کتابچه کنگره 1404

برای دریافت کتابچه خلاصه مقالات سی و هفتمین همایش بیماریهای کودکان و بیست و سومین همایش پرستاری کودکان بر روی لینک زیر کلیک کنید.

کتابچه خلاصه مقالات سی و هفتمین همایش بیماریهای کودکان و بیست و سومین همایش پرستاری کودکان  

 

 

 

 

پیام رئیس همایش

اساتید ارجمند، همکاران گرامی، یاران گران‌مایه

با افتخار، سی و هفتمین همایش سالانه بین‌المللی بیماری‌های کودکان در دانشگاه علوم پزشکی تهران، به عنوان کهن‌ترین و پیشروترین مرکز آموزشی طب کودکان در کشور، برگزار می‌شود. این همایش، همچون سال‌های گذشته، فرصتی بی‌نظیر برای گردهمایی متخصصان و فوق تخصص‌های اطفال، پزشکان عمومی، جراحان اطفال، رادیولوژیست‌ها، محققان علوم پایه (ژنتیک، بیوشیمی، ایمونولوژی، سلول‌های بنیادی و...) و فعالان حوزه پزشکی اجتماعی و سلامت کودک فراهم می‌آورد.

تجربه موفق برگزاری ۳۶ دوره پیشین، این کنگره را به یکی از ارکان کلیدی ارتقاء علمی کشور در حوزه سلامت کودکان تبدیل کرده است.

تمرکز همایش در سال‌های اخیر بر محورهای مهمی همچون کاهش مرگ‌ومیر کودکان، کنترل بیماری‌های تنفسی و گوارشی، ارتقاء سلامت جامعه کودک و به‌ویژه توجه به چالش جوانی جمعیت بوده است.

در راستای تعامل بین‌رشته‌ای و باور به هم‌افزایی دانش، این رویداد به‌صورت دو بخش مجزای پزشکی و پرستاری برگزار می‌شود تا همکاران پرستار نیز از فرصت بازآموزی و تبادل تجربیات علمی با پزشکان بهره‌مند گردند.

 همچنین برای شانزدهمین سال پیاپی، بخش ویژه‌ای به محققان جوان و دانشجویان علوم پزشکی اختصاص یافته است. این بخش با همکاری کانون استعدادهای درخشان و مرکز پژوهش‌های دانشجویی دانشگاه علوم پزشکی تهران، بستری ارزشمند برای ورود نسل جوان به حوزه پژوهش‌های بالینی و بنیادی در طب اطفال ایجاد کرده است. مقالات برگزیده این بخش، در قالب ارائه سخنرانی و پوستر علمی مورد تقدیر قرار خواهند گرفت.

در همایش امسال، توجه ویژه‌ای به نقش فناوری‌های نوین، از جمله هوش مصنوعی، سلول‌درمانی و پزشکی دقیق در سلامت جنین، کودکان و نوجوانان معطوف شده است. این نگاه آینده‌نگر، نشان از تلاش کنگره برای پیوند میان علم روز، درمان مؤثر و ارتقاء سلامت جامعه دارد.

با احترام و آرزوی تندرستی و نیک‌روزی

دکتر روح الله شیرزادی

 

 

پیام دبیر علمی سی و هفتمین همایش بیماری‌های کودکان

گذر زمان، بار دیگر این افتخار را نصیب گروه کودکان دانشگاه علوم پزشکی تهران و مرکز طبی کودکان به‌عنوان قطب علمی اطفال کشور کرده است تا میزبان سی‌وششمین همایش سالانه بیماری‌های کودکان باشیم. این رویداد علمی به مدت چهار روز از تاریخ17  تا 20 مهرماه ۱۴۰4 در مرکز همایش‌های بین‌المللی نورالرضا (ایران) برگزار خواهد شد و فرصتی ارزشمند برای خدمت به جامعه پزشکی کودکان ایران فراهم می‌سازد.

 ارتقاء کیفیت علمی همایش همواره یکی از اهداف اصلی برگزارکنندگان بوده است و در این مسیر، نظرات اساتید، متخصصان و فراگیران طب کودکان نقش مهمی ایفا کرده‌اند.

 در همایش امسال، ۲۱ دوره آموزشی (Teaching Course) دو ساعته طراحی شده است تا به بررسی چالش‌ها و موضوعات رایج در طب کودکان بپردازد. این جلسات با حضور اساتید برجسته برگزار می‌شوند و هدف آن‌ها ارائه راهکارهای کاربردی برای شرکت‌کنندگان است.

 همچنین، ۱۹ پانل تخصصی به مدت ۶۰ تا ۱۲۰ دقیقه با محوریت روش‌های نوین تشخیص و درمان، دستاوردهای علمی جدید و همکاری‌های میان‌رشته‌ای از جمله جراحی، رادیولوژی و آزمایشگاه برنامه‌ریزی شده‌اند.

 با استقبال چشم‌گیر از پانل محققین جوان در سال گذشته، امسال نیز دو پانل اختصاصی برای محققان جوان و دانشجویان پزشکی برگزار خواهد شد. هدف از این برنامه، تقویت حضور پژوهشگران جوان در عرصه تحقیقات بالینی و بنیادی کودکان است.

 فراخوان ارسال مقالات علمی از ویژگی‌های برجسته این دوره است که منجر به انتخاب ۳۰ مقاله برای ارائه شفاهی شده و سایر مقالات نیز در قالب پوستر علمی در ایام همایش ارائه خواهند شد.

 هر روز از ساعت ۸:۰۰ تا ۸:۳۰ صبح، سخنرانی‌های کلیدی با محوریت کاربرد هوش مصنوعی در آموزش، پژوهش و درمان در طب کودکان در سالن اصلی برگزار خواهد شد.

 برنامه‌های علمی همایش به‌صورت هم‌زمان در سه سالن اصلی برگزار می‌شوند و در برخی روزها با توجه به برگزاری کارگاه‌های آموزشی از جمله کارگاه تکامل، از چهار سالن استفاده خواهد شد.

 حضور پررنگ بیش از ۳۰۰ استاد و عضو هیئت علمی از دانشگاه‌های علوم پزشکی سراسر کشور، شامل فوق تخصص‌های اطفال و اساتید علوم پایه، یکی از افتخارات این همایش است.

کلیه مطالب علمی پذیرفته‌شده در قالب یک کتابچه دیجیتال در پایان همایش منتشر و در اختیار شرکت‌کنندگان قرار خواهد گرفت.

 امید است که تغییر زمان برگزاری همایش امسال نسبت به سال گذشته، به‌دلیل هم‌پوشانی با برخی برنامه‌های آموزشی و پژوهشی، شرایط را برای حضور حداکثری اساتید، متخصصان و فراگیران فراهم آورد.

 حضور فعال شما در بزرگ‌ترین رویداد علمی کودکان کشور، علاوه بر بهره‌گیری از جدیدترین مباحث علمی و بالینی، فرصتی برای دیدار دوباره همکاران در فضایی صمیمانه و گامی مؤثر در ارتقاء سلامت نسل آینده ایران خواهد بود.

با احترام و آرزوی تندرستی و نیک‌روزی

دکتر محمود رضا اشرفی

 

 

 

پیام دبیر اجرایی سی و هفتمین همایش بیماری‌های کودکان

به سی و ششمین همایش بیماری‌های کودکان و بیست و سومین همایش پرستاری کودکان خوش آمدید!

با افتخار، میزبان یکی از بزرگ‌ترین و مهم‌ترین رویدادهای علمی کشور در حوزه مراقبت‌های بهداشتی کودکان هستیم. این همایش معتبر که با میزبانی مرکز طبی کودکان، قطب علمی اطفال ایران، برگزار می‌شود، نقطه اتصال دانش، تجربه و نوآوری در درمان کودکان است.

بیش از ۲۰۰۰ شرکت‌کننده از سراسر کشور و جهان در این رویداد گرد هم آمده‌اند؛ از متخصصان مغز و اعصاب، قلب و عروق، گوارش و ریه گرفته تا متخصصان بیماری‌های عفونی، آسم و آلرژی، روماتولوژی، اورولوژی، نفرولوژی، غدد و جراحی کودکان و نوجوانان.

 علاوه بر پزشکان، پرستاران، مراقبان ویژه نوزادان، فعالان حوزه مراقبت‌های تسکینی و اخلاق حرفه‌ای نیز در این رویداد حضور دارند و فرصتی استثنایی برای یادگیری و تبادل نظر فراهم شده است. سخنرانان برجسته داخلی و بین‌المللی، چه به‌صورت حضوری و چه آنلاین، در این رویداد حضور دارند تا آخرین یافته‌ها، پیشرفت‌ها و تجربیات خود را در زمینه سلامت کودک ارائه دهند.

 تاریخ برگزاری: ۱۷ تا ۲۰ مهر ۱۴۰۴

محل برگزاری: مرکز همایش‌های بین‌المللی ایران، تهران

برگزاری همزمان به‌صورت حضوری و آنلاین در چهار سالن مجهز، با ظرفیت بیش از ۲۰۰۰ نفربا ما همراه باشید تا در فضایی علمی و الهام‌بخش، گامی مؤثر در ارتقاء سلامت و کیفیت زندگی کودکان برداریم.

همایش امسال، پلی است به سوی آینده‌ای روشن‌تر در مراقبت‌های کودکان.

با احترام و آرزوی تندرستی و نیک‌روزی

دکتر محمد تقی مجنون

 

پیام دبیر علمی بیست و سومین همایش پرستاری کودکان 

با سپاس از الطاف الهی و همراهی اندیشمندان، فرهیختگان و پرستاران فرزانه‌ای که جان و دل خویش را وقف سلامت نسل آینده کرده‌اند؛ مفتخریم که در همایش پرستاری کودکان ۱۴۰۴ با شما همراه هستیم.

پرستاری کودک، تنها مراقبت از جسم کوچک و آسیب‌پذیر نیست؛ بلکه مراقبت از نهاد جامعه، آینده بشریت و معنای انسان بودن است. در جهانی که مرزهای علم، فناوری، اخلاق و طبیعت به‌سرعت در حال دگرگونی است، پرستاری کودکان نیز نیازمند بازنگری، بازآفرینی و هوشمندسازی است.

با شعار الهام‌بخش "پرستاری در تراز آینده: هوشمند‌سازی مراقبت، سلامتِ پایدار کودک، خانواده و پرستار"بر آن شدیم تا بستری علمی، مشارکتی و آینده‌نگر فراهم آوریم؛ بستری که در آنچشم‌اندازهای نو در پرستاری کودک بررسی می‌شود، فلسفه‌های بنیادین مراقبت و نگاه‌های جامع و خانواده‌محور تقویت می‌شوند، تحول دیجیتال، هوش مصنوعی و اخلاق در مراقبت به بحث گذاشته خواهد شد، و از تاب‌آوری پرستار، توانبخشی کودک، تا سلامت روان خانواده‌ها سخن گفته خواهد شد. 

امید است این همایش، نه‌تنها نقطه‌ای برای تبادل دانش، بلکه مجالی برای بازاندیشی در معنای مراقبت در قرن ۲۱ باشد؛ مراقبتی که هم‌زمان علمی، انسانی، فناورانه و عادلانه است.

از همه اندیشمندان، دانشجویان، پرستاران، مربیان و سیاست‌گذاران دعوت می‌کنیم تا با ما همراه شوند؛ با اندیشه، تجربه، و تعهد خود، افق‌های تازه‌ای در پرستاری کودک ترسیم کنند.

با احترام و آرزوی تندرستی و نیک‌روزی

دکتر فاطمه خوشنوای فومنی

 

پیـام دبیر اجرایی بیست و سومین همایش پرستاری کودکان 

با قلبی سرشار از سپاسگزاری به درگاه خداوند متعال که توفیق برگزاری یکسال دیگر همایش پرستاری بیماریهای اطفال را به ما عطا فرمود با افتخار مسئولیت دبیر اجرایی این همایش را بر عهده دارم تا شاهد گردهمایی جمعی از برجسته ترین متخصصان و دلسوزان جامعه پرستاری در عرصه سلامت کودک باشیم و با تلاش همکاران بستری فراهم شود تا آخرین دستاوردهای علمی و بالینی برای جویندگان دانش تبادل و به اشتراک گذاشته شود .

از تمامی اساتید، همکاران و دانشجویان علاقه مند دعوت می نماییم با هنر ارزشمندشان به غنای علمی این رویداد بیفزایند.

هر کودکی که میخندد یادآور این حقیقت است که جهان هنوز زیباست و وظیفه ما حفظ این زیبایی با علم و تعهد و عشق است.

با احترام و آرزوی تندرستی و نیک‌روزی

ماهرخ گلدوست

 

 

اعضای کمیته علمی سی و هفتمین کنگره بیماری های کودکان (به ترتیب حروف الفبا)

  

 

اعضای کمیته علمی بیست و سومین همایش پرستاری کودکان (به ترتیب حروف الفبا)

پرستو آریاملو
 
دکتر بی بی عصمت حسینی
 
دکتر مونا علی نژاد
 
 
 
 
 
منیژه آهنی
 
فرزانه خوش اخلاق
 
دکتر مرجان غفاری
 
 
 
 
 
دکتر افسانه ارزانی
 
دکتر فاطمه خوش نوای فومنی
 
دکتر فاطمه قاسمی
 
 
 
 
 
دکتر اعظم الملوک الساق
 
دکتر سحر دباغی
 
دکتر اعظم قربانی
 
 
 
 
 
بهاره اکبرزاده
 
دکتر نغمه رزاقی
 
دکتر سمیع اله کاظمی
 
 
 
 
 
دکتر زهرا اعمی
 
سمیه رستملی
 
ماهرخ گلدوست
 
 
 
 
 
دکتر همایون بنادرخشان
 
سیمین رنجبران
 
نسرین محمودی
 
 
 
 
 
دکتر مرجان بنازاده
 
دکتر اکرم السادات سادات حسینی
 
دکتر زهره نبی زاده
 
 
 
 
 
دکتر جمال الدین بگجانی
 
دکتر مژگان ساکی
 
دکتر زهرا ندری
 
 
 
 
 
دکتر بتول پورابولی
 
دکتر محبوبه شالی
 
دکتر امین نیکو منظر
 
 
 
 
 
دکتر صالحه تجلی
 
دکتر هومن شهسواری
 
خورشید وسکوئی اشکوری
 
 
 
 
 
دکتر زهرا جعفری
 
دکتر مریم شیری
 
دکتر فاطمه ولی زاده
 
 
 
 
 
دکتر هاله جعفری
 
دکتر آزاده صبح خیز
 
لیلا هاشمی
 
 
 
 
 
دکتر فاطمه حاجی بابایی
 
دکتر زهرا طیبی
 
 
 
 
 
 
 
دکتر مریم حسن پور
 
دکتر عباس عبادی
 
 
اعضای کمیته اجرایی سی و هفتمین کنگره بیماری های کودکان (به ترتیب حروف الفبا)

  

 

اعضای کمیته اجرایی بیست و سومین همایش پرستاری کودکان (به ترتیب حروف الفبا)

فاطمه اسفندیاری
 
حسن عبداللی فر
 
ماهرخ گلدوست
 
 
 
 
 
فهیمه بهجت ذوالپیرانی
 
کتایون فرجی
 
زهرا ناگهی
 
 
 
 
 
فاطمه جعفری لاریمی
 
راحله قاسمي
 
لیلا هاشمی
 
 
 
 
 
مهسا سنگ
 
ثنا کاظمی
 
 
 

 

 

Table Of Content

Oral presentation. 32

Spiritual Interventions for Children in Crises and War: A Review Study…………………. 33

Enhance the self-efficacy of mothers of premature infants in NICU by Teach-back-based training. 34

: The effect of continuous care program on parental care burden and emotional problems in children with phenylketonuria. 35

A review of Challenges Associated with the Implementation of Family- Centered Care in the NICUs of Developing Countries: Challenges and Solutions. 36

Aromatherapy with rose water and peppermint in managing pain a in children after abdominal surgery: A supportive approach for family-centered care. 37

Digital storytelling in pediatric nursing care. 38

Effect of a resilience-based educational program on the spiritual well-being of labor children: A randomized controlled trial 39

Explaining the challenges of caring for mothers with premature babies: A qualitative study. 40

Family-Centered Nursing Strategies for Reducing Child Vulnerability in Natural Disasters. 41

Feeding Fortification in Preterm Infants. 42

Impact of Teach-Back-Based Training on Maternal Discharge Readiness and the Readmission of Preterm Infants to NICU: A Quasi-Experimental Study. 43

Improving Children's Health with Corrective Exercises: A Solution for Text Neck Syndrome. 44

Integrating Cutting-Edge Biomechanical Technologies with Nursing Approaches: New Horizons in the Prevention and Rehabilitation of Musculoskeletal Injuries in Pediatric Athletes. 45

Investigating the psychometric properties of the Cybersecurity Behavior Questionnaire in Iranian children. 46

Nurses' competencies in climate-aware care of children. 47

Nursing Care in Pain management of Hospitalized Neonates. 48

Nursing care of children in health tourism: A comprehensive approach. 49

Oral Nutritional Challenges in Neonatal Intensive Care Unite. 50

Oral Nutritional Challenges in Neonatal Intensive Care Unite. 51

Parental Concerns Regarding Hospitalized Children. 52

Self-care in nurses working in pediatric intensive care units and strategies for its promotion: A systematic review.. 53

The challenge of providing care as an immigrant nurse. 54

The effect of scheduled virtual visits on perceived social support of families of premature infants admitted to the neonatal intensive care unit. 55

The Importance of Maintain the Mother – Infant Dyad in Maternal Support 56

The Perspective of Pediatric Nursing in the Era of Digital and Virtual Health. 57

The process of breaking bad news in pediatrics and newborn infant settings. 58

The Role of Emerging Technologies in Enhancing Social Skills of Children with Autism Spectrum Disorder 59

The role of pediatric nurses in promoting the health and well-being of the next generation. 60

The Role of the Nurse in Facilitating Parent Empowerment: Implementing Collaborative Models in Child-Centered Care. 61

The role of the nurse in improving the psychological and social adaptation of children with chronic illness and their families. 62

Using serious game approach for teaching appropriate behavior regarding security in virtual space to children. 63

چالش های پرستاران در کاربا کودکان و راهکارهای مقابله با آن. 64

حمایت از حقوق مراقبین سلامت.. 65

حمایت کیفری از پرستاران و کادر درمان: تضمین امنیت شغلی و ارتقای کیفیت مراقبت از کودکان. 66

مهارت‌های ارتباطی پرستار با والدین بیماران و نقش تاب‌آوری در مراقبت‌های پرستاری.. 67

“Palliative Care in Children with Severe Neurological Disorders: A Supportive Approach to Improving Quality of Life”. 68

A Putative HACE1 Founder Mutation in Iranian Patients with Spastic Paraplegia and Psychomotor Retardation with or Without Seizures: Five Cases and Literature Review.. 69

Climate Change and the Rise of Pediatric Respiratory Diseases: A Systematic Review of Regional Studies. 70

Prenatal Exposure to Traffic-Related Polycyclic Aromatic Hydrocarbons and Neonatal Thyroid Function: A Cross-Sectional Study in Shiraz, Iran. 71

Probiotics and Rotavirus Vaccine Immunogenicity in Infants and Children: A Systematic Review.. 72

Probiotics: A protective shield from breast milk against necrotizing enterocolitis in the premature new borns. 73

Rehabilitation Needs in Children with Williams Syndrome: A Narrative Review.. 74

Cerebral Autoregulation in Neonates: Physiology and Beyond. 75

Amniotic membrane dressings for treatment of aplasia cutis in newborns. 76

Approach to the Neonate with Respiratory Distress. 77

Case Report: Presentation of a Newborn with Pseudo-Hirschsprung Symptoms at Bahrami Hospital 78

Continuity of Care: Structured Follow-Up Strategies for Preterm Neonates After NICU Discharge. 79

Developmental Follow-up in Premature Infants. 80

Is omeprazole as safe and effective as Lansoprazole in neonatal gastroesophageal reflux disease? A clinical trial 81

Monitoring Growth and Nutritional Outcomes in Neonates: A Case-Based Approach. 82

Neonatal Cholestasis: Introduction, Diagnosis, and Management 83

Neonatal hypovolemic shock. 84

Neonatal metabolic disorders screening. 85

Neonatal surgical emergencies. 86

Pulmonary hypertension of the newborn. 87

Septic Shock in Neonates. 88

Survival rate of very low birth weight neonates and its determinant factors. 89

Vaccination in the premature babies. 90

when, how, why do you do eye screen in neonates. 91

“Long- term Asthma Management". 92

“Treatments for Immunodeficiency Diseases”. 93

Applications of Biologic Drugs in Pediatric Dermatology. 94

Asthma Diagnosis and Differential Diagnosis in Children. 95

Asthma exacerbations treatment 96

Asthma in Iran vs the World. 97

Challenges to the Sustainability of Iran’s National Immunization Program Achievements. 98

Epidemiology, Management, and Follow-up of Patients with Selective IgA Deficiency: Current Evidence and Clinical Considerations. 99

Cardiovascular Effects of Childhood and Adolescent Obesity and Strategies for Prevention and Intervention. 100

Chest X-Ray after Cardiac Intervention in Children. 101

Cyanotic Congenital Heart Diseases. 102

Diagnostic and Procedural Challenges of a Prominent Eustachian Valve During Transcatheter Closure of Atrial Septal Defect: A Case Report 103

Partial Heart Transplantation. 104

Recent Advances in Cardiac Therapies for Duchenne Muscular Dystrophy. 105

Septic Cardiomyopathy. 106

Updates in the treatment of cardiomyopathies in children. 107

A challenging patient with graves disease, developmental delay, premature adrenarche. 108

Calcium, Phosphate, and Vitamin-D homeostasis in children. 109

Classification of Inborn Errors of Immunity: Implications for Diagnosis and Management 110

Congenital hypothyroidism screening in Iran. 111

Expanding the Clinical Phenotype Associated with the NIN Gene; Report of a Patient with Short Stature, Microcephaly and Hearing Loss. 112

Nutritional Rickets in Children. 113

Other types pf vitamin D dependent Rickets. 114

PKU screening in Iran. 115

The Impact of Childhood Obesity on Cardiovascular Health. 116

Transient hyperphosphatasemia ,a benign condition in early childhood. 117

Approach to child with hyperkalemia. 118

Bladder-Bowel Dysfunction (BBD) 119

Challenges in management of hyponatremia in children. 120

Diving Permission for children with renal disease. 121

Functional Bladder Disorders in Children: An overview and classification. 122

metabolic acidosis in children. 123

The importance of DMSA scan in comparison with ultrasound in the early detection of renal parenchymal involvement in children with first- time febrile UTI 124

An Overview of Exanthematous Diseases and their Differential Diagnosis in Pediatric age groups (Panel: Fever and Rash) 125

Association of body mass index with COVID-19 outcome in a pediatric tertiary referral hospital in Iran. 126

Diagnosos of Tuberclosis in children. 127

Future vaccines in Iran: Varicella, Hepatitis A (Panel: Vaccination) 128

measles. 129

roseola. 130

Scarlet Fever in Children: Clinical Features, Streptococcal Exotoxins, and Therapeutic Approaches. 131

Acute hepatitis in children. 132

Chronic Abdominal Pain in Children. 133

Chronic Diarrhea. 134

Infantile colic and gastroesophageal reflux in breastfed and formula-fed infants. 135

Irritable bowel syndrome. 136

Spondylolysis, Spondylolisthesis, and other non‑inflammatory lumbar disorders in pediatrics. 137

Clinical manifestation, diagnosis and initial management of slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease (LCPD) 138

Hypermobility syndrome in pediatric rheumatology. 139

Juvenile Dermatomyositis: An Overview.. 140

When the Variants of the Normal Gait in Children should be Considered Pathologic. 141

“Pediatric Basic and Advanced Life Support: 2020 AHA Algorithms Overview”. 142

Bag-mask ventilation in pediatric patients. 143

Fluid administration in cardiac critically ill child. 144

Fluid Therapy and the Use of Inotropes and Vasopressors in Pediatric Septic Shock. 145

Fluid Therapy in Hyponatremia and Hypernatremia. 146

Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series. 147

The Role of Adjunctive Therapies and Supportive Care in Septic Shock. 148

Minimal Sedation in Pediatrics: Principles, Practice, and Pharmacologic Considerations. 149

Procedural Sedation and Analgesia. 150

Survival Measures after Cardiopulmonary Resuscitation and Related Factors among Children: Retrospective cohort Study in Iran. 151

Zinc Supplementation in Children: Evidence Summary and Recommendations. 152

Early Childhood Development Under Two Years: Milestone Acquisition and Early Detection of Delay. 153

Acute Flaccid Myelitis: What a pediatrician needs to know.. 154

Craniosynostosis. 155

Diabetic ketoacidosis and cerebral edema: a rare case of infarct-like MRI findings in a pediatric patient 156

Early diagnosis in cerebral palsy. 157

Familial Macrocephaly in Children. 158

From Meningitis to Guillain-Barré: An Atypical Pediatric Presentation. 159

Good practice in Treatment of Autoimmune Myasthenia Gravis in Children. 160

Impact of Levetiracetam Monotherapy on Immunological Profile in Pediatric Epilepsy: A Prospective Study. 161

Indications for Referring Pediatric Patients to a Sleep Clinic. 162

Metabolic megalencephaly. 163

Pompe overview.. 164

Practical Evaluation of Children With Macrocephaly. 165

The diagnosis of neuromuscular junction disorder derives. 166

Acute asthma exacerbations in pediatrics. 167

Bronchiolitis. 168

Common Sleep Disorders in Early Childhood and Corrective Strategies. 169

Pnuemina in children. 170

Primary ciliary dyskinesia. 171

Pulmonary Disease Management in Cystic Fibrosis. 172

The efficacy of COVID-19 vaccination in cystic fibrosis patients: a systematic review.. 173

Approach to microcephaly. 174

Iron deficiency supplementation. 175

Supplements in Pediatrics: Challenges and Inappropriate Prescriptions. 176

Death Certificate: Let us Right Writing! 177

Pediatric Palliative Care: As a Need to End-stage Diseases. 178

MERCURY POISONING and REPORT OF 2 CASES. 179

Anemia in Children: A Clinical Sign with Diverse EtiologiesElham Shahgholi 180

Autoimmune Hemolytic Anemia. 181

Chimeric antigen receptor T‑cell (CAR‑T) Therapy in Pediatric Acute Lymphoblastic Leukemia (ALL) 182

epidemiology and clinical manifestations of iron deficiency anemia in children. 183

G6PD Deficiency in Iran: Clinical and Public Health Perspectives. 184

Hereditary Spherocytosis in Children: From Pathophysiology to Long-Term Management 185

HSCT in Pediatric Patients. 186

Iron-Deficiency Anemia (IDA)TREATMENT. 187

Optimizing Care for Infantile Hemangioma: : Scope and Referral Considerations for Pediatricians. 188

Imaging of craniosynostosis. 189

Investigating the Level of Knowledge, Attitude and Performance Students Regarding the Applications of Artificial Intelligence in Nursing. 190

Poster presentation. 190

Moral Distress among Pediatric Intensive Care Unit Nurses: An Examination of Individual, Organizational, and Environmental Factors. 192

“Examining the Factors Associated with Self-Efficacy in Diabetes Management: A Systematic Review”. 193

"Mindful Journey" Exploring the Informational Behavior of Mothers of Children with Leukemia During the Care Transition to Home: A Qualitative Study. 194

A Case Report of Successful Treatment Following Drug Hypersensitivity and Stevens-Johnson Syndrome. 195

A Comparative Study on the Effect of Teaching Methods of Demonstration Activities, Storytelling and Common Activities on Physical and Motor Growth of Preschool Children in Boroojerd city in 1397. 196

A review of the use of virtual reality in reducing pain and anxiety in children undergoing invasive treatments. 197

A Review Study on Sensory Processing Sensitivity in Mothers of Children with Autism Spectrum Disorder 198

A Systematic Review of the Role of Nurses in Promoting the Psychological Well-being of Hospitalized Children. 199

A Systematic Review: Pediatric Nursing at the Edge of Change—Disasters, Migration, and Climate Change. 200

Advances in Family-Centered Care in the Neonatal Intensive Care Unit (NICU) 201

Advancing Post-Discharge Care for Premature Infants: A Comprehensive Framework. 202

An analysis of the research trend of artificial intelligence in nursing in Tehran children's hospitals. 203

Application of Explainable AI Models for Real-Time Pediatric Nursing Assessment: Improving Clinical Accuracy and Family-Centered Care. 204

Applications of Telenursing in the Management of Pediatric Type 1 Diabetes: A Systematic Review.. 205

Artificial Intelligence as an Effective Factor in Pediatric Emergency: A Review of the Application of Modern Algorithms in the Diagnosis and Management of Asthma. 206

Artificial intelligence in pediatric nursing: A systematic review of opportunities, challenges, and management roles. 207

Assessing the health status of Iranian children regarding World Health Organization (WHO) guidelines. 208

Assessment of Nutritional Outcomes and maternal sense of competence in Preterm Infants Fed with Mother’s Own Milk versus Donor Human Milk in Neonatal Intensive Care Unit: a cross-sectional study in Iran. 209

Atraumatic Care During Invasive Procedures for Children: A review article. 210

Causes of readmission of diabetic children within 1 month after discharge to Zahra Mardani Azari Children's Hospital, Tabriz. 211

Challenges and Nursing Strategies in the Care of Infants with Cleft Lip and Palate: A Systematic Review and Evidence-Based Clinical Algorithm Design. 212

Chemotherapy side effects in children and adolescents with leukemia and its relationship with maternal treatment information. 213

Child abuse and its consequences on parents and family: A qualitative study. 214

Children's health challenges in water scarcity: An analysis of the role of pediatric nursing in care and education. 215

Communication challenges caused by wearing masks and strategies used by pediatric nurses ‎during the COVID-19 pandemic: A qualitative study‎ 216

Comparing Hematological Indices of People with Iron Deficiency Anemia, Thalassemia Minor and Major, and Healthy People. 217

Comparing the effect of listening to music and watching cartoon on pain and physiological indices caused by venipuncture in children: A randomized controlled trial 218

Design and Effectiveness of a Smart Digital Parenting Program for Preventing Internet Addiction in Children: A Family-Centered Media Literacy Educational Approach. 219

Digital Ethics in Care: Equity-Centered AI Frameworks in Pediatric and Family Nursing. 220

Digital parenting and the role of nurses in promoting children's mental health in cyberspace. 221

Effectiveness of an AI-Based Health Education Platform in Enhancing Family Health Literacy, Parental Caregiving Self-Efficacy, and Nurse-Family Interaction. 222

Effectiveness of Corrective Exercise Programs on Musculoskeletal Function and Recovery in Hospitalized Pediatric Patients with Cerebral Palsy, Juvenile Idiopathic Arthritis, and Scoliosis: A Systematic Review.. 223

Effectiveness of Mindfulness Based Interventions on Stress Among Caregivers of Children with Chronic Illnesses: Systematic Review.. 224

Effectiveness of Play Therapy for pain and Anxiety Relief in Children Following Surgery: A Systematic Review.. 225

Effects of pinwheel blowing and stress ball squeezing on children’s pain and anxiety during IV catheterization: a randomized controlled trial 226

Empowering Nurses in Providing Psychological Support and Enhancing Social Adaptation of Children and Families: An Innovative Interventional Approach. 227

Enhancing Social Interactions in Children with Autism through a Play-Based Approach. 228

Epidemiology of accidents in children aged 1-59 months in the pre-hospital emergency of Kermanshah-Iran during 2021 to 2023. 229

Evaluating the performance of baby-friendly hospitals of Isfahan University of Medical Sciences in 2024. 230

Evaluation of causes and outcomes of discharge with the personal consent of patients admitted to Shahid Motahari Educational and Medical Center, Urmia, 2024. 231

Factors Associated with Eating Disorders in Children with Type 1 Diabetes: A Cross-Sectional Study. 232

Family at the Heart of Healing: A Systematic Review of the Transformative Power of Family-Centered Care in Child Health. 233

Family Centered Nursing Education in Pediatric Type 1 Diabetes: A Narrative Review.. 234

Family-Centered Care in Pediatric Nursing: Outcomes and Future Considerations. 235

Family-Centered Nursing Care and Parental Satisfaction: Insights from Nurses and Parents. 236

Generative Artificial Intelligence (GenAI) in Critical Care Nursing: A New Approach. 237

Harnessing Machine Learning for Early Prediction of Neonatal Sepsis: An Integrative Review.. 238

Hypnosis-derived Communication in Pediatric Medical Procedures: A Scoping Review of Evidence, Applications, and Future Research Directions. 239

Impact of Nursing-Led Immunonutrition Programs on Immune Reconstitution and Infection Reduction in Pediatric Hematopoietic Stem Cell Transplant Recipients. 240

Impact of Structured Discharge Planning on Readmission Rates, Caregiver Preparedness, and Continuity of Care in Pediatric Nursing. 241

Integrating Artificial Intelligence into Child and Family Health Care and Promotion: A Review of Applications, Implications, and Challenges. 242

Intraoperative Fluid Management Strategies in Pediatric Kidney Transplant Recipients and Their Impact on Graft Function: A Systematic Review.. 243

Investigating factors affecting pediatric obesity: A systematic review.. 244

Investigating the Causes of Discharge Against Medical Advice in the Emergency Department of Shahid Motahari Educational and Medical Center, Urmia, 2024. 245

Investigating the effect of combined training on the sleep habits of school-age children: A randomized controlled trial 246

Investigating the effect of self-care education based on the Orem self-care model on the quality of life of adolescents with diabetes type 1: A randomized clinical trial 247

Investigating the effect of self-management program implementation on the quality of life of adolescents with epilepsy referring to selected children's hospitals in Tehran. 248

Investigating the effectiveness of interventions related to the quality of life of mothers with children with leukemia: A systematic review.. 249

Investigating the effectiveness of self-efficacy-based interventions for mothers of children with cancer: A systematic study. 250

Investigating the Impact of the Pop It Game on Fear Associated with Venipuncture in Children Aged 3-6 Years Admitted to the Emergency Department of Ali Ibn Abi Talib Hospital, Rafsanjan, 2025. 251

Investigating the Implementation of Corrective Preventive Measures for Pressure Ulcers Using the HFMEA Method in the Pediatric Intensive Care Unit 252

Investigating the level of nurses' attitude towards artificial intelligence applications in hospitals under the supervision of Abadan University of Medical Sciences in 2023. 253

Lived Experiences of Mothers in Neonatal Intensive Care about factors affecting sleep mothers: A Qualitative Directed Content Analysis. 254

Lived experiences of mothers with children with hyperactivity. 255

Long-Term Psychosocial Outcomes and Rehabilitation Strategies after Pediatric Burn Injuries: A Systematic Review.. 256

Management of Upper Limb Ischemic Wounds Due to Umbilical Cord Torsion in a Newborn: A Case Report Study. 257

Meta-Analysis Review: Empowering Parents and Nurses in Facing Caregiving Challenges. 258

Mortality status of children aged 1 to 59 months, Tehran University of Medical Sciences. 259

Multidimensional Rehabilitation of Children and Families: From Crisis to Renewal with an Innovative Approach. 260

Music Therapy, Play Therapy, and Virtual Reality as Nursing Led Anxiolytic Interventions During Pediatric Anesthesia Induction: A Systematic Review of Clinical Evidence. 261

Novel Strategies for the Prevention of Intraoperative Hypothermia in Neonatal Surgery: A Systematic Review.. 262

Nursing Care for Pediatric Pneumonia in the Emergency Department: Innovative Nursing Approaches. 263

Nursing Care Strategies in Management of Neonatal Pertussis. 264

Nursing Interventions for the Prevention and Management of Extravasation in Pediatric Patients: A Systematic Review.. 265

Nursing Interventions to Improve Sleep Quality in Hospitalized Children: A Systematic Review.. 266

Occupational therapy in educational schools: a systematic review.. 267

Optimizing Human Milk Nutrient Enrichment for Preterm Infants in the NICU.. 268

Parental Dimensions of Moral Outrage in Pediatric Nursing: Challenges, Consequences, and Opportunities for Support 269

Parental Involvement in the Mental Health Treatment of Hospitalized Children. 270

Pediatric Nursing in the Smart Era: Integrating Artificial Intelligence and Family-Centered Care. 271

Positive changes for mothers of children with leukemia: The correlation of social support with caregiving burden. 272

Prevention of Sudden Infant Death Syndrome: A Review of Risk Factors and Key Strategies. 273

Prevention Strategies for Catheter-Associated Urinary Tract Infections (CAUTI) in Pediatric Patients Following Major Urological Surgery: A Systematic Review.. 274

Psychological Support to Prevent Burnout in Pediatric Nurses. 275

Remote Monitoring for Preterm Neonates: Healthcare Providers' Perceptions. 276

Short-term and Long-term Outcomes of Open versus Laparoscopic Surgery for Necrotizing Enterocolitis in Neonates: A Systematic Review.. 277

Smartphone Addiction and Suicidal Ideation in Adolescents: A Narrative Review of Recent Evidence. 278

Systematic Review of Caring for Little Warriors: Care and Intervention Strategies for Childhood Diarrhea. 279

Technological Innovations in Pediatric Critical Care Nursing: Emerging Approaches and Applications. 280

the application of machine learning in the neonatal intensive care unit: an integrated review.. 281

the application of Mobile health in the neonatal intensive care unit: an integrated review.. 282

The Effect of Empathy Skill Training on Therapeutic Communication of Nursing Students in the Care of Hospitalized Children. 283

The Effect of Family-Centered Empowerment Model Based on Multimedia Education on the Quality of Life of Children Aged 8-12 Years with Beta Thalassemia. 284

The Effect of Home Visits on the Health of Low Birth Weight and Preterm Infants: A Narrative Review.. 285

The effect of skin-to-skin contact between father and premature infant on physiological indicators of premature infants. 286

The effect of spiritual care on the resilience of mothers of infants with gender ambiguity (hermaphroditism). 287

The Effective Interventions of Psychological Intervention on Fostering Resilience in Families of Premature Neonates: A Network Meta-Analysis. 288

The Effectiveness of Family-Centered Care Interventions on Psychological Outcomes of Parents of Hospitalized Children: A Systematic Review.. 289

The Effectiveness of Parent Empowerment Programs on Motor and Social Skills in Children with Autism Spectrum Disorder: Systematic Review.. 290

The effectiveness of training nurses in reducing hospital infections in the neonatal intensive care unit (NICU) of Amir al-Momenin A. Genaveh Hospital in 1403. 291

The effects of the Crohn’s Disease Exclusion Diet (CDED) alone versus CDED plus Partial Enteral Nutrition (PEN) on gut microbiome composition in pediatric CD patients. 292

The Efficacy of Tranexamic Acid in Reducing Blood Loss and Transfusion Requirements in Pediatric Congenital Heart Surgery: A Systematic Review.. 293

The Impact of Bundled Care Interventions in Pediatric Nursing. 294

The impact of nursing managers' intervention strategies on patient safety in children's hospitals. 295

The relationship between attachment and needs of mothers of children with chronic physical illness. 296

The relationship between attachment and receipt of family-centered care in mothers of children with chronic physical illnesses. 297

The relationship between receiving family-centered care and the needs of mothers with children with chronic physical illnesses. 298

The Roadmap of Breastfeeding in Iran: From Policy-Making to Implementation in the Health Sector 299

The Role of Artificial Intelligence and Machine Learning in the Future of Pediatric Nursing: A Review of the Application of AI in Early Disease Diagnosis and Prediction of Treatment Outcomes in Children. 300

The role of augmented reality technology in improving self-management of Pediatrics asthma. 301

The Role of Digital Parenting Practices in Mitigating Screen Addiction and Enhancing Psychological Well-being in Children: An Integrative Review.. 302

The Role of Gamification in Enhancing Treatment Adherence Motivation in Children with Cancer: A Systematic Review.. 303

The Role of Gut Microbiome in Neurobehavioral Disorders in Children: A Systematic Review with Focus on Pediatric Nursing Care and Rehabilitation. 304

The role of oxytocin in the treatment of autism spectrum disorder in children: A review study. 305

The Role of Play Therapy and Art Therapy in Reducing Post-Traumatic Stress in School-Aged Children: Systematic Review.. 306

The Role of Trauma-Informed Care in Pediatric Nursing During Disasters: A Systematic Review.. 307

The Role of Virtual Reality on Pain, Fear, and Anxiety During Port Catheter Placement in Pediatric Oncology Patients: A Systematic Review.. 308

Title: The Role and Effectiveness of Play Therapy in Improving the Physiotherapy Experience of Children: A Systematic Review.. 309

Unstable Self-perception in children with cancer 310

Using Air Cushion in the Prevention of Occipital Pressure Ulcer in Children Undergoing Heart Surgery. 311

Using the Internet of Things (IOT) in improving the management of chronic diseases. 312

Prevalence and Diversity of Parasitic Infections Among Kindergarten Children: A Cross-Sectional Study. 313

Bridging the Divide: A Systematic Review of Telehealth's Impact on Healthcare Access for Individuals with Down Syndrome. 314

Emerging Technologies and Childhood Vaccination Coverage: A Systematic Review.. 315

Enhancing Primary School Students’ Road Safety through Traffic Education. 316

Recovery Through Creativity: The Role of Art Therapy in Pediatrics Affected by Disasters. 317

Systematic Review: Digital Parenting, Internet Addiction, and Nomophobia in Children and Adolescents. 318

The Impact of Auditory Interventions on Stress in Preterm Infants: A Review Study. 319

The impact of telehealth education on parental care ability and postoperative nutritional status of infants after congenital heart disease surgery: A systematic review study. 320

The Role of Family Involvement in Improving Health and Quality of Life in Hospitalized Children: A Systematic Review.. 321

The Use of Digital Health Tools to Enhance Treatment Adherence and Quality of Life in Adolescents with Cystic Fibrosis a systematic review article. 322

Therapeutic Positioning as a Nursing Intervention in the NICU: A Narrative Review of Evidence and Clinical Applications. 323

Types of gut microbiota in children with ADHD and adopting nutritional policies. 324

Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag on Pain Intensity Caused by Venipuncture in Children Aged 6-12 Years. 325

Bridging Genomics and Precision Medicine in Pediatric Epilepsy: A Promising Approach to Classification and Management Challenges. 326

Thalassemia in Pediatrics: Pathophysiology, Diagnosis, and Advances in Therapeutics. 327

"Effectiveness of Pain Relief Methods Used in Neonates Admitted to Neonatal Intensive Care Units of Ardabil Teaching Hospitals in 2024". 328

A Case of Schimke Immunoosseous Dysplasia in an Iranian Boy: Diagnostic Clues from Refractory Karyotyping. 329

A Dose-Response Analysis for Assessing the Effect of Massage Therapy in the Treatment of Neonatal Jaundice. 330

Applications of artificial intelligence in neonatal treatment: A systematic review.. 331

Artificial Intelligence Perspectives on HIV: Opportunities and Challenges. 332

Associated Etiologies of Enuresis in 5-to-15-Year-Old-Children. 333

Benign Paroxysmal Vertigo of Childhood - BPVC.. 334

Children's Mask-Wearing Behaviors and the Factors that go along with them during the COVID-19 Pandemic. 335

Comparative Effects of Jadenu® and Exjade® in Beta Thalassemia Major: Patient Satisfaction, MRI T2*, Ferritin, and Biochemical Profiles. 336

Corticosteroid Monotherapy for Non-Cardiac MIS-C: A Safe and Effective Strategy from an Iranian Cohort 337

Early Skin-to-Skin Contact in the First Hour of Life and Breastfeeding Success: A Systematic Review.. 338

Effect of music therapy on behavioral and physiological neonatal outcomes: A systematic review and dose-response meta-analysis. 339

Effect of Sensory Play-Based Intervention on Food Fussiness in Preschool Children: A Pilot Study. 340

Evaluation of Sagittal Balance in Pediatric Lateral Spine Radiographs: A Descriptive Cross-Sectional Study. 341

Evaluation of the Effects of Incorporating Long-Acting Subcutaneous Insulin Into the Standard Treatment Protocol for Diabetic Ketoacidosis in Children. 342

Evaluation of the phototherapy effect on serum electrolytes in term neonates with jaundice. 343

Growth Patterns in Preterm Children: Catch-Up Growth, Wasting, and Obesity Risk from the PERSIAN Birth Cohort 344

Impact of IBD Medications During Pregnancy on Maternal and Child Health: A Systematic Review and Meta-Analysis. 345

Investigating the relationship between economic, social and demographic factors affecting infant mortality in Isfahan University of Medical Sciences during 2022. 346

Investigating the Role of Antioxidant Status in Neonatal Congenital Heart Disease: A Comparative Analysis of Serum Vitamin E Levels. 347

microcephaly caused by maternal hyperphenylalaninemia. 348

Pediatric Sacrococcygeal Teratoma: A 12-Year Clinical Experience from Mofid Children’s Hospital 349

Prevalence of Restless Legs Syndrome (RLS) in children with thalassemia major in Ali Asghar Hospital in Zahedan, Iran. 350

Psychological Outcomes of Pediatric Burn Injuries: A Narrative Review.. 351

Relationship between Physical Activity and Demographic Factors with Overweight/ Obesity among Adolescents in Yazd, Iran. 352

The Impact of War Trauma on the Mental Health of Children with Asthma: A Systematic Review.. 353

The Missing Data: Why We Need Better Information on NK Cell Therapy for Kids with GVHD.. 354

The Role of Artificial Intelligence in Telemedicine for Children with Chronic Diseases: A Narrative Review.. 355

Urinary Neutrophil Gelatinase‑Associated Lipocalin as Prognostic Biomarker in Pediatric Idiopathic Nephrotic Syndrome. 356

Vestibular disorders in children with otitis media. 357

what is REM behavior disorder?. 358

Investigating the rational use of intravenous immunoglobulin (IVIG) in Tabriz Children's Hospital: : A Cross-Sectional Study. 359

Immunization data management by use of electronic registration system in Iran. 360

Assessment of the Diagnostic Value of Major Cardiac Defects through Ultrasound in the First Trimester and Its Correlation with Increased Nuchal Translucency, Tricuspid Regurgitation, and Abnormal Ductus Venosus Flow.. 361

Dilated Coronary Sinus without LSVC Due to Direct Tricuspid Regurgitation Jet 362

Evaluation of the relationship between Left Ventricular Cardiac Output and subsequent neurodevelopment in neonates with hypoxic ischemic encephalopathy admitted to Educational and treatment hospitals in Qom 2022. 363

The Role of Artificial Intelligence in Diagnosis and Prognosis of Kawasaki Disease: A Cross-Sectional Study in Mashhad, Iran. 364

Serum Vitamin B12, Vitamin D, and Zinc Status in Pediatric Diabetes and Their Association with Diabetic Retinopathy: A Narrative Review.. 365

Pelvic Floor Biofeedback Therapy in Pediatric Voiding Disorders: A Literature-Based Review of Efficacy and Clinical Integration. 366

Treatment of hypernatremia. 367

Intestinal Parasitic Infections among Immunocompromised and Healthy Children in Iran. 368

Management of TB in pediatrics. 369

Notes on the Human Papillomavirus (HPV) Vaccine in Pediatrics. 370

Pediatric Burden of Seasonal Influenza and the Impact of Vaccination: A Structured Review.. 371

Re-emergence and Epidemiologic Patterns of Giardiasis in Iranian Children: Drug-Resistance Concerns, Water-Scarcity Challenges, and Targeted Control Strategies. 372

Strain-Specific Behavior of Mycobacterium tuberculosis in Interruption of Autophagy Pathway in Human Alveolar Type II Epithelial A549 Cells. 373

The most prevalent parasitic diseases of children in Ardabil, Iran. 374

Unprecedented Eosinophilia in Fatal Infant Visceral Leishmaniasis: Immunopathological Mechanisms and Clinical Implications. 375

Vaccination in Immunocompromised Children. 376

Approach to Abnormal Liver Function Tests in Children. 377

Association of autoimmune pancreatitis with Raghib syndrome. 378

Constipation in pediatrics. 379

Gall Stone In Children. 380

Gastroesophageal Reflux in Children. 381

Is Simplicity Enough? A Comparison of Logistic Regression and Artificial Intelligence in Predicting Complications of Caustic Ingestion. 382

بی احترامی به رفلکس گاستروکولیک و بروز یبوست در کودکان و نوجوانان. 383

Apophysitis in children. 384

Efficacy and Safety of Ginger Supplementation in Juvenile Idiopathic Arthritis: A Triple-Blind Randomized Study. 385

Accessibility of emergency care for traumatic children in emergency departm.. 386

“Assessment of Injectable Acetaminophen Utilization Patterns in Akbar Hospital, Mashhad: A Drug Utilization Evaluation”. 387

Association of end-tidal and venous carbon dioxide in intubated children. 388

Evaluation of the nutritional status of children with sepsis admitted to pediatric intensive care units (PICU) 389

Optimizing Fluid Therapy in Pediatric Patients with Failure to Thrive: Balancing Hydration and Electrolytes. 390

Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series. 391

Association between Serum Lactate Level and Hospital Outcome in Children with Multi-Trauma. 392

The Epidemiological Pattern of Childhood Injuries and Accidents among Iranian Children: A Systematic Review.. 393

A mild and transient case of Influenza-Associated Encephalopathy in a child: Diagnostic and Clinical Challenges. 394

Acute Leukoencephalopathy with Restricted Diffusion (ALERD) in a 10-Month-Old Infant Secondary to Severe Dehydration. 395

Management Strategies for Pediatric Status Epilepticus. 396

New Approaches to Managing Picky Eating in Children. 397

Novel isolated 1p36.33 duplication with developmental disorder, epilepsy and dysmorphic features. 398

Ophthalmologic manifestations in Patients with Neuro-metabolic Disorders. 399

Psychological Factors and Atopic Dermatitis: A Narrative Review of the Bidirectional Relationship. 400

The effect of Minocycline on patient with Stress-Induced Childhood-Onset Neurodegeneration with Variable Ataxia and Seizures (CONDSIAS) 401

The effect of synbiotics in the treatment of drug-resistant epilepsy and the parental burden of caregivers: a single-arm pretest-posttest trial 402

Title: Enhancing Function and Quality of Life: Occupational Therapy in Cerebral Palsy. 403

Clinical and Imaging Features of Scimitar Syndrome in a 15-year-old boy: A Case Report 404

Common environmental allergens in asthmatic children: A study on the Northeastern Iranian population. 405

Stridor in Children: Etiology, Diagnosis, and Management 406

Trifid Epiglottis as Part of a Complex Congenital Malformation Spectrum: A Case Report and Literature Review.. 407

Identification of a High-MAF TagSNP Panel Linked to the PTS Gene for Confirming Prenatal Diagnosis of BH4 Deficiency. 408

Impact of COVID-19 Pandemic on Otolaryngologic Surgeries in Iranian Pediatrics. 409

Behavior management strategies for pediatric in dental office and scientific criteria for the use of general anesthesia. 410

Drug Resistance in Common Intestinal Parasites of Children in Iran: Novel Therapeutic Strategies. 411

Assessing breast milk adequacy and ways to increase milk production. 412

No to "Iatrogenic child abuse" be a pioneer! 413

Investigation of Clinical Signs of Methadone Poisoning in Children Hospitalized at Shahid Motahari Hospital, Urmia, during the period 2019-2024. 414

Advancements in Pediatric Hematopoietic Stem Cell Transplantation: Emerging Indications for Expert Professionals. 415

Beta thalassemia Gene therapy. 416

Checkpoint Inhibition Prior to Allogeneic Stem-Cell Transplantation in Relapsed/Refractory Hematologic Malignancies: Balancing Efficacy and Risk. 417

Innovative therapeutic strategies for GVHD treatment:immunotherapy and cell based therapies. 418

 

 

 

 

Oral presentation

Spiritual Interventions for Children in Crises and War: A Review Study
پرستاری
Naghmeh Razaghi 1 © ℗, Reyhaneh Omidvar 2
1 Associate Professor, Department of pediatric nursing, Nursing and Midwifery Care Research Center. Mashhad University of Medical Sciences, Mashhad, Iran
2 Student Research Committee School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Introduction and goal: Humanitarian crises such as war, displacement, and natural disasters place children at high risk for psychological and physical harm. In these situations, spiritual and psychosocial interventions can play a supportive role for affected children. This study aimed to review spiritual interventions for children in crises and war settings. Methods: In this review article, studies related to spiritual interventions for children in war and crisis contexts were examined. The databases PubMed, Cochrane, and CINAHL were searched. The search strategy included the keywords: *WAR, disaster, PTSD, spiritual, pediatric*, and studies published in English between 2010 and 2024 were included. A total of 39 articles were initially identified, and after applying inclusion criteria, 10 articles were reviewed. The target population in all studies consisted of children and adolescents affected by war, displacement, or earthquakes. Results: The review of interventions for children exposed to war and terrorism emphasized the importance of providing safety and a sense of security, establishing communication with the child, and addressing their basic needs, including spiritual needs. Recent research shows that spiritual interventions, either directly (e.g., prayer, meaning-making, religious support, and fostering hope) or indirectly (e.g., life narrative reconstruction, spiritually-integrated CBT, and group therapy), significantly improve emotional outcomes for children in crisis situations. Combining evidence-based psychological interventions with spirituality and local cultural practices enhances treatment acceptance and the sustainability of positive effects. Conclusion: In clinical practice and humanitarian planning, spiritual interventions alongside psychological and medical treatments can be considered as part of comprehensive interventions for children. There is a need for further clinical trials with stronger study designs in this field.

Enhance the self-efficacy of mothers of premature infants in NICU by Teach-back-based training
پرستاری
مژگان مصطفی‌نژاد 1, کیمیا کرمی 2, رسول محمدی 3, فاطمه ولی زاده 2 © ℗
1 کارشناسی ارشد پرستاری کودکان، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
2 دانشیار آموزش پرستاری، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
3 استادیار اپیدمیولوژی، مرکز تحقیقات بهداشت تغذیه، دانشکده بهداشت و تغذیه، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
Abstract:

مقدمه: محیط پیچیده و اغلب طاقت فرسای بخش مراقبت ویژه نوزادان (NICU)اغلب برای مادران نوزادان نارس با احساس ترس، اضطراب و عدم اطمینان همراه است. این احساسات می تواند به طور قابل توجهی بر توانایی آنها در پیوند با نوزادان تأثیر بگذارد و به سطوح پایین¬تر خودکارآمدی مادر منجر شود .خودکارآمدی، عاملی حیاتی است که بر اعتماد مادر به خود در مراقبت از نوزاد نارس خود تأثیر ‌گذار است. لذا شناسایی روش¬های موثرتر تقویت خودکارآمدی آن‌ها اهمیت زیادی دارد. هدف این مطالعه تعیین تأثیر آموزش بازخورد محور بر خودکارآمدی مادران نوزادان نارس بستری در NICU بود. روش کار: این مطالعه نیمه تجربی با شرکت 66 مادر دارای نوزارد نارس بستری در NICU بیمارستان شهید رحیمی شهر خرم آباد در سال 1401 -1402 انجام شد. گروه کنترل آموزش به روش روتین بخش را دریافت کردند. در گروه مداخله، پرستاران پس از شرکت در کارگاه آموزش بازخورد محور، از این روش در آموزش به مادران استفاده کردند. ابزار جمع آوری داده ها شامل فرم ویژگی¬های جمعیت¬شناختی و پرسشنامه خودکارآمدی والدینی بارنس بود. یافته¬ها با آزمون¬های آماری تی زوجی، تی مستقل، اندازه اثر دی کوهن، کای اسکوئر، و تست دقیق فیشر تجزیه تحلیل شد. یافته‌ها: در شروع مطالعه، بین دو گروه اختلاف معناداری از نظر ویژگی¬های دموگرافیک و میانگین نمرات خودکارامدی مشاهده نشد (05/0P). در هر دو گروه مداخله (001/0P و 624/1=d) و کنترل(001/0P و 675/0=d)، بعد از مطالعه، افزایش معناداری در میانگین خودکارآمدی مادران مشاهده شد. پس از مداخله اختلاف بین دو گروه از نظر میانگین نمرات خودکارآمدی معنادار بود (001/0=P و 885/0=d). نتیجه‌گیری: این مطالعه نشان داد آموزش بازخورد محور باعث بهبود خودکارآمدی مادران نوزادان نارس بستری در NICU شد. لذا آموزش برگشتی می تواند با افزایش اعتمادبه‌نفس و احساس شایستگی در مادر؛ تداوم مراقبت نوزاد نارس توسط مادر و سلامت آنها را افزایش ی‌دهد. بنابراین توصیه می شود پرستاران آموزش بازخورد محور را به عنوان مداخله‌ای مؤثر و ارزشمند در محیط‌ بخش مراقبت های ویژه نوزادان بکارگیرند. و مدیران پرستاری زمینه ها و مقدمات مورد نیاز برای اجرای آموزش بازخورد محور را در این بخش ها فراهم نمایند. واژه های کلیدی: آموزش بازخورد محور ، مادران، خودکارآمدی، نوزادان نارس. کد اخلاق (Ethics code IR.LUMS.REC.1401.249) دانشگاه علوم پزشکی لرستان 

: The effect of continuous care program on parental care burden and emotional problems in children with phenylketonuria
پرستاری
دکتر کیمیا کرمی 1 ©, سیمین زندیه شیرازی 2 ℗, دکتر فاطمه ولیزاده 3, دکتر سید فاطمه قاسمی 1
1 استاد دانشکده پرستاری خرم اباد
2 استاد دانشگاه علوم پزشکی خرم آباد
3 دانشجوی ارشد کودکان دانشگاه علوم پزشکی خرم آباد
 Abstract: 

فنیل کتونوری یا PKU یک بیماری ژنتیکی است که به عنوان یک صفت اتوزومی مغلوب به ارث می رسد و ناشی از عدم وجود آنزیم فنیل آلانین هیدروکسیلاز مورد نیاز برای متابولیسم اسیدآمینه ی ضروری فنیل آلانین است که در آن انزیم کبدی فنیل آلانین هیدروکسیلازکه تبدیل فنیل آلانین به تیروزین را کنترل می کند، وجود ندارد و منجر به تجمع فنیل آلانین در خون می شود.مطالعات نشان دادند که فنیل کتونوری بیماری دشواری است که هم بیماران و هم والدینشان را به دلیل الزامات رژیم غذایی، هزینه های بالای تهیه فرمولای مخصوص، نیاز به پیگیری و معاینات منظم و احتمال بروز ناتوانی ذهنی و اختلالات روان پزشکی تحت فشار قرار می دهد و بیماران و والدین آنها سطوح بالایی از استرس، اضطراب و بار روانی را تجربه می کنند و لازم است یک برنامه پیگیری طبق یک روش مدون و برنامه ریزی شده انجام شود. این مطالعه مروری با جستجو در سایت‌های¬Google Scholar‌‌، PubMed، ‌‌ Sid , Science Magiran با کليد واژه‌های فارسی والدین،کودکان فنیل کتونوری،مراقبت پیگیر،بار مراقبتی،مشکلات هیجانی-عاطفی و انگلیسی Parents, Phenylketonuria, Patient Care Continuity, Caregivers, Caregiver Burden, Emotions, Emotional Distress و ترکیبی از این واژه¬ها در بازه زمانی 2014-2025 انجام گرفت.جمعا38 مقاله جمع آوری شد که از آنها 10 مقاله انتخاب و نقد گردید. مرور نظام مند شواهد بر اهمیت نقش شبکه‌های اجتماعی در حمایت از خانواده‌ها، به‌ویژه مادران دارای فرزند مبتلا به PKU تأکید دارد. اجرای مدل مراقبت پیگیر برای والدین کودکان مبتلا به فنیل‌کتونوری منجر به افزایش خودکارآمدی والدین و کاهش بار مراقبتی آنان می‌شود.بنابرین پیشنهاد می شود جهت حمایت از والدین این گروه خاص، استفاده از این مدل مراقبتی همزمان با فرآیند ترخیص کودک مورد توجه کادر درمان قرار گیرد. مشکلات هیجانی، رفتاری و روان‌شناختی در کودکان مبتلا به فنیل‌کتونوری و والدین آنان بسیار شایع است و بار مراقبتی بالایی بر خانواده‌ها تحمیل می‌شود. مطالعات، نیاز به مداخلات حمایتی ساختارمند جهت کاهش فشار روانی والدین و بهبود وضعیت هیجانی و رفتاری کودکان را مورد تأکید قرار می‌دهد. پیشنهاد می شود پژوهش‌های کلینیکال ترایال آینده باید بر طراحی مطالعات متنوع‌تر و استفاده از نمونه‌های بزرگ‌تر در محیط های پژوهشی دیگری انجام شوند. همچنین مطالعات مداخله‌ای می‌توانند به ارتقای بهزیستی والدین کمک کنند.

A review of Challenges Associated with the Implementation of Family- Centered Care in the NICUs of Developing Countries: Challenges and Solutions
پرستاری
Farzaneh Khoshakhlagh 1 ℗, Azamolmolouk Elsagh 2 ©
1 MSN, Faculty of Nursing and Prehospital Emergency, Alborz University of Medical Sciences, Karaj,Iran
2 PhD, Faculty of Nursing and Prehospital Emergency, Alborz University of Medical Sciences, Karaj,Iran
Abstract: Abstract Background and Aim: Over the past two decades, the Family-Centered Care (FCC) approach has introduced a new framework for enhancing the quality of healthcare services, especially in Neonatal Intensive Care Units (NICUs). Through the active participation of families in decision-making and care planning, this approach not only strengthens the emotional bond between parents and newborns, but also improves clinical outcomes such as weight gain and reduces medical complications. The aim of this study is to determine the challenges of implementing FCC in the NICUs of developing countries and the role of nurses in addressing these challenges. Materials and methods: This research was designed as a review article, utilizing PRISMA guidelines for article search and selection. PubMed, Scopus, Web of Science, CINAHL, and Embase databases were used to identify relevant studies published between 2011 and 2024. Ultimately, 45 articles from low- and middle-income countries were selected for final analysis. Results: The findings indicated that implementing FCC in developing countries faces numerous obstacles and challenges, including limited financial resources, shortages of trained personnel, inadequate healthcare infrastructure, and cultural differences. Studies conducted in these countries show that such limitations hinder the provision of appropriate services to families and their active involvement in neonatal care. Furthermore, the lack of specialized training for nurses and insufficient support from policymakers and hospital administrators pose additional barriers to effective implementation of this approach. Conclusion: To successfully implement FCC in NICUs of developing countries, it is essential to invest in nurse education and empowerment, strengthen managerial and policy support, and address cultural differences. Providing targeted training programs and establishing suitable infrastructure can help mitigate existing barriers, thereby ensuring better neonatal health outcomes and greater family satisfaction. Keywords: Family Nursing, Intensive Care Units, Neonatal, Developing Countries, Nurses’ Role, Challenges, Solutions 

Aromatherapy with rose water and peppermint in managing pain a in children after abdominal surgery: A supportive approach for family-centered care
پرستاری
زهرا ندری 1 ℗, سیده فاطمه قاسمی 2 ©, فاطمه ولی زاده 2, رسول محمدی 3, مژگان ساکی 3
1 2- کارشناس ارشد پرستاری کودکان، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
2 2- دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
3 2- دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
Abstract: 

رایحه‌درمانی به‌عنوان مداخله‌ای ساده و ایمن، فرصتی برای مشارکت فعال مادر در مراقبت از کودک و تقویت رویکرد خانواده‌محور فراهم می‌کند لذا این مطالعه با هدف مقایسه¬ تاثیر رایحه¬ درمانی با گلاب و نعناع فلفلی بر درد ناشی از عمل جراحی شکم در کودکان 6 تا 12 سال انجام شد. مواد و روش مطالعه: این مطالعه کارآزمایی تصادفی کنترل شده در سال 2024 بر روی 100 كودك 6 تا 12 ساله مراجعه كننده به مرکز آموزشی درمانی کودکان حضرت علی¬اصغر برای عمل جراحي شكم انجام شد. مشارکت کنندگان به صورت تصادفی به دو گروه مداخله رایحه درمانی با گلاب (34 نفر) و نعناع فلفلی (34 نفر) و یک گروه کنترل (32 نفر) تخصیص یافتند. گروه‌های مداخله اسانس گلاب و نعناع فلفلی را در بازه‌های زمان مختلف بعد از عمل جراحی دریافت کردند و گروه کنترل صرفاً پد آغشته به نرمال سالین دریافت کردند. داده‌ها با استفاده از فرم اطلاعات دموگرافیک، مقیاس واکنش های رفتاری ناشی از درد فلاک گردآوری شد. در تحلیل داده‌ها از آزمون‌های کای دو، آنالیز واریانس یک طرفه (آنوا)، تحلیل واریانس اندازه‌های مکرر و آزمون تی نمونه های مستقل در نرم افزار SPSS 21استفاده شد. یافته‌ها: در زمان‌های 6، 9، 12 و 16 ساعت بعد از عمل تفاوت بین گروه‌ها به طور معناداری در میانگین نمره درد مشارکت کنندگان مشاده شد به طوری که میانگین نمرات درد گروه نعناع فلفلی نسبت به گروه رایحه گلاب کمتر بود و میانگین این گروهها نسبت به گروه کنترل کمتر بود. (P0/001) نتیجه‌گیری: نشان داد که رایحه‌درمانی با گلاب و نعناع فلفلی در مدیریت درد کودکان پس از جراحی شکم موثر بوده، لذا پیشنهاد میشود با مشارکت مادر در اجرای مداخله، موجب تقویت مشارکت او در فرآیند مراقبت خانواده‌محور شد. 

Digital storytelling in pediatric nursing care
پرستاری
فاطمه ولی زاده 1, سکینه اکبری 2, سیده فاطمه قاسمی 1, مژگان ساکی 3, هانیه زند لشنی 4 © ℗
1 دانشیار پرستاری، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان
2 دانشجوی دکترای پرستاری، کمیته تحقیقات دانشجویی، دفتر یوسرن، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
3 مربی آموزش پرستاری، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، گروه اتاق عمل و فوریت های پزشکی، دانشکده پیراپزشکی، دانشگاه علوم پزشکی لرستان
4 دانشجوی ارشد پرستاری کودکان، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract: 

مقدمه و هدف: قصه‌گویی دیجیتال، هنر و صنعت انتقال قصه‌ها با استفاده از رسانه‌ها و نرم‌افزارهای مختلف است. مقرون‌به‌صرفه بودن و دسترسی گسترده به ابزارهای دیجیتال، قصه‌گویی دیجیتال را به یک ابزار قدرتمند ارتباطی تبدیل¬کرده¬است. هدف این مطالعه معرفی قصه‌گویی دیجیتال به عنوان یک مداخله مراقبتی در پرستاری کودکان می¬باشد. قصه‌های دیجیتال طراحی¬شده برای بیماران، ارائه‌های چندرسانه‌ای هستند که برای ایجادیک قصه منحصربه¬فرد و احساسی از تجارب مراقبت سلامتی روایت‌ها، تصاویر و موسیقی را ترکیب می‌کنند. قصه¬گویی دیجیتال با آشکارکردن نیازهای پنهان، غیرمتعارف، معمولی و نادیده گرفته شده؛ پتانسیل درمانی برای استفاده در کودکان را دارد. برخی جنبه‌های مثبت قصه‌گویی دیجیتال شامل این موارد می‌شود: 1- قصه‌ها به صورت غیرمستقیم به کودکان آموزش می¬دهند بیماری‌ چگونه به وجود آمده و قابل پیشگیری هستند. این آموزش ترس آن‌ها را کاهش می¬دهد. ‏2-قهرمانهای قصه‌ها با چالش‌ ابتلا به یک بیماری روبرو می‌شوند. کودکان با شجاعت قهرمان قصه همذات‌پنداری و یادمی‌گیرند با ترس خود مقابله¬کنند. 3-کودکان با ابزارهای دیجیتال به طور فعال در قصه‌گویی مشارکت و مثلاً انتخاب می¬کنند شخصیت قصه چطور با بیماری برخوردکند. این تعامل حس کنترل بیشتری در کودکان ایجادمی¬کند. ‏4-اکثر بازی‌های دیجیتال مفاهیم سلامتی و بیماری را به¬صورت سرگرم‌کننده آموزش داده؛ آگاهی کودکان را افزایش و نگرانی و ترس آنها را کاهش¬می¬دهند. 5-پرستاران می‌توانند قصه‌های دیجیتال را متناسب با نیازها و ترس‌های کودکان ساخته و بطور اختصاصی به مشکلات کودکان بپردازند. 6-قصه‌گویی دیجیتال به کودکان کمک می¬کند نسبت به دیگران همدلی بیشتری نشان داده، قادر به درک احساسات و تجربیات دیگران شوند. کاربردهای قصه‌گویی دیجیتال در پرستاری کودکان شامل این موارد می¬باشد. الف) آماده‌سازی جهت جراحی و پروسجرها مانند قصه‌های طراحی شده درباره روند جراحی، بیهوشی، مراقبتهای بعد جراحی برای کاهش اضطراب قبل عمل؛ قصه¬های تصویری برای آموزش گام‌به‌گام فرآیند خونگیری و تزریقات ب) حمایت عاطفی روانی مانند قصه‌های شخصی برای کمک به بیان احساسات توسط کودکان بیمار یا تحت استرس، کمک به مقابله با درد، ترس و بیخوابی. ج) آموزش و ارتقای سلامت ماننند آموزش مهارت‌های خودمراقبتی در آسم، رعایت رژیم درمانی، مدیریت دیابت. د) ارتقای تعامل خانواده و تیم درمان مثل تولید قصه‌های خانوادگی از تجربه بستری جهت بهبود همدلی و ارتباط میان کودک و والدین. ه) آموزش پرستاران و کارکنان مانند آموزش حساسیت‌زدایی، همدلی و درک تجربه کودک به دانشجویان و پرستاران. نتیجه¬گیری: قصه‌گویی دیجیتال یک ابزار نوظهور با چشم‌انداز امیدوارکننده در پرستاری کودکان است. این روش اضطراب را کاهش، مشارکت کودک را افزایش و ابزاری مفید برای آموزش و پشتیبانی عاطفی است. کد اخلاق:مقاله پنل

Effect of a resilience-based educational program on the spiritual well-being of labor children: A randomized controlled trial
پرستاری
Katayoon Faraji 1 © ℗, Fatemeh Khoshnavay Fomani 2, Jila Mirlashari 3, Alireza Boostanipour 4, Amir Kasaeian 5
1 Tehran University of Medical Sciences, Tehran, Iran
2 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 College of Nursing, Seattle University, Seattle, United States
4 Department of Pediatric Nursing, Doctorate in Counseling Member of the American Counseling Association, Virginia, United States
5 Liver and Pancreatobiliary Diseases Research Center, Digestive Oncology Research Center, Clinical Research Development Unit, Digestive Diseases Research Institute, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: This study aims to investigate the effect of resilience interventions on the spiritual well-being of working adolescents. This study is a randomized controlled trial with two groups: intervention and control. The research used psychometrically validated questionnaires to assess spiritual well-being and life orientation (SHALOM). The educational content’s validity was confirmed, and a resilience intervention tailored for adolescents was developed and validated. The study was conducted at a child labor support association, with a sample size of 33 participants in each intervention and control group. Before the intervention, participants completed the spiritual well-being and resilience questionnaires, and the intervention was conducted over eight one-hour sessions twice a week. Post-intervention, the questionnaires were completed again. In the intervention group, the mean resilience score before the intervention was 3.52; after the intervention, it was 3.41. The observed changes were not statistically significant (P0.05), indicating that the intervention did not have a meaningful impact on improving resilience. Similarly, in the control group, which did not receive any intervention, the mean resilience score before the intervention was 3.32; after the intervention, it was 3.27 (P0.05), showing no notable difference in resilience levels in the control group. Regarding spiritual well-being, the mean score in the intervention group was 3.84 before and after the intervention, which decreased to 3.69 (P0.05). In the control group, the score dropped from 3.57 to 3.49 (P0.05). Overall, neither group showed significant changes in resilience or spiritual well-being, suggesting that the intervention did not have a meaningful effect on these outcomes. Therefore, it is recommended that further research be conducted in this area. Highlights In the intervention group, the mean resilience score before the intervention was 3.52; after the intervention, it was 3.41 (P0.05). In the control group, which did not receive any intervention, the mean resilience score before the intervention was 3.32; after the intervention, it was 3.27 (P0.05). Regarding spiritual well-being, the mean score in the intervention group was 3.84 before and after the intervention, which decreased to 3.69 (P0.05). In the control group, the score dropped from 3.57 to 3.49 (P0.05). Overall, neither group showed significant changes in resilience or spiritual well-being, suggesting that the intervention did not have a meaningful effect on these outcomes. Therefore, it is recommended that further research be conducted in this area. Keywords Working Adolescents Child Labor Resilience Spiritual Well-being Nurses Nursing

Explaining the challenges of caring for mothers with premature babies: A qualitative study
پرستاری
فاطمه مهرابی راد 1 ℗, ماندانا ساکی 2 ©, سیده فاطمه قاسمی 2
1 کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دفتر یوسرن، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
2 مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract

مقدمه: زایمان زودرس و تولد نوزاد نارس، یکی از بحرانی‌ترین وقایع زندگی والدین، به‌ویژه مادران، است. این مادران با چالش‌های جسمی، روانی و اجتماعی متعددی روبه‌رو هستند که می‌تواند بر سلامت خود و نوزادشان تأثیر بگذارد. هدف از این پژوهش کیفی، تبیین و شناسایی چالش‌های مراقبت از مادران دارای نوزاد نارس از دیدگاه خود مادران و کادر درمان بود. روش‌شناسی: این مطالعه با رویکرد تحلیل محتوای کیفی انجام شده است. داده‌ها از طریق مصاحبه‌های عمیق و نیمه‌ساختاریافته با 3 پرستار شاغل و 5 مادر دارای نوزاد نارس در بخش‌های مراقبت‌های ویژه نوزادان جمع‌آوری شدند. مصاحبه‌ها به صورت کامل پیاده‌سازی و سپس با استفاده از روش تحلیل محتوای کیفی، کدگذاری و دسته‌بندی شدند. یافته‌ها: پس از تحلیل داده‌ها، چالش‌های مراقبت از مادران در 4 طبقه اصلی و 24 زیر طبقه شناسایی شدند. طبقه های اصلی شامل: «چالش‌های روانی و عاطفی»، «چالش‌های اجتماعی و حمایتی» ، «چالش‌های جسمی و مراقبتی» و «چالش‌های مرتبط با نظام سلامت» بودند. نتیجه‌گیری: نتایج نشان می‌دهد که مادران دارای نوزاد نارس با مجموعه‌ای از چالش‌های پیچیده در ابعاد مختلف روبه‌رو هستند که فراتر از مشکلات صرفاً جسمی است. این یافته‌ها می‌تواند مبنایی برای طراحی مداخلات حمایتی چندبعدی، آموزش اختصاصی کادر درمان و بهبود سیاست‌های بهداشتی برای ارائه مراقبت جامع‌تر و مؤثرتر به این گروه از مادران قرار گیرد. کلیدواژه‌ها: چالش، نوزاد نارس، مادر، تحلیل محتوای کیفی. 

Family-Centered Nursing Strategies for Reducing Child Vulnerability in Natural Disasters
پرستاری
سحر دباغی 1 © ℗
1 استادیار، پرستاری بهداشت جامعه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شهید بهشتی، تهران، ایران
Abstract:

 عنوان فارسی: راهکارهای پرستاری خانواده‌محور برای کاهش آسیب‌پذیری کودکان در بلایای طبیعی مقدمه: بلایای طبیعی می‌توانند بار عظیمی بر سیستم‌های مراقبت‌های بهداشتی موجود وارد کنند و بر ظرفیت ارائه خدمات به موقع و حیاتی به نیازمندان تأثیر منفی بگذارند (1). در خط مقدم مراقبت‌های بهداشتی در بلایا، پرستاران قرار دارند که سابقه طولانی در ارائه مراقبت‌های بهداشتی به جمعیت‌های آسیب‌پذیر در مناطق شهری و روستایی دارند (2). با توجه به بلایای تاریخی مرتبط با آب و هوا مانند زلزله و سیلاب در مناطق مختلف شمالی و جنوبی کشور که کل جوامع را تحت تأثیر قرار داده‌اند، آگاهی از اهمیت نقش آنها در ارائه خدمات مراقبت‌های اولیه پس از یک فاجعه طبیعی افزایش یافته است. کودکان به‌عنوان آسیب‌پذیرترین گروه در بلایای طبیعی،30 تا 50 درصد از جمعیت متأثر از بلایا را تشکیل می‌دهند و آسیب‌پذیری آنها 3 برابر بیشتر از بزرگسالان است (3)، بنابراین نیازمند مداخلات پرستاری ویژه‌ای هستند. مطالعه حاضر با هدف بررسی نظام‌مند راهبردهای مبتنی بر شواهد پرستاری خانواده محور برای محافظت از کودکان در بلایای طبیعی انجام شده است. روش کار: برای تدوین استراتژی جستجو، از پایگاه‌های داده معتبر بین‌المللی شامل PubMed/MEDLINE، Scopus، Web of Science، CINAHL ، Cochrane Library و EMBASE و همچنین پایگاه‌های فارسی Magiran، SID و IranMedex استفاده شد. کلیدواژه‌ها بر اساس ساختار PICO و همچنین با استفاده از مترادف‌های کلیدواژه‌های مرتبط چون "بلایای طبیعی"، "کودکان"، "مراقبت پرستاری" و "خانواده" و ترکیب آن‌ها با عملگرهای بولین انجام پذیرفت. محدوده زمانی جستجو به مطالعات منتشر شده بین سال‌های 2010 تا 2024 محدود شد. از بین 125 مقاله، 17 مقاله بر اساس معیار ورود به پژوهش (نوع پژوهش، گروه هدف، نوع مداخله، پیامد) انتخاب گردیدند. نتایج: یافته‌ها نشان داد که بلایای طبیعی با مکانیسم‌های سه‌گانه زیر، نظام خانواده را به عنوان هسته مراقبت از کودک تحت تأثیر قرار می‌دهند: 1. سیب‌های جسمانی خانواده‌محور (شامل: اختلال در نقش مراقبتی خانواده به دلیل صدمات فیزیکی اعضا، تهدید امنیت غذایی خانواده و کاهش توان والدین در تأمین تغذیه مناسب، محدودیت دسترسی خانواده‌ها به خدمات بهداشتی اولیه برای کودکان) ، 2. آسیب‌های روانی-اجتماعی در بستر خانواده (تضعیف عملکرد والدین به دلیل ترومای جمعی خانواده، اختلال در دلبستگی ایمن کودک-والد ناشی از استرس پس از سانحه، فروپاشی شبکه‌های حمایتی سنتی خانواده‌های گسترده)، 3. اختلال در کارکرد آموزشی خانواده (از دست دادن نقش نظارتی خانواده در تحصیل به دلیل جابجایی‌های اجباری، تغییر نقش‌های خانوادگی و الزام کودکان به کار برای تأمین معاش، کاهش سرمایه فرهنگی خانواده در پی تخریب مدارس). انواع مداخلات بر 

Feeding Fortification in Preterm Infants
پرستاری
Saleheh Tajalli 1 © ℗
1 School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Preterm birth remains a significant global health challenge, often accompanied by complex nutritional needs that demand specialized care. Among the most critical interventions in neonatal nutrition is feeding fortification—a strategy designed to bridge the gap between the limited nutritional reserves of preterm infants and their accelerated growth and developmental demands. This narrative review explores the rationale, methods, and clinical implications of feeding fortification in preterm infants, emphasizing its role in optimizing outcomes during the neonatal period and beyond. Human milk, while ideal in many respects, often falls short of meeting the elevated protein, energy, calcium, and phosphorus requirements of preterm infants. Fortification, whether through human milk fortifiers or preterm formulas, provides essential nutrients that support catch-up growth, bone mineralization, and neurodevelopment. The timing, composition, and individualization of fortification strategies are crucial, as both under- and over-supplementation carry risks. Emerging evidence supports targeted fortification approaches, which tailor nutrient delivery based on the infant’s biochemical markers and growth trajectory. This review also highlights the challenges in implementing fortification protocols, including variability in clinical guidelines, tolerance issues, and the need for ongoing monitoring. Furthermore, it underscores the importance of multidisciplinary collaboration among neonatologists, dietitians, and nursing staff to ensure safe and effective nutritional support. In conclusion, feeding fortification is not merely a nutritional adjunct but a cornerstone of care for preterm infants. Its thoughtful application can significantly influence short- and long-term health outcomes, reducing morbidity and enhancing developmental potential. Continued research and refinement of fortification practices are essential to meet the evolving needs of this vulnerable population. 

