March 2007 gender differences in diabetes control were analyzed.

Findings

Mean glycosylated hemoglobin (HbA1c), was significantly higher in females (9.25 vs. 8.01). Insulin dose per kilogram of body weight was significantly more in girls (0.91±0.31 vs. 0.74±0.37, P<0.001) self monitoring of blood glucose was performed significantly more in boys. Frequency of Diabetic ketoacidosis, height growth problems and dyslipidemia were significantly higher in girls. 1.20±0.86 vs. 0.93±0.55, P=0.004), (−0.05±1.20 vs. −0.41±1.17, P=0.015), (134.60±44.43 vs. 110.56±20.72, P=<0.001) respectively.

Conclusion

Female sex is a risk factor in glycemic control and complications of diabetes type I and females should be managed more seriously regarding self monitoring of blood glucose, nutritional and psychological factors and puberty issues.     

Relationship between Blood Pressure and Passive Smoking in Elementary School Children

Objective

Many diseases form their basis during childhood. One example is the changes in vascular structure and function, leading to atherosclerosis. In this study, we have assessed the impact of exposure to cigarette smoke on blood pressure of elementary school children in Kermanshah.

Methods

80 elementary school children exposed to cigarette smoke and 80 not exposed to smoke were studied in fall 2010. Information regarding the smoking status of parents and the children’s health were obtained through questionnaires completed by parents. After physical examination and exclusion of those children with acute and chronic diseases as well as those consuming medicine, we measured and compared blood pressure in the exposure and non-exposure groups. Data were analyzed using the ANOVA statistical test. Values are expresses as Mean±SD.

Findings

The mean systolic and diastolic blood pressures of the exposure group were higher than those of the non-exposure group (109.3±9.97/64.92±7.36 vs105.47±8.98/62.5±7.01, respectively; CI: 0.95, P<0.05). Meanwhile, difference between two groups according to sex was not statistically significant.

Conclusion

Our study indicates that systolic and diastolic blood pressures are higher in those elementary school children exposed to cigarette smoke compared to those who are not.     

Polyamine Oxidase and Diamine Oxidase Activities in Human Milk during the First Month of Lactation

Objective

Human milk (HM) is the ideal food for all newborns and infants. Apart from various bioactive compounds, including cytokines, antibodies, hormones, vitamines, it also contains polyamines, such as spermine (Sp), spermidine (Spd) and putrescine (Put).

Aim

The present study investigated polyamine metabolism in colostrum and mature human milk by measuring the polyamine oxidase (PAO) and diamine oxidase (DAO) enzyme activities, which are necessary for polyamine catabolism, as well as by determining the malondialdehyde (MDA) levels, the final product of polyamine biodegradation.

Methods

The PAO, DAO activity and MDA levels were quantified in colostrum (1st and 2nd day) as well as in mature human milk, 30th day of lactation.

Findings

We found the steady increase of PAO activity and steady decrease of DAO activity and MDA levels during first month of lactation.

Conclusion

Since the products of PAO activity such as, amino aldehydes and hydrogen peroxide (H₂O₂) might have potential antimicrobial effects, promoting the oxidative stress, it is likely that human milk PAO throughout the lactation period, contributes to the protective effects of human milk.     

Pubertal Characteristics in Girls of Qazvin Province,Iran

Objective

Puberty is a critical time between childhood and adulthood. Many studies have reported that the mean age of breast development is decreasing. The aim of this study was to provide updated data on the pubertal development of girls and to evaluate precocious puberty in our population.

Methods

This cross sectional study was conducted in 6 to 16 year old school girls during 2009-2010 in Qazvin. 2240 healthy girls from all geographical regions with every socioeconomic status were selected by a stratified multistage cluster design to obtain representative sample of population. A questionnaire including demographic data, anthropometric measurements, secondary sexual characteristics, menarche status and its onset was filled out for every participant. Secondary sexual characteristics including breast development (B_1–5) and pubic hair (PH_1–5) were evaluated according to Marshal and Tanner recommendation.

Findings

The mean±SD of height, weight, and BMI of participants was 139.7±14.5, 36.1±12.9 and 17.9±3.7 respectively. The mean age (10th – 90th percentile) of B₂ and PH₂ were 9.71(7.67–11.4) and 9.82 years (7.84–11.42) respectively. Mean age of menstruation was 12.52 years. The mean BMI was significantly higher in pubertal females comparing to prepubertal girls (P<0.001). Average duration of puberty (the time from initiation of puberty to menarche) was 2.81 years.

Conclusion

The mean age of pubertal onset in girls living in Qazvin is 9.71 years. Menarche occurs at mean age of 12.52 and onset of puberty earlier than 6.24 years will be precocious. We found that girls in Qazvin had a slightly earlier age of initiation of puberty and of menarche in comparison with other studies in Iran.     

Early Transient Neonatal Cyanosis Related to Interatrial Right-to-Left Shunting at an Altitude of 1890 Meters: A Report of Five Cases

Background

We report five term neonates born at an altitude of 1890 meters with transient early neonatal cyanosis due to right-to-left shunting at atrial level through patent foramen ovale.

Case Presentation

The five neonates with no clinical sign or symptom other than marked cyanosis were examined in two neonatal units of Erzurum city. Hematologic and radiologic examinations were normal. Partial oxygen pressure (PO₂) in the arterial blood samples was lower than 45 mmHg in all of the patients, and did not increase more than 15 mmHg in any of the patients after inhalation of 100% oxygen. Echocardiography revealed normal intracardiac structure. The right-to-left interatrial shunt at diastole was detected through a patent foramen ovale in all of these infants. By only observation with no treatment, diastolic right-to-left shunt disappeared in 40.15±9.52 hours. Oxygen saturation was increased from 69.80±9.55 percent to 90.40±8.80 percent. The patients were discharged from the hospital at 5.6±0.4 days of life. Follow up for 6 months revealed no clinical problem in any of the cases.

Conclusion

Transient cyanosis can be seen in the very early neonatal period because of interatrial right-to-left shunting in some healthy term neonates born at an altitude of 1890 meters. Decreased right atrial compliance due to relative hypoxia at that altitude can be speculated to be the causative mechanism.