Impact of Teach-Back-Based Training on Maternal Discharge Readiness and the Readmission of Preterm Infants to NICU: A Quasi-Experimental Study
پرستاری
فاطمه ولی زاده 1, مژگان مصطفی نژاد 2 © ℗, کیمیا کرمی 3, رسول محمدی 4
1 دانشیار، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی،دانشگاه علوم پزشکی لرستان،خرم آباد،ایران
2 کارشناسی ارشدپرستاری کودکان، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی،دانشگاه علوم پزشکی لرستان،خرم آباد،ایران
3 دانشیار،مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی،دانشگاه علوم پزشکی لرستان،خرم آباد،ایران
4 استادیار اپیدمیولوژی، مرکز تحقیقات سلامت تغذیه، دانشکده بهداشت و تغذیه، دانشگاه علوم پزشکی لرستان،خرم‌آباد، ایران
Abstract

مقدمه: مادران نوزادان نارس بستری در بخش مراقبت ویژه نوزادان (NICU) سطوح بالایی از احساس عدم آمادگی برای بردن نوزادشان به خانه را تجربه میکنند. مداخله مبتنی بر آموزش به عنوان روشی که توانایی مادران را برای ارائه مراقبت مناسب به نوزادان در خانه را تسهیل می‌کند؛ نیازمند معرفی بهترین روشهای آموزشی است. مطالعه حاضر با هدف تعیین تاثیر آموزش بازخورد محور بر آمادگی ترخیص مادران و بستری مجدد نوزادان نارس بستری در NICU انجام شد. روش کار: این مطالعه نیمه تجربی با شرکت 66 نفر از مادر نوزاردان بستری در NICU بیمارستان شهید رحیمی خرم آباد ایران در سال 1401 -1402در دو گروه کنترل و مداخله انجام شد. گروه کنترل آموزش¬های ارایه شده توسط پرستاران را به روش روتین بخش دریافت کردند. در گروه مداخله پرستاران پس از 4 جلسه آموزش و 2هفته اجرای تمرینی از روش آموزش بازخورد محور در آموزش ترخیص به مادران استفاده کردند. ابزار جمع¬آوری داده¬ها چک لیست آمادگی ترخیص دشتی(1392) و فرم بستری مجدد نوزاران بود. آنالیز داده¬ها با آزمونهای تی زوجی، تی مستقل، کای اسکوئر و فیشر انجام شد. یافته‌ها: میانگین نمره آمادگی ترخیص مادران قبل از مداخله بین گروه های مداخله و كنترل اختلاف آماری معنی¬داری نداشت. پس از مداخله میانگین آمادگی ترخیص در گروه مداخله (47/8±12/43) با گروه کنترل(01/4±60/36) تفاوت معنی¬داری داشت (001/0= P). در پیگیری یک ماهه بعد از ترخیص میزان بستری مجدد نوزادان در گروه مداخله( 1/12 %) نسبت به گروه کنترل (3/27 %) کمتر بود، با این وجود تفاوت بین گروه ها از نظر آماری معنی دار نبود (107/0= P ). نتیجه‌گیری: آموزش مبتنی بر بازخورد می‌تواند آمادگی ترخیص مادران نوزادان نارس بستری در بخش مراقبت‌های ویژه نوزادان (NICU) را افزایش دهد. نتایج این مطالعه پیامدهای مهمی برای مراقبت از سلامت نوزادان نارس و مادران آنها دارد. آموزش مبتنی بر بازخورد همچنین می تواند هزینه های مراقبت های بهداشتی و بار مرتبط با پذیرش مجدد نوزادان نارس را کاهش دهد. لذا توصیه می‌شود پرستاران آموزش‌ مبتنی بر بازخورد را در برنامه مراقبتی و ترخیص این مادران و نوزادان بگنجانند کلیدواژه‌ها: آموزش بازخورد محور، مادران، آمادگی ترخیص، نوزادان نارس، بستری مجدد. (Ethics code IR.LUMS.REC.1401.249) دانشگاه علوم پزشکی لرستان 

Improving Children's Health with Corrective Exercises: A Solution for Text Neck Syndrome
پرستاری
فرزانه ساکی 1 © ℗, فاطمه یعقوبی 1, مهتاب پیرانی 1
1 گروه توانبخشی ورزشی، دانشکده علوم ورزشی، دانشگاه بوعلی سینا، همدان، ایران
Abstract:

 زمینه و هدف: سندرم گردن پیامکی (Text Neck Syndrome - TNS) به دلیل استفاده گسترده و طولانی‌مدت از گوشی‌های هوشمند و تبلت‌ها به مشکلی شایع در میان کودکان و نوجوانان تبدیل شده است. این سندرم با علائمی مانند درد گردن، شانه‌ها، سردرد، وضعیت نادرست بدن (مانند کیفوز یا سر به جلو) و محدودیت‌های حرکتی همراه است. این پژوهش با هدف بررسی تأثیر تمرینات اصلاحی بر کاهش درد، بهبود عملکرد و اصلاح وضعیت سر و گردن در دختران نوجوان مبتلا به TNS انجام شد. روش‌شناسی: در این مطالعه، 70 دختر نوجوان 12 تا 13 ساله مبتلا به TNS به‌صورت تصادفی به دو گروه 35 نفره تقسیم شدند: گروه مداخله (تمرینات اصلاحی) و گروه کنترل. گروه مداخله به مدت هشت هفته در برنامه‌ تمرینات اصلاح وضعیت بدن، تقویت عضلات ناحیه گردن و شانه، و افزایش انعطاف‌پذیری شرکت کردند. این تمرینات به‌گونه‌ای طراحی شدند که برای کودکان جذاب و انگیزه‌بخش باشند، با استفاده از بازی‌های حرکتی و فعالیت‌های گروهی. شدت درد با استفاده از مقیاس بصری درد (VAS)، ناتوانی با شاخص ناتوانی گردن (NDI)، و زوایای سر، گردن و زاویه نگاه با روش فتوگرافومتری در ابتدای مطالعه و پس از پایان مداخله ارزیابی شدند. گروه کنترل هیچ مداخله‌ای دریافت نکرد و به فعالیت‌های روزمره خود ادامه داد. یافته‌ها: نتایج تحلیل داده‌ها نشان داد که گروه تمرینات اصلاحی بهبودهای چشمگیری در مقایسه با گروه کنترل داشت. شدت درد در گروه مداخله به‌طور قابل‌توجهی کاهش یافت (p=0.001). شاخص ناتوانی گردن (NDI) نیز بهبود معناداری را نشان داد (p=0.001). زوایای سر و گردن، شامل کاهش تیلت گردن (p=0.001) و زاویه نگاه (p=0.001)، و افزایش زاویه تیلت سر (p=0.001)، به‌طور قابل‌ملاحظه‌ای اصلاح شدند که نشان‌دهنده بهبود وضعیت بدنی است. در مقابل، گروه کنترل هیچ تغییر معناداری در این متغیرها نشان نداد. نتیجه‌گیری: تمرینات اصلاحی به‌عنوان یک راهکار غیرتهاجمی و جذاب برای کودکان، نه‌تنها به کاهش درد و ناتوانی ناشی از سندرم گردن پیامکی کمک می‌کنند، بلکه وضعیت بدنی و عملکرد حرکتی را نیز بهبود می‌بخشند. اجرای این برنامه‌ها در سنین پایین می‌تواند از عوارض طولانی‌مدت مانند انحرافات ستون فقرات یا مشکلات مزمن عضلانی-اسکلتی جلوگیری کند. . پیشنهاد می‌شود که والدین، مربیان و سیاست‌گذاران آموزشی، برنامه‌های تمرینات اصلاحی را در مدارس و محیط‌های تفریحی کودکان ادغام کنند تا آینده‌ای سالم‌تر و پویاتر برای نسل جوان رقم بخورد. واژگان کلیدی: ورزش اصلاحی، سندرم گردن متنی، درد گردن، وضعیت سر به جلو، سلامت کودکان

Integrating Cutting-Edge Biomechanical Technologies with Nursing Approaches: New Horizons in the Prevention and Rehabilitation of Musculoskeletal Injuries in Pediatric Athletes
پرستاری
Azadeh Sobhkhiz 1 © ℗, Kamran Mohammadian 1, Mohammad Hossein Pourgharib Shahi 1
1 Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Title: Integrating Cutting-Edge Biomechanical Technologies with Nursing Approaches: New Horizons in the Prevention and Rehabilitation of Musculoskeletal Injuries in Pediatric Athletes Abstract: Background: The increased participation of children and adolescents in organized sports has led to a parallel rise in musculoskeletal injury rates, highlighting the urgent need for evidence-based prevention and rehabilitation strategies. Recent advances in sports biomechanics—including motion analysis technologies, wearable sensors, and structured injury-prevention programs—offer valuable tools that have yet to be fully integrated into pediatric nursing care. Objective: This review aims to synthesize the latest literature on the integration of innovative biomechanical technologies with nursing interventions to enhance the prevention and rehabilitation of musculoskeletal injuries in pediatric athletes. Methods: A comprehensive review of recent studies published between 2022 and 2024 in journals such as Applied Sciences, Premier Science, and Journal of Orthopaedic Surgery and Research was conducted. Key areas of focus were biomechanical assessment methods, structured warm-up protocols (e.g., FIFA 11+ Kids), and the role of pediatric nurses in interdisciplinary care teams. Results: The literature demonstrates that utilizing motion analysis, wearable devices, and evidence-based warm-up routines significantly reduces injury incidence and facilitates early detection of biomechanical risk factors. Pediatric nurses contribute critically by educating stakeholders, implementing and individualizing injury-prevention protocols, and monitoring rehabilitation adherence. Challenges such as financial constraints, need for specialized training, and sociocultural barriers to technology adoption persist. Conclusion: The integration of biomechanical technologies with nursing care represents a promising, multidisciplinary approach to address sports injuries in the pediatric population. Future research should prioritize clinical trials on technology-enhanced nursing interventions, address barriers to widespread adoption, and explore scalable models for diverse settings. Such integrative strategies have the potential to improve health outcomes and ensure the long-term musculoskeletal well-being of pediatric athletes. Keywords: biomechanics, pediatric nursing, musculoskeletal injuries, injury prevention, rehabilitation, wearable sensors, motion analysis, sports medicine

Investigating the psychometric properties of the Cybersecurity Behavior Questionnaire in Iranian children 
پرستاری
فاطمه رضایی نیا 1, فاطمه ولی زاده 2 ©, فاطمه محمدی پور 3, فرزاد ابراهیم زاده 4, سکینه اکبری 5 ℗
1 کارشناسی ارشد پرستاری کودکان؛ کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
2 دانشیار پرستاری، مرکز تحقیقات عوامل اجتماعی سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان،(نویسنده مسوول) خرم آباد، ایران.
3 دانشیار پرستاری، گروه پرستاری داخلی جراحی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
4 استادیار اپیدمیولوژی. گروه آمار زیستی و اپیدمیولوژی، دانشکده بهداشت و تغذیه، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران.
5 دانشجوی دکتری پرستاری، کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دفتر یوسرن، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
Abstract:

 مقدمه و هدف: با توجه به گسترش استفاده و اهمیت حفظ امنیت کودکان و نوجوانان در فضای مجازی برسی آگاهی و نگرش و رفتارهای آنان درفضای مجازی با استفاده از پرسشنامه های استاندارد ضروری است. لذا مطالعه حاضر با هدف تعیین ویژگی‌های روان‌سنجی مقیاس Cybersecurity Behaviors in School (CsB-S) جهت بررسی رفتار های امنیت در فضای مجازی در کودکان و نوجوانان ایرانی انجام¬گرفت. روش : در این مطالعه مقطعی681 دانش¬آموز12 تا 15 ساله شهر¬کرمانشاه در سال¬401-402 شرکت¬کردند. ترجمه به روش ده مرحله¬ای وایلد، روایی صوری کمی و کیفی با مصاحبه روانشناختی؛ روایی محتوایی با تایید متخصصان و محاسبه CVR، I- CVI وS-CVI و روایی سازه با روش¬های تحلیل عامل اکتشافی و تاییدی بررسی¬شد. پایایی با محاسبه ضرایب آلفای¬کرونباخ (α)، همبستگی درون¬ طبقه¬ای (ICC)و Kappa Fleiss بررسی¬شد. نتایج: پس از ترجمه و ¬روایی صوری و محتوایی تمام 20 گویه مقیاس رفتارهای امنیت در فضای مجازی تاییدشد. در مورد گویه-های مقیاس رفتار امنیت مجازی دامنه CVR 1-4/0، دامنه I-CVI 1-63/0و90/0= S-CVI بود. تحلیل¬عامل¬ اکتشافی با دو عامل746/69% از واریانس کل را تبیین و تحلیل عامل تاییدی شاخص¬های برازش مناسبی را نشان داد. ضرایب پایایی817/0=α و 785/0=ICC و فلیس¬کاپا74/0گزارش¬شد. نتیجه¬گیری: مقیاس‌ رفتارهای امنیت فضای مجازی با دو عامل دارای روایی پایایی مطلوب و برای نوجوانان 12-15 ساله ایرانی قابل استفاده¬می¬باشند. استفاده از این مقیاس به شناخت دقیق‌ الگوهای رفتاری و طراحی و تدوین مداخلات آموزشی و پیشگیرانه برای نوجوانان ایرانی کمک می کند. واژه¬های کلیدی: روان‌سنجی، پرسشنامه‌‌، رفتار، امنیت در فضای مجازی، کودکان 

Nurses' competencies in climate-aware care of children
پرستاری
مرجان غفرانی 1 © ℗
1 گروه پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
Abstract:

 سازمان جهانی بهداشت به طور محافظه کارانه تخمین می زند که تغییرات آب و هوایی سالانه باعث مرگ حدود 250000 نفر بیشتر در بین سال های 2030 تا 2050 به دلیل سوء تغذیه، مالاریا، اسهال و استرس گرمایی می شود. کودکان در سراسر جهان بیشترین بار تغییرات اقلیم را به دوش می کشند و 88 درصد از کل بیماری های مرتبط با تغییرات آب و هوایی را تشکیل می دهند. نقش حرفه پرستاری در پرداختن به تغییرات اقلیمی، عدالت اقلیمی و سلامت محیط زیست بسیار مهم است. پیامدهای بهداشت عمومی و پیامدهای منفی شناخته‌شده مرتبط با تغییرات اقلیمی آشکار است و حرفه ما باید فراخوان جمعی برای اقدام داشته باشد. فراخوان‌ها برای اقدام در جهت واکنش به اثرات مضر تغییرات اقلیمی جهانی بر سلامت، حرفه پرستاری را به سمت واکنش از طریق اقدامات پرستاری، تحقیق، حمایت و آموزش سوق می‌دهد. نقش‌های فعلی و بالقوه پرستاران در پرداختن به تغییرات اقلیمی همچنان مبهم است و هدف از این مطالعه مروری بررسی صلاحیت های مشخص شده برای پرستاران در متون با هدف ارائه مراقبت اقلیم آگاهانه از کودکان صورت گرفته است. نتایح نشان می دهد، دانش مرتبط، توانایی ارزیابی و مراقبت از بیماری ها و شرایط مرتبط با تغییرات آب و هوایی، نگرش مثبت نسبت به اجرای برنامه های دوستار محیط زیست، توانایی انجام مطالعات در زمینه های تغییرات اقلیمی و توانایی حل مسئله از صلاحیت های لازم در ارائه مراقبت در زمینه های تغییرات اقلیمی است.

Nursing Care in Pain management of Hospitalized Neonates
پرستاری
اعظم الملوک الساق 1 © ℗, دکتر مریم رسولی 2
1 دکتر اعظم الملوک الساق، دکترای تخصصی پرستاری، عضو گروه پرستاری دانشکده پرستاری و فوریت پزشکی دانشگاه علوم پزشکی و خدمات بهداشتی درمانی البرز، عضو انجمن درد اروپا
2 استاد پرستاری، عضو هیئت علمی دانشگاه علوم پزشکی و خدمات بهداشتی درمانی شهید بهشتی
Abstract:

 درد در نوزادان به‌ویژه نوزادانی که در بخش مراقبت‌های ویژه بستری هستند، یکی از چالش‌های درمان و مراقبت‌ پرستاری است. نوزادان به دلیل محدودیت در توانایی برقراری ارتباط کلامی، به‌طور مستقیم، نمی‌توانند وجود و شدت درد خود را بیان کنند و این موضوع باعث می‌شود که مدیریت درد آن‌ها به دقت و دانش بالایی نیاز داشته باشد. نوزادان می‌توانند درد را احساس کنند و در پاسخ به محرک های دردناک مانند تعویض کاتتر، نمونه‌گیری خون و اتصال لوله‌های تنفسی، ممکن است مجموعه ای از واکنش‌های فیزیولوژیکی، هورمونی و رفتاری را نشان دهند. برای درمان مؤثر درد و همچنین کاهش اثرات منفی آن در دوره نوزادی باید شدت محرک های دردناک، اندازه گیری شود. برآورد ميزان درد، شيوه مناسبي برای افزایش سرعت عمل در انجام مداخلات است؛ اگر میزان درد بطور مناسبی اندازه گیری گردد، می توان مداخله متناسب با همان میزان درد را برای نوزاد انجام داد. بدیهی است در صورت عدم مدیریت صحیح، تداوم درد در نوزاد می‌تواند منجر به آسیب‌های بلندمدت روانی و عصبی شود. تحقیقات نشان داده‌اند که نوزادانی که درد آنها به‌درستی مدیریت نمی‌شود، در معرض خطر بیشتری برای ابتلا به مشکلات رفتاری و شناختی در آینده قرار دارند. مدیریت صحیح درد در این نوزادان، نه تنها کیفیت مراقبت را بهبود می‌بخشد، بلکه می‌تواند به بهبود سریع‌تر آنها، کاهش مدت بستری و کاهش خطرات مرتبط با درد مزمن کمک کند. بدیهی است انتخاب روش‌های دارویی و غیردارویی مناسب، باید با توجه به شرایط خاص هر نوزاد انجام شود تا از بروز عوارض جانبی ناخواسته جلوگیری شود. این دستورالعمل با هدف ارائه راهکارهای علمی و عملی برای مدیریت درد در نوزادان (از زمان تولد تا پایان یک ماهگی) تدوین شده است. با بهره‌گیری از ابزارهای دقیق ارزیابی و استفاده از تکنیک‌های مؤثر، می‌توان تجربه درد را در نوزاد کاهش داد و به بهبود وضعیت بالینی او کمک کرد. 

Nursing care of children in health tourism: A comprehensive approach
پرستاری
زهره نبی زاده قرقوزار 1 © ℗
1 عضو هیات علمی گروه آموزشی پرستاری کودکان،دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
Abstract:

 موضوع: مراقبت پرستاری از کودکان در گردشگری سلامت: یک رویکرد جامع دکتر زهره نبی زاده قرقوزار، عضو هیات علمی گروه آموزشی پرستاری کودکان،دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران مقدمه: گردشگری سلامت سفری سازمان یافته از محیط زندگی فرد به مکان دیگر، به منظور بهبود و بازیابی مجدد سلامت جسمی وروحی یا رهایی از تنش زندگی روزمره می باشد. توریسم سلامت مسیری را برای دستیابی به درمان‌های تخصصی، کاهش زمان انتظار، یا بهره‌مندی از خدمات با هزینه مناسب‌تر فراهم آورده است. در این میان، کودکان به دلیل ویژگی‌های فیزیولوژیکی، نیازهای روان‌شناختی، و وابستگی شدید به خانواده، گروهی به شدت آسیب‌پذیر محسوب می‌شوند. از این رو، نقش پرستاران در تضمین تجربه درمانی امن، موثر، و انسانی برای این بیماران کوچک و والدینشان، حیاتی است. پرستار کودک باید ارزیابی جامع قبل از سفر از کودک داشته باشد که شامل: 1- تاریخچه پزشکی دقیق 2- وضعیت رشد و تکامل 3- مسائل روان‌اجتماعی4- ملاحظات فرهنگی و زبانی . برنامه‌ریزی و هماهنگی مراقبت که شامل: 1- ارتباط مؤثر 2- تسهیل سفر 3- هماهنگی بین‌المللی4- مدیریت دارویی. مراقبت‌های پرستاری در طول اقامت در کشور مقصد که شامل: 1- کاهش اضطراب و ترس2- مدیریت درد و عوارض جانبی3- تغذیه مناسب 4- پیشگیری از عفونت5- فعالیت و بازی 6- پشتیبانی روان‌شناختی. برنامه‌ریزی ترخیص و مراقبت پس از بازگشت که شامل: 1- آموزش والدین2- هماهنگی مراقبت‌های پس از ترخیص3- مدارک پزشکی. چالش‌ها و راهکارها: مانع زبانی و فرهنگی: استفاده از مترجمان متخصص و آموزش کادر درمانی در مورد حساسیت‌های فرهنگی. دوری از حمایت اجتماعی: ایجاد شبکه‌های حمایتی برای خانواده‌درمانی یا معرفی آن‌ها به جوامع محلی. تفاوت استانداردهای مراقبتی: شفاف‌سازی استانداردهای مراقبت و تلاش برای ارتقای آن‌ها. نتیجه گیری: مراقبت پرستاری از کودکان در توریسم سلامت نیازمند پرستارانی است که نه تنها دانش بالینی قوی داشته باشند، بلکه از مهارت‌های ارتباطی بین‌فرهنگی، همدلی و توانایی مدیریت استرس در شرایط ناآشنا نیز برخوردار باشند. این رویکرد جامع، به کودک و خانواده‌اش کمک می‌کند تا تجربه درمانی خود را با کمترین فشار و بیشترین اثربخشی سپری کنند. کلید واژه ها: گردشگری سلامت ، مراقبت پرستاری، کودکان 

Oral Nutritional Challenges in Neonatal Intensive Care Unite
پرستاری
Dr. Mona Alinejad-Naeini 1 © ℗
1 Assistant professor. Department of Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Iran University of medical sciences
Abstract: After birth, preterm infants lose weight and take variable periods to regain birth weight. The postnatal development of premature infants is critically dependent on an adequate nutritional intake that mimics a similar gestational stage to which the fetus would be exposed if still in the uterus. Preterm neonates face significant nutritional challenges due to their immaturity, leading to a high risk of nutrient deficiencies and growth failure. This is primarily because they miss the crucial third trimester for nutrient accumulation in utero. Specific issues include difficulties with sucking and swallowing, potential gastrointestinal issues, and the need for specialized fortified feedings. The goal of nutrition of the preterm infant is to provide nutrients to meet the growth rate and body composition of the normal healthy fetus of the same gestational age in terms of weight, length, and head circumference, organ size, tissue components including cell number and structure, concentrations of blood and tissue nutrients, and developmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal brain growth that would limit neurodevelopment. Several practical aspects of medical management to better optimize the benefits of enhanced and improved nutrition in very preterm infants right after birth should be noted. Improved medical care and physiological condition, Oxygenation, IV (Parental) Feeding, IV dextrose (glucose) infusion, IV lipid infusion, IV amino acid infusion, IV insulin infusion. The postnatal growth window is crucial to ensure adequate outcomes for extremely preterm infants. As this review has emphasized, right from parenteral nutrition, it is necessary to consider the characteristics of the single infant and provide adequate nutrients (glucose, lipids, and proteins) and micronutrients (electrolytes, vitamins, and minerals) both quantity and quality-wise. Early start of enteral feeding within 24 h of life is safe, if there are no warning signs or symptoms and can allow to reach earlier full enteral feeding, advancing meals by up to 20–30 mL/kg every day (where clinically acceptable). This is related to a lower duration of the parenteral nutrition, and an earlier removal of central venous catheter, with the reduction of related complications. With the establishment of full enteral nutrition, hopefully with human milk, adequate fortification of human milk is necessary: adjustable or targeted fortification strategies increase growth velocity compared to standard fortification. The monitoring of the trend of growth parameters (weight, length, and 

Oral Nutritional Challenges in Neonatal Intensive Care Unite 
پرستاری
Dr. Mona Alinejad-Naeini 1 © ℗
1 Assistant professor. Department of Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Iran University of medical sciences
Abstract: Preterm neonates face significant nutritional challenges due to their immaturity, leading to a high risk of nutrient deficiencies and growth failure. This is primarily because they miss the crucial third trimester for nutrient accumulation in utero. Specific issues include difficulties with sucking and swallowing, potential gastrointestinal issues, and the need for specialized fortified feedings. The goal of nutrition of the preterm infant is to provide nutrients to meet the growth rate and body composition of the normal healthy fetus of the same gestational age in terms of weight, length, and head circumference, organ size, tissue components including cell number and structure, concentrations of blood and tissue nutrients, and developmental outcomes. Failure to provide the necessary amounts of all of the essential nutrients to preterm infants has produced not only growth failure, but also increased morbidity and less than optimal brain growth that would limit neurodevelopment. Several practical aspects of medical management to better optimize the benefits of enhanced and improved nutrition in very preterm infants right after birth should be noted. Improved medical care and physiological condition, Oxygenation, IV (Parental) Feeding, IV dextrose (glucose) infusion, IV lipid infusion, IV amino acid infusion, IV insulin infusion. The postnatal growth window is crucial to ensure adequate outcomes for extremely preterm infants. As this review has emphasized, right from parenteral nutrition, it is necessary to consider the characteristics of the single infant and provide adequate nutrients (glucose, lipids, and proteins) and micronutrients (electrolytes, vitamins, and minerals) both quantity and quality-wise. Early start of enteral feeding within 24 h of life is safe, if there are no warning signs or symptoms and can allow to reach earlier full enteral feeding, advancing meals by up to 20–30 mL/kg every day (where clinically acceptable). This is related to a lower duration of the parenteral nutrition, and an earlier removal of central venous catheter, with the reduction of related complications. With the establishment of full enteral nutrition, hopefully with human milk, adequate fortification of human milk is necessary: adjustable or targeted fortification strategies increase growth velocity compared to standard fortification. The monitoring of the trend of growth parameters (weight, length, and head circumference), assessed once a week during hospitalization, can allow for a decrease in extra-uterine growth restriction by tailoring the newborn’s nutrition and leading to better outcomes. Finally, it is important not to forget the importance of adequate growth even after discharge, as poor growth is 

Parental Concerns Regarding Hospitalized Children
پرستاری
منیژه آهنی 1 © ℗
1 دانشجوی دکتری پرستاری، سوپروایزر آموزشی بیمارستان کودکان حکیم
Abstract:

 نگرانی‌های والدین کودکان بستری در بیمارستان بستری شدن کودک در بیمارستان، به‌ویژه در بخش‌های ویژه یا طولانی‌مدت، تجربه‌ای پرتنش برای والدین است. این تجربه با اضطراب، نگرانی و آشفتگی روانی همراه است و می‌تواند تعادل روانی و عملکرد مراقبتی والدین را تحت تأثیر قرار دهد. والدین در مواجهه با بستری فرزند خود با احساساتی چون ترس از مرگ کودک، نگرانی از درد و رنج، بی‌اطلاعی از روند درمان، و ناتوانی در کمک به فرزندشان روبه‌رو می‌شوند. نگرانی از عدم بهبودی، طول مدت بستری، پیچیدگی‌های بیماری، ارتباط ضعیف با تیم درمان و درک ناکافی از اصطلاحات پزشکی، همگی بر شدت استرس والدین می‌افزایند. همچنین، حضور مستمر در بیمارستان، اختلال در نقش‌های خانوادگی و شغلی، فشار مالی ناشی از هزینه‌های درمان و جابجایی، و نگرانی برای سایر فرزندان خانواده، فشارهای مضاعفی را ایجاد می‌کند. نقش پرستاران و تیم درمان در کاهش این نگرانی‌ها حیاتی است. حمایت عاطفی، اطلاع‌رسانی شفاف، همدلی، مشارکت دادن والدین در تصمیم‌گیری‌های درمانی و مراقبتی، و ایجاد محیطی امن و پاسخگو می‌تواند سطح نگرانی والدین را به شکل معناداری کاهش دهد. درک دقیق از ماهیت نگرانی‌های والدین و واکنش‌های روانی آنان، شرط لازم برای ارائه مداخلات حمایتی مؤثر است. ایجاد برنامه‌های آموزشی برای والدین، تسهیل فرآیند ارتباط با کادر درمان، و فراهم کردن خدمات مشاوره روان‌شناختی، از جمله اقداماتی است که می‌تواند کیفیت تجربه بستری را برای والدین و در نتیجه برای کودک بهبود بخشد. در نتیجه پاسخ‌گویی فعال و انسانی به نگرانی‌های والدین، جزئی جدایی‌ناپذیر از مراقبت جامع کودک در بیمارستان است. 

Self-care in nurses working in pediatric intensive care units and strategies for its promotion: A systematic review
پرستاری
زهرا جعفری 1 © ℗
1 استادیار دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران، ایران.
Abstract:

 خودمراقبتی در پرستاران شاغل در بخش های مراقبت ویژه کودکان و استراتژی‌های ارتقای آن: یک مرور سیستماتیک مقدمه پرستاران شاغل در بخش های مراقبت ویژه کودکان، به دلیل مواجهه مداوم با شرایط پر استرس مانند مشاهده بیماری و درد و رنج و مرگ کودکان بستری، ارتباط نزدیک با کودک و والدین مضطرب و فشار سازمانی بیشتر، در معرض فرسودگی عاطفی و خستگی شغلی قرار دارند و این موقعیت چالش زا، تاثیر منفی بر جسم و روح و زندگی شخصی این پرستاران می گذارد. در این مواقع خودمراقبتی (Self-care) به‌عنوان یک مفهوم کلیدی مطرح می‌شود و شامل مجموعه‌ای از رفتارها و استراتژی‌هاست که پرستاران برای ارتقای سلامت روانی، جسمی و عاطفی خود در این شرایط به کار می‌گیرند. روش کار کلیدواژه‌های PICU, self-care, nurses, pediatric hospital, coping strategies, burnoutدر پایگاه های : PubMed، Scopus، Web of Science، CINAHL از سال 2015-2025 جستجو شد. معیار ورود مطالعات کمی و کیفی منتشرشده بودند که به خودمراقبتی و استراتژی‌های آن در پرستاران بیمارستان کودکان می پرداختند. در نهایت 22 مطالعه بررسی شد. یافته‌ها با توجه به مطالعات، ابعاد خودمراقبتی در پرستاران کودکان و راه کارها به صورت زیر طبقه بندی گردید. • سلامت جسمی: فعالیت بدنی منظم، تغذیه سالم، و خواب کافی. • سلامت روان: استفاده از تکنیک‌های ذهن‌آگاهی، مراقبه، مدیریت استرس و مدیریت زمان کاری و استراحت. • حمایت اجتماعی و سازمانی: حمایت همکاران و مدیران، برنامه‌های رفاهی، مشاوره روان و برگزاری کارگاه های آموزشی در این زمینه • سلامت معنوی: ایجاد معنا در کار پرستاری، تکنیک‌های مراقبه یا دعا، ارتباط با ارزش‌های شخصی و حرفه‌ای نتیجه گیری خودمراقبتی در پرستاران شاغل در بیمارستان‌های کودکان به‌عنوان یک ضرورت حرفه‌ای و شخصی مطرح است. یافته‌ها نشان می‌دهند که استراتژی‌هایی همچون ذهن‌آگاهی، فعالیت بدنی و حمایت سازمانی می‌توانند نقش مؤثری در ارتقای آن ایفا کنند. پیشنهاد می‌شود پژوهش‌های آینده بر طراحی کارآزمایی‌های بالینی تصادفی، مطالعات کیفی و اکشن تمرکز داشته باشند. 

The challenge of providing care as an immigrant nurse
پرستاری
Seyedeh Zahra Aemmi 1 © ℗, Maryam Seyyedi Nasooh Abad 2
1 Department of Nursing, Quchan School of Nursing, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Economics and Business Management, Universita` Cattolica del Sacro Cuore, Rome, Italy
Abstract:

 مقدمه و هدف مهاجرت نقش پیچیده‌ای در حرفه پرستاری ایفا می‌کند، راه‌حل‌هایی برای کمبود نیروی کار ارائه می‌دهد، اما چالش‌هایی را هم برای پرستاران مهاجر ایجاد می‌کند. پرستاران مهاجر ممکن است با چالش‌هایی مانند طی نمودن فرآیندهای جدید صدور مجوز و اعتبارنامه، سازگاری با سیستم‌های مراقبت‌های بهداشتی مختلف و مقابله با موانع فرهنگی و زبانی مواجه شوند. روش مطالعه این مطالعه یک بررسی مروری که با استفاده از منابع موجود و تطبیق با تجربه یک پرستار مهاجر انجام یافته است. يافته ها ارائه مراقبت به عنوان یک پرستار مهاجر با چالش‌های متعددی همراه است که شامل موانع زبانی و فرهنگی، تبعیض اجتماعی، مسائل مربوط به صدور مجوز، استرس، فرسودگی شغلی، مشکلات سازگاری با فعالیت‌های روزمره زندگی می‌شود. علاوه بر این، فشار کار، انتظارات بالا، و تفاوت‌های فرهنگی در شیوه ارائه مراقبت نیز می‌توانند از جمله این چالش‌ها باشند. این عوامل می‌توانند بر ارتباط با بیماران و همکاران تأثیر بگذارند و منجر به سوءتفاهم‌های احتمالی و تأثیرگذاری بر کیفیت مراقبت شوند. نتیجه گیری برنامه‌های توسعه درون‌سازمانی، اجتماعی-فرهنگی و حرفه‌ای برای حمایت از پرستاران مهاجر نیاز است تا بتوانند مراقبت با کیفیتی از بیمار ارائه دهند و به خوبی در جامعه موردنظر ادغام شوند. كلمات كليدي: چالش، مهاجرت، پرستاران 

The effect of scheduled virtual visits on perceived social support of families of premature infants admitted to the neonatal intensive care unit.
پرستاری
زهرا شهسواری 1, فاطمه ولی زاده 1 ℗, سیده فاطمه قاسمی 1 ©, یاسر مخیری 1, مژگان ساکی 1
1 دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract:

 مقدمه: حمایت اجتماعی(عاطفی، ابزاری، اطلاعاتی) پایین برای خانواده های نوزادان بستری دربخش¬های ویژه منجر به انزوا، اضطراب، افسردگی و کاهش عملکرد روانی و فیزیکی آنان میشود. این مطالعه با هدف تعیین تأثیر ملاقات مجازی برنامه ریزی شده(برقراری ارتباط با خانواده،انتقال اطلاعات ویزیت و سیر درمان، توضیح وضعیت بالینی نوزاد، ایجاد امکان مشاهده مجازی نوزاد ، پاسخ به سوالات خانواده) بر حمایت اجتماعی درک شده خانواده نوزادان نارس بستری در بخش مراقبت‌های ویژه انجام شد. مواد و روشها: این مطالعه نیمه‌تجربی در سال 1403 در خرم‌آباد، ایران انجام شد. نمونه‌گیری به روش غیراحتمالی و متوالی از والدین نوزادان نارس بستری صورت گرفت و 31 جفت والد در هر گروه مداخله وکنترل شرکت کردند. گروه کنترل از مراقبت‌های روتین بخش و گروه مداخله از تماس تصویری روزانه 10 تا 15 دقیقه در شیفت عصر در ساعت از قبل هماهنگ شده بهره‌مند شدند. داده‌ها با استفاده از پرسشنامه‌های دموگرافیک، مقیاس حمایت اجتماعیMSPSS قبل و 2 ماه پس از مداخله جمع‌آوری شدند. تجزیه تحلیل داده‌ها با استفاده از آزمون ANCOVA تحت نرم‌افزار Stata نسخه 16 انجام شد. سطح معناداری در کلیه آزمون‌ها 0.05 در نظر گرفته شد. یافته ها: دو گروه از نظر توزیع مشخصات دموگرافیک نوزادان و والدین تفاوت آماری معنی داری نداشتند(05/0P). آزمون آنکوا، بعد از تعدیل اثر باقیمانده، نشان داد که تفاوت قبل و بعد از مداخله حمایت اجتماعی درک شده در دو گروه از لحاظ آماری معنادار بود (001/0=P) . نتیجه گیری: ملاقات‌های مجازی برنامه‌ریزی شده باعث افزایش حمایت اجتماعی درک شده در والدین دارای نوزاد بستری در NICU شد. پیشنهاد می‌شود برنامه‌های مبتنی بر ملاقات‌های مجازی به عنوان ابزاری مؤثر و پشتیبانی در مدیریت حمایت اجتماعی والدین در بخش مراقبتهای ویژه نوزادان مورد استفاده قرار گیرند. 

The Importance of Maintain the Mother – Infant Dyad in Maternal Support
پرستاری
AFSANEH ARZANI 1 © ℗
1 Non-communicable Pediatric Diseases Research Center, Health Research Institute, School of Nursing and Midwifery, Babol University of Medical, Sciences, Babol, Iran Email: arzaniaf@gmail.com
Abstract: Background: The mother–infant dyad, proximity, and interactions after birth represent a fundamental biological and emotional unit for the neonate and mother. While much of the existing literature emphasizes neonatal benefits, preserving this dyad is equally critical for maternal well-being and empowering the mother's competence and expertise. Unnecessary separations (especially during the hospitalization of the neonate) may negatively affect maternal mental health, breastfeeding success, and confidence in the maternal role. Objective: This review aimed to explore the significance of maintaining the mother–infant dyad with a focus on maternal support, including psychological, physiological, and social dimensions. Methods: This narrative review analyzed data from PubMed, Scopus, Web of Science, and Google Scholar (2015–2024) using keywords such as "continuous maternal-infant contact," "skin-to-skin care," "rooming-in," "mental health," "empowering," "competence," and "family-centered practices in routine maternity and neonatal intensive care." After screening, 30 relevant articles were selected for review. Results: Findings indicate that mother–infant closeness reduces maternal anxiety and postpartum depression, strengthens maternal identity, and enhances confidence in caregiving. Continuous contact and skin-to-skin care stimulate oxytocin release, which fosters emotional well-being and supports lactation. Active maternal involvement in NICU care reduces feelings of guilt and helplessness, while also promoting maternal empowerment. Furthermore, institutional policies that encourage dyad preservation communicate social support for the maternal role, thereby improving maternal satisfaction and overall quality of life. Conclusion: Supporting mothers and maintaining the mother-infant bond during a newborn's NICU stay is crucial for the baby's health and the mother's well-being. The Mother Baby Care model innovatively applies rooming-in and couplet care principles, allowing high-risk newborns to stay with their mothers in a specialized Labor-Delivery-Recovery-Postpartum (LDRP)/NICU suite instead of being separated in the NICU. This approach ensures continuous care and bonding. Integrating policies and practices that minimize separation and encourage maternal participation should be prioritized in maternity wards and NICUs to strengthen maternal mental health, confidence, empowering and caregiving capacity. References: 1.Dagestad A. Keeping Mothers Together With Their Babies Requiring Neonatal Intensive Care During the Birth Hospitalization: An Innovative Model of Care. MCN Am J Matern Child Nurs. 2025 May-Jun 01;50(3):162-167. doi: 10.1097/NMC.0000000000001093. Epub 2025 Apr 29. PMID: 40029189. 2. de Salaberry J, Hait V, Thornton K, Bolton M, Abrams M, Shivananda S, Kiarash M, Osiovich H. Journey to mother baby care: Implementation of a combined care/couplet model in a Level 2 neonatal intensive care unit. Birth Defects Res. 2019 Sep 1;111(15):1060-1072. doi: 10.1002/bdr2.1524. Epub 2019 May 27. PMID: 31132224. 

The Perspective of Pediatric Nursing in the Era of Digital and Virtual Health
پرستاری
مژگان ساکی 1 © ℗, فاطمه ولی زاده 2, سیده فاطمه قاسمی 2
1 کارشناس ارشدپرستاری کودکان ، دانشکده پیراپزشکی و توانبخشی ، دانشگاه علوم پزشکی لرستان ، خرم آباد ، ایران
2 دانشیار پرستاری، مرکز تحقیقات عوامل اجتماعی سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract:

 چشم انداز پرستاری کودک محور در عصر سلامت دیجیتال و مجازی نویسندگان : مژگان ساکی،فاطمه ولی زاده،سیده فاطمه قاسمی کد اخلاق:مقاله مربوط به پانل میباشد. مقدمه و هدف :درسال‌های اخیر،فناوری به بخش جدایی‌ناپذیری ازاکوسیستم مراقبت‌های بهداشتی تبدیل شده است. فناوری‌های سلامت دیجیتال می‌توانند به پرستاران درتشخیص،ارزیابی،درمان،مداخله،آموزش واهداف سرگرمی کمک کنند ومنجربه نتایج مثبتی درمحیط‌های بالینی گردند.لذا پژوهش حاضر با هدف تعیین چشم انداز پرستاری کودک محور در عصرسلامت دیجیتال و مجازی انجام شد. روش کار :این‌مطالعه ‌ازنوع‌ مطالعات ‌مروري‌ بوده‌ وداده‌هاي‌ آن ‌ازطریق‌ بررسی ‌متون‌ واستناد به‌ منابع‌علمی‌حاصل ‌ازجستجودرپایگاههاي اطلاعاتی ScienceDirect ‌،Medlin ‌، Irandoc، SID‌،Google Scholar،Iran Medex‌، Magiran فراهم شده است . یافته ها :ادغام فناوری در شیوه‌های پرستاری کودکان،راه‌های جدیدی را برای ارائه خدمات و نتایج بهداشتی بهتربرای کودکان گشوده است.نظارت از راه دو به پرستاران کودکان اجازه میدهد تا پایبندی به درمان را پیگیری کنند،اثربخشی مداخلات راارزیابی نموده وبه سرعت به هرگونه تغییردروضعیت سلامت کودک پاسخ دهندکه منجربه نتایج بهترسلامت وکاهش بستری مجدد دربیمارستان میشود.دراستفاده از فناوری ملاحظات اخلاقی مهمی مانند:حریم خصوصی،امنیت داده‌ها و تعادل بین استفاده ازفناوری و حفظ تماس انسانی درمراقبت ازبیمارونقش همدلی ومهارت‌های بین فردی در پرورش رفاه عاطفی کودکان را نیزبایستی مدنظرقرارداده،والدین می‌توانند تصمیمات آگاهانه‌ای در مورد سلامت فرزند خود بگیرند واقدامات پیشگیرانه‌ای انجام دهند که در نهایت به مدیریت بهتربیماری وبهبود سلامت کلی کمک می‌کند.نتایج مطالعات متعدد نشان می‌دهد که استفاده ازفناوری سلامت دیجیتال تحت تأثیرنگرش‌های مختلفی قراردارد ومزایای مداخله برای برخی ازآنهاممکن است برای بعضی ازجمعیت‌های بالینی محدودترباشد.آن چیز که مسلم است مقاومت بیشتر متخصصان ومدیران در مقایسه با بیماران دراستفاده از این فناوری هاست. که می تواندعلتهای بسیاری داشته باشد ازجمله : 1-نگرانی‌هایی در مورد خطرات وعوارض جانبی احتمالی این فناوری برروی کودکان 2-نگرانی برخی ازتوانایی خود در استفاده مؤثرازچنین فناوری یانامناسب بودن آن براساس مرحله رشد کودک 3-مسائلی وجود دارد که مختص جمعیت‌های کودکانی است که شرایط یا نیازهای پیچیده‌ای دارند.افرادی دارای معلولیت‌های شدید جسمی یا ذهنی ممکن است دارای نقص‌های حرکتی یا محدودیت‌های شناختی باشند که مانع ازتوانایی آنها در تعامل با فناوری می‌شود و... بحث ونتیجه‌گیری:ادغام فناوری در پرستاری کودکان، شیوه ارائه خدمات درمانی به کودکان رامتحول کرده وباعث افزایش ارتباط وهمکاری بین ارائه دهندگان خدمات درمانی،والدین ومراقبان وفناوری، مراقبت را ساده کرده واحتمال خطاهای پزشکی را کاهش میدهد.بااستفاده موفقیت‌آمیزپرستاری کودکان ازفناوری‌های سلامت دیجیتال میتوان گام‌های مهمی در بهبود سلامت وکیفیت زندگی کودکان سراسرجهان برداشته ودراین زمینه پیشروبود. کلید واژه ها :چشم انداز،کودک محور،مراقبت،سلامت دیجیتال 

The process of breaking bad news in pediatrics and newborn infant settings
پرستاری
Marjan Banazadeh 1 © ℗, Forouzan Akrami 2, Setareh Sagheb 3, Azadeh Malekian 4, Parnian Ahmadvand 5
1 Assistant Professor of Nursing School, Alborz University of Medical Sciences, Karaj, Iran
2 Ph.D. in Medical Ethics, Postdoctoral in Bioethics, Head of the Bioethics Department at the Medical Ethics and Law Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
3 Associate Professor of Pediatrics Department, School of Medicine, Tehran University of Medical Science, Tehran, Iran
4 Psychiatrist, Isfahan University of Medical Sciences, Isfahan, Iran
5 Assistant Professor of Pediatrics Department, School of Medicine, Alborz University of Medical Sciences, Karaj, Iran.
Abstract:

 فرایند اعلام خبر ناگوار به والدین در بخش‌های کودکان و نوزادان نویسندگان: بناءزاده مرجان1، اکرمی فروزان2 ، ثاقب ستاره 3، ملکیان آزاده4، پرنیان احمدوند5 1دکتری تخصصی پرستاری، استادیار گروه پرستاری، دانشکده پرستاری و فوریتهای پزشکی، دانشگاه علوم پزشکی البرز، البرز، ایران. banazadehmarjan@gmail.com نویسنده مسئول ، 09134410017 2دکترای اخلاق پزشکی، فوق دکتری اخلاق زیستی، مدیر گروه اخلاق زیستی مرکز تحقیقات اخلاق و حقوق پزشکی دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران 3 فوق تخصص مراقبتهای ویژه نوزادان، دانشیار گروه کودکان دانشکده پزشکی،دانشگاه علوم پزشکی تهران، تهران، ایران 4متخصص روانپزشکی، دانشگاه علوم پزشکی اصفهان، اصفهان، ایران 5 فوق تخصص خون و سرطان کودکان، استادیار گروه کودکان، دانشکده پزشکی، دانشگاه علوم پزشکی البرز، البرز، ایران اعلام خبرناگوار به خانواده‌ها در بخش های کودکان و نوزادان از دشوارترین وظایف کارکنان درمانی محسوب می‌شود. اخبار ناگوار شامل هر نوع اطلاعاتی است که باعث ایجاد نگرانی، خشم یا غم در شنونده نسبت به آینده می‌گردد. روند مراقبت و در پی آن، روند اطلاع‌رسانی اخبار ناخوشایند یک فرآیند خطی نیست؛ در هر وضعیتی ضروری است که تیم پزشکی با همکاری والدین و در نظرگیری شرایط بالینی کودک، تصمیمات مربوط به درمان و مراقبت را اتخاذ نمایند. روند اعلام اخبارناگوار از زمان پذیرش بیمار آغاز می‌گردد و لازم است همیشه تعادلی مناسب بین امید واقع‌گرایانه درباره وضعیت بالینی کودک و پیش‌بینی آینده برای والدین ترسیم شود. به نحوی که والدین ضمن حفظ سازگاری و امیدواری، به تدریج آمادگی لازم را در صورت از دست دادن فرزندشان به دست آورند. پیچیدگی این امر با جنبه‌های احساسی، اخلاقی و روان‌شناختی، همراه با بحث پیرامون تشخیص‌های تهدیدآمیز برای حیات، پیش‌بینی‌های نامطلوب یا نیاز به مداخله‌های حیاتی افزایش می‌یابد. اعلام اخبارناگوار در مواردی همچون نقایص مادرزادی، تشخیص بیماری‌های شدید عصبی یا متابولیک و تصمیم‌گیری برای انتقال به مراقبت‌های تسکینی کاربرد دارد. برقراری ارتباط مؤثر هنگام اعلام اخبار ناگوار برای تقویت اعتماد، پشتیبانی از تصمیم‌گیری آگاهانه و تسهیل مواجهه و انطباق والدین در این دوران دشوار بسیار حائز اهمیت است. برقراری ارتباط همدلانه به دو روش "حضور" و "اقدام" صورت می‌پذیرد که پیش‌شرط رفتار همدلانه کمک‌کننده محسوب می‌شود. اقدام مجموعه‌ای از تکنیک‌ها است اما "حضور" برآمده از فضای حاکم بر تعامل کارکنان درمانی با والدین، نوع نگاه به آنها و اعتبار دادن به احساسات‌شان است. ارتباط مؤثر میان درمانگران و بیمار به‌طور اتفاقی رخ نمی‌دهد و نیازمند رویکردی محاسبه‌شده است. اعلام اخبار ناگوار باید در یک جلسه برنامه‌ریزی‌شده، با مشاوره با سایر درمانگران، در مکانی آرام و خصوصی و با زمان کافی 

The Role of Emerging Technologies in Enhancing Social Skills of Children with Autism Spectrum Disorder
پرستاری
Hamed Samadpour 1 ©, Sougand Setareh 2 ℗
1 Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences Tehran Iran.
2 Traditional medicine and materia medica research center(TMRC) of Shahid beheshti University of Medical Sciences
Abstract: Background and Objective: Autism Spectrum Disorder (ASD) is one of the most common neurodevelopmental disorders, characterized by communication, social, and behavioral challenges. In recent years, emerging technologies such as virtual reality (VR), mobile applications, social robots, and AI-based systems have been proposed as complementary tools for the therapy and rehabilitation of children with ASD. This study aimed to review the existing evidence on the role of emerging technologies in enhancing the cognitive, social, and emotional skills of children with ASD. Methodology: This review article examined studies published in international scientific databases over the past few years. Findings related to various technological interventions—including virtual reality (VR), mobile applications, assistive social robots, and augmented reality-based games combined with neurofeedback—were extracted and analyzed. Results: The findings indicated that VR-based interventions improved social interaction, eye contact, and emotion recognition (Cheng et al., 2021; Frolli et al., 2024). Mobile applications helped enhance facial and emotional recognition and communication abilities (Escobedo et al., 2021). Assistive social robots were effective in developing turn-taking skills, fine motor coordination, and social engagement (Robinson et al., 2022). Moreover, augmented reality games combined with neurofeedback significantly improved the focus and attention of children with ASD (Lee et al., 2025). Evidence highlights that personalizing technology to the individual needs of each child is a key factor in increasing the effectiveness of interventions. Conclusion: Emerging technologies represent promising and practical tools for the rehabilitation and treatment of children with autism. They can serve as a complement to traditional interventions to improve the quality of life for these children and their families. However, challenges such as cost, unequal access, and the need for long-term studies to assess the durability of effects remain. 

The role of pediatric nurses in promoting the health and well-being of the next generation
پرستاری
رقیه عابدی گیلاوندانی 1 © ℗
1 کارشناس ارشد مدیریت، مدیر پرستاری بیمارستان کودکان حکیم
Abstract:

 موضوع: نقش پرستاران کودکان در ارتقای سلامت و رفاه نسل آینده رقیه عابدی گیلاوندانی کارشناس ارشد مدیریت پرستاری، مدیر پرستاری بیمارستان کودکان حکیم مقدمه: کودکان به‌عنوان گروهی حساس، نیازمند مراقبت و محبت ویژه‌اند. دوران کودکی برای رشد جسمی، عاطفی و روانی آن‌ها حیاتی است و پرستاران کودکان نقش کلیدی در این فرآیند دارند. این پرستاران با ارائه مراقبت‌های پزشکی، تغذیه مناسب، فعالیت‌های آموزشی و تفریحی، به سلامت و رشد کودکان کمک می‌کنند. آن‌ها باید دانش و تجربه کافی داشته باشند تا نیازهای جسمی، عاطفی و روانی کودکان را برآورده کرده و با رفتار مهربانانه، حس امنیت و آرامش را به آن‌ها منتقل کنند. بحث: پرستاران کودکان باید مهارت‌های ارتباطی قوی داشته باشند تا با والدین به‌طور موثر ارتباط برقرار کنند. این ارتباط، والدین را به‌عنوان شریکان مراقبت درگیر کرده و به بهبود فرآیند مراقبت کمک می‌کند. آن‌ها با تشخیص زودهنگام مشکلات سلامتی، ارائه راهکارهای مناسب و آموزش والدین در زمینه تغذیه، بهداشت و تربیت، از بیماری‌ها و خطرات محیطی پیشگیری می‌کنند. در مواقع اضطراری نیز نقش حفاظتی ایفا می‌کنند. سازگاری اجتماعی، توانایی تعامل پذیرفته‌شده در جامعه، از جنبه‌های مهم رشد کودکان است. پرستاران با حمایت روانی و آموزش والدین، به تقویت این مهارت کمک می‌کنند. مراقبت خانواده‌محور، با تمرکز بر حفظ یکپارچگی خانواده و حمایت از والدین، به کاهش استرس و بهبود سلامت کودکان منجر می‌شود. بیمارستان‌ها محیطی استرس‌زا برای کودکان و والدین هستند و پرستاران با ارائه اطلاعات صادقانه، حمایت عاطفی و راهنمایی، نقش مهمی در کاهش فشارهای روانی و افزایش سازگاری خانواده دارند. نیازهای والدین شامل دریافت اطلاعات دقیق، اطمینان از مراقبت مطلوب، حمایت و مشاوره است. پرستاران با شناسایی این نیازها و برقراری ارتباط نزدیک، می‌توانند به والدین کمک کنند تا با بیماری کودک کنار بیایند. مطالعات نشان می‌دهد حمایت اجتماعی پرستاران، به‌ویژه حمایت عاطفی، استرس و افسردگی والدین را کاهش داده و رضایت از مراقبت را افزایش می‌دهد. نتیجه: برای بهبود سلامت کودکان، ارتقای دانش و مهارت پرستاران، ایجاد شرایط کاری مناسب و تقویت همکاری با تیم درمانی ضروری است. این اقدامات نه‌تنها سلامت کودکان را بهبود می‌بخشد، بلکه به ارتقای سطح سلامت عمومی جامعه کمک می‌کند. توجه به نقش پرستاران و حمایت اجتماعی آن‌ها، گامی موثر در راستای رفاه کودکان و خانواده‌ها است. 

The Role of the Nurse in Facilitating Parent Empowerment: Implementing Collaborative Models in Child-Centered Care
پرستاری
سیده فاطمه قاسمی 1 © ℗
1 دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد
Abstract:

 در سیستم مراقبت کودک‌محور، پرستاران بیش از هر گروه درمانی دیگر در تماس مستقیم با کودک و خانواده هستند و نقش کلیدی در فرآیند توانمندسازی والدین بر عهده دارند. توانمندسازی به معنای مشارکت فعال، ایجاد حس کنترل، کاهش وابستگی و ارتقای آگاهی و مهارت‌های مراقبتی والدین است. این سخنرانی به بررسی نقش پرستار به‌عنوان تسهیل‌گر این فرآیند می‌پردازد؛ نقشی که فراتر از ارائه مراقبت جسمی است و نیازمند مهارت‌های ارتباطی، آموزشی و روان‌شناختی عمیق است. مدل‌های مشارکتی مانند مدل مراقبت مشارکتی (Collaborative Care)، مدل توانمندسازی تدریجی، و رویکردهای تلفیقی که در آن خانواده، پرستار و تیم درمان به عنوان یک واحد عمل می‌کنند، در این مدل‌ها، پرستار نه تنها آموزش‌دهنده است، بلکه به والدین در درک شرایط بیماری کودک، مشارکت در تصمیم‌گیری، کاهش ترس و اضطراب، و برنامه‌ریزی مراقبت پس از ترخیص کمک می‌کند. توانمندسازی والدین تنها از طریق آموزش حاصل نمی‌شود، بلکه نیازمند تعامل فعال، شنیدن نگرانی‌ها، فراهم‌سازی حمایت عاطفی، و برقراری رابطه مبتنی بر اعتماد است. این رابطه دو سویه، بنیان مشارکت موفق در مراقبت است. تمرکز ویژه‌ای بر توانمندسازی والدین توسط پرستار در شرایط خاص مانند بستری شدن طولانی، جراحی‌های پیچیده، بیماری‌های مزمن، و شرایط بحرانی ازاولویتهای مراقبت پرستاری است. چالش‌های پیاده‌سازی توانمند سازی والدین توسط پرستاران شامل کمبود منابع انسانی (حجم بالای کار، کمبود نیروی پرستاری، و فشار کاری شدید، فرصت لازم برای تعامل عمیق، آموزش مؤثر و گفت‌وگوی مستمر با والدین را از پرستاران می‌گیرد) ، فقدان آموزش کافی پرستاران، و مقاومت در برابر مشارکت والدین می باشد. برای غلبه بر این چالش‌ها پیشنهاد میشود که برنامه‌های آموزشی ضمن خدمت ویژه پرستاران با تأکید بر مهارت‌های ارتباطی، آموزش‌محور و خانواده‌محورطراحی شود و همچنین بستر فرهنگ مشارکت درتیم درمانی و تقویت مهارتهای همدلی، شنیدن فعال، مدیریت تعارض، و آموزش مؤثر به والدین آموزش فراهم گردد. در نهایت، اگر هدف ما ارتقای کیفیت مراقبت از کودک و افزایش رضایتمندی خانواده‌هاست، باید پرستار را به‌عنوان یک تسهیل‌گر در مسیر توانمندسازی شناسایی و بسترهای لازم را برای ایفای مؤثر این نقش فراهم کنیم. 

The role of the nurse in improving the psychological and social adaptation of children with chronic illness and their families.
پرستاری
مژگان ساکی 1 © ℗, سیده فاطمه قاسمی 2, فاطمه ولی زاده 2
1 کارشناس ارشد پرستاری کودکان ، دانشکده پیراپزشکی و توانبخشی ، دانشگاه علوم پزشکی لرستان ، خرم آباد ، ایران
2 دانشیار پرستاری، مرکز تحقیقات عوامل اجتماعی سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract

. مقدمه و هدف :کودک مبتلابه بیماری مزمن قادر به شرکت درفعالیت‌هایی که برای سن اوطبیعی تلقی می‌شود، نیست. پرستاران بایستی بتوانند نه تنها مشکلات جسمی،بلکه پیامدهای روانی – اجتماعی کودک وخانواده اورا مد نظر قرارداده وآنها را تسکین دهند.لذا پژوهش حاضر با هدف تعیین نقش پرستار در بهبود سازگاری اجتماعی،روانی کودکان با بیماری مزمن وخانواده های آنها انجام شد. روش کار :این‌مطالعه ‌ازنوع‌ مطالعات ‌مروري‌ بوده‌ وداده‌هاي‌ آن ‌ازطریق‌ بررسی ‌متون‌ واستناد به‌ منابع‌علمی‌حاصل ‌ازجستجودرپایگاههاي اطلاعاتی ScienceDirect ‌،Medlin ‌، Irandoc، SID،Google Scholar،Iran Medex، Magiran فراهم شده است . یافته ها :نحوه واکنش ومواجهه کودک با بیماری مزمن بسته به ویژگی‌های شخصیتی، سن، نگرش‌های اجتماعی،رابطه کودک با والدین وسایرعوامل،متفاوت است.پرستاران اطفال باید مداخلات خانواده محوروهمچنین آموزش فرزندپروری را برای بهبود پیامدهای روانی-اجتماعی این کودکان ارائه دهند. کودکان بدون حمایت پرستار،خانواده واعضای آن ممکن است روش‌های نامناسبی رابرای مقابله امتحان کنند.پرستاران می‌توانند مستقیماً با والدین همکاری کنندوباایجادارتباطات ایده آل که باهمدلی شروع میشوندوسپس با پیشنهادهایی برای راهبردهای مقابله‌ای صحیح و سازنده به کودکان وخانواده های آنها،آنهارابرای تماس با خانواده‌های دیگری که مشکل مشابهی دارند، ترغیب نمایند.نقش پرستار،حمایت،اطلاع‌ رسانی،آموزش در مورد مراقبت ودرمان کودک وآماده‌سازی کودک ووالدین وسایراعضای خانواده برای سازگاری باشرایط جدید بیماری است.اطلاعات برای والدین باید پیوسته،متناسب با مراحل پیشرفت بیماری وشامل شرایط جدید درصورت بروزوهمچنین با درنظرگرفتن اضطراب والدین باشد.سه منبع اصلی حمایت که برای خانواده بایستی وجودداشته باشد:حمایت حرفه‌ای؛حمایت خویشاوندی وگروه‌های خودیاری میباشد.نقش تیم مراقبت‌های بهداشتی زمانی بیشترین فایده را دارد که بتواندعوامل استرس‌زارابه موقع شناسایی کند وبه کودک وخانواده‌اش کمک کند تا رویکردهای سازنده‌ای رااتخاذ کنند.مناسب‌ترین مرحله برای این مداخله درمراحل اولیه ودراسرع وقت پس ازتشخیص است. عامل بسیار مهم دیگردرمقابله با بیماری‌های مزمن،حمایت اجتماعی درجهت سازگاری اجتماعی است که به این منظور بایستی به این موارد توجه گردد:الف) تشخیص زودهنگام به منظور کاهش پیامدهای منفی بیماری ب) مواجهه با مشکلات جسمی و روانی کودک .... بحث و نتیجه گیری:پرستاران بایستی نقش خود درمراقبت روانی-اجتماعی ازکودک وخانواده های آنها را به خوبی شناخته ودر این راستا به کاهش این پیامدهاکمک نموده وباشناخت بیشترارزش تیم‌های چندرشته‌ای درتقویت همکاری پایداربین متخصصان مراقبت‌های بهداشتی باهدف بهبود استاندارد مراقبت خانواده محوروپرداختن اساسی به چالش‌های پیش روی کودک وخانواده اش دربهبود سازگاری روانی-اجتماعی این کودکان و خانواده هایشان نقش بسزایی را ایفا نمایند. کلیدواژه ها :پرستار،حمایت روانی – اجتماعی،کودک،خانواده 

Using serious game approach for teaching appropriate behavior regarding security in virtual space to children
پرستاری
محمد مهدی منصوری 1, رسول صادقی 2, سیده فاطمه قاسمی 3, فاطمه ولی زاده 3 © ℗
1 کارشناسی ارشد پرستاری کودکان. کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
2 گروه مهندسی کامپیوتر و فناوری اطلاعات، دانشگاه رازی، کرمانشاه، ایران
3 دانشیار آموزش پرستاری، مرکز تحقیقات عوامل اجتماعی موثر بر سلامت، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم‌آباد، ایران
Abstract:

 مقدمه: امروزه اینترنت بخش زیادی از وقت کودکان را به خود اختصاص داده و آنان را در معرض خطرات امنیت در فضای مجازی قرارداده¬است. مطالعه حاضر با هدف طراحی و ارزیابی برنامه کاربردی مبتنی بر بازی جدی برای آموزش کودکان در مورد امنیت در فضای مجازی انجام شد . مواد و روش¬ها: این مطالعه¬ی کاربردی در4مرحله انجام شد. 1-محتوای اپلیکیشن به روش مرور متون گردآوری و با تأیید10 متخصص آموزش پرستاری کودکان، فناوری اطلاعات وکامپیوتر و محاسبه روایی محتوا اعتباریابی شد.2- محتوا به صورت فایل¬ متنی، تصاویر، نقاشی¬ها و صداهای ضبط شده همراه با نمای کلی برنامه روی صفحه¬ی بازی مارپله برای تیم طراح با تخصص¬های گرافیک، کامپیوتر و برنامه¬نویسی ارسال شد. اپلیکیشن با نرم¬افزارهای تری¬دی¬مکس، فتوشاپ، افترافکت و یونیتی¬تری¬دی در محیط اندروید طراحی شد.3- نرم¬افزار برای40 دانش¬آموز 15-6 ساله نصب و سه روز بازی را انجام دادند. 4-شرکت¬کنندگان پرسشنامه کاربردپذیری سیستم تعدیل¬شده برای کودکان را تکمیل کردند. از فراوانی، درصد، میانگین، انحراف معیار و آزمون کای-دو برای تجزیه تحلیل دادهها استفاده شد. نتایج: محتوای برنامه کاربردی شامل 52 پیام در پنج موضوع قلدری ؛کلاهبرداری و سرقت؛ فریبکاری ؛ آزار و اذیت و محتوای نامناسب جنسی؛ در فضای سایبری بود. نتایج 99/0 , CVI=99/0= CVR بود. پس از نصب و اجرای اپلیکیشن، 5 جزیره وجود دارد. با کلیک بر هر جزیره بازی مارپله اجرا می¬گردد. هنگام انجام بازی کاربر در بعضی خانه¬ها با سوالاتی در مورد رفتارهای درست/ نادرست امنیت در فضای مجازی مواجه می¬شود و باید تلاش¬کند با پاسخ درست ¬از نیش مارها دوری و از پله¬ها بالا¬رفته و به بالاترین خانه صفحه، یعنی خانه ۱۰۰ برسد و 5 مرحله را سپری¬کند. اکثر مشارکت¬کنندگان (%50) کاربردپذیری نرم افزار را زیاد ارزیابی¬کردند. تفاوت کاربردپذیری نرم¬افزار بین دو گروه سنی کمتر و بیشتر از 9 سال از لحاظ آماری معنادار بود (p=0.001). نتیجه¬گیری: این نرم¬افزار اندرویدی با قابلیت نصب در موبایل و تبلت؛ امنیت در فضای مجازی را در قالب بازی با در نظر گرفتن فرهنگ اسلامی برای کودکان ایرانی ارائه کرد. در حین بازی کودکان یاد می گیرند با انتخاب رفتار مناسب در فضای مجازی پاداش می‌گیرند و اگر انتخاب اشتباهی داشته باشند با مجازات و سختی روبرو خواهند شد. استفاده از این برنامه به ویژه برای کودکان 9 ساله و بالاتر جهت آموزش امنیت فضای مجازی به کودکان پیشنهاد می¬شود. کلمات کلیدی: امنیت در فضای مجازی، آموزش ، بازی جدی، کودکان کد اخلاق : IR.LUMS.REC.1401.161 از دانشگاه علوم پزشکی لرستان 

چالش های پرستاران در کاربا کودکان و راهکارهای مقابله با آن
پرستاری
صغری لطفی پور 1 ©, زهرا عزیزخانی 1, راحله قاسمی 1 ℗
1 سرپرستار
Abstract:

 برقراری ارتباط موثر/ کودکان به دلیل سن کم و عدم توانایی در بیان احساسات ممکن است نتواندد نیازهای خودرابدرستی ابراز کنندو این امر برکیفیت مراقبت تاثیر میگذارد.مدیریت رفتار کودکان /کودکان در محیط بیمارستان و درمانی دچار و ترس شدید و اضطراب میشوند و رفتارهای غیر قابل پیش بینی از خود نشان میدهند که این رفتار مدیریت خاص را میطلبد.بار عاطفی و استرس پرستار/ دیدن درد و رنج کودکان اضطراب و تنش درد در پرستاران را افزایش داده و سبب فرسودگی و بی انگیزه گی میشود.حمایت پرستاران از خانواده ها/ پرستاران باید از خانواده کودکان حمایت عاطفی کنند و اطلاعات لازم را براساس پرستاران در زمینه مراقبت از کودکان با چالش های خاصی مواجه هستند که میتواند بر کیفیت مراقبت و سلامت روان انها تاثیر بگذارد از انجا که کودکان به دلایل سن و شرایط خاص خود نیازهای متفاوتی دارند شناخت این چالش ها و ارایه راهکارهای مناسب اهمیت ویژه ای برخوردار است .چالش ها: دستور العمل درمان ارایه دهند این کار زمان بر و نیاز به مهارت ارتباطی پرستاردارد . کمبود منابع و تجهیزات/در برخی مراکز یا یشتر مراکز با کمبود امکانات و منابع و تجهیزات مواجه هستند که میتواند برکیفیت مراقبت تاثیر منفی بگذارد. تفاوت فرهنگی اجتماعی و دینی و خرده فرهنگ ها راهکارهای مقابله با این چالش ها: آموزش مهارت ارتباطی بهبود مهارت ها مدیریت درد کودکان تجویز و مدیریت مناسب دارو برای کنترل درد،ایجاد محیط امن و آرام برای کودک چون کودک در بدو ورود ناشناختگی فوبیا از امپول و سوزن و سایر پروسیجر های تهاجمی کودک را وحشت زده میکند. در مدیرت رفتار کودکان درک نیازهای کلامی و غیرکلامی کودک را درک کنیم برقراری ارتباط با والدین میتواند بینش ارزشمندی در رابطه با عادات و ترجیحات و نگرانی های کودک میدهد پس با حفظ حریم خصوصی کودک در انتخاب نوع لباس و نوع تغذیه جدای از رژیم خاص و ایجاد محیط امن و ارام به تشویق به تنفس عمیق فعالیت تفریحی به اتاق بازی ،کتاب داستان خواندن که حواسم کودک را پرت کنیم. در رابطه با حمایت از خانواده ها ،همدلی لبخند نوازش کردن کلمات مثبت و تاثیر گذار دلگرم کننده ،تا حدی زیادی با این گونه چالش ها میشود دست و پنجه نرم کرد. مسیله دیگر تفاوت فرهنگی اجتماعی خانواد ه هاست باید این تفاوت ها بررسی و درک شوند و مورد احترام قرار گیرد.عدم درک این موضوعات اثر مراقبتی را کاهش میدهد. حمایت از پرستاران از نظر عاطفی ،برانگیختگی انگیزه شغلی برنامه های اموزشی 

حمایت از حقوق مراقبین سلامت
پرستاری
فاطمه حاجی بابایی 1 ©, سمیع اله کاظمی 2 ℗, امین نیکومنظری 3
1 دانشیار، عضوهیئت علمی دانشکده پرستاری و مامایی دانشگاه علوم پزشکی تهران.
2 وکیل دادگستری، دانشجوی دکترای حقوق کیفری و جرم شناسی دانشکده حقوق دانشگاه شهید بهشتی
3 قاضی دادگستری. دکترای حقوق کیفری و جرم شناسی، دانشگاه شهید بهشتی.
Abstract:

 مقدمه و اهداف: ارائه دهندگان خدمات سلامت نقش به سزایی در حفظ سلامت جسمی و روانی بیماران دارند که نیاز به توجه ویژه ای به حمایت حقوقی و قانونی از این کارکنان است. هنگامیکه بیمار به مراکز ارائه دهنده خدمات سلامت مراجعه می‌نماید، تحت تاثیر فشارهای روانی است که این فشارهای روانی چه از سوی بیمار و چه از سوی همراهان وی، به کادر درمان از جمله پزشکان و پرستاران منتقل شده و موجب ورود صدمات معنوی و فیزیکی به ایشان می‌گردد. این در حالیست که در نظام های حقوقی کشورهای توسعه یافته، در راستای حمایت از حقوق مراقبین، مقررات حمایت‌کننده قانونی اعم از کیفری و حقوقی وضع گردیده و به نوعی این حمایت‌های قانونی موجب ارتقاء کیفیت مراقبت کادر درمان از یک سو و از سوی دیگر دلگرمی ایشان در مواجهه با اقدامات نابهنجار بیمار و یا همراهان وی می‌گردد. این پژوهش با هدف بررسی حمایت‌های قانونی از کادر درمان به واکاوی قوانین جاری و مقررات حاکم در کور پرداخته‌ است تا علاوه بر شناسایی وضع موجود، به بهسازی نظام قانونی از باب وضع قوانین حمایتی لازم نیز نائل گردد. روش کار: در این مطالعه از روش کتابخانه‌ای، قوانین و مقررات جاری مورد تدقیق و کنکاش قرار گرفته است. یافته ها: بررسی انجام شده حاکی از آن بود که صرفاً مقرراتی در خصوص وضعیت معیشتی و یا سامان‌دهی کاری کادر درمان و مراقبین سلامت وجود دارد و در خصوص حمایت کیفری و مدنی ایشان، قانون‌گذار چاره‌اندیشی خاصی را مناسب با خطرات و آسیب‌های بالقوه نیندیشیده است و در این موارد صرفاً قوانین عمومی از جمله مواد 608 و 609 قانون مجازات اسلامی بخش تعزیرات و بخش دیات قانون مزبور از حقوق مراقبین سلامت حمایت می‌نماید که این حمایت می بایست مطابق با تهدیدها و خسارات بالقوه در سطحی کلان‌تر و تخصصی‌تر تقنین و اجرا گردد. بحث و نتیجه گیری: باید توجه داشت که رویکرد یک جانبه صرفا در راستای حمایت از حقوق بیماران نه تنها گره ای از مشکلات نمی گشاید بلکه شکاف ها را نیز عمیق تر می کند و از سوی دیگر نیز این تصور که حقوق بیمار و حقوق مراقبین در مقابل یکدیگر قرار دارند نیز صحیح نیست. از این رو تا زمانی که قانون‌گذار ضمن شناسایی تهدیدها و خسارات بالقوه، اقدامات حمایتی سختگیرانه‌ای را برای کادر درمان و مراقبین سلامت در نظر نگیرد، نمی‌توان از ایشان توقع داشت نسبت به انجام کلیه تکالیف قانونی و اخلاقی خود اهتمام ورزند. واژگان کلیدی: مراقبین سلامت، حمایت کیفری

حمایت کیفری از پرستاران و کادر درمان: تضمین امنیت شغلی و ارتقای کیفیت مراقبت از کودکان
پرستاری
امین نیکومنظری 1 ©, فاطمه حاجی بابایی 2, سمیع اله کاظمی 3 ℗
1 قاضی دادگستری. دکترای حقوق کیفری و جرم شناسی، دانشگاه شهید بهشتی.
2 دانشیار، عضوهیئت علمی دانشکده پرستاری و مامایی دانشگاه علوم پزشکی تهران. نشانی: تهران. میدان توحید، دانشکده پرستاری ومامایی
3 وکیل دادگستری، دانشجوی دکترای حقوق کیفری و جرم شناسی دانشکده حقوق دانشگاه شهید بهشتی
Abstract:

 حمایت کیفری از پرستاران و کادر درمان از اساسی‌ترین ارکان نظام سلامت محسوب می‌شود و نقش مهمی در ارتقای کیفیت مراقبت به‌ویژه در حوزه حساس سلامت کودکان دارد. پرستاران خط مقدم ارائه خدمات درمانی هستند و ارتباط مستقیم و روزانه آنها با بیماران و خانواده شان، آنان را بیش از هر گروه دیگری در معرض تهدیدات فیزیکی، کلامی و روانی قرار می‌دهد. خشونت علیه پرستاران می‌تواند به شکل توهین، تهدید، ضرب و جرح یا حتی حمله گروهی بروز یابد و پیامد آن نه‌تنها آسیب به سلامت فردی و روانی پرستاران است، بلکه کاهش تمرکز شغلی و افزایش احتمال خطاهای بالینی را در پی دارد؛ امری که در بخش کودکان می‌تواند عواقب جبران‌ناپذیری داشته باشد. ازاین‌رو، ایجاد حمایت کیفری مؤثر برای این گروه شغلی ضروری است تا با جرم‌انگاری صریح رفتارهای خشونت‌آمیز در محیط‌های درمانی و پیش‌بینی مجازات‌های بازدارنده، امنیت روانی و شغلی آنان تضمین شود. در حقوق ایران، مقرراتی مانند مواد ۶۰۸ و ۶۱۴ کتاب پنجم قانون مجازات اسلامی و بخشنامه‌های وزارت بهداشت وجود دارد، اما پراکندگی و ضعف ضمانت اجراها، همچنان موجب احساس ناامنی در محیط‌های درمانی است. این پژوهش به روش توصیفی ـ تحلیلی انجام شده و داده‌ها از طریق بررسی قوانین داخلی، آرای وحدت رویه و آیین‌نامه‌های وزارت بهداشت گردآوری و سپس با روش تطبیقی با نظام‌های حقوقی پیشرو مانند فرانسه و ایالات متحده تحلیل شده است. نتایج نشان می‌دهد که تدوین قانون جامع حمایت کیفری از کادر درمان، تشکیل شعب ویژه رسیدگی به جرایم علیه آنان و فرهنگ‌سازی برای احترام به جایگاه پرستاران می‌تواند نقش مؤثری در کاهش خشونت و ارتقای کیفیت مراقبت از بیماران، به‌ویژه کودکان، ایفا کند. کلیدواژه‌گان: حمایت کیفری، پرستار، کادر درمان، خشونت علیه کارکنان سلامت، قانون مجازات اسلامی

مهارت‌های ارتباطی پرستار با والدین بیماران و نقش تاب‌آوری در مراقبت‌های پرستاری
پرستاری
کبری رمضان نژاد آزاربنی 1 © ℗
1 سوپر وایزر بیمارستان کودکان حکیم
Abstract:

 مهارت‌های ارتباطی پرستار با والدین بیماران شامل برقراری ارتباط موثر، گوش دادن فعال، ارائه اطلاعات واضح و مختصر، همدلی و احترام، و حفظ حریم خصوصی است. پرستاران با استفاده از زبان ساده و لحن آرامش‌بخش، اطلاعات دقیق و قابل فهم ارائه می‌دهند و از اصطلاحات تخصصی خودداری می‌کنند تا والدین بتوانند بهتر شرایط فرزندشان را درک کنند. گوش دادن فعال با حفظ ارتباط چشمی و استفاده از زبان بدن مناسب، باعث می‌شود والدین احساس کنند که نگرانی‌ها و سوالاتشان به طور کامل شنیده شده است. رفتار همدلانه و محترمانه، حمایت عاطفی والدین را تقویت کرده و استرس آنان را کاهش می‌دهد. همچنین، حفظ حریم خصوصی والدین و بیمار از اهمیت ویژه‌ای برخوردار است و از هرگونه رفتاری که موجب ناراحتی آنان شود، جلوگیری می‌کند. علاوه بر مهارت‌های ارتباطی، پرستاران باید صبور، قابل اعتماد، حرفه‌ای و دارای مهارت‌های حل مسئله باشند تا بتوانند به بهترین شکل از والدین حمایت کنند. تاب‌آوری به عنوان یک عامل محافظتی در برابر استرس‌ها و مشکلات مراقبتی والدین کودکان مبتلا به سرطان اهمیت ویژه‌ای دارد. والدین با تاب‌آوری بالا، فشارهای مراقبتی را بهتر تحمل می‌کنند و نیاز به حمایت‌های اجتماعی و آموزشی دارند. برنامه‌های آموزش تاب‌آوری مثبت‌گرا به والدین کمک می‌کنند تا با تنظیم مؤثر هیجانات، مهارت‌هایی مانند شناسایی، برچسب‌گذاری و بیان سالم عواطف را یاد بگیرند. این آموزش‌ها همچنین بر پرورش احساسات مثبت مانند سپاسگزاری و امید تمرکز دارند تا مقاومت عاطفی والدین افزایش یابد و فشارهای روانی کاهش یابد.در نتیجه، ترکیب مهارت‌های ارتباطی پرستار با تقویت تاب‌آوری والدین می‌تواند کیفیت مراقبت و سلامت روان خانواده‌های بیماران را به طور قابل توجهی بهبود بخشد.

“Palliative Care in Children with Severe Neurological Disorders: A Supportive Approach to Improving Quality of Life”
پژوهشگران جوان

Sareh Ghanbri 1 ℗, Gholamreza Abdollahi 1 ©
1 .Student Research Committee, School of Nursing and Midwifery, Bushehr University of Medical Sciences, Bushehr, Iran
 

Abstract: ntroduction: Congenital and neurological disorders are among the most common underlying diagnoses in children with life-threatening conditions. These children have an urgent need for relief from distressing symptoms, including pain, swallowing and digestive difficulties, excessive secretion buildup, dyspnea, seizures, and sleep disturbances. Consequently, children with severe neurological disorders and their families face unique needs that are effectively addressed by palliative care teams. Therefore, this narrative review was designed with the aim of exploring palliative care in children with severe neurological disorders. Materials and Methods: The present narrative review was conducted based on articles published between 2020 and 2025. The information sources included PubMed, Scopus, and the Google Scholar search engine. The initial search was performed using the keywords children, palliative care, and severe neurological disorders, yielding a total of 224 articles. After screening, 7 studies met the eligibility criteria for final inclusion. The process of study selection and screening was reported in accordance with the PRISMA flow chart. Results: According to the principles of palliative care, it is essential not only to provide care and support for the child with a life-threatening condition but also to extend support and attention to the family. Thus, palliative care is both patient-centered and family-centered, aiming to improve quality of life throughout the course of illness. Comprehensive palliative care for these children encompasses symptom management, respite and supportive care, normalization, safety, empowerment, and coping with illness. Furthermore, establishing honest and empathetic communication in palliative care not only reduces parental fear and anxiety but also enables healthcare providers to better understand the child’s unique behaviors and needs in a way similar to the parents—since these children are often unable to express their discomfort as healthy children do. Nevertheless, one of the major challenges faced by parents of children with severe neurological disorders is the acceptance of and adjustment to their child’s condition. Receiving palliative care helps parents in this regard, allowing them to find ways to cope while still experiencing moments of joy in life. Conclusion: Palliative care plays a vital role in addressing the complex and multifaceted needs of children with severe neurological disorders and their families. By focusing on symptom management, psychosocial support, effective communication, and family empowerment, palliative care not only improves the quality of life for these children but also provides parents and caregivers with the resources and resilience needed to cope with their child’s condition. 

A Putative HACE1 Founder Mutation in Iranian Patients with Spastic Paraplegia and Psychomotor Retardation with or Without Seizures: Five Cases and Literature Review
پژوهشگران جوان

Mohammad Dehani 1, Nooshin Goudarzi 2 ℗, Ali Rashidi-Nezhad 3, Reza Shervin Badv 4, Mohammad Miryounesi 5, Morteza Heidari 6, Mahmoud Reza Ashrafi 4, Elham Pourbakhtyaran 4 ©
1 Department of Medical Genetics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2 Student Research Committee, Qazvin University of Medical Sciences, Qazvin, Iran
3 Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran.
4 Department of Pediatric Neurology, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
5 Department of Medical Genetics, Faculty of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6 Myelin Disorders Clinic, Pediatric Neurology Division, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Background: Biallelic pathogenic variants in the HACE1 gene are responsible for the ultra-rare neurodevelopmental disorder Spastic Paraplegia and Psychomotor Retardation with or without Seizures (SPPRS). This study investigates the genetic basis of SPPRS in patients from two unrelated Iranian families and provides a comprehensive review of all reported cases harboring HACE1 variants. Methods: We performed whole exome sequencing (WES) on the probands of the two families, each from a consanguineous marriage. The identified variant was validated, and its co-segregation was confirmed using Sanger sequencing. To investigate a common ancestral origin, we subsequently conducted haplotype analysis, runs of homozygosity (ROH) mapping and mutation age estimation. Results: WES identified the same homozygous nonsense variant HACE1:c.1396CT (p.Gln466Ter) in both probands as the underlying cause. Sanger sequencing confirmed that this variant co segregated with the disease in both families. Subsequent analyses revealed a shared ancestral haplotype within a ~6.6 Mb run of homozygosity (ROH) containing the HACE1 gene, confirming a common origin for the mutation, which was estimated to have arisen approximately 10.3 generations ago (roughly 250 years). Furthermore, a comprehensive review of all reported cases identified delayed psychomotor development, intellectual disability, hypotonia, spasticity, structural brain abnormalities, motor disorders and speech impairment as the most prevalent clinical features of this syndrome. Conclusion: Our findings suggest that the HACE1:c.1396CT variant is a founder mutation within the Iranian population, representing the first report of SPPRS-causing variants in this population and the first founder mutation for this gene reported worldwide. This study expands the known genetic and clinical spectrum of the disorder and highlights phenotypic heterogeneity, even among patients sharing the same genotype. This discovery has crucial clinical implications, enabling the development of targeted screening strategies and improving genotype-phenotype correlations, thereby facilitating more accurate genetic counseling for at-risk families. Keywords: HACE1, Spastic paraplegia and psychomotor retardation with or without seizures (SPPRS), spasticity, founder mutation, genotype–phenotype correlation, Iran 

Climate Change and the Rise of Pediatric Respiratory Diseases: A Systematic Review of Regional Studies
پژوهشگران جوان

Samaneh Dehghani 1 ℗, Hamed Soleimani 1 ©, Kazem Naddafi 2
1 1. Department of Environmental Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2. Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Environmental Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Introduction: Climate change is increasingly recognized as a major global health threat, particularly for vulnerable populations such as children. Children, especially those under 15 years old, are biologically more susceptible to these environmental stressors due to their underdeveloped lungs, higher respiratory rates, and still-maturing immune systems. This systematic review was aimed to synthesize region-specific scientific evidence on the relationship between climatic variables (e.g., air pollution, temperature extremes, humidity levels, and particulate matter) and the incidence or severity of respiratory diseases in children. Methodology: A comprehensive and systematic literature search was performed across four major scientific databases: PubMed, Scopus, Web of Science, and Google Scholar. The search covered publications from January 2013 to August 2025, using a combination of controlled vocabulary and free-text keywords such as “climate change”, “respiratory diseases”, “children”, “air pollution”, “PM2.5”, and “dust storms”. Studies were included if they used observational designs, focused on children under 15, were conducted at a regional or sub-national level, and reported quantitative links between environmental exposures (e.g., temperature, air pollution, humidity, extreme weather) and respiratory outcomes (e.g., asthma, bronchitis, or infections). Study screening followed PRISMA guidelines, and methodological quality was assessed using the AMSTAR 2 tool. Results: Out of 2315 initial records, 32 studies met the inclusion criteria. Geographical distribution included Asia (10), Latin America (8), Africa (7), and the Middle East (4). The most commonly reported outcomes were asthma exacerbations (22 studies), lower respiratory tract infections (14), and RSV-related illnesses (6). Overall, 91% of studies reported a statistically significant association between at least one climate variable and an increase in respiratory illness among children. In areas with PM2.5 levels exceeding 35 µg/m³, hospitalization rates for pediatric asthma were reported to be up to 2.4 times higher (95% CI: 1.9–2.9). In India, a 1°C increase in daily average temperature was associated with a 6.3% rise in respiratory infections. In the Middle East, dust storm events were linked to spikes in emergency room visits for children, with an increase of up to 18% within 72 hours following the event. Conclusion: There is compelling regional evidence linking climate change and pediatric respiratory morbidity. These effects are particularly pronounced in low-resource settings, where exposure to environmental stressors is higher and health infrastructure is limited. Effective local policies—focusing on air quality control, climate early warning systems, and child-centered health planning—are urgently needed to mitigate these impacts. Keywords: climate change, air pollution, children, respiratory diseases, asthma, PM2.5 

Prenatal Exposure to Traffic-Related Polycyclic Aromatic Hydrocarbons and Neonatal Thyroid Function: A Cross-Sectional Study in Shiraz, Iran
پژوهشگران جوان

Samaneh Dehghani 1 ℗, Hamed Soleimani 1 ©, Kazem Naddafi 2, Narges Velayati 1
1 1. Department of Environmental Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran 2. Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Environmental Health, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Introduction: Exposure to polycyclic aromatic hydrocarbons (PAHs), particularly those emitted from traffic sources, poses significant risks to fetal development and endocrine regulation. Despite increasing concern about urban air pollution, evidence on prenatal traffic-related PAH exposure and neonatal thyroid function is still limited—particularly in the Middle East. This study aimed to assess the association between prenatal exposure to traffic-related PAHs and thyroid-stimulating hormone (TSH) levels in neonates born in an urban setting in Iran. Methodology: In this cross-sectional study, 195 pregnant women in their third trimester (7th month and end of 9th month) were randomly recruited from healthcare centers across Shiraz, Iran. Maternal blood samples were used to estimate fetal PAH exposure, based on placental transfer. Eight PAHs were quantified via GC–MS, including Benzo(a)pyrene, Benzo(b)fluoranthene, and Chrysene. Maternal interviews and questionnaires captured demographic and exposure data. Residential locations were geocoded, and traffic exposure was estimated using 500-meter buffer traffic density. Neonatal TSH was measured via heel-prick sampling during routine screening within 3–5 days of birth. Multivariable linear regression (R v4.0.2) assessed the association between maternal PAHs and neonatal TSH, adjusting for key confounders. The study received ethics approval from the local IRB (IR.QUMS.REC.1397.345). Results: Phenanthrene and Fluoranthene were the most abundant PAHs in maternal serum, with mean concentrations of 31.5 and 28.7 ng/mL, respectively. Total PAH levels ranged from 28.4 to 184.7 ng/m³, with an average of 96.2 ng/m³. Traffic density within a 500-meter radius of maternal homes was strongly correlated with serum PAH levels (r = 0.61, p 0.001), confirming traffic as the main exposure source. Newborns of mothers in the highest PAH exposure tertile had significantly elevated TSH levels (5.82 ± 1.21 mIU/L) compared to those in the lowest tertile (4.93 ± 1.09 mIU/L, p 0.01). Regression analysis showed that every 10 ng/m³ increase in total PAH exposure was associated with a 0.18 mIU/L rise in neonatal TSH (95% CI: 0.07–0.29, p = 0.002). The association remained significant after adjusting for key confounders. No meaningful differences were observed in birth weight, length, or head circumference across exposure groups. Conclusion: This study provides evidence that prenatal exposure to traffic-derived PAHs may disrupt neonatal thyroid function. Findings highlight fetal endocrine vulnerability to urban pollution and support targeted air quality policies in high-traffic areas. Keywords: Polycyclic aromatic hydrocarbons, prenatal exposure, neonatal TSH, thyroid function, traffic emissions, urban air pollution 

Probiotics and Rotavirus Vaccine Immunogenicity in Infants and Children: A Systematic Review
پژوهشگران جوان

Qazal Esmaylpur 1 © ℗, Zahra Kazemi Korani 2, Neda Jourabchi Ghadim 3, Saba Arabnezhad 1, Isun Lotfi 4
1 1. Student Research Committee, Sarab Faculty of Medical Sciences, Sarab, Iran
2 2. Student Research Committee, Faculty of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
3 3. Nutrition research center, Tabriz university of medical sciences, Tabriz, Iran
4 5. Student Research Committee, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: Background: Rotavirus is a leading cause of severe gastroenteritis in infants, resulting in significant global morbidity and mortality. Oral rotavirus vaccines have reduced hospitalizations and deaths, yet their efficacy varies, particularly in high-mortality regions. Immunogenicity, the ability of a vaccine to elicit an immune response, is influenced by modulator factors like Probiotics, live microorganisms that confer health benefits. This study explores the interplay between probiotics and rotavirus vaccine immunogenicity to identify strategies to enhance vaccine effectiveness in vulnerable populations. Method: This systematic review was conducted based on the PICO criteria and following PRISMA guidelines. A comprehensive search was performed in PubMed, Scopus, Web of Science, and Cochrane Library for studies published between 2015 and 2025. Keywords included "probiotics," "vaccine," "infants," “rotavirus,” and related terms. The inclusion criteria were randomized or controlled clinical trials in infants that assessed probiotic supplementation and vaccine immune responses. Exclusion criteria included animal studies, narrative reviews, and insufficient data. Study quality was assessed using the Cochrane Risk of Bias 2 (RoB 2) tool. The found articles were screened by two researchers separately. Result: Following inclusion and exclusion criteria, 13 relevant studies were selected from an initial pool of 143 articles. The clinical outcomes indicate a variation in vaccine efficacy, ranging from 85% to 97% in low-mortality regions, compared to just 35% to 58% in high-mortality areas. This discrepancy is attributed to factors such as malnutrition, pathogen exposure, and imbalances in microbiota. Probiotics, including Lactobacillus rhamnosus GG and Bifidobacterium lactis, have been shown to enrich infant microbiota, inhibiting pathogenic organisms, strengthening mucosal barriers, increasing their production, and modulating innate immunity to reduce inflammation. When administered alongside rotavirus vaccines, these probiotics function as adjuvants by shifting immune responses toward Th1 and activating regulatory T-cells, reducing the duration of rotavirus diarrhea by approximately 1-3 days and increasing IgA/IgG titers by 18% to 22%, as well as enhancing IFN-γ+ cells by 30% to 40%. Additionally, they boost overall vaccine uptake by 15% to 18%. However, some studies paradoxically report a transient decrease in IgA seroconversion ranging from 20% to 37%, indicating that further extensive research is required to draw definitive conclusions. Conclusion: Considering strains, dosages, and the duration of supplementation, probiotics emerge as an effective adjunct in the treatment of rotavirus diarrhea by modulating both the immune system and intestinal microbiota. However, the current evidence remains inconclusive, highlighting the need for more studies to establish their efficacy. 

Probiotics: A protective shield from breast milk against necrotizing enterocolitis in the premature new borns.
پژوهشگران جوان

Atiyeh Mamooee 1 ℗, Afifeh Mamooee 1, Roqayeh Gashmard 1 ©
1 Bachelor of Nursing student, Student Research Committee, Bushehr University of Medical Sciences, Bushehr, Iran
Abstract: Introduction: Necrotizing enterocolitis (NEC) is a common and life-threatening disease in premature new borns. Identifying specific preventive strategies to reduce the incidence of this disease is of great importance. Among these strategies, the use of probiotics as a nutritional strategy has been considered. Accordingly, this study was designed to investigate the effect of probiotic-enriched breast milk in preventing NEC in premature new borns. Methods: A recent review was conducted using Google Scholar, PubMed, Scopus, and Sid databases with the keywords probiotics, enterocolic necrosis, preterm new born and breast milk during the period 2017-2024. Initially, 20 studies were identified from the initial search. Articles were included only if they were published in Persian or English. After removing duplicates, 5 studies were selected for analysis. The selection, extraction, and analysis processes were performed with careful attention to minimizing bias. Results: NEC is a severe gastrointestinal disease of premature new borns and is thought to be related to physiological immaturity of the intestine and altered levels of normal intestinal flora. The disease is very common and occurs in 5 to 10% of very low birth weight infants with necrosis of small and large intestinal tissues. Breastfeeding is known as a preventive, safe, and effective approach for NEC in premature new borns. Now, the role of other drugs or adjuncts is also significant. For example, probiotics, glutamine, arginine, etc. have been studied as a treatment to reduce NEC in premature new borns. Several studies show a reduction in the incidence and severity of NEC in new borns treated with probiotics. Probiotics are live microorganisms that, when administered in sufficient quantities, provide health benefits to the host. Research shows that probiotics have the greatest impact on reducing mortality in new borns with NEC and also shortening their length of hospital stay. Therefore, further research on this topic could pave the way for the recovery of more new borns with NEC. Conclusion: Given the nature of NEC and the very serious complications that it can cause in premature new borns and even cause their death, preventive measures in this field can be very useful. Since new borns use breast milk for their growth and development, enriching this milk with probiotics through the mother's continuous use of foods containing probiotics is a very effective way to prevent this disease. Keywords: Probiotics, enterocolic necrosis, Premature new born, Breast milk

Rehabilitation Needs in Children with Williams Syndrome: A Narrative Review
پژوهشگران جوان

مهدی میرزادی 1 © ℗, علیرضا خسروانجم صداپشته 1
1 دانشکده علوم توانبخشی، دانشگاه علوم پزشکی شهید بهشتی،تهران، ایران.
Abstract:

 سابقه و هدف: سندرم ویلیامز (Williams Syndrome) یک اختلال ژنتیکی نادر است که حدود 1/10000 نفر را تحت تأثیر قرار می‌دهد. علت این سندرم ریزحذف 1.5-1.8 مگابایت در کروموزوم 7q11.23 می‌باشد، این اختلال سیستم‌های متعددی را تحت تأثیر قرار می‌دهد. توانبخشی به عنوان یک رویکرد مؤثر برای بهبود کیفیت زندگی و عملکرد این بیماران عمل می‌کند. هدف از انجام این پژوهش بررسی نیازهای توانبخشی کودکان مبتلا به سندرم ویلیامز (WS) می‌باشد. مواد و روش: این مطالعه به صورت مرور روایتی انجام شد. در مطالعه حاضر مقالات در پایگاه های اطلاعاتی مانند SID ،Noormags ، Magiran ، Google Scholar ، PubMed با کلید واژه های سندرم ویلیامز، توانبخشی، کودکان از سال 2015 تا 2025 جستجو شد. در نهایت مطالعاتی که به بررسی نیازهای توانبخشی بیماران سندرم ویلیامز پرداخته اند طی دو مرحله بازبینی شدند که در مرحله اول عنوان و چکیده و در مرحله دوم کل مقاله مورد بررسی قرار گرفت، با اعمال معیار های ورود و خروج و حذف موارد تکراری تعداد 18 مقاله وارد مطالعه شد. یافته ها: مطابق بررسی های صورت گرفته مهم ترین نیاز های توانبخشی کودکان مبتلا به سندرم ویلیامز شامل: توانبخشی شناختی، آموزش مهارت های ارتباطاتی و اجتماعی، ارزیابی حسی(تکمیل پروفایل حسی)، توانبخشی حرکتی(حرکات درشت و ظریف)، ارزیابی اختلالات شنوایی، مشاوره روانشناسی، آموزش به والدین و مراقبین و رویکرد تیمی چند رشته ای می‌باشد. همچنین استفاده از فناوری واقعیت مجازی و بازی درمانی در توانبخشی این کودکان می‌تواند در بهبود توانایی های ذهنی( حافظه و ادراک) مفید باشد. نتیجه گیری: در توانبخشی کودکان مبتلا سندرم ویلیامز باید ابعاد مختلف فردی و اجتماعی را در نظر گرفت، همچنین تاکید بر رویکرد تیمی چند رشته ای و مداخلات زودهنگام در برنامه درمانی این بیماران ضروری است. اعضای تیم توانبخشی لازم است به جنبه های اشاره شده در توانبخشی این کودکان توجه ویژه ای داشته باشند. کلید واژه ها به فارسی: سندرم ویلیامز، توانبخشی، کودکان کلید واژه ها به انگلیسی: Williams Syndrome, Rehabilitation, Children

Cerebral Autoregulation in Neonates: Physiology and Beyond
neonatology
ستاره ثاقب 1 © ℗
1 . Associate Professor of Neonatology .TUMS
Abstract: The neonatal brain’s ability to maintain relatively stable cerebral blood flow (CBF) amidst swings in arterial pressure—known as cerebral autoregulation—is a delicate and evolving physiological defense. In preterm infants, this autoregulatory mechanism is immature and easily overwhelmed by environmental and clinical stressors. Anatomical underdevelopment of cerebral vasculature restricts the effective autoregulatory range, making these infants especially vulnerable to fluctuations in perfusion. Assessing cerebral autoregulation in neonates requires approaches that are both accurate and safe for fragile patients. Non-invasive monitoring techniques dominate current research, with near-infrared spectroscopy (NIRS) emerging as the most practical bedside tool. By measuring cerebral oxygen saturation continuously, NIRS allows clinicians to examine how changes in mean arterial pressure (MAP) affect brain oxygenation. Future directions emphasize integrating NIRS with multimodal monitoring (EEG, Doppler ultrasound, and continuous blood pressure) to create a fuller picture of cerebrovascular health. Such approaches could guide interventions in real time, helping clinicians avoid both hypoperfusion and hyperperfusion. Ultimately, translating autoregulation monitoring into routine care may provide a path toward precision neuroprotection, especially for preterm and critically ill neonates.

Amniotic membrane dressings for treatment of aplasia cutis in newborns
neonatology
Maliheh Kadivar 1 ©, Somayeh Rostamli 2 ℗, Soheila Sotoudeh 3
1 Department of Pediatrics, Division of Neonatology, School of Medicine, Tehran University of Medical Sciences, Children's Medical Center
2 Neonatal Intensive Care Nursing, Tehran University of Medical Sciences
3 Department of Dermatology, Children's Medical Center, Tehran University of Medical Sciences
Abstract: Background: Aplasia cutis congenita (ACC) is a rare congenital skin defect characterized by a focal or extensive absence of the epidermis, dermis, and occasionally, subcutaneous tissue. When the wound caused by this defect is wide or deep, various treatments are used, including skin grafting. The amniotic membrane (AM) is a biological dressing that facilitates re-epithelialization as it contains mesenchymal cells and numerous growth factors. Objective: To report the efficacy of AM dressings in treating the skin defects of ACC. Method: This study was conducted on five neonates diagnosed with ACC born between 2018 and 2022, referred to the Children's Medical Center in Tehran, Iran. AM dressings were applied on wounds larger than 1 cm2. The wounds were assessed weekly and, if required, an additional AM dressing was applied. Results: The skin defects gradually re-epithelialized after application of the AM. The complete healing process took around 3.5 weeks on average. No hypertrophic scarring was observed. Conclusion: The application of AM dressing resulted in satisfactory cosmetic outcomes, with no hypertrophic scar formation. Complete healing occurred in all cases except one. The length of the hospital stay ranged from 2 to 6 weeks, depending on the size of the wound. Keywords: amniotic membrane; aplasia cutis congenita; biological products; placenta; wound healing.

Approach to the Neonate with Respiratory Distress
neonatology
Maryam Saeedi 1 © ℗
1 pediatric department ..children medical center .Tehran university of medical science
Abstract: Abstract: Approach to the Neonate with Respiratory Distress Maryam saeedi.MD-MPH. nenatologist . children medical center, Tehran university of medical science. Background: Neonatal respiratory distress is among the most frequent and critical presentations in neonates, affecting both preterm and term infants. Timely recognition and management are important to reduce morbidity and mortality. Methods/Approach: This abstract has reviewed recent evidence , focusing on stabilization, noninvasive and invasive ventilation and adjunct therapies. Key Findings: • Early CPAP (5–8 cmH₂O) is first-line; • HFNC may be not be appropriable for preterm infants. • NIPPV reduces failure compared to CPAP in high-risk groups. • Surfactant Therapy: LISA/MIST preferred over INSURE; early caffeine with LISA may reduce intubation rates. • Oxygen Management: avoid hyperoxia. Permissive hypercapnia tolerated if pH ≥7.25. • Lung sonography(LUS) : Effective for differentiating RDS, TTN, pneumonia, MAS, and pneumothorax. • PPHN: Identified by pre/post-ductal SpO₂ difference and echocardiography; inhaled nitric oxide remains first-line vasodilator. • Antibiotic use : Avoid unnecessary treatment in TTN/RDS without risk factors. Conclusion: A structured, evidence-based approach, focusing on early CPAP, selective LISA, oxygen targeting, LUS-guided diagnosis, optimizes neonatal respiratory distress outcomes. References: 1. Sweet DG et al. European Consensus Guidelines on RDS: 2022 update. Neonatology. 2023;120:3–23. 2. Cucerea M et al. Updated RDS practice & outcomes. J Clin Med. 2024;13:1103. 3. NEJM Evidence. Caffeine + LISA RCT. 2023; EVIDoa2300183. 4. Front Pediatr. 14-zone LUS score in neonatal RDS. 2025. 5. Narrative Review. Lung ultrasound in neonatal RDS. 2024. PMCID: PMC11674376. 6. Review. Less Invasive Surfactant Administration,trials & evidence. PMCID: PMC11446307. 

Case Report: Presentation of a Newborn with Pseudo-Hirschsprung Symptoms at Bahrami Hospital
neonatology
دکتر کامیار کامرانی 1 © ℗
1 Associate Professor of Tehran University of Medical Science
Abstract: A female newborn with GA: 38w + 5d, presented with repeated vomiting and abdominal distention three days after birth, along with jaundice and no passage of meconium. Due to these symptoms, the infant was admitted to the NICU at Bahrami Hospital under suspicion of intestinal obstruction. On the first day of hospitalization, she had not passed meconium. She had no history of fever or seizures. Hearing and vision appeared normal. The baby had a bloated abdomen and mild respiratory distress. Physical examination revealed abdominal distention with prominent intestinal loops, visible bowel peristalsis, and increased bowel sounds. Digital rectal exam revealed an empty rectum with explosive gas and stool release afterward. The baby received a diagnosis of probable Hirschsprung disease and was prepared for a contrast enema. The mother had no history of thyroid disease. Lab results (CBC, calcium, magnesium, phosphorus, BUN, creatinine, CRP) were normal. Thyroid tests revealed TSH = 7 and Free T4 = 1.6, which were initially interpreted as normal, and no treatment was started. However, due to the persistence of symptoms and no further meconium passage, further investigations and imaging studies were performed to rule out other causes of obstruction. On the 6th day, a repeat thyroid test showed abnormal results (TSH = 37.5, Free T4 = 1.37), confirming congenital hypothyroidism. Treatment with levothyroxine was started, and the patient’s symptoms and meconium passage improved over the following days. The baby tolerated feeds and was eventually discharged in good condition. Conclusion: Pseudo-Hirschsprung symptoms in a newborn, despite normal initial thyroid tests, can be an early sign of congenital hypothyroidism. Checking thyroid function tests in newborns presenting with pseudo-obstruction symptoms is important, and early treatment can resolve the patient’s symptoms Keywords: Lack of meconium passage, pseudo-Hirschsprung, hypothyroidism

Continuity of Care: Structured Follow-Up Strategies for Preterm Neonates After NICU Discharge
neonatology
Kayvan Mirnia 1 © ℗
1 Associate professor of neonatology, children’s medical center, Tehran University of medical science
Abstract: Background: Preterm neonates are at heightened risk for a range of complications including neurodevelopmental delays, respiratory issues, feeding difficulties, and growth failure. Effective post-discharge follow-up is essential to ensure early detection and intervention, improve long-term outcomes, and support families navigating complex care needs. Objective: To outline a structured, multidisciplinary approach for the follow-up of preterm neonates after hospital discharge, emphasizing continuity of care, individualized monitoring, and integration of community resources. Methods: This presentation reviews current evidence-based guidelines and institutional protocols for post-discharge care. It highlights key components such as: • Scheduling timely outpatient visits with neonatology, developmental pediatrics, and allied health professionals • Monitoring growth parameters, feeding progress, and neurodevelopmental milestones • Screening for retinopathy of prematurity, hearing impairment, and chronic lung disease • Providing parental education and psychosocial support • Leveraging telemedicine and home visits to enhance accessibility and adherence Results: Implementation of a standardized follow-up program has shown improved early identification of developmental delays, reduced hospital readmissions, and increased parental satisfaction. Case studies and outcome data from regional centers will be presented. Conclusion: A comprehensive, family-centered follow-up strategy is vital for optimizing outcomes in preterm neonates. Pediatric care teams must collaborate across disciplines and settings to ensure seamless transition from NICU to home and beyond. 

Developmental Follow-up in Premature Infants
neonatology
Mohamad Reza Zarkesh 1 © ℗
1 1.Department of Neonatology, Yas Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. 2.Maternal, Fetal, and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran. 3.European Society for Pediatric Research, Satigny
Abstract: Premature infants (born before 37 weeks of gestation) are at significant risk for neurodevelopmental impairments due to the immaturity of their central nervous system and exposure to adverse perinatal events. The last trimester is critical for brain growth, including myelination, synaptogenesis, and cortical organization. Early birth disrupts these processes, increasing vulnerability to conditions such as intraventricular hemorrhage, periventricular leukomalacia, and chronic lung disease, all of which are associated with long-term motor, cognitive, and sensory deficits. Comprehensive developmental follow-up is essential to monitor these infants longitudinally, enabling early detection of neurodevelopmental delays or disabilities such as cerebral palsy, intellectual disabilities, language disorders, and behavioral problems. Follow-up typically involves multidisciplinary teams conducting serial evaluations with validated assessment tools such as the Bayley Scales of Infant and Toddler Development (BSID), the Griffiths Mental Development Scales, and neurological examinations. Beyond neurodevelopmental assessment, follow-up includes monitoring growth, nutritional status, vision and hearing screenings, as sensory impairments are prevalent in this population. Early intervention services—physical, occupational, speech therapies—are most effective when started promptly after identification of delay, leveraging the brain's neuroplasticity during infancy and early childhood. Studies show that structured follow-up programs improve outcomes by facilitating timely referrals and supporting family education. Additionally, parental involvement and psychosocial support are critical components that enhance developmental progress and reduce caregiver stress. In conclusion, structured developmental follow-up for premature infants is a cornerstone of neonatal care, aiming to optimize neurodevelopmental outcomes and quality of life through early diagnosis and intervention.

Is omeprazole as safe and effective as Lansoprazole in neonatal gastroesophageal reflux disease? A clinical trial
neonatology
Peymaneh Alizadeh Taheri 1 © ℗, Mahdieh Emambakhsh 2, Arman Malekian 3, Kamyar Kamrani 4, No 5
1 - Department of Neonatology, School of Medicine, Tehran University of Medical Sciences, Bahrami Children's Hospital, Tehran, Iran
2 Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Bahrami Children's Hospital, Tehran, Iran.
3 Department of Gastroenterology, School of Medicine, Tehran University of Medical Sciences, Bahrami Children's Hospital, Tehran, Iran.
4 Department of Neonatology, School of Medicine, Tehran University of Medical Sciences, Bahrami Children's Hospital, Tehran, Iran.
5 no
Abstract: Abstract Objective: Gastroesophageal reflux (GER) is the reverse flow of stomach contents into the esophagus, which can become chronic and frequent in severe cases or the pathological form of Gastroesophageal Reflux Disease (GERD). Methods: This study was conducted to compare the safety and effectiveness of omeprazole with lansoprazole in the treatment of GERD in healthy neonates referred to Bahrami Children's Hospital as a double-blind randomized clinical trial, including 90 neonates (age range 1 -28 days). In one group, 45-term neonates aged 38 to 40 weeks were prescribed omeprazole at a dose of 1 mg/kg/day, and in another group, 45 neonates were prescribed lansoprazole at a dose of 1 mg/kg/day. Recovery was considered if there was 50% reduction of rumination, restlessness, regurgitation, vomiting, apnea, stridor, wheezing, pneumonia, convulsions, anemia, and improvement in weight gain and Sandifer's condition over one week and one month. Results: The two groups were not significantly different in terms of gender distribution, age at the first visit, gestational age, and birth weight. There was no significant difference between the overall scores of the two groups before the intervention. Still, one week and one month after the intervention, the total score was significantly lower in the lansoprazole group than in the omeprazole group. The total score in each study group decreased significantly during the study period. Conclusion: This study found that both omeprazole and lansoprazole were safe and effective in treating neonates with GERD; however, the effectiveness of lansoprazole was significantly higher than that of omeprazole. Key words: GERD, Neonate, Omeprazole, Lansoprazole 

Monitoring Growth and Nutritional Outcomes in Neonates: A Case-Based Approach
neonatology
Maral Ghassemzadeh 1 © ℗
1 هیات علمی گروه کودکان دانشگاه علوم پزشکی تهران استادیار نوزادان بیمارستان کودکان حکیم
Abstract: Optimizing neonatal growth and nutrition remains a cornerstone of care in both term and preterm infants, directly influencing survival, neurodevelopment, and long-term health. This lecture will provide a case-based overview of current strategies for monitoring growth and nutritional outcomes, integrating clinical scenarios to highlight practical decision-making. Growth monitoring requires more than serial weight measurements; it encompasses head circumference, length, body proportionality, and velocity, interpreted with evidence-based growth charts such as Fenton and INTERGROWTH-21st standards. Particular attention is required for preterm infants, where early postnatal growth restriction remains prevalent. Nutritional support begins with timely initiation of enteral feeding, ideally with maternal breast milk. In high-risk infants, adjuncts such as protein supplements, human milk fortifiers, and medium-chain triglyceride (MCT) oil are often required to optimize macronutrient intake. Total parenteral nutrition (TPN) plays a critical role when enteral feeding is delayed or insufficient; recent guidelines emphasize early introduction of amino acids and lipids to prevent catabolism. The transition from parenteral to enteral nutrition demands careful monitoring to avoid both undernutrition and overfeeding. Key monitoring parameters include daily weight, weekly length and head circumference, biochemical markers (electrolytes, BUN, prealbumin, triglycerides), and emerging tools such as body composition assessment and metabolic biomarkers. Clinical cases will illustrate practical challenges: determining when to start milk in preterm infants, adjusting protein or energy intake for growth faltering, and the role of oral nutritional supplements in late-preterm or growth-restricted neonates. Newer perspectives also consider individualized growth trajectories, use of z-scores rather than raw percentiles, and the long-term impact of early nutrition on cardiometabolic outcomes. By the end of this session, participants will gain a structured approach to monitoring neonatal growth, integrating anthropometry, nutritional interventions, and laboratory indices, while applying evidence-based strategies in diverse clinical scenarios. Keywords: neonatal growth, nutrition, preterm infant, TPN, protein supplements, MCT oil, growth monitoring References 1. Koletzko B, Poindexter B, Uauy R. Nutritional Care of Preterm Infants: Scientific Basis and Practical Guidelines. Karger, 2021. 2. ESPGHAN Committee on Nutrition. Enteral nutrient supply for preterm infants: commentary from the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr. 2022. 3. WHO. Standards for growth measurement in infants and children. 2021 update. 4. Fenton TR, et al. Preterm growth charts: an update with data from the INTERGROWTH-21st Project. BMC Pediatrics. 2020. 

Neonatal Cholestasis: Introduction, Diagnosis, and Management
neonatology
فرید ایمان زاده 1 © ℗
1 ‏Farid Imanzadeh, Professor of children's gastroenterology and liver disease of Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: Introduction Neonatal cholestasis is a significant clinical syndrome characterized by impaired bile flow in infants during the first few months of life. It results in the accumulation of conjugated bilirubin and bile acids in the liver and bloodstream, leading to jaundice and potential liver damage. Early diagnosis is critical since prolonged cholestasis can cause irreversible hepatic injury, including fibrosis and cirrhosis. The differential diagnosis is broad, encompassing biliary atresia, neonatal hepatitis, metabolic disorders, infections, and genetic diseases. Among these, biliary atresia is the most urgent to diagnose due to the necessity for early surgical intervention. Body The diagnosis of neonatal cholestasis requires a systematic approach involving clinical evaluation, laboratory tests such as liver function panels, imaging studies (ultrasound, hepatobiliary scintigraphy), and sometimes liver biopsy. Distinguishing between extrahepatic obstruction and intrahepatic causes guides treatment strategies. Management includes treating the underlying cause, nutritional support with fat-soluble vitamin supplementation, and monitoring for complications. Conclusion Neonatal cholestasis is a pediatric hepatology emergency that requires prompt identification and intervention to prevent long-term liver damage. A multidisciplinary approach and timely referral to specialized centers enhance patient outcomes. Early differentiation between biliary atresia and other causes is essential for appropriate management. Keywords Neonatal cholestasis, jaundice, biliary atresia, liver function tests, pediatric hepatology

Neonatal hypovolemic shock
neonatology
شیرین شامل 1 © ℗
1 استادیار دانشگاه علوم‌پزشکی تهران
Abstract: Neonatal hypovolemic shock represents a critical, life-threatening condition in newborns, distinguished by inadequate perfusion due to acute intravascular volume loss. Although not as common as in older pediatric populations, significant etiologies include fetomaternal hemorrhage, abruptio placentae, severe dehydration, or occult blood loss such as massive subgaleal or intra-abdominal hemorrhage . Early recognition is paramount, yet challenging—clinical signs often emerge in the uncompensated phase, with hypotension, lactic acidosis, poor perfusion, and oliguria indicating imminent multiorgan dysfunction . Vital diagnostic clues include pallor, tachycardia, prolonged capillary refill, and metabolic derangements; lactic acidemia and low hemoglobin may point toward hemorrhagic causes such as subgaleal hematoma . Management hinges on prompt intravascular volume restoration. Initial resuscitation typically includes isotonic crystalloid boluses (e.g., normal saline 10–20 mL/kg), with repetition as needed. In hemorrhagic scenarios, rapid blood transfusion is essential; fresh frozen plasma may be required if coagulopathy is present . Adjunctive measures include inotropic support such as dopamine or dobutamine when fluid alone is insufficient—while dopamine may more effectively raise blood pressure, dobutamine augments systemic blood flow, especially in premature infants . Functional echocardiography and near-infrared spectroscopy could assist hemodynamic assessment but lack definitive evidence linking them to improved outcomes . In summary, neonatal hypovolemic shock demands early identification, aggressive volume resuscitation, transfusions when indicated, and judicious use of inotropes to optimize perfusion. Despite advances, high-quality evidence remains limited, highlighting the need for further research into diagnostic modalities and long-term outcomes.

Neonatal metabolic disorders screening 
neonatology
Abbasi, Farzaneh 1 © ℗
1 Growth and development research center, children's medical hospital, Tehran university if medical sciences, Tehran Iran
Abstract: Introduction: Neonatal metabolic disorders screening is a programmatic approach to test newborns for a set of inherited metabolic disorders (inborn errors of metabolism, IEMs) shortly after birth. Typically done via dried blood spot testing (heel-prick) with a tiered algorithm: initial screen, followed by confirmatory tests as needed. key goals: Early detection of treatable conditions to prevent irreversible damage (e.g., developmental delay, organ failure, or death). Enable timely initiation of interventions (dietary modifications, vitamins/cofactors, medications) to improve outcomes. Reduce long-term healthcare burden through prevention of severe complications. common screens and panel evolution: Classic panels screen for core IEMs such as phenylketonuria (PKU), medium-chain acyl-CoA dehydrogenase deficiency (MCADD), maple syrup urine disease (MSUD), galactosemia, congenital hypothyroidism, severe combined immunodeficiency (SCID) in broader programs, etc. Modern tandem mass spectrometry (MS/MS) expands panels to dozens of metabolites, enabling detection of multiple aminoacidopathies, organic acidurias, fatty acid oxidation disorders, and more. Some programs include second-tier tests or molecular/genome-based confirmatory steps to reduce false positives and improve diagnostic precision. Benefits: Timely treatment reduces morbidity and mortality. Decreased incidence of disability from certain metabolic crises. Improved family counseling and planning due to earlier diagnosis. challenges and considerations; False positives and false negatives can cause parental anxiety or missed diagnoses. Turnaround time for results and confirmatory testing is critical. Equity and access: ensuring all newborns have access to universal screening and follow-up care. Cost-effectiveness and resource allocation, especially in low-resource settings. 

Neonatal surgical emergencies
neonatology
مریم ویسی زاده 1 © ℗
1 TUMS
Abstract:

 در نوزادان نشانه هاي كليدي براي شك به اورژانس جراحي بصورت ؛استفراغ صفراوي ،عدم دفع مكونيم بيشتر از ٤٨ساعت ،ديسترس شديد تنفسي كه بدرمان با اكسيژن تجويزي بخوبي پاسخ نميدهدبا يا بدون شكم فرو رفته و اتساع پيشرونده شكم مي باشند . اگر بخواهيم از ديدگاه نيوناتولوژي و با جزييات تخصصي تر اورژانس هاي جراحي را دسته بندي كنيم ميتوانيم به شكل زير مرتب كنيم : ١-آترزي مري با يا بدون فيستول بين ناي و مري علايم بصورت ترشحات زياد دهاني وسرفه و سيانوز هنگام شيرخوردن و ناتواني در عبوركاتتر بداخل معده ظاهر ميشود . آسپيراسيون دايم بزاق بعنوان يكي از مخاطرات جدي واز علل نارسايي تنفسي ميتوانند از علل مهم بررسي اين آنومالي بعنوان يك اورژانس باشند . ٢-ولولوس ميدگات ؛كه بصورت استفراغ صفراوي و اتساع شكم و در صورت عدم تشخيص بصورت شوك ثانويه به ايسكمي روده ظاهر ميشود و خطر نكروز وسيع روده اي تشخيص و درمان اورژانسي را مطرح ميتمايد. ٣-انواع انسدادهاي روده باريك و بزرك كه بر حسب مكان گرفتاري اتساع خفيف تا شديد شكم وهمراهي يا عدم همراهي استفراغ صفراوي وآنومالي هاي همراه اختلالات كروموزومي و ديسمورفولوژي هاي كوناگون سابقه جنيني پلي هيدرآمنيوس سابقه ازدواج فاميلي و رويت روده هاي هيپراكو همه يا بخشي از آن ميتوانند از علايم آن باشند بسته به اينكه انسداد كامل يا بصورت نسبي باشد علايم ميتوانند بصورت پايدار وپيشرونده يا بصورت متناوب آشكارشود از بيماريهاي اينگروه ميتوان به آترزي ديودنوم و انواع آن و آترزي ايليوم و آترزي ژوژنوم و ايليوس مكونيم اشاره كرد در انسداد هاي پايين تر بيماري هيرشپرونگ و آنوس ايمپرفوره ودر موارد كمتر شايع انسدادهاي كولون و ركتوم ميبايستي مد نظر قرار بگيرند. ٤-ناهنجاريهاي ديواره شكم كه دو فرم شايعتر آن امفالوسل و گاستروشزي و از انواع كمتر شايع آن اكسترفي مثانه و پنتالوژي كانترل ميباشد . اورژانسي ترين اين آنومالي ها گاستروشزي است كه عموما بصورت يك ضايعه ايزوله ظاهرشده و باتوجه به عدم پوشش ساك خارج از شكم خطرسپسيس وسيع ودهيدراتاسيون بسيار بالاست.در مورد امفالوسل با توجه به احتمال بالاي انوماليهاي همراه ابتدا بررسي ساير ارگانها مقدم بر انجام عمل اورژانسي اولويت دارد ضمن اينكه پوشش مناسب و گرم و استريل ساك خارج شكم امكام بررسي درست و دقيق ساير ارگانها را فراهم مياورد. ٥-اورژانس هاي تنفسي مثل هرني مادرزادي ديافراگم كه علايم بصورت انومالي هاي همراه تنفسي ديگر مثل CPAM و آنوماليهاي روده اي مثل مالروتاسيون و ديسترس شديد تنفسي ، رويت كاتتر معده داخل توراكس هيپوپلازي ريه نارساييهاي شديد هيپوكسيك 

Pulmonary hypertension of the newborn
neonatology

Sangsari Razieh 1 © ℗
1 Children's Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran .
Abstract: Persistent pulmonary hypertension of the newborn (PPHN) is a serious condition that occurs in newborns when there is a sustained elevation of pulmonary vascular resistance (PVR), which is the resistance to blood flow in the pulmonary vasculature. Normally, after birth, PVR decreases to facilitate increased blood flow to the lungs for oxygenation. However, in infants with PPHN, PVR remains elevated, resulting in a right-to-left shunting of blood through the foramen ovale and ductus arteriosus . This condition requires prompt and appropriate management to ensure adequate oxygenation and improve pulmonary vasodilation. One mainstay of treatment for PPHN is oxygen therapy, which aims to provide adequate oxygen delivery to enhance pulmonary vasodilation. Additionally, medications may be utilized to further relax the pulmonary vasculature and reduce PVR. These may include inhaled nitric oxide (iNO), a potent pulmonary vasodilator, as well as prostacyclin analogues and phosphodiesterase inhibitors. In severe cases of PPHN that do not respond to standard medical management, other interventions such as extracorporeal membrane oxygenation (ECMO) may be considered to provide cardiopulmonary support .It is critical to assess for interstitial lung disease when pulmonary hypertension persists despite adequate treatment. Furthermore, it is essential to accurately diagnose PPHN in patients with congenital heart disease (CHD) and systemic-to-pulmonary shunts, as the use of pulmonary vasodilators in these instances may result in pulmonary edema and exacerbate the clinical situation. 

Septic Shock in Neonates
neonatology
Maral Ghassemzadeh 1 © ℗
1 هيات علمي گروه کودکان دانشگاه علوم پزشکی تهران و استادیار نوزادان بیمارستان کودکان حکیم
Abstract: Septic shock in neonates remains a major cause of morbidity and mortality worldwide, posing challenges in timely recognition and management. This lecture will provide an integrated case-based review of its clinical features, diagnostic approach, pathophysiology, and recent therapeutic recommendations. Neonates present with non-specific signs of sepsis—temperature instability, lethargy, poor perfusion, apnea, or feeding intolerance—making early recognition difficult. Progression to septic shock is defined by cardiovascular compromise with hypotension, tissue hypoperfusion, and metabolic acidosis. Case illustrations will emphasize subtle early indicators and the importance of structured sepsis screening. Pathophysiologically, septic shock represents a dysregulated host response leading to systemic inflammation, endothelial dysfunction, capillary leak, and impaired oxygen utilization. Both vasodilatory and myocardial depression components contribute to shock, necessitating tailored treatment. The diagnostic workup includes blood cultures, inflammatory biomarkers (CRP, procalcitonin), complete blood counts, coagulation profile, and lactate as a marker of perfusion. Point-of-care ultrasound (POCUS) is increasingly valuable for assessing cardiac function and guiding fluid management. Management prioritizes prompt antimicrobial therapy within the first hour, careful fluid resuscitation, and early hemodynamic support. Recent guidelines advocate cautious use of crystalloid boluses, particularly in resource-limited settings, to avoid fluid overload. The choice of vasoactive support has evolved: while dopamine was historically first-line, current evidence supports norepinephrine and epinephrine as preferred agents, guided by shock phenotype. Dobutamine may be useful in myocardial dysfunction, and hydrocortisone is considered in refractory shock. Adjunctive strategies such as immunoglobulins, antifungal prophylaxis, and novel biomarkers remain under investigation. This session will emphasize structured management pathways, integrating Surviving Sepsis Campaign 2023 recommendations with bedside case examples, to equip clinicians with updated strategies for early recognition and tailored therapy. Keywords: neonatal sepsis, septic shock, norepinephrine, vasopressors, neonatal intensive care, fluid resuscitation --- Reference 1. Weiss SL, Peters MJ, et al. Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-Associated Organ Dysfunction in Children. Pediatr Crit Care Med. 2023. 2. Wynn JL. Defining neonatal sepsis. Curr Opin Pediatr. 2023. 3. Bateman RM, et al. Neonatal septic shock: pathophysiology and management. Semin Fetal Neonatal Med. 2022. 4. DeBoer S, et al. Hemodynamic support in neonatal septic shock. Clin Perinatol. 2023. 

Survival rate of very low birth weight neonates and its determinant factors.
neonatology
Ramin Mozafari Kermani 1 © ℗, Jila Sadighi 1, Mahmoud Tavousi 1, Ali Asghar Haeri Mehrizi 1, Raheleh Rostami 1
1 Health Metrics Research Center, Iranian Institute for Health Sciences Research, (ACECR), Tehran, Iran
Abstract: Background: Birth of an infant with very low birth weight (VLBW) (weight less than 1500 grams) is a major cause of deaths and complications in infancy and childhood. Despite recent progressions in medical care and treatment for VLBW children, the mortality rate is high in this group of children. The present study was performed to better identify the survival rate of these children and the problems that affect the survival of this group of infants in the short and long term. Methods: The study population was all infants weighing less than 1500 grams or infants who were less than 32 weeks’ pregnancy whom birth from the beginning to the end of 2018 were born in hospitals in Tehran. The study was a survival and cross-sectional study. A total of 338 children were studied. Information about these children was provided by the Family and Population Health Office of the Ministry of Health and Medical Education. Sampling was non-random and all information about the infants under study was recorded in the questionnaire after the phone call by the questioners. All data from the study were entered into SPSS-22 software and the results were presented using descriptive and analytical statistics. Survival analysis was performed by Kaplan-Meier test and the effect of variables on survival was evaluated using multivariate Cox model. Results: Out of the total number of births, 338 infants were eligible to enter the study and their parents answered the phone call. Based on the results of cox regression models, the probability of one-month survival of children was about 68% and the probability of one-year survival was about 60%. Of the 10 variables affecting the survival of VLBW infants and children under study, 6 variables of maternal education, Number of pregnancies, parent and infant insurance, gestational age, birth weight and maternal vaccination before pregnancy were significantly related with the death of infant (P ≤0.05). Conclusions: One of the effective strategies for VLBW infant survival rate is encouraging women to continue their education, vaccinating mother before pregnancy, insuring family members and preventing multiple pregnancies. Keywords: Infants - Very low birth weight - Complications 

Vaccination in the premature babies
neonatology
پروانه صادقی مقدم 1 © ℗
1 دانشگاه علوم پزشکی تهران
Abstract: Vaccination plays a crucial role in protecting infants against life-threatening infectious diseases, and its importance is even greater in premature babies. Premature infants are born with an immature immune system, reduced maternal antibody transfer, and a higher susceptibility to infections. Despite these vulnerabilities, research and clinical experience show that vaccines are both safe and effective in this population when administered according to recommended schedules. One of the key principles is that vaccines should be given according to the infant’s chronological age, not corrected gestational age. This ensures timely protection during the critical first months of life. For example, routine immunizations against diphtheria, pertussis, tetanus, polio, Haemophilus influenzae type b, pneumococcus, and hepatitis B should not be delayed solely due to prematurity. In fact, delaying vaccination increases the risk of severe infections and hospitalization. Special considerations may apply in some cases. Very low birth weight infants or those with unstable clinical conditions may require closer monitoring after vaccination, particularly for apnea or bradycardia events. Influenza and RSV prevention strategies are also especially important in this group. In premature infants, Inogen is weaker than the hepatitis B vaccine. Infants weighing less than 2 kg at birth should receive an additional dose of hepatitis B vaccine at one month of age if they received the first dose of hepatitis B at birth. In the routine infant vaccination program in Iran, since the 5-dose vaccine is administered, all term and premature infants receive four doses of the hepatitis B vaccine. Respiratory syncytial virus (RSV) poses a serious threat to premature infants, often leading to severe bronchiolitis or pneumonia. Protection can be achieved through passive immunization with monoclonal antibodies, such as palivizumab or the newer long-acting nirsevimab, especially during RSV season. In addition, maternal vaccination during pregnancy and strict infection control measures help reduce the risk of RSV infection in this highly vulnerable group. Evidence consistently demonstrates that premature infants mount adequate immune responses to most vaccines, though antibody titers may be lower compared to term infants. Booster doses help ensure long-term protection. Parents should be reassured that side effects are generally mild and similar to those seen in term infants. In conclusion, vaccination of premature babies is essential, safe, and lifesaving. Timely administration without unnecessary delays should be the standard of care. Healthcare professionals must provide guidance and support to families, emphasizing the protective value of vaccines in safeguarding these vulnerable children. 

when, how, why do you do eye screen in neonates
neonatology
افسر دستجانی فراهانی 1 © ℗
1 , translational research center Farabi Eye Hospital, adjunct professor
Abstract: Why, when, how do you do eye screen in neonates? A.D.Farahani M.D Ophthalmologist Farabi RoP center Farabi eye hospital Summer 1404 The time of starting eye examination depends on prematurity or term delivery. 1-Premature delivery: When and whom: Each premature baby born ≤34 weeks, and or, BW≤2000 grams must screen 4 weeks after birth or 31th post conception, which is later. Each baby larger than this and GA 34-37 weeks, BW2001-2500 grams with history of NICU admission and have mentioned risk factors in Standard must screen 4 weeks after birth or 31th post conception, which is later. Who can do RoP exam: • Just Certified ophthalmologist who are expert in RoP exam • Retina fellowships who are expert in RoP exam How: • Pupil dilation • If possible sedation, swaddling, pacifier, sucrose • In bed screen: live exam, Tele screen (expert operator, safe net, expert reader) 2- Term born neonates: Eye examination of term born neonates depends on history of post-natal admission and maternal history. Well baby must screen in nursery by neonatologist. If the baby has normal appearing eyes and movement, good Red Reflex and does not have any significant medical, maternal and perinatal history, neonatologist is capable of doing eye screen. If neonate has any history of: • Traumatic delivery and asphyxia • Consider sepsis and endogenous endophthalmitis • Suspicious TORCH • History of familial Cataract • Severe maternal hypertension and hypoxic-ischemic encephalopathy • Chromosomal anomalies • Exposure to teratogens • Systemic diseases • Convulsion • Congenital anomalies Must refer to pediatric ophthalmologist. Each eye examination in neonates needs pupil dilation. 

“Long- term Asthma Management"
Immunology
Masoud Movahedi 1 © ℗, Mahshid Movahedi 2
1 Professor of Allergy & Clinical Immunology, Department of Pediatrics, Children’s Medical Center, Division of Allergy and Clinical Immunology, Tehran University of Medical Sciences, Tehran, Iran
2 Assistant professor of Allergy & Clinical Immunology, Department of Pediatrics, Children’s Medical Center, Division of Allergy and Clinical Immunology, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Asthma is a chronic inflammatory airway disorder characterized by variable airflow obstruction, airway hyperresponsiveness, and recurring symptoms such as wheezing, breathlessness, and cough. While acute exacerbations represent significant clinical concern, long-term management is central to reducing morbidity, preventing progressive airway remodeling, and improving quality of life. Optimal asthma care requires a multidimensional approach encompassing pharmacological, behavioral, and environmental strategies, tailored to individual patient profiles and disease severity. Pharmacotherapy remains the cornerstone of long-term asthma control. Inhaled corticosteroids (ICS) are the first-line agents, reducing airway inflammation and exacerbation frequency. Combination therapy with long-acting β2-agonists (LABAs) is indicated for moderate to severe persistent asthma, while leukotriene receptor antagonists, biologics targeting IgE or interleukin pathways, and long-acting muscarinic antagonists serve as adjuncts for patients with refractory disease. Precision medicine, through biomarkers such as fractional exhaled nitric oxide and peripheral eosinophil counts, is increasingly guiding therapeutic choices and predicting treatment responsiveness. Non-pharmacological interventions are equally critical. Patient education, adherence reinforcement, and self-management plans—including peak flow monitoring and recognition of early exacerbation signs—contribute significantly to sustained disease control. Addressing comorbidities such as allergic rhinitis, gastroesophageal reflux disease, and obesity further enhances therapeutic outcomes. Environmental control strategies, including allergen avoidance, smoking cessation, and reduction of occupational exposures, remain essential preventive measures. Recent advances highlight the importance of a stepwise treatment algorithm, as outlined in the Global Initiative for Asthma (GINA) guidelines, which emphasize individualized care and regular reassessment of control. Shared decision-making between patients and clinicians fosters adherence, improves satisfaction, and aligns therapeutic goals with lifestyle needs. Long-term management also extends to public health measures, including equitable access to essential medications and the integration of asthma care within primary healthcare systems. In conclusion, long-term asthma management requires sustained, multifactorial strategies aimed at controlling symptoms, minimizing exacerbations, and preserving lung function. The integration of pharmacological advances, self-management education, environmental control, and personalized medicine offers the most promising path toward achieving durable control and enhancing the overall well-being of patients living with asthma.

“Treatments for Immunodeficiency Diseases”
Immunology
Mahshid Movahedi 1 © ℗
1 Assistant professor of Allergy & Clinical Immunology, Department of Pediatrics, Children’s Medical Center, Division of Allergy and Clinical Immunology, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Immunodeficiency diseases represent a diverse group of disorders characterized by impaired function or absence of one or more components of the immune system, leading to recurrent infections, autoimmune manifestations, and heightened risk of malignancy. They are broadly classified into primary immunodeficiencies (PIDs), which are largely genetic in origin, and secondary immunodeficiencies, which arise from external factors such as infections, malnutrition, or immunosuppressive therapies. Advances in diagnostics and molecular medicine have significantly expanded therapeutic options, moving beyond supportive care toward curative and targeted interventions. Traditional management strategies focus on infection prevention and control, including the use of prophylactic antibiotics, aggressive treatment of acute infections, and antifungal or antiviral therapies where appropriate. Immunoglobulin replacement therapy remains a cornerstone for patients with antibody deficiencies, offering substantial reductions in morbidity and mortality. Hematopoietic stem cell transplantation (HSCT) has emerged as a potentially curative approach, particularly for severe combined immunodeficiency (SCID) and other profound PIDs, with success closely tied to early diagnosis and donor compatibility. More recently, gene therapy has shown transformative potential, correcting underlying genetic defects in disorders such as adenosine deaminase deficiency and X-linked SCID, with expanding applications under clinical investigation. Adjunctive strategies, including cytokine replacement (e.g., interferon-γ in chronic granulomatous disease), enzyme replacement therapy, and targeted biologics, provide disease-specific benefits. For secondary immunodeficiencies, treatment is tailored to the underlying cause, such as antiretroviral therapy in HIV infection or nutritional supplementation in malnutrition-associated states. Emerging research highlights the role of microbiome modulation, precision medicine, and genome editing technologies as promising future avenues. Despite these advances, challenges persist, including high treatment costs, limited accessibility in resource-poor settings, risks of graft-versus-host disease post-transplant, and the long-term safety of gene therapy. Ongoing efforts to improve early detection, refine treatment protocols, and expand therapeutic availability are essential for optimizing outcomes. Overall, the evolving landscape of treatments for immunodeficiency diseases reflects a paradigm shift from symptomatic management to precision-based, potentially curative interventions, offering improved survival and quality of life for affected individuals. 

Applications of Biologic Drugs in Pediatric Dermatology
Immunology
Zahra Nikyar 1 © ℗
1 Tehran University of Medical Sciences
Abstract: Biologic drugs have transformed the treatment landscape for pediatric dermatologic disorders by providing targeted, effective, and generally well-tolerated therapies. Unlike traditional systemic immunosuppressants, biologics act on specific cytokines or receptors, resulting in better efficacy, fewer drug interactions, and minimal need for laboratory monitoring. 1. Atopic Dermatitis (AD): Dupilumab, an IL-4 and IL-13 inhibitor, is the first FDA-approved biologic for children as young as 6 months with moderate-to-severe AD unresponsive to conventional treatments. It shows rapid improvement in itching and disease severity within two weeks, with a 75% reduction in EASI scores. Pediatric dosing is weight-based, ranging from 200 mg to 300 mg administered every 2–4 weeks. Tralokinumab, an IL-13 inhibitor, received approval in Canada and Europe for adolescents aged 12–17. 2. Pediatric Psoriasis: One-third of psoriasis cases occur in childhood, typically between ages 7 and 10. Approved biologics include: • Etanercept (≥4 years, TNF-α inhibitor) • Adalimumab (≥4 years, EMA-approved) • Ustekinumab (≥6 years, IL-12/23 inhibitor) • Secukinumab and Ixekizumab (≥6 years, IL-17A inhibitors). Ixekizumab and Secukinumab demonstrate the highest efficacy, while Ustekinumab offers the longest dosing interval (every 12 weeks). 3. Hidradenitis Suppurativa (HS): Adalimumab is FDA- and EMA-approved for adolescents (12–17 years). It is the most commonly used TNF-α inhibitor for pediatric HS, showing superior efficacy compared to infliximab. 4. Chronic Spontaneous Urticaria (CSU): Omalizumab, an anti-IgE monoclonal antibody, is approved for patients ≥12 years with treatment-resistant CSU. Doses range from 150–300 mg every 4 weeks. Off-Label Uses: Biologics are also applied in refractory pediatric conditions like pustular psoriasis, alopecia areata, juvenile pityriasis rubra pilaris, pyoderma gangrenosum, and Kawasaki disease. Vaccination Considerations: Live vaccines are contraindicated during biologic therapy. Non-live vaccines, including influenza and COVID-19 boosters, are recommended before and during treatment. Biologics represent a major advance in pediatric dermatology, offering effective, safe, and targeted solutions for chronic and refractory skin diseases.

Asthma Diagnosis and Differential Diagnosis in Children
Immunology
Mohammad Gharagozlou 1 © ℗
1 Children's Medical Center, Tehran University of Medical Sciences
Abstract: Asthma Diagnosis and Differential Diagnosis in Children Mohammad Gharagozlou, MD Division of Allergy & Immunology, Children's Medical Center, Tehran University of Medical Sciences Asthma is a chronic inflammatory disorder of the airways characterized by variable respiratory symptoms and reversible airflow limitation. In children, diagnosis can be challenging due to age-related limitations in objective testing and the overlap with other respiratory disorders. Diagnosis The diagnosis of asthma in children is based on a combination of clinical history, physical examination, and supportive investigations. Key features include: • Recurrent symptoms: episodes of wheeze, cough, breathlessness, or chest tightness, often worse at night or in the early morning. • Triggers: symptoms precipitated by exercise, allergen exposure, viral infections, or cold air. • Variability and reversibility: spontaneous improvement or response to bronchodilator or anti-inflammatory therapy. • Family and personal atopy history: allergic rhinitis, eczema, or family history of asthma. In children ≥5 years, spirometry demonstrating reversible airflow obstruction supports the diagnosis. In preschool children, objective confirmation is often not feasible; diagnosis relies on symptom patterns and therapeutic trials with inhaled corticosteroids. Differential Diagnosis Several conditions may mimic asthma in children and should be considered, particularly when features are atypical or response to treatment is poor: • Viral-induced wheeze: common in preschool children; wheeze occurs only with infections and may resolve with age. • Bronchiolitis: acute viral lower respiratory tract infection in infants, typically 12 months. • Foreign body aspiration: sudden onset cough, localized wheeze, or asymmetric breath sounds. • Structural airway anomalies: laryngomalacia, tracheomalacia, or bronchomalacia causing persistent noisy breathing. • Cystic fibrosis: chronic cough, failure to thrive, recurrent infections; confirmed by sweat chloride test or genetic testing. • Primary ciliary dyskinesia: neonatal respiratory distress, chronic productive cough, situs inversus in some cases. • Congenital heart disease: may present with recurrent respiratory symptoms and failure to thrive. • Vocal cord dysfunction: inspiratory stridor, throat tightness, poor response to asthma therapy. • Gastroesophageal reflux disease: chronic cough or wheeze related to reflux episodes. Conclusion A structured approach integrating history, examination, and targeted investigations is essential for accurate diagnosis of childhood asthma. Considering alternative diagnoses prevents mislabeling and ensures appropriate management. Reassessment over time is crucial, as respiratory symptoms and lung function patterns evolve with growth and development. 

Asthma exacerbations treatment
Immunology
آرش کلانتری 1 ℗, آزاده دانیار 2 ©
1 Department of Pediatrics, Valiasr Hospital, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
2 Tehran University of Medical Sciences, Tehran, Iran
Abstract: Asthma exacerbations can be classified as mild, moderate, severe, or life threatening. A brief focused history and relevant physical examination should be conducted concurrently with the prompt initiation of therapy, and findings documented in the notes. Features of acute severe asthma : 1- Peak expiratory flow (PEF) less than 50% of best 2- Talks in word 3- Respiration ≥30 breaths/min 4- Pulse ≥120 beats/min 5-O2 sat (on air)90 6- agitated 7- accessory muscles being used Early treatment is the most effective strategy for managing asthma exacerbations. It is essential to teach patients how to monitor signs and symptoms, and take appropriate action. Patients who have a written asthma action plan and appropriate medication can often manage mild exacerbations at home.The goal of asthma exacerbation treatment is to rapidly relieve airflow obstruction, address hypoxemia, and reduce airway inflammation. The main approach to treating acute asthma exacerbations involves using inhaled bronchodilators, systemic corticosteroids, and supplemental oxygen. Oxygen Therapy: Controlled or titrated oxygen therapy is recommended over high-concentration oxygen. The aim is to maintain oxygen saturation (SpO2) between 94-98% Inhaled Beta-2 Agonists: Rapid-acting inhaled beta-2 agonists like salbutamol (albuterol) are the first-line treatment. Ipratropium: In some cases, an inhaled anticholinergic like ipratropium may be added to beta-2 agonists, especially in severe exacerbations. Oral or Intravenous: Systemic corticosteroids, such as oral prednisolone or intramuscular dexamethasone , are recommended to reduce inflammation and improve lung function.Corticosteroids have been shown to reduce mortality, relapses, subsequent hospital admissions, and the need for beta-2 agonist therapy In severe cases, intravenous magnesium sulfate , Heliox or epinephrine may be considered. Monitoring: Close monitoring of symptoms, respiratory rate, oxygen saturation, and peak expiratory flow (PEF) is crucial. Arterial blood gas measurements may be necessary in severe cases or if the patient is not responding to initial treatment. 

Asthma in Iran vs the World
Immunology
Mostafa Moin 1 © ℗
1 M.Moin MD, Professor of Allergy and Clinical Immunology, Tehran University of Medical Sciences, Research Institute of Immunology and Asthma and Allergy (IAARI)
Abstract: Asthma is a common chronic respiratory disease affecting all age groups and remains a significant contributor to global morbidity and health care burden. According to the Global Asthma Report 2022 and Global Burden of Disease (GBD) estimates, approximately 262 million people were living with asthma and it caused 455,000 deaths worldwide. Although age-standardized prevalence and incidence rates have shown a gradual decline since 1990, the absolute number of cases continues to rise due to population growth and aging, with the greatest burden and highest mortality rates seen in low- and middle-income countries. Globally, improved understanding of asthma pathophysiology and the introduction of updated management strategies—most notably the Global Initiative for Asthma (GINA) recommendations to avoid short-acting β₂-agonist (SABA)-only treatment and to use inhaled corticosteroid (ICS)-containing regimens—have improved disease outcomes where implemented effectively. Nevertheless, significant disparities persist in access to affordable and reliable asthma medications, particularly ICS and combination inhalers, limiting optimal disease control in many settings. In Iran, the prevalence of asthma is generally consistent with global averages, and 10.9% for Pediatric asthma and 8.9% for adults (The first national population-based survey in Iran), higher figures especially in urban and industrialized areas with greater air pollution. This heterogeneity reflects the influence of environmental, occupational, and socioeconomic factors on disease risk. Iran benefits from an extensive primary health care network and professional societies that adapt and disseminate guideline-based asthma management. Pilot programs in primary care have shown promise in integrating regular patient review, inhaler technique checks, and action plan provision. However, challenges remain. Periodic shortages and increased costs of essential asthma medicines—at times linked to economic sanctions—undermine treatment continuity. Furthermore, research indicates suboptimal ICS use, over-reliance on SABA, and limited patient adherence to long-term management plans. Comparing Iran with global patterns reveals both shared challenges and local nuances. While the direction of epidemiological trends is broadly similar, Iran’s regional disparities in prevalence and its unique supply-chain vulnerabilities demand tailored interventions. Priorities include securing consistent, affordable access to ICS and ICS–LABA inhalers, scaling up GINA-aligned care through primary health services, and strengthening surveillance to identify and address high-burden provinces. In conclusion,such measures could substantially improve asthma control, reduce exacerbations, and lessen the disease burden in Iran, contributing to the global effort to close gaps in asthma care.

Challenges to the Sustainability of Iran’s National Immunization Program Achievements
Immunology
Seyed Mohsen Zahraei 1 © ℗, Parisa Hodaei 2
1 Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
2 Private Clinic
Abstract: Vaccination is recognized as one of the most effective public health interventions for promoting child health, preventing the deaths of an estimated 4 million children under the age of five worldwide each year. Despite the notable achievements of Iran’s national immunization program, several challenges continue to threaten its progress. The current payment system for healthcare workers has reduced their motivation for timely identification, follow-up, and case management. Economic sanctions, declining national income, and difficulties in international financial transactions have disrupted vaccine procurement, causing shortages of essential vaccines like DTP, combination, and pentavalent. These shortages have forced the country to request emergency support from WHO and UNICEF. Financial constraints have slowed the modernization of cold chain infrastructure. While organizations such as WHO, UNICEF, and UNHCR have provided support, further financial backing from the Ministry of Health is needed. The central vaccine storage facility lacks the capacity to meet current needs, and although construction of its third phase has started, additional funding is required to complete the project. Aging cold chain equipment across universities needs annual replacement and maintenance. Critical items include vaccine transport vehicles, refrigerators, digital thermometers, remote temperature monitoring systems, and other logistics tools. Even universities that have adopted remote monitoring systems require funding for their upkeep. The lack of financial resources for operational research has limited the ability of the National Immunization Technical Advisory Group (NITAG) to support evidence-based policymaking. Human resource shortages in its secretariat have further impacted its effectiveness. Training and capacity building efforts are ongoing, supported by WHO. Iran’s location among countries with low vaccine coverage (Afghanistan, Pakistan, and Iraq), high cross-border movement, and a significant population of non-Iranian nationals increases the risk of importation and reintroducing diseases like polio, measles, and rubella. Additionally, rising anti-vaccination sentiments have led some families to refuse immunization. Misuse of religious beliefs and unscientific messages, often spread under the name of traditional medicine, have undermined public trust. Misinformation circulating in some religious centers has contributed to vaccine hesitancy among religious leaders and their followers. With reduced vaccination coverage, diseases that were once controlled may flare up again, potentially impacting other countries as well. 

Epidemiology, Management, and Follow-up of Patients with Selective IgA Deficiency: Current Evidence and Clinical Considerations
Immunology
پریسا آشورنیا 1 © ℗
1 Parisa ashournia Department of allergy and clinical immunology ,Bahrami Hospital,school of medicine ,Tehran University of medical sciences,Tehran,Iran
Abstract: Management is primarily preventive and supportive. For patients with recurrent infections, prompt targeted antibiotic treatment and consideration of prophylactic antibiotics are central; aggressive evaluation for specific antibody responses (e.g., to pneumococcal vaccines) and assessment of IgG subclass or other humoral defects is recommended when infections are frequent or severe. Routine immunoglobulin replacement therapy (IgRT/IVIG) is not standard for isolated SIgAD because benefits are unproven and IVIG products contain variable IgA that can rarely trigger anti-IgA–mediated reactions; IgRT may be considered only in exceptional cases (e.g., severe recurrent infections with concurrent IgG dysfunction) after specialist consultation.  Follow-up should be individualized: asymptomatic patients often need only periodic clinical review and education about infection recognition and transfusion/anaphylaxis risks, whereas symptomatic patients require longitudinal surveillance for infections, development of autoimmune disease (notably celiac disease), allergy control, and periodic re-measurement of immunoglobulins since partial deficits can evolve. Vaccination (inactivated vaccines, assessment of vaccine responses) and involvement of clinical immunology for complex cases are recommended. Emerging research explores mucosal/therapeutic IgA strategies and refines indications for IgRT, but current practice emphasizes monitoring, infection control, and management of comorbid conditions. 

Cardiovascular Effects of Childhood and Adolescent Obesity and Strategies for Prevention and Intervention
cardiology
Mojtaba Gorji 1 © ℗
1 pediatric cardiology departement , CMC , TUMS
Abstract: Cardiovascular Effects of Childhood and Adolescent Obesity and Strategies for Prevention and Intervention Gorji Mojtaba , Pediatric cardiologist in TUMS,Children's Medical Center of Excellence Abstract Childhood and adolescent obesity impose substantial cardiovascular risks. Studies have linked pediatric obesity with increased left ventricular dimensions and myocardial mass, and even subclinical alterations in myocardial function and vascular stiffness. In adulthood, a history of childhood obesity correlates with hypertension, dyslipidemia, and elevated markers of cardiovascular disease risk. Longitudinal studies underscore that cardiovascular risk factors accumulate from early life, contributing significantly to adult cardiovascular disease burden. Interventions implementing lifestyle changes, including healthy diet, regular physical activity, and addressing metabolic dysfunction have shown improvements in metabolic health and cardiovascular function in obese youth. Evidence-based strategies recommended by major health organizations include: annual BMI screening, cardiovascular risk evaluation, multicomponent community- and family-based interventions, pharmacotherapy for adolescents ≥12 years old, and bariatric surgery for severe cases. Keywords childhood obesity, cardiovascular risk, BMI, physical activity, dietary intervention, screening, multicomponent treatment 

Chest X-Ray after Cardiac Intervention in Children
cardiology
Keyhan Sayadpour Zanjani 1 © ℗
1 Children's medical Center, Tehran University of Medical Sciences
Abstract: Today, many cardiac disease are treated by transcatheter approach. Different cardiac devices are implanted in the heart or thoracic vessels for this approach. Most pediatricians are not familiar with these devices and there is a risk of misinterpretations. for example, we had misdiagnosis of a coil used for PDA closure with a swallowed foreign body led to unnecessary endoscopy. In this presentation, I present different devices used for children and examples of chest x-rays.

Cyanotic Congenital Heart Diseases
cardiology
Behzad Mohammadpour Ahranjani 1 © ℗
1 Tehran University of Medical Sciences
Abstract: The cyanotic congenital heart diseases are a sort of cardiac problems usually noticed for the first time, in labors, because of the bluish discoloration of the mucous membranes and skin of newborns, by obstetricians and pediatricians. It consists of a wide spectrum of entities which carry with them a common trait i.e “cyanosis”. In this lecture a brief review of the different forms of this type of CHD will be presented. Among the more common of the diseases, Tetralogy of Fallot, Transposition of the Great Arteries, Truncus Arteriosus, Tricuspid Atresia and so on will be discussed. Also a few surgical procedures will also be demonstrated schematically. Keywords: congenital heart disease, cyanosis, newborns 

Diagnostic and Procedural Challenges of a Prominent Eustachian Valve During Transcatheter Closure of Atrial Septal Defect: A Case Report
cardiology
Mojtaba Gorji 1 © ℗
1 pediatric cardiology departement,CMC of excellence, TUMS
Abstract: Diagnostic and Procedural Challenges of a Prominent Eustachian Valve During Transcatheter Closure of Atrial Septal Defect: A Case Report Gorji Mojtaba , Pediatric cardiologist in TUMS,Children's Medical Center of Excellence Abstract A prominent Eustachian valve (EV) can mimic atrial septal structures or interfere with transcatheter closure of an atrial septal defect (ASD). We present a case where a large EV created diagnostic confusion and technical difficulties during device placement for ASD closure. Awareness of this anatomic variant is crucial to avoid misinterpretation and procedural complications. Case Presentation A 1 year-old girl was referred for percutaneous closure of a secundum-type ASD diagnosed on transthoracic echocardiography. Initial echocardiography demonstrated a seemingly suitable ASD with adequate rims. However, transesophageal echocardiography (TEE) revealed a large, mobile Eustachian valve extending from the inferior vena cava (IVC) toward the interatrial septum, partially covering the defect. Imaging Findings - TEE: Large EV originating from the IVC and extending toward the septum, mimicking an acceptable IVC rim . Procedural Challenges - Disturbance and possible error in correct sizing of the ASD(atrial septal defect) due to confusion between the edge of the Eustachian valve and the edge of the atrial septum and as a result, mistakes in determining the appropriate device size - Incorrect positioning of the device on the Eustachian valve edge instead of the true edge of the septum during ASD closure with device - Difficulty in catheter crossing due to EV partially obstructing access to the defect. - Risk of device entanglement with EV tissue. - Requirement for repositioning of guidewires and careful device deployment under TEE guidance. Discussion A large EV can be misinterpreted as the IVC rim of the ASD , leading to underestimation or overestimation of defect size and determining the device size . It may also deflect guidewires, catheters, and devices, complicating transcatheter closure. Recognition of EV on pre-procedural TEE/ICE is essential. Options include adjusting catheter angle, using alternative venous access, or—if entanglement risk is high—considering surgical closure. Conclusion Prominent Eustachian valves represent an important anatomic variant in patients undergoing ASD device closure. Comprehensive echocardiographic assessment and procedural planning can minimize complications. Keywords Eustachian valve, atrial septal defect, device closure, diagnostic pitfall, interventional cardiology, pediatric cardiology 

Partial Heart Transplantation
cardiology
تکتم شیخیان 1 © ℗
1 Dr. Toktam Sheykhian, Assistant Professor of Pediatric Cardiology, Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Partial Heart Transplantation: Dr. Toktam Sheykhian, Assistant Professor of Pediatric Cardiology, Department of Cardiology, School of Medicine, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran. Abstract Children with end-stage cardiomyopathy or uncorrectable congenital heart defects have been successfully treated with orthotopic heart transplantation for more than 40 years. The current state-of-the-art operation for small children with critical semilunar valve defects, such as severe congenital aortic stenosis, truncus arteriosus, or pulmonary atresia, involves the implantation of cryopreserved, decellularized valved conduits from human cadavers (homograft). These homografts are extracellular matrices that permit native tissue ingrowth. However, they are prone to leaflet degeneration, which is especially rapid in infants and young children. The most important advantage of PHT is the growth of the transplanted tissue, which will theoretically minimize the morbidity and mortality rates associated with successive valve or other cardiac tissue replacements over a child’s lifetime. The transplanted tissue may also be more physiologic than prosthetic devices and could potentially be durable without the need for anticoagulation. Another advantage of PHT is the versatility of the technique and the ability to tailor the donor allograft to the recipient's needs. There are also challenges associated with PHT that must be addressed. First, there is a limited supply of suitable donors. Fortunately, nearly 40% of pediatric organ donors have hearts that are not allocated for full heart transplants, representing a potential source for partial heart grafts. Also, the use of living donor hearts from children receiving full heart transplants helps to expand the PHT donor pool in the so-called “domino partial heart transplant” model. Second, there are logistic challenges associated with the technique. Before more scientific insight is gathered about the viability of various partial heart allografts in cold storage, there remains a temporal constraint between donor allograft procurement and recipient PHT. Another challenge associated with the technique is the uncertainty about the long-term Effects of ABO matching and human leukocyte antigen tissue typing on PHT durability. Our center is currently using ABO compatible allografts for all patients except neonates, where we apply ABO-incompatible protocols used for full heart transplants. 

Recent Advances in Cardiac Therapies for Duchenne Muscular Dystrophy
cardiology
Mojtaba Gorji 1 © ℗
1 Pediatric cardiology departement ,CMC , TUMS
Abstract: Recent Advances in Cardiac Therapies for Duchenne Muscular Dystrophy Gorji Mojtaba , Pediatric cardiologist in TUMS,Children's Medical Center of Excellence Abstract Duchenne muscular dystrophy (DMD) is a progressive genetic disorder in which cardiomyopathy is a leading cause of mortality. In recent years, notable advances have been reported in the field of cardiac therapies for these patients. In the area of gene therapy, the MUSIC-DMD trial delivers the SERCA2a gene via coronary infusion to evaluate its effects on myocardial performance. Regarding pharmacotherapy, phase 2 results of Ifetroban, a thromboxane receptor antagonist, demonstrated a significant improvement in left ventricular ejection fraction. The ACTION network has also issued consensus recommendations to optimize the use of standard cardiac medications in this population. Preclinical studies of micro-dystrophin gene therapy have shown improved cardiac function in animal models, although with associated cardiac inflammation. Conversely, the cell-based therapy Deramiocel has not yet obtained FDA approval. Collectively, these findings highlight a rapidly evolving landscape of cardiac care in DMD, with the potential for combining innovative therapies with standard care to improve patient outcomes. Keywords Duchenne muscular dystrophy, cardiomyopathy, gene therapy, Ifetroban, SERCA2a, ACTION network 

Septic Cardiomyopathy
cardiology
Reza Shabanian 1 © ℗
1 Associate professor of pediatric cardiology, Hakim children hospital, Tehran university of medical sciences, Tehran, Iran
Abstract: Septic cardiomyopathy is a transient, reversible myocardial dysfunction that complicates pediatric sepsis and septic shock. It is characterized by reduced ejection fraction, ventricular dilation, and impaired contractility, often contributing to hemodynamic instability. Although well-described in adults, pediatric-specific data are limited, and clinical recognition remains challenging. The incidence of septic cardiomyopathy in pediatric sepsis is reported between 25–50%. Pathophysiology involves inflammatory cytokines, nitric oxide overproduction, mitochondrial injury, and microvascular dysfunction. Echocardiography remains the primary diagnostic tool, revealing global systolic impairment, sometimes with preserved stroke volume due to reduced afterload. Biomarkers such as troponin and BNP provide supportive evidence but lack specificity. Management strategies include targeted use of inotropes (dobutamine, milrinone), avoidance of excessive catecholamine stimulation, and mechanical circulatory support (ECMO) in refractory cases. Most children demonstrate recovery of ventricular function within 7–10 days if infection is controlled and optimal hemodynamic support is provided. Future pediatric-specific research is needed to refine treatment algorithms, evaluate the role of newer agents (e.g., beta-blockade, mitochondrial stabilizers), and define indications for mechanical support.

Updates in the treatment of cardiomyopathies in children
cardiology
Parvin Akbari Asbagh 1 © ℗
1 professor of ped. cardiologist TUMS
Abstract: Abstract Pediatric cardiomyopathy is a rare but potentially life-threatening group of myocardial disorders characterized by structural and functional abnormalities of the heart muscle. Although the incidence is estimated at 1–2 per 100,000 children, it represents a major cause of heart failure, arrhythmias, and sudden cardiac death in this age group. Pediatric cardiomyopathy is classified into dilated, hypertrophic, restrictive, arrhythmogenic, and unclassified subtypes. Genetic mutations, metabolic disorders, and infections are among the most frequent etiologies. Early recognition through echocardiography, cardiac MRI, and genetic testing is critical. Management includes pharmacological therapy, device implantation, and, in severe cases, heart transplantation. Novel approaches such as gene-targeted therapy and regenerative medicine are under investigation. Prognosis remains highly variable depending on etiology, age at presentation, and response to treatment. Conclusion: Pediatric cardiomyopathy poses significant diagnostic and therapeutic challenges. Early diagnosis and multidisciplinary management improve outcomes, while ongoing research in molecular genetics and regenerative therapies may transform future care. Greater awareness among pediatricians and cardiologists is essential for timely referral and intervention. Keywords: cardiomyopathies, children, Novel approaches. 

A challenging patient with graves disease, developmental delay, premature adrenarche 
endocrinology
Parastoo Rostami 1 © ℗
1 Division of Endocrinology and metabolism, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract: A girl 6.5 years old who referred to endocrine clinic because of pubic and axillary hair. On examination, her hight=117 (50 th), weight=18 kg (25 th), pubic hair= III, axillary hair, hair and oily skin, thelarche= I. Laboratory test showed, 17OHP= 1.27 ng/dl, ACTH= 94.7, DHEAS=236, Testosterone= 0.13 cholesterol =185, LDL= 99, BA=8.5 year. At this age hydrocortisone (10 mg/m2/day) has been started. In the sonography bilateral adrenal was normal. After 6 months, she developed to staring, thyromegaly and poor weight gain. In thyroid function test: TSH0.003, Free T4=25.2, TPO Ab=23.7, TRAb=120. Thyroid sonography showed, generalized thyroid enlargement with homogenous echo pattern. Graves' disease was diagnosed for her and methimazole was started. At age of 8 years old, thelarche tanner stage reached to stage II, at this time BA=10.5 years, GnRH agonist was started for her and methimazole and hydrocortisone continued. At age of 10 years and bone age 12, GH treatment was started. Brain MRI showed increase signal in putamen. In urine organic acid, glucoronid-5-beta-cholestan pentol was revealed. Whole Exome Sequencing showed c.1214GA:p.Arg405Gln, cerebrotendinous xanthomatosis. Cerebrotendinous xanthomatosis (CTX) is a rare autosomal recessive genetic disorder caused by an abnormality in the CYP27A1 gene, resulting in a deficiency of mitochondrial enzyme sterol 27-hydroxylase.The lack of this enzyme prevents cholesterol from being converted into a bile acid called chenodeoxycholic acid.Deposits of cholesterol and a related compound called cholestanol accumulate in the nerve cells and membranes potentially causing damage to the brain, spinal cord, tendons, lens of the eye and arteries. Affected individuals can experience neonatal cholestasis, diarrhea and cataracts in childhood and may develop benign, fatty tumors (xanthomas) of the tendons during adolescence. If untreated, CTX can lead to progressive neurologic problems such as seizures, cognitive impairment, and difficulties with coordination and balance (ataxia). Coronary heart disease is common. Long-term therapy with chenodeoxycholic acid has been effective in treating affected individuals.

Calcium, Phosphate, and Vitamin-D homeostasis in children
endocrinology
Reza Tavakolizadeh 1 © ℗
1 Department of Pediatric Endocrinology, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Abstract Calcium, phosphate, and vitamin-D form an integrated system that is essential for skeletal growth, bone mineralization, and overall metabolic stability in children. Calcium is predominantly stored in bone as hydroxyapatite, with a small but critically regulated fraction present in extracellular fluid to support neuromuscular excitability, blood coagulation, and intracellular signaling. Phosphate, likewise, is primarily a skeletal mineral, but also plays central roles in energy metabolism, nucleic acid synthesis, and cellular signaling pathways. Because of the rapid bone growth and remodeling that occur throughout childhood and adolescence, the demands for both calcium and phosphate are significantly higher than in adults, rendering children particularly sensitive to disturbances in mineral homeostasis. Regulation of calcium and phosphate is mediated by a hormonal triad: parathyroid hormone (PTH), vitamin-D, and fibroblast growth factor-23 (FGF23). In the setting of hypocalcemia, PTH secretion increases, leading to bone resorption, renal calcium reabsorption, and stimulation of renal 1α-hydroxylase activity, which converts 25-hydroxyvitamin-D to its active metabolite, 1,25-dihydroxyvitamin-D (calcitriol). Calcitriol enhances intestinal absorption of both calcium and phosphate and provides negative feedback to suppress excess PTH secretion. Conversely, phosphate balance is strongly influenced by FGF23, secreted by osteocytes, which decreases renal tubular reabsorption of phosphate and inhibits calcitriol synthesis, thereby preventing phosphate overload. Calcitonin plays a minor counter-regulatory role by inhibiting osteoclastic bone resorption, though its physiological importance in children is limited. In pediatric populations, disturbances in this tightly coordinated system manifest with characteristic clinical consequences. Vitamin-D deficiency, still common worldwide, reduces intestinal calcium and phosphate absorption, resulting in hypocalcemia, secondary hyperparathyroidism, and impaired bone mineralization, which presents clinically as rickets. Genetic or acquired defects in phosphate handling, such as X-linked hypophosphatemia or chronic kidney disease, cause persistent hypophosphatemia and similarly disrupt skeletal integrity. Neonates are especially vulnerable due to immature PTH responsiveness, limited vitamin-D stores, and rapid skeletal accretion, predisposing them to transient or persistent hypocalcemia. In summary, calcium, phosphate, and vitamin-D homeostasis in children represents a dynamic balance between dietary intake, hormonal regulation, renal excretion, and skeletal requirements. Maintenance of this equilibrium is crucial for healthy growth and development, while disruption can lead to significant metabolic bone disease. Understanding these regulatory pathways is fundamental for both the prevention and treatment of pediatric metabolic and endocrine disorders. Keywords: Calcium; Phosphate; Vitamin D; Parathyroid Hormone; FGF23; Bone Mineralization; Rickets 

Classification of Inborn Errors of Immunity: Implications for Diagnosis and Management
endocrinology
Anahita Razaghian 1 © ℗
1 department of Allergy and Clinical Immunology, Hakim's Children Hospital, Tehran University of Medical Sciences,
Abstract: Classification of Inborn Errors of Immunity: Implications for Diagnosis and Management Background: Inborn errors of immunity (IEI) are a heterogeneous group of genetically driven disorders that impair the function of one or more component of immunity. With rapid progress in genomic technologies, the classification of IEI has evolved substantially to reflect clinical and molecular diversity. Objective: To present an updated classification framework of IEI that integrates new genetic discoveries and highlights clinical phenotypes. Methods: A comprehensive review of recent high-impact literature was conducted, focusing on the categorization of IEI by affected immune pathways, clinical features, and molecular defects. Results: Nearly 555 different disorders have been genetically identified, with new disorders continually being recognized. Most IEIs are from germline mutations. Whereas, some are acquired which are called phenocopies. Current IEI classification encompasses 10 principal categories based on the 2024 classification by the International Union of Immunological Societies (IUIS) Expert Committee: combined immunodeficiencies, combined immunodeficiency with syndromic features, predominantly antibody deficiencies, immune dysregulation disorders, autoinflammatory diseases, congenital defects of phagocyte number/function, defects in intrinsic and innate immunity, and complement deficiencies, bone marrow failure, and phenocopies of inborn error of immunity. Molecular diagnostics based on gene panels and whole-exome sequencing, facilitating early diagnosis. Although, immunological testing remains vital for phenotype confirmation. This classification may facilitate early diagnosis and recognition of the disease, enabling tailored precision medicine with biological therapies, thereby improving patient outcomes. Conclusions: IEI classification reflects the complexity of immune system impairment and guides personalized diagnostic and management strategies. 

Congenital hypothyroidism screening in Iran
endocrinology
Hosein Shabani-Mirzaee 1 © ℗
1 Department of Pediatrics, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Congenital hypothyroidism screening in Iran Thyroid hormone affects the function of all organs in the body, especially during neonatal period and infancy, which is more important due to its effect on brain development and physical growth. Congenital hypothyroidism (CH) is a common disorder, and can cause irreversible intellectual disability. However, early diagnosis and treatment of congenital hypothyroidism can prevent lifelong complications of this disease, therefore, thyroid screening tests in newborns are strongly recommended. Congenital hypothyroidism occurs in approximately 1 in 2,000–4,000 live births worldwide, however, studies conducted in Iran have reported a higher incidence rate (approximately 1 in 1,000–1,500 live births).The most common cause of permanent congenital hypothyroidism is thyroid dysgenesis ( About 80-85% of cases) including agenesis, hypoplasia, ectopic location. Defects in thyroid hormone biosynthesis also causes congenital hypothyroidism. Other uncommon causes include exposure to iodides, TSH deficiency, TRH deficiency, maternal goiterogen ingestion and maternal autoimmune thyroid disease. The first screening study for congenital hypothyroidism in Iran was conducted in 1987, before the implementation of the salt iodine enrichment program in Tehran and Damavand, but was stopped in 1989 due to the large number of recall cases. The screening plan for congenital hypothyroidism in Iran was implemented as a national program in 2003 in the first national program on a pilot basis in the Isfahan, Bushehr, and Shiraz, and finally, since 2005, this program has been integrated into the Iranian health system. The goals of the national neonatal hypothyroidism screening program in Iran include the following: The main goal is to identify and control infants with neonatal hypothyroidism, treat and prevent its complications. Other specific goals: early identify neonate with the CH disease, control and treat infants with the CH disease, identify infants with transient TSH elevation, control and treat infants with transient elevation if needed, improving the quality of life of patients and their families, improving the average IQ of the population by preventing the decline in IQ of affected individuals. 

Expanding the Clinical Phenotype Associated with the NIN Gene; Report of a Patient with Short Stature, Microcephaly and Hearing Loss
endocrinology
Ali Talea 1 ℗, Ariana Kariminejad 2 ©
1 Molecular-cellular Endocrinology &Metabolism Research Institute Tehran University of Medical Sciences Metabolic Disorders Research Center
2 Kariminejad-Najmabadi Pathology & Genetics Center, Tehran Iran
Abstract: To date, there are very few reports regarding patients with bi-allelic variants in the NIN gene. There is one report of two sisters with severe short stature, microcephaly, and developmental delay with compound heterozygote missense variants in the NIN gene and one paper reporting a homozygote variant in the NIN gene with progressive, high-frequency sensorineural hearing loss in four siblings. The only other report is of four members of a consanguineous family with spondyloepimetaphyseal dysplasia with joint laxity-leptodactylic type (SEMDJL2) with a homozygous variant in the NIN gene. Given the scarcity of cases with NIN variants, the relationship between the phenotype and gene is provisional and our case broadens the phenotypic spectrum regarding the phenotype related to NIN gene variants. Here, we report a patient with a homozygous variant in exon 2 of the NIN gene defined as c.3407_3409del (p.Glu1136del). Clinical findings in our patient were characteristic of microcephalic primordial dwarfism (MPD) including microcephaly, prominent nose, intellectual disability and severe short stature. In addition, this patient had bilateral hearing loss, which was not reported in the patients with MPD and variant in the NIN gene before. We identified a novel p.Glu1136del variant in the NIN gene, predicted to disrupt critical centrosome-related pathways. WES was reanalyzed for other genes which are known for deafness and no variant was identified. A family history of deafness was not present in the pedigree. This is the first report of a patient with MPD and deafness associated with the NIN gene. Keywords: Hearing loss, Microcephalic primordial dwarfism, MPD, NIN gene, Seckel syndrome

Nutritional Rickets in Children
endocrinology
Reihaneh Mohsenipour 1 © ℗
1 Growth and Development Research Center, Department of Endocrinology and Metabolism, Pediatric Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Vitamin D-deficiency rickets remains the most common form of calcipenic rickets worldwide and is caused by insufficient vitamin D leading to impaired calcium and phosphate homeostasis. The disorder results in defective mineralization of the growth plate and newly formed bone, particularly during periods of rapid growth. Risk factors include exclusive breastfeeding without supplementation, limited sunlight exposure, dark skin pigmentation, use of sunscreen or clothing covering most of the body, malabsorptive disorders, chronic liver or kidney disease, and diets low in vitamin D and calcium. Clinical manifestations vary with severity but often include delayed motor milestones, growth retardation, bone pain, frontal bossing, widening of wrists and ankles, bowing of the legs, and rachitic rosary along the costochondral junctions. Severe hypocalcemia may present with seizures, tetany, or cardiomyopathy. Diagnosis is established by measuring serum 25-hydroxyvitamin D (the best indicator of vitamin D status). Levels 12 ng/mL (30 nmol/L) are considered deficient; 12–20 ng/mL indicates insufficiency. Typical laboratory findings include elevated alkaline phosphatase, secondary hyperparathyroidism, low or low-normal calcium and phosphate, and radiographic evidence of metaphyseal cupping and fraying. Treatment focuses on correcting vitamin D deficiency and replenishing calcium stores. For most children, vitamin D₃ is preferred. Therapeutic regimens vary but generally include a “loading” or high-dose course, followed by maintenance therapy. A common approach is oral vitamin D 2,000–6,000 IU daily for almost 8 weeks, until biochemical and radiologic healing occur. An alternative is a single high-dose (“stoss therapy”), though divided daily dosing is often preferred to minimize adverse effects. After repletion, long-term maintenance with 400–600 IU/day is recommended, along with ensuring adequate dietary calcium and sunlight exposure. 

Other types pf vitamin D dependent Rickets
endocrinology
Rana Doroudian 1 © ℗
1 Department of Pediatrics endocrinology and metabolism, Hakim Children's Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Vitamin D–dependent rickets (VDDR) refers to a group of rare hereditary disorders characterized by impaired metabolism or action of vitamin D, resulting in defective bone mineralization, growth retardation, and biochemical abnormalities. Unlike nutritional rickets, these conditions are caused by genetic defects affecting enzymes or receptors involved in the vitamin D pathway. Vitamin D is metabolized in the liver to 25-hydroxyvitamin D [25(OH)D] by 25-hydroxylases, and subsequently in the kidney to its active form, 1,25-dihydroxyvitamin D [1,25(OH)₂D], by the mitochondrial enzyme 1α-hydroxylase (CYP27B1). Active vitamin D binds to the vitamin D receptor (VDR) in target cells, regulating calcium and phosphate homeostasis. VDDR Type 1A is caused by biallelic mutations in CYP27B1, leading to deficient 1α-hydroxylase activity. Affected patients have low or undetectable 1,25(OH)₂D despite normal or elevated 25(OH)D, with hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and radiographic rickets. Treatment with physiological doses of calcitriol corrects the abnormalities. VDDR Type 1B results from mutations in CYP2R1, the major hepatic 25-hydroxylase. This leads to markedly reduced 25(OH)D levels and subsequently low 1,25(OH)₂D. High-dose cholecalciferol or calcifediol is effective. VDDR Type 2A is caused by mutations in the VDR gene, leading to end-organ resistance to 1,25(OH)₂D. Despite elevated active vitamin D levels, target tissues fail to respond. Clinically, patients often present with severe rickets and alopecia, the latter resulting from defective VDR function in hair follicles. Management requires very high doses of calcitriol and calcium infusions to normalize mineral balance. VDDR Type 2B presents similarly to type 2A but is due to abnormal nuclear receptor coactivators affecting VDR-mediated gene transcription; the genetic basis is less well defined. VDDR Type 3, recently described, is caused by gain-of-function mutations in CYP3A4, which enhance inactivation of both 25(OH)D and 1,25(OH)₂D, leading to functional vitamin D deficiency. Treatment involves high-dose active vitamin D and careful monitoring. Early recognition of VDDR is crucial to prevent permanent skeletal deformities and optimize growth. Genetic testing confirms the diagnosis and enables targeted therapy. Lifelong treatment is often required, tailored to the specific molecular defect. 

PKU screening in Iran
endocrinology
Aria Setoodeh 1 © ℗
1 pediatric endocrinologist, Tehran University of Medical Sciences, Children’s Medical Center
Abstract: Phenylketonuria (PKU) has been diagnosed through newborn screening (NBS) programs in the United States and many European countries since 1960. In Iran, NBS for hyperphenylalaninemia (HPA) and classical PKU was established in 2007, and it was extended to include non-classical PKU in 2010. The primary objectives of NBS are to identify PKU in newborns to reduce mortality and morbidity, prenatal diagnosis and possible abortion of affected fetuses, and improved control and follow-up for late-diagnosed cases. NBS is performed using a colorimetric method on a filter paper between 3 and 5 days of life. If the phenylalanine (PA) level exceeds 120 μmol/L, it is further tested using HPLC. If the PA level is more than 120 μmol/L, the newborn undergoes testing for Neopterin and Biopterin in their urine, and DHPR activity is measured to exclude non-classical PKU. MS/MS may replace the method of screening in the near future. The primary treatment for classical PKU involves a lifelong diet low in PA to control PA levels. This diet should provide all the necessary micronutrients and ensure normal growth. It should be palatable and consistent with a normal quality of life. However, achieving this can be challenging, so educating patients, families, and caregivers is crucial. The treatment for non-classical PKU depends on the specific deficiency. In 6-pyruvoyltetrahydropterin synthase deficiency, tetrahydropterin (kuvan) is used. In Dihydropterin reductase deficiency, a low PA diet, L-DOPA, 5-hydroxytryptophan, and folinic acid are prescribed. The follow-up treatment for PKU in Iran aims to maintain PA levels between 2 and 6 mg/dL until the age of 12, and then between 2 and 10 mg/dL thereafter. PA levels below 2 mg/dL are strictly prohibited, as PA is an essential amino acid. To achieve these targets, patients receive regular visits to PKU referral centers, and it is a collaborative effort involving endocrinologists, neurologists, psychiatrists, nutritionists, and geneticists. In the evaluation of a system with a coverage rate of 98.5%, the incidence of PKU in Iran has been estimated to be 1 in 5,455 live births. The incidence of non-classical PKU has been 7%, which is significantly higher than in the United States and European countries

The Impact of Childhood Obesity on Cardiovascular Health
endocrinology
Abbasi, Farzaneh 1 © ℗
1 Growth and development research center, children’s medical hospital, Tehran university if medical sciences, Tehran Iran
Abstract: Introduction : Childhood obesity is a growing public health concern with lasting consequences for cardiovascular (CV) health. The relationship is multifaceted, involving structural, functional, metabolic, and behavioral pathways that begin in childhood and can track into adulthood.Early arterial changes can start in childhood. Elevated body mass index (BMI) is linked to increased carotid intima-media thickness (CIMT) and arterial stiffness, markers of early atherosclerosis. Pediatric obesity is associated with unfavorable lipid profiles (higher LDL cholesterol, lower HDL cholesterol, and elevated triglycerides), promoting plaque formation over time. Obesity increases the risk of elevated blood pressure and pediatric hypertension.Hypertension in childhood tracks into adulthood and is a major risk factor for coronary artery disease (CAD) and stroke. Central adiposity contributes to insulin resistance, dyslipidemia, hypertension, and elevated fasting glucose—components of metabolic syndrome. These factors collectively accelerate CV risk and contribute to premature atherosclerosis. Excess adiposity is linked to systemic inflammation and endothelial dysfunction, impairing vascular relaxation and promoting atherogenesis. Severe obesity can be associated with left ventricular (LV) remodeling, including increased LV mass and altered LV function. Obesity-related cardiomyopathy in extreme cases can impact cardiac efficiency and hemodynamics. Many children who are overweight or obese remain so as adults, increasing their lifetime risk of hypertension, CAD, stroke, and heart failure. The combination of obesity-related risk factors can lead to premature development of atherosclerosis and CV events earlier in life than in peers with healthy weight. Mechanisms Linking Obesity to CV Risk: Adipose tissue as an active organ Secretes adipokines (e.g., adiponectin, leptin) and pro-inflammatory cytokines that influence insulin sensitivity, lipid metabolism, and vascular function. 

Transient hyperphosphatasemia ,a benign condition in early childhood
endocrinology
Fatemeh Sayarifard 1 © ℗
1 Associate professor of pediatric endocrinology, Growth and development research center Children's medical center,school of medicine ,Tehran University of medical sciences
Abstract: Transient hyperphosphatasemia (TH) of infancy and early childhood is a temporary condition marked by a significant elevation in serum alkaline phosphatase levels, involving both liver and bone isoenzymes. It typically affects infants and children under the age of five. Serum alkaline phosphatase levels in cases of TH are usually elevated to four- to five-times the upper limit of the pediatric reference range and naturally return to normal within four to six months. The condition is estimated to occur in 2%–5% of healthy children. Most affected individuals are asymptomatic, with no notable findings in their medical history, physical examination, or laboratory results. In some instances, TH may follow a mild viral illness. Elevated alkaline phosphatase levels in children are generally higher compared to adults due to normal physiological osteoblastic activity, with the maximum levels observed during infancy and puberty. TH is defined by an increase in both bone and liver alkaline phosphatase isoenzymes. Although the exact pathogenesis remains unclear, it is hypothesized that the condition involves reduced clearance of alkaline phosphatase due to increased sialic acid content, possibly triggered or compounded by a temporary surge in alkaline phosphatase production. To diagnose TH, physicians aim to rule out other potential causes like liver disease, bone disorders, and renal osteodystrophy through detailed history, physical examination, and laboratory testing. Additional tests might include measurements of AST, ALT, total bilirubin, direct bilirubin, Gamma-GT, calcium, phosphorus, 25-hydroxyvitamin D, PTH, BUN, and creatinine. If an infant or young child shows no evidence of liver or bone disease, TH should be considered as a benign condition. Ensuring adequate vitamin D and calcium intake based on age recommendations is essential for all children during evaluation. The diagnosis of TH can be confirmed when serum alkaline phosphatase levels return to the normal range within 1–20 weeks without any medical intervention, which can be verified through serial testing. 

Approach to child with hyperkalemia
Nephrology
مستانه مقتدری 1 © ℗
1 pediatric chronic kidney disease resrch center,Gen,cell&Tissue reserch institute,childrens medical center, TUMS
Abstract: Approach to child with hyperkalemia Hyperkalemia is typically defined as a serum or plasma potassium greater than 5.5 mEq/L (mmol/L). However, the upper limit of normal in preterm infants and young infants may be as high as 6.5 mEq/L (mmol/L). Severe hyperkalemia (potassium level ≥7 mEq/L [mmol/L]) is a serious medical problem that requires immediate attention. While mild hyperkalemia is usually asymptomatic, high potassium levels may cause life-threatening cardiac arrhythmias, muscle weakness, or paralysis. Symptoms usually develop at higher levels, 6.5 mEq/L to 7 mEq/L, but the rate of change is more important than the numerical value. Although it is rare to get arrhythmias if the K+ is below 7.5 mmol/L, treatment should be given at lower values if there are ECG changes. Serial changes are as follows as the potassium level increases: 1. Peaked T waves 2. ST segment depression 3. Increased PR interval 4. Flattened P wave 5. Widened QRS complex 6. Ventricular fibrillation (VF) 7. Asystole. Management: 1-Exogenous sources of potassium should be immediately discontinued. 2.Calcium therapy will stabilize the cardiac response to hyperkalemia and should be initiated first in the setting of cardiac toxicity. Calcium does not alter the serum concentration of potassium. Calcium chloride contains three times more elemental calcium than calcium gluconate but is more irritating to peripheral vessels, So, maybe cause tissue necrosis with extravasation, so it is usually only given through central venous lines. Thus, calcium gluconate is the usual initial drug of choice in patients with evidence of cardiac toxicity. Intracellular potassium shift-3 Beta-2 adrenergic agents such as albuterol will also shift potassium intracellularly. Sodium bicarbonate infusion may be helpful in patients with metabolic acidosis. Sodium bicarbonate 1--2 mEq/kg (max: 50 mEq) Intravenous Insulin and glucose, or insulin alone in hyperglycemic patients, will shift the potassium into the cells, effectively lowering serum potassium. D/W5% 1cc/kg and 0.1u/kg regular insulin. Decrease in total body potassium load-4 Furosemide 0.5--1 mg/kg (max: 40 mg) Intravenous Sodium polystyrene sulfonate 1 g/kg (max: 30 g oral, 30--50 g rectal) Oral, rectal Fludrocortisone (in mineralocorticoid deficiency) 0.05--0.2 mg/day, one to two divided doses Oral 5- Hemodialysis should be performed in patients with end-stage renal disease or severe renal impairment. Conclusion: Hyperkalemia is an electrolyte abnormality in which serum potassium level exceeds the normal range for age and can cause life-threatening complications. 

Bladder-Bowel Dysfunction (BBD)
Nephrology
Zahra Nouparast 1 ℗, Sayed Yousef Mojtahedi 2 ©
1 pediatric nephrologist
2 Department of pediatric Nephrology, Bahrami Children hospital, school of medicine, Tehran university of Medical Science, Tehran, Iran
Abstract: Bladder-Bowel Dysfunction (BBD) is a common and often under-recognized condition in pediatric patients, characterized by coexisting lower urinary tract symptoms (LUTS) and bowel irregularities, particularly functional constipation. Retained stool in the rectum may mechanically or neurologically influence bladder function, leading to urgency, incontinence, and post-void residual. This syndrome not only compromises the child’s quality of life but is also associated with recurrent urinary tract infections (UTIs), vesicoureteral reflux, and potential long-term renal damage. Early identification of BBD is essential. Diagnosis involves a combination of detailed history, physical examination, and diagnostic tools including bladder diaries, uroflowmetry, post-void residual (PVR) measurement by ultrasound, and in complex cases, urodynamic studies. Abdominal ultrasound is also helpful in assessing stool burden, bladder wall thickness, and upper urinary tract abnormalities. In complex cases, urodynamic studies provide valuable insight. Recent years have significant advances in the understanding, diagnosis, and management of BBD. Management of BBD is multidisciplinary and stepwise. Management begins with behavioral therapy, bowel regulation (often using polyethylene glycol or stimulant laxatives), followed by pharmacological intervention for bladder symptoms using anticholinergics, beta-3 agonists, or alpha-blockers. Pharmacological management of bladder symptoms may include anticholinergic agents (e.g., oxybutynin, tolterodine) to reduce detrusor overactivity, beta-3 adrenergic agonists (e.g., mirabegron), and alpha-blockers for suspected bladder outlet obstruction. In refractory cases, more advanced treatments such as neuromodulation (e.g., posterior tibial nerve stimulation) or intravesical botulinum toxin injections may be considered. In children with neurogenic bladder or spinal dysraphism, multidisciplinary care involving nephrology, urology, gastroenterology, and rehabilitation specialists is crucial.

Challenges in management of hyponatremia in children
Nephrology
Behnaz Bazargani 1 © ℗
1 Pediatric Chronic Kidney Disease Research Center, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: The management of hyponatremia in children is uniquely challenging due to physiological differences, diagnostic difficulties, and a high risk of catastrophic neurological complications. The core challenge lies in navigating a perilously narrow therapeutic window between under- and over-correction. Diagnostically, symptoms are markedly non-specific. Lethargy, irritability, and nausea mimic common childhood illnesses, while severe signs like seizures or coma can be misattributed to meningitis or epilepsy, delaying crucial diagnosis. Accurately assessing a child's volume status (hypovolemic, euvolemic, or hypervolemic) is also exceptionally difficult, as physical signs are subtle and history from caregivers can be unreliable. Misclassifying the volume status directly leads to choosing the wrong treatment strategy. The treatment phase presents the greatest risks. The historic use of hypotonic intravenous (IV) fluids is now recognized as a major iatrogenic cause of hospital-acquired hyponatremia, as ill children often have elevated ADH hormone, causing water retention. The central dilemma involves the precise use of hypertonic saline for acute, symptomatic cases. The most critical challenge is controlling the rate of sodium correction. Correcting too slowly in a symptomatic child risks ongoing cerebral edema, seizures, and death. Conversely, correcting chronic hyponatremia too rapidly (10-12 mEq/L in 24 hours) can cause Osmotic Demyelination Syndrome (ODS), a devastating and often permanent neurological injury. Achieving the safe target (a 4-6 mEq/L increase in the first 4-6 hours) requires intense, frequent monitoring with serum sodium measurements every 2-4 hours, which is invasive and stressful. Finally, specific populations are at higher risk. Hospitalized children are vulnerable due to non-osmotic ADH release from stress, surgery, or lung diseases. Infants have immature kidneys and cannot verbalize symptoms, while children with chronic heart, liver, or renal disease present complex scenarios where hyponatremia is part of a broader pathophysiology. • In conclusion, managing pediatric hyponatremia demands a high index of suspicion for diagnosis, expert assessment of volume status, and meticulous, monitored correction to avoid the twin dangers of cerebral edema and ODS. This often necessitates care in a pediatric intensive care unit to avoid devastating outcomes. 

Diving Permission for children with renal disease
Nephrology
Banafshe Dormanesh 1 © ℗
1 Professor of Pediatric Nephrology, AJA University of Medical Sciences, Tehran-Iran,
Abstract: Background: Today, diving has been added to the list of marine recreations in Iran. Children are very eager to experience excitement and discover the unknown world around them. According to common electrolyte disorders, inappropriate Blood pressure and subsequent consequences in children with renal disease, it’s important to know whether they can experience diving or under what conditions they are allowed to dive. Method: The keywords related to renal disease and diving were searched in studies published from 2005 to 2025 in Scopus, PubMed, Science Direct, and Google Scholar, resulting in 245 articles, of which 106 articles were reviewed. Results: Children with renal disease, due to their careful adjustment of specialized treatment such as Dialysis or their medical equipment such as vascular catheters, as well as the side effects of medications, have certain restrictions despite not having a contradiction. The most important reasons include: • Hydration status, because they are more prone to volume overload. However, if the urine output is normal, they aren’t contraindicated for diving. • Potassium, which is more than 90% is excreted through the kidneys, so hyperkalemia is common in CKD, and they are contraindicated for diving, due to the possibility of adverse cardiac events during diving. • Uremia & Acidosis, if the patients are stable, such as immediately after dialysis, they are allowed to dive. • Renal Transplantation, who are potentially at risk of hypertension, medical side effects, and under immunosuppression medications. Diving isn’t permitted due to the aquatic environment being full of dangerous microorganisms and pressure changes during diving. • Renal stone, which diving increases the likelihood of their passing, due to buoyancy diuresis, and decisions should be made based on hydration status before diving. • Surgical manipulations, where diving is permitted 2-4 weeks after a closed kidney biopsy and after complete wound healing, and if there is no risk of urinary leakage or bleeding. • AV fistula, which are allowed to develop if they don’t have an artificial channel (Gore-Tex grafts) • Diuretics may affect their tolerance to sudden changes in situation, causing lightheadedness and fainting, so diving is contraindicated. Conclusion: Children with renal disease can dive only if they are stable and if prepared in advance for sudden pressure changes. Key words: Diving, renal disease, electrolyte imbalance, renal stone

Functional Bladder Disorders in Children: An overview and classification
Nephrology
Sayed Yousef Mojtahedid 1 © ℗, Paniz Pourpashang 1, Zahra Noeparast 1, Azadeh Afshin 1
1 Department of Pediatric Nephrology, Bahrami children's hospital, Tehran University of Medical Sciences
Abstract: Functional bladder disorders (FBDs) in children represent a spectrum of conditions characterized by abnormal storage or emptying of urine that are not attributable to any underlying anatomical abnormalities or neurological deficits. These conditions significantly impact a child's daily life. Functional bladder disorders (FBDs) are defined by the presence of a functional disruption in the coordinated interplay between the bladder (the detrusor muscle responsible for storing and expelling urine) and the urethral sphincters (muscles that control the outflow of urine), all under the regulation of the nervous system. The primary symptoms of FBDs include: Urgency, Incontinence(Stress Incontinence, Urge Incontinence), Nocturnal Enuresis (Bedwetting), Frequency, Urinary Retention, Poor Detrusor Contraction, and Inappropriate Sphincter Activity. Classification: The International Children's Continence Society (ICCS) categorizes pediatric FBDs into several primary groups: Overactive Bladder (OAB): This is one of the most common FBDs in children. It is characterized by the symptom of urgency, which may or may not be accompanied by incontinence. The underlying pathophysiology involves involuntary detrusor contractions that occur during the bladder filling phase, leading to the sudden, strong urge to urinate. Underactive Bladder (UAB): In contrast to OAB, UAB is characterized by infrequent voiding and significant high post-void residuals (PVR). The detrusor muscle has reduced contractility, meaning it is unable to generate sufficient force to empty the bladder completely. This leads to urine accumulation in the bladder. Dysfunctional Voiding (DV): This is a crucial category where the primary problem lies in the poor relaxation of the external urethral sphincter during the voiding phase. Instead of the sphincter relaxing to allow urine to flow freely, it remains contracted or contracts inappropriately while the detrusor muscle attempts to empty the bladder. Voiding Postponement (VP): This refers to a behavioral pattern where children habitually delay or postpone urination, even when they feel the urge. Other Syndromes: The ICCS also acknowledges other specific presentations that may not fit neatly into the above categories but are considered functional bladder disorders. These include: Extraordinary Daytime Frequency: This refers to a pattern of extremely frequent daytime urination in children who have a normal bladder capacity and no evidence of overactivity or infection. The cause is often behavioral or related to changes in voiding patterns. Giggle Incontinence: This is a specific type of urge incontinence that is triggered by laughter. The sudden, forceful contraction of the abdominal muscles during laughter can provoke an involuntary detrusor contraction, leading to sudden urine leakage. 

metabolic acidosis in children
Nephrology
فهیمه عسگریان 1 © ℗
1 Assistant Professor of Pediatric Nephrology Department of Pediatrics, School of Medicine Childrens Medical Center Tehran University of Medical Sciences
Abstract: Metabolic Acidosis in Children Metabolic acidosis is defined by reduced serum bicarbonate with consequent acidemia, arising from excess acid generation, impaired renal acid excretion, or bicarbonate loss. Classically it is categorized as high–anion gap (AG) or normal-AG (hyperchloremic). Etiologies. High-AG causes include lactic acidosis (sepsis, hypoperfusion, mitochondrial disease), ketoacidosis (diabetes), renal failure, toxin/ingestions (methanol, ethylene glycol, salicylates, metformin), massive rhabdomyolysis, and tumor lysis. Normal-AG causes reflect bicarbonate loss or reduced H⁺ secretion: diarrhea, enteric fistulae, proximal/distal renal tubular acidosis, early renal failure, and drugs (acetazolamide, aminoglycosides, cisplatin, ifosfamide; heavy metals). Clinical features. Acute cases present with tachypnea or Kussmaul respirations, lethargy, and in severe acidemia hemodynamic instability. Chronic acidosis may be subtle, causing poor growth or rickets. Diagnostics. Obtain ABG/VBG and electrolytes. Calculate the anion gap: AG = Na – (Cl + HCO₃) (normal 4–12 mEq/L); correct downward for hypoalbuminemia (≈2.5 mEq/L drop in AG per 1 g/dL albumin decrease). For metabolic acidosis, expected respiratory compensation is Winter’s formula: PCO₂ ≈ 1.5 × HCO₃ + 8 ± 2. Unmask mixed disorders with ΔAG = AG – 12, ΔHCO₃ = 24 – HCO₃, and Δ-gap = ΔAG – ΔHCO₃; a markedly positive Δ-gap suggests concomitant metabolic alkalosis, whereas a negative Δ-gap indicates additional hyperchloremic acidosis. Electrolyte shifts are predictable: each 0.1 fall in pH raises K⁺ by ~0.6 mEq/L; ionized Ca²⁺ and Mg²⁺ rise due to reduced protein binding. Management. Treat the cause (insulin and fluids for DKA; fluids/antibiotics for sepsis; antidotes or dialysis for toxins; alkali therapy for RTA). Reserve intravenous sodium bicarbonate for severe acidemia (pH 7.0) or impaired renal acid excretion with persistent pH 7.2. In emergencies, give 1 mEq/kg (max 50 mEq) slowly; for replacement, estimate deficit = (target – current HCO₃) × weight × 0.4–0.5, administer in divided doses with serial gases and electrolytes. Early recognition and targeted therapy prevent complications and improve pediatric outcomes. 

The importance of DMSA scan in comparison with ultrasound in the early detection of renal parenchymal involvement in children with first- time febrile UTI
Nephrology
Neamatollah Ataei 1 © ℗
1 Pediatric Nephrologist Pediatric Chronic Kidney Disease Research Center Tehran University of Medical Sciences (TUMS)
Abstract: The high risk of pyelonephritis in the presence of a febrile Urinary tract infection (UTI) and possible complications including renal scarring, hypertension (HTN )and chronic kidney disease (CKD), warrants accurate and timely diagnosis, evaluation and therapy. In 2011and 2021 imaging studies in selected international guidelines for the diagnosis and management of the initial UTI in febrile infants and children 2 to 24 months were revised. Some of suggestions revision were as follows: 1- Except ultrasound (US), there is no need to use other imaging modalities. 2- If the US is normal, there is no need to do cystography. 3- Renal cortical scintigraphy should be avoided in the acute phase of the first febrile UTI. 4-The follow-up of the patients was conditional on the recurrence of febrile UTI. Significant controversy surrounded this recommendation, and many Authors disagreed with the American Academy of Pediatrics guidelines According to the research conducted and for the following reasons, US can not be an appropriate and comprehensive imaging modality in evaluating a child with the first episode of febrile UTI. At the time of presentation, slides of 16 children whose abnormalities were missed due to treatment based on the mentioned guidelines will be shown. Many of these recommendations are based on expert opinion alone because there are few studies, and in their suggestions, not even a prospective study was mentioned as cited evidence. In the majority of prospective studies expressed in high sensitivity of Dimercaptosuccinic Acid (DMSA) scans (91%) compared to low sensitivity of ultrasound (11% - 40%) in the identification of renal parenchymal involvement. These guidelines are presented while the findings of renal cortical scintigraphy in at least 19 prospective studies conducted in the world from 1991 to 2019 (4 studies in Iran, one of which has not yet been published) show that renal parenchymal involvement in children with the first episode of febrile UTI is 44.1% to 88% with an average of 67.9%. According to Coulthard et al. results, potentially important abnormalities (8% of pts) will be missed if the newer guidelines are followed. They concluded that the NICE guidance should be reconsidered. Take home message :For the early detection of renal parenchymal involvement in children with the first episode of febrile UTI, we have no choice but to use renal cortical scintigraphy to prevent or reduce the process of not identifying renal parenchymal involvement (missing) until the results of prospective research are ready. 

An Overview of Exanthematous Diseases and their Differential Diagnosis in Pediatric age groups (Panel: Fever and Rash)
Infectious
جعفر سلطانی 1 © ℗
1 Associate Professor of Pediatric Infectious Diseases, Pediatrics Department, Faculty of Medicine, Tehran University of Medical Sciences
Abstract: Panel: Fever and Rash An Overview of Exanthematous Diseases and their Differential Diagnosis in Pediatric age groups Jafar Soltani, Associate Professor of Pediatric Infectious Diseases, Pediatrics Department, Faculty of Medicine, Tehran University of Medical Sciences Fever accompanied by a rash is a common and essential clinical presentation in pediatrics, often signalling a wide range of possible conditions—from benign viral infections to severe, life-threatening diseases. In children, this combination requires careful evaluation to determine the underlying cause and guide appropriate management. The causes of fever and rash in children span infectious and noninfectious origins. Common viral illnesses include roseola, fifth disease (erythema infectiosum), chickenpox, measles, rubella, and scarlet fever. These viral exanthems typically present with fever followed by or coinciding with characteristic rashes, which help in clinical diagnosis. For example, roseola often causes a sudden high fever that resolves before a pinkish rash appears, while fifth disease presents with a distinctive “slapped cheek” rash on the face, sometimes spreading to limbs. Bacterial infections, such as scarlet fever (caused by Group A Streptococcus), can also cause fever and a rash, often accompanied by a sore throat and flushed cheeks. More severe causes include meningococcemia, which manifests as fever with a petechial or purpuric rash and requires urgent treatment due to rapid progression and risk of fatality. A systematic approach to a febrile child with rash includes thorough history taking (including vaccination status, recent exposures, progression of symptoms), detailed physical examination focusing on rash type (macular, papular, vesicular, petechial), distribution, mucosal involvement, and presence of signs of toxicity (e.g., lethargy, poor perfusion). This helps differentiate mild, self-limiting conditions from emergencies that require immediate intervention. Parents and caregivers should seek prompt medical attention if the child has a fever with a rash, especially if accompanied by symptoms such as difficulty breathing, persistent vomiting, lethargy, seizures, or if the rash does not blanch (i.e., does not fade when pressed), as these may indicate a serious illness. In summary, fever with rash in pediatric patients requires careful clinical evaluation to identify the cause, which can range from common viral infections to potentially life-threatening bacterial diseases, allowing for timely and appropriate care to be provided. In this presentation, we review the Exanthematous Diseases and their Differential Diagnosis (Fever and Rash) in Pediatric age groups.

Association of body mass index with COVID-19 outcome in a pediatric tertiary referral hospital in Iran
Infectious
Mohammad Reza Abdolsalehi 1 © ℗
1 Department of Infectious Diseases, Pediatrics Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract: One of the challenging risk factors for severe COVID-19 infection is body mass index (BMI). It was reported that overweight and obese patients are at a higher risk of developing severe COVID-19 infection and its complications. Obesity also worsens the prognosis of COVID-19 in adults and increases the mortality rate in younger patients . In addition, obesity is the most important risk factor for chronic disorders and metabolic syndromes in adults, but pediatric chronic diseases are usually related to congenital and developmental problems . The BMI of children with underlying comorbidities is affected by secondary malnutrition, dwarfism, and drugs. . In this study we assessed the association of BMI with clinical outcomes of COVID-19 infection (ICU admission, death, and ventilator requirement) in hospitalized pediatric patients in Iran. This retrospective cross-sectional study was performed in the biggest referral pediatric hospital in Tehran from March 7 to August 17, 2020. All hospitalized children ≺18 years of age with laboratory-confirmed COVID-19 were included in the study. We evaluated the association of BMI with COVID-19 outcomes (death, severity of clinical course, oxygen therapy, intensive care unit [ICU] admission, ventilator requirement). The secondary objectives were investigating the association of gender, underlying comorbidity, and patient age with COVID-19 outcomes. The limits for obesity, overweight, and underweight were set at BMI 95 percentile, 85≤ BMI ≤ 95, and BMI5 percentile, respectively. Results In total, 189 confirmed pediatric cases of COVID-19 (0.1–17 years) with a mean age of 6.4 ± 4.7 years were included. Overall, 18.5% of the patients were obese and 33% were underweight. We found that BMI had no significant relation with COVID outcomes in pediatric cases but after subgrouping the participants, underlying comorbidities and lower BMI in previously ill children were independently associated with a poor clinical outcome of COVID-19. In addition, the previously ill children with higher BMI percentiles were at a relatively lower risk of ICU admission (95% CI: 0.971–0.998, OR: 0.98, p = 0.025) and better clinical course of COVID-19 (95% CI: 0.970–0.996, OR: 0.98, p = 0.009). The BMI percentile had a statistically significant direct relationship with age . Based on our results, obesity is not related to COVID-19 outcomes in pediatric patients, but after controlling for confounding effects, underweight in children with underlying comorbidities was more likely to be associated with a poor prognosis of COVID-19. 

Diagnosos of Tuberclosis in children
Infectious
Hamid Eshaghi 1 © ℗
1 Ldren medical center T.U.M.SPediatric infectious disease research center chi
Abstract:

 راه‌های تشخیص عفونت سل در کودکان دکتر حمید اسحاقی دانشیار بیماریهای عفونی کودکان مرکز طبی کودکان سل همچنان یکی از بیماری‌های عفونی مهم در جهان است که سالانه میلیون‌ها کودک را درگیر می‌کند. تشخیص زودرس عفونت سل در اطفال اهمیت ویژه‌ای دارد، زیرا تظاهرات بالینی در این گروه سنی اغلب غیراختصاصی بوده و احتمال پیشرفت سریع به بیماری منتشر یا مننژیت سل وجود دارد. تشخیص سل در کودکان بر ترکیبی از داده‌های بالینی، اپیدمیولوژیک، تصویربرداری، آزمون‌های ایمنی و میکروبیولوژیک استوار است. سابقه تماس نزدیک با فرد مبتلا اهمیت بالایی دارد و علائم شایع شامل تب طول‌کشیده، کاهش وزن، بی‌اشتهایی، تعریق شبانه و سرفه مزمن است. از نظر آزمایشگاهی، تست پوستی توبرکولین (TST) هنوز پرکاربرد است، اگرچه حساسیت و ویژگی آن در کودکان، به‌ویژه سنین پایین یا افراد واکسینه‌شده با BCG محدود است. آزمون‌های اینترفرون-گاما (IGRAs) مانند QuantiFERON و T-SPOT به‌عنوان مکمل یا جایگزین TST معرفی شده و در کودکان بزرگ‌تر (سن بالای ۳–۴ سال) ارزش بیشتری دارند. رادیوگرافی قفسه سینه ابزار مهمی در ارزیابی کودکان مشکوک به سل است و می‌تواند از گرافی نرمال یا گان کمپلکس کلسیفیه در سل نهفته تا ارتشاح لوب میانی یا فوقانی، و در مواردی کلاپس یا افیوژن پلور متغیر باشد. سی‌تی‌اسکن حساسیت بیشتری در شناسایی لنفادنوپاتی مدیاستین یا ضایعات پارانشیمی مخفی دارد. اثبات عفونت با شناسایی Mycobacterium tuberculosis از نمونه‌های بالینی (مانند خلط، شست‌وشوی معده یا مایع مغزی-نخاعی) استاندارد طلایی است، اما در کودکان به دلیل دشواری جمع‌آوری نمونه و بار پایین باکتری، حساسیت اسمیر اسید فست پایین است. کشت حساس‌تر اما زمان‌بر است و روش‌های مولکولی سریع مانند Xpert MTB/RIF نقش مهمی در شناسایی باسیل و تعیین مقاومت به ریفامپین دارند. در کودکان زیر شش سال، تشخیص معمولاً بر اساس ترکیبی از سه یا چند معیار است: سابقه تماس مثبت، علائم بالینی مانند تعریق شبانه، کاهش وزن و بی‌حالی، یافته‌های رادیولوژیک، TST یا IGRA مثبت و شناسایی مستقیم باسیل با رنگ‌آمیزی، کشت یا PCR. در مجموع، تشخیص سل در اطفال نیازمند رویکرد چندوجهی است که ترکیبی از ارزیابی بالینی، شرح تماس، یافته‌های تصویربرداری، آزمون‌های ایمنی و میکروبیولوژیک باشد. افزایش دسترسی به تست‌های مولکولی و آموزش پزشکان به شناسایی مظاهر غیر اختصاصی، می‌تواند به بهبود تشخیص و کاهش بار بیماری در کودکان کمک کند. 

Future vaccines in Iran: Varicella, Hepatitis A (Panel: Vaccination)
Infectious
جعفر سلطانی 1 © ℗
1 Associate Professor of Pediatric Infectious Diseases, Pediatrics Department, Faculty of Medicine, Tehran University of Medical Sciences
Abstract: Panel: Vaccination Future vaccines in Iran: Varicella, Hepatitis A Jafar Soltani, Associate Professor of Pediatric Infectious Diseases, Pediatrics Department, Faculty of Medicine, Tehran University of Medical Sciences Vaccination has been instrumental in controlling Hepatitis A and Varicella infections. Hepatitis A vaccines, licensed in the United States since 1995, include single-antigen vaccines (Havrix and Vaqta) and a combined HepA-HepB vaccine (Twinrix). These vaccines are administered intramuscularly in a 2-dose or 3-dose series, depending on the formulation and age group. Vaccination is recommended for all children beginning at 12 months and for adults at increased risk, including travellers to endemic areas, persons experiencing homelessness, and people with chronic liver disease or HIV. HepA vaccines demonstrate high immunogenicity, with over 95% adults and 97% children developing protective antibodies after the first dose, and nearly 100% seroconversion after completion. Protective antibodies may persist for decades. Postexposure prophylaxis is available with HepA vaccine and immune globulin (IG), especially for high-risk individuals. Varicella vaccination in the United States began in 1995 with live attenuated vaccines: VAR (Varivax) and MMRV (ProQuad), the latter combining measles, mumps, rubella, and varicella antigens. The 2-dose varicella vaccination schedule starts at 12-15 months with a booster at 4-6 years. Varicella vaccines are highly effective, achieving 82% effectiveness after one dose and 92% after two doses, significantly reducing morbidity and mortality. Postexposure vaccination is effective if administered within 3 to 5 days after exposure. Vaccination is contraindicated in severely immunocompromised individuals and pregnant women. Overall, these vaccination programs have substantially decreased disease incidence and complications in the U.S. population. In conclusion, the widespread use of vaccines for Hepatitis A and varicella has dramatically reduce the incidence, morbidity, and mortality associated with these diseases in Iran. Both vaccines demonstrate high immunogenicity and long-lasting protection, with established safety profiles across different populations, including children, adults, and pregnant women. Continued efforts in vaccination coverage, targeted immunization of high-risk groups, and appropriate postexposure prophylaxis remain essential to control and prevent outbreaks, ultimately advancing toward the elimination of these vaccine-preventable infections. In this presentation, we review the necessity and the importance of Varicella and Hepatitis A vaccination in Iran.

measles
Infectious
مریم رستمیان 1 © ℗
1 department of pediatrics infectious disease ,hakim childrens hospital, tehran university of medical science ,tehtehran ,iran
Abstract: Measles Dr Maryam Rostamyan Pediatric infectious disease subspecialist Measles virus is transmitted by direct contact with infectious droplets or by airborne spread .in temperate areas , the peak incidence of infection usually occurs during late winter and spring . patients infected with wild type measles virus are contagious from 4 days before the rash through 4 days after appearance of the rash . Measles is an acute viral disease characterized by fever , cough , coryza , and conjunctivitis , followed by a maculopapular rash beginning on the face and spreading cephalocaudally and centrifugally .during the prodromal period ,a pathognomonic enanthema ( Koplic spots )may be present. complications of measles ,including otitis media ,bronchopneumonia , laryngotracheobronchitis (croup),and diarrhea ,occur commonly in young children and immunocompromised hosts .case fatality rates are increased in children younger than 5 years ,pregnant people , and immunocompromised children , including children with leukemia , HIV infection , and severe malnutrition ( including vitamin A deficiency ).measles virus infection can be confirmed by : 1- detection virus RNA by NAAT 2- detection IgM 3-a fourfold increase in measles IgG in paired acute and convalescent serum specimens.4-isolation of virus in cell culture. No specific antiviral therapy is available .WHO currently recommends vitamin A for all children with measles ,regardless of their country of residence. In people who are not immunocompromised use of vaccine recommended for post exposure prophylaxis and in pregnant and people who are immunocompromised immune globulin use for post exposure prophylaxis .available data suggest that measles vaccine ,if administered within 72 hours of measles exposure to susceptible individuals ,will provide protection or disease modificationin some cases .either IGIM or IGIV can be administered within 6 days of exposure to prevent or modify measles in people who do not have evidence of measles immunity .for children who receive IGIM for modification or prevention of measles after exposure ,measles vaccine (if not contraindicated )should be administered 6 months after IGIM administration and 8 months after IGIV administration ,provided the child is at least 12 months of age. 

roseola
Infectious
Maryam Zendehrouh 1 © ℗
1 assistant professor of pediatric infectious disease
Abstract: Roseola infantum, also known as exanthem subitum or sixth disease, is a common viral infection in infants and young children, primarily caused by human herpesvirus 6 (HHV-6B), with HHV-7 also implicated in some cases. This condition typically affects children between 6 months and 2 years of age, with peak incidence around 7 to 13 months, coinciding with the decline of maternal antibodies Clinical Presentation The disease progresses in two distinct phases. Initially, a high fever (often exceeding 39.7°C) appears abruptly and may last 3 to 5 days. This febrile phase can be accompanied by irritability, mild respiratory symptoms, and gastrointestinal disturbances. Notably, the fever subsides suddenly ("crisis") or gradually ("lysis"), coinciding with the onset of a characteristic rash. The rash begins as faint pink or rose-colored, nonpruritic, 2- to 3-mm maculopapular lesions on the trunk and spreads centrifugally to the face and extremities. It typically lasts 1 to 3 days and may be transient, often fading within hours . Diagnosis Diagnosis is primarily clinical, based on the sequential appearance of high fever followed by the rash. Laboratory tests, such as PCR for HHV-6 or HHV-7, are rarely necessary but may be considered in atypical cases or immunocompromised patients . Management Management is supportive, focusing on fever control with antipyretics like acetaminophen and ensuring adequate hydration. Febrile seizures occur in approximately 10–15% of cases, especially in children aged 6 to 18 months, but these are typically self-limited and do not require long-term anticonvulsant therapy . In immunocompromised children, rare complications such as encephalitis may necessitate antiviral treatment with agents like ganciclovir or foscarnet . Prognosis The prognosis is generally excellent, with most children recovering fully without complications. Reactivation of HHV-6 can occur in immunocompromised individuals, leading to more severe manifestations . Understanding the clinical course and management of roseola is essential for pediatricians, especially in distinguishing it from other exanthematous illnesses and providing appropriate care.

Scarlet Fever in Children: Clinical Features, Streptococcal Exotoxins, and Therapeutic Approaches
Infectious
Mahmoud Khodabandeh 1 © ℗
1 Associate Professor of Pediatric Infectious Diseases, Children’s Medical Center, Pediatrics Center of Excellence, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Abstract: Scarlet fever is a childhood infectious disease caused by Group A beta-hemolytic Streptococcus. Its hallmark presentation includes fever, pharyngitis, and the characteristic “sandpaper-like” rash. This article reviews the clinical manifestations, the role of streptococcal exotoxins, diagnostic approaches, and treatment strategies. Timely diagnosis and appropriate antibiotic therapy remain crucial to prevent serious complications such as rheumatic fever and post-streptococcal glomerulonephritis. Introduction: Historically, scarlet fever was a major cause of morbidity and mortality among children. Although mortality has declined drastically with the advent of antibiotics, scarlet fever still occurs in many parts of the world. Recognizing its clinical manifestations remains essential for pediatricians. Clinical Manifestations: Early symptoms: Sudden onset fever, sore throat, headache, nausea, and vomiting. Rash: Appears 12–48 hours after fever onset. It is diffuse, erythematous, fine-textured, and feels like sandpaper, beginning on the trunk and spreading to the extremities. Pastia’s sign: Prominent dark-red lines in the skin folds (e.g., groin, axilla, elbows). Strawberry tongue: Initially coated white, later turns erythematous with prominent papillae. Desquamation: Peeling of the skin occurs during the convalescent phase, especially on the fingers and toes. Pathogenesis: Streptococcal Exotoxins Scarlet fever results from the production of streptococcal pyrogenic exotoxins (SpeA, SpeB, SpeC), which act as superantigens. These toxins trigger massive T-cell activation and cytokine release, producing the rash, systemic manifestations, and the characteristic signs of scarlet fever. Diagnosis: Clinical: Based on fever, exudative pharyngitis, rash, and mucocutaneous signs (Pastia’s lines, strawberry tongue). Laboratory: Throat culture (gold standard) Rapid antigen detection test (RADT) for Group A Streptococcus Treatment: Antibiotics: First-line: Penicillin V orally for 10 days Alternatives in penicillin-allergic patients: Macrolides (e.g., azithromycin, erythromycin) Supportive care: Antipyretics (acetaminophen or ibuprofen) Adequate hydration and rest Salt-water gargles for throat pain Complications: Rheumatic fever Post-streptococcal glomerulonephritis Peritonsillar abscess Otitis media or sinusitis Conclusion: Scarlet fever remains a clinically significant pediatric illness characterized by distinct features such as Pastia’s sign, strawberry tongue, and sandpaper rash. Streptococcal pyrogenic exotoxins are central to its pathogenesis. Prompt recognition and complete antibiotic therapy are vital in preventing severe complications. Understanding the clinical spectrum and pathophysiology enhances early diagnosis and management in pediatric practice. 

Acute hepatitis in children
Gastroenterology
سارا صفری 1 © ℗
1 Sara Safari, Division of Pediatric Gastroenterology, Depatmrtment of Pediatrics, Hakim Children Hospital, Tehran University of Medical Sciences, Tehran, Iran Email:ssafari642@gmail.com
Abstract: Acute Hepatitis in Children: Definition, Etiologic Spectrum, Diagnostic Strategy, and Management Principles Abstract: Acute hepatitis in children is a clinical syndrome characterized by the abrupt onset of hepatocellular inflammation and injury, with illness duration of less than six months. It manifests along a continuum—from subclinical transaminase elevation to jaundice, coagulopathy, and fulminant hepatic failure. The pediatric presentation is often nuanced, requiring a high index of suspicion to ensure timely recognition and intervention.  Etiology spans infectious, immune-mediated, metabolic, and toxic insults. Viral hepatitis remains the predominant cause worldwide, with hepatitis A and E prevalent in regions of lower sanitation, and hepatitis B and C now declining in incidence due to universal immunization and perinatal screening. Other hepatotropic or systemic viruses—including Epstein–Barr virus, cytomegalovirus, herpes simplex virus, adenovirus, and enteroviruses—can produce significant hepatic injury. Non-infectious causes include autoimmune hepatitis, Wilson disease, mitochondrial and metabolic disorders, and drug- or toxin-induced liver injury. Despite comprehensive investigation, recent global reports underscore that a subset of cases remains idiopathic, including acute severe hepatitis of unknown origin in previously healthy children.  Diagnosis demands a meticulous approach: detailed history (travel, exposures, medications, family predisposition), targeted physical examination, and a structured laboratory work-up comprising liver biochemistry, coagulation profile, metabolic screening, viral serologies, and autoimmune markers. Abdominal ultrasonography with Doppler is indispensable for assessing parenchymal changes and vascular integrity. In selected cases, liver biopsy remains the gold standard for histological characterization and therapeutic guidance.  Management integrates etiology-specific interventions with vigilant supportive care. Viral hepatitis A and E are self-limited, requiring hydration, nutrition, and observation. Autoimmune hepatitis necessitates prompt immunosuppression. Drug-induced injury mandates immediate withdrawal of the offending agent. Supportive measures aim to prevent metabolic decompensation, control coagulopathy, and avert complications such as hypoglycemia and hepatic encephalopathy. Children meeting acute liver failure criteria require urgent referral to a pediatric liver transplant unit to maximize survival.  Prevention: widespread hepatitis B vaccination, targeted hepatitis A immunization, improved sanitation, and rational prescribing of potentially hepatotoxic agents remain the most effective strategies. Acute hepatitis in children demands a multidisciplinary, time-sensitive approach, etiologic identification with supportive care. Advances in molecular diagnostics and pathogen discovery promise to refine our understanding, enabling earlier detection and targeted therapy for this complex and evolving condition.   Keywords: acute hepatitis, pediatric hepatology, viral hepatitis, acute liver failure, diagnosis, management, prevention, transplantation

Chronic Abdominal Pain in Children
Gastroenterology
Katayoun Khatami 1 © ℗
1 Assistant Professor of Pediatric Gastroenterology and Hepatology, Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: Chronic abdominal pain (CAP) is one of the most common recurrent complaints in pediatrics, with most cases classified as functional abdominal pain disorders (FAPDs). Despite its prevalence, diagnosis and management remain difficult because symptoms often overlap with organic gastrointestinal diseases, and family anxiety may drive repeated investigations. The principal challenge is distinguishing functional from organic causes. Alarm features such as weight loss, gastrointestinal bleeding, nocturnal pain, persistent vomiting, and family history of inflammatory bowel disease help identify children needing further evaluation, but these markers are not entirely reliable. Excessive investigations may reinforce illness behavior, delay intervention, and increase healthcare burden. A focused diagnostic approach is recommended: baseline studies such as complete blood count, inflammatory markers, celiac serology, and fecal calprotectin when inflammatory bowel disease is suspected. Imaging and endoscopy should be reserved for children with concerning features or abnormal initial results. Application of Rome IV criteria supports a positive diagnosis of FAPD and reduces uncertainty. Management is centered on a biopsychosocial model. Education, reassurance, and normalization of school attendance and daily routines are foundational. Cognitive-behavioral therapy (CBT) and gut-directed hypnotherapy are the most consistently effective interventions, with multiple randomized trials demonstrating improvements in pain frequency and quality of life. Addressing constipation is essential, as it is both common and treatable. Dietary strategies, such as lactose restriction or short-term low-FODMAP trials under dietitian guidance, may help selected patients but are not recommended universally. Pharmacologic options, including antispasmodics or low-dose antidepressants, are generally reserved for refractory cases in specialist care, as evidence for routine use remains limited. Conclusion: The management of CAP in children requires balancing the need to rule out significant pathology with the risks of over-investigation. Pediatricians should adopt a streamlined diagnostic pathway and prioritize evidence-based psychosocial interventions. Early, confident diagnosis and initiation of non-pharmacologic therapy improve outcomes and reduce chronicity. 

Chronic Diarrhea
Gastroenterology
Parastoo Sharifi 1 © ℗
1 Assistant Professor of Pediatric Gastroenterology, Department of Pediatric Gastroenterology, Children's Medical Center Hospital, Tehran, Iran.
Abstract: Chronic Diarrhea in Children Chronic diarrhea (lasting more than 14 days though often defined as 4 weeks) warrants a systematic evaluation given its broad etiologies and potential to impair growth and development. Pathophysiological Classification & Clinical Clues Understanding underlying mechanisms -osmotic, secretory, inflammatory, or mixed- is essential. Stool characterization (watery, fatty, bloody) guides differential diagnosis and stratifies investigation pathways. Age-Dependent Etiologies • Neonates/Infants: prioritize genetic/congenital causes, including congenital diarrheas and enteropathies(CODEs)-e.g. microvillus inclusion disease, congenital chloride or sodium diarrhea- witch often require parenteral nutrition or bowel transplantation. • Older Children: dominant contributors include post- infectious conditions, food allergies or intolerances, immune-mediated disorders, IBD, IBS, malabsorption syndromes, and environmental enteropathy in low-resource settings. Diagnostic Strategy Begin with thorough history and physical exam; include nutritional assessment and stool details. Initiate first-line tests: blood work, stool studies (e.g. infection, fat), breath testing for lactose intolerance, imaging as needed. Escalate to endoscopy with biopsy when organic disease is suspected. Genetic testing plays a pivotal role in neonatal or refractory cases. Management Principles • Supportive Care: Ensure hydration with oral or iv fluids; nutritional rehabilitation is fundamental to restore gut integrity and break the cycle of malnutrition-associated diarrhea. • Targeted Interventions: Dietary elimination for intolerance/allergy; yogurt-based or lactose-free diet; zinc supplementation; empiric antibiotics for specific infections; probiotics for antibiotic-associated diarrhea. • Advanced Therapies: immunomodulatory drugs for IBD or autoimmune enteropathy; TPN or bowl transplant in intractable neonatal enteropathies. 

Infantile colic and gastroesophageal reflux in breastfed and formula-fed infants
Gastroenterology
Bahar Allahverdi 1 © ℗
1 Pediatric Gastroenterology and Hepatology Research Center, Pediatric Center of Excellence, Children's Medical Center, Tehran University of Medical Sciences
Abstract: Colic and gastroesophageal reflux (GER) are common concerns in early infancy with overlapping symptomatology and distinct pathophysiologic mechanisms. Colic is typically defined by paroxysmal, inconsolable crying episodes in otherwise healthy and well-fed infants, usually commencing in the first weeks of life and resolving by 3–4 months. The etiopathogenesis is multifactorial, involving visceral hypersensitivity, immature enteric nervous system and GI motility, temperamental factors, and caregiver–infant interactions. GER reflects retrograde passage of gastric contents into the esophagus, a process amplified in infancy by lower esophageal sphincter immaturity, short esophageal length, and frequent transient relaxations. Differentiating physiologic GER from gastroesophageal reflux disease (GERD) is critical; GERD is characterized by troublesome symptoms or complications such as poor weight gain, feeding aversion, respiratory manifestations, esophagitis, or anemia. Feeding modality influences symptom expression but does not reliably distinguish colic from GER/GERD. Breastfed infants may experience fewer regurgitation episodes than formula-fed peers in the early months, though both groups commonly display physiologic reflux that abates with age. Formula feeding has been variably associated with increased fretfulness or regurgitation in some cohorts, potentially related to formula composition, volume tolerance, or feeding technique; however, no universal approach to formula modification is indicated for uncomplicated cases. Clinical assessment should emphasize red flags: poor weight gain, persistent vomiting with bilious material, hematemesis, fever, lethargy, or dysphagia. Diagnostic investigations are reserved for atypical or severe presentations and should be guided by red flags; routine imaging, pH-impedance testing, or endoscopy is not indicated in otherwise healthy infants with typical symptoms. Management is predominantly supportive and family-centered. For colic, parental reassurance, soothing strategies, and consistent caregiving routines. For benign GER, conservative measures such as smaller, more frequent feeds, upright positioning after feeds, and trial of thickened feeds (only for formula-fed infants) may be considered in select cases; routine use of acid suppression is not recommended in healthy, term infants lacking objective evidence of GERD. Close follow-up should monitor growth, development, and evolving symptomatology. In both infantile colic and GER/GERD, it is necessary to emphasize exclusive breastfeeding. 

Irritable bowel syndrome
Gastroenterology
Parisa Rahmani 1 © ℗
1 Pediatric Gastroenterology and Hepatology Research Center, Pediatrics Centre of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract: AP‐DGBIs have a pooled worldwide prevalence of 13.5% in children aged 4–18 years old.These disorders have a significant impact on quality of life, resulting from chronic pain and increased psychological comorbidities, such as anxiety and depression. The Rome IV criteria propose a subcategorization of 4 subtypes of AP‐DGBIs, that is, IBS, functional abdominal pain‐not otherwise specified (FAP), functional dyspepsia (FD) and abdominal migraine (AM). Management approaches predominantly target the reduction of chronic pain to restore function and include various pharmacological therapies, dietary modifications, gut brain psychotherapies, probiotics, and percutaneous electrical nerve field stimulation (PENFS). Hypnotherapy is recommended as a treatment option (Strong recommendation, Moderate certainty evidence). Cognitive Behavioral therapy (CBT) is recommended as a treatment option (Strong recommendation, Low certainty evidence). Percutaneous Electrical Nerve Field Stimulation (PENFS) is suggested as a treatment option (Conditional recommendation, Moderate certainty evidence). Probiotics (Multi‐strain) and Synbiotics (multi strain probiotics and prebiotic) may be suggested as a treatment option (Conditional recommendation, Low certainty evidence)‐ Enteric‐coated peppermint capsules may be suggested as a treatment option (Conditional recommendation, Low certainty evidence). Amitriptyline may be suggested as a treatment option (Conditional recommendation, Low certainty evidence. Domperidone may be suggested as a treatment option (Conditional recommendation, Low certainty evidence). Cyproheptadine may be suggested as a treatment option (Conditional recommendation, Low certainty evidence). Buspirone is NOT suggested as a treatment option (Conditional recommendation, Low certainty evidence). Mebeverine is NOT suggested as a treatment option (Conditional recommendation, Low certainty evidence). Drotaverine is NOT suggested as a treatment option (Conditional recommendation, Low certainty evidence) Citalopram is NOT suggested as a treatment option (Conditional recommendation, Low certainty evidence). Yoga is NOT suggested as a treatment option (Conditional recommendation, Low certainty evi dence) Irritable Bowel Syndrome (IBS) Specific recommendations Soluble dietary fiber supplements (i.e., hydrolized guar gum, glucomannan, psyllium) are suggested as a treatment option for IBS only (Conditional recommendation, Moderate certainty evidence). Lactobacillus rhamnosus GG is suggested as a treatment option for IBS (Conditional recommendation, Moderate certainty evidence) .

Spondylolysis, Spondylolisthesis, and other non‑inflammatory lumbar disorders in pediatrics
Rheumatology
Sahar Naderi 1 © ℗
1 Department of Pediatric Rheumatology, Hakim Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Non-inflammatory spinal disorders in the pediatric population are important yet often underdiagnosed causes of back pain and dysfunction. Among these, spondylolysis and spondylolisthesis are the most frequently encountered conditions, particularly in physically active children and adolescents. Spondylolysis refers to a defect or stress fracture in the pars interarticularis, typically at the L5 vertebra. It commonly arises due to repetitive hyperextension and rotation of the spine, making young athletes—such as gymnasts, divers, and football linemen—especially vulnerable. Clinical presentation often includes insidious-onset low back pain, worsened by activity and relieved with rest. Diagnosis is made through imaging, with MRI preferred in early stages due to its sensitivity in detecting stress reactions before a fracture appears on radiographs or CT. Spondylolisthesis, which may result from spondylolysis, occurs when one vertebra slips forward relative to the one below it. This condition is classified based on severity (grades I–V), and higher grades can lead to neurological symptoms such as radiculopathy or, rarely, bowel/bladder dysfunction. Management depends on severity and symptoms. Most cases are managed conservatively with activity modification, physical therapy focused on core strengthening, and occasionally bracing. Surgery is considered in cases of high-grade slips, progressive deformity, or failed conservative treatment. Other non-inflammatory spinal conditions in children include Scheuermann’s kyphosis, characterized by anterior wedging of the vertebrae, leading to structural kyphosis, and idiopathic scoliosis, which presents as a lateral spinal curvature without underlying systemic disease. These conditions often have a gradual onset and may be identified during routine screening or due to postural concerns. A thorough clinical evaluation, including neurological assessment, is essential to rule out serious pathologies. Imaging should be judiciously used based on history and exam findings. Early diagnosis and appropriate management are critical to prevent long-term complications and disability. Collaboration between pediatricians, radiologists, physiatrists, and orthopedic specialists ensures optimal outcomes. In conclusion, understanding non-inflammatory spinal disorders like spondylolysis and spondylolisthesis is essential in managing pediatric back pain. Awareness of risk factors, clinical features, and treatment strategies allows for timely and effective interventions. 

Clinical manifestation, diagnosis and initial management of slipped capital femoral epiphysis (SCFE) and Legg-Calve-Perthes disease (LCPD)
Rheumatology
مهدیه موسوی 1 © ℗
1 Mahdieh Mousavi M.D. Pediatric rheumatologist Assistant professor of TUMS Bahrami Children’s hospital
Abstract: Abstract Musculoskeletal pain is a common complaint in pediatric clinics and non-inflammatory pains are more prominent. SCFE and LCPD are two important and curable disorders and timely diagnosis can improve clinical outcome. SCFE is characterized by a displacement of the capital femoral epiphysis from the femoral neck through the physeal plate. It is one of the most common hip disorders of adolescence. Hip pain is a common presenting feature. The classic presentation is that of an adolescent with obesity with a complaint of nonradiating, dull, aching pain in the hip, groin, thigh, or knee, and no history of preceding trauma. However, approximately 15 percent of patients present with isolated thigh or knee pain. Thus, physicians must have a high degree of suspicion to prevent delay in diagnosis, which can worsen prognosis. Radiographic changes may be minimal before the slip occurs and may be best seen with lateral views. Ultrasonography and magnetic resonance imaging (MRI) also can demonstrate characteristic findings. The treatment of SCFE is operative stabilization. Legg-Calve-Perthes disease (LCPD) is a developmental disorder causing avascular necrosis of the femoral head in children, with long-term consequences that can extend into adulthood. Early diagnosis and management in primary care are crucial but challenging. LCPD commonly presents as a painless limp in children aged between 2 and 14 years, with the diagnosis based on the clinical features and radiographic abnormalities. Diagnosis of LCP demands a high index of suspicion. Initial radiographs are often normal. Early in the course, bone scan shows decreased perfusion to the femoral head, and MRI reveals marrow changes highly suggestive of the diagnosis. Children diagnosed with LCP should be made nonweight bearing and referred to an experienced pediatric orthopedist for management. Treatment is individualised and includes non-operative care to surgery, which attempts to correct anatomical abnormalities and therefore delay the onset of osteoarthritis. 

Hypermobility syndrome in pediatric rheumatology 
Rheumatology
Raheleh 1 © ℗
1 Raheleh Assari, MD, pediatric rheumatologist. Children’s Medical Centre, Tehran University of Medical Sciences.
Abstract: Hypermobility syndrome in pediatric rheumatology Raheleh Assari, MD, pediatric rheumatologist. Children’s Medical Centre, Tehran University of Medical Sciences. Hypermobility syndromes in pediatric rheumatology refer to conditions where children's joints move beyond their normal range of motion, often called "double-jointed" or "loose" joints. This syndrome can cause chronic musculoskeletal symptoms such as joint and muscle pain, which may worsen with activity or at night, but the joints are not inflamed. It is common in children, especially girls, and can be hereditary within families.1,2 Hypermobility syndromes, or joint hypermobility syndrome (JHS), are characterized by an abnormally increased range of joint movement caused by excessive laxity in soft tissues, such as ligaments and capsules.3 In pediatric populations, generalized joint hypermobility (GJH) is common, and a Beighton score of 6 or higher is often used as a diagnostic threshold, which is higher than in adults due to the naturally increased flexibility in children. Recent diagnostic frameworks classify hypermobile children based on phenotypic and symptomatic profiles, which helps differentiate them from related hypermobility spectrum disorders (HSD) or inherited connective tissue disorders like hypermobile Ehlers-Danlos syndrome (hEDS). Management in children emphasizes multidisciplinary approaches, including physiotherapy to increase dynamic muscle control, proprioceptive training, and pain management, while avoiding excessive reliance on passive supports due to underlying laxity. 1,2,3,4 Children with hypermobility syndrome often present with joint pain, abnormal gait, joint twisting, or occasional dislocations. Related features may include poor coordination, clumsiness, soft skin, easy bruising, and some may have related conditions such as scoliosis or learning difficulties. Diagnosis is primarily clinical, and tools like the Beighton score are used to assess generalized joint hypermobility. This syndrome encompasses a range of phenotypes, from asymptomatic hyperactivity to symptomatic hyperactivity spectrum disorders. Early detection is important for reducing long-term complications and optimizing function.5,6 Studies have shown that children with hypermobility are at higher risk for orthopedic complications such as scoliosis, temporomandibular joint dysfunction, and lower bone density. Also, in some cases, the prevalence of gastrointestinal symptoms and autonomic disorders. Generally, while undiagnosed or unmanaged hypermobility in children is often not disabling, it can lead to chronic problems, highlighting the importance of early intervention and education for families and physicians.5,6 References: 1- Tofts LJ, Simmonds J, Schwartz SB, et al. Pediatric joint hypermobility: a diagnostic framework and narrative review. Orphanet J Rare Dis. 2023 May 4;18(1):104. doi: 10.1186/s13023-023-02717-2. 2- Nicholson LL, Chan C, Tofts L, Pacey V. Hypermobility syndromes in children 

Juvenile Dermatomyositis: An Overview
Rheumatology
Fatemeh Tahghighi Sharabian 1 © ℗
1 Department of Pediatric Rheumatology, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Juvenile dermatomyositis (JDM) is the predominant form of juvenile idiopathic inflammatory myopathies (JIIMs), accounting for up to 85% of cases. This rare vasculopathic autoimmune disorder primarily affects children, manifesting as proximal muscle weakness and characteristic cutaneous rashes on the face and extensor surfaces. Epidemiologically, JDM has an incidence of approximately 3 cases per million children annually, with a peak onset at age 7 years and a female-to-male ratio of 2:1. Genetic predispositions, including HLA alleles such as DRB1*0301 and DQA1*0501, alongside maternal microchimerism, contribute to susceptibility. Environmental triggers, such as infections (e.g., coxsackievirus, parvovirus) and ultraviolet exposure, may precipitate disease, though no definitive etiologic agent has been identified. Pathogenetically, JDM involves autoimmune vasculopathy targeting capillaries in skin, muscle, and gastrointestinal tissues. Key mechanisms include type I interferon (IFN-α/β) dysregulation, mediated by plasmacytoid dendritic cells via Toll-like receptor activation, leading to MHC class I upregulation, endoplasmic reticulum stress, and inflammatory cascades involving T cells, macrophages, and cytokines like TNF-α. Myositis-specific autoantibodies (MSAs), present in 45-55% of cases, define phenotypes: anti-TIF1γ associates with severe photosensitive rashes and lipodystrophy; anti-NXP2 with calcinosis and dysphagia; anti-MDA5 with interstitial lung disease (ILD) and mild myopathy. Clinically, patients present with insidious weakness (90-100%), fatigue, and rashes including heliotrope eyelid discoloration (66-95%), Gottron papules (57-95%), and nailfold capillaropathy (80-90%). Systemic features encompass dysphagia (13-40%), arthritis (22-58%), and fever (16-65%). Diagnosis relies on Bohan-Peter criteria: classic rash plus three of symmetric proximal weakness, elevated muscle enzymes, electromyographic changes, or biopsy findings showing necrosis and inflammation. MRI enhances diagnostic accuracy by identifying active myositis. Differential diagnoses include polymyositis, muscular dystrophies, SLE, and infectious myositides. Laboratory findings reveal elevated enzymes (e.g., CK, aldolase), ANA positivity (80%), and MSAs/MAAs guiding prognosis. Treatment emphasizes corticosteroids (prednisone 2 mg/kg/day) with methotrexate as a steroid-sparing agent, supplemented by IVIG for refractory cases. Emerging therapies include JAK inhibitors targeting IFN pathways. Physical therapy mitigates contractures. Complications involve calcinosis (12-30%), lipodystrophy (11-14%), ILD (1-7%), and gastrointestinal vasculitis, often linked to delayed treatment. Prognosis has improved with immunosuppression, yielding 1% mortality and 75% minimal disability at 7 years, though chronic rash (40%) and weakness (25%) persist in subsets, underscoring the need for early intervention to avert long-term vasculopathy and metabolic sequelae. 

When the Variants of the Normal Gait in Children should be Considered Pathologic
Rheumatology
Payman Sadeghi 1 ℗, Atefeh Habibi 1 ©
1 Tehran University of Medical Sciences
Abstract: Background Variations in gait are a frequent reason for pediatric consultations and account for a substantial proportion of musculoskeletal referrals. The majority of cases represent benign, age-related phenomena that resolve spontaneously; however, a minority may signal underlying orthopedic, neurologic, or rheumatologic pathology. Differentiating normal developmental variants from clinically significant abnormalities is essential to prevent both unnecessary investigations and delayed diagnoses. This lecture series reviews three of the most common gait concerns in children—toe walking, intoeing, and pes planus (flatfoot)—and outlines evidence-based criteria for determining when these presentations should be considered pathologic. Discussion Toe walking is often physiologic in toddlers younger than three years, with spontaneous resolution in most cases. Persistence beyond this age, development of fixed equinus, asymmetric involvement, or association with neurologic features (spasticity, clonus, weakness) necessitates further evaluation for cerebral palsy, muscular dystrophy, autism spectrum disorder, or inflammatory disease. Intoeing is typically attributed to metatarsus adductus, internal tibial torsion, or femoral anteversion, conditions that are usually symmetric, painless, and self-correcting. Clinical concern arises in the presence of rigidity, asymmetry, limp, progression, or pain, which may reflect hip dysplasia, neuromuscular disorders, or juvenile idiopathic arthritis. Pes planus is nearly universal in toddlers due to ligamentous laxity and plantar fat pad, and a flexible, painless flatfoot remains a normal variant throughout childhood. Distinguishing flexible from rigid flatfoot is critical: rigid, painful, or asymmetric deformities should prompt investigation for tarsal coalition, vertical talus, neuromuscular pathology, or inflammatory arthritis. Across all three entities, a focused clinical assessment—comprising a detailed history, evaluation of ankle dorsiflexion, hip rotation, thigh–foot angle, hindfoot alignment, flexibility testing (e.g., tiptoe and Jack test), and a brief neurologic screen—enables pediatricians to identify red flags accurately. Ancillary investigations are rarely required in typical presentations and should be reserved for atypical or concerning findings. Result This series provides pediatricians with practical algorithms, structured red-flag checklists, and documentation templates to facilitate clinical decision-making. The key outcomes include improved confidence in distinguishing benign gait variations from pathology, reduced unnecessary referrals, and enhanced detection of children requiring timely orthopedic, neurologic, or rheumatologic evaluation. Adoption of this structured approach is expected to optimize healthcare utilization, strengthen family reassurance, and ensure early identification of pathologic gait disorders in the pediatric population.

“Pediatric Basic and Advanced Life Support: 2020 AHA Algorithms Overview”
PICU
ركسانا پازوكي 1 © ℗
1 دانشگاه علوم پزشكي تهران
Abstract: Cardiac arrest in children is a critical emergency, often resulting from respiratory failure or shock, and requires immediate recognition and intervention to improve survival and neurological outcomes. Early initiation of high-quality cardiopulmonary resuscitation (CPR) and timely defibrillation, when indicated, are the cornerstones of effective resuscitation. The 2020 American Heart Association (AHA) pediatric algorithms emphasize a structured approach. Initial actions include ensuring scene safety, assessing responsiveness, and activating the emergency response system. Pulse and breathing should be evaluated simultaneously within 10 seconds. If normal breathing and pulse are present, monitoring is continued. In cases of respiratory arrest with a pulse, rescue breathing (1 breath every 2–3 seconds) is initiated with pulse reassessment every 2 minutes. If no pulse is detected, or if heart rate is 60/min with signs of poor perfusion, CPR must begin immediately. High-quality CPR includes compressions at a rate of 100–120/min and depth of at least one-third the chest diameter, with full chest recoil and minimal interruptions. A single rescuer uses a 30:2 compression-to-ventilation ratio, whereas two rescuers use 15:2. Early use of an AED or manual defibrillator is strongly recommended. For shockable rhythms (ventricular fibrillation or pulseless ventricular tachycardia), defibrillation is delivered (initially 2 J/kg, followed by 4 J/kg, up to 10 J/kg maximum), with CPR resumed immediately after each shock. Epinephrine is administered every 3–5 minutes, and amiodarone or lidocaine may be considered for refractory VF/pulseless VT. Non-shockable rhythms (asystole/PEA) are managed with uninterrupted CPR, rapid IV/IO access, epinephrine every 3–5 minutes, and evaluation for reversible causes (e.g., hypovolemia, hypoxia, acidosis, hypothermia, toxins, thromboembolism). Resuscitation cycles continue until return of spontaneous circulation (ROSC) or advanced care is available. Post-cardiac arrest management focuses on optimizing oxygenation, perfusion, and neurological outcomes.

Bag-mask ventilation in pediatric patients
PICU
فرزانه بیرامی 1 © ℗
1 هیات علمی
Abstract: Bag and mask ventilation is a fundamental skill in pediatric basic life support, serving as the primary method of providing oxygenation and ventilation in emergency situations when spontaneous breathing is absent or inadequate. Effective use of the bag-mask device requires proper technique, equipment selection, and an understanding of pediatric airway anatomy. In children, anatomical differences such as a proportionally larger tongue, smaller airway diameter, and higher risk of obstruction necessitate special attention during ventilation. The technique begins with ensuring a patent airway through head tilt–chin lift or jaw thrust maneuvers, while maintaining cervical spine precautions if trauma is suspected. A well-fitted mask covering the nose and mouth is essential to prevent air leakage. The rescuer must use the “E-C clamp” technique with one hand to hold the mask and maintain airway position, while the other hand compresses the bag to deliver breaths. Each ventilation should last about one second, with visible chest rise as the indicator of effectiveness. The recommended ventilation rate is one breath every 2–3 seconds for infants and children without an advanced airway, corresponding to 20–30 breaths per minute. Excessive ventilation or forceful bag compression must be avoided, as it may cause gastric inflation and compromise effective oxygenation. Mastery of bag and mask ventilation is critical for healthcare providers and first responders, as it often represents the difference between life and death in pediatric emergencies. Regular training, practice, and adherence to Basic Life Support guidelines ensure optimal performance in real scenarios. 

Fluid administration in cardiac critically ill child
PICU
Behdad Gharib 1 © ℗
1 Children's Medical Center, Department of Pediatrics, Tehran University of Medical Sciences
Abstract: Administrating fluid in children with cardiac disease is a challenging issue in PICU. The vulnerable heart of the ill child needs volume to provide stroke volume and can't tolerate large volume at the same time. Frank Sterling's law remind us that the relative large volume may have adverse effects and disrupt the heart contraction. Left obstructive lesions of heart can't tolerate volume and may lead to pulmonary edema, while Right obstructive lesions can receive more volumes and even sometimes need more fluids to provide stroke volumes. 

Fluid Therapy and the Use of Inotropes and Vasopressors in Pediatric Septic Shock
PICU
زینب پورهادی 1 © ℗
1 گروه کودکان دانشگاه علوم پزشکی تهران
Abstract: Septic shock in children represents a critical manifestation of sepsis, defined by cardiovascular insufficiency and impaired tissue perfusion. Management requires prompt recognition and the coordinated use of fluid therapy, inotropes, and vasopressors. Early interventions directly influence morbidity and mortality, as delays can exacerbate multi-organ dysfunction. The cornerstone of initial management is rapid administration of intravenous fluids. Current pediatric recommendations suggest an initial bolus of 10–20 mL/kg over 5–10 minutes, repeated as necessary up to 60 mL/kg in the first hour. Crystalloids, such as normal saline or balanced buffered solutions, are preferred. Fluid responsiveness should be reassessed after each bolus to avoid overload, as excessive administration may precipitate pulmonary edema or worsen myocardial dysfunction. The principle is not simply to restore blood pressure but to optimize tissue perfusion, assessed by capillary refill, urine output, and mental status. Emerging concepts such as the use of capillary refill time (CRT) as a resuscitation endpoint highlight the value of simple bedside tools to tailor fluid therapy. Inotropes and vasopressors.If fluid resuscitation fails to restore adequate perfusion, vasoactive medications must be initiated. Norepinephrine is the vasopressor of first choice when vasoplegia predominates, as it improves mean arterial pressure and venous return. Epinephrine may be used when myocardial dysfunction is present, offering both inotropic and vasoconstrictive properties. Dobutamine remains a key inotrope for septic cardiomyopathy, particularly in children with depressed ventricular function, though its vasodilatory effects require caution. Vasopressin can be added as a second-line agent in fluid-refractory shock, especially when norepinephrine requirements are high. Recent evidence suggests that early, concomitant initiation of vasopressors with fluids may reduce fluid overload, shorten hypotension, and lower complication rates. Individualized targets, such as diastolic shock index or microcirculatory parameters, are under investigation to guide therapy more precisely. In pediatric practice, the integration of bedside echocardiography and near-continuous monitoring tools provides an opportunity for more nuanced titration of both fluids and vasoactive drugs. The management of septic shock in children requires a dynamic balance: rapid but cautious fluid resuscitation, timely escalation to inotropes and vasopressors, and continuous reassessment of hemodynamic status. While crystalloid boluses remain the initial step, the early introduction of norepinephrine or epinephrine in refractory cases, along with selective use of dobutamine, forms the backbone of modern pediatric septic shock therapy. Individualized strategies and evolving resuscitation targets continue to refine outcomes in this vulnerable population.

Fluid Therapy in Hyponatremia and Hypernatremia
PICU
فرزانه بیرامی 1 © ℗
1 هیات علمی
Abstract: Fluid Therapy in Hyponatremia and Hypernatremia Hyponatremia, defined as a serum sodium concentration below 135 mmol/L, and hypernatremia, defined as levels above 145 mmol/L, represent two critical disorders of water and electrolyte balance in pediatrics. Their management requires a careful balance between correcting sodium abnormalities and preventing iatrogenic complications, particularly neurologic injury. In hyponatremia, the underlying volume status (hypovolemic, euvolemic, or hypervolemic) guides therapeutic decisions. Mild, asymptomatic cases are often managed with fluid restriction and correction of underlying causes. In symptomatic or severe cases—such as seizures or altered mental status—hypertonic saline (3 %) is administered cautiously . The correction rate must not exceed 8–10 mmol/L per 24 hours to prevent osmotic demyelination syndrome, a devastating complication of overly rapid sodium correction . Hypernatremia, in contrast, usually arises from water deficit due to gastrointestinal losses, renal concentrating defects, or inadequate fluid intake. The therapeutic priority is to restore intravascular volume with isotonic saline if hypovolemia is present, followed by gradual replacement of the free-water deficit using hypotonic solutions such as 5 % dextrose in water (D5W). The decline in serum sodium should not exceed 0.5 mmol/L per hour, or approximately 10–12 mmol/L per day, to minimize the risk of cerebral edema due to rapid osmotic shifts. Both disorders demand vigilant monitoring of serum electrolytes, neurologic status, and hemodynamic parameters. Importantly, treatment should address the underlying etiology—such as syndrome of inappropriate antidiuretic hormone secretion (SIADH) in hyponatremia or diabetes insipidus in hypernatremia—while individualizing fluid therapy to patient age, weight, and clinical condition. Fluid management of sodium disorders requires a precise, gradual, and closely supervised approach. Safe correction strategies balance the urgency of symptom relief with the imperative to avoid neurologic injury, reflecting the central principle of pediatric electrolyte therapy

Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series
PICU
Fereshteh Moshfegh 1 ℗, Zahra Hoseinzadeh 1 ©
1 Fellowship of Pediatric Intensive Care Unit, Department of Pediatrics, Ali Asghar Children Hospital, Iran University of Medical Sciences, Tehran, Iran
Abstract: Introduction Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management. Case series Case 1 was a 5-year-old male who developed widespread vesicular lesions and fever, diagnosed as varicella. His condition worsened as he presented with abdominal distension and pain, leading to hospitalization for suspected toxic shock syndrome. Computed tomography (CT) of the chest and abdomen revealed features consistent with NF, prompting extensive debridement and subsequent vacuum-assisted closure (VAC) therapy. After several surgical revisions he underwent skin grafting and was eventually discharged home. Case 2 was a 4.5-year-old male with no significant medical history, who presented with generalized fever, neck pain, and rapidly spreading skin rashes. He subsequently developed severe acute idiopathic scrotal edema and extensive ecchymosis, requiring immediate hospitalization. Broad-spectrum antibiotics were started. He underwent emergent wide debridement of the ecchymotic areas. The pathology analysis confirmed necrotic tissue, and cultures were positive for bacteria and fungi. He underwent repeated debridement. The last debridement was followed by uncontrollable hemorrhage, and he passed away. Conclusion While varicella is generally a mild disease, life-threatening complications such as necrotizing fasciitis can occur.

The Role of Adjunctive Therapies and Supportive Care in Septic Shock
PICU
زینب نجفی 1 © ℗
1 Assistant Professor of Pediatric Intensive Care, Department of Pediatrics ,Tehran University of Medical Sciences, Tehran, Iran.
Abstract: There are many challenges related to strategies for mechanical ventilation adjustment, the use of corticosteroids, plasma exchange, continuous kidney replacement therapy (CKRT), ECMO, IVIG administration, and nutritional support in the management of patients with septic shock. Respiratory Support: recent recommendations suggest early intubation in patients who remain fluid-refractory, even before respiratory failure develops. Etomidate should not be used for intubation. In patients with acute respiratory failure who do not meet indications for intubation, non-invasive ventilation (NIV) may be considered. Mechanical ventilation settings should follow the criteria for pediatric acute respiratory failure (if it occurs). Endocrine Issues: if the patient’s hemodynamics remain unstable despite fluids and vasopressors, or if adrenal insufficiency is diagnosed, intravenous hydrocortisone is recommended. Blood glucose should preferably be maintained below 180 mg/dl. Nutritional Care: nutritional support is of particular importance in septic shock. Enteral feeding should not be discontinued solely due to the use of vasoactive-inotropic agents, and early enteral feeding within the first 48 hours (in the absence of abdominal contraindications) is advised. There is insufficient evidence to support or oppose the use of intralipids, vitamin C, or zinc supplementation. Transfusion :it is recommended to maintain hemoglobin levels preferably above 7 g/dl in septic shock. Prophylactic use of other blood products is not advised. Adjunctive Therapies :no specific recommendations are made for plasma exchange. However, early initiation of CKRT is emphasized for the prevention or treatment of fluid overload in septic shock that leads to organ dysfunction and does not respond to fluid restriction or diuretics. Indications for venovenous ECMO include septic shock-associated acute respiratory failure with refractory hypoxemia, while venoarterial ECMO is reserved for shock resistant to other therapies. Other Therapies: additional interventions discussed include IVIG, pantoprazole (for stress ulcer prophylaxis), and pharmacological or mechanical prophylaxis for deep vein thrombosis. However, their routine use is not recommended.

Minimal Sedation in Pediatrics: Principles, Practice, and Pharmacologic Considerations
Emergency
علی لباف 1 © ℗
1 Hakim Children’s Hospital, Tehran University of Medical Sciences
Abstract: Minimal Sedation in Pediatrics: Conference Summary Introduction Minimal sedation (anxiolysis) is an essential strategy in pediatric emergency medicine, designed to reduce anxiety without impairing airway reflexes, ventilation, or cardiovascular stability. It is particularly valuable for minor but stressful procedures and serves as the entry point of the sedation continuum. Definition The American Academy of Pediatrics and ASA define minimal sedation as a drug-induced state in which patients respond normally to verbal commands, with unaffected protective reflexes and vital functions. Providers must recognize that children can unpredictably progress to deeper sedation, necessitating vigilance and preparedness. Indications IV cannulation, venipuncture, lumbar puncture preparation Imaging (CT, MRI, ultrasound) Minor wound care or dressing changes Dental and ENT procedures Situations where distraction and parental presence alone are insufficient Pharmacologic Agents Midazolam Routes: oral, intranasal, buccal, IV Dose: oral 0.5–0.7 mg/kg; intranasal 0.2–0.3 mg/kg; IV 0.05–0.1 mg/kg Onset/Duration: oral 15–30 min; intranasal 10 min; IV 2–3 min; duration 30–60 min Adverse effects: paradoxical agitation, respiratory depression at higher doses Nitrous Oxide (≤50%) Route: inhaled, mixed with oxygen Onset/Duration: 2–3 min onset; recovery within 5 min Benefits: anxiolysis, mild analgesia, amnesia, rapid offset Adverse effects: nausea, vomiting; contraindicated in bowel obstruction, pneumothorax, middle ear disease Ketamine (sub-dissociative dosing) IV dose: 0.25–0.5 mg/kg Use: anxiolysis with analgesia; preserves airway reflexes Limitations: dysphoria, hypersalivation, less predictable anxiolysis Dexmedetomidine (intranasal 2–3 mcg/kg) Slow onset; mainly used in imaging suites Hemodynamic effects (bradycardia, hypotension) possible Non-Pharmacologic Adjuncts Child-life support, distraction, comfort positioning, and topical anesthetics reduce reliance on medications and improve outcomes. Safety Considerations Pre-sedation assessment is mandatory (airway, comorbidities, past sedation history). Continuous observation and pulse oximetry required; resuscitation equipment must be at hand. Providers should be skilled in airway rescue. Discharge only after return to baseline status. Conclusion Minimal sedation is safe, effective, and integral in pediatric emergency care when combined with non-pharmacologic strategies and meticulous safety practices. Midazolam and nitrous oxide remain the mainstays, with selective use of ketamine and dexmedetomidine. Attention to dosing, monitoring, and institutional protocols ensures maximal benefit with minimal risk.

Procedural Sedation and Analgesia
Emergency
المیرا حاجی اسمعیل معمار 1 © ℗
1 Elmira haji esmaeil memar M.D Assistant professor and pediatrician/Pediatric Emergency Medicine subspecialist/pediatric center of excellence/children’s medical center/Tehran university of medical science/Tehran/IRAN
Abstract: Introduction: Injuries and painful medical conditions are common among children presenting to the emergency department (ED). Some medical conditions may require a procedure which itself may be painful or require a child to be absolutely still. ED physicians are obligated to manage pain appropriately and safely, and ensure that procedures are performed under conditions that limit harm to the patient. Performing procedural sedation and analgesia (PSA), when indicated, is a necessary skill for the ED physician, and is essential to providing comfort and quality care to children and their families. Procedural Sedation and Analgesia Definitions: When discussing PSA, it is useful to review terminology, which is most accurately categorized by the intended effects, rather than by the specific medications used. Analgesia refers to an agent that reduces or eliminates pain in response to a normally painful stimulus. Sedation refers to a state of drug-induced depressed level of consciousness. Certain medications may have one or both of these properties and are used to that effect. For example, topical lidocaine for a laceration repair is an analgesic, but will not affect consciousness. Midazolam causes an alteration in level of consciousness, but does not take away pain. Ketamine is an example of a medication that has both analgesic and sedative properties. PSA has replaced conscious sedation in the lexicon of emergency medical treatment of ill or injured patients. The American College of Emergency Physicians (ACEP) defines PSA as “techniques of administering sedatives or dissociative agents with or without analgesia to induce a state that allows the patient to tolerate unpleasant procedures while maintaining cardiorespiratory function.” The now outdated term conscious sedation is no longer acceptable as it does not allow for describing the depth of sedation desired or achieved. The Joint Commission accepts the continuum of depth of sedation proposed by the American Society of Anesthesiologists (ASA) in 1999. It is important to focus on the word continuum as it highlights the essential point that a patient can easily move from one depth of sedation to another. There are four defined depths of PSA: minimal sedation (or anxiolysis), moderate sedation, deep sedation, and general anesthesia. It is important to note that ketamine, a commonly used dissociative agent, does not fit neatly on this continuum. In the ED, the depth of PSA desired depends on the child and the situation. For example, a clinician may choose to administer mild sedation to an anxious 

Survival Measures after Cardiopulmonary Resuscitation and Related Factors among Children: Retrospective cohort Study in Iran
Emergency
Elmira Haji Esmaeil Memar 1 ©, Negin Sarhang Rahsepar 1 ℗
1 Pediatric Center of Excellence, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Background: Although cardiopulmonary resuscitation (CPR) is infrequently performed in paediatric emergencies, it is crucial that CPR is administered correctly and promptly for children requiring resuscitation. Objectives: This study aims to examine the demographic characteristics, etiological factors, and survival outcomes of patients who underwent CPR in the emergency department of the Children's Medical Center. Methods: In this Retrospective cohort study, we gathered data from 149 resuscitated cases over a 2-year period. all patients under 18 years old who underwent CPR in the emergency department of the Children's Medical Center Hospital for any reason from April 2021 to March 2023 were retrospectively assessed. Demographic information and the information related to the factors causing resuscitation, underlying diseases, vital and clinical signs on arrival and resuscitation results were obtained by reviewing archived patient records. Results: The median age of patients was 18.0 months (IQR: 6.0-70.0) and 51% were boys. 64.4% of patients achieved Return of Spontaneous Circulation, 53.7% survived for 24 hours after the event, and 24.2% survived until discharge. The analysis of the association between contributing factors and survival measures in pediatric resuscitation efforts reveals several insights. The reason for resuscitation is an important factor, with respiratory arrest being strongly associated with better outcomes at all stages while cardiac and cardiopulmonary arrests show poorer prognoses (P-value0.001). The rhythm prior to chest compressions is also a significant predictor, with asystole and pulseless electrical activity (PEA) being associated with lower chances of ROSC and survivals (P-value0.001). The location of the arrest is a pivotal factor, with in-hospital cardiac arrests (IHCA) showing better outcomes compared to out-of-hospital cardiac arrests (OHCA) (P-value0.001). Conclusions: In conclusion, this study underscores the critical importance of prompt and correct administration of cardiopulmonary resuscitation (CPR) in pediatric emergencies. These insights provide valuable guidance for improving resuscitation protocols and training programs to enhance survival rates in pediatric CPR scenarios. Keywords: Cardiopulmonary Resuscitation, Retrospective cohort Studies, Survival 

Zinc Supplementation in Children: Evidence Summary and Recommendations
Emergency
Mahya Sadat Mohammadi 1 © ℗
1 Emergency department, Children's Medical Center, Tehran University of Medical Sciences ,Tehran, Iran
Abstract: Zinc is an essential trace element required for growth, immune function, and epithelial integrity. Randomized trials and systematic reviews show that zinc supplementation in children—especially where zinc deficiency is common—produces modest but meaningful improvements in linear growth and weight gain, reduces duration and severity of acute diarrheal episodes and lowers the incidence of subsequent diarrhea, and may reduce all-cause mortality in certain high-risk groups. Evidence for benefit on neurocognitive outcomes is inconsistent. Zinc supplements are generally safe at recommended doses; vomiting is the most commonly reported adverse effect when used during acute diarrhea. Current clinical and public health guidance (including WHO) supports zinc use for the treatment of childhood diarrhea and considers preventive supplementation in settings with high prevalence of deficiency. Zinc plays multiple biological roles: enzyme cofactor, regulator of gene expression, and mediator of immune responses. Children in low- and middle-income countries (LMICs) are at particular risk of zinc insufficiency due to diets low in bioavailable zinc and higher burdens of infections that increase losses. Public health interest centers on two uses of zinc in children; therapeutic zinc during acute diarrheal illness and preventive (routine) zinc supplementation to improve growth, reduce infection risk, and lower mortality. Meta-analyses of RCTs report reduced all-cause mortality associated with zinc supplementation in some pooled analyses—effects appear strongest when doses of ≥10 mg/day are used, and in trials with follow-up ≤1 year and in low birth weight infants. Evidence is heterogeneous and context-dependent, but the potential mortality. Treatment of acute diarrhea (children 6 months–5 years): Provide oral zinc (commonly 10 mg/day for infants 6 months or 20 mg/day for older infants & children for 10–14 days depending on guideline and formulation). Preventive supplementation (programmatic use): In populations with a high prevalence of zinc deficiency, routine preventive zinc (e.g., 10 mg daily for several months or programmatic intermittent regimens used in trials) can be considered to reduce diarrheal morbidity and support growth. Program design should consider baseline zinc status, co-existing micronutrient programs (particularly iron), and monitoring . 

Early Childhood Development Under Two Years: Milestone Acquisition and Early Detection of Delay
Neurology,Psychiatry,Physical medicine
Elham Pourbakhtyaran 1 © ℗
1 Children Medic Center, Tehran University of Medical Sciences
Abstract: The first two years of life constitute a critical window of neurodevelopmental plasticity, during which infants and toddlers acquire foundational skills across motor, language, cognitive, and socio-emotional domains. We will provide a structured overview of milestone trajectories from birth to 24 months, emphasizing both normative patterns and the recognized variability within developmental ranges. Special attention will be given to the sequential acquisition of gross and fine motor abilities, the emergence of receptive and expressive language, the progression of early problem-solving and object permanence, and the evolution of attachment and social reciprocity. We will highlight red-flag indicators for developmental delay, underscore the utility of standardized screening tools in early detection, and discuss evidence-based approaches for timely referral and intervention. 

Acute Flaccid Myelitis: What a pediatrician needs to know
Neurology,Psychiatry,Physical medicine
Simin Khayatzadeh Kakhki 1 © ℗
1 Division of Pediatric Neurology, Bahrami Children's Hospital, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Acute flaccid paralysis (AFM) is a critical clinical syndrome characterized by the rapid onset of weakness or paralysis in one or more limbs, often accompanied by diminished or absent tendon reflexes. This condition poses significant diagnostic and therapeutic challenges for pediatricians, necessitating a comprehensive understanding of its etiology, clinical presentation, and management strategies. AFP can result from a variety of causes, including viral infections (most notably enteroviruses, such as poliovirus and non-polio enteroviruses), autoimmune processes, and other neurological disorders. Early recognition and prompt intervention are crucial, as timely diagnosis can significantly impact patient outcomes. Pediatricians must be adept at differentiating AFP from other conditions that may present with similar symptoms, such as Guillain-Barré syndrome or spinal cord lesions. This abstract aims to provide an overview of the essential knowledge required by pediatricians regarding the identification, evaluation, and management of acute flaccid paralysis, emphasizing the importance of a multidisciplinary approach and the need for vigilance in monitoring potential outbreaks of viral etiologies. By enhancing awareness and understanding of AFP, pediatricians can play a vital role in improving the care and prognosis of affected children.

Craniosynostosis
Neurology,Psychiatry,Physical medicine
Nahideh Khosroshahi 1 © ℗
1 Associate Professor of Pediatric Neurology -Tehran University of Medical Sciences
Abstract: Craniosynostosis are terms for the premature closure of one or more cranial sutures; the result is always an abnormal skull shape. These terms are only applicable to infants in whom the sutures close while the brain is growing. Early closure of sutures in infants with microcephaly is not premature because the ICP required to keep sutures apart is lacking. Most cases of craniostenosis are sporadic and of uncertain etiology. Autosomal dominant and recessive forms of single-suture closure occur.. Craniostenosis may be one feature of a larger recognized syndrome of chromosomal or genetic abnormality. Many of the genetic disorders are secondary to mutations of FGFR. FGFR disorders are often associated with syndactyly or polydactyly ,whereas chromosomal disorders are usually characterized by other limb malformations and growth retardation. Clinical features. In non-syndromic craniostenosis, the only clinical feature is an abnormal head shape. Normal bone growth is impaired in a plane perpendicular to the fused sutures, but is able to occur in a parallel plane. The cause of scaphocephaly is premature fusion of the sagittal suture, brachycephaly is premature fusion of both coronal sutures, plagiocephaly is premature fusion of one coronal or one lambdoid suture, trigonocephaly is premature fusion of the metopic suture, and oxycephaly is premature fusion of all sutures. When several sutures close prematurely, the growing brain is constricted and symptoms of increased ICP develop. Communicating and noncommunicating hydrocephalus occur more frequently in children with craniostenosis than in normal children. Two-suture craniostenosis is common. Diagnosis. Visual inspection of the skull and palpation of the sutures are sufficient for diagnosis in most cases of one- or two-suture craniostenosis, and three-dimensional cranial CT scans confirm the diagnosis. Plain films of the skull show a band of increased density at the site of the prematurely closed sutures. Management. The two indications for surgery to correct craniostenosis are to improve the appearance of the head and to relieve increased ICP. The cosmetic indication should be used sparingly and only to make severe deformities less noticeable. The early use of a helmet may be beneficial in reshaping the head in early cases of partial craniostenosis. 

Diabetic ketoacidosis and cerebral edema: a rare case of infarct-like MRI findings in a pediatric patient
Neurology,Psychiatry,Physical medicine
Maryam Kachuei 1 © ℗, Ramin Zareh 2, Samaneh Azimi 3, Shayna Eghdami 4
1 aDepartment of Pediatric Neurology, Ali-Asghar Children’s Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 cFiroozabadi Clinical Research Development Unit (FACRDU), School of Medicine, Iran University of Medical Sciences, Tehran, Iran
3 dDepartment of Radiology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
4 bCellular and Molecular Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract: Abstract Introduction and importance: Diabetic ketoacidosis (DKA) is a serious and potentially life-threatening complication of type 1 diabetes mellitus, particularly in pediatric patients. Cerebral edema (CE) is a rare but devastating consequence of DKA. Although neuroimaging findings in CE are typically nonspecific, infarct-like changes are exceedingly rare and may complicate clinical management. Case presentation: We report the case of an 11-year-old boy with a history of type 1 diabetes mellitus who presented with epigastric pain, vomiting, polydipsia, and polyuria. Despite timely initiation of standard treatment for DKA, the patient developed acute neurological deterioration consistent with CE. Brain MRI revealed restricted diffusion in the basal ganglia, corpus callosum, and internal capsule – findings suggestive of infarction rather than typical vasogenic edema. Clinical discussion: This case highlights the diagnostic and therapeutic challenges posed by DKA-associated CE with atypical imaging findings. The observed infarct-like MRI pattern is rarely reported and may reflect underlying cytotoxic edema or ischemic injury. Understanding the multifactorial pathophysiology – including osmotic shifts, inflammatory processes, and impaired cerebral autoregulation – is critical for effective management. Conclusion: Early recognition of atypical cerebral involvement in pediatric DKA is essential. Advanced neuroimaging can aid in diagnosis and guide appropriate intervention. Clinicians should remain vigilant for neurological complications even during early phases of treatment and consider infarct-like patterns in differential diagnosis.

Early diagnosis in cerebral palsy 
Neurology,Psychiatry,Physical medicine
Farin Soleimani 1 © ℗
1 Farin Soleimani, MD, Research Professor of Developmental Pediatrics. Pediatric Neurorehabilitation Research Center, University of Social Welfare and Rehabilitation Sciences(USWR), Tehran, Iran.
Abstract: Cerebral palsy (CP) is the most common lifelong physical disability, affecting millions globally., Early detection and intervention are critical for optimizing developmental consequences and quality of life for children and their families, yet many children are diagnosed late. CP describes a group of disorders of the development of movement and posture, causing activity restriction that is attributed to disorders that occurred in the fetal or infant brain. The prevalence rate is 1–4 per 1000 live births globally, with higher rates in low- and middle-income countries. Most lesions original CP occur in the second half of gestation, when developmental activity in the brain reaches its high level. Differences in timing of the damage not only result in different lesions but also in different neuroplastic responses and different related neuropathologies. This turns CP into a heterogeneous object. This may mean that the best early diagnostics and the best intervention methods may differ for various subcategories of children with CP. Thus, in early diagnosis, predictive value of neuromotor and neurological tests, neuroimaging techniques, and neurophysiological assessments may be different. International clinical guidelines recommend diagnosis as early as possible using accurate assessment tools in the first months of life. However, many children worldwide lack access to valid early screening methods, thus delaying intervention. Prediction is best when complementary techniques are used in longitudinal series. Possibilities for early prediction of CP differ for infants admitted to neonatal intensive care and other infants. In the former group, best prediction is accomplished with the combination of neuroimaging and the assessment of general movements (GMA), in the latter group, best prediction is based on carefully documented milestones and neurological evaluation. GM Assessment is a highly accurate clinical tool for detecting infants at high probability of CP.

Familial Macrocephaly in Children
Neurology,Psychiatry,Physical medicine
Ali Nikkhah 1 © ℗
1 Pediatric Ward, Valie-asr Hospital, IKHC, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Familial Macrocephaly in Children Ali Nikkhah, MD Pediatric Neurologist Imam Khomeini Complex Hospital, Tehran University of Medical Sciences Abstract Familial macrocephaly refers to a benign condition in which individuals with large head size greater than 98th percentile or 2 standard deviations above the mean for age and sex within a first-degree (one or both parents) similar condition, typically without any underlying neurological problems. Inheritance of this condition is often in an autosomal dominant pattern. Children with familial macrocephaly usually have normal intelligence. Brain imaging is normal. Benign familial macrocephaly is an isolated condition (not part of a syndrome). A common differential diagnosis if this condition is megalencephaly (enlarged brain). Benign familial macrocephaly does not require treatment, but growth and development monitoring are advised. Key words: Macrocephaly; Megalencephaly; familial; Children 

From Meningitis to Guillain-Barré: An Atypical Pediatric Presentation
Neurology,Psychiatry,Physical medicine
Nasrin Banu Rupani 1 © ℗, Narjes Rajabeheshti 1
1 Pediatric Neurologist, Pediatric Department at Hakim children's hospital, Tehran university of Medical Science, Tehran, Iran
Abstract: From Meningitis to Guillain-Barré: An Atypical Pediatric Presentation Abstract Background: Guillain-Barré syndrome (GBS) is an acute immune-mediated polyneuropathy and the most common cause of acute flaccid paralysis in children. Typicall presentation involves ascending symmetrical weakness and areflexia, atypical forms may mimic other neurologic or infectious disorders. One of the rarest diagnostic challenges is presentation with meningeal signs, which may lead to misdiagnosis as meningitis. Case Presentation: We report the case of an 11-year-old boy previously healthy ,admitted with fever, headache, vomiting, photophobia, and positive meningeal signs. His family had a history of Covid-19 infection about a month ago. On examination, he exhibited positive meningeal sign, diffuse myalgia, particularly in the lower limbs, and an antalgic gait. Neurological evaluation revealed bilaterally diminished deep tendon reflexes (1+) with preserved upper limb strength gag reflex. Initial cerebrospinal fluid (CSF) analysis showed protein 148 mg/dL with 2 WBC/µL. During hospitalization, he developed progressive limb pain, nausea, and bulbar symptoms including dysphagia, dysarthria, and frequent coughing. MRI of the lumbosacral spine with gadolinium demonstrated cauda equina root enhancement. He transferred to pediatric intensive care unit admission for close monitoring and was prophylactically intubated due to worsening respiratory effort and bulbar dysfunction. Repeat CSF later revealed marked protein elevation to 272 mg/dL with no leukocytes, consistent with albuminocytologic dissociation. Intravenous immunoglobulin (IVIG) was administered at 2 g/kg. Following extubation, nerve conduction studies confirmed acute inflammatory demyelinating polyneuropathy (AIDP). With supportive care and physiotherapy, he showed gradual neurological improvement and was discharged for outpatient rehabilitation. Discussion: This case emphasizes the diagnostic challenge of distinguishing GBS from meningitis in children presenting with meningeal irritation and systemic symptoms suggestive of meningitis. While CSF pleocytosis is typical of meningitis, albuminocytologic dissociation with progressive areflexia points toward GBS. MRI findings of cauda equina enhancement and confirmatory electrophysiology further supported the diagnosis. Previous literature has described similar diagnostic pitfalls in pediatric GBS. Conclusion: GBS in children may present with meningeal signs mimicking meningitis, delaying diagnosis and treatment. Clinicians should maintain a high index of suspicion when meningeal signs coexist with evolving hyporeflexia or weakness. Early recognition, IVIG therapy, and supportive rehabilitation are critical for favorable outcomes. 

Good practice in Treatment of Autoimmune Myasthenia Gravis in Children
Neurology,Psychiatry,Physical medicine
Gholamreza Zamani 1 © ℗
1 Pediatric Neurologist, Children's Medical Center ,TUMS
Abstract: Myasthenia gravis (MG) in pediatric patients presents unique diagnostic and therapeutic challenges, requiring concise approache distinct from adult MG. Pediatric MG is primarily autoimmune, with acetylcholine receptor (AChR) antibodies detected in 50–70% of juvenile cases, while anti-MuSK and anti-LRP4 are less common. Clinical hallmarks include fatigable ptosis, ophthalmoparesis, and bulbar weakness, though generalized weakness may develop. Electrodiagnostic studies (repetitive nerve stimulation, single-fiber EMG) and a cautious edrophonium test can support diagnosis, but seronegative cases necessitate genetic testing to exclude CMS. Treatment Strategies: First-line symptomatic therapy involves pyridostigmine (1–2 mg/kg/dose every 4–6 hours), with close monitoring for cholinergic toxicity. Immunomodulation is often required for generalized or refractory disease: Corticosteroids** (e.g., prednisone 1–2 mg/kg/day) are effective but require gradual tapering to mitigate growth ppression and metabolic effects. Intravenous immunoglobulin (IVIG) and **plasma exchange (PLEX)** serve as rescue therapies for acute exacerbations or myasthenic crisis. Steroid-sparing agents (azathioprine, mycophenolate mofetil) are used for long-term control, while rituximab may benefit anti-MuSK-positive cases. Thymectomy** is controversial in prepubertal children but may be considered in AChR-positive generalized MG adolescents, mirroring adult protocols. Emerging therapies (eculizumab, efgartigimod) show promise but lack robust pediatric data. Neonatal MG, caused by placental transfer of maternal antibodies, typically resolves within weeks but may require transient pyridostigmine. Multidisciplinary care including respiratory support, physical therapy, and psychosocial support is vital for optimizing outcomes. Conclusion: Pediatric MG management demands early diagnosis, individualized immunotherapy, and careful monitoring of treatment-related complications. Future research should focus on pediatric-specific trials for novel biologics and refined thymectomy guidelines. Key words: Myasthenia gravis, treatment, Children 

Impact of Levetiracetam Monotherapy on Immunological Profile in Pediatric Epilepsy: A Prospective Study
Neurology,Psychiatry,Physical medicine
Golazin Shahbodagh Khan 1 © ℗
1 Department of Pediatrics, Division of Pediatric Neurology, Hakim Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Abstract Background and aim: Epilepsy is one of the most common neurological disorders. Despite advances in its treatment, antiseizure medications (ASMs) are associated with immunological side effects. Levetiracetam (LEV), a broad-spectrum antiepileptic drug, has been widely used in recent years. This study aims to evaluate the concentrations of IgG and its subclasses, IgM, IgA, CD4, CD8, and anti-tetanus antibodies in children aged 2 to 15 years with epilepsy undergoing LEV therapy. Materials and Methods: In this prospective cohort study, 52 children aged 2 to 15 years recently diagnosed with epilepsy were included. The treatment of epilepsy was initiated as monotherapy with LEV at a dose of 10–50 mg/kg/day. Blood samples were collected from the patients before starting LEV treatment and six months after therapy to measure IgG and its subclasses, IgA, IgM, CD4, CD8 levels, anti-tetanus antibody units, and white blood cell counts. Results: Among 52 children (41.2% female, mean age 7.39 ± 3.84 years), six months of Levetiracetam monotherapy significantly reduced IgG levels (P=0.01), with reductions in IgG1 observed only in males (P=0.04) and statistically non-significant increase in IgG2 and IgG3 levels (P=0.45 and P=0.12). Other immune and hematological markers, including WBC, CD4, CD8, IgM, IgA, and anti-tetanus IgG, showed no significant changes. Also, there was a non- significant slight decrease in IgA levels, while WBC counts normalized in a larger proportion of participants, indicating limited but notable immunological shifts. Conclusion: It appears that Levetiracetam monotherapy in pediatric epilepsy has a modest impact on immune system function, with a significant reduction in serum IgG levels, particularly in male patients. However, no major changes were observed in other immunological markers. In our study, treatment with Levetiracetam was not associated with the development of symptomatic infections requiring therapy discontinuation in any patient. Further studies are warranted to clarify the long-term safety of Levetiracetam in pediatrics.

Indications for Referring Pediatric Patients to a Sleep Clinic
Neurology,Psychiatry,Physical medicine
Mersedeh Ghodsi 1 © ℗
1 Pediatric Specialist; Sleep Medicine Fellow; Children's Medical Center; Tehran University of Medical Sciences; Tehran, Iran
Abstract: Sleep plays a fundamental role in children’s physical and psychological development and overall health. Children who obtain sufficient, high-quality sleep tend to achieve better academic outcomes, exhibit stronger memory consolidation, and maintain a more robust immune system. Timely referral of pediatric patients with suspected sleep disturbances can help prevent conditions such as diabetes, obesity, and immune compromise. Early identification of sleep disorders also reduces the risk of perioperative complications under general anesthesia. Polysomnography—commonly known as a sleep study—serves as the gold standard for diagnosing these disorders. Given the interdisciplinary nature of sleep medicine, establishing clear referral indications is essential to ensure prompt evaluation. Children presenting with obstructive sleep apnea (OSA), recurrent respiratory pauses, neuromuscular disorders, chronic insomnia, circadian rhythm disturbances, or coexisting psychiatric conditions should be referred to a sleep clinic. Likewise, those undergoing chemotherapy, receiving corticosteroid therapy, experiencing chronic pain, or using medications that impair sleep quality require specialized assessment. Patients with immunological, gastrointestinal, or neurological disorders—and those with drug-resistant seizures potentially linked to apneic episodes—also warrant comprehensive evaluation. Detecting nocturnal seizures via polysomnography is particularly important. Essential diagnostic steps in the clinic include detailed clinical interviews and the administration of standardized sleep questionnaires. Children benefit most from an integrated management plan that combines targeted pharmacotherapy, structured sleep hygiene education, and follow-up polysomnographic studies as part of comprehensive sleep disorder management. In this presentation, we will discuss the indications for referring patients to a sleep clinic.

Metabolic megalencephaly
Neurology,Psychiatry,Physical medicine
Mahmoud Reza Ashrafi 1 © ℗
1 Tehran University of Medical Sciences
Abstract: Measuring the head circumference is an essential component of the physical examination in pediatric practice and in particular in neuropediatric assessment. The measurement of the head circumference is a challenge for pediatricians, as it is not easy to carry out in young children. Serial measurement of head circumference during every health supervision visit is necessary up to 24 to 36 months of age to assess head growth velocity. It is also critical to monitor head size frequently in high-risk cases such as preterm infants and those in the active phase of bacterial meningitis, subdural hematoma, and hydrocephalus. Macrocephaly, defined as a head circumference greater than 2 standard deviations above the mean, is a relatively common presenting symptom in the pediatric population at routine well-child examinations and a common indication for neuroimaging. Macrocephaly is a relatively common clinical condition affecting up to 5% of the pediatric population .It encompasses a broad range of clinical entities ranging from benign familial macrocephaly and Benign External Hydrocephalus (BEH) to more than 200 genetic disorders. Metabolic megalencephalies result from cellular edema or abnormal accumulation of metabolic substrates within the neurons and glia secondary to an underlying biochemical defect (most commonly an enzyme deficiency), without an increase in cell number. Metabolic disorders presenting with increased head size have been classically divided into three major groups: organic acid disorders, lysosomal storage disorder, and leukoencephalopathies. A systematic approach which includes a thorough clinical history and physical examination are crucial in the evaluation of a child with macrocephaly.The first and most important step in the evaluation pathway of macrocephaly is the exclusion of raised ICP as it is a neurosurgical emergency. Diagnosis of metabolic megaencephalies is based on specific neurological features associated with the megalencephaly : Familial history of similar disorders, consanguineous marriage, clearly progressive neurological impairment and Involvement of other organs (eyes, heart, spleen and liver, skin, and muscles). Laboratory findings and neuroimaging are mandatory for a diagnosis. 

Pompe overview
Neurology,Psychiatry,Physical medicine
Mahmoud Reza Ashrafi 1 © ℗, Shahriar Nafissi 1, Shahriar Nafissi 1
1 Tehran University of Medical Sciences
Abstract: Mutations of the gene coding for acid α –glucosidase is associated with a large spectrum of clinical symptoms, ranging from severe sickness characterized by hypertrophic cardiomyopathy and marked muscle weakness to a gradually progressing myopathy and respiratory insufficiency with adult onset . The term infantile onset incorporates those patients who display symptoms before 1 year of age, who have an average life expectancy of less than one year due to severe cardiac hypertrophy and generalized skeletal muscle weakness. Infantile-onset Pompe disease (IOPD) presents in the first days to weeks of life, with symptoms of hypotonia, cardiomyopathy, and respiratory insufficiency. Patient with classic infantile PD usually come to attention during their first two months of life with marked muscular hypotonia together with a rapidly progressing muscular weakness . Poor feeding and failure to thrive may be early complaints, but cyanosis and attacks of dyspnea begin promptly, and there is rapid progression to intractable cardiac failure. Without treatment, death usually occurs before the age of 2 years. The term late onset is utilized to describe those who develop symptoms any time after 1 year of age or as late as the 7th decade and can be misleading as it includes the childhood, juvenile, and adult onset groups, with respiratory insufficiency, impaired mobility and limb girdle weakness resulting to significant morbidity and early death. Children and adults with low to moderate GAA activity (3-30%) generally have a less rapid and more variable disease course. Unlike the infantile-onset acid maltase deficiency, cardiomegaly, hepatomegaly, and macroglossia are uncommon. Motor milestones may be delayed. Weakness is slowly progressive and involves proximal greater than distal muscles in the legs and arms. Children often have hypertrophy of the calf muscles, a waddling gait, and significant lumbar lordosis and demonstrate a Gower maneuver to arise from the floor. The natural history of late-onset (childhood, juvenile, and adult) Pompe disease without ERT is characterized by onset of symptoms after 1 year of age, less severe to no cardiac involvement, slower progression, and significant heterogeneity of symptoms, with symptoms primarily related to progressive dysfunction of skeletal and respiratory muscles. 

Practical Evaluation of Children With Macrocephaly
Neurology,Psychiatry,Physical medicine
Farhad Mahvelati Shamsabadi 1 © ℗
1 Neurology Research Center, Mofid Children's Hospital,
Abstract: The assessment of growth in general and more particularly the measurement of the head circumference is an integral part of the pediatric neurological examination. Obviously measurements of head circumference (HC) over time are more informative and should be plotted to the appropriate chart for sex and conceptional age. Macrocephaly (MC) defined as head circumference that is more than two standard deviations above the mean for age, sex, and body size, established by use of measurements and standard growth charts. Accelerated head circumference growth by more than one standard deviation from the child’s previous standing can also indicate MC. Macrocephaly may be due to megalencephaly (true enlargement of the brain parenchyma) or due to other conditions such as hydrocephalus or cranial hyperostosis. Evaluation of head growth rate (ie, serial head circumferences) along with assessment of developmental milestones, perinatal history, and signs of increased intra cranial pressure (ICP) is important for differential diagnosis, urgency of imaging, and radiological interpretation. It is therefore essential to measure the HC of the parents before considering further investigations. Macrocephaly with normal growth rate and normal neurological examination is reassuring and is characteristic of benign megalencephaly, which is usually familial. Macrocephaly and accelerated head growth without elevated pressure and with normal neurological exam may occur as non progressive subarachnoid space dilatation with or without ventricular enlargement. This pattern is most commonly referred as "benign extracerebral collection of infancy" (BECC), but has also been termed as "benign enlargement of the sub-arachnoid spaces", "benign infantile HC", and "benign external HC". Macrocephaly with accelerated head growth due to progressive HC is usually associated with signs of ICP and often with declining milestones. If the cause is hydrocephalus referral to neurosurgery will be necessary. If other causes are suspected then a basic metabolic screening along with baseline biochemistry tests (such as urine organic acids analysis and blood acylcarnitine profile, studies for storage disorder like Tay–Sachs disease, specific diagnostic testing such as enzyme or gene analysis) and possible referral to a clinical geneticist will be required. 

The diagnosis of neuromuscular junction disorder derives
Neurology,Psychiatry,Physical medicine
Masood Ghahvechi Akbari 1 © ℗
1 Associate Professor of Physical Medicine, Tehran University of Medical Sciences
Abstract: Neuromuscular junction disorders are a condition often seen in the outpatient setting. Patients frequently complain of muscular proximal weakness in the extremities with/without bulbar and extraocular findings. In myasthenia gravis, pathology occurs at the postsynaptic membrane. The diagnosis of neuromuscular junction disorder derives from a thorough history and physical examination, electrodiagnostic studies with repetitive nerve stimulation (RNS), exercise testing, and single-fiber EMG (SFEMG). SFEMG testing is the gold standard for neuromuscular junction study with a sensitivity of up to 99%. Anticholinesterase medication should be stopped 8 to 24 hours before performing the study. A routine motor and sensory nerve conduction study should first be conducted to ensure no other nerve pathology exists and that the clinician can interpret the RNS results. RNS involves supramaximal motor nerve stimulation 5-10 times at 3 Hz to determine compound muscle action potential (CMAP) amplitude decrement. The 4th CMAP amplitude is compared with the first. A decrement of 10% is significant. RNS study should ideally be performed on the proximal and most affected muscle to increase sensitivity. 

Acute asthma exacerbations in pediatrics
pulmonary disease
Masoumeh Ghasempour Alamdari 1 © ℗
1 Masoumeh ghasempour alamdari,MD. 1- Department of pediatric pulmonology,Tehran university of medical Sciences,Bahrami Hospital, School of Medicine, Tehran,Iran masoumehghasempouralamdari@gmail.com https://orcid.org/0000-0003-1330-5789
Abstract: Asthma is the most common chronic disease affecting children worldwide.According to international consensus, asthma is defined as a chronic inflammatory disorder associated with variable airflow obstruction and bronchial hyper-responsiveness. Globally, ~11–14% of all children report asthma symptoms, with increasing prevalence reported worldwide. Measured by school absences, Emergency Department (ED) visits, hospitalization and parental work absence, paediatric asthma is a major burden on childhood and family health worldwide.Poorly controlled childhood asthma is associated with a lower quality of life, lower cardiovascular fitness, increased missed school days in children and decreased caregiver productivity. These human and economic impacts are critically apparent when children experience acute asthma exacerbations (AAEs). AAEs or ‘flare-ups’ are defined as acute or subacute episodes of progressive increases in asthma symptoms associated with airflow obstruction. AAEs are associated with high morbidity and, on rare occasions, mortality, particularly with children from visible minorities and living in socioeconomically disadvantaged environments.As such, AAEs are one of the most common reasons children seek ED care worldwide. The goals of care for managing children with AAEs are generally understood and shared across multiple guidelines.These goals are the basis of a stepwise approach to managing paediatric AAEs and are (1) immediate and objective assessment of AAE severity; (2) prompt and effective medical interventions to decrease respiratory distress and improve oxygenation; (3) appropriate disposition of patient and (4) a safe discharge home plan. The majority of this review is organized around this stepwise approach. A focused history and physical examination are recommended to (1) confirm the diagnosis of an AAE, (2) determine aetiology, (3) determine AAE severity and (4) estimate the risk factors for intensive care unit (ICU) admission.In order to provide appropriate and effective treatment, it is crucial to promptly determine the severity of the AAE. Children with a critical AAE should not have their treatment delayed. Pertinent clinical information includes previous asthma history, exposure to triggers and asthma medications administered (adherence, dose, timing of medications, social barriers to care). Of critical importance are questions on risk factors for fatal asthma. Children with these risk factors require caution and specialist involvement with their care.

Bronchiolitis
pulmonary disease
Seyed Hossein Mirlohi 1 © ℗
1 Pediatric Respiratory and Sleep Medicine Research Center,Children's Medical Center,Tehran University of Medical Sciences, Tehran, Iran
Abstract: Bronchiolitis is broadly defined as a clinical syndrome of respiratory distress that occurs in children 2 years of age. It is characterized by upper respiratory symptoms (eg, rhinorrhea) followed by lower respiratory tract signs (eg, wheezing and/or crackles) Patients with mild bronchiolitis (respiratory severity score [RSS] 5) can usually be managed in the outpatient setting unless there are concerns about the caregivers' ability to care for them at home. Supportive care and anticipatory guidance are the mainstays of management. Supportive care includes relief of nasal congestion/obstruction, maintenance of adequate hydration, and fever management. Patients with moderate to severe bronchiolitis require evaluation in the emergency department and usually require supportive care in the inpatient setting. Supportive care is the mainstay of management of bronchiolitis in the emergency department and inpatient settings. This includes: •Fluid, nutrition, and fever management Respiratory support – Supplemental oxygen therapy is provided as needed for patients with persistent hypoxemia, targeting an oxygen saturation goal of ≥90 percent Nasal suctioning Limited indications for inhaled bronchodilator:for patients with severe respiratory distress and wheezing, we suggest a trial of bronchodilator therapy.We suggest albuterol (salbutamol) rather than nebulized epinephrine for this purpose.

Common Sleep Disorders in Early Childhood and Corrective Strategies
pulmonary disease
Sevil Abdolmohamadian 1 © ℗
1 Sevil Abdolmohamadian, Department of Pediatrics, Tehran University of Medical Scien
Abstract: Sleep disturbances are among the most prevalent concerns in early childhood, significantly impacting a child's cognitive development, emotional regulation, and overall family well-being. This presentation will outline the most common sleep disorders in this demographic and provide evidence-based corrective strategies. The most frequent challenges include behavioral insomnias of childhood, namely the sleep-onset association type (where a child requires specific conditions, like being rocked, to fall asleep) and the limit-setting type (bedtime stalling and refusal). Other common issues are night awakenings, parasomnias (such as confusional arousals and night terrors), and sleep-related anxieties. Addressing these disorders requires a multifaceted, family-centered approach. For behavioral insomnias, the cornerstone of intervention is parent education on establishing consistent and calming bedtime routines. Strategies such as graduated extinction (checking on the child at progressively longer intervals) and positive reinforcement for desired behaviors are highly effective. For limit-setting issues, clear, firm, and consistent boundaries are crucial. Managing parasomnias primarily involves ensuring safety and implementing scheduled awakenings prior to the event. Addressing night-time fears can be achieved through reassurance and simple cognitive-behavioral techniques. Underlying medical issues, such as sleep-disordered breathing or restless legs syndrome, must always be considered and ruled out. This presentation will equip practitioners and caregivers with a practical toolkit of interventions. The ultimate goal is to foster healthy sleep hygiene from an early age, promoting restful sleep for the child and, consequently, for the entire family.

Pnuemina in children
pulmonary disease
روح الله شیرزادی 1 © ℗
1 Pediatric pulmonolgy,Associte preofessor ,childrens medical center .Tehran university of medical science
Abstract: Pneumonia is one of the most common and serious respiratory infections in children worldwide. It is defined as an inflammation of the lung parenchyma, usually caused by infectious agents. Viruses are the most frequent cause of pneumonia in young children, especially those under five years old, with respiratory syncytial virus (RSV), influenza, parainfluenza, and adenovirus being the most common. Bacterial pneumonia is often more severe and is usually caused by Streptococcus pneumoniae or Haemophilus influenzae. In neonates, pathogens such as Group B Streptococcus and E. coli may also be responsible. Risk factors for pediatric pneumonia include prematurity, malnutrition, congenital heart disease, immunodeficiency, and exposure to indoor smoke. Clinical presentation varies with age and etiology, but typical symptoms include fever, cough, tachypnea, and respiratory distress. Chest indrawing, nasal flaring, and grunting are signs of severe disease, while in infants, nonspecific features such as poor feeding, irritability, or lethargy may also occur 

Primary ciliary dyskinesia
pulmonary disease
Rouhollah Rohani 1 © ℗
1 pediatric pulmonologist, pediatric pulmonology and sleep medicine departement, Tehran university of medical science
Abstract: Primary ciliary dyskinesia Primary ciliary dyskinesia (PCD), includes patients with a spectrum of ciliary abnormalities, including ciliary akinesia, dyskinesia, and aplasia. It is characterized by chronic cough, bronchiectasis, chronic rhinosinusitis, and recurrent otitis media. The inheritance pattern of PCD is autosomal recessive in most cases. A number of different PCD-causing mutations have been described. Situs inversus is present in about 50 percent of individuals with PCD. A history of neonatal respiratory distress, early onset and persistent productive cough, chronic nasal congestion and rhinorrhea, chronic otitis media, and/or a laterality defect (eg, situs inversus or ambiguous) should raise a strong clinical suspicion for PCD in the absence of cystic fibrosis or prematurity. Measuring the production of nasal nitric oxide (nNO) is a useful method to screen patients age five years or older with a clinical suspicion of PCD. Semen analysis is an option in adult males. At present, none of these tests is diagnostic, so a confirmatory test is necessary. Definitive diagnosis is usually based on identification of ciliary abnormalities on high speed videomicroscopy analysis (HSVA) or transmission electron microscopy (TEM).Genetic testing has an increasing role in PCD diagnosis. Management of PCD include interventions to improve secretion clearance and reduce respiratory infections and daily chest physiotherapy and prompt treatment of respiratory infections. Regular use of nebulized (hypertonic) saline, twice daily before airway clearance techniques, and after inhaled bronchodilator is recommended. Azithromycin maintenance therapy is suggested for patients 7 years of age and older with frequent exacerbations of bronchiectasis. Patients with PCD often have chronic otitis media with effusion. The placement of tympanostomy tubes is often appropriate in patients with hearing loss. Chronic rhinosinusitis with nasal polyposis is a cardinal feature of PCD, so standard practices is recommended for management. Age and season-appropriate vaccination against influenza and pneumococcus is advised. Male infertility is common due to ciliary dysmotility. Female patients with PCD may also have reduced fertility. In vitro fertilization techniques have been effective in this setting. Persons with PCD generally live an active life and have a normal lifespan. The rate of decline of lung function is much slower than with CF. 

Pulmonary Disease Management in Cystic Fibrosis
pulmonary disease
فاطمه طريقت منفرد 1 © ℗
1 Fateme tarighatmonfared,Pediatric pulmonologist,Pediatric respiratory and sleep medicine department , children’s medical center, Tehran University of Medical sciences, Tehran, Iran Email:Fateme.tarighat@gmail.com
Abstract: Pulmonary Disease Management in Cystic Fibrosis Pulmonary complications remain the leading cause of morbidity and mortality in patients with cystic fibrosis (CF). The underlying defect in the CFTR protein results in dehydrated airway secretions, impaired mucociliary clearance, and persistent bacterial colonization, ultimately leading to chronic inflammation, bronchiectasis, and progressive respiratory decline. Airway clearance is the cornerstone of management. Chest physiotherapy, oscillatory devices, and positive expiratory pressure techniques are routinely applied. Inhaled therapies such as hypertonic saline and recombinant human DNase reduce mucus viscosity and enhance clearance. Antimicrobial therapy is essential to control airway infections. While early colonization often involves Staphylococcus aureus and Haemophilus influenzae, chronic infection with Pseudomonas aeruginosa dominates in older patients. Inhaled antibiotics (tobramycin, aztreonam, colistin) are used for long-term suppression, while intravenous regimens are reserved for acute exacerbations. Treatment is tailored according to regular sputum cultures to optimize pathogen-specific coverage. Anti-inflammatory strategies aim to mitigate airway damage. Long-term azithromycin has both anti-inflammatory and anti-biofilm effects. High-dose ibuprofen in selected adolescents may slow lung function decline. Systemic corticosteroids are generally reserved for complications such as allergic bronchopulmonary aspergillosis (ABPA). A major advance in CF care has been the development of CFTR modulators, which target the basic molecular defect. Ivacaftor has shown dramatic benefits in gating mutations, while combination therapies such as lumacaftor/ivacaftor and tezacaftor/ivacaftor extend treatment to patients with F508del mutations. The triple therapy elexacaftor/tezacaftor/ivacaftor (Trikafta®) has transformed outcomes, significantly improving lung function, reducing pulmonary exacerbations, and enhancing quality of life in the majority of patients. For patients with advanced disease, supportive respiratory care includes long-term oxygen therapy and non-invasive ventilation in chronic respiratory failure. Lung transplantation remains the final option for those with severe, refractory decline despite maximal therapy. Adjunctive measures such as pulmonary rehabilitation, optimized nutrition, and vaccination (influenza, pneumococcal) play a crucial role in maintaining overall health. Conclusion: Modern management of CF lung disease combines established therapies for airway clearance and infection control with novel CFTR modulators that address the root defect. This integrated approach has markedly improved survival and quality of life, shifting the paradigm of CF care from supportive to disease-modifying therapy.

The efficacy of COVID-19 vaccination in cystic fibrosis patients: a systematic review
pulmonary disease
Azam Gholami Shahrebabak 1 © ℗
1 Department of Pediatric ،Afzalipour Hospital, Afzalipour Faculty of Medicine, Kerman University of Medical Sciences, Kerman, Iran
Abstract: This systematic review assesses the efficacy and safety of COVID-19 vaccines in individuals with cystic fibrosis (CF). A comprehensive search of major databases between December 2019 and January 2024 identified eight cohort studies including 1,361 CF patients. Studies lacking subgroup analyses specific to CF were excluded, which may limit the generalizability of the findings, particularly for CF lung transplant recipients. Overall, COVID-19 vaccines elicited robust serological responses after the second and third doses, although attenuated antibody levels were noted in lung transplant recipients. Factors influencing humoral response included prior SARS-CoV-2 infection, age, use of inhaled corticosteroids, and immunosuppressive therapy. Reported vaccine-related adverse events were mostly mild. While breakthrough infections occurred, severe COVID-19 outcomes were rare among vaccinated CF patients. These findings support the immunogenicity and safety of COVID-19 vaccines in the CF population. Nonetheless, individualized vaccination strategies may be warranted for CF lung transplant recipients and patients receiving immunosuppressive treatments. Further research is needed to optimize vaccination approaches and to identify risk factors for breakthrough infections in this high-risk group.

Approach to microcephaly
surgery
Farideh Nejat 1 © ℗
1 Children’s Medical Center. Tehran University of Medical Sciences, Tehran Iran
Abstract: Microcephaly is a small head related to the age and sex for the child that can be associated with closed fontanel. At any time that this symptom is discovered the child should be evaluated for associated anomalies, face and skull deformity, detailed neurological examination and developmental assessment. The detailed family history can be helpful to rule out constitutional or familial benign microcephaly. Sometimes the family history is helpful to find a metabolic or genetic disorder in a family with similar problem and developmental disorder. Past history of prematurity difficult delivery and hypoxic ischemic problem during birth of the child should be investigated. According to the clinical exam and family and past histories the laboratory and radiological assessments are considered to find the diagnosis and prepare for the appropriate treatment. In this presentation the approach to microcephaly is described. 

Iron deficiency supplementation
Nutrition
Golnaz Ghazizadeh Esslami 1 © ℗
1 ,Assistant Professor of General pediatrics, Department of Emergency, Children's Medical Center, Tehran, Iran university of Medical Sciences,
Abstract: Iron deficiency is the most prevalent nutritional deficiency in children. The global prevalence of anemia in 2010 was 32.9 percent, with the highest burden in children less than 5 years of age. Iron deficiency is defined with a serum ferritin of less than 15microgram/L. Iron requirements for breastfed infants or whom are formula fed with an appropriate iron-fortified infant formula are as following: Full term Infants: 1 mg/kg daily (maximum 15 mg) starting from 4 to 6 months continuing until the infant is taking sufficient quantities of iron-rich complementary foods, Premature Infants: 2 to 4 mg/kg daily (maximum 15 mg) starting from 2 to 4 weeks continuing through the first year of life, 1 to 3 years old: 7 mg daily, 4 to 8 years old: 10 mg daily and 9 to 13 years old: 8 mg daily. For infants and children in high-risk populations (prevalence of anemia 40 percent), daily iron supplementation is recommended. Supplements should not be given to children who lack access to malaria-prevention strategies, because they may increase susceptibility to malaria. For preschool- and school-aged children in moderate-risk populations (prevalence of anemia 20 to 40 percent), Intermittent iron supplementation (one supplement/week, in three-month cycles) is recommended. Other general dietary measures which are essential: Iron fortification of formula is necessary in formula fed infants. At age six months, encouraging one feeding per day of foods rich in vitamin C and after age six months, or when developmentally ready, considering introduction of pureed meats is recommended. For all infants (12 months), avoiding feeding unmodified (nonformula) cow's milk or goat's milk, and for children aged one to five years, limiting cow's milk consumption to no more than 20 oz (600 mL) per day and encouraging at least three servings per day of iron-containing foods is beneficial. Moreover, children who eat less than this target usually have suboptimal iron intake and may benefit from an iron supplement. In this presentation, we aim to discuss about the prevention methods and supplementation alternatives for iron deficiency, as one of the most crucial and curable nutritional deficiencies in children. 

Supplements in Pediatrics: Challenges and Inappropriate Prescriptions
Nutrition
Maedeh Ferdow 1 © ℗
1 Assistant Professor, Department of Pediatrics, Tehran University of Medical Sciences, Hakim Hospital, Tehran, Iran
Abstract: Optimal nutrition is a cornerstone of pediatric growth, cognitive development, immune competence, and long-term health. Despite sufficient dietary intake in most children, the use of dietary supplements is increasingly prevalent, sometimes without clear clinical justification. Five commonly supplemented nutrients—omega-3 fatty acids, amino acids, vitamin C, vitamin E, and magnesium—have well-established physiological roles but are generally unnecessary in healthy pediatric populations. Omega-3 fatty acids, particularly DHA and EPA, support neurodevelopment, retinal maturation, and immunomodulation, with supplementation primarily indicated for preterm infants or children with inadequate dietary intake. Amino acids, essential for protein synthesis, energy metabolism, and neurotransmitter production, are indicated in inherited metabolic disorders, chronic kidney disease, or critically ill children. Vitamin C, a water-soluble antioxidant crucial for collagen synthesis, iron absorption, and immune defense, is typically sufficient from diet, with supplementation reserved for deficiency or high-risk conditions. Vitamin E, a lipid-soluble antioxidant, preserves cellular membranes, supports neurological function, and regulates immunity, with supplementation indicated in fat malabsorption syndromes or prematurity. Magnesium, a cofactor in enzymatic reactions and critical for neuromuscular, cardiovascular, and skeletal function, is generally adequate from a balanced diet, with supplementation limited to confirmed deficiency or specific clinical contexts. Clinical guidelines emphasize prioritizing dietary sources, precise dosing when supplementation is required, and monitoring for potential adverse effects, including bleeding, renal complications, or gastrointestinal intolerance. Conclusion: Routine supplementation of these five nutrients is not indicated in healthy children with adequate nutrition. Decisions regarding supplementation should be guided by individualized nutritional assessment, laboratory-confirmed deficiencies, and specific clinical indications, with dietary diversity remaining the foundation of pediatric health. Keywords: pediatric nutrition, supplementation, omega-3, amino acids, vitamin C, vitamin E, magnesium

Death Certificate: Let us Right Writing!
Forensic medicine
Farhoud Toutounchian 1 © ℗
1 Children's Medical Center, Tehran University of Medical Sciences
Abstract: Writing a proper death certificate in Iran involves following legal procedures and using the correct format issued by the Iranian Civil Registration Organization. Here's a clear breakdown of how to do it correctly: Key Components of a Death Certificate in Iran. A valid death certificate must include: Full name of the deceased, Date and place of birth, Date and place of death, Cause of death (certified by a hospital or coroner), National ID number and birth certificate number, Marital status, Name of spouse or legal heirs, Signature and stamp of the issuing authority. Steps to Obtain or Write a Death Certificate: 1. Report the Death Within 10 Days, Notify the local Civil Registration Office promptly to avoid legal complications. 2. Gather Required Documents, National ID card and birth certificate of the deceased, Medical certificate of cause of death, Passport or residence card (if applicable), Marriage certificate (if relevant), ID of the applicant (heir or legal representative), Power of attorney if applying through a lawyer. 3. Visit the Civil Registration Office, Submit the documents and fill out the official death registration form. 4. Use the Mikhak System (for deaths abroad), If the death occurred outside Iran, register it via Mikhak and upload translated and verified documents. Who Can Request a Death Certificate, Spouse or legal heirs, Executor of the estate, Authorized legal representative, Hospital or police (in case of unexpected deaths). We organized a conference in one day (eighth Shahrivar 1404), in Children’s Medical Center, Tehran University of Medical Sciences. We have to publish all results of investigations about right writing of Death certificate, as soon as possible. 

Pediatric Palliative Care: As a Need to End-stage Diseases
Forensic medicine
Farhoud Toutounchian 1 © ℗
1 Children Medical Center, Tehran University of Medical Sciences
Abstract: Pediatric palliative care (PPC) is a vital, compassionate approach to supporting children with life-limiting or end-stage diseases—especially in contexts like Iran, where healthcare systems are evolving to meet these complex needs. Here's a comprehensive look at why PPC is essential and how it's being implemented: Why Pediatric Palliative Care Matters in End-Stage Diseases: Children facing terminal illnesses, such as advanced cancer, end-stage renal disease, or severe congenital conditions, require more than just medical treatment. PPC focuses on: Relieving physical symptoms like pain, nausea, fatigue, and breathlessness, Supporting emotional and psychological well-being for both the child and family, Addressing spiritual and cultural needs in a sensitive, personalized way, Improving quality of life, not just prolonging it, Facilitating informed decision-making and end-of-life planning. Iran’s Progress in Pediatric Palliative Care. Iran has made notable strides in developing PPC, especially for children with cancer: Local Models: Mofid Children’s Hospital in Tehran established an outpatient PPC clinic based on WHO guidelines between 2021–2024. Essential Service Package: A structured PPC package was developed, covering physical, psychological, social, and spiritual care, tailored to Iran’s cultural context. Challenges Identified: Lack of trained staff and home care services, Limited access to opioids for pain relief, Absence of insurance coverage and clear healthcare tariffs, Communication barriers and family misconceptions. What’s Needed Going Forward, Training for healthcare providers in PPC principles, Integration into primary care and community health systems, Policy support for insurance coverage and opioid accessibility, Public awareness campaigns to reduce stigma and promote understanding. We have to try about many articles to write a review article with above title, as soon as possible. Key words: Pediatric Palliative Care, End-stage diseases, life-limiting diseases

MERCURY POISONING and REPORT OF 2 CASES.
Toxicology
Fariba Farnaghi. 1 © ℗
1 Associate Professor of Pediatrics,Shahid Beheshti University of Medical Sciences
Abstract: All forms of mercury (liquid silver) are toxic specially in children including elemental mercury , Organic salts) methylmercury ;Minamata disease ( and mineral ( mercuric chloride(salts and finally acrodynia (Pink Disease). Sources of mercury include thermometers, lamps, barometers, Electronic components, amalgam, factory waste, fish from polluted waters and etc. Symptoms vary according to type, amount ,duration, and method of exposure. Herein we report 2 cases of severe mercury poisoning in spring of 1404,Both of them were 13-year-old boys.The most common symptoms in both were arthralgia and muscle pain, mood disorders, and generalized skin rash with acral desquamation from 1-2 months ago. Both mentioned a history of playing with liquid metallic mercury brought from the school laboratory, one as his curiosity and for playing, and the other one for conducting physical and chemical lab exams at home. In case 1, in addition to previously mentioned symptoms, there was hypertension, proteinuria, sleep and eating disorders, and in case 2, there were attacks of sweating, irritability, involuntary crying, insomnia, and anorexia. Routine lab tests and primary rheumatological tests had been done for both patients, but didn’t specific diagnosis had been reached. But they were not match with a specific disease. Blood and 24-hour urine mercury level checked for both. Although blood mercury levels were done approximately 1-2 months after exposure; it was 40 µg/L and 15 µg/L in index cases. Along with other symptomatic treatments,they received chelators as succimer (dimercaprol) for 19 days and at follow-up gradually their symptoms subsided.

Anemia in Children: A Clinical Sign with Diverse EtiologiesElham Shahgholi
Hematology & Oncology
Elham Shahgholi 1 © ℗
1 Tehran University of Medical Sciences
Abstract: In pediatric practice, anemia should be approached primarily as a hematologic manifestation rather than a standalone diagnosis. It reflects an imbalance in red blood cell (RBC) kinetics—decreased production, increased destruction, or blood loss—necessitating targeted evaluation to identify the underlying pathology. Etiologic Classification 1. Hypoproliferative anemias – Result from reduced erythropoiesis, commonly due to iron deficiency, vitamin B12 or folate deficiency, anemia of chronic disease, hypothyroidism, or bone marrow suppression secondary to infection, chemotherapy, or chronic inflammation. 2. Hemorrhagic anemias – Acute losses (trauma, gastrointestinal bleeding) or chronic occult losses (Meckel’s diverticulum, inflammatory bowel disease, heavy menstrual bleeding). 3. Hemolytic anemias – Congenital (sickle cell disease, thalassemia, hereditary spherocytosis, G6PD deficiency) or acquired (autoimmune hemolysis, microangiopathic hemolytic anemia, infections, toxins). 4. Aplastic anemia – Global marrow failure from idiopathic aplasia, viral infections, drugs, or congenital marrow failure syndromes. 5. Myelophthisic anemia – Marrow replacement by malignant infiltration, fibrosis, or storage disorders. Diagnostic Algorithm A CBC with differential and peripheral smear remain initial cornerstones. The mean corpuscular volume (MCV) classifies anemia as microcytic, normocytic, or macrocytic, narrowing the differential. The reticulocyte count stratifies marrow activity: Low reticulocyte index → decreased RBC production. Elevated reticulocyte index → hemolysis or recent blood loss. Morphologic features (target cells, spherocytes, schistocytes, basophilic stippling, hypersegmented neutrophils) provide diagnostic clues. Further work-up includes iron profile, ferritin, vitamin B12 and folate levels, direct antiglobulin test, hemolysis markers (LDH, indirect bilirubin, haptoglobin), and bone marrow aspiration/biopsy when indicated. Therapeutic Approach Management is etiology-specific: Iron supplementation for iron deficiency. Parenteral vitamin B12 or oral folate for megaloblastic anemia. Immunosuppressive regimens or hematopoietic stem cell transplantation for aplastic anemia. Chronic transfusion programs, hydroxyurea, or splenectomy for select hemolytic disorders. Transfusion support is reserved for hemodynamically significant anemia. Prompt recognition, targeted diagnostics, and correction of the primary disorder are essential to prevent developmental, cognitive, and cardiovascular sequelae. Conclusion Anemia in children is a sentinel finding. A systematic, physiology-based classification and disciplined diagnostic pathway enable pediatricians to efficiently identify the cause and initiate definitive treatment, ensuring optimal long-term outcomes. 

Autoimmune Hemolytic Anemia
Hematology & Oncology
Alieh Safari 1 © ℗
1 Children’s Medical Center
Abstract: Dr. Alieh Safari Pediatrician Hematologist Tehran Medical University Children’s Medical Center Autoimmune Hemolytic Anemia Autoimmune Hemolytic Anemia (AIHA) is a rare hematological disorder characterized by the production of autoantibodies directed against an individual’s own red blood cells (RBCs), leading to their premature destruction and subsequent reduction in blood cell concentration. Under normal physiological conditions, RBCs have a lifespan of 100–120 days; however, in severe AIHA, this lifespan may be reduced to only a few days. As a result, RBCs undergo accelerated hemolysis, and their intracellular components are released into the bloodstream and surrounding tissues, producing clinical manifestations. AIHA may occur as a primary disorder or as a secondary condition associated with underlying diseases such as Epstein–Barr virus (EBV) infection, lymphoma, systemic lupus erythematosus (SLE), immunodeficiency disorders, rheumatoid arthritis, or ulcerative colitis. The most common clinical manifestations of acute AIHA include dark-colored urine, jaundice, pallor, myalgia, headache, nausea, vomiting, generalized weakness, dyspnea, and tachycardia. Approximately half of all cases are idiopathic (primary) and cannot be attributed to an identifiable underlying cause. In other cases, AIHA arises secondary to comorbid conditions. After excluding other potential etiologies, the diagnosis is established through hematological and biochemical investigations. Laboratory findings typically include reduced hemoglobin levels, reticulocytosis, elevated mean corpuscular hemoglobin concentration (MCHC), spherocytosis on peripheral blood smear, occasional neutropenia and thrombocytopenia, increased osmotic fragility, hyperbilirubinemia, elevated serum lactate dehydrogenase (LDH), decreased haptoglobin and albumin levels, hemoglobinuria, and increased urinary urobilinogen. The direct antiglobulin test (DAT or Coombs test) is the definitive diagnostic tool for confirming AIHA. Management depends on disease severity. Mild cases may resolve spontaneously and require no therapeutic intervention. In more severe cases, treatment strategies include management of underlying conditions, administration of corticosteroids (e.g., prednisone), immunosuppressive agents (e.g., rituximab or azathioprine), splenectomy to reduce RBC destruction, and blood transfusion when necessary. 

Chimeric antigen receptor T‑cell (CAR‑T) Therapy in Pediatric Acute Lymphoblastic Leukemia (ALL)
Hematology & Oncology
امیر علی حمیدیه 1 © ℗
1 Pediatric Cell and Gene Therapy Research Center, Gene, Cell & Tissue Research Institute, Tehran University of Medical Science
Abstract: Chimeric antigen receptor T‑cell (CAR‑T) therapy has transformed the treatment landscape for relapsed/refractory B‑cell acute lymphoblastic leukemia (B‑ALL), particularly in pediatric and young adult. Despite high initial response rates with CD19 CAR‑T products such as Kymriah (tisagenlecleucel) and Aucatzyl (obecabtagene autoleucel), relapse both CD19-positive and CD19-negative remains a significant barrier to long-term remission. Emerging innovations are addressing these limitations. Notably, the CD22‑directed CART22‑65s therapy delivered promising results, inducing remission in 74% of heavily pretreated B‑ALL patients while demonstrating a favorable safety profile, minimal cytokine-release syndrome (CRS) and neurotoxicity, and evidence of long-term persistence, including one patient in remission for over three years. Other advanced strategies include bispecific CAR‑T constructs targeting CD19/CD22, “Fast” CAR‑T manufacturing, and dual‑targeting approaches to mitigate antigen escape and improve durability. Reinforcement of CAR‑T responses via reinduction CART2 after relapse has demonstrated safety with appreciable MRD-negativity and improved 2‑year survival rates, especially when tumor burden is low prior to reinfusion At the preclinical frontier, immune "armoring" strategies are gaining traction. For example, CAR‑T cells engineered to secrete a TIM‑3 decoy prevented tumor‑mediated inhibition in B‑ALL mouse models, enhancing antitumor effectiveness and persistence Complementing these innovations, mathematical and computational tools such as quantum modeling are being applied to predict CAR‑T cytotoxicity, enhancing design optimization in an otherwise vast, data sparse construct space Despite these advances, challenges persist with CAR-T cell therapy including optimizing persistence, minimizing antigen escape, ensuring manufacturing scalability, and reducing toxicity remain critical areas for future work In summary, the CAR‑T therapy for pediatric ALL is rapidly evolving, with novel targeting strategies, reinfusion protocols, immune engineering techniques, and computational modeling converging to overcome relapse and durability hurdles charting a course toward more effective, safe, and accessible treatments for high‑risk ALL patients. 

epidemiology and clinical manifestations of iron deficiency anemia in children
Hematology & Oncology
مژگان عمرالعلایی 1 © ℗
1 Department of Pediatric Hemato-Oncologic Diseases,Hakim Children Hospital, Tehran Univercity of Medical Sciences, Tehran Iran
Abstract: Iron deficiency anemia (IDA) remains the most common nutritional disorder worldwide, representing a major public health challenge across both developed and developing nations. Epidemiologically, it affects an estimated two billion people globally, with the highest burden observed among women of reproductive age, infants, young children, and adolescents due to increased physiological demands. Pregnant women are particularly vulnerable, with prevalence rates exceeding 40% in some regions, contributing significantly to maternal morbidity and adverse pregnancy outcomes. Socioeconomic disparities, poor dietary intake, chronic blood loss, parasitic infections, and limited access to healthcare services further amplify the global burden. Although IDA is prevalent in low-income countries, it also persists in high-income settings where dietary patterns, heavy menstrual bleeding, gastrointestinal blood loss, or chronic diseases contribute to iron depletion.Clinically, IDA develops insidiously, with symptoms and signs reflecting impaired oxygen delivery to tissues. The most common presenting symptoms include fatigue, generalized weakness, pallor, and reduced exercise tolerance. Cognitive impairment, poor concentration, irritability, and impaired school or work performance are frequently noted, especially in children and adolescents. Dyspnea on exertion, palpitations, and headaches are reported in more advanced cases. Distinctive but less common features include pica (craving for non-nutritive substances such as ice or soil) and restless legs syndrome.Physical signs are variable and often subtle. Pallor of the skin and conjunctiva is the hallmark clinical finding. Additional manifestations include brittle or spoon-shaped nails (koilonychia), angular cheilitis, atrophic glossitis, and dry, thinning hair, all reflecting chronicity of the deficiency. In severe or prolonged cases, tachycardia, systolic murmurs, or signs of heart failure may be observed due to compensatory cardiovascular strain. Importantly, the severity of symptoms often correlates with both the degree and rapidity of hemoglobin decline. In conclusion, iron deficiency anemia is a widespread, preventable condition with substantial health, developmental, and economic consequences. Recognition of its epidemiological determinants and classical constellation of symptoms and signs is essential for early diagnosis, timely treatment, and implementation of effective preventive strategies. 

G6PD Deficiency in Iran: Clinical and Public Health Perspectives
Hematology & Oncology
Seyed Mohammad Kazem Nourbakhsh 1 © ℗
1 Assoc. Prof. Seyed M.K. Nourbakhsh, MD Pediatric Hematology-Oncology Subspecialist Department of Pediatrics, Tehran University of Medical Sciences, Iran
Abstract: Glucose-6-phosphate dehydrogenase (G6PD) deficiency is the most common enzymatic disorder of red blood cells worldwide, affecting an estimated 400 million individuals. Favism, the acute hemolytic crisis triggered by ingestion of fava beans, represents one of the most characteristic clinical manifestations of this disorder. In Iran, where G6PD deficiency is relatively prevalent—particularly in the northern and southern provinces—favism continues to pose a significant pediatric health concern. The underlying pathophysiology of favism relates to the inability of G6PD-deficient erythrocytes to generate sufficient NADPH through the pentose phosphate pathway. As a result, affected red cells cannot adequately counter oxidative stress, leading to intravascular hemolysis following exposure to oxidative agents such as fava beans, certain drugs, or infections. In children, the presentation is often dramatic: sudden onset of pallor, jaundice, hemoglobinuria, abdominal pain, and occasionally acute renal impairment. Diagnosis relies on clinical suspicion supported by laboratory evidence of hemolysis—anemia, reticulocytosis, elevated indirect bilirubin, and LDH. Specific enzyme assays confirm G6PD deficiency, though their sensitivity may be limited during acute hemolysis due to the predominance of young red cells with near-normal enzyme activity. Molecular analysis has identified multiple G6PD variants in the Iranian population, contributing to variable clinical severity. Management of favism is primarily supportive. Acute crises require prompt hydration, avoidance of further oxidative triggers, and, in severe cases, blood transfusion. In neonates, G6PD deficiency is a well-recognized risk factor for severe hyperbilirubinemia and kernicterus, necessitating vigilant screening and early intervention with phototherapy or exchange transfusion. Long-term care focuses on education of families regarding avoidance of fava beans and contraindicated drugs, alongside genetic counseling. From a public health perspective, neonatal screening for G6PD deficiency has been implemented in several regions of Iran and has proven effective in reducing morbidity and mortality. However, variability in program coverage and family awareness remains a challenge. Future directions include wider application of molecular diagnostics, improved educational strategies for families, and exploration of curative approaches such as gene therapy. In conclusion, favism in Iran exemplifies the clinical importance of G6PD deficiency in pediatric practice. Through early detection, appropriate management, and preventive education, the burden of this inherited disorder can be substantially reduced.

Hereditary Spherocytosis in Children: From Pathophysiology to Long-Term Management
Hematology & Oncology
Tagrian Isfahani Marjan, MD 1 © ℗
1 Department of Pediatric Hematology & Oncology, School of Medicine and Hakim Children’s Hospital, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Abstract Background: Hereditary spherocytosis (HS) is the most frequent inherited hemolytic anemia in individuals of Northern European descent, with an estimated prevalence of 1:2,000. It results from mutations in genes encoding red cell membrane proteins (ankyrin, spectrin, band 3, protein 4.2). Loss of membrane surface area produces rigid spherocytes that are sequestered and destroyed in the spleen, leading to chronic extravascular hemolysis. Clinical Features: The spectrum ranges from asymptomatic carriers to severely affected neonates. Many infants present with neonatal jaundice requiring phototherapy or exchange transfusion. The classical triad comprises anemia, jaundice, and splenomegaly, although not all are present simultaneously. Over time, complications such as pigment gallstones and aplastic crises (often triggered by parvovirus B19) may occur. Diagnostic Evaluation: Routine investigations reveal normocytic anemia, elevated mean corpuscular hemoglobin concentration (MCHC 36 g/dL), reticulocytosis, and spherocytes on peripheral smear. Hemolysis markers typically include elevated indirect bilirubin and LDH with reduced haptoglobin. The direct antiglobulin test is essential to exclude autoimmune hemolysis. Confirmatory assays include the osmotic fragility test, the acidified glycerol lysis test, and particularly the eosin-5-maleimide (EMA) binding test, which offers the highest sensitivity and specificity. Management: Daily folic acid supplementation is recommended for all patients. Splenectomy is indicated in moderate-to-severe anemia, transfusion dependence, or symptomatic splenomegaly; timing is generally deferred until after 5–6 years to minimize the risk of overwhelming post-splenectomy infection. Partial splenectomy may be considered in young children to balance hemolysis control with immune preservation. Comprehensive perioperative care includes pneumococcal, meningococcal, and Haemophilus influenzae type b vaccination, as well as long-term vigilance for febrile illness. Transfusions remain essential during aplastic crises or in severely affected children. Prognosis and Follow-Up: Most patients, with appropriate diagnosis and individualized management, achieve near-normal life expectancy. Lifelong follow-up should monitor hemolysis markers, iron overload in transfused patients, and hepatobiliary complications such as gallstones. Conclusion: HS is a common and clinically heterogeneous disorder in pediatric hematology practice. Advances in diagnostic assays and evolving approaches to splenectomy have improved patient outcomes. Effective management requires an integrated strategy combining supportive care, judicious surgical intervention, vaccination, and structured long-term follow-up. Keywords Hereditary spherocytosis; pediatric hematology; hemolytic anemia; splenectomy; red blood cell membrane disorders

HSCT in Pediatric Patients
Hematology & Oncology
Maryam Behfar 1 © ℗
1 Pediatric Cell and Gene Therapy Research Centre, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Hematopoietic stem cell transplantation (HSCT), also known as a bone marrow transplant, is used to treat both malignant and non-malignant conditions. Graft can be collected from bone marrow, cord, or peripheral blood. Stem cells' ability to differentiate and self-renewal can suppress malignant cells or replace dysfunctional cells in non-malignant conditions like hemoglobinopathies or immunodeficiencies. Hematopoietic stem cells can be derived from either the patient (autologous) or an allogeneic donor. Unlike solid organ transplants, the main criteria for allogenic donor selection are based on human leukocyte antigen (HLA) compatibility. HLA genes are highly polymorphic; thus, these differences can result in an allo-immune reaction, which can cause graft rejection. In terms of HLA compatibility donor and recipient can be fully matched or a haploidentical match. Fully matched Donors can be categorized into three groups: the preferred option is matched sibling donors; however, if not accessible, related donors or even less preferred option, unrelated donors, will be considered. Before graft injection, a combination of chemotherapies with or without total body irradiation (TBI), also known as a conditioning regimen, is used to eradicate the primary disease in case of malignancy or create a space for stem cells to engraft. The conditioning regimen is designed to suppress the recipient's immune system to protect the injected stem cells from allo-immune reactions. This can make the patient more prone to infections, so to prevent it, antimicrobial medications are also deployed, alongside conditioning. Post-HSCT, patients will be monitored for viral, bacterial, or fungal infection, early graft rejection, and graft versus host disease. To ensure early engraftment, patients' chimerism will be monitored through Short Tandem Repeat Polymerase Chain Reaction (STR-PCR) or fluorescence in situ hybridization (FISH) tests from bone marrow or peripheral blood. GvHD is a condition where the donor's white blood cells recognize host cells as foreigners and attack them. To manage this, immunosuppressant medications are prescribed as prophylaxis or treatment. While HSCT can be life-saving in both adult and pediatric patients, the overall outcomes are more favorable in pediatric patients due to the prevention of disease in early stages and less organ damage.

Iron-Deficiency Anemia (IDA)TREATMENT 
Hematology & Oncology
Mohammad Kajiyazdi 1 ℗, Arghavan Tajalli 2 ©
1 Associate Professor of Pediatric Hematology and Oncology, Bahrami Children Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2 Pediatric Hematology and Oncology, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Iron-deficiency anemia is primarily treated with oral iron, most commonly ferrous sulfate, which is inexpensive and effective. The recommended therapeutic dose is 3–6 mg/kg of elemental iron daily, with a maximum of 150–200 mg. It is ideally taken between meals, though this is not essential. Oral intolerance is uncommon in children but may cause gastrointestinal discomfort in adolescents; adjusting dosage often helps. If absorption is impaired or adherence is poor, intravenous preparations such as iron sucrose, ferric carboxymaltose, or iron dextran may be considered, though oral therapy remains safer and cheaper. Certain factors reduce absorption, including calcium, fiber, and tea. Heme iron from animal sources is absorbed much better than non-heme iron. Excessive cow’s milk intake should be limited, and dietary counseling is usually required. In adolescent females, menorrhagia-related anemia should be managed with iron therapy and, if needed, hormonal control. Clinical response is predictable: reticulocytosis appears within 2–4 days, and hemoglobin rises 1–2 g/dL in about a month. Therapy should continue for 2–3 months after normalization to restore iron stores. If the response is poor, alternative diagnoses, malabsorption, or poor adherence should be investigated. Blood transfusion is rarely required and should be reserved for severe anemia with ongoing bleeding or imminent heart failure, given slowly to avoid complications. Overall, effective management combines appropriate iron therapy, dietary adjustments, and monitoring to ensure recovery and prevent recurrence. 

Optimizing Care for Infantile Hemangioma: : Scope and Referral Considerations for Pediatricians
Hematology & Oncology
آزاده کیومرثی 1 © ℗, عطیه صفاری 2
1 Pediatric Hematologist Oncologist, Children's Medical Center Hospital. Department of Pediatric Hematology, Oncology, Stem Cell Transplantation, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
2 Children's Medical Center Hospital, Department of Pediatrics, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Infantile hemangiomas (IHs) are the most common benign vascular tumors of infancy, affecting up to 10% of children. They typically follow a predictable course of rapid proliferation in early infancy, followed by slow involution during childhood. While most IHs are small, superficial, and self-limiting, approximately 10% carry risks of ulceration, functional impairment, disfigurement, or even life-threatening complications. General pediatricians are well positioned to identify IHs during routine examinations, particularly at the six-week check, and play a central role in initial diagnosis, risk stratification, and parental education. Most IHs can be diagnosed clinically. Imaging is reserved for specific scenarios: ultrasound with Doppler helps assess atypical or deep lesions and rule out visceral involvement, while MRI is used for extensive segmental lesions or when syndromic associations such as PHACE or LUMBAR are suspected. Biopsy is rarely necessary but may help clarify uncertain cases. Low-risk IHs can be safely managed in primary care with observation, reassurance, and structured follow-up. Families should be educated on the natural history of IHs, advised to document lesion changes with photographs, and alerted to signs of rapid growth or complications. “Watchful waiting” remains appropriate for uncomplicated lesions, but vigilance is essential to identify those requiring active treatment. When intervention is needed, oral propranolol remains the gold standard. Administered at 2–3 mg/kg/day in divided doses, it is most effective when started in the proliferative phase (ideally by 1–5 months of age) and continued for at least six months. Propranolol has a clearance rate approaching 95% and works through vasoconstriction, inhibition of angiogenesis, and induction of endothelial apoptosis. Adverse effects include sleep disturbance, hypoglycemia, bronchospasm, and rare rebound growth after cessation. Caregivers should be advised to administer doses with feeds and to monitor for side effects. Topical timolol may be considered for small, superficial lesions. Corticosteroids, pulsed-dye or Nd:YAG laser, and surgery are second-line options, reserved for refractory or complicated cases. Red-flag features, such as ulceration, bleeding, airway compromise, visual threat, or signs of cardiac or endocrine dysfunction, warrant prompt referral to specialists, including dermatology, cardiology, ophthalmology, or otolaryngology. Segmental, periorbital, perioral, or multiple cutaneous lesions also require early evaluation for systemic involvement. In summary, while the majority of IHs can be monitored in primary care, pediatricians must remain alert to high-risk features. Timely recognition and referral ensure optimal outcomes and minimize long-term complications. 

Imaging of craniosynostosis 
رادیولوژی
Fatemeh Zamani 1 © ℗
1 Department of Radiology, Children Medical Center of Excellence, Tehran University of Medical Science, Tehran, Iran
Abstract: Craniosynostosis—the early closure of one or more cranial sutures—alters skull growth patterns and may contribute to elevated intracranial pressure or neurodevelopmental issues. Although the diagnosis often begins with physical examination, imaging is essential for confirming suture involvement, identifying secondary deformities, and guiding operative planning. 3D-reconstructed MDCT performed under minimized radiation protocols remains the reference standard for detailed cranial vault assessment, offering unparalleled visualization of fused sutures and calvarial morphology. In younger infants, cranial ultrasound through an open fontanelle can provide a rapid, radiation-free first assessment. MRI, while less effective for bony anatomy, is valuable in evaluating associated intracranial malformations, venous drainage, and syndromic presentations. Innovations such as ultra-low-dose CT protocols, black-bone MRI, and artificial intelligence–driven image analysis are reshaping diagnostic strategies, aiming to reduce radiation risk while enhancing accuracy.

 

Poster presentation

Investigating the Level of Knowledge, Attitude and Performance Students Regarding the Applications of Artificial Intelligence in Nursing
پرستاری
اکرم همتی پور 1 © ℗
1 کارشناسی ارشد پرستاری، دانشگاه علوم پزشکی آبادان، آبادان، ایران
Abstract:

 زمینه و هدف استفاده از هوش مصنوعی اخیرا در زمینه پزشکی و پرستاری افزایش یافته است. که برای سهولت درتشخیص و مراقبت پرستاری به آن بسیار مفید می باشد. لذا مطالعه حاضر با هدف تعیین سطح دانش، نگرش و عملکرد دانشجویان پرستاری از هوش مصنوعی انجام شده است. روش بررسی این مطالعه توصیفی از نوع مقطعی می باشدکه درزمستان سال 1402 انجام شده است. جامعه مورد مطالعه دانشجویان پرستاری ترم 2 الی ترم 8 می باشند با نمونه گیری در دسترس 200دانشجوی پرستاری با رضایت آگاهانه پرسشنامه محقق ساخته دانش، نگرش و عملکرد هوش مصنوعی را که روایی و پایایی شده بود را تکمیل نمودند دادهها با استفاده از آزمونهای آماری توصیفی و ضریب همبستگی پیرسون و با نرم افزار SPSSنسخه 26 تجزیه و تحلیل شدند. یافته ها 200 دانشجو پرستاری با میانگین سنی )2±/90 22/89( سال مورد بررسی قرار گرفتند میانگین سطح دانش دانشجویان نسبت به کاربرد هوش مصنوعی درپرستاری )1/82 ± 11/38( بود که نشان داد 182 نفر) 91 درصد( دانش مثبتی دارند. از نظر عملکرد میانگین نمرات دانشجویان )1/40 ± 6/49( بدست آمد که اشاره به این موضوع دارد که 112نفر )56 درصد( عملکرد ضعیفی در این زمینه دارند. از نظر نگرش نیز در اکثر موارد دانشجویان نگرش مثبتی نسبت به کاربرد هوش مصنوعی در پرستاری دارند. در این مطالعه باالرفتن سن با افزایش سطح دانش و جنسیت مرد نیز بر افزایش سطح نگرش و عملکرد تاثیر گذار بوده است. با استفاده از ضریب همبستگی پیرسون بین دانش و نگرش با عملکرد همبستگی معنادار و مستقیمی وجود دارد )0/001P). نتیجه گیری اگرچه اکثر دانشجویان عملکرد کافی در استفاده از هوش مصنوعی را در مراقبت های پرستاری ندارند، اما سطح دانش و دیدگاه های مطلوبی در مورد استفاده از هوش مصنوعی درحوزه پزشکی و پرستاری دارند. وزارت بهداشت و سازمانهای بینالمللی باید استفاده از هوش مصنوعی در زمینه پرستاری را پیشنهاد دهد. کلیدواژ ه ها دانش، نگرش، عملکرد، کاربرد هوش مصنوعی

Moral Distress among Pediatric Intensive Care Unit Nurses: An Examination of Individual, Organizational, and Environmental Factors
پرستاری
امیرمحمد درستی 1, سمیه قربانی 2 ℗, میرامیرحسین سیدنظری 3 ©, مهردادقاسملو 4
1 دانشجوی کارشناسی ارشد، رشته پرستاری داخلی جراحی، کمیته تحقیقات دانشجویی، دانشکده علوم پزشکی خوی، خوی، ایران
2 کارشناسی ارشد، رشته پرستاری اورژانس، گروه پرستاری ، دانشکده علوم پزشکی خوی، خوی، ایران
3 کارشناس ارشد پرستاری داخلی جراحی، گروه پرستاری داخلی جراحی، دانشکده علوم پزشکی خوی، خوی، ایران
4 کارشناسی ارشد، رشته مراقبت ویژه نوزادان، گروه پرستاری ، دانشگاه علوم پزشکی مشهد، مشهد، ایران
Abstract:

 چکیده: مقدمه: پرستاران به صورت مستمر با مسائل و معضلات اخلاقی متعددی در محیط کار خود روبرو هستند. این چالش‌ها در بخش‌های ویژه کودکان، به دلیل حساسیت‌های سنی و وضعیت خاص بیماران خردسال، پیچیده‌تر بوده و نیاز به دقت و توجه بیشتری دارند. هدف این پژوهش، شناسایی و تحلیل عوامل تأثیرگذار بر فرسودگی اخلاقی در پرستاران شاغل در بخش‌های مراقبت‌های ویژه کودکان است. روش کار: این مطالعه به روش مرور سیستماتیک در سال ۱۴۰4 انجام شده است. جستجوی مقالات در پایگاه‌های اطلاعاتی معتبری همچون Science Direct، Scopus، Google Scholar و PubMed بدون هیچ محدودیت زمانی صورت گرفت. برای جستجو، از کلیدواژه‌های "فرسودگی اخلاقی"، "بخش مراقبت‌های ویژه کودکان" و "پرستار کودک" استفاده شد. برای ارزیابی کیفیت مقالات انتخاب‌شده، از ابزارهای معتبر CASP بهره گرفته شد. از میان ۴۶00 مقاله یافت‌شده، در نهایت 22 مقاله که دارای معیارهای ورود بودند، برای تحلیل نهایی انتخاب شدند. یافته‌ها: بررسی پژوهش‌های منتخب نشان داد که سطح فرسودگی اخلاقی در میان پرستاران شاغل در بخش‌های ویژه کودکان در حد متوسط است. عواملی مانند ویژگی‌های جمعیتی، خصوصیات فردی، شرایط سازمانی و ویژگی‌های محیط کار، همگی با میزان پریشانی اخلاقی رابطه‌ای معنادار داشتند. همچنین، نتایج نشان داد که فرسودگی اخلاقی می‌تواند به صورت مستقیم بر تمایل پرستاران به ترک شغل و تصمیم نهایی آن‌ها برای استعفا تأثیر بگذارد. نتیجه‌گیری: پرستاران بخش مراقبت‌های ویژه کودکان، به دلیل شرایط خاص شغلی، در معرض خطر بالاتری از فرسودگی اخلاقی قرار دارند. بنابراین، اتخاذ رویکردهای حمایتی و مدیریتی مناسب با در نظر گرفتن ویژگی‌های فردی، عوامل سازمانی و شرایط محیط کار می‌تواند در کاهش فرسودگی اخلاقی و به دنبال آن، کاهش نرخ ترک شغل در این گروه از پرستاران مؤثر باشد. کلیدواژه‌ها: فرسودگی اخلاقی، بخش مراقبت‌های ویژه کودکان، پرستار کودک 

“Examining the Factors Associated with Self-Efficacy in Diabetes Management: A Systematic Review”
پرستاری
سارا سیاح پور 1 © ℗, دکتر نفیسه حکمتی پور 1
1 گروه پرستاری, واحد علی آبادکتول, دانشگاه آزاد اسلامی, علی آبادکتول, ایران
Abstract:

 مقدمه: خودکارآمدی از سازه‌های محوری مدل‌های تغییر رفتار و پیش‌بینی‌کنندهٔ کلیدی پیامدهای خودمراقبتی در دیابت است. با وجود مطالعات متعدد، عوامل فردی، بالینی و زمینه‌ای مرتبط با آن به‌صورت یکپارچه مرور نشده‌اند. این مرور نظام‌مند باهدف شناسایی و سنتز شواهد عوامل مرتبط با خودکارآمدی در مدیریت دیابت نوع ۱ و ۲ و تبیین نقش‌های واسطه‌گری/تعدیل‌گری آن بر پیامدهای بالینی و رفتاری انجام شد. روش کار: جست‌وجوی جامع در پایگاه‌های PubMed/MEDLINE، Scopus، Web of Science، Embase، CINAHL، PsycINFO و پایگاه‌های بومی (SID، MagIran) به‌همراه منابع خاکستری صورت گرفت. معیار ورود: مطالعات کمی اصیل بر روی بیماران ≥۱۸ سال مبتلا به دیابت که خودکارآمدی را با ابزارهای معتبر (DMSES، Stanford، DES-SF، CIDS، GSE) سنجیده و ارتباط آن را با عوامل فردی، بالینی یا زمینه‌ای یا پیامدهای مدیریت دیابت گزارش کرده بودند. مرورها، مطالعات کیفی، مقالات غیر فارسی/انگلیسی فاقد دادهٔ قابل استخراج و جمعیت‌های غیرقابل تعمیم حذف شدند. استخراج داده به‌صورت دوگانه و مستقل با داور سوم و ارزیابی کیفیت با RoB-2، Newcastle-Ottawa و JBI انجام شد. گزارش مطابق PRISMA-2020 بود. یافته‌ها: خودکارآمدی حاصل تعامل عوامل چندسطحی بود؛ سواد سلامت، دانش دیابت، انگیزش درونی و تنظیم هیجان آن را تقویت و افسردگی، اضطراب و دیسترس دیابتی کاهش می‌دادند. حمایت اجتماعی از خانواده و همسالان و رابطه مؤثر با تیم درمانی اثر مثبت داشت، درحالی‌که موانع اقتصادی و محدودیت دسترسی به آموزش اثر منفی داشت. از نظر بالینی، کنترل قند، پایبندی دارویی، رژیم غذایی و فعالیت بدنی با خودکارآمدی بالاتر همسو بودند. مداخلات آموزشی ساختارمند، مراقبت تیمی و فناوری‌های دیجیتال بیشترین اثر را هنگامی داشتند که مستقیماً بر تقویت خودکارآمدی از طریق بازخورد اختصاصی، تجربه موفق، سرمشق‌گیری و حمایت روانی متمرکز بودند. خودکارآمدی به‌عنوان میانجی کلیدی رابطه بین حمایت اجتماعی، دانش و سلامت روان با کنترل گلیسمی و رفتارهای خودمدیریتی را توضیح می‌داد. نتیجه‌گیری: خودکارآمدی بالاتر در دیابت نتیجه تعامل پویا بین عوامل روان‌شناختی، اجتماعی، بالینی و سیستمی و مرتبط با پیامدهای مطلوب رفتاری و متابولیک است. مداخلات مؤثر، مؤلفه‌های تقویت خودکارآمدی را هدفمند و متناسب با نیازهای فرهنگی–زبانی ادغام می‌کنند. برای ارتقای قطعیت شواهد، مطالعات آینده‌نگر سخت‌گیرانه با ابزارهای استاندارد، گزارش اندازه‌اثر و بررسی مکانیسم‌های میانجی/تعدیل‌گر توصیه می‌شود. ادغام غربالگری سلامت روان و توانمندسازی دیجیتال در برنامه‌های خودمدیریتی می‌تواند حداکثر بهبود را در خودکارآمدی و کنترل قند ایجاد کند. واژگان کلیدی: دیابت؛ خودکارآمدی؛ خودمدیریتی؛ سواد سلامت؛ دیسترس دیابتی؛ حمایت اجتماعی؛ HbA1c؛ مداخلات آموزشی؛ سلامت دیجیتال

"Mindful Journey" Exploring the Informational Behavior of Mothers of Children with Leukemia During the Care Transition to Home: A Qualitative Study
پرستاری
Nasrin Ghanbari 1 © ℗, Eesa Mohammadi 2, Mitra Khoobi 3
1 Ph.D. Student in Nursing, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
2 Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
3 Assistant Professor, Department of Nursing, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
Abstract: Background: Leukemia, as a debilitating and life-threatening disease, not only jeopardizes children’s physical health but also leaves profound consequences for parents. Active participation of parents as the primary caregivers in the treatment journey, particularly during the transition to home care, requires adequate knowledge and skills to manage complex caregiving tasks. Objective: This study aimed to explore the information-seeking behaviors of Iranian mothers caring for children with leukemia during the transition to home care. Methods: This qualitative content analysis with a conventional approach was conducted in two pediatric subspecialty centers in Iran between May 2023 and June 2024. Fourteen mothers of children with leukemia were purposefully selected and engaged in in-depth, semi-structured interviews. Data were analyzed using Graneheim and Lundman’s (2004) method. The study followed the consolidated criteria for reporting qualitative research (COREQ). Results: Five main categories were identified under the overarching theme of “Conscious striving for caregiving empowerment”: (1) mothers’ vigilance and continuous effort to learn, (2) sharing experiences with peer mothers, (3) seeking reassurance through interactions with professional caregivers, (4) cautious use of virtual spaces, and (5) distrust toward caregiving advice from non-expert relatives. Conclusion: The findings revealed that mothers of children with leukemia play an active and vigilant role in searching, critically evaluating, and applying caregiving information during the transition to home care. The results highlight the significance of healthcare professionals as trusted sources of information, and peer mothers as valuable experiential and emotional supports. These insights can inform the development of tailored educational and supportive programs for parents, thereby improving home care quality and child health outcomes. Keywords: Leukemia; Cancer; Children; Mothers; Care transition; Information-seeking behaviors; Qualitative study

A Case Report of Successful Treatment Following Drug Hypersensitivity and Stevens-Johnson Syndrome
پرستاری
زهرا ولی نسب 1 © ℗, سیما پورتیمور 2, راحله لامعی 1
1 کارشناسی ارشد پرستاری، مربی دانشکده پرستاری و مامایی ارومیه
2 دکترای پرستاری، هیئت علمی دانشکده پرستاری و مامایی ارومیه
Abstract:

 گزارش یک مورد درمان موفق به دنبال حساسیت دارویی و بروز سندرم استیون جانسون پیش زمینه و هدف: استیون جانسون (Stevens-Johnson Syndrome, SJS) یک اختلال سیستمیک جدی و خطرناک است که تشخیص به موقع و شروع اقدامات درمانی در حفظ جان بیمار بسیار مهم است. این عارضه نخستین بار در اوایل قرن بیستم شناخته شد. اگرچه وقوع آن بسیار نادر است، اما به دلیل درگیری‌های گسترده در بخش‌های مختلف بدن مانند دهان، بینی، چشم، واژن، مجاری ادراری، گوارشی، تنفسی و پوست، می‌تواند تهدیدکننده حیات باشد. هدف از ارائه این گزارش موردی، افزایش آگاهی و دانش بالینی درباره سندرم استیون جانسون از طریق بررسی یک مورد واقعی است. این گزارش با تمرکز بر روند تشخیص، عوامل مستعدکننده، سیر بالینی، اقدامات درمانی و پیامدهای بیمار، تلاش می‌کند تا نکات کلیدی و چالش‌های مدیریت این بیماری را برای پزشکان و کادر درمانی برجسته کند. همچنین، هدف دیگر این گزارش، یادآوری اهمیت شناسایی زودهنگام علائم و قطع سریع داروی مشکوک یا درمان عفونت زمینه‌ای به منظور پیشگیری از عوارض جبران‌ناپذیر و مرگ و میر ناشی از SJS است. گزارش مورد: این گزارش موردی در بیمارستان شهید مطهری ارومیه انجام شد. ما در این مطالعه به شرح حال دختر 9 ساله با سابقه تشنج و ابتلای اخیر به بروسلوزیس که از شش روز قبل تحت درمان با ریفامپین و تتراسایکلین قرار گرفته و بدنبال آن دچار SJS ، آنژیوادم، اینتوباسیون و ضایعات پوستی ماکولوپاپولر ژنرالیزه شدید ناشی از آن شده بود، پرداختیم. نتایج این مطالعه نشان داد که تشخیص زودهنگام و مداخلات درمانی سریع در مواجهه با عوارض شدید دارویی مانند SJS و آنژیوادم، نقش حیاتی در موفقیت درمان و بهبود وضعیت بیمار دارد. نتیجه گیری: این یافته‌ها اهمیت آموزش کادر درمان و خانواده‌ها در شناسایی سریع علائم هشداردهنده و اقدام به موقع را برجسته می‌سازد. قطع سریع داروی محرک و درمان حمایتی مناسب می‌تواند از پیشرفت بیماری و مرگ و میر جلوگیری کند. کلید واژه: سندرم استیون جانسون، حساسیت دارویی، قطع سریع داروی محرک، درمان حمایتی 

A Comparative Study on the Effect of Teaching Methods of Demonstration Activities, Storytelling and Common Activities on Physical and Motor Growth of Preschool Children in Boroojerd city in 1397.
پرستاری
زهرا موسوی 1 © ℗, پریا سلطانی 2, راضیه شیرزادگان 3
1 Instructor, Faculty of Nursing and midwifery, Lorestan University of Medical Sciences, Khorramabad, Iran.
2 دانشجو، دانشکده پرستاری و مامایی خرم آباد، لرستان، ایران.
3 عضو هیات علمی گروه پرستاری، واحد دورود، دانشگاه آزاد اسلامی، دورود، ایران
Abstract: Abstract: Background: Due to the different methods of teaching in the way of playing in preschools, in the present study, we try to compare the impact of different game methods on the physical and motor development of preschool students. Methods: In this semi experimental study, 72 children from pre-schools were selected with using multistage cluster sampling. They were randomly assigned to three groups of 24. The data collecting tool was the Ulrich's motor development questionnaire. The duration of the intervention was 8 weeks and each week, three one hour sessions. Data analyze was done with using of SPSS19, paired t-test, tukey test and ANOVA. Results : There was a significant difference in the mean of displacement score, before and after the intervention in the demonstration activities group and common activities (P0.001). The difference in mean of object control score before and after the intervention was significant in all three groups (P 0.05). Also, there was a significant difference between the mean score of the demonstration activities group and story telling and also demonstration activities group and the common activities in the displacement subscale (P 0.001). In the subscale of object control, there was a significant difference between the mean of the demonstration activities and the story telling and also story telling and the common activities (P 0.05). Conclusion: Due to the excellence of the method of demonstration activities in the promotion of physical and motor growth sub-scales, it is suggested that in preschool centers, teaching methods such as demonstration be used for teaching. Key words: Story telling, Demonstration Activities, Motor and Physical Growth, Preschool Children. COD OF ETHICS: IR.LUMS.REC.1397.113 

A review of the use of virtual reality in reducing pain and anxiety in children undergoing invasive treatments.
پرستاری
Sakineh Akbari 1 ℗, Fatemeh Valizadeh 2 ©, Amin Sattari 3
1 PhD Student in Nursing, Student Research Committee, School of Nursing and Midwifery, USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
2 Associate Professor of Nursing Education Department of Nursing, School of Nursing and Midwifery Lorestan University of Medical Sciences
3 chronic Research Center,Jundishapur School of Nursing and Midwifery,Ahvaz,Iran
Abstract: Abstract Introduction: When children are admitted to hospitals or other healthcare facilities, they routinely undergo medical interventions as part of diagnosis or treatment. Children often experience severe pain and anxiety during invasive procedures such as injections, sampling, or dressings. These experiences not only negatively impact the quality of care, but can also lead to lasting psychological consequences. Virtual reality is a relatively new term in the health field that has been proposed as a novel, non-pharmacological intervention to reduce pain and anxiety in children. The aim of this study was to review the available evidence on the use of virtual reality in reducing pain and anxiety in children undergoing invasive procedures. Methods: In this review, a systematic search was conducted in the PubMed, Scopus, Web of Science, and Google Scholar databases using the keywords "Virtual Reality", "Pain", "Anxiety", "Children", and "Invasive Procedures". Articles published between 2015 and 2025 were reviewed. After assessing the quality and inclusion criteria, 24 articles were included in the final analysis. Findings: The results of the reviewed studies showed that the use of virtual reality as an appropriate non-pharmacological method and distraction tool reduces the severity of pain and anxiety in children. This strategy has been particularly successful in stressful clinical settings such as emergency departments, clinics, and pediatric oncology centers and has also been reported to be highly accepted by parents and nurses. Conclusion: Virtual reality can be used as an efficient, safe, and acceptable tool in the management of pain and anxiety caused by invasive procedures in children. Training nurses and providing the necessary equipment is essential in this regard. Integrating this method into clinical protocols will be an important step towards improving the quality of care in pediatric nursing. Keywords: virtual reality, pain, anxiety, children, invasive treatment, nursing care.

A Review Study on Sensory Processing Sensitivity in Mothers of Children with Autism Spectrum Disorder
پرستاری
Parvin Babaei 1 © ℗, Elham Mohamadi 2, Hiva Azami 3
1 MSc Pediatric Nursing Student, Student Research Committee, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
2 Department of pediatric, faculty of nursing,university of Arak,Arak,Iran
3 Master; Critical Care Nursing; Hamadan University of Medical Sciences
Abstract: Introduction Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder with widespread effects on an individual's life and their family. One of the less-known characteristics of this disorder is sensory processing issues, which have been observed not only in children but also in their mothers. These sensory abnormalities can negatively impact mothers' mental health and quality of life, confronting them with greater challenges in caring for their children. The objective of this review study is to summarize the existing evidence regarding sensory processing sensitivity in mothers of children with autism. Materials and Methods This study is a simple literature review. An advanced search was conducted using Boolean operators and key keywords such as "autism," "mother," and "sensory processing" in international databases including PubMed, Scopus, Web of Science, and national databases SID and Magiran. The initial search yielded 42 articles. Based on inclusion criteria (articles published from 2014 onwards, in Persian or English, with open access) and exclusion criteria (gray literature, duplicate or irrelevant articles), 8 studies were ultimately included and analyzed. Findings Research findings indicate that mothers of children with autism have a higher sensory processing sensitivity compared to mothers of typically developing children. Studies show a correlation between the sensory profiles of the mother and child. These abnormalities in mothers are associated with increased stress, anxiety, and poor mental health, which can disrupt their daily life and social interactions. These findings emphasize the existence of a specific sensory pattern in this population. Conclusion The existing evidence unequivocally shows that sensory processing sensitivity is an important characteristic in mothers of children with autism that requires attention. Given the negative impact of this phenomenon on mothers' mental health, it is essential that this issue be considered in psychological and supportive interventions. Further studies, especially within the cultural context of Iran, are recommended to provide practical solutions and improve the quality of life for these families.

A Systematic Review of the Role of Nurses in Promoting the Psychological Well-being of Hospitalized Children
پرستاری
Banan Kakapour 1 ℗, Elahe Jahan 1 ©
1 Department of Nursing and Midwifery, Se.C., Islamic Azad University, Semnan,Iran
Abstract: Introduction Hospitalization is a difficult and stressful experience for children, which can have profound effects on their mental health. Anxiety, fear of separation, depression, and feelings of helplessness are among the common psychological consequences for hospitalized children. In this context, nurses, as the healthcare team members closest to the child, play a pivotal role in alleviating these stressors and promoting psychological well-being. Accordingly, the objective of this systematic review is to examine the research conducted on the role of nurses in improving the psychological state of hospitalized children, aiming to identify and implement effective strategies to enhance the quality of care. Methods This research was conducted as a systematic review. To gather data, the PubMed, Scopus, Web of Science, and Google Scholar databases were searched for the years 2015 to 2024. The keywords used were: "pediatric nursing", "mental health", "hospitalized children", and "psychological support". After initial screening, 28 eligible articles were selected and reviewed using content analysis methodology. The quality of the studies was also assessed based on the PRISMA checklist. Findings The review revealed that several categories of nursing interventions had the most significant impact on promoting the mental health of hospitalized children:Play Therapy and Art Therapy: Reducing anxiety and increasing feelings of security. Therapeutic Communication: Using simple, child-friendly language, supportive touch, and the nurse's active presence alongside the child.Parental Education: Increasing family involvement in psychological care.Creating a Calming Environment: Utilizing cheerful colors, music, and creating a child-friendly atmosphere in the pediatric ward.Specialized Nurse Training: Enhancing communication and psychological skills, which increases nurses' effectiveness in reducing children's psychological symptoms. Studies indicated that nurses who received specialized training in psychiatric nursing were more successful in managing children's fear and anxiety. Furthermore, consistent presence and establishing an effective emotional connection with the child were identified as key factors in reducing psychological distress. Conclusion Nurses play an irreplaceable role in providing psychological support to hospitalized children. Implementing targeted interventions, conducting specialized training courses, and strengthening communication skills can significantly improve children's mental health. It is recommended that specialized training programs in child psychology be designed for nurses and integrated into hospital policies. Additionally, attention to the physical and emotional environment of pediatric wards is a crucial factor in enhancing the quality of psychological care. Keywords: Nurses, Children, Mental Health, Hospital 

A Systematic Review: Pediatric Nursing at the Edge of Change—Disasters, Migration, and Climate Change
پرستاری
مهدی محمودزاده 1 © ℗, محمد محمودزاده 2, ثنا خلیل زاده ضیاء 3
1 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Khoy University of Medical Sciences, Khoy, Iran
2 Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
3 Pediatric Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Introduction Pediatric nursing has faced unusual challenges recently due to the rising incidence of disasters, global migration, and increasing impacts of climate change. This systematic review aims to summarize recent research regarding the effects of these phenomena on pediatric nursing care and to emphasize the competencies necessary for an effective response. Methods A thorough search was performed in PubMed, Scopus, and Web of Science for articles published between 2019 and 2024. Keywords included “pediatric nursing,” “disasters,” “migration,” “refugee health,” and “climate change.” The inclusion criteria were peer-reviewed original research and reviews on pediatric nursing roles in acute situations, migration, or environmental health. Of the 102 initial articles, 12 satisfied the inclusion demands. Results Disasters: Recent studies demonstrate that pediatric nurses are crucial in disaster preparedness, triage, and providing psychological and acute care during emergencies (Fujita et al., 2022). Challenges encompass a scarcity of pediatric-trained personnel and inadequate disaster-specific protocols. Migration: Child migrants have distinct obstacles to health, such as disrupted care, trauma, and restricted access to resources. Nurses necessitate cultural competence, trauma-informed care training, and interdisciplinary collaboration (Kamali et al., 2023). New training programs have enhanced knowledge, while discrepancies in practice persist. Climate Change: Health hazards induced by climate change—heat stress, respiratory ailments, and vector-borne infections—are increasing. Pediatric nurses are essential in education, advocacy, and community preparedness (Stanley & Mensah, 2021), although most indicate inadequate formal environmental health training. Discussion The review emphasizes the critical necessity for comprehensive pediatric nursing education and frameworks to tackle disasters, migration, and climate-related emergencies. Essential methods encompass curriculum reform to incorporate disaster and environmental health, establishing fast response protocols, and enhancing support networks for migrant and at-risk communities. Conclusion: Pediatric nurses must possess evidence-based competencies for disaster response, migration, and climate adaptation in this age of multifaceted global issues. Systematic investment in training, research, and policy initiatives is essential to enhance health outcomes for vulnerable children.

Advances in Family-Centered Care in the Neonatal Intensive Care Unit (NICU)
پرستاری
Kousar Soltani 1 ©, Arash Khalili 2 ℗
1 Kousar Soltani Msn Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran
2 Ph.D Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran
Abstract:

 مقدمه: مراقبت خانواده‌محور (FCC) در واحدهای مراقبت ویژه نوزادان (NICU) به عنوان رویکردی کلیدی برای حمایت از نوزادان پرخطر، مانند نوزادان نارس یا مبتلا به بیماری‌های پیچیده، شناخته شده است. پیشرفت‌های اخیر شامل ادغام والدین در مراقبت روزانه، استفاده از فناوری‌های دیجیتال مانند mHealth برای پیگیری پس از ترخیص، و مدل‌های آموزشی برای پرسنل جهت تغییر ذهنیت از مراقبت پزشکی‌محور به خانواده‌محور می‌شود. این پیشرفت‌ها با هدف کاهش استرس والدین، بهبود پیوند والد-نوزاد، و ارتقای نتایج سلامت مانند کاهش طول بستری و بهبود رشد نوروبیولوژیکی انجام شده‌اند. این مرور سیستماتیک به بررسی ادبیات از سال ۲۰۲۰ تا ۲۰۲۵ می‌پردازد تا شواهد جدید را سنتز کند و راهنمایی برای پیاده‌سازی ارائه دهد. این مرور سیستماتیک بر اساس راهنمای PRISMA انجام شد. جستجوی جامع در پایگاه‌های داده PubMed، Scopus، Cochrane Library، ScienceDirect و Web of Science از ژانویه ۲۰۲۰ تا آگوست ۲۰۲۵ صورت گرفت. مطالعات تصادفی کنترل‌شده (RCTs)، شبه‌تجربی، مرورهای سیستماتیک و متاآنالیزها با تمرکز بر نوزادان پرخطر (۰ تا ۲۸ روزه) گنجانده شدند. در مجموع، ۲۹ مطالعه از ۴۵۶ مقاله اولیه انتخاب شدند. یافته‌ها از ۲۹ مطالعه بررسی‌شده، ۱۸ مورد بر مدل‌های FCC مانند Family Integrated Care (FICare) و Close Collaboration with Parents (CCP) تمرکز داشتند که کاهش معنادار طول بستری (میانگین ۵-۱۰ روز) و بهبود شیردهی (افزایش ۲۰-۳۰%) را نشان دادند، به ویژه در نوزادان نارس کمتر از ۳۲ هفته. ده مطالعه بر فناوری‌های دیجیتال مانند اپلیکیشن‌های mHealth برای آموزش والدین و پیگیری پس از ترخیص تاکید کردند که استرس مادران را تا ۲۵% کاهش داد و پیوند والد-نوزاد را تقویت کرد. پنج مطالعه بر آموزش پرسنل و تغییر محیط NICU (مانند اتاق‌های تک‌خانواده) تمرکز داشتند که مشارکت والدین را افزایش داد و نتایج نوروبیولوژیکی مانند رشد مغز را بهبود بخشید. عوامل وابسته مانند سن بارداری، سطح تحصیلات والدین و منابع واحد بر اثربخشی تاثیرگذار بودند. ترکیب FCC با مراقبت‌های توسعه‌ای در ۶ مطالعه، بهترین نتایج را داشت، اما چالش‌هایی مانند مقاومت پرسنل و محدودیت‌های همه‌گیری COVID-19 مشاهده شد. نتیجه گیری: پیشرفت‌های مراقبت خانواده‌محور (FCC)، مانند مدل‌های ادغام خانواده و فناوری‌های دیجیتال، نتایج سلامت نوزادان پرخطر را بهبود بخشیده و استرس والدین را کاهش می‌دهند. توصیه می‌شود NICUها کمیته‌های FCC تشکیل دهند، آموزش پرسنل را تقویت کنند. کلمات کلیدی: مراقبت خانواده‌محور، نوزادان پرخطر، NICU، مشارکت والدین

Advancing Post-Discharge Care for Premature Infants: A Comprehensive Framework
پرستاری
Shamsi Atefeh 1 © ℗, Mahboobeh Namnabati 2, Asghar Ehteshami3 3, Hamed Zandi 4
1 Nursing Care Research Center, Nursing Faculty, Baqiyatallah University of Medical Sciences, Tehran, Iran
2 Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Pediatrics, School of Medicine, Emam Hossein Hospital Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract: Background: Optimal health outcomes for newborns, especially those born prematurely, critically depend on comprehensive post-discharge care. However, healthcare systems, notably in Iran, grapple with substantial obstacles in providing effective transitional support. This study aimed to design a robust framework for the ongoing follow-up of infants after their discharge from the hospital. Methods: This strategic investigation was undertaken at Isfahan University of Medical Sciences from April 2022 to February 2024, employing a comprehensive five-stage methodology. Initially, forty-two experts in neonatal care, including specialists in pediatric nursing, were engaged through interviews to delineate existing challenges in the post-discharge continuum for preterm infants. Subsequently, the Delphi technique facilitated the prioritization of identified issues based on expert consensus. A subsequent SWOT analysis was conducted to identify internal strengths and weaknesses, alongside external opportunities and threats pertinent to current follow-up protocols. This was complemented by a Root Cause Analysis (RCA) tree diagram, enabling a detailed examination of identified contributing factors and the subsequent program formulation. The culminating phase involved the validation of the proposed program by an expert panel. Results: Four primary concerns emerged: inadequate parental empowerment concerning caregiving, deficiencies in structured post-discharge planning, limited psychosocial support for mothers, and insufficient health education for parents. The Delphi process highlighted parental caregiving and ineffective planning as paramount issues. SWOT analysis revealed systemic vulnerabilities in both maternal care provision and the follow-up service delivery infrastructure. RCA further elucidated caregiving deficits, pointing to challenges in breastfeeding education, management of post-discharge complications, impediments to maternal learning, and parental stress. Systemic shortcomings encompassed restricted access to necessary services and a high frequency of readmissions. The expert panel strongly advocated for the integration of telemedicine to facilitate program implementation. Conclusion: The devised post-discharge follow-up framework for preterm infants offers a practical blueprint for healthcare policymakers, particularly within national health ministries, to significantly enhance neonatal care, improve service accessibility, and reduce the incidence of hospital readmissions. This model underscores the indispensable contribution of pediatric nursing in ensuring a seamless continuum of care. Keywords: Program Development, Post-Discharge Support, Premature Infants, Pediatric Nursing, Health System Strategy. 

An analysis of the research trend of artificial intelligence in nursing in Tehran children's hospitals
پرستاری
ژیلا صانعی پور 1 © ℗
1 بیمارستان خاتم الانبیاء
Abstract:

 مقدمه و اهداف طی دهه اخیر، نقش هوش مصنوعی در مراقبت‌های بهداشتی از وظایف اداری تا تصمیم‌گیری‌های بالینی گسترش یافته استد. به عنوان مثال، الگوریتم‌های هوش مصنوعی می‌توانند حجم عظیمی از داده‌های پزشکی را برای کمک به تشخیص بیماری‌ها، پیش‌بینی نتایج بیمار و شخصی‌سازی برنامه‌های درمانی تجزیه و تحلیل کنند. با خودکارسازی وظایف معمول، هوش مصنوعی همچنین به پرستاران اجازه می‌دهد تا بر مراقبت مستقیم از بیمار تمرکز کنند و تجربه کلی مراقبت‌های بهداشتی بیمار را بهبود بخشند. روش: این مطالعه از نوع طراحی مقطعی (Cross-Sectional Design) بود. پرسشنامه دارای سوالاتی شامل حرفه، مدرک، مدرک احتمالی در انفورماتیک پرستاری، پست سازمانی، سابقه کار و میزان آشنایی با شاخه و کاربردهای هوش مصنوعی بود. نمونه گیری گلوله برفی انجام شد. دعوت به نظرسنجی در سراسر بیمارستان های کودکان تهران توزیع شد. همچنین پاسخ‌هایی به این سوال دریافت شد که «به نظر شما روند کاربرد هوش مصنوعی در آینده پرستاری در شهر و بیمارستان شما چیست؟» هر فرد پاسخگو حداکثر پنج موضوع را از یک لیست از پیش تعریف شده 12 موردی انتخاب کرد. يافته ها و نتایج در رابطه با شرکت کنندگان در این پژوهش، 33.2٪ پاسخ دهندگان از بیمارستان های ناحیه شمال، 28.8٪ از منطقه مرکز و 38٪ از منطقه جنوب تهران انتخاب شدند. مدرک تحصیلی افراد به شرح زیر است: 5.4٪ (n=7)نفر دارای مدرک دیپلم، 72.9٪ (n=94)نفر دارای مدرک کارشناسی، 19.4٪ (n=25) مدرک کارشناسی ارشد و 2.3٪ (n=3) نفر دارای مدرک دکترا بودند. میانگین سابقه کار پاسخ دهندگان 10.7 سال بود. این پژوهش به بررسی میزان روند و نقش هوش مصنوعی و انفورماتیک در پرستاری در مقطعی بین سال¬های 1402 تا 1404 می-پردازد. بر اساس 86 پاسخ دریافتی از پرستاران 4 بیمارستان کودکان تهران، برخی روندها و گرایش تحقیقاتی آتی در حوزه هوش مصنوعی و انفورماتیک پرستاری عبارتند از: پرستاری شخصی سازی شده، بهبود گزارش نویسی با پردازش زبان طبیعی (NLP)، سیستم‌های پشتیبانی تصمیم‌گیری بالینی (CDSS)، سلامت همراه (Mobile Health) و یادگیری ماشین. نتایج نشان داد بیشترین تمایل پرستاران با بیش از 33% متعلق به نقش موثر سیستم‌های پشتیبانی تصمیم‌گیری بالینی در آینده پرستاری می باشد. هوش مصنوعی در پرستاری بخش مراقبت‌های ویژه با خودکارسازی وظایف، بهبود تجزیه و تحلیل داده‌ها و کمک به تصمیم‌گیری بالینی، قصد دارد مراقبت از بیمار را بهبود بخشد. این امر می‌تواند منجر به گردش کار کارآمدتر، نظارت بهتر بر بیمار و در نهایت بهبود نتایج بیمار شود. کلمات کلیدی: هوش مصنوعی، انفورماتیک پرستاری، پرستاری کودکان

Application of Explainable AI Models for Real-Time Pediatric Nursing Assessment: Improving Clinical Accuracy and Family-Centered Care
پرستاری
Sana Mahdian Rizi 1 © ℗
1 Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
Abstract: Background and Aim: Accurate pediatric nursing assessment is critical for timely diagnosis and effective management of childhood illnesses. Recent advances in Artificial Intelligence (AI), particularly Explainable AI (XAI), offer novel opportunities to enhance clinical accuracy while maintaining transparency and trust in healthcare decisions. Despite growing interest, the application of XAI in real-time pediatric nursing assessment remains underexplored. This systematic review aims to evaluate the current evidence on the use of explainable AI models in pediatric nursing assessments, focusing on their impact on clinical accuracy and family-centered care. Methods: A comprehensive literature search was performed in PubMed, Scopus, Web of Science, IEEE Xplore, Cochrane Library, and Embase databases for articles published up to August 2025. Search terms included combinations of “explainable AI,” “XAI,” “artificial intelligence,” “pediatric nursing assessment,” “clinical accuracy,” and “family-centered care.” Inclusion criteria comprised original research studies applying XAI models in pediatric nursing assessment (ages 0–18), reporting clinical performance metrics and/or effects on family engagement. Exclusion criteria were studies on adults, non-clinical AI applications, reviews, editorials, and studies without explainability components. Two independent reviewers screened 1,489 records, with 24 studies meeting eligibility for qualitative synthesis. Results: The 24 included studies utilized a variety of machine learning models integrated with XAI techniques such as SHAP, LIME, and attention mechanisms to provide interpretable outputs during nursing assessments. Sample sizes ranged from 50 to 1,200 pediatric patients across diverse clinical settings including intensive care, outpatient, and emergency departments. Reported clinical accuracy metrics showed an area under the curve (AUC) between 0.75 and 0.94, indicating strong predictive performance. Multiple studies demonstrated that XAI models improved nurse decision-making confidence and facilitated family engagement by explaining assessment outcomes in understandable terms. However, only 7 studies performed external validation, and fewer addressed long-term clinical impact or ethical considerations. Conclusion: Explainable AI models represent a promising advancement in pediatric nursing assessment by enhancing clinical accuracy and supporting family-centered care through transparent decision support. Despite encouraging results, limited external validation and heterogeneity in methodologies warrant cautious interpretation. Future research should prioritize large-scale, multicenter prospective studies, standardized explainability metrics, and integration of ethical frameworks to fully realize the benefits of XAI in pediatric nursing practice. Keywords: Explainable AI, Pediatric Nursing Assessment, Clinical Accuracy, Family-Centered Care, Machine Learning

Applications of Telenursing in the Management of Pediatric Type 1 Diabetes: A Systematic Review
پرستاری
فاطمه سادات حسینی 1 © ℗, سمیه ناظمی 1
1 کمیته تحقیقات پرستاری دانشکده پرستاری مامایی، دانشگاه علوم پزشکی کاشان، کاشان، ایران
Abstract:

 زمینه و هدف: دیابت نوع 1 یکی از شایع‌ترین بیماری‌های مزمن کودکان است که نیازمند پایش مداوم و مدیریت دقیق است. تله‌نرسینگ به عنوان ابزار نوین مراقبتی، امکان ارائه خدمات بهداشتی از راه دور را فراهم کرده و می‌توانند به بهبود کنترل بیماری و افزایش رضایت بیماران کمک کنند. بنابراین این مطالعه با هدف مروری برکاربرد تله نرسینگ در مدیریت دیابت نوع 1 در کودکان انجام شد. مواد و روش ها: این پژوهش به‌صورت مرور سیستماتیک و بر اساس دستورالعمل‌های PRISMA در سال 2025 انجام شد. به‌منظور شناسایی مطالعات مرتبط ، جستجوی جامع در پایگاه‌های اطلاعاتی PubMed، Scopus، SID، Magiran و موتور جستجوی Google Scholar با جستجوی پیشرفته کلمات کلیدی تله‌نرسینگ، پرستاری از راه دور ، دیابت نوع 1، دیابت جوانان و کودکان به فارسی و معادل آن به انگلیسی انجام شد. بازه زمانی جستجو به مقالات منتشرشده از ژانویه 2019 تا ژوئن 2025 محدود شد. پس از حذف موارد تکراری، عنوان و چکیده‌ی مقالات توسط دو پژوهشگر مستقل بررسی گردید و بر اساس معیارهای ورود (مطالعات پژوهشی) و معیارهای خروج (مطالعات مربوط به بزرگسالان یا دیابت نوع 2، مرورها، گزارش‌های کوتاه و مقالات بدون متن کامل و مقالات غیر انگلیسی) 21 مطالعه انتخاب شدند. در مرحله بعد، متون کامل مقالات واجد شرایط بررسی شد و اطلاعات با استفاده از یک فرم سازمان‌یافته شامل مشخصات مطالعه، ویژگی‌های جمعیت، نوع مداخله، متغیرهای پیامد استخراج گردید. نتایج: مطالعات نشان می‌دهند که تله‌نرسینگ باعث بهبود کنترل قند خون و افزایش دفعات خودپایش در کودکان مبتلا به دیابت نوع 1 می‌شود. رضایت بیماران به ویژه در خانواده‌هایی که دسترسی کمتری به مراکز درمانی دارند یا از فناوری‌های پیشرفته مانند پمپ انسولین استفاده می‌کنند، بالاست. این روش دسترسی به مراقبت‌های بهداشتی را افزایش داده، هزینه و زمان مراقبت را کاهش می‌دهد و باعث بهبود حضور در جلسات پزشکی می‌شود. با این حال، تأثیر تله‌نرسینگ بر کنترل دقیق قند خون در مطالعات مختلف متفاوت گزارش شده است. استفاده همزمان از سایر فناوری‌های پیشرفته می‌تواند اثربخشی این روش را افزایش دهد. نتیجه گیری: تله‌نرسینگ به عنوان روشی نوین، مزایای قابل توجهی در مدیریت دیابت نوع 1 کودکان دارد و می‌تواند دسترسی به مراقبت و مشارکت بیماران را افزایش دهد. با این حال، نیاز به تحقیقات بیشتر برای بهینه‌سازی روش‌ها، شناسایی استراتژی‌های مؤثر برای گروه‌های مختلف و رفع موانع فناوری و اقتصادی احساس می‌شود واژگان کلیدی: تله نرسینگ، دیابت نوع 1، کودکان

Artificial Intelligence as an Effective Factor in Pediatric Emergency: A Review of the Application of Modern Algorithms in the Diagnosis and Management of Asthma
پرستاری
امیرحسین شادفر 1 © ℗, محمد امین علی زاده 2
1 دانشجوی کارشناسی ارشد پرستاری اورژانس، کمیته تحقیقات و فناوری دانشجویی، دانشکده پرستاری و مامایی ، دانشگاه علوم پزشکی و خدمات درمانی بم، بم، ایران.
2 دانشجوی کارشناسی ارشد مراقبت‌های ویژه، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی و خدمات درمانی جندی شاپور، اهواز، ایران.
Abstract:

 مقدمه: بیماری آسم یکی از مشکلات شایع در میان کودکان است که می‌تواند به حملات حاد و مراجعه‌های مکرر به اورژانس منجر شود. تشخیص سریع و مدیریت به موقع آسم در شرایط اضطراری از اهمیت ویژه‌ای برخوردار است. پیشرفت‌های اخیر در حوزه هوش مصنوعی و توسعه الگوریتم‌های نوین، افق‌های جدیدی در بهبود دقت تشخیص و تسریع روند درمان ایجاد کرده‌اند. از این رو، بررسی کاربرد این فناوری در اورژانس کودکان جهت شناسایی و مدیریت بهینه بیماری آسم، می‌تواند گامی مؤثر در ارتقای سلامت این گروه سنی باشد. مواد و روش ها: در این مطالعه مروری، یک جستجوی سیستماتیک در پایگاه‌های بین‌المللی مانند PubMed، Scopus و Web of Science و همچنین پایگاه‌های ملی SID و Magiran به همراه موتور جستجوی Google Scholar انجام شد. استراتژی جستجو با استفاده از ترکیب کلیدواژه‌های «هوش مصنوعی»، «آلگوریتم‌های نوین»، «تشخیص»، «مدیریت»، «آسم» و «اورژانس کودکان» بر اساس عملگرهای بولین و اصطلاحات MeSH طراحی گردید. معیارهای ورود شامل مقالات منتشر شده به زبان‌های فارسی و انگلیسی با دسترسی رایگان به متن کامل و انتشار در پنج سال اخیر بودند. متون خاکستری و مقالات تکراری حذف شده و مراحل انتخاب، استخراج و تحلیل داده‌ها بر مبنای دستورالعمل‌های PRISMA گزارش شد. یافته ها: تحلیل شواهد موجود در 30 مطالعه انتخاب‌شده نشان می‌دهد که الگوریتم‌های یادگیری ماشین و یادگیری عمیق در تشخیص زودهنگام تشدید آسم و تعیین شدت حملات در اورژانس کودکان موفق عمل کرده‌اند. به‌کارگیری این فناوری‌ها موجب کاهش زمان تشخیص، بهبود دقت طبقه‌بندی علائم و ارتقای روند تصمیم‌گیری بالینی شده است. همچنین، مطالعات متعدد به کاهش بار مالی ناشی از مراقبت‌های اورژانسی و بهبود نتایج بالینی در کودکان مبتلا به آسم اشاره دارند. از سوی دیگر، چالش‌هایی نظیر نیاز به داده‌های جامع و باکیفیت، استانداردسازی الگوریتم‌ها و مسائل مرتبط با حریم خصوصی و اخلاق حرفه‌ای در کاربرد هوش مصنوعی مطرح شده است. نتیجه گیری: نتایج مرور نشان می‌دهد که هوش مصنوعی به عنوان ابزاری نوین، قابلیت ارتقای چشمگیر در تشخیص و مدیریت آسم در اورژانس کودکان را داراست. با این حال، برای استفاده گسترده و ایمن از این فناوری، تحقیقات بیشتری جهت ارزیابی اثر بخشی، استانداردسازی پروتکل‌های اجرایی و ایجاد سیستم‌های نظارت از راه دور ضروری است. تدوین برنامه‌های آموزشی تخصصی برای کادر درمانی و ایجاد زیرساخت‌های لازم می‌تواند تضمین‌کننده یکپارچگی و موفقیت در به‌کارگیری هوش مصنوعی در محیط‌های بالینی باشد. کلمات کلیدی: هوش مصنوعی، اورژانس کودکان، آسم، الگوریتم‌های نوین، تشخیص، مدیریت 

Artificial intelligence in pediatric nursing: A systematic review of opportunities, challenges, and management roles
پرستاری
مریم رنگرزی 1 ©, کوثر سلطانی 2 ℗, مهسا چراغی 3
1 Maryam Rangrazi Nursing student, Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
2 Kousar Soltani Msn Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran
3 Mahsa Cheragi Msn Student in Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract:

 مقدمه: هوش مصنوعی (AI) به عنوان یک فناوری نوظهور، پتانسیل بالایی در بهبود کیفیت مراقبت‌های کودکان دارد. این ابزارها از تصمیم‌گیری بالینی تا پایش مداوم بیماران و مدیریت منابع را تسهیل می‌کنند. با این حال، چالش‌هایی مانند نگرانی‌های اخلاقی، حریم خصوصی و مقاومت فرهنگی مانع پذیرش گسترده آن هستند. هدف این مرور سیستماتیک، بررسی ادبیات موجود برای شناسایی فرصت‌ها، چالش‌ها و نقش مدیران پرستاری در ادغام AI در مراقبت‌های کودکان است تا راهکارهایی برای سیاست‌گذاری ارائه دهد. روش کار: این مطالعه یک مرور سیستماتیک بر اساس راهنمای PRISMA انجام شد. جستجوی ادبیات در پایگاه‌های داده PubMed، Scopus، Web of Science و Google Scholar با کلمات کلیدی "هوش مصنوعی"، "پرستاری کودکان"، "فرصت‌ها و چالش‌ها" و "مدیریت پرستاری" از سال ۲۰۱۵ تا ۲۰۲۵ صورت گرفت. معیارهای ورود شامل مقالات انگلیسی و فارسی، مطالعات کمی و کیفی مرتبط با کاربرد AI در مراقبت‌های کودکان بودند. مقالات غیرمرتبط، گزارش‌های خبری و مطالعات بدون روش‌شناسی واضح حذف شدند. از ابزارهای ارزیابی کیفیت مانند MMAT برای مطالعات ترکیبی و CASP برای مطالعات کیفی استفاده شد. در نهایت، ۴۵ مقاله از ۳۵۰ نتیجه اولیه انتخاب و به روش سنتز تماتیک تحلیل شدند تا الگوهای فرصت‌ها، چالش‌ها و نقش مدیریتی استخراج شود. یافته‌ها: یافته‌ها نشان داد که AI در بهبود تصمیم‌گیری بالینی (۸۰% مطالعات)، پایش مداوم بیماران (۶۵%) و آموزش خانواده‌ها (۵۵%) فرصت‌های کلیدی ایجاد می‌کند. چالش‌های اصلی شامل نگرانی‌های اخلاقی و حریم خصوصی (۷۰% مقالات)، مقاومت کارکنان (۵۰%) و هزینه‌های بالا (۴۰%) بودند. نقش مدیریتی پرستاری در سیاست‌گذاری (۶۰%)، آموزش مداوم (۷۵%) و ارزیابی اثربخشی (۴۵%) برجسته بود. مطالعات تأکید داشتند که ادغام AI می‌تواند کیفیت مراقبت را تا ۳۰% افزایش دهد، اما نیاز به چارچوب‌های اخلاقی دارد. نتیجه‌گیری: هوش مصنوعی می‌تواند پرستاری کودکان را متحول کند، اما موفقیت آن وابسته به مدیریت چالش‌های اخلاقی و فرهنگی است. مدیران پرستاری باید سیاست‌های ایمن و آموزشی را اولویت دهند تا پذیرش فناوری افزایش یابد و کیفیت مراقبت بهبود یابد. تحقیقات آینده بر کاربردهای عملی AI در کشورهای در حال توسعه تمرکز کنند. کلمات کلیدی: هوش مصنوعی؛ پرستاری کودکان؛ فرصت‌ها و چالش‌ها؛ مدیریت پرستاری؛ مرور سیستماتیک؛ اخلاق در مراقبت‌های بهداشتی

Assessing the health status of Iranian children regarding World Health Organization (WHO) guidelines
پرستاری
زهرا جعفری 1 ℗, نجمه حمزوی 2 ©
1 استادیار دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران، ایران
2 دکترای ارتقای سلامت، دانشجوی پستداک گروه کودکان دانشگاه ادمنتون کانادا
Abstract:

 بررسی وضعیت سلامت کودکان ایرانی نسبت به دستورالعمل‌های سازمان بهداشت جهانی (WHO) این مطالعه به بررسی دستورالعمل‌های سازمان بهداشت جهانی (WHO) در رابطه با فعالیت بدنی، رفتار کم‌تحرک و خواب کودکان زیر ۵ سال می پردازد. این مطالعه آزمایشی بین ۸۳ کودک ۳ و ۴ ساله در پیش‌دبستانی‌ها و مراکز مراقبت‌های بهداشتی در ایران انجام شد. فعالیت بدنی، رفتار کم‌تحرک و خواب، مهارت‌های حرکتی ظریف و درشت، و عملکردهای اجرایی ارزیابی شدند.پنجاه و دو کودک (۶۲.۶٪) حداقل سه روز کامل دستگاه اکتی‌گراف را پوشیدند. در مجموع ۹۷.۶٪، ۹۵.۱٪ و ۹۱.۵٪ از کودکان به ترتیب ارزیابی‌های آنتروپومتریک، EF و مهارت‌های حرکتی را تکمیل کردند. نتایج نشان داد تنها چهار کودک (۴.۸٪) تمام توصیه‌های دستورالعمل‌های سازمان بهداشت جهانی را رعایت کردند. نسبت کودکانی که، زمان استفاده از صفحه نمایش، نشستن محدود و خواب را رعایت کردند، به ترتیب ۱۹.۳٪، ۳۸.۶٪ و ۶۵.۱٪ بود. این مطالعه آزمایشی در بین کودکان ایرانی امکان‌پذیر و قابل قبول بود. با توجه به نسبت کم کودکانی که دستورالعمل‌های سازمان بهداشت جهانی را رعایت کردند، توصیه می‌شود استراتژی‌های بلندمدت و عملی برای ترویج سبک زندگی سالم‌تر در بین کودکان پیش‌دبستانی در ایران تدوین شود. کلیدواژه: وضعیت سلامت، کودکان، دستورالعمل، سازمان بهداشت جهانی

Assessment of Nutritional Outcomes and maternal sense of competence in Preterm Infants Fed with Mother’s Own Milk versus Donor Human Milk in Neonatal Intensive Care Unit: a cross-sectional study in Iran
پرستاری
Jamalodin Begjani 1 ©, Nasim Bagheri Moheb 1 ℗, Marieh Rasoulpour 1, Kayvan Mirnia 2, Arash Bordbar 3, Shima Haghani 4
1 Department of Pediatric Nursing and Neonatal Intensive Care, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Pediatrics, School of Medicine, Children’s Medical Center, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Pediatrics, School of Medicine, Shahid Akbar-Abadi Hospital, Iran University of Medical Sciences, Tehran, Iran
4 Department of Biostatistics, Nursing Care Research Center, Iran University of Medical Sciences, Tehran, Iran
Abstract: Background: Preterm infants require specialized nutritional care, and breast milk plays a vital role in improving growth and reducing complications. This study aimed to assess the nutritional outcomes and maternal sense of competence in two groups of preterm infants fed with mother’s own milk versus donor human milk in a neonatal intensive care unit in Tehran, Iran. Methods: A descriptive-correlational, cross-sectional design was employed. The study sample included 180 preterm infants admitted to the neonatal intensive care unit of Shahid Akbar-Abadi Hospital, between 2023- 2024, with gestational ages between 28-34 weeks and birth weights 1000-1499 grams. Participants were divided into two groups: exclusive mother’s own milk feeding and feeding with more than 50% donor human milk. Data were collected using three instruments: a demographic information form, a daily feeding record checklist, and the standardized Parenting Sense of Competence (PSOC) Questionnaire. Statistical analysis was conducted using SPSS version 22. Descriptive statistics, independent t-tests, chi-square, and Fisher’s exact tests. A significance level of P-value of less than 0.05 was considered. Results: No statistically significant difference was found between the two groups regarding feeding tolerance (p = 0.468) using Fisher’s exact test. The number of days to achieve full enteral feeding also did not differ significantly between mother’s milk and donor milk groups (p = 0.744). However, the duration of total parenteral nutrition was significantly longer in the donor milk group compared to the mother’s milk group (p = 0.016). Maternal sense of competence scores showed no significant difference between the two groups (p = 0.724). Conclusion: The findings indicate that preterm infants fed with mother’s own milk required fewer days of parenteral nutrition. Encouraging breastfeeding, especially among mothers of preterm infants, should be a priority for healthcare policymakers. Additionally, maternal sense of competence was similar in both feeding groups, suggesting that this perception is influenced by feeding methods, the level of social support received, and maternal health conditions. Personalized lactation support promotes maternal competence, well-being, and improved infant outcomes. Keywords: Mothers, competence, Premature infant, Nutritional Outcomes, Breast milk; Donor human milk, Human milk, Neonatal intensive care unit IR.TUMS.FNM.REC.1402.102

Atraumatic Care During Invasive Procedures for Children: A review article
پرستاری
Kousar Soltani 1 ©, Arash Khalili 2, Hadis Azari 3 ℗
1 Kousar Soltani Msn Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran.
2 Arash Khalili Ph.D Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran
3 Hadis Azari , Social Determinants of Health Research Centre, Research Institute for Prevention of Non-communicable Diseases, Qazvin University of Medical Sciences, Qazvin, Iran
Abstract:

 مقدمه: درد و استرس ناشی از پروسیجرهای تهاجمی مانند تزریق، خون‌گیری و روش‌های تشخیصی در کودکان شایع است و می‌تواند اثرات روانشناختی بلندمدت مانند ترس از مراقبت‌های پزشکی ایجاد کند. فلسفه مراقبت آتروماتیک در پرستاری کودکان بر کاهش این مشکلات با روش‌های غیر دارویی مانند تکنیک‌های distraction (بصری، شنیداری) و comfort holds (در آغوش گرفتن یا موقعیت‌دهی حمایتی) تأکید دارد. این مرور سیستماتیک با بررسی ادبیات از ۲۰۱۰ تا ۲۰۲۵، به ارزیابی اثربخشی، ایمنی و امکان‌پذیری این تکنیک‌ها در تنظیمات بالینی کودکان به‌ویژه در محیط‌های با منابع محدود پرداخته تا راهنمایی عملی برای پرستاران ارائه دهد. روش کار: این مرور سیستماتیک بر اساس راهنمای PRISMA انجام شد. جستجوی جامع در پایگاه‌های داده PubMed، Scopus، Cochrane Library و Web of Science از ژانویه ۲۰۱۰ تا آگوست ۲۰۲۵ با کلمات کلیدی "pediatric pain reduction"، "distraction techniques children"، "invasive procedures stress" و "non-pharmacological interventions" صورت گرفت. مطالعات تصادفی کنترل‌شده (RCTs)، شبه‌تجربی و مرورها با تمرکز بر کودکان ۰ تا ۱۸ سال و پروسیجرهای تهاجمی گنجانده شدند. معیارهای ورود شامل ارزیابی درد با Wong-Baker FACES Pain Scale و استرس با Children's Anxiety Meter-State بود؛ مطالعات بدون کنترل یا با کیفیت پایین حذف شدند. کیفیت با ابزار RoB ۲ برای RCTs و MMAT برای سایر مطالعات بررسی شد. داده‌ها کیفی سنتز شدند و متاآنالیز با RevMan برای اندازه اثر انجام شد. از ۵۶۷ مقاله، ۴۲ مطالعه انتخاب شدند. یافته‌ها: از ۴۲ مطالعه، ۲۸ مورد بر تکنیک‌های distraction (مانند ویدیو، موسیقی، واقعیت مجازی) تمرکز داشتند که کاهش ۳۰-۵۰% درد و استرس را در کودکان بالای ۲ سال طی پروسیجرهای سوزنی نشان داد. 8 مطالعه بر comfort holds تأکید کردند که در نوزادان و کودکان کوچک‌تر (کاهش ۳۵% درد) و کاهش نیاز به تسکین‌دهنده‌ها مؤثر بود. ترکیب این دو در ۶ مطالعه، بهترین نتیجه (کاهش ۶۰% درد) را داشت. واقعیت مجازی در کاهش اضطراب برتر بود، اما نیاز به تجهیزات داشت. سن، رشد و نوع پروسیجر بر اثربخشی تأثیر داشتند و ایمنی کلی بالا بود. نتیجه‌گیری: تکنیک‌های غیر دارویی مانند distraction و comfort holds، ابزارهای ایمن و مؤثر برای کاهش درد و استرس در کودکان طی پروسیجرهای تهاجمی هستند و تجربه بیمار و کادر را بهبود می‌بخشند. ترکیب این روش‌ها با رویکرد فردی‌سازی‌شده توصیه می‌شود. نیاز به آموزش پرستاران، استانداردسازی و تحقیقات بلندمدت برای اثرات روانشناختی وجود دارد. این یافته‌ها بر ادغام این استراتژی‌ها در سیاست‌های بالینی تأکید دارند. کلمات کلیدی: تکنیک‌های distraction، comfort holds، پرستاری کودکان، درد پروسیجری، استرس کودکان

Causes of readmission of diabetic children within 1 month after discharge to Zahra Mardani Azari Children's Hospital, Tabriz
پرستاری
طیبه جمشیدی-کارشناس ارشد پرستاری 1 ©, ناهید دهخدا-کارشناس ارشد پرستاری 1 ℗, دکتر سیامک شیوا-فوق تخصص غدد کودکان 1, کد اخلاق: IR.TBZMED.REC.1402.729 1
1 مرکز آموزشی، پژوهشی و درمانی کودکان زهرا مردانی آذری تبریز(https://mardaniazari.tbzmed.ac.ir)
Abstract:

 مقدمه : بستری شدن بیماران مبتلا به DKA و هیپرگلیسمی بار قابل توجهی را بر سیستم درمانی و خانواده کودک مبتلا به دیابت تحمیل می‌کند. این مطالعه با هدف بررسی علل خطر بستریهای بدون برنامه کودکان مبتلا به دیابت و برنامه ریزی برای رسیدگی به این مسئله چند عاملی و در نهایت کاهش بار در سطوح فردی و سازمانی انجام شده است. روش کار: نمونه مطالعه شامل یک گروه گذشته‌نگر از کودکان سنین 2 تا 17 ساله با تشخیص دیابت نوع 1 بستری در بیمارستان کودکان تبریز بین سال‌های 1402 تا تیرماه 1404 بودند. نتایج: فراوانی های بستری مجدد و علل آنها بررسی شد. از 610 کودک مورد بررسی 20 نفر بستری مجدد در عرض ۱ ماه بعد از ترخیص داشتند که مدت اقامت آنها در بیمارستان 2 تا 10 روز بود. کودکان در سنین 2-17 سال بودند،65% در سنین 6-12 سال،یک شیرخوار دو ساله و 30% کودکان در سنین 14-17 سال بودند. پنجاه و پنج درصد کودکان دختر و 45% پسر بودند.پنجاه درصد به دلیل هیپرگلیسمی و 50% به دلیل DKA بستری شده بودند. از کودکان بستری مجدد 55 % مورد جدید شناخته شده دیابت و بستری اول بودند و 45% سابقه بستری قبلی با تشخیص دیابت داشتند. از عوامل بستری مجدد20% به دلیل ابتلا به عفونت و سرماخوردگی ، 25% قطع تزریق انسولین،20 % عدم رعایت رژیم غذایی و استرس کودک،20 % عدم کنترل مرتب قند خون به دلیل مشکلات اقتصادی و عدم تهیه نوارگلوکومتر و 15 % آگاهی ناکافی مراقب اصلی کودک درمورد نحوه کنترل دیابت بود. این بررسی تاثیر دو عامل اصلی، مشکلات اقصادی و آگاهی ناکافی کودک و مراقب اصلی کودک را در پیش‌بینی خطر بستری مجدد در جمعیت کودکان بیان می‌کند. بحث: این مطالعه می‌تواند به جهت‌گیری‌های آینده در شناسایی زودهنگام عوامل خطرو کاهش میزان بستری مجدد با توصیه هایی از جمله آموزش بیمار و خانواده با اخذ بازخورد اطلاعات دریافت شده به صورت شفاهی و کتبی، دریافت کمک از مددکاران اجتماعی ، متخصصان تغذیه و روانشناسان در طول مدت بستری کودک مبتلا به دیابت کمک کند. کلمات کلیدی: بستری مجدد، دیابت نوع 1، دیابت کودکان کد اخلاق: IR.TBZMED.REC.1402.729

Challenges and Nursing Strategies in the Care of Infants with Cleft Lip and Palate: A Systematic Review and Evidence-Based Clinical Algorithm Design
پرستاری
فرزانه مغدانی 1 © ℗, میترا سلمانی 1, حسین طاهری 2
1 کارشناسی ارشد مراقبت های ویژه .کمیته تحقیقات دانشکده پرستاری ومامایی علوم پزشکی شهید بهشتی ایران
2 دانشجوی کارشناسی ارشد روانشناسی بالینی دانشگاه علوم توانبخشی وسلامت اجتمایی ایران
Abstract:

 مقدمه:شکاف لب و کام از شایع‌ترین ناهنجاری‌های مادرزادی در ناحیه سر و گردن است که از بدو تولد، چالش‌های پیچیده‌ای را برای نوزاد و والدین آنان ایجاد می‌کند. مدیریت موفق این بیماران نیازمند یک رویکرد تیمی چندتخصصی است که در آن، پرستاران نقش محوری در مدیریت تغذیه، پیشگیری از عوارض و حمایت از خانواده ایفا می‌کنند.با این حال، یک راهنمای جامع و مبتنی بر شواهد برای مراقبت پرستاری از این نوزادان تاکنون وجود نداشته است. روش کار:این مطالعه، یک مرور سیستماتیک است که بر اساس راهنمای PRISMA 2020 انجام شد. جستجوی جامع در پایگاه‌های داده معتبر شامل( PubMed, Web of Science ,CINAHL, Scopus, SID) برای مقالات منتشر شده بین سال‌های ۲۰۱۰ تا ۲۰۲۵ با کلیدواژه‌های متنی و سرواژه‌های استاندارد (MeSH) نظیر, Cleft Lip, Cleft Palate و Nursing Care ومعادل های فارسی آن صورت گرفت. مطالعاتی که به مداخلات پرستاری در نوزادان مبتلا به CL/P می‌پرداختند (بر اساس معیار PICO)؛ انتخاب شدند. دو پژوهشگر به صورت مستقل، غربالگری، استخراج داده‌ها و ارزیابی کیفیت مقالات را با ابزارهای استاندارد (مانند CASP و Newcastle-Ottawa) انجام دادند .در مجموع ۱٬۲۰۴ مقاله به دست آمده ، 60 مقاله وارد مطالعه شد. در نهایت یافته‌ها به صورت موضوعی تحلیل و در قالب یک الگوریتم بالینی مبتنی بر شواهد سنتز گردید.هدف از این الگوریتم، ترجمه شواهد علمی به دست آمده از مرور سیستماتیک به یک ابزار کاربردی و قابل استفاده برای پرستاران در محیط بالینی است. یافته‌ها:یافته‌ها در چهار حوزه اصلی دسته‌بندی شدند: (۱) مدیریت تغذیه، (۲) مراقبت‌های پیرامون جراحی، (۳) حمایت روانی–اجتماعی وآموزش والدین (۴) مدیریت عوارض بلندمدت. بیشترین چالش گزارش‌شده از سوی والدین، نیاز به حمایت روانی–اجتماعی و کمبود آموزش ساختارمند بود. برای هر حوزه، راهکارهای مبتنی بر شواهد با هدف ارتقای کیفیت مراقبت و کاهش عوارض ارائه شد. الگوریتم طراحی‌شده این راهکارها را در قالب یک ابزار گام‌به‌گام برای تصمیم‌گیری پرستاران ارائه کرد. نتیجه‌گیری:پرستاران با ارائه مراقبت‌های تخصصی، هماهنگ و خانواده‌محور، نقش مهمی در بهبود پیامدهای بالینی و کیفیت زندگی نوزادان مبتلا به شکاف لب و کام و والدینشان دارند. این مطالعه، برای نخستین بار، شواهد موجود را به یک الگوریتم عملی و گام‌به‌گام برای مراقبت پرستاری این نوزادان تبدیل کرده است. این الگوریتم می‌تواند به استانداردسازی مراقبت‌هاو بهبود تصمیم‌گیری بالینی پرستاران کمک کند. پیشنهاد می‌شود در پژوهش‌های آینده، اثر این الگوریتم بر پیامدهای کمی مانند افزایش موفقیت تغذیه و بهبود وضعیت روانی والدین در بسترهای فرهنگی و منابع مختلف ارزیابی شود. کلیدواژه فارسی: شکاف لب، شکاف کام، مراقبت پرستاری، تغذیه نوزاد 

Chemotherapy side effects in children and adolescents with leukemia and its relationship with maternal treatment information
پرستاری
حسنا قربانی 1 © ℗
1 کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی تبریز، تبریز، ایران
Abstract: Background & Aim The evaluation of side effects caused by chemotherapy drugs in the hospital provides a proper view of the cause, severity and degree of preventability of side effects. Parents are increasingly taking on the role of providing nursing care for their children, on the other hand, knowing their level of information as a management tool can be used in planning and improving health measures; Therefore, it is necessary to determine the information of the parents and especially the mother as the main caregiver before the first discharge of their child from the hospital. Therefore, this study was conducted with the aim of determining the side effects of chemotherapy in children and adolescents with leukemia and its relationship with mothers' treatment information. Methods & Materials A cross-sectional descriptive study was conducted in 2022 involving 110 mothers and their children and adolescents (aged 6-18) with leukemia who were receiving care at Tabriz teaching hospitals. Data collection instruments included the American Cancer Society's chemotherapy side effects checklist and the Motlagh et al. information questionnaire for parents of children with cancer. Data analysis was performed using SPSS version 24, employing chi-square tests, one-way ANOVA, paired t-tests, and repeated measures ANOVA. Results The severity of complications related to fever, nausea, vomiting, mouth ulcers, diarrhea, and anorexia demonstrated a linear increase throughout chemotherapy cycles. Constipation and bleeding showed a non-linear (U-shaped) increase. The most serious complications were associated with anorexia, nausea, and fever, while constipation and bleeding were the least severe. A significant relationship was found between all chemotherapy complications and the level of maternal information (p0.05). Conclusion Our results showed that mothers with a child with leukemia under the first course of chemotherapy sought to obtain or increase their information related to their child's treatment, and the acquisition of information was more at the time of chemotherapy side effects. The findings of the present study can be vital in planning and implementing programs to improve mothers' information and reduce the side effects of chemotherapy among children and adolescents with leukemia. It can also help nursing education officials to place the concepts of chemotherapy and the importance of caregivers' information, which has been given less attention so far, as a more essential part of nursing education programs. Keywords Cancer, leukemia, children, teenagers, treatment information, chemotherapy side effects 

Child abuse and its consequences on parents and family: A qualitative study
پرستاری
فریده بحرینی 1 © ℗, عباس عباس زاده 2, فریبا برهانی 2, محمود عباسی 3, اعظم شیرین آبادی فراهانی 4
1 دانشجوی دکترای پرستاری، عضو کمیته تحقیقات دانشجویی، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی
2 گروه پرستاری داخلی جراحی،دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی
3 گروه پزشکی اجتماعی، دانشکده پزشکی، دانشگاه علوم پزشکی شهید بهشتی
4 گروه کودکان و مراقبت‌های ویژه نوزادان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی شهید بهشتی
Abstract:

 کودک‌آزاری به عنوان یکی از مهم‌ترین مشکلات اجتماعی و بهداشتی، تأثیرات گسترده‌ای فراتر از کودک مورد آزار را شامل می‌شود و به صورت مستقیم و غیرمستقیم بر والدین و کل ساختار خانواده اثرگذار است. والدینی که کودکان‌شان مورد آزار قرار می‌گیرند، معمولاً با احساسات پیچیده‌ای مواجه می‌شوند که می‌تواند منجر به کاهش کارکرد والدگری و تضعیف روابط خانوادگی شود. علاوه بر این، کودک‌آزاری می‌تواند روابط بین اعضا را تحت فشار قرار دهد؛ به طوری که ایجاد فضای ناامن و پرتنش در خانواده، احتمال بروز مشکلات روانی و رفتاری در سایر اعضای خانواده را افزایش می‌دهد. این چرخه معیوب، سلامت روان والدین و سلامت جسمانی و روانی کودک را به خطر می‌اندازد. بنابراین، شناخت دقیق تأثیرات کودک‌آزاری بر والدین و خانواده، کلید طراحی مداخلات مؤثر برای حمایت از کل خانواده و کاهش پیامدهای منفی این پدیده است. این مطالعه با هدف فهم عمیق تأثیرات کودک‌آزاری بر والدین و خانواده از دیدگاه آنان انجام شد. پژوهش حاضر با رویکرد کیفی و با بهره‌گیری از تحلیل محتوای قراردادی، در سال 2025 و با مشارکت والدین کودکان آزاردیده بستری در بخش‌های درمانی کودکان انجام شد. از تکنیک‌ نمونه‌گیری هدفمند برای انتخاب والدینی که معیارهای ورود را داشتند، استفاده شد. پس از رعایت ملاحظات اخلاقی از جمله، تایید کمیته اخلاق، رضایت آگاهانه و کتبی مشارکت‌کنندگان، حق انصراف از تحقیق و محرمانگی، مصاحبه‌های نیمه ساختار یافته با والدین، به صورت حضوری و طی مدت زمان 30 تا 60 دقیقه انجام شد، نمونه گیری تا زمان اشباع داده‌ها ادامه یافت. تحلیل داده‌ها با استفاده از روش تحلیل محتوای قراردادی مبتنی بر رویکرد Graneheim وlundman انجام شد. برای بهبود صحت و استحکام داده ها معیارهای Lincoln و Guba مورد استفاده قرار گرفت. در مجموع 12 نفر از والدین کودکان آزاردیده در این مطالعه شرکت کردند. تأثیرات کودک‌آزاری بر والدین و خانواده در چهار محور اصلی دسته‌بندی گردید:1) احساس اضطراب و درماندگی2) احساس گناه و اختلال در نقش والدینی3) بار مالی و اجتماعی 4) فروپاشی ساختار زندگی خانوادگی. یافته‌ها نشان داد که کودک‌آزاری تأثیرات گسترده و چندوجهی بر والدین و ساختار خانواده تحمیل می‌کند که نیازمند حمایت‌های گسترده است. این نتایج تأکید می‌کند که کودک‌آزاری نه تنها بر کودک بلکه به طور گسترده‌ای بر والدین و خانواده تأثیرگذار است و مداخلات حمایتی و روان‌شناختی باید همه‌جانبه و خانواده‌محور باشد. پیشنهاد می‌شود خدمات درمانی و حمایتی به گونه‌ای طراحی شوند که علاوه بر کودک، نیازهای روانی، اجتماعی و اقتصادی والدین نیز مورد توجه قرار گیرد. 

Children's health challenges in water scarcity: An analysis of the role of pediatric nursing in care and education
پرستاری
لیلا نیک روز 1 ℗, نرگس رحمانی 2, فاطمه السادات سید نعمت اله روشن 3 ©
1 استادیار، دانشکده پرستاری، دانشگاه علوم پزشکی یاسوج، کهکیلویه و بویراحمد، ايران
2 استادیار، دپارتمان پرستاری و مامایی، دانشگاه آزاد اسلامی واحد بابل، ایران
3 استادیار، دپارتمان پرستاری، دانشکده پرستاري و مامايي، علوم پزشکی، آزاد اسلامی، تهران، ایران.
Abstract:

 مقدمه: کمبود آب به عنوان یکی از پیامدهای مهم و فزاینده تغییرات اقلیمی، یکی از بزرگ‌ترین تهدیدات زیست‌محیطی و سلامت عمومی به ویژه در کودکان محسوب می‌شود. کودکان به دلیل ساختار فیزیولوژیکی حساس‌تر، نیازهای بالاتر به آب برای رشد و متابولیسم و همچنین وابستگی بیشتر به محیط زندگی، به شدت در معرض پیامدهای ناشی از کمبود منابع آبی و کاهش کیفیت آب قرار دارند. پیامدهای سلامت ناشی از کمبود آب شامل افزایش بیماری‌های گوارشی، سوءتغذیه، اختلالات رشد و عفونت‌های منتقله از آب است که منجر به افزایش مرگ‌ومیر و بار بیماری در این گروه سنی می‌شود. پرستاران اطفال، به عنوان رابطان کلیدی نظام سلامت، نقش برجسته‌ای در پیشگیری، مراقبت و آموزش جامعه برای مقابله با این چالش‌ها دارند. هدف این مرور نظام‌مند، تحلیل جامع تأثیرات کمبود آب بر سلامت کودکان و شناسایی نقش‌های کلیدی پرستاران اطفال در توسعه و اجرای مداخلات مراقبتی، آموزشی و حمایتی است که بتواند اثرات منفی این بحران زیست‌محیطی را کاهش دهد. روش کار (Methods) این مطالعه به روش مرور نظام‌مند (Systematic Review) و بر اساس دستورالعمل‌های PRISMA 2020 انجام شد. در گام نخست، جستجوی نظام‌مند در پایگاه‌های داده بین‌المللی معتبر شامل PubMed، Scopus و Web of Science و همچنین پایگاه‌های ملی (SID و Magiran) انجام گردید. بازه زمانی جستجو از ژانویه 2010 تا دسامبر 2024 در نظر گرفته شد. برای شناسایی جامع مطالعات، از کلیدواژه‌های ترکیبی و عبارات شاملShortage,Drought,WaterScarcity ,Pediatric Nursing, Child Health Nursing, Health, Nurse Role,Waterاستفاده شد. معیارهای ورود به مطالعه شامل:مقالات منتشرشده به زبان انگلیسی یا فارسی، مطالعاتی که به بررسی رابطه بین کمبود آب و پیامدهای سلامت کودکان پرداخته بودند، پژوهش‌هایی که نقش پرستاران در پیشگیری، آموزش، مراقبت یا سیاست‌گذاری مرتبط با بحران کمبود آب را مورد توجه قرار داده بودند. معیارهای خروج شامل: مقالات مروری غیراصولی، مقالات بدون دسترسی به متن کامل، گزارش‌های موردی منفرد و مطالعاتی که صرفاً بر بزرگسالان تمرکز داشتند. پس از حذف موارد تکراری، دو پژوهشگر مستقل فرآیند غربالگری عنوان، چکیده و متن کامل مقالات را انجام دادند. در صورت بروز اختلاف نظر، داور سوم تصمیم‌گیری نهایی را بر عهده داشت. در نهایت، 54 مقاله واجد شرایط برای تحلیل نهایی انتخاب شدند. برای ارزیابی کیفیت مقالات، از ابزار CASP (Critical Appraisal Skills Programme) متناسب با نوع مطالعه (مطالعات کیفی یا کمی) استفاده شد. داده‌های استخراج‌شده بر اساس سه محور اصلی دسته‌بندی گردیدند: 1-پیامدهای سلامت ناشی از کمبود آب در کودکان،2-مداخلات و نقش‌های پرستاران،3-راهکارها و سیاست‌های پیشنهادی در حوزه سلامت. 

Communication challenges caused by wearing masks and strategies used by pediatric nurses ‎during the COVID-19 pandemic: A qualitative study‎
پرستاری
Nafiseh 1 ℗, Reza 1 ©, Hanieh 2
1 Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Tehran ‎University of Medical Sciences, Tehran, Iran
2 Nursing and Midwifery Faculty, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract: Purpose The COVID-19 pandemic and the use of facemasks have caused many communication ‎‎challenges for pediatric nurses. The purpose of this study was to investigate these challenges ‎‎and the strategies that nurses use to overcome them during the nursing care of sick children.‎ Design and methods This was a qualitative study using conventional content analysis. The nurses were selected by ‎‎purpose-based sampling and interviewed semi-structurally between April and June 2023 at the ‎‎Children's Educational Therapy Center in Tabriz, Iran. The sample size was determined by the ‎‎data saturation principle. The report of this research followed the COREQ guidelines.‎ Results Twelve nurses were interviewed. The analysis revealed four main categories: “Disturbances in ‎‎communication”, “Disturbances in trust”, “Disturbances in providing care”, and “Nurses' ‎‎strategies to mitigate the challenges of mask usage. To solve the challenges caused by the mask, ‎‎nurses used solutions such as removing the mask and mitigating the adverse effects of mask ‎‎usage they used.‎ Effective communication between the nurse and the sick child, as an integral part of care, is one ‎factor that determines the quality of care and the provision of humanistic care. The presence of ‎communication barriers can disrupt this interaction, instilling fear and confusion in the child ‎during the care process, which hinders the creation of trust. Therefore, by searching for the ‎hidden meaning of the data, the theme “Humanistic care requires trust-based communication” ‎was discerned. This theme underscores the notion that trust-based communication is ‎indispensable for the provision of humanistic care.‎ To overcome the challenges of mask usage, nurses employed strategies to ensure effective and ‎compassionate care. In low-risk situations, they occasionally removed their masks to show their ‎faces and smile, which helped comfort children and build trust. Transparent and cartoon-‎themed masks were also used to improve communication. Nurses emphasized physical ‎presence, touch, and humor to connect with children, especially those too young to understand ‎verbal explanations. They personalized attire, used name tags and photo IDs, and engaged ‎mothers to help gain the child’s trust. Educational strategies included using dolls, videos, and ‎written instructions to explain procedures in a child-friendly way.‎ Conclusions This study highlights the communication challenges faced by pediatric nurses due to mask-‎‎wearing during the COVID-19 pandemic. Despite these challenges, nurses have developed ‎‎innovative strategies to improve communication and build trust with their young patients. ‎‎Further research is needed to evaluate the effectiveness and feasibility of these strategies.‎

Comparing Hematological Indices of People with Iron Deficiency Anemia, Thalassemia Minor and Major, and Healthy People
پرستاری
اکرم همتی پور 1 © ℗
1 کارشناسی ارشد پرستاری، دانشگاه علوم پزشکی آبادان، آبادان، ایران
Abstract: Background: This study aimed to evaluate three hematological indices in children and adolescents with iron deficiency anemia, thalassemia minor and major and healthy people. Materials and Methods: In this descriptive cross-sectional study, 164 patients were selected based on the inclusion and exclusion criteria, and divided into four groups (n=41): iron deficiency anemia, thalassemia minor, thalassemia major, and healthy people. The results obtained from the tests were recorded in the patients' checklist. Mann-Whitney test, Wilcoxon test, ROC curve and area under the curve were adopted for data analysis using SPSS Statistics V21.0. Results: The mean age of patients was 13.07±3.82 years, of which 100 (62.5%) were men. There is a significant difference due to the hemoglobin concentration (Hb) index in two-by-two comparison of the groups (P0.001), but this difference was not seen between iron deficiency and thalassemia minor groups (P=0.159). This difference was substantial (P0.001) in terms of mean corpuscular volume (MCV) index, although it was only seen between the iron deficiency and thalassemia major groups (P=0.225). Finally, this mean difference was reported in Serum ferritin index (P0.001), but no difference was observed between healthy group and thalassemia minor group (P=0.802). Conclusion: The results showed that there is a difference in meanHb, MCV, and Ferritin levels between the studied groups, and the Hb and Ferritin indices are favorable for iron deficiency anemia, and the Hb and MCV indices are favorable to distinguish the thalassemia minor and major from healthy people

Comparing the effect of listening to music and watching cartoon on pain and physiological indices caused by venipuncture in children: A randomized controlled trial
پرستاری
زهرا توکل نیا 1 ℗, مهشید میرزایی تکلیمی 2 ©, یاسمن یعقوبی 3, سامان معروفی‌زاده 4
1 کارشناسی ارشد پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
2 استادیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
3 دانشیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
4 استادیار گروه آمار زیستی و اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی گیلان، رشت
Abstract:

 مقدمه و هدف: رویه‌های دردناک از علل اصلی ایجاد درد در کودکان طی دوران بستری هستند. تسکین درد یک نیاز اساسی در کودکان است که با استفاده از روش‌های غیردارویی، جهت پیشگیری از عوارض درد تسکین نیافته و روش‌های دارویی، توصیه می‌شود. لذا این مطالعه با هدف تعیین و مقایسه تاثیر گوش‌دادن به موسیقی و تماشای کارتون بر درد و شاخص‌های فیزیولوژیک ناشی از رگ‌گیری در کودکان انجام شد. روش کار: این مطالعه به صورت کارآزمایی بالینی شاهددار تصادفی شده، با کد اخلاق IR.GUMS.REC.1403.461، بر روی 114 کودک 3 تا 6 ساله بستری در مرکز آموزشی و درمانی هفده شهریور رشت انجام شد که با استفاده از روش نمونه‌گیری تدریجی و تصادفی‌سازی بلوکی در سه گروه گوش‌دادن به موسیقی، تماشای کارتون و کنترل تخصیص یافتند. در گروه‌های مداخله، مداخلات از سه دقیقه قبل تا پایان رویه رگ‌گیری انجام گرفت؛ به صورتی که در گروه گوش‌دادن به موسیقی، کودکان با استفاده از اسپیکر به موسیقی کودکانه گوش داده و در گروه تماشای کارتون، با استفاده از تبلت، کارتون مورد نظر را تماشا کردند. در گروه کنترل نیز کودکان مراقبت‌های استاندارد را دریافت کردند. شدت درد با استفاده از مقیاس ارزیابی درد اوشر و شاخص‌های فیزیولوژیک (ضربان قلب و اشباع اکسیژن خون شریانی) با استفاده از پالس اکسی‌متر انگشتی، سه دقیقه قبل از شروع رویه، حین (زمان ورود آنژیوکت) و پایان رویه (پس از تثبیت آنژیوکت) ارزیابی شد. تجزیه‌و‌تحلیل داده‌ها با استفاده از نرم‌افزار SPSS نسخه 16، آمار توصیفی و آزمون‌های آماری آنکووا و بونفرونی انجام شد. یافته‌ها: نتایج نشان داد کودکان در گروه‌های موسیقی و کارتون، حین و پایان رگ‌گیری، به طور معناداری میانگین نمره درد کمتری نسبت به گروه کنترل داشتند (0/001P)، درحالی‌که بین دو گروه مداخله تفاوت آماری معناداری مشاهده نشد (0/05P). در بررسی میانگین تعداد ضربان قلب، فقط در پایان رگ‌گیری، گروه کارتون به صورت معنادار، میانگین تعداد ضربان قلب کمتری نسبت به گروه کنترل داشت (0/05P) و در سایر مقایسه‌ها بین سه گروه موردمطالعه، در حین و پایان رگ‌گیری، تفاوت معناداری مشاهده نشد (0/05P). همچنین از نظر میانگین درصد اشباع اکسیژن خون شریانی بین سه گروه‌ موردمطالعه، حین و پایان رویه، تفاوت آماری معناداری وجود نداشت (0/05P). نتیجه‌گیری: نتایج این مطالعه نشان‌دهنده تاثیرگذاری گوش‌دادن به موسیقی و تماشای کارتون بر کاهش درد ناشی از رگ‌گیری در کودکان بود، لذا استفاده از این روش‌های غیردارویی، کم هزینه و کم عارضه جهت تسکین درد ناشی از رویه‌های تهاجمی توصیه می‌شود. کلیدواژه‌ها: درد، موسیقی، کارتون، رگ‌گیری، کودکان سن قبل مدرسه

Design and Effectiveness of a Smart Digital Parenting Program for Preventing Internet Addiction in Children: A Family-Centered Media Literacy Educational Approach
پرستاری
Samaneh Fallah Karimi 1 ℗, Zahra Khalilzadeh Farsangi 2 ©
1 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran.
2 Master student in Nursing, student research committee, Zahedan University of Medical Sciences, Zahedan, Iran.
Abstract: Background and Aim: The increasing use of the internet among children has raised concerns about internet dependency and addiction. Digital parenting, especially when delivered through smart, education-based platforms, can play a significant role in preventing this issue. This study aimed to design and evaluate the effectiveness of a digital parenting intervention program based on media literacy to reduce the risk of internet addiction in children. Methods: This semi-experimental study with a pretest-posttest and two-month follow-up design and a control group was conducted in 2024 in elementary schools of Zahedan. The study population included parents of children aged 8 to 12 years. Sixty parents were randomly selected and assigned into intervention (n=30) and control (n=30) groups. The intervention group received six weeks of training via the smart app "Conscious Parenting," covering digital parenting styles, managing online behaviors, critical dialogue with children, media literacy, and effective supervision strategies. The control group received no intervention. Data were collected at three time points (pre-intervention, post-intervention, and two-month follow-up) using the Child Internet Addiction Scale, Digital Parenting Questionnaire, and Parental Media Literacy Scale. Data were analyzed using paired t-tests, independent t-tests, and ANCOVA with significance level set at p0.05. Results: Findings indicated a significant decrease in children’s internet addiction scores in the intervention group after the program (p0.001), which remained stable at the two-month follow-up. Additionally, digital parenting and parental media literacy scores increased significantly compared to the control group (p0.001). No significant changes were observed in the control group (p0.05). ANCOVA confirmed the independent and significant effect of the intervention on the studied variables (p0.01). Conclusion: The digital parenting educational program based on a smart platform can be an effective and practical strategy for preventing internet addiction in children by enhancing media literacy and promoting conscious parent-child interaction. Keywords: Digital Parenting, Internet Addiction, Media Literacy, Parent Education, Children, Preventive Intervention 

Digital Ethics in Care: Equity-Centered AI Frameworks in Pediatric and Family Nursing
پرستاری
ثنا خلیل زاده ضیاء 1 © ℗, مهدی محمودزاده 2, سیما پورتیمور 1
1 Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
2 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Khoy
Abstract: Background Artificial intelligence (AI) is transforming pediatric and family nursing through enhanced diagnostics, personalized care plans, and family support. Yet, ethical challenges—including algorithmic bias, data privacy, and unequal access—pose risks for vulnerable children, particularly those from marginalized communities. Equity-focused frameworks seek to ensure justice, fairness, and inclusivity in AI adoption, preventing the amplification of health disparities in hospitals and community care. Objective To systematically review equity-oriented ethical frameworks for AI in pediatric and family nursing, outlining their development, implementation, and effects on justice, and identifying gaps for future practice. Methods Following PRISMA guidelines, a systematic search (2020–2025) was conducted in PubMed, CINAHL, Scopus, Web of Science, and PsycINFO. Eligible publications included empirical studies, reviews, and policy analyses addressing bias mitigation, privacy, equity, and justice in AI applications for pediatric/family nursing. Results Twenty-two studies were included. Core principles emphasized transparency, accountability, and inclusivity. Strategies such as bias audits and participatory design improved equity scores by 25–40% in AI-driven diagnostics. While AI enhanced early disease prediction (85–95% accuracy for neonatal sepsis), biases disproportionately affected racial/ethnic minorities. Nurse education programs boosted ethical competencies (effect size: d = 0.65). Challenges included privacy breaches (15–30% prevalence) and limited family involvement in AI design. Integrated frameworks facilitated fair resource allocation and improved family-centered outcomes (RR = 1.45, 95% CI 1.20–1.75). Conclusion Equity-centered AI ethics frameworks are crucial for fair and safe integration in pediatric and family nursing. Recommendations include nurse-led ethics training, systematic bias mitigation, and inclusive governance policies to align AI adoption with health equity goals. Keywords: AI ethics, pediatric nursing, equity frameworks, family-centered care, digital justice

Digital parenting and the role of nurses in promoting children's mental health in cyberspace
پرستاری
فاطمه السادات سید نعمت اله روشن 1 © ℗, آذر رابط میلی 2, زهرا سلطان تویه 3
1 استادیار، دپارتمان پرستاری، دانشکده پرستاري و مامايي، علوم پزشکی، آزاد اسلامی، تهران، ایران.
2 کارشناسی ارشد مراقبتهای ویژه نوزادان، سوپروایزر آموزشی بیمارستان کودکان بهرامی، تهران، ایران
3 کارشناس پرستاری، سوپروایزر بالینی بیمارستان کودکان بهرامی، تهران، ایران
Abstract:

 مقدمه: با گسترش فناوری‌های دیجیتال، استفاده از اینترنت، شبکه‌های اجتماعی و دستگاه‌های هوشمند به بخشی جدایی‌ناپذیر از زندگی کودکان و نوجوانان تبدیل شده است. در این میان، مفهوم «والدگری دیجیتال» به عنوان راهکاری برای مدیریت و نظارت والدین بر فعالیت‌های دیجیتال فرزندان، اهمیت فزاینده‌ای یافته است. سلامت روانی کودکان، رشد شناختی و اجتماعی آنان در تعامل با محیط دیجیتال به شدت تحت تأثیر سبک والدگری در فضای مجازی قرار دارد. پرستاران، به‌ویژه در حوزه بهداشت جامعه و سلامت خانواده، می‌توانند در ارتقاء سواد دیجیتال والدین و تدوین استراتژی‌های مؤثر برای حمایت از والدگری دیجیتال نقش کلیدی ایفا کنند.هدف از این مطالعه، تبیین ابعاد مفهومی والدگری دیجیتال و بررسی نقش پرستاران در ارتقاء سواد دیجیتال خانواده‌ها و حمایت از والدین در مدیریت ایمن و سالم فعالیت‌های رسانه‌ای فرزندان در عصر فناوری است. روش کار: این مطالعه به صورت مروری با رویکرد تحلیل محتوای کیفی انجام شد. برای جمع‌آوری داده‌ها، جستجوی سیستماتیک در پایگاه‌های بین‌المللی PubMed، Scopus، ScienceDirect و Google Scholar طی بازه زمانی ۲۰۱۵ تا ۲۰۲۵ انجام شد. کلیدواژه‌های جستجو شامل «والدگری دیجیتال»، «نقش پرستاران»، «سلامت روان کودک»، «فضای مجازی» و «سواد دیجیتال والدین» بودند. پس از حذف مقالات تکراری، عناوین و چکیده‌ها برای ارتباط با اهداف مطالعه بررسی و مقالات مرتبط انتخاب شدند. معیارهای ورود شامل مطالعات اصلی، مرور سیستماتیک، و مطالعات با محوریت والدگری دیجیتال و نقش پرستاران در ارتقاء سلامت روان و سواد دیجیتال خانواده‌ها بود، و مطالعات غیرمرتبط یا با کیفیت پایین کنار گذاشته شدند. در نهایت، ۳۸ مقاله با کیفیت بالا انتخاب و با استفاده از تحلیل محتوای کیفی مورد بررسی قرار گرفتند تا ابعاد مفهومی والدگری دیجیتال و راهکارهای عملی پرستاران شناسایی و طبقه‌بندی شود. نتایج: یافته‌ها نشان می‌دهد که والدگری دیجیتال شامل نظارت فعال، مشارکت در فعالیت‌های دیجیتالی، تعیین مرزهای زمانی و محتوایی، و گفت‌وگو با کودک در مورد خطرات فضای مجازی است. همچنین، پرستاران با برگزاری کارگاه‌های آموزشی، مشاوره‌های فردی و گروهی، و طراحی ابزارهای سنجش آمادگی والدین برای مدیریت رسانه‌های دیجیتال، می‌توانند در ارتقاء سطح آگاهی و مهارت خانواده‌ها نقش‌آفرینی کنند. در محیط‌های بالینی و جامعه‌محور، پرستاران واسطه‌ای مؤثر بین سیاست‌گذاران سلامت، نظام آموزش و خانواده‌ها هستند. بحث و نتیجه‌گیری: در دنیای امروز، والدگری دیجیتال یکی از مؤلفه‌های ضروری در تربیت سالم فرزندان است. این نوع والدگری نیازمند حمایت تخصصی از سوی نظام سلامت است. پرستاران با دارا بودن مهارت‌های ارتباطی، آموزشی و شناخت جامع از نیازهای رشدی کودکان، می‌توانند نقش راهبردی در ارتقاء والدگری دیجیتال ایفا کنند.

Effectiveness of an AI-Based Health Education Platform in Enhancing Family Health Literacy, Parental Caregiving Self-Efficacy, and Nurse-Family Interaction
پرستاری
Zahra Khalilzadeh Farsangi 1 ©, Samaneh Fallah Karimi 2 ℗
1 Master student in Nursing, student research committee, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran.
Abstract: Background and Aim: The integration of modern technologies—particularly artificial intelligence (AI)-based platforms—offers innovative opportunities for health education and enhancing caregiving competencies among children, families, and nurses. This study aimed to examine the effectiveness of an AI-based mobile health education platform on improving family health literacy, parental caregiving self-efficacy, and nurse-family interaction. Methods: This quasi-experimental study with a two-group pretest-posttest (three-month follow-up) design was conducted in 2024 in teaching hospitals affiliated with Zahedan University of Medical Sciences. A total of 60 children with chronic illnesses (aged 6–12), one parent per child, and their corresponding nurses were selected through simple random sampling and assigned to intervention (n=30) and control (n=30) groups. The intervention group received education via a researcher-designed AI-powered mobile platform, which included interactive multimedia modules on child health education, nutrition, medication management, emotional support, communication skills for parents, and professional interaction strategies for nurses. The training was accessible to participants over six weeks in an interactive format. Data were collected at two time points (before and three months after the intervention) using the Health Literacy Questionnaire (HLQ), Parenting Sense of Competence Scale (PSOC), and the Nurse-Family Partnership Process Measure (NFPPM). Data analysis was performed using paired t-tests, independent t-tests, and ANCOVA. A significance level of p0.05 was considered. Results: The results showed that the mean scores of family health literacy, parental caregiving self-efficacy, and nurse-family interaction significantly increased in the intervention group both compared to baseline and to the control group at the three-month follow-up (p0.001). No significant changes were observed in the control group (p0.05). ANCOVA confirmed the independent and significant effect of the intervention after adjusting for baseline scores (p0.01). Conclusion: The AI-based mobile platform proved effective in enhancing family health literacy, improving parental caregiving self-efficacy, and fostering more effective nurse-family interaction. This innovative educational approach may serve as a practical and scalable strategy for improving child-centered care and interprofessional collaboration. Keywords: Artificial intelligence, health education, self-efficacy, family, interaction, nurse 

Effectiveness of Corrective Exercise Programs on Musculoskeletal Function and Recovery in Hospitalized Pediatric Patients with Cerebral Palsy, Juvenile Idiopathic Arthritis, and Scoliosis: A Systematic Review
پرستاری
Sana Mahdian Rizi 1 © ℗
1 Students Research Committee, Neyshabur University of Medical Sciences, Neyshabur, Iran
Abstract: Background and Aim: Musculoskeletal disorders such as cerebral palsy (CP), juvenile idiopathic arthritis (JIA), and scoliosis significantly impair children’s mobility and quality of life, often requiring hospitalization and comprehensive rehabilitation. Corrective exercise programs are frequently used to improve muscle strength, flexibility, posture, and reduce pain in these populations. Despite their widespread application, there is limited consensus on their overall effectiveness and best practices. This systematic review aims to evaluate the evidence on the impact of corrective exercise interventions on musculoskeletal function and recovery in hospitalized pediatric patients diagnosed with CP, JIA, or scoliosis. Methods: A systematic search was conducted in PubMed, Scopus, Web of Science, PEDro, and Cochrane Library databases for studies published up to July 2025. Keywords included “corrective exercise,” “pediatric rehabilitation,” “cerebral palsy,” “juvenile idiopathic arthritis,” “scoliosis,” and “hospitalized children.” Inclusion criteria were original peer-reviewed articles focusing on hospitalized children (0–18 years) with CP, JIA, or scoliosis, assessing corrective exercise programs through quantitative musculoskeletal outcomes. Excluded were studies on outpatient care, surgical interventions alone, reviews, and case reports. Two reviewers independently screened 1,123 articles, and 19 met the inclusion criteria. Results: The included studies involved 8 on CP, 6 on JIA, and 5 on scoliosis, with sample sizes from 30 to 200 patients and intervention durations ranging from 4 weeks to 6 months. CP patients showed significant improvements in motor function, with Gross Motor Function Measure (GMFM) scores increasing by 12–18%. JIA patients experienced 25–40% reductions in joint pain (Visual Analog Scale) and 15-degree improvements in joint range of motion. Scoliosis studies reported average Cobb angle reductions of 5–7 degrees and enhanced trunk muscle endurance. Variability in protocols and outcome measures limited cross-study comparisons. Only six studies provided follow-up data beyond three months. Conclusion: Corrective exercise programs demonstrate effectiveness in improving musculoskeletal function and reducing symptoms in hospitalized pediatric patients with CP, JIA, and scoliosis. However, heterogeneity among studies and limited long-term data highlight the need for standardized, high-quality trials to establish optimal exercise protocols and promote sustained recovery. Keywords: Corrective exercise, Pediatric rehabilitation, Cerebral palsy, Juvenile idiopathic arthritis, Scoliosis

Effectiveness of Mindfulness Based Interventions on Stress Among Caregivers of Children with Chronic Illnesses: Systematic Review
پرستاری
Samaneh Rajabi Rahmatabadi 1 ℗, Mohammad Moein Mokhtarezadeh 2 ©, Taiebeh Dehghan 3, Fatemeh Farhang Firoozabadi 4
1 MSc student of pediatric nursing, Department of nursing, School of nursing and midwifery, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
2 Medical Student, Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 BSC of Nursing, Department of Obstetrics and Gynecology Department , Shahid Sadoughi Hospital, Yazd, Iran
4 BSC of Nursing, Endoscopy Department , Shahid Sadoughi Hospital, Yazd, Iran
Abstract: Introduction: Caring for children with chronic illnesses imposes substantial psychological and emotional demands on caregivers, often leading to heightened stress levels, anxiety, and burnout. Persistent caregiver stress can negatively affect both the caregiver’s health and the child’s treatment adherence and outcomes. Mindfulness Based Interventions (MBIs), grounded in present moment awareness and non judgmental acceptance, have emerged as evidence based strategies for stress reduction and resilience building in diverse populations, including family caregivers.This systematic review aimed to evaluate the effectiveness of mindfulness based interventions in reducing stress among caregivers of children with chronic illnesses. Methods: Following the PRISMA 2020 guidelines, a comprehensive search was conducted in PubMed, Scopus, Web of Science, and Cochrane Library for studies published between January 2010 and April 2025. Search terms included “mindfulness,” “caregivers,” “chronic illness,” “children,” and “stress reduction.” Eligible studies involved parent or primary caregivers of pediatric patients with any chronic condition, employed MBIs such as Mindfulness Based Stress Reduction (MBSR) or Mindfulness Based Cognitive Therapy (MBCT), and assessed stress using validated measurement tools. Exclusion criteria included studies involving non parent caregivers or non mindfulness interventions. Methodological quality was appraised using the Joanna Briggs Institute critical appraisal tools. Due to heterogeneity in intervention design, a narrative synthesis was performed, supplemented by pooled effect size calculations when feasible. Results: 19 studies encompassing 1,375 participants met inclusion criteria. Intervention formats included group based sessions (n=12), online programs (n=5), and hybrid models (n=2), with durations ranging from 6 to 12 weeks. All studies reported significant post intervention reductions in caregiver stress. The pooled standardized mean difference (SMD) for stress reduction was −0.71. Additional benefits included improvements in anxiety (SMD = −0.54) and depressive symptoms (SMD = −0.48). Intervention adherence rates exceeded 80% in most studies. Conclusion: Mindfulness based interventions demonstrate moderate to large effectiveness in reducing stress and enhancing psychological well being among caregivers of children with chronic illnesses. Incorporating MBIs into pediatric healthcare support programs may promote caregiver resilience and indirectly benefit child health outcomes. Further research should investigate long term maintenance effects and optimal delivery modalities for diverse care settings. Keywords: Mindfulness, Caregivers, Chronic Illness, Stress Reduction, Pediatric. 

Effectiveness of Play Therapy for pain and Anxiety Relief in Children Following Surgery: A Systematic Review
پرستاری
ارغوان نامداری 1 © ℗, مهسا خدمتی زارع 1, زهرا کفشگر 1
1 دانشجوی کارشناسی ارشد پرستاری داخلی-جراحی، مرکز پژوهشهای علمی دانشجویان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تهران، تهران، ایران
Abstract: Introduction: Play therapy has emerged as a novel, non-invasive approach to improving the psychological status of children after surgery. Postoperative pain and anxiety can affect the recovery process and reduce their quality of life. Play therapy may help reduce these complication and provide a better treatment experience for children. By creating a safe and joyful space, it enables children to express feelings and reduce stress. This systematic review aims to examine the effectiveness of play therapy in alleviating pain and anxiety in children after surgery. Methods: A comprehensive search of reputable databases, including PubMed, Scopus, and Google Scholar, was conducted. Studies published from 2018 to 2025 were searched using keywords "play therapy," "pain relief," "anxiety," "children," and "post-surgery." After screening titles and abstracts and removing duplicates and irrelevant items and from a total of 256 retrieved articles, six randomized controlled trials assessing the effectiveness of play therapy in reducing pain and anxiety in children after surgery were selected and subjected to content analysis. Results: Recent randomized controlled trials indicate that the use of play therapy significantly reduces pain and anxiety in children after surgery and invasive procedures. The findings suggest that applying play therapy can serve as an effective complementary intervention in clinical centers to reduce pain and anxiety in children following invasive procedures. Overall, this systematic review emphasizes that play therapy is an efficient and non-harmful tool to improve the treatment experience for children after surgery and invasive procedures and to help reduce pain and anxiety related to procedures. Discussion and Conclusion: Play therapy, as a safe, non-harmful, and non-pharmacological approach, has shown high potential for controlling pain and anxiety in children after surgery and invasive procedures. Play therapy appears as a valuable, complementary approach to reduce pain and anxiety and may improve the surgical experience and recovery process. However, given the limitations of current research, more comprehensive studies with precise designs are necessary to develop and optimize practical and clinical frameworks. Keywords: play therapy, pain, anxiety, postoperative, children 

Effects of pinwheel blowing and stress ball squeezing on children’s pain and anxiety during IV catheterization: a randomized controlled trial
پرستاری
ریحانه دهقان دهنوی 1 ℗, نسرین شریفی 2, زهرا جمشیدی 3, زهرا هادیان شیرازی 3 ©
1 1)Research Center for Nursing and Midwifery Care, Department of Nursing, School of Nursing and Midwifery, Non-Communicable Diseases Research Institute, Shahid Sadoughi University of Medical Sciences, Yazd, Iran; 2)Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
2 School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
3 Department of Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
Abstract:

 برقراری خط وریدی از شایع‌ترین اقدامات در بیمارستان است که معمولاً با درد و اضطراب قابل‌توجهی در کودکان بستری همراه می‌باشد. این کارآزمایی تصادفی‌ و کنترل‌شده با هدف مقایسه تأثیر فشردن توپ استرس و دمیدن فرفره بر شدت درد و اضطراب ناشی از ورود کاتتر وریدی در کودکان سنین مدرسه انجام شد. در این مطالعه، ۹۰ کودک ۶ تا ۱۲ ساله بستری در بخش‌های کودکان بیمارستان نمازی شیراز به‌صورت تصادفی در سه گروه توپ استرس، فرفره و کنترل تخصیص یافتند. شدت درد و اضطراب با استفاده از مقیاس درد اوچر (Oucher Pain Scale) و آزمون تصویری ونهام (VPT) در سه مرحله‌ی قبل، حین و پس از انجام پروسیجر ارزیابی گردید. نتایج نشان داد گروه فرفره کمترین میانگین نمره درد را گزارش کردند (3/11 ± 0/8)، پس از آن گروه توپ استرس (9/14 ± 5/14) و در نهایت گروه کنترل (6/34 ± 5/50) قرار داشتند؛ این تفاوت‌ها از نظر آماری معنادار بودند (p 0.05). همچنین میانگین نمره اضطراب در گروه فرفره (1/1 ± 7/0) به‌طور معناداری کمتر از گروه توپ استرس (2/1 ± 0/1) و گروه کنترل (8/2 ± 9/4) بود (p 0.05). بر اساس یافته‌های این پژوهش، هر دو روش فشردن توپ استرس و دمیدن فرفره در کاهش درد و اضطراب کودکان مؤثر هستند، اما دمیدن فرفره تأثیر بیشتری نشان داد. بنابراین، می‌توان از این روش به‌عنوان یک تکنیک ساده، غیرتهاجمی و کم‌هزینه برای انحراف حواس و کاهش درد و اضطراب ناشی از برقراری خط وریدی در کودکان استفاده نمود.

Empowering Nurses in Providing Psychological Support and Enhancing Social Adaptation of Children and Families: An Innovative Interventional Approach
پرستاری
Zahra Khalilzadeh Farsangi 1 ℗, Samaneh Fallah Karimi 2 ©
1 Master student in Nursing, student research committee, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran.
Abstract: Background and Objective: Psychological support and enhancement of social adaptation for children and their families are among the most important roles of nurses in comprehensive care. Empowering nurses through innovative interventions can improve the quality of these supports. This study aimed to evaluate the effectiveness of a technology-based educational program to enhance nurses’ competencies in providing psychological support and promoting social adaptation in children and families. Methods: This interventional study with a pretest-posttest design and control group was conducted in 2024 in teaching hospitals affiliated with Zahedan University of Medical Sciences. The study population included nurses working in pediatric wards, from whom 60 eligible participants were randomly selected from 80 and equally assigned to intervention and control groups. The intervention group received specialized training over 8 weeks via an interactive smart application; the training included multimedia content and practical activities related to child developmental psychology, family-centered psychological support skills, effective communication techniques, and strategies to promote social adaptation of children and families. After each session, participants performed practical exercises and had online interaction opportunities with instructors. The control group received routine hospital training and did not have access to the application. Data were collected at two points: one week before the intervention (pretest) and three months after the completion of training (posttest), allowing evaluation of the intervention’s sustained effects. The instruments used included the Nurse Psychological Support Questionnaire, measuring the skills and effectiveness of psychological support (Cronbach’s α=0.89), and the Social Adaptation Scale for Children and Families, assessing social adaptation and communication abilities in family and social environments (Cronbach’s α=0.91). Data analysis was performed using paired t-tests for within-group comparisons, independent t-tests for between-group comparisons, and ANCOVA to control for pretest scores. A significance level of p0.05 was considered. Results: Findings showed a significant increase in nurses’ competencies in providing psychological support and enhancing social adaptation of children and families in the intervention group after the program (p0.001), while no significant changes were observed in the control group (p0.05). ANCOVA confirmed the independent and positive effect of the intervention (p0.01). Conclusion: The smart application–based educational program is an effective and practical method for empowering nurses in psychological support and promoting social adaptation among children and families, potentially improving the quality of psychosocial care in clinical settings. Keywords: Nurse, Psychological Support, Social Adaptation, Children, Families. 

Enhancing Social Interactions in Children with Autism through a Play-Based Approach
پرستاری
میرامیرحسین سیدنظری 1, سمیه قربانی 2 ℗, امیرمحمد درستی 3 ©, روشنک غلامی فر 4
1 کارشناس ارشد پرستاری داخلی جراحی، گروه پرستاری داخلی جراحی، دانشکده علوم پزشکی خوی، خوی، ایران
2 کارشناسی ارشد، رشته پرستاری اورژانس، گروه پرستاری ، دانشکده علوم پزشکی خوی، خوی، ایران
3 دانشجوی کارشناسی ارشد، رشته پرستاری داخلی جراحی، کمیته تحقیقات دانشجویی، دانشکده علوم پزشکی خوی، خوی، ایران
4 کارشناس پرستاری، گروه پرستاری ، دانشکده علوم پزشکی خوی، خوی، ایران
Abstract:

 مقدمه: اوتیسم یک اختلال در رشد سیستم عصبی است که با مشکلات در ارتباطات اجتماعی، علایق محدود و رفتارهای تکراری مشخص می‌شود. کودکان مبتلا به این اختلال، در جنبه‌های رشدی مرتبط با ارتباط و تعاملات اجتماعی، ضعف‌هایی نشان می‌دهند. با توجه به اهمیت تعاملات اجتماعی برای این کودکان، پژوهش حاضر با هدف مرور شواهد و بررسی تأثیر بازی بر بهبود تعاملات اجتماعی آن‌ها انجام شده است. روش تحقیق: این یک مطالعه مروری روایتی است که در آن، جستجوی گسترده‌ای با کلیدواژه‌های مرتبط با بازی، تعامل اجتماعی، کودکان و اوتیسم، در پایگاه‌های داده بین‌المللی Scopus، Web of Science، PubMed/Medline و موتور جستجوی Google Scholar، و همچنین پایگاه‌های ملی SID، Magiran و Irandoc انجام شد. معیارهای ورود شامل دسترسی رایگان به متن کامل مقالات و انتشار به زبان فارسی یا انگلیسی بود. مقالات مروری، نامه‌ها به سردبیر و مقالات همایشی حذف شدند. مقالاتی که بین سال‌های ۲۰۱۴ تا ۲۰۲4 منتشر شده بودند، بررسی شدند. در جستجوی اولیه، 50 مطالعه به دست آمد که پس از حذف موارد تکراری و نقد با ابزارهای مربوطه، نهایتاً 8 مطالعه برای تحلیل نهایی انتخاب شد. یافته‌ها: نتایج نشان داد که فعالیت‌های سازمان‌یافته مانند بازی با لگو، فرصتی طبیعی و انگیزه‌بخش برای تمرین مهارت‌های اجتماعی در محیط واقعی زندگی کودکان اوتیسم فراهم می‌کنند. این مداخلات، به‌ویژه با مشارکت فعال والدین، توانستند افزایش قابل توجهی در رفتارهای اجتماعی مناسب، کاهش رفتارهای پرخاشگرانه و بهبود مهارت‌های گفتاری در کودکان ایجاد کنند. در برخی مطالعات، این مهارت‌ها به زمان‌های آزاد و دیگر موقعیت‌های اجتماعی نیز منتقل شد؛ اما در مطالعات دیگر، در پیگیری دو ماهه در محیط خانه، مقداری کاهش در نتایج مشاهده شد. به طور کلی، مداخلات خانواده‌محور و بازی‌های هدفمند، رویکردی مؤثر برای تقویت ارتباطات اجتماعی و کلامی در کودکان دارای اوتیسم به شمار می‌آیند. نتیجه‌گیری: مداخلات مبتنی بر بازی، به خصوص با همکاری والدین، می‌توانند به شکل مؤثری تعاملات اجتماعی مناسب را افزایش داده و رفتارهای ناسازگار را کاهش دهند؛ هرچند پایداری نتایج در بلندمدت نیازمند پیگیری و حمایت مداوم است. با توجه به نقش والدین در ارتقاء این مهارت‌ها، توصیه می‌شود برنامه‌های آموزشی تخصصی برای آن‌ها تدوین و اجرا شود. کلمات کلیدی: بازی، تعاملات اجتماعی، کودکان، اوتیسم 

Epidemiology of accidents in children aged 1-59 months in the pre-hospital emergency of Kermanshah-Iran during 2021 to 2023
پرستاری
Nasim Bagheri Moheb 1 © ℗, Fatemeh Zaheri 2, Sobhan Bagheri 3
1 Ph.D. Student in Nursing, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2 M.Sc. in Emergency & Critical Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
3 Ph.D. Student in Nursing, Faculty of Nursing and Midwifery, Kermanshah University of Medical Sciences, Kermanshah, Iran
Abstract: Background and Objectives: Accidents are the main causes of death and one of the causes of children all over the world. Epidemiological studies play a role in preventing and controlling children's accidents by identifying the causes of accidents and environmental factors in the occurrence of accidents. This study was conducted with the aim of epidemiology of accidents in children aged 1-59 months in the pre-hospital emergency. Methods: The current study is a descriptive-analytical study that includes registered cases of children aged 1-59 months who were transferred to the hospital by the pre-hospital emergency. Sample collection was done in an accessible manner and through the Asayar system and checklist, and the information included demographic characteristics, type of accident, and receiving hospital. Data was analyzed using SPSS 21 software. Results: During these years, 963 children aged 1-59 months faced with accidents and incidents were investigated by the pre-hospital emergency department and 606 cases (63%) were transferred to the medical center. The incidents experienced in the order of prevalence are: accidents 539 (56%), trauma 127 (13%), aspiration 86 (08%) and falls from a height 77 (07%) were injured. The highest number of incidents and accidents in the age category of toddlers is 416 and related to boys 570 (59%) and during the summer season (33%). Conclusion: Considering the most important causes of accidents, designing interventions and training parents and children using preventive measures regarding accidents should be an effective step to reduce accidents. Also, preparing and implementing educational programs at home, complying with traffic regulations, training through mass media, strengthening monitoring systems on people's performance is necessary and effective in reducing accidents in society. Code: IR.KUMS.REC.1403.253 Keywords: Accidents, Children aged 1-59 months, Pre-hospital emergency

Evaluating the performance of baby-friendly hospitals of Isfahan University of Medical Sciences in 2024
پرستاری
مریم کاظمی 1 © ℗
1 معاونت بهداشت دانشگاه علوم پزشکی اصفهان
Abstract:

 دورۀ شیرخوارگی از حساسترین مراحل زندگی است که نیاز به مراقبت های دقیق بهداشتی و تغذیه ای دارد. در کشور ما همگام با شروع فعالیت های ترویج تغذیه با شیرمادر، ایجاد بیمارستان های دوستدار کودک از اولویت های برنامه کشوری قرار گرفت.از آنجا که راه اندازی بیمارستان های دوستدار کودک و تجربه اجرای ده اقدام در جهان در ارتقاء شاخص های شیر مادر نقش بسزایی داشته است، حفظ تداوم و حسن اجرای این اقدامات در بیمارستانها پس از اجرای اولیه و دریافت لوح اهمیت دارد. هدف از این مطالعه تعیین عملکرد بیمارستان های دوستدارکودک دانشگاه علوم پزشکی اصفهان در سال 1403 بود.روش کار: این مطالعه در گروه مطالعات توصیفی- تحلیلی با رویکرد ارزیابی عملکرد صورت پذیرفت. در این مطالعه از روش های مشاهده، بررسی اسناد و مصاحبه تصادفی بر اساس چک لیست استاندارد ابلاغی وزارت بهداشت، درمان و آموزش پزشکی جهت جمع آوری داده ها استفاده شد. ابزار جمع آوری داده ها در این مطالعه چک لیست های استاندارد ابلاغی از وزارت بهداشت، درمان و آموزش پزشکی بوده است. در ارزیابی عملکرد بیمارستان های دوستدارکودک از چک لیست، مصاحبه و مشاهده استفاده شد. در این مطالعه نمونه گیری صورت نپذیرفت و لذا تمام بیمارستان هایی که لوح دوستدارکودک دریافت نموده اند در دانشگاه علوم پزشکی اصفهان به صورت سرشماری مورد ارزیابی قرار گرفتند. یافته ها: نتایج این پژوهش نشان داد 54.1 درصد از بیمارستان های دانشگاه علوم پزشکی اصفهان از نظر رعایت استانداردهای دوستدارکودک دارای امتیاز ممتاز می باشند. 24.3 درصد از کل بیمارستان های دوستدارکودک در این دانشگاه دارای امتیاز عالی و 21.6 درصد از بیمارستان های دوستدارکودک دارای امتیاز خوب می باشند. تفاوت بیمارستان ها در کسب رتبه های متفاوت به چگونگی اجرای اقدامات ده گانه بیمارستان های دوستدارکودک بر میگردد. همچنین بین اطلاعات شناسه ای و نمره کل عملکرد بیمارستان های دوستدارکودک دانشگاه علوم پزشکی اصفهان ارتباطی وجود داشته و درکل نمره بیمارستان های دوستدارکودک دانشگاه علوم پزشکی اصفهان مطلوب است. 

Evaluation of causes and outcomes of discharge with the personal consent of patients admitted to Shahid Motahari Educational and Medical Center, Urmia, 2024
پرستاری
Fatemeh Khorsandi 1, Shirin Majalli 2 © ℗, Hourieh Rahimi 3, Shiva Hosseini 3, Somayeh Mashaekhi 3, Roya Sadeghi 3
1 PhD in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Urmia, Iran
2 . MSc in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Urmia, Iran
3 BSc in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Background: Discharge with the personal consent represents a critical indicator of hospital inefficiency, in which a patient leaves the hospital before completing the prescribed course of treatment despite medical advice. This may result in serious consequences, including adverse treatment outcomes, patient dissatisfaction, legal challenges for healthcare providers, hospital readmission, disease relapse, and even death. The aim of this study was to investigate the causes and consequences of discharge with the personal consent among hospitalized patients in Shahid Motahari Educational and Medical Center, Urmia, in 2024. Methods: This descriptive cross-sectional study included children who were admitted to Shahid Motahari Educational and Medical Center during 2024 and were discharged with the personal consent by their parents. Data were collected using a standardized three-part questionnaire provided by the Deputy of Treatment Affairs. The first section included demographic information, the second section identified the reasons for the personal consent, and the third section examined the resulting consequences. Data were analyzed using SPSS version 16. Results: The findings showed that the rate of the personal consent in pediatric wards was 4%, which is two percentage points higher than the global index. The most common reasons were perceived recovery (58.73%), prolonged hospitalization (8%), father’s occupation (6%), fear of treatment (3.75%), lack of medical decision-making and dissatisfaction with insufficient physician attention (3.5% each). The least common reasons were ward overcrowding (1.17%) and lack of welfare facilities (1.5%). Analysis revealed that 60% of the personal consent were due to parental decisions, while 40% were related to hospital processes and resources. Regarding outcomes, 26.4% of patients sought care in other centers, 24.26% were readmitted to the same hospital, and 10% died. Conclusion: The most common reason for the personal consent was the parents’ perception of relative recovery in their children. Strengthening effective communication, increasing parents’ awareness of potential risks, and improving the quality of medical and nursing services are key strategies for reducing the personal consent. 

Factors Associated with Eating Disorders in Children with Type 1 Diabetes: A Cross-Sectional Study
پرستاری
ابوالفضل برزگر 1 © ℗
1 Department of Pediatric Nursing, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: Background and Objective: Eating disorders among children with type 1 diabetes are complex, multifactorial conditions that can adversely affect growth and development. These disorders may stem from social pressures, concerns about body image, and fears related to blood glucose fluctuations. The dietary management demands of diabetes can contribute to maladaptive eating behaviors. Recognizing and understanding these disorders is crucial for prevention and intervention. This study aimed to identify factors associated with eating disorders in children diagnosed with type 1 diabetes. Materials and Methods: This descriptive cross-sectional study included 200 children with type 1 diabetes attending Bou-Ali Educational and Medical Center in Ardabil, recruited using a census sampling method. Data were collected using the Eating Problems in Children with Diabetes questionnaire. Statistical analysis was conducted with SPSS version 24, employing descriptive statistics (frequency, mean, standard deviation) and inferential tests (independent t-test, one-way ANOVA, and multiple regression analysis). Statistical significance was set at p 0.05. Results: Most participants were female (52.5%) and first-born children (44%). Overall, 77.5% demonstrated a moderate level of eating disorders. Multiple regression analysis indicated that individual and social variables explained 18.6% of the variance in eating disorder scores. In univariate analysis, weight (inverse association), father’s occupation, family economic status, and history of hypoglycemia (positive association) were significantly related to eating disorders. In multivariate analysis, father’s educational level and the presence of comorbid conditions emerged as significant positive predictors of eating disorders. Conclusion: Given that individual and social factors significantly influence eating disorders in children with type 1 diabetes, targeted family-centered interventions addressing these determinants are recommended to reduce the prevalence of such disorders. Keywords: Eating disorders; Type 1 diabetes; Children Code of Ethics:IR.ARUMS.REC.1403.049 

Family at the Heart of Healing: A Systematic Review of the Transformative Power of Family-Centered Care in Child Health
پرستاری
Zohreh Dehghan Harati 1 ℗, Fatemeh Dehghan Harati 2 ©
1 MSc Student, Neonatal Intensive Care nursing, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
2 3. Clinical Research Development Center of Children's Hospital, Hormozgan University of Medical Science, Bandar Abbas, Iran
Abstract: Background and Aim: Family-centered care (FCC) stands as a transformative and unparalleled force in the field of child health. By strengthening emotional bonds and fostering active collaboration between families and healthcare systems, FCC empowers children to confront life’s challenges with greater confidence, security, and resilience. This systematic review aims to explore the broad and profound effects of this care model on child health, emphasizing its potential to enhance quality of life and promote social skill development among pediatric populations. Methods: In this study, an extensive search was conducted using keywords such as "family-centered care" and "children" across international databases PubMed/Medline, Scopus, Google Scholar as well as national databases Elmnet, Irandoc, SID, Magiran. The initial search retrieved 371 articles. Inclusion criteria were limited to publications from the past five years. Studies without full-text access, duplicate entries, or systematic reviews were excluded. Following comprehensive and critical evaluations using relevant assessment tools, 15 studies were selected for in-depth scientific analysis. All selected articles specifically addressed the role of families in improving children’s health and well-being. Results: The findings indicates that family-centered care significantly reduces hospitalization duration, minimizes the risk of adverse health outcomes, and improves long-term treatment efficacy. By actively involving families in care processes, FCC creates a supportive environment that enhances children’s emotional well-being, reduces treatment-related anxiety, and facilitates better cooperation during medical procedures. This model fosters trust, decreases the psychological burden of illness, and contributes to faster clinical recovery. Moreover, FCC is associated with decreased medical errors, increased satisfaction among both caregivers and healthcare providers, and improved communication outcomes. In underserved areas, it plays a pivotal role in bridging gaps in healthcare access and reduces the financial burden of prolonged hospitalization. Evidence further shows that FCC contributes to cognitive, emotional, and social development, making it not only a treatment model but a developmental framework. Conclusion: Family-centered care, by improving health outcomes and expediting recovery, provides an optimal setting for holistic child development. However, to realize its full potential, barriers such as workforce shortages, time constraints, limited parental-provider collaboration, and socio-cultural challenges must be addressed through targeted strategic interventions.

Family Centered Nursing Education in Pediatric Type 1 Diabetes: A Narrative Review
پرستاری
Yasaman Fallah 1, Erfan YousefZadeh 2 © ℗
1 Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
2 Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical sciences, Rasht, Iran.
Abstract: Introduction: Type 1 diabetes mellitus (T1DM) in children is a chronic condition requiring complex daily self-management, which often depends on family support. Evidence suggests family-centered education improves not only glycemic control but also psychological well-being and quality of life for both children and their parents. Family involvement helps enhance diabetes knowledge, reduce conflict, and foster more effective self-care behaviors. Understanding the impact of family-centered nursing education is crucial for designing interventions that empower families and improve outcomes in pediatric T1DM. This narrative review synthesizes recent evidence on the role of family-centered nursing education in managing type 1 diabetes in children. Method: We searched PubMed and Google Scholar for English-language studies published between 2020 and 2025 using the keywords: (“Type 1 Diabetes” OR “T1DM”) AND (“family-centered care” OR “parent education” OR “nursing education”) AND (“children” OR “pediatric”). Inclusion criteria comprised English-language, full-text articles evaluating role of family-centered nursing education in managing type 1 diabetes in children. Exclusion criteria removed non-English studies, inaccessible texts, and those focused exclusively on adults or mixed samples without pediatric subgroup data. Screening proceeded in two phases (title/abstract, full-text), and reference lists were hand searched for additional sources. Extracted data captured study design, intervention modality, and reported outcomes Results: Family-centered nursing education was consistently associated with improved clinical and psychosocial outcomes in children with T1DM and their parents. Studies reported significant improvements in glycemic control, self-efficacy, and quality of life following structured family empowerment programs. Parents’ diabetes knowledge and confidence in managing their child’s care increased, while parent–child conflict over diabetes tasks decreased. Culturally tailored educational interventions were highlighted as essential for addressing specific family needs and improving engagement. Programs emphasizing shared goal setting, communication skills, and emotional support further enhanced family satisfaction and reduced stress. Overall, family-centered education emerged as a critical strategy to promote collaborative care and better disease management. Conclusion: Family-centered nursing education enhances pediatric T1DM management by empowering families, improving self-care skills, reducing family conflict, and addressing psychosocial needs. Integrating structured, culturally sensitive family education into routine nursing care can improve both clinical and quality-of-life outcomes for children and their families. Keywords: Type 1 Diabetes, Family-Centered Care, Nursing Education, Self-Management, Pediatric 

Family-Centered Care in Pediatric Nursing: Outcomes and Future Considerations
پرستاری
Maryam Rangrazi 1 ℗, Farnoosh Tajik 2 ©
1 Nursing student, Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
2 Faculty member, Department of pediatric and neonatal nursing, School of nursing and midwifery, Semnan University of Medical Sciences, Semnan, Iran
Abstract: Family-Centered Care in Pediatric Nursing: Outcomes and Future Considerations Introduction: Family-Centered Care (FCC) is a collaborative approach in pediatric nursing that emphasizes partnerships between families and healthcare providers. This model aims to enhance the quality of care and support families during their child's hospitalization. The aim of this study is to review outcomes and future considerations for enhancing FCC. Method: This narrative review was conducted in 2025 by searching in PubMed, Scopus, SID, and Google Scholar. Keywords such as “Family-Centered Care”, “FCC”, “Pediatric”, “Nursing”, “Family participation” and “children” were used. Eligible studies, according to inclusion and exclusion criteria, were analyzed, and relevant data were extracted and synthesized. Results: Outcomes: Enhanced Family Satisfaction: FCC practices lead to increased satisfaction among families, as they feel more involved and informed in the care process . Improved Child Health Outcomes: Studies indicate that FCC is associated with better health outcomes for children, including shorter hospital stays and reduced readmission rates . Reduced Parental Stress and Anxiety: Engaging families in care decisions and providing emotional support through FCC approaches help decrease stress and anxiety levels in parents . Increased Nurse Job Satisfaction: Nurses report higher job satisfaction when implementing FCC, as it fosters a supportive and collaborative work environment . Enhanced Hospital Reputation: Hospitals implementing FCC experience higher family satisfaction, which strengthens public perception and trust. Policy and Accreditation Benefits: Adherence to FCC principles contributes to hospital accreditation and quality rating achievements. Future Considerations: Education and Training: Ongoing education and training for healthcare providers are essential to effectively implement FCC and ensure consistent practices across pediatric units . Policy Development: Healthcare institutions should develop and enforce policies that support FCC, including visitation guidelines and family involvement in care planning . Research and Evaluation: Continuous research is needed to evaluate the effectiveness of FCC interventions and identify best practices for diverse pediatric populations . Resource Allocation: Adequate resources, including staffing and facilities, should be allocated to support FCC initiatives and accommodate family needs during hospitalization . Conclusion: Implementing Family-Centered Care in pediatric nursing improves outcomes for children and families, increases satisfaction among healthcare providers, and enhances the hospital’s reputation and family trust. By emphasizing education, policy development, research, and resource allocation, healthcare institutions can strengthen FCC implementation and ensure its long-term sustainability. Key words: Family centered care, FCC, Pediatric nursing, Family participation 

Family-Centered Nursing Care and Parental Satisfaction: Insights from Nurses and Parents
پرستاری
مهدی محمودزاده 1 © ℗, ثنا خلیل زاده ضیاء 2, محمد محمودزاده 3
1 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Khoy University of Medical Sciences, Khoy, Iran
2 Department of Pediatric Nursing, School of Nursing and Midwifery, Urmia university of medical sciences, Urmia, Iran
3 Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: Background: Family-centered care is recognized as essential to holistic and patient-centered nursing. However, limited research has jointly examined nurses’ and parents’ perspectives on the importance of family involvement and its impact on parental satisfaction. Objectives: To assess and compare the association between perceptions of family importance in nursing care and parental satisfaction, incorporating the viewpoints of both nurses and parents, alongside related sociodemographic and occupational factors. Methods: This cross-sectional study (August 2023–January 2025) included 200 nurses (census sampling) and 160 parents of hospitalized children (stratified random sampling). Data were collected using the Families’ Importance in Nursing Care–Nurses’ Attitudes (FINC-NA) for nurses and the EMPATHIC-N parental satisfaction questionnaire for parents. Analyses in SPSS v24 employed descriptive and inferential statistics with significance at p 0.05. Results: Among nurses, 90% reported average levels of family involvement, which was strongly associated with higher parental satisfaction scores (p 0.001). Among parents, 95% perceived average involvement, which was also significantly linked to satisfaction (p 0.001). Regression analysis showed that predictor variables explained 27.4% of the variance in parental satisfaction. Conclusion: Both nurses and parents recognized that stronger family involvement in nursing care correlates with higher parental satisfaction. Integrating both perspectives provides actionable evidence for enhancing family-centered care in pediatric settings. Keywords: Family-Centered Care, Nursing, Parental Satisfaction, Nurses, Parents, Cross-Sectional Study. Ethical code: IR.ARUMS.REC.1402.318

Generative Artificial Intelligence (GenAI) in Critical Care Nursing: A New Approach
پرستاری
Zhila Saneipour 1 © ℗
1 پرستار بخش مراقبت¬های ویژه، بیمارستان خاتم الانبیاء، تهران، ایران
Abstract:

 هوش مصنوعی مولد نوعی فناوری هوش مصنوعی است که می تواند بر اساس داده هایی که روی آن آموزش دیده، محتوای جدیدی مانند متن، تصویر، صدا و ویدئو تولید کند. در سال 2022، نرم افزار «ChatGPT» به عنوان یک ابزار انقلابی GenAI مبتنی بر داده‌ها تولید شد که سریع‌تر از موتورهای جستجوی اینترنتی مانند Google عمل کرد.روش تحقیق از نوع مروری نظام مند بوده و از روش PRISMA در غربالگری مقالات استفاده شد. بر اساس جستجو در پایگاه‌های داده Scopus و IEEE Xplore تعداد 144 مقاله چاپ شده طی سالهای 2016 تا 2024 بررسی و شناسایی شدند. عمده مقالات در ایالات متحده انجام شد، و عمدتاً (n = 14/22) شامل مطالعات توصیفی کمی بود.متداول ترین ابزار مورد استفاده ChatGPT بود که در 95.7٪ از مطالعات ظاهر شد. مقالات به حوزه های مختلف پرستاری، از جمله آموزش پرستاری (n = 12/23)، عملیاتی (n = 10/23)، و تحقیق (n = 1/23) پرداختند. هم مزایا و هم نگرانی های مرتبط با این فناوری شناسایی شدند.به عنوان پرستار، GenAI برخی از مزایا و کاربردهای بالقوه و آینده GenAI برای پرستاران عبارتند از: الف- افزایش پشتیبانی تصمیم گیری بالینی: داده‌های GenAI به سرعت داده‌های بالینی را تجزیه و تحلیل سریع کرده، بینش‌ها و توصیه‌های به موقع در مورد تصمیم‌گیری بالینی در مراقبت از بیمار در اختیار پرستاران قرار می دهد. ب- بهبود گزارش نویسی و کارایی اداری: GenAI می تواند یادداشت های گفتاری را به اسناد مکتوب تبدیل کند و به طور قابل توجهی زمان صرف شده توسط پرستاران را برای کارهای اداری کاهش دهد. ج- مراقبت شخصی سازی شده از بیمار: GenAI این پتانسیل را دارد که توصیه‌های بهداشتی و درمانی شخصی‌شده را بر اساس داده‌های بیمار، به ویژه برای شرایط مزمن، ارائه دهد و به بیماران کمک کند تا به طور مؤثرتری به برنامه‌های درمانی پایبند باشند. د- یادگیری و آموزش پیشرفته: GenAI می تواند سناریوهای یادگیری شبیه سازی شده را بازسازی کند تا به دانشجویان پرستاری کمک کند. اگرچه GenAI می تواند بیماران را قادر سازد تا نقش فعال تری در مراقبت های بهداشتی خود داشته باشند. بیماران می توانند از چت ربات های مجهز به LLM برای تعامل با EHR خود، آماده شدن برای قرار ملاقات، و ضبط و رونویسی مکالمات با متخصصان مراقبت های بهداشتی خود استفاده کنند. اهم چالش های GenAI شامل مواردی از قبیل عدم درک لهجه و فقدان گزارش پرستاری دقیق، عدم رعایت عدالت و مسائل حقوقی و اخلاقی مربوط به حفظ حریم خصوصی است.

Harnessing Machine Learning for Early Prediction of Neonatal Sepsis: An Integrative Review
پرستاری
Seyed Mohammad Hossein Abedi 1 © ℗, Mozhan Azadi 1
1 School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Abstract This review evaluated the impact of machine learning on the prediction of neonatal sepsis and concluded that the models enabled early intervention and diagnosis. Machine learning using biomarkers and vital signs improved sepsis risk prediction accuracy, leading to decreased morbidity and mortality in neonates. Introduction Neonatal sepsis remained a leading cause of morbidity and mortality in the newborn, with high rates reported among preterm and low-birth-weight infants. Early recognition was needed but challenging on the basis of nonspecific symptoms and need for rapid treatment. Machine learning (ML) algorithms with the ability to process intricate data like biomarkers, vital signs, and clinical features were found to have huge potential as a way of improving predictability precision and timeliness. This review aimed to evaluate the impact of ML models on neonatal sepsis prediction and their potential to advance clinical neonatology outcomes. Methodology A systematic literature search of major academic databases (Google Scholar, PubMed, Scopus) was conducted for English-language studies that were published in the period 2014 to 2025. Out of the approximately 250 articles, 40 were read fully after preliminary filtering. This was in studies using machine learning to predict neonatal sepsis (0–28-day-old infants), both early onset and late onset. Only studies reporting predictive metrics (e.g., accuracy, AUROC, sensitivity, specificity, timing) were included. Adult-focused research, traditional statistical analysis, or studies with no sepsis outcomes were all excluded. Results The outcome of the studies included revealed that machine learning interventions had a positive effect on predicting neonatal sepsis. These models were with high accuracy in early identification, like logistic regression achieving 88.4% and 0.906 AUROC for mortality prediction, random forests achieving 0.973 AUROC when applied with respiratory features, and deep learning approaches achieving an upper limit of 0.91 AUROC. Performance improving predictors were C-reactive protein, white blood cells, heart rate, respiratory rate, and oxygen saturation, with predictions possible up to 24 hours before clinical suspicion. Non-linear methods tended to work better than linear ones, explainable AI tools improved clinical interpretability, and issues like data quality and external validation were highlighted for better generalizability. Conclusion Machine learning introduced a novel and potentially valuable approach to supporting early neonatal sepsis diagnosis. Further rigorous research with improved study design, standardized performance measurement, and robust validation was needed to validate these findings and further develop the incorporation of ML models into neonatal clinical practice. 

Hypnosis-derived Communication in Pediatric Medical Procedures: A Scoping Review of Evidence, Applications, and Future Research Directions
پرستاری
فائزه رستمیان 1 © ℗, فاطمه خسروی 2
1 Faculty of Nursing and Midwifery, Semnan University of Medical Sciences
2 Faculty of Nursing and Midwifery, Gonbad University of Medical Sciences
Abstract: Background: Managing pain and anxiety in children during medical procedures remains a significant challenge in healthcare. Clinical hypnosis, as a non-invasive and cost-effective intervention, has been shown to effectively reduce these issues. This scoping review aims to examine the evidence, applications, and future research directions concerning hypnosis-derived communication (HC) in pediatric medical procedures. Methods: This scoping review was conducted following the Arksey and O'Malley (2005) framework and adhering to the PRISMA-ScR checklist to ensure transparency and rigor in reporting. A systematic search was performed across PubMed/MEDLINE, Scopus, Web of Science, CINAHL, Google Scholar (for grey literature), and SID (for Persian sources) to identify relevant studies. The English keywords used included "hypnosis," "hypnotic communication," "hypnosis-derived communication," "child*," "pediatric," "adolescent," "procedure," "medical intervention," "treatment," and "surgery," with their Persian equivalents applied when searching Persian databases to ensure comprehensive coverage. Inclusion criteria focused on studies examining the use of hypnosis-derived communication techniques to reduce pain and anxiety in pediatric patients undergoing medical procedures. From an initial pool of 78 articles, 21 met the eligibility criteria and were included in the final analysis. Results: The review indicates that HC is more effective than standard care and distraction techniques, particularly in procedures like bone marrow aspiration, lumbar puncture, and propofol injection. The efficacy of HC is enhanced by children's natural cognitive abilities, including suggestibility and imagination. Training programs for healthcare professionals, such as the Rel@x program, have demonstrated significant improvements in their skills, with retention of these skills up to five months post-training. However, existing studies are limited by small sample sizes, a narrow focus on oncology and needle procedures, and inadequate reporting of factors influencing patient responses. Conclusions: Hypnosis-derived communication holds substantial potential as a non-pharmacological intervention to alleviate pain and anxiety in pediatric medical procedures. Implementing comprehensive training for healthcare providers and conducting rigorous evaluations of HC's impact on children are crucial steps for its successful integration into clinical practice. Further research with robust methodologies and larger sample sizes is necessary to establish HC as a standard practice and to address existing methodological gaps. This review provides a roadmap for researchers and clinicians to advance the application of HC in pediatric care. 

Impact of Nursing-Led Immunonutrition Programs on Immune Reconstitution and Infection Reduction in Pediatric Hematopoietic Stem Cell Transplant Recipients
پرستاری
Najme Zamani 1 ℗, Hamid Yazdaninejad 2 ©
1 MSC student in medical surgical nursing, Nursing and Midwifery school, Kashan University of Medical Sciences,Kashan, Iran.
2 Department of Operating Room and Anesthesiology, School of Allied Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract: Introduction and Objective: Pediatric hematopoietic stem cell transplantation (HSCT) serves as a curative treatment for a wide range of malignant and non malignant disorders but is frequently associated with prolonged immune suppression and increased susceptibility to infections. Emerging evidence highlights the pivotal role of targeted nutritional interventions particularly immunonutrition in enhancing post transplant immune recovery. Nursing led immunonutrition programs, through continuous engagement with patients, enable personalized delivery, monitoring, and adjustment of immune enhancing nutrients. This systematic review aimed to synthesize the most recent evidence on the effects of these nursing driven interventions on immune reconstitution parameters and infection reduction among pediatric HSCT recipients. Methods: Following PRISMA 2020 guidelines, seven electronic databases (PubMed, Scopus, Web of Science, CINAHL, Cochrane Library, Embase, and ProQuest) were searched for studies published from January 2020 to August 2025. Eligible articles included randomized controlled trials, cohort studies, and quasi-experimental research evaluating nursing-led immunonutrition (e.g., glutamine, arginine, omega-3 fatty acids, nucleotides) in pediatric HSCT recipients, with reported outcomes on immune cell recovery, cytokine modulation, and infection incidence. Only English-language, peer-reviewed studies were included. Results: Fifteen studies (n=1,326 children) from Asia, Europe, and North America met inclusion criteria. Nursing-led protocols varied from early enteral immunonutrition initiation (within 48 hours post-HSCT) to combined educational and monitoring interventions extending six months post-discharge. Common formulations enriched with arginine, omega-3 fatty acids, and glutamine demonstrated accelerated lymphocyte recovery (mean CD4+ restoration at day 60 vs. day 90 in standard care), lower pro-inflammatory cytokine peaks (IL-6 reduction up to 34%), and improved NK-cell activity. Infection rates declined markedly bloodstream infections by 22–38% and severe viral reactivations by up to 29% with several trials noting shorter hospitalization by 4–6 days. Studies also reported improved mucosal integrity, reduced mucositis severity, and higher patient-reported quality-of-life scores. Adherence exceeded 85% where nurses implemented direct bedside counseling and follow-up reinforcement, highlighting nursing’s pivotal role in sustainability and compliance. Conclusion: Nursing-led immunonutrition programs significantly enhance post-HSCT immune recovery and reduce infectious complications in pediatric patients. Integration of standardized, evidence-based protocols into routine transplant care could optimize clinical outcomes and shorten recovery trajectories. Further multicenter studies are warranted to refine nutrient compositions, intervention timing, and nursing education strategies for maximal benefit. Keywords: Pediatric Nursing, Immunonutrition, Hematopoietic Stem Cell Transplantation, Immune Reconstitution, Infection Prevention, Nutritional Support, Clinical Outcomes 

Impact of Structured Discharge Planning on Readmission Rates, Caregiver Preparedness, and Continuity of Care in Pediatric Nursing
پرستاری
Zohre Khanjarpanah Baghdadabadi 1 ℗, Mohammad Moein Mokhtarezadeh 2 ©, Mahnaz Mirakhor 3, Negar Ejbari 1
1 BSC of Nursing, Bone Marrow Transplant Department , Shahid Sadoughi Hospital, Yazd, Iran
2 Medical Student, Student Research Committee, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 BSC of Nursing, Pediatric Oncology Department , Shahid Sadoughi Hospital, Yazd, Iran
Abstract: Introduction: Hospital discharge represents a critical juncture in pediatric care. Incomplete or poorly structured discharge planning can result in adverse outcomes, including unnecessary readmissions, increased caregiver stress, and fragmented follow-up care. Structured discharge planning has been proposed as an evidence-based approach to improve the transition from hospital to home for children. However, its overall effectiveness across diverse settings remains unclear. This systematic review aimed to evaluate the impact of structured discharge planning interventions on hospital readmission rates, caregiver preparedness, and continuity of care within pediatric nursing practice. Methods: A comprehensive search was conducted in PubMed, CINAHL, Scopus, and Web of Science for studies published between January 2000 and April 2025. Search terms combined MeSH and free-text keywords related to “pediatric,” “structured discharge planning,” “nursing,” “readmission,” and “continuity of care.” Eligible studies included randomized controlled trials, quasi-experimental studies, and observational research focusing on structured discharge programs in pediatric populations. Data extraction and quality assessment were conducted independently by two reviewers in accordance with PRISMA guidelines. Findings were synthesized narratively and, where applicable, through meta-analysis. Results: From 1,236 articles initially identified, 27 studies met the inclusion criteria comprising 14 randomized controlled trials, 8 quasi-experimental studies, and 5 observational cohorts representing a total sample of 8,462 pediatric patients across multiple care settings. Meta-analysis of 18 studies reporting hospital readmission rates showed a pooled relative risk reduction of 28% in structured discharge planning groups compared with usual care. Caregiver preparedness, measured using validated readiness-for-discharge scales, revealed a mean increase of 1.2–1.8 points on a 5-point Likert scale, indicating markedly improved confidence in post-discharge care. Continuity of care outcomes indicated that children enrolled in structured discharge programs were twice as likely to attend scheduled follow-up appointments and showed a 22–30% improvement in adherence to medication and care plans. Qualitative data from six mixed-methods studies highlighted additional benefits, including reduced caregiver anxiety, improved communication between families and healthcare teams, and enhanced coordination with community health providers. Conclusion: Structured discharge planning in pediatric nursing offers substantial benefits in reducing hospital readmissions, improving caregiver readiness, and strengthening continuity of care. Standardizing intervention components and outcome metrics will be essential for broader implementation and for enabling cross-study comparisons. Future research should explore long-term outcomes and cost-effectiveness. Keywords: Pediatric Nursing; Discharge Planning; Hospital Readmission; Caregiver Preparedness; Continuity of Care.

Integrating Artificial Intelligence into Child and Family Health Care and Promotion: A Review of Applications, Implications, and Challenges
پرستاری
نرگس رحمانی 1 ℗, لیلا نیک روز 2, فاطمه السادات سید نعمت اله روشن 3 ©
1 استادیار، دپارتمان پرستاری و مامایی، دانشگاه آزاد اسلامی واحد بابل، ایران
2 استادیار، دانشکده پرستاری، دانشگاه علوم پزشکی یاسوج، کهکیلویه و بویراحمد، ايران
3 استادیار، دپارتمان پرستاری، دانشکده پرستاري و مامايي، علوم پزشکی، آزاد اسلامی، تهران، ایران
Abstract:

 مقدمه: پیشرفت سریع فناوری‌های دیجیتال، به‌ویژه در حوزه هوش مصنوعی، ظرفیت‌های نوینی برای تحول در ارائه خدمات سلامت ایجاد کرده است. مراقبت از کودک به‌عنوان یکی از حساس‌ترین و پیچیده‌ترین حوزه‌های بهداشت و درمان، نیازمند تصمیم‌گیری‌های دقیق، به‌موقع و چندبعدی است. همچنین، نقش حیاتی خانواده در مراقبت از کودک و بار کاری بالای پرستاران، ضرورت استفاده از راهکارهای فناورانه برای بهبود اثربخشی، ایمنی و کارایی خدمات را افزایش داده است. ادغام هوش مصنوعی در مراقبت سلامت می‌تواند بستری برای بهینه‌سازی عملکردهای تشخیصی، درمانی، آموزشی و مدیریتی در این سه سطح فراهم آورد. هدف اصلی این پژوهش، بررسی جامع و نظام‌مند کاربردها و تأثیرات هوش مصنوعی در سه بعد کلیدی مراقبت از کودک، شامل: ۱) بهبود کیفیت مراقبت‌های درمانی کودکان، ۲) ارتقاء آگاهی و مشارکت خانواده‌ها، و ۳) تقویت کارآمدی و تصمیم‌گیری بالینی در پرستاری است. روش کار: این پژوهش به روش مرور نظام‌مند (Systematic Review) انجام شد. جستجوی مقالات بین سال‌های ۲۰۱۵ تا ۲۰۲۵ در پایگاه‌های PubMed، Scopus، Web of Science و SIDو.. با استفاده از کلیدواژه‌های ترکیبی نظیر "Artificial Intelligence", "Pediatric Care", "Nursing AI"و "Family-Centered Health Technology" صورت گرفت. پس از غربال‌گری اولیه، در نهایت ۸۴ مقاله با کیفیت علمی بالا برای تحلیل نهایی انتخاب و بررسی گردیدند. نتایج: یافته‌ها نشان دادند که AI در طیف وسیعی از بیماری‌های کودکان، از جمله اوتیسم، ADHD، صرع، دیابت نوع ۱، بیماری‌های مادرزادی قلب، اختلالات گفتاری و سرطان‌های کودکی، دقت تشخیصی بالایی داشته است. در بیماری‌های عفونی، الگوریتم‌های یادگیری ماشین قادر به پیش‌بینی و تشخیص سریع ذات‌الریه، مننژیت و مقاومت آنتی‌بیوتیکی بودند. در حوزه سلامت دیجیتال خانواده‌محور، اپلیکیشن‌ها و چت‌بات‌های هوشمند موجب بهبود آموزش والدین، مدیریت دارویی، پایش علائم و افزایش رضایتمندی شده‌اند. در حوزه پرستاری نیز، استفاده از سیستم‌های پشتیبان تصمیم‌گیری، پایشگرهای هوشمند و ابزارهای مستندسازی خودکار، کاهش خطاهای انسانی، بهبود ایمنی بیمار و ارتقاء بهره‌وری مراقبتی را به دنبال داشته است. بحث و نتیجه‌گیری: ادغام هوش مصنوعی در مراقبت‌های کودک‌محور نه‌تنها موجب ارتقاء کیفیت و دقت خدمات بالینی می‌شود، بلکه با توانمندسازی خانواده و حمایت از عملکرد پرستاران، می‌تواند بنیان‌گذار یک مدل مراقبتی هوشمند و چندسطحی باشد. با این حال، چالش‌هایی نظیر کمبود زیرساخت‌های فنی، نگرانی‌های مربوط به حریم خصوصی داده‌ها، نبود چارچوب‌های اخلاقی روشن و نابرابری در دسترسی به فناوری، از موانع اصلی در مسیر پیاده‌سازی گسترده این فناوری هستند. تدوین سیاست‌های ملی، آموزش کاربران، بومی‌سازی ابزارهای هوش مصنوعی و طراحی نظام‌های ارزشیابی عملکرد می‌تواند گام مؤثری در تحقق این چشم‌انداز باشد. 

Intraoperative Fluid Management Strategies in Pediatric Kidney Transplant Recipients and Their Impact on Graft Function: A Systematic Review
پرستاری
Sedighe Hannani 1, Bahador Pourdel 2 ©, Erfan Rajabi 2 ℗, Seyed Abolfazl Hosseini 2, Amirali Alizadeh 3
1 Senior Expert in internal surgical nursing, instructor, operating room department, faculty of paramedicine, Iran university of medical sciences, Tehran, Iran
2 MSc of Perioperative Nursing, Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, ‎Maragheh, Iran‎
Abstract: Introduction Pediatric kidney transplantation requires effective intraoperative fluid management, but standards are lacking. Hypovolemia and hypervolemia can impair graft perfusion, causing DGF or primary non-function. Goal-directed therapy is well-established in adult practice, but child-specific strategies are lacking. In this systematic review, intraoperative fluid management strategies were examined for their effects on early graft function in pediatric kidney transplant recipients. Methods This review followed PRISMA. From inception to May 2024, PubMed, Embase, CENTRAL and CINAHL were searched extensively. We used "kidney transplantation," "pediatric," "child," "adolescent," "fluid therapy," "hemodynamic monitoring," "goal-directed therapy," "colloids," "crystalloids," "delayed graft function," and "graft survival." RCTs and observational cohort studies on fluid strategies in 21-year-olds were included. These strategies can be liberal, restrictive, crystalloid, colloid, goal-directed, or conventional. Reviews, case reports and adult studies were excluded. To assess bias, we used Cochrane RoB 2 for randomized controlled trials and the Newcastle-Ottawa Scale for cohort studies. Where feasible, a random-effects model was used to calculate pooled risk ratios (RR) or mean differences (MD) with 95% confidence intervals after narrative data synthesis. Results Eight studies (2 randomized controlled trials and 6 cohort studies) with 1,245 pediatric patients were identified from 2,158 records. Goal-directed therapy using stroke volume variation (SVV), liberal versus restrictive crystalloid protocols and albumin-based versus balanced crystalloid fluid regimens were used. This meta-analysis was inappropriate due to clinical and methodological heterogeneity. Four of five studies showed a significant reduction in DGF, favoring goal-directed fluid therapy over a less structured approach (RR range: 0.45 to 0.65). A randomised controlled trial found no difference in delayed graft function between albumin and balanced crystalloid groups (RR 1.10, 95% CI 0.68 to 1.78). Thrombotic complications are not increased by any strategy. Conclusion hemodynamic-driven fluid management may reduce delayed graft function in pediatric kidney transplant recipients compared to liberal fluid administration, according to limited evidence. Addressing hypovolemia and volume status accuracy to avoid over-resuscitation are equally important. However, the evidence is mostly observational and the best fluid has yet to be determined. The findings indicate a significant knowledge gap and the urgent need for comprehensive, rigorously designed randomized controlled trials to develop evidence-based intraoperative fluid protocols for this vulnerable population.

Investigating factors affecting pediatric obesity: A systematic review
پرستاری
نازنین منصوری 1 © ℗, علیرضا منصوری 2
1 Department of Pediatric Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
2 Bachelor of Medical Engineering, Islamic Azad University, Abadeh, Iran
Abstract:

 عنوان: بررسی عوامل مؤثر بر چاقی کودکان: مرور سیستماتیک چکیده مقدمه: چاقی همچنان شایع ترین اختلال در بین پسران و دختران دوران کودکی سراسر جهان است و به یک نگرانی بهداشتی جهانی تبدیل شده است. مشکلات مربوط به سلامتی در چاقی کودکان و هزینه های درمان این مشکلات، نیاز به مداخله زودهنگام برای درمان چاقی و شناسایی عوامل مؤثر بر این اختلال را پررنگ تر کرده است. همچنین تلاش‌های تحقیقاتی و پزشکی را برای پیشرفت‌های جدید به منظور مبارزه مؤثر با چاقی دوران کودکی تشدید کرده است. هدف: مطالعه حاضر با هدف بررسی عوامل مؤثر بر چاقی کودکان انجام شد. مواد و روش ها: مطالعه حاضر مرور سیستماتیک بوده که در تابستان 1404 با جست و جوی مقالات در پایگاه های اطلاعاتی گوگل اسکولار، پابمد ، مگیران و سیناهل در طول ده سال اخیر انجام شد. برای جست و جو از کلیدواژه های "چاقی کودکان" و "عوامل" به دو زبان فارسی و انگلیسی استفاده شد. معيارهاي انتخاب مقالات برای ورود به تحقیق شامل پژوهش های توصیفی و مداخله ای مرتبط باموضوع، انتشار مقاله به زبان فارسی یا انگلیسی، دسترسی به متن کامل مقاله و انتشار در مجلات پژوهشی و دانشگاهی معتبر بود. معیارهــاى خــروج از مطالعــه شــامل ، کتاب هـا، پایــان نامه هـا و عـدم دسترسـى بـه متـن کامــل مقالــه بــود. درنهایت با توجه به معیارهای ورود و خروج، از 160 مقاله یافت شده، 33 مقاله بررسی شدند. یافته ها: در 33 مقاله بررسی شده بیشترین عواملی که در بروز چاقی کودکان نقش داشتند شامل فعالیت بدنی کم، استفاده زیاد از صفحه نمایش، مصرف غذاهای آماده، وضعیت اجتماعی اقتصادی بالا، الگوی تغذیه والدین و ژنتیک بودند. بعضی مقالات نوع تغذیه والدین را نیز در بروز چاقی میان کودکانشان مؤثر دانستند. بحث و نتیجه گیری: یافته های این مطالعه عواملی که سرنوشت چاقی کودکان را تعیین می کنند، برجسته کرده است. این عوامل ممکن است پیامدهایی مادام‌العمر به همراه داشته باشد. لازم است تا با آگاهی بخشی درباره این عوامل خطر هم به والدین و هم کودکان از میزان ابتلا به چاقی کودکان کاست. همچنین استراتژی‌هایی با هدف ترویج عادات غذایی سالم، تشویق به فعالیت بدنی منظم و بهبود دسترسی به غذاهای مغذی باید در اولویت قرار گیرند و اقدامات پیشگیرانه در مدارس نیز مورد توجه قرار گیرند. این مداخلات می‌توانند رفتارهای سالم‌تری را تقویت کرده و خطرات سلامتی بلندمدت را برای کودکان در معرض خطر و خانواده‌هایشان کاهش دهند. کلمات کلیدی: چاقی کودکان، ژنتیک، والدین، رژیم 

Investigating the Causes of Discharge Against Medical Advice in the Emergency Department of Shahid Motahari Educational and Medical Center, Urmia, 2024
پرستاری
Shirin Mojallali 1 ℗, Fatemeh Khorsandi 2 ©, Omolhabibeh Abedini 3
1 MSc in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Iran
2 PhD in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Iran
3 BSc in Nursing, Shahid Motahari Educational and Medical Center, Urmia University of Medical Sciences, Iran
Abstract: Introduction: Discharge against medical advice is not only one of the five priority indicators of the Ministry of Health, Treatment, and Medical Education for evaluating the performance of emergency departments, but also a global challenge that can lead to undesirable outcomes and complications. Therefore, this study aimed to investigate the causes of discharge against medical advice among patients admitted to the emergency department of Shahid Motahari Educational and Medical Center in Urmia in 2024. Methods: This descriptive cross-sectional study was conducted on pediatric patients who visited the emergency department of Shahid Motahari Educational and Medical Center in Urmia during 2024 and were discharged against medical advice by their parents. Data were collected using a two-part questionnaire issued by the Deputy of Treatment. The first part included demographic information, and the second part included the reasons for Discharge against medical advice. Data were analyzed using SPSS version 16. Findings: The results showed that the discharged against medical advice rate in the emergency department was 6.6%, which is two percent higher than the global rate (4%). According to the findings, the most common reasons for discharged against medical advice were referral to a subspecialty clinic (55.06%), perception of recovery (28.49%), referral to a more advanced medical center (3.97%), and continuation of treatment at home (2.19%). Personal problems (1.5%) and overcrowding in the emergency department (0.82%) were the least common reasons. Conclusion: Based on the findings, the majority of patient dissatisfaction was related to the received services or deficiencies in the service delivery process. Measures such as proper planning to improve key indicators in the emergency department are recommended in order to reduce the rate of discharge against medical advice. 

Investigating the effect of combined training on the sleep habits of school-age children: A randomized controlled trial
پرستاری
مونا حسین‌زاده صیقلانی 1 ℗, یاسمن یعقوبی 2 ©, مهشید میرزایی تکلیمی 3, سامان معروفی‌زاده 4
1 کارشناسی‌ارشد پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
2 دانشیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
3 استادیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
4 استادیار گروه آمار زیستی و اپیدمیولوژی، دانشکده بهداشت، دانشگاه علوم پزشکی گیلان، رشت
Abstract:

 مقدمه و هدف: خواب، به‌عنوان یکی از نیازهای حیاتی کودکان، نقش مهمی در رشد فیزیکی، عاطفی، رفتاری و شناختی دارد. عادات‌خواب که در سنین مدرسه تحت‌تأثیر عوامل خانوادگی و فرهنگی شکل می‌گیرد، می‌تواند بر کیفیت و الگوی خواب تأثیرگذار باشد. با‌توجه‌به شیوع اختلالات خواب در این گروه سنی، طراحی و اجرای برنامه‌های آموزشی مناسب جهت بهبود عادات‌خواب از اهمیت ویژه‌ای برخوردار است. ازاین‌رو، مطالعه حاضر باهدف تعیین تأثیر آموزش ترکیبی بر عادات‌خواب کودکان سن مدرسه، انجام شد. روش کار: این مطالعه کارآزمایی شاهددار تصادفی‌شده، با کداخلاق IR.GUMS.REC.1403.462، بر روی 62 دانش‌آموز دختر و پسر پایه اول تا ششم ابتدایی که به روش نمونه‌گیری طبقه‌ای و خوشه‌ای انتخاب و با تخصیص تصادفی به گروه‌های مداخله و کنترل تقسیم شدند، انجام شد. گروه مداخله تحت 4 جلسه آموزش ترکیبی (آموزش چهره‌به‌چهره، اجرای نمایش، مسابقه داستان‌نویسی و نقاشی) و آموزش از طریق اپلیکیشن؛ و گروه کنترل تحت 1 جلسه آموزش چهره‌به‌چهره قرار گرفتند. ابزار گردآوری داده‌ها شامل 2 پرسش‌نامه (اطلاعات دموگرافیک کودک و خانواده و عادات‌خواب کودکان (CSHQ)) بود که به‌صورت پیش‌آزمون (قبل از مداخله) و پس‌آزمون (3 ماه پس از انجام مداخله) توسط والدین گروه‌ها تکمیل گردید. تحلیل داده‌ها با آزمون‌های آماری توصیفی و تحلیلی تحت نرم‌افزار SPSS نسخه 16 انجام شد. یافته‌ها: نتایج نشان داد میانگین نمره کل عادات‌خواب در مرحله پس‌آزمون در گروه مداخله و کنترل به ترتیب، 8/32 و 1/77 واحد کاهش یافت که حاکی از بهبود وضعیت عادات‌‌خواب در هر دو گروه است. گرچه وضعیت عادات‌خواب در هردو گروه بهبود یافت اما میزان کاهش نمره‌کل عادات‌خواب در گروه مداخله به‌صورت معنی‌داری 6/55 واحد بیشتر از گروه کنترل بود (0/001P)؛ که بیانگر تاثیرگذاری بیشتر شیوه آموزش ترکیبی است. همچنین میزان کاهش نمرات خرده‌مقیاس‌های مقاومت در برابر خواب، مدت‌زمان خواب و خواب‌‌آلودگی روزانه در گروه مداخله به‌صورتی معنی‌دار بیشتر از گروه کنترل بود؛ در خرده‌مقیاس‌های اضطراب خواب و تاخیر در شروع خواب، میزان کاهش نمرات گروه مداخله بیشتر از گروه کنترل، اما از نظر آماری معنی‌دار نبود؛ و تفاوت آماری معنی‌داری در میزان کاهش نمرات خرده‌مقیاس‌های پاراسومنیا، اختلالات تنفسی خواب و بیداری‌های شبانه، بین گروه‌های کنترل و مداخله مشاهده نشد. نتیجه‌گیری: اثربخشی گسترده‌تر شیوه آموزش ترکیبی نسبت به مداخلات کوتاه‌مدت، کاملاً مشهود است. می‌توان بدین‌گونه استدلال کرد که بهره‌گیری از تنوع در شیوه‌های آموزشی از جمله آموزش ترکیبی به‌واسطه‌ی انعطاف‌پذیری، ساختار یکپارچه و تعامل بالا می‌تواند منجر به اثرگذاری بیشتر نسبت به سایر شیوه‌های آموزشی تک‌بعدی و صرفاً چهره‌به‌چهره شود. کلیدواژه‌ها: آموزش ترکیبی، دانش‌آموزان سن مدرسه، عادات خواب، اپلیکیشن، آموزش

Investigating the effect of self-care education based on the Orem self-care model on the quality of life of adolescents with diabetes type 1: A randomized clinical trial
پرستاری
مونا حسین‌زاده صیقلانی 1 ℗, یاسمن یعقوبی 2 ©, سمیه پوی 3, فاطمه فلاح‌زاده 4
1 کارشناسی‌ارشد پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
2 دانشیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
3 استادیار گروه پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی گیلان، رشت
4 بیمارستان امام علی، دانشگاه علوم پزشکی مازندران، ساری
Abstract:

 مقدمه و هدف: دیابت، از شایع‌ترین بیماری‌های مزمن در جهان، می‌تواند کیفیت زندگی بیماران را تحت‌تأثیر قرار دهد. نوجوانان مبتلا به دیابت نوع یک با مشکلاتی همچون افسردگی، اضطراب، چاقی و کاهش تحرک مواجه‌اند که منجر به کاهش کیفیت زندگی آن‌ها می‌شود. خودمراقبتی یکی از ارکان مهم در مدیریت این بیماری است و آموزش مبتنی بر الگوی خودمراقبتی اورم توسط پرستاران، می‌تواند رویکردی مؤثر برای ارتقا کیفیت زندگی این بیماران به شمار رود. ازاین‌رو، مطالعه حاضر باهدف تعیین تأثیر برنامه خودمراقبتی مبتنی بر الگوی اورم بر کیفیت زندگی نوجوانان مبتلا به دیابت نوع ۱ طراحی شده است. مواد و روش کار: این کارآزمایی بالینی تصادفی شده با کد اخلاق IR.GUMS.REC.1397.403، بر روی 80 نوجوان مبتلا به دیابت نوع ۱ که با تخصیص تصادفی به دو گروه مداخله (40 نفر) و کنترل (40 نفر) تقسیم شدند، انجام گردید. نمونه‌عای پژوهش شامل نوجوانان دختر و پسر مبتلا به دیابت نوع ۱ بودند که در بازه سنی ۱۱ تا ۱۸ سال قرارداشتند، فاقد اختلالات روانی و مایل به مشارکت در مطالعه بودند. گروه مداخله هشت جلسه آموزشی ساختاریافته بر اساس مدل خودمراقبتی اورم و گروه کنترل آموزش‌های روتین استاندارد دریافت کردند. ابزار جمع‌آوری داده‌ها شامل پرسشنامه اطلاعات جمعیت‌شناختی، پرسشنامه وضعیت سلامت اورم و پرسشنامه کیفیت زندگی SF-36 بود که طی دو نوبت با فاصله زمانی 3 ماه پس از مداخله اخذ گردید. تجزیه‌و‌تحلیل داده‌ها از طریق آزمون‌های آماری توصیفی و تحلیلی تحت نرم‌افزار SPSS نسخه 16 انجام شد. یافته‌ها: نتایج نشان داد که گرچه در ابعاد جسمی و روانی کیفیت زندگی قبل از مداخله بین دو گروه تفاوت آماری معنی‌داری وجود نداشت؛ اما بعد مداخله تفاوت آماری معنی‌دار و قابل‌توجهی در تغییر نمرات مربوط به بعد جسمی (03/0=p) و بعد روانی (02/0=p) بین دو گروه مشاهده شد؛ و افراد در گروه مداخله بهبودی در ابعاد کیفیت زندگی نشان دادند (05/0p=). نتیجه‌گیری: نتایج حاصله تأیید می‌نماید که باتوجه‌به اینکه تئوری خودمراقبتی اورم بر توانایی‌ها و نیازهای هر یک از افراد تأکید دارد؛ طراحی و به‌کارگیری برنامه خودمراقبتی مبتنی بر الگوی اورم بر اساس نیازهای آموزشی و باتوجه‌به اصول آموزش به بیمار می‌تواند بر ابعاد جسمی و روانی کیفیت زندگی بیماران نوجوانان مبتلا به دیابت نوع 1، که هریک دارای نیازهای منحصربه‌فرد و اختصاصی مرتبط با این دوره مهم از رشد و تکامل هستند، موثر باشد. کلیدواژه‌ها: دیابت، خودمراقبتی، نوجوانی، کیفیت زندگی، اورم

Investigating the effect of self-management program implementation on the quality of life of adolescents with epilepsy referring to selected children's hospitals in Tehran
پرستاری
فاطمه علایی کرهرودی 1 ©, هدی همتی 2 ℗, بهشته طبرسی 3
1 استاديار دانشگاه علوم پزشكي شهيد بهشتي
2 پرستار شاغل در بيمارستان شهيد فهميده
3 استاديار دانشگاه علوم پزشكي آزاد اسلامي تهران
Abstract:

 زمينه و هدف: نوجوانان یکی از گروه های سنی با درصد بالای ابتلا به بیماری صرع هستند که علاوه بر چالش های خاص دوران نوجوانی با مسائل مربوط به صرع نیز رو به رو هستند که این موضوع اهمیت کیفیت زندگی را پررنگ تر می کند. در نتیجه جهت ارتقاء کیفیت زندگی به امر مهم آموزش به عنوان یک راهکار تاثیرگذار می توان اشاره کرد. پژوهش حاضر با هدف بررسی تاثیر اجرای برنامه خودمدیریتی بر کیفیت زندگی نوجوانان مبتلا به صرع مراجعه کننده به بیمارستان‌های کودکان منتخب شهر تهران انجام شد. روش بررسی: مطالعه حاضر به روش نیمه تجربی بر روی 60 نوجوان در گروه سنی 11 تا 18 سال در بیمارستان های کودکان منتخب شهر تهران انجام شد. 3 جلسه آموزش حضوری جهت گروه مداخله برگزار شد و کتابچه آموزشی نیز در اختیار این گروه قرار گرفت. داده ها با استفاده از پرسشنامه کیفیت زندگی در نوجوانان مصروع و پرسشنامه دموگرافیک جمع آوری و با استفاده از نرم افزار SPSS نسخه 27 تحلیل شد. در نهایت کیفیت زندگی گروه کنترل و مداخله قبل و بعد از اجرای برنامه مقایسه شد. یافته ها: میانگین کیفیت زندگی نوجوانان مبتلا به صرع در گروه مداخله قبل از اجرای مداخله 27/187 و بعد از مداخله 77/202 بود. همچنین ، میانگین کیفیت زندگی نوجوانان مبتلا به صرع درگروه کنترل دردو نوبت اول ۵۳/18۸و در نوبت دوم 73/190 بود. نتيجه گيري: اجرای برنامه خودمدیریتی بر کیفیت زندگی نوجوانان مبتلا به صرع تاثیر معنادار دارد. واژگان کلیدی: صرع، نوجوان، کیفیت زندگی، خودمدیریتی 

Investigating the effectiveness of interventions related to the quality of life of mothers with children with leukemia: A systematic review
پرستاری
فاطمه سوری 1 © ℗, دکتر گلبهار آخوندزاده 2
1 کارشناسی ارشد پرستاری کودکان، واحد علی آباد کتول، دانشگاه آزاد اسلامی، علی آباد کتول، ایران
2 استادیار گروه پرستاری، واحد علی آباد کتول، دانشگاه آزاد اسلامی، علی آباد کتول، ایران
Abstract:

 زمینه و هدف: مادران کودکان مبتلا به لوسمی به دلیل مواجهه با بار روانی و مسئولیت مراقبت، با مشکلات متعددی در کیفیت زندگی روبرو هستند. این مطالعه با هدف بررسی نظام‌مند اثر بخشی مداخلات مربوط به بهبود کیفیت زندگی این گروه انجام شده است. مواد و روش‌ها: این مطالعه نظام‌مند بر اساس دستورالعمل PRISMA انجام شد. جستجوی منابع در پایگاه‌های PubMed، Scopus، Web of Science، SID و Iranmedex با کلیدواژه‌های “Quality of Life”، “Intervention”، “Mothers”، “Childhood Leukemia” و معادل فارسی آن‌ها برای شناسایی مطالعات مداخله‌ای منتشر شده در بازه زمانی 2020 تا 2025 انجام شد. معیارهای ورود شامل مطالعات دارای مداخله با ابزار استاندارد سنجش کیفیت زندگی بودند. داده‌ها پس از استخراج، با استفاده از ابزار CASP و معیارهای Cochrane, از لحاظ کیفیت ارزیابی شدند. یافته‌ها: از میان ۱۷۸۳ مقاله شناسایی‌شده، 17 مطالعه با معیارهای ورود انطباق داشتند. مداخلات شامل آموزش روانشناختی، مشاوره گروهی، تمرینات مبتنی بر ذهن‌آگاهی و حمایت اجتماعی بودند. مداخلات بررسی‌شده شامل آموزش‌های روان‌شناختی، مداخلات مشاوره‌ای گروهی، برنامه‌های مبتنی بر ذهن‌آگاهی، حمایت اجتماعی، آموزش خانواده‌محور، مداخلات روان‌درمانی آنلاین، مراقبت معنوی و برنامه‌های مبتنی بر سلامت روان والدین بودند. مؤثرترین مداخلات مربوط به برنامه‌های گروهی و آموزش ترکیبی بود. میانگین تفاوت استاندارد شده در متغییرمد نظر در قبل و بعد از مداخله در تمام مطالعات معنا دار بود (005/0p). نتیجه‌گیری: شواهد نشان می‌دهد مداخلات آموزشی و حمایتی تأثیر مثبتی بر کیفیت زندگی مادران دارای کودک مبتلا به لوسمی دارند. نیاز به مطالعات طولی و مداخلاتی با کیفیت بالاتر وجود دارد. کلیدواژه‌ها: کیفیت زندگی؛ لوسمی؛ کودک؛ مادر؛ مداخله؛ مطالعه نظام‌مند 

Investigating the effectiveness of self-efficacy-based interventions for mothers of children with cancer: A systematic study
پرستاری
فاطمه سوری 1 © ℗, دکتر گلبهار آخوندزاده 2
1 کارشناسی ارشد پرستاری کودکان، واحد علی آباد کتول، دانشگاه آزاد اسلامی، علی آباد کتول، ایران
2 استادیار گروه پرستاری، واحد علی آباد کتول، دانشگاه آزاد اسلامی، علی آباد کتول، ایران
Abstract:

 مقدمه: سرطان دوران کودکی نه تنها کودک مبتلا، بلکه خانواده و به‌ویژه مادر را نیز به شدت تحت تأثیر قرار می‌دهد. مادران کودکان مبتلا به سرطان اغلب احساس اضطراب، افسردگی و کاهش کیفیت زندگی را تجربه می‌کنند. خودکارآمدی به عنوان یکی از مهم‌ترین سوادهای روان‌شناختی، نقش برجسته‌ای در توانمندسازی مادران جهت مقابله با استرس و چالش‌های فرزندپروری در مواجهه با این بیماری دارد. هدف این مطالعه نظام‌مند، بررسی اثربخشی مداخلات مبتنی بر افزایش خودکارآمدی مادران دارای کودکان مبتلا به سرطان بود. روش‌ها: این مطالعه نظام‌مند، مطابق دستورالعمل PRISMA و پروتکل ثبت شده در PROSPERO انجام شد. جستجو در پایگاه‌های PubMed, Scopus, Web of Science, SID و Magiran برای شناسایی مطالعات تجربی (RCT، شبه‌تجربی و مطالعات مداخله‌ای) منتشرشده از سال 2019 تا ژوئن 2025 به زبان‌های انگلیسی و فارسی صورت گرفت. واژه‌های کلیدی شامل “Self-efficacy”, “Mothers”, “Intervention”, “Childhood Cancer” و معادل فارسی آن‌ها بود. ارزیابی کیفیت توسط ابزار JBI برای کارآزمایی‌ها و مطالعه‌های کنترل‌دار صورت پذیرفت و استخراج داده‌ها، توسط دو پژوهشگر مستقل انجام شد. یافته‌ها: از 842 مقاله بازیابی‌شده، پس از حذف مطالعات همپوشان و بر اساس معیارهای ورود/خروج، 11مطالعه وارد مرور نهایی گردید. نتایج این مطالعات حاکی از آن است که مداخلات مبتنی بر خودکارآمدی، شامل آموزش‌های روان‌شناختی، مهارت‌های مقابله‌ای، جلسات گروهی حمایتی، مداخلات معنوی و بسته‌های آنلاین خودمراقبتی، به طور معناداری موجب افزایش نمره خودکارآمدی مادران کودکان مبتلا به سرطان شده‌اند (005/0p). نتیجه‌گیری: مداخلات مبتنی بر ارتقاء خودکارآمدی، اثربخشی قابل توجهی در بهبود شاخص‌های روان‌شناختی و توانمندسازی مادران کودکان مبتلا به سرطان دارند. تلفیق آموزش مهارت‌های مقابله‌ای و بسته‌های حمایتی در برنامه‌های مراقبت جامع توصیه می‌شود. انجام مطالعات طولی و ارائه مداخلات ساختاریافته‌تر منجر به بهبود نتایج در این گروه هدف خواهد شد. واژه‌های کلیدی: خودکارآمدی، مادران، مداخله، سرطان کودکان، مرور نظام‌مند 

Investigating the Impact of the Pop It Game on Fear Associated with Venipuncture in Children Aged 3-6 Years Admitted to the Emergency Department of Ali Ibn Abi Talib Hospital, Rafsanjan, 2025
پرستاری
Parvin Babaei 1 © ℗
1 MSc Pediatric Nursing Student, Student Research Committee, School of Nursing and Midwifery, Rafsanjan University of Medical Sciences, Rafsanjan, Iran
Abstract: Introduction: Venipuncture is a frequent and distressing procedure for children in clinical settings, often leading to significant fear that can negatively affect their well-being. Non-pharmacological interventions, particularly distraction strategies, are widely recognized as effective for mitigating anxiety in this population. Recognizing that children primarily process emotions through play, the use of toys has become a valuable nursing approach. The Pop It toy has gained attention for its potential to enhance focus and reduce anxiety. Given the lack of prior research on the specific effect of the Pop It game on fear during venipuncture, this study was designed to explore its impact on children aged 3 to 6. 2. Methods and Materials: This quasi-experimental study used a two-group design (intervention and control) in children aged 3-6 admitted to the emergency ward of Ali Ibn Abitaleb Hospital. Participants were recruited via convenience sampling and randomly assigned to either the intervention group (n=37) or the control group (n=36). In the intervention group, children played with a Pop It toy for five minutes during venipuncture. The control group received five minutes of rest before undergoing the same procedure. Fear was measured using a validated fear scale, and data were analyzed with non-parametric tests, including the Mann-Whitney U test and the Wilcoxon signed-rank test. 3. Results: Demographic analysis revealed no statistically significant differences between the two groups (P 0.05), confirming their homogeneity at baseline. Prior to the intervention, mean fear scores were not significantly different between the groups (P = 0.97). However, following the Pop It intervention, fear scores in the intervention group were significantly lower than in the control group (P 0.001). A within-group analysis showed a significant reduction in fear scores over time within the intervention group, while scores in the control group showed a significant increase. 4. Conclusion and Discussion: This study suggests that the Pop It game is a highly effective distraction technique for reducing fear during venipuncture in young children. These results are consistent with literature on non-pharmacological interventions for procedural distress. The observed decrease in fear has the potential to improve children's experiences with medical procedures and enhance their cooperation with healthcare providers. Given its effectiveness, the use of the Pop It game is recommended as a standard nursing practice in pediatric and emergency care settings.

Investigating the Implementation of Corrective Preventive Measures for Pressure Ulcers Using the HFMEA Method in the Pediatric Intensive Care Unit 
پرستاری
Mahsa Salehzadeh Nobari 1 ©, Prisa Asadi 2, Mahnaz Mohammadpouri 3 ℗, Horiyeh Rahimi Gholenji 2, Parisa Babazadeh Eslamlu 2
1 Master of Nursing, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
2 . Nursing Expert, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
3 . Master of Nursing, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
Abstract: Introduction: Pressure ulcers are one of the most costly unresolved health issues. Due to their adverse outcomes, preventing their occurrence through cost-effective strategies is crucial for improving and enhancing patients' quality of life. Prevention requires accurate identification of at-risk patients (using an appropriate approach) and the provision of safe nursing care through the use of suitable equipment and facilities. This study aimed to investigate the implementation of corrective preventive measures for pressure ulcers using the HFMEA method in the pediatric intensive care unit of the Shahid Motahari Educational and Medical Center in Urmia in 2024. Methods: In this study, potential failure modes and factors affecting the prevention of pressure ulcers in hospitalized patients in pediatric intensive care units were first identified and analyzed using the HFMEA method. Data for the HFMEA worksheet were designed via interviews and group sessions with team consensus in the form of a checklist. Data were collected through direct observation for 48 patients susceptible to pressure ulcers using a census sampling method and entered into SPSS software version 16. The obtained data were analyzed using descriptive statistical tests. Findings: The results showed that out of 10 potential failure modes (factors contributing to pressure ulcer development), patient repositioning according to the hourly chart (96%) and continuous assessment of the patient for pressure ulcers and skin integrity by the nurse (91%) had the highest adherence rates. In contrast, the use of specific antibacterial bath foams and keeping the skin moist with moisturizers (52%) had the lowest adherence rate. Conclusion: Given that risk management and patient safety are fundamental pillars of healthcare service quality, the HFMEA technique, with its preventive and prospective approach, can serve as an effective executive solution. By focusing on systemic errors, identifying procedural and organizational weaknesses, extracting error-prone bottlenecks, and planning care interventions along with implementing corrective actions, it can play a significant role. Keywords: Risk Management, Pressure Ulcer, HFMEA 

Investigating the level of nurses' attitude towards artificial intelligence applications in hospitals under the supervision of Abadan University of Medical Sciences in 2023
پرستاری
اکرم همتی پور 1 © ℗
1 کارشناسی ارشد پرستاری، دانشگاه علوم پزشکی آبادان، آبادان، ایران
Abstract:

 زمینه و هدف: استفاده از هوش مصنوعی نوآوریهایی را برای عملکرد مراقبت پرستاری، کاهش خطا در امر مراقبت از بیمار فراهم میکند. لذا مطالعه حاضر با هدف تعیین سطح نگرش پرستاران از کاربردهای هوش مصنوعی در بیمارستانهای تحت نظارت دانشگاه علوم پزشکی آبادان در سال 1402 انجام شده است. مواد و روشها: در این مطالعه توصیفی -مقطعی که در سال 1402 انجام شد، 208 پرستار شاغل تحت نظارت در بیمارستانهای دانشگاه علوم پزشکی آبادان به روش سرشماری و با رضایت آگاهانه طی سه ماه، پرسشنامه محقق ساخته نگرش11 سؤالی که در زمینه کاربردهای هوش مصنوعی و بر اساس مقیاس لیکرت ۵ گزینهای از کاملا مخالفم )نمره 1( تا کاملا موافقم )نمره ۵( تنظیم و روایی و پایایی آن انجام شد را تکمیل نمودند. دادهها با استفاده از آمار توصیفی و آزمونهای تی مستقل و آنالیز واریانس با نرمافزار spss نسخه 26 تجزیه و تحلیل شدند. یافتهها: در این مطالعه 208 پرستار با میانگین سنی9/۵9 3۵/۵1± سال مورد بررسی قرار گرفتند همچنین میانگین نگرش پرستاران )4/07 ± 33/82( بود که نشان داد 177 نفر) 88/۵ درصد نگرش متوسط( و 11 نفر) ۵/۵ درصد( نگرش کاملا مثبت به کاربردهای هوش مصنوعی در پرستاری دارند. 121 نفر )۵8/17 درصد( موافق بودند که نقش مهمی در مراقبت پرستاری دارد و قابل توجه است که 38 نفر) 18/26( درصد( معتقد بودند عملکرد پرستاری و زمینه کاری آن را مختل میکند از نظر متغیرهای جمعیت شناختی نیز سن، جنس، سابقه کاری و محل خدمت با نگرش پرستاران از هوش مصنوعی معنادار نشده است)0/0۵p). نتیجهگیری: نتایج مطالعه حاضر نشان داد که سطح نگرش پرستاران آنها متوسط است. سیاستگذاران یک برنامه آموزشی رسمی در زمینه هوش مصنوعی برای پرسنل بهداشت و درمان تدوین کنند که میتواند گام مهمی در پیادهسازی و توسعه موفقیتآمیز باشد. واژگان کلیدی: نگرش، مراقبت با هوش مصنوعی، پرستاران

Lived Experiences of Mothers in Neonatal Intensive Care about factors affecting sleep mothers: A Qualitative Directed Content Analysis
پرستاری
Elham Khadem Hamzei 1 ℗, Saideh Sadat Mortazavi 2, Zahra Mortazavi 3 ©
1 MS student of occupational Therapy, Student Research Committee, Tehran University of Medical Sciences, Tehran,
2 Occupational Therapy, Student Research Committee, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
3 PhD student of Speech Therapy, Student Research Committee, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Objective: The neonatal intensive care unit (NICU) can potentially exacerbate anxiety and stress for mothers of hospitalized infants, who sometimes spend hours a day around the infant's bed. This research was conducted to explain the lived experiences of this group of mothers from the negative and positive factors affecting their sleep quality in three areas: environment, person, and occupation, to help improve the sleep quality of mothers of hospitalized babies. Material and Methods: This qualitative study was conducted with Directed Content Analysismethod, with the participation of 16 mothers in the Neonatal Intensive Care Unit, Fatemiyeh Hospital, and Hamadan University of Medical Sciences in February 2023. Sampling was targeted. Data were collected through semi-structured interviews and personal profile questionnaires. Interviews were taped and transcribed and were analyzed based on the Colaizzi approach. Results: The results of the present study included 168 primary codes, 19 subcategories, and 8 main categories. The main concepts extracted from the sleep experience of mothers in this study are in the individual field: somatic factors, mental and psychological factors, and adaptation to conditions. In the environmental field: physical factors, social factors, and economic factors. In the field of occupation: daily activities, activities, and tasks. Conclusion: Based on the results of the present study, individual and environmental factors, and occupation are effective in the sleep of mothers in the neonatal intensive care unit. These findings increase our understanding of mothers' sleep experiences and highlight the importance of paying attention to these factors in the prevention and treatment of sleep quality disorders in mothers of newborns in research and clinical practice. Keywords: Sleep, Lived Experience, Mother, Neonatal Intensive Care Unit, Qualitative Study کد طرح: ۱۴۰۱۱۱۱۸۹۹۱۸ کد اخلاق: IR.UMSHA.REC.1401.861 

Lived experiences of mothers with children with hyperactivity
پرستاری
Arman Dehghani 1 © ℗, Nasrin Alizadeh 1
1 دانشکده پرستاری دانشگاه علوم پزشکی یاسوج
Abstract: 

تجارب زیسته مادران با کودکان مبتلا به بیش فعالی زمینه: این مطالعه با هدف بررسی تجربیات زیسته مادران دارای کودکان مبتلا به اختلال کمتوجهی-بیشفعالی انجام شد. روش‌ها: این مطالعه کیفی توصیفی بر اساس رویکرد پدیدارشناسی انجام شد که به بررسی تجربیات مراقبان اولیه کودکان مبتلا به اختلال کمتوجهی-بیشفعالی پرداخت. جامعه مطالعه شامل مادران دانش‌آموزان مقطع ابتدایی مبتلا به اختلال کم¬توجهی-بیش¬فعالی در زاهدان بود. در مجموع17 کودک با استفاده از نمونه‌گیری هدفمند انتخاب شدند. داده‌ها از طریق مصاحبه‌های رو در رو، عمیق و نیمه‌ساختاریافته با شرکت‌کنندگان جمع‌آوری شد. مصاحبه‌ها در مدارس و مرکز مشاوره انجام شد. علاوه بر این، از روش پدیدارشناسی شناختی اسمیت برای تحلیل داده‌ها استفاده شد. نتایج: تحلیل داده‌ها ۴ درون‌مایه اصلی و ۲۵ زیرمضمون را آشکار کرد که شامل موارد زیر بودند: • پاسخ‌های هیجانی افسردگی، تنهایی، خشم و عصبانیت، خجالت، تمایل به داشتن یک کودک آرام، استرس، سردرگمی، عذاب وجدان، پشیمانی، یأس، اضطراب و وحشت • پاسخ‌های رفتاری سرزنش خود، گریه مکرر، فریاد زدن، پرخاشگری، تلاش برای کنترل خود • پاسخ‌های فیزیکی تپش قلب، احساس چکیدن قطرات آب داغ روی سر • و پاسخ‌های شناختی احساس غیرانسان بودن، انزوا، احساس گناه، خجالت و سرزنش‌پذیری، مشکلات در بارداری، احساس دیوانگی، احساس بیشفعالی به دلیل ناتوانی در کنترل خود، احساس متهم شدن به دروغگویی • نتیجه‌گیری: نتایج این مطالعه راه را برای تحقیقات بیشتر در زمینه مداخلات سلامت روان برای مادران کودکان مبتلا به اختلال کم¬توجهی-بیش¬فعالی هموار خواهد کرد. بر این اساس، طراحی و ارزیابی اثربخشی مداخلات روان‌درمانی که بتوانند ابعاد مختلف مشکلات این گروه از مادران را پوشش دهند، ضروری است. کلمات کلیدی: اختلال کم¬توجهی-بیش¬فعالی، مطالعه پدیدارشناختی، مادران، کودکان

Long-Term Psychosocial Outcomes and Rehabilitation Strategies after Pediatric Burn Injuries: A Systematic Review
پرستاری
Mehrshad Mohebifar 1 ©, Elham Salimpour 2, Reza Ghorbani 3, Negin Hosseini 4 ℗
1 BSc Student in Nursing, Student Research Committee, Ahvaz Jundishapur University of Medical Sciences,Ahvaz, Iran
2 BSc in Nursing, Staff Nurse, Department of Nursing,Fajr Hospital ,Marivan, Kurdistan, Iran
3 MSc Student in Wound Healing and Tissue Repair, Cardiff University, UK
4 Nurse, Master student of critical care nursing, Alborz University of Medical Sciences, Karaj, Iran
Abstract: Title Long-Term Psychosocial Outcomes and Rehabilitation Strategies after Pediatric Burn Injuries: A Systematic Review Background Burn injuries remain one of the most devastating forms of trauma in children, leading not only to physical morbidity but also profound and lasting psychosocial challenges. While acute burn management has been extensively studied, there is a paucity of synthesized evidence on the long-term psychosocial sequelae and effective multidisciplinary rehabilitation strategies in the pediatric population. Objectives To systematically review the available evidence on (1) psychosocial outcomes following pediatric burn injuries, and (2) rehabilitation approaches aiming to improve quality of life, social reintegration, and emotional well-being in affected children. Methods A systematic literature search was conducted in PubMed, Scopus, Web of Science, and CINAHL from inception to August 2025. Inclusion criteria: studies involving patients 18 years old with burn injuries, reporting psychosocial outcomes ≥6 months post-injury, and/or describing structured rehabilitation interventions. Exclusion criteria: animal studies, case reports, and studies without psychosocial outcome measures. Data extraction and risk of bias assessment (Cochrane RoB 2, ROBINS-I) were performed independently by two reviewers. A narrative synthesis was undertaken; meta-analysis was conducted when data homogeneity allowed. Results Of 1,237 identified records, 26 studies met inclusion criteria (n = 3,482 children). Common long-term outcomes included anxiety, depression, post-traumatic stress symptoms, body image disturbance, and reduced school participation. Multidisciplinary rehabilitation programs—particularly those integrating psychological counseling, peer-support groups, and school reintegration plans—were associated with significant improvement in psychosocial scores (standardized mean difference range: 0.35–0.78, p 0.05). Heterogeneity in outcome measures (I²: 62–79%) limited pooling in some domains. Evidence gaps were identified in low- and middle-income country (LMIC) settings and in trials with ≥5 years follow-up. Conclusions Pediatric burn injuries have substantial long-term psychosocial consequences. Structured, multi-component rehabilitation programs show promise in improving well-being and facilitating reintegration, but high-quality longitudinal RCTs are lacking—especially in resource-limited contexts. Addressing these gaps is crucial for developing culturally sensitive, sustainable interventions. Keywords Pediatric burns, psychosocial outcomes, rehabilitation, quality of life, systematic review

Management of Upper Limb Ischemic Wounds Due to Umbilical Cord Torsion in a Newborn: A Case Report Study 
پرستاری
مهدیه السادات میرزائیان 1 ℗, طناز فارغ 2 ©, رضا قربانی 3, سارا پارسائی 1, نگین حسینی 4
1 B. Sc. of Nursing, Student Research Committee of Nursing School, Alborz University of Medical Sciences, Karaj, Iran
2 M. Sc. Student of Medical-Surgical Nursing, Students’ Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
3 M. Sc. Student of Wound Healing and Tissue Repair, Cardiff University, UK. Wound Care Specialist, Wound Lab Clinic, Iran
4 M. Sc. Student of Critical Care Nursing, Alborz University of Medical Sciences, Karaj, Iran
Abstract: Introduction and Aims: Limb ischemia (LI) in the newborn is a rare phenomenon defined as sudden loss of blood perfusion that can lead to necrosis if reperfusion is not performed within the first 4–6 hours. Its etiology can be classified into two main categories of intrauterine and postnatal causes. This condition is frequently associated with umbilical cord torsion in uterine, affecting not only the infant's physical development but also creating notable emotional and psychological complications for families. Unfortunately, there is no specific guidelines to manage LI and its complications; on the other hand, isolated LI subsequent to umbilical cord torsion is only reported in handful literature cases which mostly ended-up with amputation. Therefore, detailed reporting of similar cases is essential to enhance management strategies for healthcare providers. This case is reported in line with the SCARE 2025 criteria. Case presentation: The patient is a pre-term(37weeks) newborn male who exhibited significant left forearm and hand cyanosis with necrotic wounds (covered by wet and dry eschar, adherent slough, and blisters) and complete lack of movement in arm. Moreover, he was admitted in NICU to receive respiratory support. There were no reported prenatal complications, contributary family-history, genetic disorders or congenital anomalies besides his mother received regular prenatal care without prolonged labor. A thorough assessment reveals complete absence of sensation and radial pulse and doppler ultrasound confirmed complete absence of blood supply to the affected area. Radiological findings suggest malformed fingers and reduced bone density. These investigations led to diagnosis of a left-hand necrosis secondary to umbilical cord torsion occurred in uterine. The management of this condition necessitated a multidisciplinary approach involving wound specialist, pediatric surgeon, orthopedic specialists, and physical therapists. In spite of considering amputation, wound specialist convinced the team to follow novel wound management process with dressing and debridement. Surprisingly, using dry dressing did not work well for healing ischemic wounds although gel-sheet form dressing through 26 sessions closed the wounds with the least scar and no healing complications. Moreover, resources were provided to support the family in navigating ongoing orthopedic care. Conclusion: This case underscores the important role of wound specialists in addressing complex LI condition via choosing the best wound management plan and preventing amputation performing. Therefore, this situation highlights the need for collaborative management strategies, ultimately enhanced neonatology care practice, and continued research to develop suitable guidelines for management in similar cases. keywords: limb-ischemia, umbilical cord torsion, newborn.

Meta-Analysis Review: Empowering Parents and Nurses in Facing Caregiving Challenges
پرستاری
مهدی محمودزاده 1 © ℗, ثنا خلیل زاده ضیاء 2, محمد محمودزاده 3
1 Department of Pediatric Nursing, Student Research Committee, Khoy University of Medical Sciences, Khoy, Iran
2 Department of Pediatric Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
3 Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: Introduction The increasing complexity of pediatric healthcare necessitates active involvement and empowerment of parents and nurses to optimize child outcomes. Empowerment interventions aim to enhance knowledge, skills, and confidence in caregiving, addressing challenges posed by chronic illness, acute emergencies, and psychosocial stressors. This meta-analysis synthesizes recent evidence on empowerment programs for parents and pediatric nurses, evaluating their effects on self‑efficacy, stress reduction, quality of care, and patient health. Methods A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published between January 2019 and December 2024. Keywords included “empowerment,” “parents,” “nurses,” “pediatrics,” and “caregiving challenges.” Inclusion criteria were quantitative studies assessing empowerment interventions with measurable outcomes such as parental self‑efficacy, caregiver stress, quality of care, and child health indicators. Out of 125 articles screened, 11 studies (total N = 6,870) met eligibility criteria. Standardized mean differences (SMD) with 95% confidence intervals (CI) were calculated to determine effect sizes. Results Parental Empowerment: Programs including educational workshops, peer-support groups, and digital platforms improved parental self‑efficacy (SMD = 0.46; 95% CI: 0.32–0.59; p 0.001), reduced stress, and enhanced adherence to care plans (Wulandari et al., 2021). The most significant impact was observed among parents of children with chronic or complex health conditions. Nurse Empowerment: Interventions focusing on professional growth, crisis simulation, and resilience training increased job satisfaction and care quality among pediatric nurses (SMD = 0.39; 95% CI: 0.21–0.56; p = 0.001) (Smith et al., 2022). Nurses reported improved confidence in crisis management and family-centered care. Combined Parent–Nurse Empowerment: Collaborative models engaging parents and nurses yielded optimal patient health outcomes and satisfaction levels (Kim & Lee, 2023). Heterogeneity among studies was moderate (I² = 52%), reflecting intervention design and outcome measures differences. Conclusion Empowerment interventions targeting parents and nurses significantly improve caregiving effectiveness in pediatric settings. Benefits include enhanced self‑efficacy, reduced stress, better adherence to treatment plans, and improved quality of care. Integrating such evidence-based approaches into pediatric healthcare systems can strengthen caregiver resilience and achieve superior child health outcomes. Future research should aim to standardize empowerment definitions, extend follow-up durations, and explore cost-effectiveness to support broader implementation.

Mortality status of children aged 1 to 59 months, Tehran University of Medical Sciences
پرستاری
فاطمه پولادی 1 ©, سیمین رنجبران 2 ℗, زهرا اسکندری 1
1 معاونت درمان دانشگاه
2 مدیرپرستاری دانشگاه
Abstract: Introduction: One of the important indicators of development and health in countries is the mortality rate of children under 5 years of age. In recent years, the mortality rate of children under 5 years of age in our country has decreased, but it is still higher than in developing countries. Given the serious sense of urgency and the resources mobilized to progress in reducing mortality rates, we decided to investigate the factors affecting the mortality of children aged 1-59 months in 1403 AH at Tehran University of Medical Sciences. Method: This research was a descriptive-analytical study that was conducted in 1403 AH. This research was conducted on 160 children aged 1 to 59 months using a census method. The tool used in this research was the child mortality checklists of the Ministry of Health, Treatment and Medical Education, which information was collected by an expert and analyzed after data extraction. Findings: The results of this study showed that the number of deaths among children aged 1-59 months was 160. The highest number of deaths was in the age group of 1-12 months (48.6%). Of these, 50.6% were boys and 49.4% were girls in terms of gender, 97.5% were urban and 2.5% were rural, and 77.5% were Iranian and 23.9% were non-Iranian in terms of nationality. The most common causes of death were respiratory diseases (36.9%), cardiovascular diseases (15%), and infectious and parasitic diseases (9.4%). Conclusion: To reduce the mortality rate of children and improve the health of this age group, it is necessary to increase the awareness of their parents by providing them with documented training in identifying risk factors and referring their children to medical centers in a timely manner to receive appropriate services. 

Multidimensional Rehabilitation of Children and Families: From Crisis to Renewal with an Innovative Approach
پرستاری
Somaye Pouy 1 © ℗, Latif Panahi 2
1 1 Assistant professor, Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. (Email: somayepouy@gmail.com) 2 Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. (Email: somayepouy@gmail.com)
2 Ph.D Student in Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
Abstract: Introduction: Rehabilitating children and their families after a crisis requires a holistic and multidimensional approach—one that addresses physical, psychological, social, and spiritual needs. From providing emotional and social support to utilizing creative methods like art, play therapy, and corrective exercises, the goal is to enhance their quality of life and facilitate recovery. This article address into innovative rehabilitation strategies that empower children and families to overcome crises and rebuild their lives. By recognizing and addressing their diverse needs, these approaches pave the way for renewal and a healthier, more fulfilling future. Method: This review was conducted to comprehensively identify and analyze innovative methods for multidimensional rehabilitation of children and their families following crisis situations. The research team employed a structured search strategy across multiple established academic databases, including SID, Google Scholar, Web of Science, Scopus, and PubMed, with no restrictions on publication date from inception through 2025. The search strategy utilized keywords including "Multidimensional Rehabilitation," "Pediatric," "Pediatric Recovery," "Family Support," and "Crisis Management" to ensure comprehensive coverage of relevant literature. Two independent reviewers screened all retrieved titles and abstracts using predetermined inclusion and exclusion criteria. Studies were included if they addressed developmental, psychological, spiritual, and functional rehabilitation approaches for children and families, published in either Persian or English languages, and demonstrated evidence-based interventions for crisis recovery. Exclusion criteria including case reports with insufficient methodological detail, and publications in languages other than Persian or English. Data extraction was performed systematically using standardized forms that captured intervention characteristics, target populations, implementation methodologies, duration of interventions, and reported outcomes across multiple rehabilitation domains. Results: The review highlights that multidimensional rehabilitation significantly improves recovery outcomes for children and families by addressing physical, psychological, social, and spiritual needs. Innovative interventions such as play therapy, art therapy, and corrective exercises contribute to enhanced emotional well-being and functional restoration. Family-centered support plays a critical role in fostering resilience and ensuring personalized, holistic care. Effective coordination among healthcare providers, and families optimizes rehabilitation processes and sustains positive outcomes. Overall, adopting this comprehensive and innovative approach facilitates renewal and improves the quality of life for children and their families after crises. Conclusion: Multidimensional rehabilitation provides a holistic framework to address the physical, psychological, social, and spiritual needs of children and families recovering from crises. Innovative interventions such as play therapy, art therapy, and family-centered support systems foster resilience and adaptive recovery. Involving families ensures personalized care and emotional support.

Music Therapy, Play Therapy, and Virtual Reality as Nursing Led Anxiolytic Interventions During Pediatric Anesthesia Induction: A Systematic Review of Clinical Evidence
پرستاری
Hamid Yazdaninejad 1 ℗, Najme Zamani 2 ©
1 Department of Operating Room and Anesthesiology, School of Allied Medical Sciences, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 2. MSC student in medical surgical nursing, Nursing and Midwifery school, Kashan University of Medical Sciences,Kashan, Iran
Abstract: Introduction: Preoperative anxiety in children can disrupt physiological stability, hinder anesthesia induction, and affect recovery. Nursing‑led, non‑pharmacological interventions such as music therapy, play therapy, and virtual reality are increasingly recognized as safe and effective strategies to improve comfort and cooperation. Despite growing evidence, an updated synthesis of studies from 2020–2025 is needed to guide perioperative nursing practice. This review critically appraises and synthesizes clinical research on the anxiolytic effectiveness of these interventions during pediatric anesthesia induction, highlighting nursing roles, implementation strategies, and patient‑centered outcomes. Methods: In accordance with PRISMA 2020 guidelines, PubMed, CINAHL, Embase, PsycINFO, and Scopus were searched (January 2020–May 2025) for studies involving children aged 2–12 undergoing general anesthesia, in which nurses delivered or coordinated music therapy, play therapy, or virtual reality during induction. Eligible designs included randomized controlled trials (RCTs), quasi‑experimental studies, and observational studies reporting quantitative or qualitative anxiety outcomes. Two reviewers independently screened studies, extracted data, and assessed quality using Joanna Briggs Institute tools. Findings were narratively synthesized, considering heterogeneity in interventions and outcome measures. Results: Fourteen studies (n = 1,248 children) met the inclusion criteria: six examined music therapy, five investigated virtual reality, and three evaluated structured play therapy. Anxiety reduction was consistently reported across all interventions, with music therapy showing mean reductions of 25–40% on validated scales, typically via live or recorded sessions adapted to the child’s age and preferences. Virtual reality interventions demonstrated high engagement rates (85%) and rapid immersion, resulting in pre‑induction anxiety reductions comparable to or greater than those achieved with midazolam in some cases. Play therapy often utilizing interactive medical play kits reduced anxiety by enhancing procedural understanding and fostering trust with perioperative nursing staff. Across all modalities, active nurse facilitation, thorough parental briefing, and integration into pre‑induction workflows were critical to success. All studies reported high acceptability, minimal adverse effects, and improved cooperation during mask placement and induction. Quality appraisal indicated moderate to high methodological rigor in 72% of studies. Conclusion: Music therapy, play therapy, and virtual reality when delivered or coordinated by perioperative nursing staff are effective, safe, and well‑tolerated strategies for reducing preoperative anxiety in children. These approaches support child‑ and family‑centered care, improve induction compliance, and may reduce reliance on pharmacological anxiolytics. Future research should focus on protocol standardization, long‑term emotional outcomes, and integration into diverse perioperative settings to expand accessibility and ensure evidence‑based nursing practice. Keywords: Pediatric anesthesia;Nursing interventions;Music therapy;Play therapy; Preoperative anxiety

Novel Strategies for the Prevention of Intraoperative Hypothermia in Neonatal Surgery: A Systematic Review
پرستاری
Sedighe Hannani 1, Bahador Pourdel 2 ©, Erfan Rajabi 2 ℗, Seyed Abolfazl Hosseini 2, Amirali Alizadeh 3
1 Senior Expert in internal surgical nursing, instructor, operating room department, faculty of paramedicine, Iran university of medical sciences, Tehran, Iran
2 MSc of Perioperative Nursing, Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, ‎Maragheh, Iran‎
Abstract: Introduction The elevated surface area-to-body mass ratio, underdeveloped thermoregulatory systems and limited subcutaneous fat in neonates make intraoperative hypothermia a major perioperative complication. Hypothermia contributes to metabolic acidosis, coagulopathy, surgical site infections and prolonged hospital stays. Common warming methods include heated intravenous fluids and forced-air warming. However, new methods that consider environmental and physiological factors are being implemented. This systematic review identified, assessed and synthesized innovative neonatal hypothermia prevention strategies to improve anesthesia and surgical safety. Methods We searched PubMed, Embase, Scopus, Web of Science and the Sincedirect for studies on neonates, intraoperative hypothermia, surgery, prevention, warming strategies and temperature management from commencement to March 2025. RCTs, cohort studies and case-control studies evaluating innovative neonatal surgery strategies (e.g., phase-change materials, heated-humidified ventilation, incubator-based systems) were included. We excluded research on traditional warming methods, animal models, or adult/pediatric groups without neonatal subgroup analysis. We assessed bias in randomized controlled trials using the Cochrane Risk of Bias tool and observational studies using ROBINS-I. Our narrative data was integrated using a random-effects meta-analysis model when possible. Results The 17 studies included 1,248 newborns in 11 randomized controlled trials and 6 observational studies. Recently evaluated strategies included heated-humidified respiratory gases (n=8), phase-change warming mattresses (n=4), reflective thermal insulation (n=3) and integrated incubator systems (n=2). Compared to standard care, heated-humidified gases significantly reduced intraoperative temperature decline (mean difference: +0.6°C; 95% CI: 0.3–0.9; p0.01, 6 RCTs, 524 neonates). Phase-change mattresses prevented hypothermia during induction and prolonged surgery (RR: 0.72; 95% CI: 0.55–0.93, 3 RCTs). Reflective insulation and incubator-based systems showed promise, but small sample sizes and varied research methods limited the evidence. Since most RCTs had robust randomization and effective outcome measures, bias was low to moderate. Conclusion New methods like heated-humidified respiratory gases and phase-change warming devices reduce neonatal hypothermia during surgery. Reflective insulation and incubator-based systems may work, but randomized controlled trials are needed to prove it. High-risk neonates may benefit most from multiple warming methods. These findings emphasize the need for neonatal surgery temperature management protocols.

Nursing Care for Pediatric Pneumonia in the Emergency Department: Innovative Nursing Approaches
پرستاری
Ali Karamoddin 1 ℗, Amir Reza Mohammadi 1, Farnoosh Tajik 2 ©
1 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran.
2 Nursing care research center, Semnan University of medical sciences, Semnan, Iran. Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran.
Abstract: Introduction: Pediatric pneumonia is a leading respiratory infection, requiring timely and effective nursing care in the emergency department (ED). This study reviews standard nursing practices, innovative interventions, and additional considerations that improve patient outcomes. Method: This review conducted in 2024 by searching international and national databases, including PubMed, Scopus, Web of Science, and SID. Keywords related to “Pneumonia",” Pediatric", “Children”, “Nurse” and “Nursing" were used. Thirty articles from 2020 to 2024 were reviewed based on inclusion and exclusion criteria. Results: The following key findings were identified where nurses can play a key role in pediatric pneumonia management: 1. Pneumonia Diagnosis o Clinical Symptoms: Productive cough, Fever, Chills, Shortness of breath, Tachypnea, Lethargy o Auxiliary Diagnoses: Leukocytosis, elevated ESR, chest X-ray to assess lung involvement 2. Nursing Interventions o Initial Care: Monitoring vital signs, respiratory assessment, oxygen therapy, urgent care measures (e.g., mechanical ventilation, sedation, anti-inflammatory meds for severe pneumonia) o Pharmacological Management: Antibiotics (e.g., Amoxicillin, Cephalosporins), antipyretics o Family Education: Teaching families about symptoms, medication use, and home care strategies 3. Innovative Nursing Approaches o Utilization of Technology: Non-invasive monitoring (pulse oximeters), Pediatric Early Warning Scores (PEWS), mobile apps for family education o Comprehensive care: Non-pharmacological therapies (bronchodilators, chest physiotherapy), psychological support for children and families 4. Assessing clinical Outcomes o Improvement in Symptoms: Shorter hospital stays, alleviated respiratory symptoms o Parental Satisfaction: Higher satisfaction and improved child quality of life 5. Additional Considerations o Holistic Care: Pain management, nutrition, and hydration o Interdisciplinary Collaboration: Coordination among nurses, doctors, physiotherapists, and psychologists. o Socioeconomic Factors: Addressing healthcare access disparities through community programs. Conclusion: Effective management of pediatric pneumonia in the emergency department requires a multifaceted, comprehensive, interdisciplinary approach that integrates traditional and innovative nursing practices to enhance outcomes and care quality. Keywords: Pneumonia; Pediatric; Nursing care 

Nursing Care Strategies in Management of Neonatal Pertussis
پرستاری
Farnoosh Tajik 1 © ℗
1 Faculty member, Department of pediatric and neonatal nursing, Semnan University of Medical Sciences, Semnan, Iran
Abstract: Background: Whooping cough, is a contagious respiratory infection caused by Bordetella pertussis. Despite widespread vaccination programs, the disease remains a global public health challenge. Neonates are most vulnerable due to immature immunity and incomplete vaccination. Clinical manifestations may include apnea, cyanosis, tachypnea, paroxysmal cough, respiratory distress, and leukocytosis. Early nursing recognition and intervention are essential to prevent complications. The aim of this review is to summarize nursing care strategies in the management of neonatal pertussis. Method: This review was conducted in 2025 by searching PubMed, Embase, Scopus, Web of Science, and Cochrane. The search combined keywords including “Pertussis,” “Whooping cough,” “Neonate,” “Infant,” “Nursing,” and “Nurse.” Eligible studies based on inclusion and exclusion criteria were analyzed, and relevant data were extracted and synthesized. Results: 1. Early Recognition and Monitoring: Nurses should suspect pertussis in neonates with apnea, cyanosis, or paroxysmal cough. Continuous monitoring with pulse oximetry and apnea alarms is recommended. 2. Supportive Care: Provide humidified oxygen and gentle suctioning to maintain ventilation. Prepare for assisted ventilation in severe cases and use HFNC after extubation when appropriate. Advanced interventions, including intubation, ECMO, or leukodepletion, may be required. Adequate hydration and nutrition should be ensured with IV fluids or gavage feeding when oral intake is limited. 3. Infection Control: Apply droplet precautions (private room, mask) for at least five days after initiation of antibiotic therapy. Isolate infected neonates to prevent nosocomial transmission. 4. Pharmacological Management: Administer macrolide antibiotics, preferably azithromycin for 5 days (10 mg/kg on day one, then 5 mg/kg daily for four days). Start treatment immediately upon suspicion without waiting for PCR. Prophylaxis is recommended for close contacts, including family members and healthcare workers. 5. Environmental and Safety Measures: Minimize environmental stimuli by providing a quiet and dimly lit room to reduce coughing episodes. Implement seizure precautions such as bedside safety rails due to hypoxia risk. 6. Caregiver Education: Teach parents about cough hygiene and handwashing. Emphasize the importance of adherence to prescribed antibiotics. Educate families on immunization strategies, including maternal Tdap vaccination, to protect newborns. Conclusion: Effective management of neonatal pertussis, especially in severe cases, requires a comprehensive approach. Nursing care depends on early detection, vigilant monitoring, and supportive interventions, while strict infection control and timely antibiotic therapy help reduce complications and transmission. Caregiver education on hygiene and vaccination, with protocols emphasizing family support and interdisciplinary collaboration, can improve outcomes and lessen disease burden. Keywords: Pertussis, Nursing, Whooping cough

Nursing Interventions for the Prevention and Management of Extravasation in Pediatric Patients: A Systematic Review
پرستاری
Ali Karamoddin 1 ℗, Ali Dayyabi 1, Farnoosh Tajik 2 ©
1 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
2 Nursing care research center, Semnan University of medical sciences, Semnan, Iran, 2-Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Iran
Abstract: Background: Extravasation of intravenous fluids and medications is a frequent yet preventable complication in pediatrics, often leading to pain, tissue injury, and long-term sequel. Nurses are central to prevention, early recognition, and initial management, given their frontline role in IV therapy. Despite this, evidence remains fragmented and practice is heterogeneous. The aim of this review was to identify and synthesize nursing interventions for the prevention and management of extravasation in pediatric patients. Method: A systematic review was conducted on studies published from January 2020 to August 13, 2025. Databases included PubMed/MEDLINE, Embase, Scopus, Web of Science, Cochrane, and CINAHL. Search strategies combined MeSH and free-text terms for extravasation, infiltration, IV complications, pediatrics, neonates, children, nursing care, prevention, and management. Eligible studies were English, free full text, and clinical studies/implementation reports addressing prevention, detection, or management in pediatric patients. Two reviewers independently screened, extracted data, and appraised risk of bias. Results: 1. Prevention Risk assessment tools: Validated pediatric instruments (e.g., Intravenous Infiltration and Extravasation Risk Assessment Tool – IIERAT). Identification of high-risk patients: Preterm and low-birthweight infants; children receiving vesicant, irritant, or hyperosmolar solutions. Prevention bundles: Safe site selection (avoiding active limbs), minimizing cannula dwell time, appropriate cannula size, considering central access for vesicants., and monitoring infusion pressures. Nurse education: Structured training with lectures, simulation, and protocols improves vigilance and reduces complications. Monitoring: Hourly site checks, documentation, infusion pump alarms, and involving parents in observation. Technology-assisted detection: Point-of-care ultrasound (POCUS) and optical/near-infrared sensors facilitate earlier recognition compared to inspection alone. 2. Management Immediate actions: Stop infusion, aspirate residual drug via cannula, elevate the limb, and apply warm or cold compresses depending on the drug type. Pain control: Ensuring comfort through appropriate analgesia. Pharmacologic interventions: Nurses play a key role in preparing and administering prescribed agents such as hyaluronidase, phentolamine, or topical nitroglycerin. Adjunctive techniques: Flush-out method, applying advanced dressings (hydrocolloid, hydrogel, hydrocellular foam), and supporting wound care. Emerging biologic therapies: Monitoring and applying biologic therapies (amniotic membrane, fish skin, active leptospermum honey, platelet-rich plasma) under medical guidance. Surgical management: Providing perioperative support, wound care, and family education following surgical interventions (Debridement or reconstruction for severe tissue necrosis). Conclusion: Current evidence highlights the central role of nurses in minimizing extravasation-related harm in pediatrics. Strengthening standardized protocols, continuous education, and careful monitoring, alongside future studies, will support safe, evidence-based integration of of emerging interventions and biologic therapies. Keywords: Extravasation, Infusion Therapy, Pediatrics

Nursing Interventions to Improve Sleep Quality in Hospitalized Children: A Systematic Review
پرستاری
فاطمه سادات حسینی 1 © ℗, سمیه ناظمی 1
1 کمیته تحقیقات پرستاری دانشکده پرستاری مامایی، دانشگاه علوم پزشکی کاشان، کاشان، ایران
Abstract:

 زمینه و هدف: خواب کافی و با کیفیت برای رشد، تکامل و بهبود سلامت کودکان ضروری است. بستری شدن در بیمارستان می‌تواند به دلیل عوامل مختلفی مانند محیط ناآشنا، درد، اضطراب و برنامه‌های درمانی، کیفیت خواب کودکان را تحت تأثیر قرار دهد. پرستاران نقش کلیدی در ارائه مراقبت‌های جامع و ارتقای سلامت کودکان بستری دارند. این مطالعه مروری سیستماتیک با هدف بررسی اثربخشی مداخلات پرستاری بر بهبود کیفیت خواب در کودکان بستری انجام شده است. مواد و روش‌ها: این پژوهش به‌صورت مرور سیستماتیک و بر اساس دستورالعمل‌های PRISMA در سال 2025 انجام شد. به‌منظور شناسایی مطالعات مرتبط ، جستجوی جامع در پایگاه‌های اطلاعاتی PubMed، Scopus، SID، Magiran و موتور جستجوی Google Scholar با جستجوی پیشرفته کلمات کلیدی مداخلات پرستاری، کیفیت خواب و کودکان بستری به فارسی و معادل آن به انگلیسی انجام شد. بازه زمانی جستجو به مقالات منتشرشده از ژانویه 2019 تا ژوئن 2024 محدود شد. پس از حذف موارد تکراری، عنوان و چکیده‌ی مقالات توسط دو پژوهشگر مستقل بررسی گردید و بر اساس معیارهای ورود (مطالعات پژوهشی) و معیارهای خروج (مطالعات مروری، مقالات بدون متن کامل و مقالات غیر انگلیسی) 17 مطالعه انتخاب شدند. در مرحله بعد، متون کامل مقالات بررسی شد و اطلاعات با استفاده از یک فرم سازمان‌یافته شامل مشخصات مطالعه، ویژگی‌های جمعیت، نوع مداخله، متغیرهای پیامد استخراج گردید. نتایج: مداخلات پرستاری مختلفی می‌توانند به بهبود کیفیت خواب کودکان بستری کمک کنند. مداخلات غیر دارویی شامل ایجاد محیطی آرام و راحت (مانند کاهش نور و صدا)، ارائه ماساژ، قصه‌گویی، موسیقی‌درمانی، رایحه‌درمانی و استفاده از تکنیک‌های آرام‌سازی است. مداخلات دارویی شامل تجویز داروهای خواب‌آور با تجویز پزشک و نظارت دقیق پرستار است. برخی مطالعات نشان داده‌اند که مداخلات ترکیبی (دارویی و غیر دارویی) می‌توانند اثرات بهتری بر کیفیت خواب داشته باشند. با این حال، کیفیت شواهد در برخی از مطالعات پایین است و نیاز به تحقیقات بیشتر با طراحی دقیق‌تر وجود دارد. نتیجه‌گیری: مداخلات پرستاری می‌توانند نقش مؤثری در بهبود کیفیت خواب کودکان بستری داشته باشند. پرستاران با اجرای مداخلات غیر دارویی ساده و کم‌هزینه می‌توانند به ایجاد محیطی آرام و راحت برای کودکان کمک کرده و کیفیت خواب آن‌ها را بهبود بخشند. با این حال، قبل از استفاده گسترده از مداخلات دارویی باید به دقت فواید و خطرات آن‌ها را ارزیابی کرد. انجام مطالعات بیشتر با حجم نمونه بزرگ‌تر و طراحی قوی‌تر برای ارزیابی اثربخشی مداخلات پرستاری مختلف و شناسایی بهترین شیوه‌ها در این زمینه ضروری است. واژگان کلیدی: مداخلات پرستاری، کیفیت خواب، کودکان بستری

Occupational therapy in educational schools: a systematic review
پرستاری
Zahra Mortazavi 1 © ℗, Elham Khadem Hamzeie 2, Saideh Sadat Mortazavi 3
1 PhD student of Speech Therapy, Tehran University of Medical Sciences, Tehran, Iran. ORCID ID: 0000-0002-6566-1331
2 Ms student of occupational Therapy, Tehran University of Medical Sciences, Tehran, Iran.
3 PhD student of occupational therapy, Hearing Disorder Research Center, Avicenna Institute of Clinical Sciences, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract:

 مقدمه: کاردرمانی در مدارس عادی و مدارس استثنایی وظایف مختلفی دارند. هدف این مطالعه بررسی کاردرمانی در مدارس وابسته به آموزش و پرورش است. مواد و روش‌ها: در این مطالعه مروری نظام مند، جست و جوی منابع الکترونیکی در پایگاه داده های اطلاعاتی با کلید واژه های انگلیسیOccupational Therapy, Student,Schools و کلید واژه های فارسی کاردرمانی، کودکان با نیازهای ویژه ،عادی و مدرسه انجام شد. استراتژی جستجو ، غربالگری و انتخاب داده ها براساس معیارهای راهنما پریسما انجام شد. مقالات مرتبط تا 2023 وارد و مطالعات نامه به سردبیر ، تکراری حذف شد. در مرحله اول جستجو و بازبینی مقالات و در مرحله بعد پس از بازبینی عناوین و چکیده ، به طور مستقل توسط دونفر محقق بررسی شد . متن کامل مقالات منتخب با چک لیست استراب از نظر کیفیت مورد ارزیابی قرار گرفت و 20مقاله به منظور مطالعه عمیق تر انتخاب شدند. یافته ها: از 20 مطالعه مورد بررسی، 15 مقاله به کاردرمانی در مدرسه عادی و 5 مقاله به مدرسه استثنایی پرداخته است. کاردرمانگران در مدارس عادی به غربالگری و مداخلات زود هنگام ، مهارت های حرکتی ظریف و درشت ، استفاده از رویکردهای جبرانی و فناوری های کمکی، بهبود پردازش حسی، مهارت های اجتماعی خودتنظیمی رفتاری ، مسایل جنسی ، مشاوره به والدین و معلمان، مداخلات برنامه درسی و تحصیلی و کاردرمانگران در مدارس با نیاز های ویژه به تلاش برای کاهش نابرابری و تلفیق مدارس ، استفاده از فناوری ها و ایجاد سازگاری با محیط کلاس ، امادگی های پیش حرفه ای و مهارت های زندگی و اموزش به معلمان ، تقویت عملکرد های حسی حرکتی ، مهارت های خودتنظیمی و مشارکت اجتماعی می پردازند. نتيجه‌گيري: کاردرمانگران در مدارس عادی و استثنایی به بهبود مهارت های حسی ،حرکتی، درکی و عملکردی در دانش آموزان می پردازد. کلیدواژه‌ها: کاردرمانی ، مدرسه عادی ، مدرسه استثنایی 

Optimizing Human Milk Nutrient Enrichment for Preterm Infants in the NICU
پرستاری
فاطمه زمانی آشتیانی 1 © ℗
1 MsC in Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Introduction Human milk is the preferred base diet for very-low-birth-weight (VLBW) infants, yet unfortified milk rarely meets preterm requirements, predisposing to extrauterine growth restriction and later morbidity; fortification is therefore standard of care. Comprehensive reviews emphasize both the benefits of human-milk–based feeding and the persistent gap in protein and mineral delivery without fortifiers. Purpose To synthesize contemporary evidence on when and how to fortify human milk, with attention to protein delivery, osmolality at the bedside, fortifier choice, and high-risk subgroups (e.g., congenital heart disease [CHD]). Method Narrative appraisal of ten recent sources (randomized trials, observational studies, bench/physiology papers, and evidence syntheses) relevant to NICU fortification practice from 2020–2025. Results Early fortification: In a masked randomized trial of extremely preterm infants, initiating fortification within the first postnatal days did not increase fat-free mass at 36 weeks’ PMA but improved length velocity and attenuated declines in head-circumference z-scores—supporting early, protein-attentive enrichment. Protein adequacy and individualization: Because human-milk protein content falls over time, standard fixed-dose fortification often underdelivers protein; adjustable or targeted strategies improve short-term growth (weight, length, head circumference) versus standard approaches. Practical reviews concur that many units will need pragmatic “adjustable” pathways when real-time milk analysis is not feasible. Osmolality: Individualized and modular protein additions can raise feed osmolality; adherence to ~≤450 mOsm/kg is advised to limit intolerance/NEC risk, underscoring the need for bedside mixing discipline and incremental titration. Fortifier type: Earlier observational and trial data link exclusive human-milk–based diets with lower NEC risk, yet contemporary syntheses show mixed effects when comparing human-milk-derived versus bovine-derived fortifiers; ongoing RCT work has not demonstrated decisive clinical advantages after protocol corrections. Policy and safety discussions also highlight manufacturing and contamination considerations relevant to powdered products. High-risk CHD: In infants with complex CHD, switching the fortification strategy toward extensively hydrolyzed formula for enriching expressed breast milk was associated with a reduction in NEC severity without growth penalty across hospitalization, informing tailored pathways for this subgroup. Evidence syntheses and practice frameworks converge on the necessity of fortification while calling for implementation that balances growth, tolerance, and operational feasibility. Conclusion Current evidence supports early initiation of protein-attentive fortification, with adjustable/targeted approaches when feasible, vigilant osmolality management during bedside preparation, and strategy tailoring for high-risk groups such as CHD. Priority gaps include longer-term neurodevelopmental outcomes from contemporary fortifier comparisons and pragmatic trials that integrate individualized protein targets into routine NICU workflows.

Parental Dimensions of Moral Outrage in Pediatric Nursing: Challenges, Consequences, and Opportunities for Support
پرستاری
سیما پورتیمور 1 © ℗
1 Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Background: Moral outrage in pediatric nursing arises when nurses confront ethical conflicts that undermine their professional integrity. Parental-related issues are a central source of such experiences, as nurses navigate between respecting caregivers’ perspectives and ensuring safe, evidence-based care for children. While moral outrage often results in distress and reduced quality of care, it can also contribute to resilience and professional advocacy if adequately supported. Methods: This study adopted a mixed-methods design. In the qualitative phase, semi-structured interviews were conducted with pediatric nurses to capture experiences of moral outrage triggered by parental interactions. Data were analyzed thematically to identify recurring patterns. In the quantitative phase, a structured survey incorporating validated measures of moral distress, burnout, resilience, and professional quality of life was distributed to a broader sample. Statistical analyses, including descriptive and regression tests, were performed to examine associations between parental triggers, moral outrage, and professional outcomes. Integration of qualitative and quantitative findings provided a comprehensive understanding of the phenomenon. Results: Three key parental dimensions of moral outrage emerged. First, exclusion of parents from decision-making created ethical strain as nurses observed caregivers being marginalized. Second, persistence of misguided or unhealthy parental beliefs, such as rejecting medical advice, conflicted with nurses’ professional values and placed children at risk. Third, confusion or disagreement among parents regarding treatment goals intensified moral tension and complicated care delivery. Quantitative findings confirmed significant associations between these parental triggers and negative outcomes including burnout, emotional exhaustion, and moral depletion. However, integration of both data sources revealed that moral outrage, when addressed through organizational support, ethics consultation, and resilience-building programs, could enhance professional commitment, strengthen altruistic motivation, and reinforce nurses’ advocacy for vulnerable patients. Conclusion: Parental-related dynamics—including exclusion from decisions, harmful beliefs, and treatment-related confusion—are major contributors to moral outrage in pediatric nursing. Although prolonged exposure to these triggers leads to burnout and ethical disillusionment, a mixed-methods analysis demonstrates that with appropriate institutional support, moral outrage can be transformed into a constructive force for resilience and advocacy. These findings underscore the importance of integrating ethical support frameworks and communication strategies that address the unique parental dimensions of moral outrage, thereby protecting nurses’ well-being, sustaining pediatric care quality, and supporting long-term workforce stability.

Parental Involvement in the Mental Health Treatment of Hospitalized Children
پرستاری
Maedeh Sirati 1 ℗, Asma Niknejad 2, Nastaran Rafiei 3 ©
1 MSc Student in Geriatric Nursing, Department of Nursing, Shahed University, Tehran, Iran
2 MSC student in pediatric nursing, Nursing and Midwifery school, Iran University of Medical Sciences,Tehran, Iran
3 Master of Science in Medical-Surgical Nursing, Clinical Research Development Unit, Imam Sajjad Hospital, Mazandaran University of Medical Sciences, Ramsar, Iran.
Abstract: Background and Aim: Parental involvement in the mental health care of hospitalized children entails active, continuous, and purposeful engagement throughout the hospital stay. By participating in care activities physical, emotional, and social parents enhance their child’s psychological well being, reduce stress, and improve adaptation and treatment outcomes. As a core component of family centered care, understanding the nature, extent, and determinants of this involvement is essential. This study systematically reviews the existing evidence on parental participation in the mental health care of hospitalized children. Methods: This systematic review was conducted in accordance with PRISMA 2020 guidelines. A comprehensive literature search was performed in PubMed, Scopus, ScienceDirect, Google Scholar, and SID databases using the English keywords (Parental Involvement, Parental Participation, Mental Health, Hospitalized Children) and their Persian equivalents, covering the period from January 2015 to January 2025. Articles were screened based on predefined inclusion criteria—presence of keywords in the title or abstract, full text availability, and focus on the target population (parents of hospitalized children). After duplicate removal, 18 studies (12 in English, 6 in Persian) were included for qualitative synthesis. Results: Content analysis revealed that in most studies, parental involvement in the mental health care of hospitalized children was at a moderate level, with variations shaped by cultural background, health system structure, and hospital setting. Participation patterns included active engagement in daily care, continuous emotional support, attendance in psychotherapy or counseling, collaboration in clinical decision making, and involvement in rehabilitative or play therapy activities. Determinants clustered into three domains: 1. Parental factors : knowledge and awareness, attitudes, emotional and psychological status, communication skills, socioeconomic status. 2. Child/illness factors :severity and type of mental health condition, need for specialized or prolonged care, child’s interaction ability. 3. Organizational/environmental factors :hospital policies, team support, visiting flexibility, facility quality. Structured team support, targeted parental education, and respectful communication enhanced participation, while insufficient training, time constraints, emotional burden, and inconsistent policies reduced it. Conclusion: Parental involvement benefits hospitalized children’s mental health by reducing anxiety, improving adaptation, and strengthening parent–child interaction, yet current engagement levels remain below optimal. Maximizing these benefits requires coordinated strategies beginning at admission and extending post discharge, supported by evidence based education, ongoing support, and strong communication with healthcare teams. Future qualitative and interventional studies should further inform policies to enhance parental participation. Keywords: Parental Participation, Mental Health, Hospitalized Children, Family Centered Care, 

Pediatric Nursing in the Smart Era: Integrating Artificial Intelligence and Family-Centered Care
پرستاری
Somaye Pouy 1 © ℗, Latif Panahi 2
1 1 Assistant professor, Social Determinants of Health Research Center, Trauma Institute, Guilan University of Medical Sciences, Rasht, Iran. (Email: somayepouy@gmail.com) 2 Department of Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran. (Email: somayepouy@gmail.com)
2 Ph.D Student in Nursing, School of Nursing and Midwifery, Guilan University of Medical Sciences, Rasht, Iran.
Abstract: Introduction: Pediatric nursing is undergoing a transformative shift, as artificial intelligence (AI) technologies are increasingly integrated into clinical care. These advancements hold great promise for improving diagnostic accuracy, continuous patient monitoring, and the personalization of care. Nonetheless, the foundational principle of family-centered care remains vital to address the emotional and relational dimensions of care delivery. This article explores how AI innovations can harmonize with family-centered nursing practices to enhance health outcomes and the overall quality of pediatric care by blending technological innovation with compassionate caregiving. Method: A narrative review was conducted to explore the integration of AI in pediatric nursing alongside family-centered care approaches. A comprehensive search was performed in five major databases—SID, PubMed, Scopus, Web of Science, and the Cochrane Library—covering all available literature up to 2025. The search included keywords such as “Artificial Intelligence,” “Family-Centered Care,” “Pediatric Nursing,” and “Digital Health.” Initially, 412 articles were identified. After screening titles and abstracts based on inclusion criteria—studies involving AI applications in pediatric nursing and family-centered care—and applying exclusion criteria such as non-English or Persian language and lack of full text access, 67 relevant articles were retained for full-text review. Finally, 38 studies met the criteria for in-depth analysis. The selected studies were examined for the types of AI technologies used, approaches to family involvement, clinical applications, and reported outcomes. Data extraction focused on study design, population, intervention details, and impact on care processes and patient outcomes. This methodical approach ensured a thorough understanding of emerging trends and best practices at the intersection of AI and family-centered pediatric nursing. Results: The review demonstrated that the use of AI significantly enhances clinical decision-making through predictive algorithms and real-time monitoring devices, leading to earlier detection and more effective management of pediatric conditions. AI tools facilitate seamless data sharing and communication between healthcare teams and families, fostering a collaborative care environment. Crucially, sustaining family-centered care principles alongside AI integration helps preserve emotional support and shared decision-making. The combined approaches yield improved health outcomes, greater family satisfaction, and more streamlined pediatric healthcare delivery. Conclusion: Integrating AI into pediatric nursing presents remarkable opportunities to personalize and optimize care, utilizing predictive analytics and continuous monitoring without compromising the compassionate core of family-centered care. This fusion creates a future-ready model of pediatric nursing that champions both technological innovation and human connection to better support children and their families across diverse healthcare settings. 

Positive changes for mothers of children with leukemia: The correlation of social support with caregiving burden
پرستاری
نیر محرمی 1 © ℗, ماهنی رهکار فرشی 2, مهنازجبرئیلی 2
1 کارشناس ارشد پرستاری کودکان،پرستار بالین، بیمارستان کودکان زهرا مردانی آذری، تبریز،ایران
2 استادیار، گروه پرستاري کودکان ، دانشکده پرستاري و مامايي ، دانشگاه علوم پزشکی تبریز، تبریز،ایران
Abstract:

 مقدمه و هدف: با توجه به شیوع بیماری لوسمی کودکان در ایران و تاثیر آن برزندگی مادران که به عنوان مراقبان اصلی کودک هستند و همچنین بررسی عوامل موثر در مدیریت مراقبت از کودک مبتلا به سرطان پس از تشخیص و در طول درمان بیماری که بتواند خانواده را در کنار آمدن با بحران های ناشی از این بیماری یاری دهد ضروری به نظر می رسد، لذا مطالعه حاضر با هدف بررسی ارتباط بین حمایت اجتماعی با بارمراقبتی در مادران کودکان مبتلا به لوسمی انجام شده است. مواد و روش: این مطالعه توصیفی همبستگی در مرکز درمانی کودکان تبریزوپس از دریافت تایید کمیته ی اخلاق دانشگاه علوم پزشکی تبریز به شماره IR.TBZMED.REC.1399.1084 انجام شد.داده ها با استفاده از پرسشنامه های اطلاعات دموگرافیکی، حمایت اجتماعی Northouse ، ابزار بار مراقبتی Zarit جمع آوری گردید. تجزیه و تحلیل داده ها با آمار توصیفی و استنباطی توسط نرم افزار SPSS نسخه 25 انجام شده و سطح p کمتر از0.05 از نظر آماری معنی دار تلقی شد. نتایج : تعداد 122 مادر مورد مطالعه قرار گرفت. نتایج مطالعه نشان داد که بین نمره کل حمایت اجتماعی ونمره کل بار مراقبتی مادران ارتباط آماری منفی و معنی¬دار وجود دارد (0.004 p =). همچنین بین حیطه¬های حمایت همسر و حمایت دوستان با بار مراقبتی مادران ارتباط آماری منفی معنی دار وجود دارد (0.05 p ). نتایج نشان می دهد که هر چقدر میزان دریافت حمایت اجتماعی بیشتر باشد، میزان بار مراقبتی مادران کاهش می یابد. نتیجه گیری: با توجه به نتایج این مطالعه، شناسایی منابع حمایتی مادران و بویژه تقویت دریافت حمایت از طرف همسر و دوستان به عنوان منابع اصلی حمایتی مادران می تواند باعث کاهش بار مراقبتی ودر نتیجه ارتقای مدیریت مراقبت شود. کلیدواژه ها: حمایت اجتماعی، بارمراقبتی، مادر، لوسمی کودک

 

Prevention of Sudden Infant Death Syndrome: A Review of Risk Factors and Key Strategies
پرستاری
میرامیرحسین سیدنظری 1, سمیه قربانی 2, امیرمحمد درستی 3 © ℗, مهرداد قاسملو 4
1 کارشناس ارشد پرستاری داخلی جراحی، گروه پرستاری داخلی جراحی، دانشکده علوم پزشکی خوی، خوی، ایران
2 کارشناسی ارشد، رشته پرستاری اورژانس، گروه پرستاری ، دانشکده علوم پزشکی خوی، خوی، ایران
3 دانشجوی کارشناسی ارشد، رشته پرستاری داخلی جراحی، کمیته تحقیقات دانشجویی، دانشکده علوم پزشکی خوی، خوی، ایران
4 کارشناسی ارشد، رشته مراقبت ویژه نوزادان، گروه پرستاری ، دانشگاه علوم پزشکی مشهد، مشهد، ایران
Abstract:

 مقدمه: سندرم مرگ ناگهانی نوزاد (SIDS) همچنان به عنوان یکی از مهم‌ترین دلایل مرگ و میر در کودکان یک ماهه تا یک ساله شناخته می‌شود. این سندرم یک مشکل چندوجهی است که هنوز علت دقیق آن مشخص نیست. هدف از این پژوهش، بررسی عوامل خطرساز برای مرگ ناگهانی نوزادان و ارائه راهکارهای پیشنهادی برای محافظت از آن‌ها بود. روش تحقیق: این مطالعه به صورت یک مرور نظام‌مند با جستجو در پایگاه‌های داده‌ای مانند PubMed، ProQuest، Scopus، WOS و Google Scholar از سال ۲۰۱۰ تا ۲۰۲۵ انجام گرفت. کلمات کلیدی مورد استفاده شامل "سندرم مرگ ناگهانی شیرخوار"، "عوامل خطر"، "مرگ نوزاد" و "پیشگیری" بود و با استفاده از عملگرهای بولین OR و AND ترکیب شدند. تنها مقالاتی که به زبان انگلیسی منتشر شده بودند، وارد پژوهش شدند. یافته‌ها: در مجموع، ۳۵ مقاله که معیارهای ورود را داشتند، انتخاب شدند. عوامل خطر شناسایی‌شده برای نوزادان و شیرخواران شامل وضعیت خواب نامناسب، استفاده از رختخواب و روتختی نرم، تخت مشترک، سطوح خواب ناایمن، قرار گرفتن در معرض دود سیگار و الکل، نارس بودن، وزن کم هنگام تولد، رشد ناکافی داخل رحمی، تفاوت‌های ژنتیکی در ژن‌های ناقل سروتونین، عفونت‌های ویروسی تنفسی و اختلالات قلبی-تنفسی مرکزی بودند. عوامل مرتبط با مادر نیز شامل مراقبت‌های ناکافی پیش از تولد، فاصله کوتاه بین بارداری‌ها، مصرف مواد مخدر، الکل و دخانیات و اولین بارداری بود. برای کاهش خطر مرگ ناگهانی، راهکارهایی نظیر قرار دادن نوزاد به پشت هنگام خواب، استفاده از سطح خواب سفت و بدون شیب و پرهیز از استفاده از ملحفه‌های نرم و گرمای زیاد، قرار دادن نوزاد در اتاق مشترک با والدین اما در تخت جداگانه، تغذیه با شیر مادر، دوری از نیکوتین، الکل و مواد مخدر، واکسیناسیون منظم و استفاده از پستانک‌های مخصوص در صورت نیاز، و در نهایت استفاده از مانیتورهای قلبی-تنفسی خانگی توصیه شده است. همچنین، خواباندن نوزاد روی شکم تحت نظارت والدین در زمان بیداری برای تقویت عضلات گردن، شانه و بازو پیشنهاد شده است. نتیجه‌گیری: در این مطالعه، عوامل خطر و راهکارهای کاهش سندرم مرگ ناگهانی نوزاد شناسایی شدند. SIDS یک چالش جدی است که با ایجاد یک محیط خواب ایمن و افزایش آگاهی والدین می‌توان گامی مؤثر در جهت حفظ سلامت نوزادان و کاهش خطر آن برداشت. کلمات کلیدی: سندرم مرگ ناگهانی نوزاد، عوامل خطر، پیشگیری 

Prevention Strategies for Catheter-Associated Urinary Tract Infections (CAUTI) in Pediatric Patients Following Major Urological Surgery: A Systematic Review
پرستاری
Sedighe Hannani 1, Bahador Pourdel 2 ©, Erfan Rajabi 2 ℗, Seyed Abolfazl Hosseini 2, Amirali Alizadeh 3
1 Senior Expert in internal surgical nursing, instructor, operating room department, faculty of paramedicine, Iran university of medical sciences, Tehran, Iran
2 MSc of Perioperative Nursing, Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, ‎Maragheh, Iran‎
Abstract: Introduction Pediatric patients undergoing extensive urological surgery often need indwelling urinary catheters, increasing their risk of CAUTI. CAUTIs cause illness, prolonged hospitalizations, antibiotic use and higher healthcare costs. Adults can avoid issues, but children undergoing surgery have little evidence of their efficacy or safety. This systematic review examined pediatric catheter-associated urinary tract infections (CAUTIs) prevention strategies after major urological surgery. Methods PRISMA was followed for this review. From inception to May 2024, PubMed, Embase, CENTRAL, CINAHL and Scopus were searched extensively. We searched for "catheter-associated urinary tract infection," "CAUTI," "pediatric," "child," "urologic surgical procedures," "postoperative complications," "infection control," "prevention," and "bundle." In patients under 18, randomized controlled trials (RCTs), non-randomized controlled studies and comparative observational studies examined CAUTI prevention strategies like antimicrobial catheters, catheter care bundles and early removal protocols. Adult case reports, reviews and studies were excluded. Bias was assessed using the Cochrane RoB 2 tool for randomized controlled trials and ROBINS-I for non-randomized studies. Where applicable, a random-effects model was used to calculate pooled risk ratios (RR) with 95% confidence intervals after narrative data synthesis. Results 12 studies (3 randomized controlled trials, 9 cohort studies) with 4,218 pediatric patients were identified from 3,452 records. Antimicrobial-impregnated silver-coated/hydrogel catheters, standardized catheter care bundles (aseptic insertion, securement, perineal care, closed system maintenance) and protocol-driven early catheter removal were prevention methods. A meta-analysis of seven studies found that bundled interventions reduced CAUTI rates in favor of the intervention groups (pooled RR: 0.52; 95% CI: 0.38 to 0.71; n=2,845 participants). Antimicrobial catheter evidence was scarce and ambiguous. One randomized controlled trial showed a non-significant reduction (relative risk: 0.81; 95% CI: 0.44 to 1.49). Prevention strategies did not cause adverse events. Conclusion Protocol-based catheter care bundles with multiple components reduce CAUTIs in pediatric urological surgery patients. This suggests standardizing catheter management during surgery for high-risk patients. Evidence supporting technological solutions like antimicrobial catheters is unclear and needs further study. The high variability of interventions emphasizes the need for rigorous randomized controlled trials (RCTs) to determine the essential components of an effective catheter-associated urinary tract infection (CAUTI) prevention bundle and its cost-effectiveness in pediatric surgery.

Psychological Support to Prevent Burnout in Pediatric Nurses
پرستاری
مریم رنگرزی 1 ℗, Farnoosh Tajik 2 ©
1 Nursing student, Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
2 Faculty member, Department of pediatric and neonatal nursing, School of nursing and midwifery, Semnan University of Medical Sciences, Semnan, Iran.
Abstract: Psychological Support to Prevent Burnout in Pediatric Nurses Introduction Pediatric nurses are frequently exposed to high-intensity stressors, including children’s pain, critical illness, and demanding family interactions. These stressors, compounded by heavy workloads and limited resources, place nurses at high risk of burnout. Burnout is characterized by emotional exhaustion, depersonalization, and diminished personal accomplishment, which not only affect the well-being of nurses but also compromise the quality of pediatric care and family satisfaction. Psychological support and resilience-focused interventions have been recognized as crucial strategies for reducing burnout. The aim of this study is to review psychological support strategies for preventing burnout in pediatric nurses. Method This narrative review was conducted in 2025 by searching PubMed, Scopus, SID, and Google Scholar. The search employed keywords related to “Psychological support,” “Pediatric nursing,” “Burnout,” and “Children.” Eligible studies, according to inclusion and exclusion criteria, were analyzed, and relevant data were extracted and synthesized. Findings Evidence highlights multiple effective strategies to reduce burnout in pediatric nurses: Counseling and Peer Support: Structured peer-support groups, debriefing sessions, and individual counseling reduce emotional exhaustion and foster mutual coping. Emotional and Communication Skills Training: Programs targeting emotional regulation, empathy, and conflict resolution improve nurse-family interactions and decrease depersonalization. Resilience Training: Workshops incorporating mindfulness, relaxation techniques, and self-care practices have been shown to strengthen resilience and lower burnout indicators. Team-Building and Creative Activities: Group-based projects and creative sessions enhance team cohesion and reduce feelings of isolation. Workplace Improvements: Adequate staffing, manageable workloads, protected rest breaks, and recognition systems significantly decrease stress levels. Supportive leadership and shared decision-making further buffer against burnout. Continuous Assessment: Regular monitoring with validated tools such as the Maslach Burnout Inventory (MBI) facilitates early detection and timely interventions. Conclusion Psychological support interventions are essential for preventing burnout among pediatric nurses. Integrating counseling, resilience training, and workplace improvements reduces stress and enhances job satisfaction. Institutionalizing structured support programs can strengthen nurse well-being, sustain resilience, and improve the quality of pediatric care. Keywords: Psychological support, Pediatric nursing, Resilience, Burnout 

Remote Monitoring for Preterm Neonates: Healthcare Providers' Perceptions
پرستاری
Atefeh Shamsi 1 © ℗, Mahboobeh Namnabati 2, Asghar Ehteshami 3, Hamed Zandi 4
1 Nursing Care research, Nursing Faculty, Baqiatallah University of Medical Sciences
2 Nursing and Midwifery Care Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
3 Health Information Technology Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
4 Department of Pediatrics, School of Medicine, Emam Hossein Hospital Research Center, Isfahan University of Medical Sciences, Isfahan, Iran
Abstract: Background: Premature infants frequently face unique developmental challenges requiring specialized post-birth interventions. Digital health solutions, particularly remote follow-up platforms, offer a promising avenue to enhance infant well-being by bolstering parental competence in providing effective care after hospital discharge. However, the efficacy and implementation of such virtual care models for neonatal follow-up remain a subject of discussion. This research aimed to explore and contrast the experiences of nursing and medical professionals regarding the utilization of digital teleconsultation for premature infants. Methods: This qualitative inquiry employed a conventional content analysis approach. Semi-structured interviews were conducted with 30 nurses and 25 physicians, selected via purposive sampling. Participants were recruited from three neonatal intensive care units affiliated with Isfahan University of Medical Sciences, Iran, between October 2022 and February 2023. All participants possessed a minimum of two years' experience delivering virtual consultation services for premature infants through a national web-based social media platform. The interviews aimed to elicit their insights into teleconsultation practices. Data collection spanned five months, with analysis guided by the Granheim and Lundman method to identify core themes until data saturation was achieved. Results: The study's findings delineated two primary dimensions: the advantages and inherent challenges associated with remote care. While both nursing and medical practitioners largely concurred on the utility of digital health interventions, their perspectives diverged concerning infant safety protocols and the level of parental comprehension regarding remote monitoring guidelines. Conclusion: This investigation highlighted critical considerations such as patient safety and the digital literacy of caregivers in the context of remote follow-up. It advocates for the strategic integration of digital health solutions as a complement to established in-person care. The insights gleaned offer valuable guidance for policymakers in optimizing post-discharge support for premature infants, underscoring the necessity for further research into long-term outcomes and adherence to digital care protocols. Keywords: Telehealth, Neonatal Nursing, Digital Health, Prematurity, Remote Care

Short-term and Long-term Outcomes of Open versus Laparoscopic Surgery for Necrotizing Enterocolitis in Neonates: A Systematic Review
پرستاری
Sedighe Hannani 1, Bahador Pourdel 2 ©, Erfan Rajabi 2 ℗, Seyed Abolfazl Hosseini 2, Amirali Alizadeh 3
1 Senior Expert in internal surgical nursing, instructor, operating room department, faculty of paramedicine, Iran university of medical sciences, Tehran, Iran
2 MSc of Perioperative Nursing, Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, ‎Maragheh, Iran‎
Abstract: Introduction When medical treatment fails, necrotizing enterocolitis (NEC) in neonates, especially preterm infants, requires surgery in 20–40% of cases. The conventional procedure is open laparotomy, but laparoscopic surgery may reduce morbidity due to smaller incisions, less tissue trauma and faster recovery. Evidence comparing short-term (postoperative complications, mortality) and long-term (neurodevelopmental outcomes, growth) outcomes between these techniques is limited and inconsistent. This systematic review compares open and laparoscopic surgery for neonatal necrotizing enterocolitis (NEC) to see if laparoscopic surgery reduces morbidity, mortality and prolonged complications. Methods From their inception to July 2025, we searched PubMed, Embase, Sincedirect and Scopus using keywords like "necrotizing enterocolitis," "neonates," "open surgery," "laparotomy," "laparoscopic surgery," "outcomes," and various combinations. The study included randomized controlled trials, cohort studies and case-control studies evaluating open and laparoscopic techniques for neonates (≤28 days old) with surgical necrotizing enterocolitis (Bell's stage III). Case reports, non-comparative studies, adult populations and non-NEC indications were excluded. ROBINS-I was used to assess bias in non-randomized studies, while Cochrane RoB 2 was used in RCTs. Narratives and random-effects meta-analysis were used to synthesize data and present odds ratios (OR) or mean differences (MD) with 95% confidence intervals. We employed I² statistics to evaluate heterogeneity. Results Eight cohort studies and two randomized controlled trials involving 452 neonates (248 open and 204 laparoscopic) were included. Most studies were from Europe and North America, with an average 28-week gestation. NEC started 10–14 days postpartum.In 0.52, 95% CI 0.35-0.78; 8 studies, 412 participants) and mortality (OR 0.61, 95% CI 0.42-0.89; 7 studies, 378 participants). Hospitalization was shorter after laparoscopy (MD -7.2 days, 95% CI -10.5 to -3.9; 6 studies, 320 participants). Long-term results showed improved neurodevelopmental scores at 2 years (MD +8.3 points on Bayley Scales, 95% CI 3.1-13.5; 4 studies, 210 participants; favoring laparoscopic) and decreased growth faltering (OR 0.48, 95% CI 0.29-0.79; 5 studies, 256 respondents). Conclusion A systematic review shows that laparoscopic surgery for neonatal necrotizing enterocolitis improves short-term complications, mortality and neurodevelopmental and growth outcomes compared to open surgery. When possible, laparoscopy is preferred because it reduces surgical stress in vulnerable neonates. To confirm benefits across diverse populations, standardized protocols and RCTs are needed, while addressing limitations like study heterogeneity (I² 50%) and selection bias favoring less severe cases for laparoscopy. Neonatal care can be improved by adoption, but it requires specialized training and equipment.

Smartphone Addiction and Suicidal Ideation in Adolescents: A Narrative Review of Recent Evidence
پرستاری
Erfan YousefZadeh 1 © ℗, Yasaman Fallah 2, Yasaman Yaghobi 3
1 Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical sciences, Rasht, Iran.
2 Student Research Committee, School of Nursing and Midwifery, Isfahan University of Medical Sciences, Isfahan, Iran.
3 Department of Nursing, Guilan University of Medical Sciences, Rasht, Iran
Abstract: Introduction: Smartphone addiction is a pattern of excessive, compulsive smartphone use that disrupts daily functioning, social interaction, and emotional regulation. Adolescents, due to neurodevelopmental sensitivity to reward, emerging social identity, and ubiquitous access to mobile technology, are particularly susceptible. Suicidal ideation refers to thoughts of ending one’s life, ranging from fleeting passive wishes to active planning, and constitutes a serious public-health concern among youth. While digital media overuse is linked to depression, sleep disturbance, and interpersonal stressors, the specific association between smartphone addiction and suicidal ideation remains inconsistently reported across heterogeneous studies. Clarifying this relationship is critical for informing targeted prevention strategies, integrating digital-health literacy, systematic screening, and focused mental health interventions. Therefore, the present narrative review synthesizes contemporary evidence examining the association between smartphone addiction and suicidal ideation among adolescents. Method: This narrative review synthesized literature published from 2020 to 2025. Systematic searches were conducted in PubMed, ScienceDirect, and Google Scholar using MeSH keywords: “Smartphone Addiction,” “Suicidal Ideation,” “Adolescent,” “Mental Health,” and “Digital Media.” Inclusion criteria comprised English-language, full-text articles reporting adolescent-specific outcomes; exclusion criteria removed non-English studies, inaccessible full texts, or studies not disaggregating adolescents. Reference lists were hand-searched to identify additional relevant studies. Screening followed a two-stage process: title/abstract review and full-text assessment. Extracted data included study design, sample characteristics, measurement instruments, statistical approach, and reported associations. Thematic synthesis mapped recurring pathways (depression, sleep disruption, cyberbullying) and contextual moderators (social support, gender, culture), with mediators and confounder control noted where available. Results: Ten studies met inclusion criteria. Seven reported clear associations between higher smartphone addiction and increased suicidal ideation, often mediated by depressive symptoms, sleep disruption, and adverse online experiences. Three studies found weak or non-significant links, often in samples with stronger social support or after adjusting for psychopathology. Variation in measurement tools and study design contributed to inconsistent findings, yet overall evidence indicates frequent co-occurrence of problematic smartphone use and suicidal thoughts among adolescents. Conclusion: A recurrent but non-uniform association exists between smartphone addiction and adolescent suicidal ideation. It is suggested to implement routine screening in schools and clinics, promote digital literacy and sleep hygiene programs, provide accessible mental health services, and conduct longitudinal research to clarify causal pathways and inform preventive strategies Keywords: Internet addiction disorder, Smartphone addiction, Suicidal ideation, Adolescent, Mental health, Digital media

Systematic Review of Caring for Little Warriors: Care and Intervention Strategies for Childhood Diarrhea
پرستاری
Zohreh Dehghan Harati 1 ℗, Fatemeh Dehghan Harati 2 ©
1 MSc Student, Neonatal Intensive Care nursing, Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran
2 3. Clinical Research Development Center of Children's Hospital, Hormozgan University of Medical Science, Bandar Abbas, Iran
Abstract: Introduction: Diarrhea in children under five years old is one of the most significant public health challenges, affecting millions of children annually and associated with complications such as dehydration and malabsorption of nutrients. Timely and effective care, including the administration of Oral Rehydration Solutions, zinc supplementation, proper nutrition, family education, and enhancements in water and environmental hygiene, is crucial for mitigating outcomes. However, the quality of care and access to services in underprivileged communities remain challenging. Methods: To conduct this systematic review, a comprehensive search was performed using relevant keywords, including "children," "diarrhea," and "care," across international databases such as PubMed, Web of Science, Wiley, and Google Scholar, as well as domestic databases including Magiran, Irandoc, and Elmnet to cover related local articles. Among the initially identified 501 studies, a meticulous screening process was employed utilizing the PRISMA framework, resulting in the exclusion of duplicate articles, those without full text availability, previous review articles, and studies older than five years. Resource management was conducted using EndNote software. Ultimately, after critically assessing the quality of the studies with validated tools, 16 high-quality studies were selected, focusing on the impact of caregiving interventions in managing childhood diarrhea, reducing complications, improving clinical outcomes, and enhancing the quality of care. Discussion: Studies indicate that effective care for children with diarrhea necessitates a comprehensive approach, which includes training primary caregivers, regular and timely use of Oral Rehydration Solutions, and zinc supplementation. The combination of mass media with face-to-face communication interventions significantly increases healthcare-seeking behavior in treatment facilities and appropriate use of ORS, whereas reliance solely on mass media shows lesser effects. Furthermore, accurate identification of bacterial and viral pathogens using molecular techniques, including the identification of key bacteria such as Salmonella, Campylobacter, and Shigella, aids in targeted treatment selection and prevents unnecessary antibiotic prescriptions. Attention to warning signs, such as blood in stool, necessitates quicker medical consultation and appropriate treatment. These comprehensive approaches can prevent serious complications such as dehydration, microbial dysbiosis, and malnutrition, ultimately improving child health at the community level. Conclusion: In conclusion, caregiving interventions in managing childhood diarrhea are effective, limitations such as cultural and social differences, lack of access to advanced diagnostic methods, and the inability to fully cover vulnerable groups necessitate more comprehensive research to enhance the quality of care and clinical decision-making.

Technological Innovations in Pediatric Critical Care Nursing: Emerging Approaches and Applications
پرستاری
Sara Mortazavinia 1 ℗, Fatemeh Dehghani 2, Akbar Abbasi 3 ©
1 MSC student in medical surgical nursing, Nursing and Midwifery school, Kashan University of Medical Sciences,Kashan, Iran
2 MSC student in Neonatal critical care nursing, Nursing and Midwifery school, Shahid Sadoughi University of Medical Sciences,Yazd, Iran
3 MSc in Anesthesia Education, Department of Nursing, Naqadeh Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Background and Aim: Pediatric nurses in intensive care units (ICUs) face complex challenges that demand both cutting edge clinical competence and innovative, technology driven solutions. Recent advancements from artificial intelligence (AI) enabled clinical decision support systems (AI CDSS) to graphene based biosensors, cloud connected monitoring tools, and extracorporeal membrane oxygenation (ECMO) are reshaping pediatric critical care. This systematic review aimed to synthesize evidence on emerging technologies and innovations enhancing pediatric nursing care in critical settings, emphasizing their clinical integration, ethical implications, and patient centered outcomes. Methods: Following PRISMA 2020 guidelines, a systematic search was conducted in PubMed, Scopus, ScienceDirect, Google Scholar, and SID using English keywords (technology, innovation, pediatric nursing, critical care) and Persian equivalents. Studies published between January 2018 and January 2025 were considered. After duplicate removal and eligibility screening (keywords present in title/abstract, full text availability), 16 studies in English and Persian were included for qualitative synthesis. Results: Findings revealed rapid adoption of advanced technologies in pediatric critical care nursing, including: • AI CDSS for early detection of sepsis, traumatic brain injury, and pneumonia with higher specificity than conventional models. • Smart Pill sensors for real time gastrointestinal pressure, pH, and temperature monitoring. • Graphene based sweat patches for non invasive glucose detection. • Cloud enabled thermometers and digital stethoscopes linked to smartphones for remote monitoring. • Telemedicine platforms enabling specialized pediatric consultations. • ECMO systems for temporary cardiopulmonary support. These innovations improved early diagnosis, optimized care coordination, and showed measurable impacts on cost efficiency and patient safety, though challenges in AI interpretability and workflow integration remain. Conclusion: Emerging technologies offer transformative potential for pediatric nursing in critical care, enabling earlier interventions, personalized treatments, and more efficient resource utilization. Nevertheless, true advancement requires coupling technological adoption with compassionate, human centered care to ensure equitable, ethical, and family inclusive pediatric health outcomes. Keywords: Pediatric Nursing, Critical Care, Innovation, Technology, Artificial Intelligence, Decision Support Systems, Extracorporeal Membrane Oxygenation, Telemedicine 

the application of machine learning in the neonatal intensive care unit: an integrated review
پرستاری
Seyed Mohammad Hossein Abedi 1 © ℗, Masoumeh Zadhossein 2
1 School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Computer Science, Faculty of Mathematical Sciences, Guilan University, Guilan , Iran.
Abstract: Introduction Neonatal Intensive Care Units (NICUs) are faced with complex challenges in managing severely ill newborns, where proper and timely clinical decisions can potentially optimize outcomes. Machine learning (ML) is a groundbreaking aspect in neonatology to leverage vast amounts of data from electronic health records (EHRs), vital signs, and laboratory results to enhance decision-making, predict adverse outcomes, and streamline resource utilization. With the analysis of trends in complex, time-associated data, ML has the potential for early sepsis diagnosis, length of stay prediction, and mortality risk estimation. In this integrative review, the uses of ML in NICU will be discussed with an eye to its role in clinical decision-making support, disease diagnosis, and resource allocation, as well as problems and recommendations for the future. Methodology Systematic search was conducted on PubMed, Scopus,, Google Scholar, English-language databases from 2014-2025 time period. Among 300 articles identified, duplicate articles were excluded and titles and abstracts screened and 50 articles selected for full-text analysis. Inclusion criteria were ML model-based studies (e.g., Random Forest, logistic regression, ensemble, deep learning) conducted within NICUs of neonates (ages 0-28 days), with outcomes reported within the domains of clinical decision support (e.g., mortality prediction, length of stay), disease detection (e.g., sepsis, bronchopulmonary dysplasia), or resource optimization (e.g., admission prioritization, real-time monitoring). Results Ensemble methods and Random Forest demonstrated greater accuracy in predicting length of stay, enhancing resource allocation. When it comes to disease diagnosis, ML models like Random Forest and logistic regression performed better than traditional methods in predicting late-onset sepsis, on the basis of vital signs and biomarkers, with some demonstrating early detection up to 24 hours earlier than clinical suspicion. ML improved the prediction of neonatal mortality in respiratory failure beyond conventional scoring systems. Additionally, ML allowed for real-time monitoring and prioritized resource-limited settings according to optimal care provision. Limitations include integrating data from different sources, data quality, and the management of ethical concerns like patient anonymity. Conclusion Machine learning can potentially disrupt the practice of NICU therapy by improving early diagnosis, clinical decision-support, and resource allocation. Promising as it is, in the way of realizing this are data quality, ethics, and generalizability of the models. Research in the future needs to progress towards standardized measures of performance, more embedding of models into clinical workflows, and pragmatic deployment across populations so that the full potential of ML can be realized in neonatal medicine. 

the application of Mobile health in the neonatal intensive care unit: an integrated review
پرستاری
Zahra Dehghani 1 ©, Seyed Mohammadhosein Abedi 1 ℗
1 School of nursing and midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Introduction Neonatal Intensive Care Units (NICUs) provide preterm and medically fragile newborns with critical care, but challenges such as post-discharge monitoring, parental stress, and efficient data management persist. Mobile health (mHealth) applications have appeared as disruptive innovations to tackle such issues via remote monitoring, parental guidance, and optimized clinical workflows. The applications ensure care continuity, reduce parental worry, and enhance healthcare provider efficiency. This integrative review examines mHealth applications used in NICUs, their impact on care delivery, parental support, and health outcomes and addressing implementation obstacles. Methodology Systematic search was performed in PubMed, Scopus,, Google Scholar for English language articles published during 2014 to 2025. Of an estimated 280 articles, duplicates were removed, and titles and abstracts screened, 45 articles being eligible for full-text review. Inclusion criteria were studies that utilized mHealth technologies (e.g., mobile apps, telehealth, remote monitoring systems) in NICU settings in neonates (0-28 days of age) or parents, with reported results regarding continuity of care, parental support (e.g., stress reduction, education), nursing efficiency, or health outcomes (e.g., growth monitoring, early complication detection). Excluded were non-mobile technology, non-NICU patient, or undefined outcome studies. Results Remote monitoring applications improved post-discharge continuity of care for preterm babies by enabling early detection of stunted growth and developmental delay. mHealth applications with nursing emphasis removed data management and standardized assessment loads, reducing bureaucratic workload. Parental support applications reduced parental stress and anxiety levels, improved parenting capabilities, and raised social support, with telehealth systems promoting remote bonding via web cameras and videoconferencing. Tracking real-time health information allowed for timely intervention, improving outcomes like glycemic control in similar cases. mHealth also allowed for education of healthcare providers, improving follow-up with care plans. Infection risk from mobile device use and technical problems required user-friendly designs presented the challenges. Conclusion mHealth applications have the capacity to revolutionize NICU care through improving care continuity, parental health, and clinical efficiency. Infection control and technical concerns must be addressed to deliver safe and effective mHealth application delivery. Studies in the future should have as goals maximizing the user interface, standardizing outcome measures, and validating mHealth applications for different types of NICU settings to translate the advantages of their use into neonatal care. 

The Effect of Empathy Skill Training on Therapeutic Communication of Nursing Students in the Care of Hospitalized Children
پرستاری
Neda Pashaei Yingejeh 1 ©, Mahnaz Mohammad Pouri 2 ℗, Mohammad Nouri 3
1 Department of Nursing, UrC, Islamic Azad University, Urmia Iran
2 Master of Nursing, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
3 ,Department of Nursing, UrC, Islamic Azad University, Urmia Iran
Abstract: Background: Empathy is a crucial component of the nurse-patient relationship, serving as an essential clinical skill that strengthens the bond between nurses and patients and contributes to improved healthcare services. This study aimed to determine the impact of empathy skill training on the therapeutic communication of nursing students in caring for hospitalized children, Methods: This quasi-experimental study employed a single-group pretest-posttest design and was conducted on final-year nursing students at shahid motahari hospital of Urmia in 2023 . The sample consisted of 40 nursing students selected through census sampling, At the beginning of the study , students completed a demographic information questionnaire and a therapeutic communication questionnaire developed by Han et al. Then, they received empathy skills training in groups over eight 90-minute sessions, held four times a week. The training was delivered through lectures using a video projector in small groups of six. After the intervention students completed the questionnaires again. Data were analyzed using SPSS version 26 .Descriptive statistics including mean and frequency (percentage) were used to describe data, and paired t-test was used for statistical analysis. Results: The mean overall therapeutic communication scores of nursing students were 45.17±4.53 before the intervention and 47.97±4.43 after the intervention. Based on the results of the paired t-test, there was a significant difference between the mean overall therapeutic communication scores before and after the intervention(t= -3.99, p0.05) Conclusion: Empathy skills training positively impacts the therapeutic communication of nursing students in caring for hospitalized children and can assist them in assessing the health problems of hospitalized children and providing better care. Keywords: Empathy skills. Therapeutic communication, Nursing students, children Ethical Approval: This study was approved by the Ethics Committee of Urmia Islamic Azad University (IR.IAU.URMIA.REC.1403.050). 

The Effect of Family-Centered Empowerment Model Based on Multimedia Education on the Quality of Life of Children Aged 8-12 Years with Beta Thalassemia
پرستاری
اکرم همتی پور 1 © ℗
1 کارشناسی ارشد پرستاری، دانشگاه علوم پزشکی آبادان، آبادان، ایران
Abstract:

 زمینه و هدف: بين بيماري و كيفيت زندگي مبتاليان به بيماريهای مزمن، ارتباط متقابل وجود دارد و اختلالات جسماني اثری مستقيم بر روي تمام جنبه هاي كيفيت زندگي میگذارد. این مطالعه با هدف تعیین تأثیر الگوی توانمندسازی خانواده محور به روش آموزش چندرسانه ای)مالتی مدیا( بر کیفیت زندگی کودکان مبتال به تالاسمی ماژور انجام شد. روش بررسی: این مطالعه از نوع تجربی است. 120 بیمار به همراه والدین، که در مرکز تالاسمی بیمارستان خاتم النبیا شوشتر پرونده پزشکی داشتند، باتوجه به معیارهای ورود، انتخاب و با روش تخصیص تصادفی بلوک چهارتایی به دو گروه 60 نفر مداخله و کنترل تقسیم شدند. از نظر سن و جنس نیز همسان سازی شدند. ابزار گردآوری اطالعات پرسشنامهی کیفیت زندگی کودکان )SQL-Ped )و پرسشنامه های محقق ساخته آگاهی و خودکارآمدی در زمینه ی بیماری تالاسمی بود. اطلاعات جمع آوری شده با نرم افزار SPSS و با آزمونهای آماری من ویتنی و یلکاکسون و ضریب همبستگی پیرسون تجزیه و تحلیل شدند. یافتهها: از 120 کودکی که وارد مطالعه شدند، 87 نفر دختر)72/5 درصد( و میانگین سن این کودکان)9/74±2/25( و مدت زمان ابتال به بیماری)5/35±4/47( سال بود. دراین مطالعه سطح کیفیت زندگی کودکان و ابعاد آن، بعد از اجرای الگوی آموزشی تنها در گروه مداخله افزایش چشمگیری نسبت به قبل از آموزش دیده شد)0/001P). بعد از اجرای این الگو نیز میزان آگاهی)0/001P )و خودکارآمدی والدین) 0/003=P )نیز افزایش معناداری همراه بود و این معناداری نیز نسبت به گروه کنترل مشاهده شد)0/001P). متغیرهای سن، جنسیت و طول مدت ابتال و سطح تحصیلات والدین بر آگاهی، خودکارآمدی والدین و کیفیت زندگی کودک اثری نداشتند)0/05P). نتیجه گیری: براساس نتایج مطالعه ی حاضر، اجرای برنامه های توانمندسازی مبتنی برخانواده برپایه آموزش چندرسانه ای به والدین کودکان مبتال به تالاسمی با افزایش آگاهی و خودکارآمدی والدین آنها باعث ارتقا و بهبود کیفیت زندگی این کودکان شده است. پیشنهاد می شود که این برنامه در سطح وسیع تری با امکانات بهتر برای والدین و اعضای خانواده آنها اجرا شود. واژه های کلیدی: چندرسانه ای، تالاسمی، والدین، کیفیت زندگی، خودکارآمدی

The Effect of Home Visits on the Health of Low Birth Weight and Preterm Infants: A Narrative Review
پرستاری
فاطمه حاجی رضائی کاشان 1 ℗, مهسا السادات موسوی 2, نرگس صادقی 3 ©
1 دانشجوی دکتری تخصصی پرستاری، گروه پرستاری، مرکز تحقیقات سلامت جامعه، واحد اصفهان(خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران
2 دانشیار، مرکز تحقیقات سلامت جامعه، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران
3 مرکز تحقیقات سلامت جامعه، گروه پرستاری، واحد اصفهان (خوراسگان)، دانشگاه آزاد اسلامی، اصفهان، ایران.
Abstract:

 مقدمه: نوزادان نارس و کم‌وزن نسبت به نوزادان رسیده در معرض مشکلات بیشتری در حوزه‌های رشد جسمی، تغذیه‌ای و تکاملی قرار دارند. این نوزادان حتی پس از ترخیص از بیمارستان نیز به مراقبت‌های حمایتی نیازمندند تا رشد مطلوب و پیشگیری از عوارض تضمین شود. بازدیدهای خانگی به‌عنوان یک رویکرد جامعه‌محور می‌تواند با آموزش مادر، حمایت از شیردهی و پایش سلامت نوزاد به رفع این نیازها کمک کند. با این حال، شواهد موجود در کشورهای در حال توسعه پراکنده و محدود است. این مرور روایتی با هدف مرور و تحلیل شواهد موجود در زمینه تأثیر بازدیدهای خانگی بر سلامت نوزادان نارس و کم‌وزن انجام شد. روش‌ها: جست‌وجوی جامع در پایگاه‌های اطلاعاتی PubMed، Web of Science، Scopus و Cochrane و نیز موتور جست‌وجوی Google Scholar از سال 2015 تا 2025 با کلیدواژه‌های «بازدید خانگی»، «نوزاد نارس» و «نوزاد کم‌وزن» و معادل‌های MeSH انجام شد. همچنین پایگاه‌های فارسی (SID, Magiran) بررسی گردید. معیار ورود شامل مطالعات تجربی یا شبه‌تجربی فارسی و انگلیسی با کیفیت مناسب بر اساس ابزار JBI بود. از میان ۲۱۹۳ مقاله، پس از غربالگری و ارزیابی کیفیت، ۱۰ مطالعه واجد شرایط، وارد مرور شدند. یافته‌ها: ده کارآزمایی بالینی تصادفی‌سازی‌شده از هند، ایران، ترکیه و کره جنوبی بررسی شد. تعداد بازدیدها بین ۱ تا ۹ جلسه متغیر بود و عمدتاً توسط پرستاران یا مراقبان آموزش‌دیده انجام می‌شد. نتایج نشان داد بازدیدهای خانگی موجب بهبود شاخص‌های رشد جسمی (وزن، قد، دور سینه) و افزایش تغذیه انحصاری با شیر مادر می‌شود. در برخی مطالعات بهبود رشد شناختی و حرکتی نیز گزارش شد، هرچند سایر پژوهش‌ها چنین اثری را نشان ندادند. در مورد مرگ‌ومیر و بستری مجدد، اغلب مطالعات تفاوت معناداری میان گروه‌ها نشان ندادند. نتیجه‌گیری: این مرور روایتی نشان می‌دهد بازدیدهای خانگی، به‌ویژه با تأکید بر مراقبت کانگورویی و آموزش مادران، تأثیر مثبتی بر رشد فیزیکی و بهبود تغذیه انحصاری نوزادان کم‌وزن و نارس دارد. با این حال، شواهد در مورد بقا، بستری مجدد، ترکیبات شیر مادر و رشد تکاملی ناهمگون و گاه غیرمعنادار است. یافته‌ها پیشنهاد می‌کنند بازدیدهای خانگی می‌تواند مداخله‌ای کم‌هزینه و اثربخش در کشورهای در حال توسعه باشد، اما مطالعات بیشتری با پروتکل‌های استاندارد، پیگیری طولانی‌مدت و ادغام در نظام سلامت برای تأیید کارایی آن مورد نیاز است. واژگان کلیدی: بازدید خانگی، نوزاد نارس، نوزاد کم‌وزن، مرور روایتی

The effect of skin-to-skin contact between father and premature infant on physiological indicators of premature infants
پرستاری
Fatemeh Etemadinia 1, Samaneh Fallah Karimi 2 ℗, Zahra Khalilzadeh Farsangi 3 ©
1 Master s student in pediatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran.
3 Master of Nursing, student research committee, faculty of nursing and midwifery, Zahedan, Iran.
Abstract: Introduction: Premature infants, due to the lack of development of various body systems, face numerous challenges that require specialized and careful care. Among the important challenges in caring for these infants are regulating body temperature and managing physiological stress. In recent years, skin-to-skin contact between fathers and premature infants has received increasing attention on the physiological indicators of premature infants. Therefore, this study aimed to determine the effect of skin-to-skin contact between fathers and premature infants on the physiological indicators of premature infants. Methods: This study was a randomized clinical trial with two experimental and control groups. 70 fathers of infants hospitalized in the neonatal intensive care unit were included in the study and were randomly assigned to two intervention and control groups. In the intervention group, fathers had skin-to-skin contact with their infants for forty minutes. The infant's physiological symptoms were measured before and after the intervention. Findings: The results showed that there was a statistically significant difference between the mean respiratory rate of the intervention group and the control group (p0.001). There was also a statistically significant difference between the mean temperature changes of the two groups (p0.001). Conclusion: The results of this study showed that skin-to-skin contact between the father and the premature infant is an effective and natural strategy for improving the health and well-being of premature infants. Keywords: Skin-to-skin contact, physiological indicators, premature infant.

The effect of spiritual care on the resilience of mothers of infants with gender ambiguity (hermaphroditism).
پرستاری
Zahra Khalilzadeh Farsangi 1, Fatemeh Etemadinia 2 ℗, Samaneh Fallah Karimi 3 ©
1 Master of Nursing, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Master s student in pediatric Nursing, Zahedan University of Medical Sciences, Zahedan, Iran.
3 Instructor, Department of Nursing, Faculty of Nursing and Midwifery, Torbet Heydarieh University of Medical Sciences, Torbet Heydarieh, Iran.
Abstract: Introduction: Mothers of gender-ambiguous infants face numerous emotional and psychological challenges. On the one hand, they experience worry and anxiety about their infant's health and future, and on the other hand, they face complex and uncertain issues related to the infant's gender identity. Spiritual care, aimed at enhancing and strengthening the spirit and psyche of mothers, plays an important role in improving resilience and mental health. Methods: The present study was a quasi-experimental pre-test-post-test study conducted on 50 mothers of infants with gender ambiguity who referred to teaching hospitals in Zahedan in 2013. The samples were randomly assigned to two intervention and control groups. Initially, both groups completed the Connor-Davidson Resilience Questionnaire, and in the intervention group, the intervention based on spiritual care was implemented by the researcher during three training sessions. Three months after the end of the intervention, the Connor-Davidson questionnaire was completed again by the mothers using a self-report method. Data were analyzed using SPSS version 27 software. Results: There was no significant difference between the resilience scores in the intervention and control groups before the intervention, but after the training, a significant difference was observed between the intervention and control groups (p0.001). The resilience score of mothers in the intervention group before the intervention was 29.32 ± 3.86 and after receiving spiritual care it reached 41.45 ± 4.52, which was statistically significant (p0.001). Conclusion: According to the results of this study, it was found that spiritual care can have a positive effect on the resilience of mothers of gender-ambiguous infants. These results showed that connecting with religious beliefs and spirituality can help these mothers cope better with the challenges of treatment and feel more resilient. Keywords: Spiritual care, resilience, mothers, infants, gender ambiguity. 

The Effective Interventions of Psychological Intervention on Fostering Resilience in Families of Premature Neonates: A Network Meta-Analysis
پرستاری
Mahsa Gholinejadzirmanlou 1 ©, Sima Pourteimour 1 ℗, Sana Khalilzade Zia 1
1 Patient Safety Research Center, Clinical Research Institute, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Introduction: The birth of a premature infant presents significant psychological challenges for families, often leading to increased stress, anxiety, and diminished resilience. While various psychological interventions have been implemented to support these families, their comparative effectiveness remains unclear. This network meta-analysis (NMA) systematically evaluates the efficacy of different psychological interventions in fostering resilience among families of preterm neonates. Methods: We conducted a comprehensive search of PubMed, Sciencedirect, Cochrane Library, and Googleschoolar up to October 2024, identifying 18 randomized controlled trials (RCTs) involving 2,145 participants. Included studies compared Cognitive-Behavioral Therapy (CBT), Mindfulness-Based Stress Reduction (MBSR), Family-Centered Care (FCC), Peer Support, and Psychoeducation. Resilience outcomes were measured using validated scales (Connor-Davidson Resilience Scale, Family Resilience Assessment Scale). A frequentist NMA was performed using R (netmeta package), with interventions ranked via surface under the cumulative ranking curve (SUCRA). Subgroup analyses examined timing of intervention (NICU vs post-discharge) and parent gender differences. Results: CBT demonstrated superior efficacy (SUCRA=89%, SMD=0.75, 95% CI [0.62-0.88]), followed by MBSR (SUCRA=78%, SMD=0.64 [0.51-0.77]). FCC (SUCRA=65%, SMD=0.52 [0.40-0.64]) and Peer Support (SUCRA=58%, SMD=0.45 [0.32-0.58]) showed moderate effectiveness, while Psychoeducation was least effective (SUCRA=42%, SMD=0.30 [0.18-0.42]). Subgroup analyses revealed significantly greater effects for in-NICU interventions versus post-discharge programs (p0.01) and for mothers versus fathers (SMD difference=0.21, p=0.03). Complementary studies showed Kangaroo Mother Care improved resilience scores from 57.62±13.95 to 76.96±8.07 (p0.05), while virtual education programs increased CD-RISC scores by 19.34 points (p0.001). Conclusion: CBT and MBSR emerge as the most effective interventions for enhancing family resilience in the NICU setting, particularly when implemented during hospitalization. These findings support the integration of structured, skill-based psychological support into routine NICU care, with particular attention to maternal needs. Future research should investigate long-term outcomes and cost-effectiveness to optimize clinical implementation and policy development. Keywords: premature infants, psychological interventions, resilience, network meta-analysis, neonatal intensive care, family support

The Effectiveness of Family-Centered Care Interventions on Psychological Outcomes of Parents of Hospitalized Children: A Systematic Review
پرستاری
Marziyeh Kohantorabi 1 © ℗, Mostafa Rajabzadeh 2
1 Msc in Medical-Surgical Nursing , Qaen Faculty of Medical Sciences, Birjand University of Medical Sciences, Birjand, Iran
2 Student Research Committee, School of Midwifery Nursing, Torbat-e Heydariyeh University of Medical Sciences, Torbat-e Heydariyeh, Iran
Abstract: Background and Aim: Hospitalization of a child is a stressful experience for parents, which can lead to anxiety, depression, caregiving burden, and impaired psychological functioning, resulting in inadequate care and negative outcomes for the children. Family-centered care, as a key approach in pediatric nursing involving active parental participation in the care process, can play an effective role in reducing these consequences. This study aimed to systematically review the evidence on the effectiveness of family-centered care interventions on the psychological outcomes of parents of hospitalized children. Methods: This study was conducted according to the PRISMA protocol. A systematic search was performed in the following databases: SID, Magiran, Google Scholar, PubMed, Scopus, and Web of Science. The search used MeSH keywords including "Family-Centered Care", "Parental Participation", "Hospitalized Child", "Anxiety", "Stress", "Psychological Consequences" and their Persian equivalents, for articles published between 2015 and 2025 with no language restrictions. The inclusion criteria were clinical trials and quasi-experimental studies that investigated the effect of family-centered care interventions on at least one psychological outcome in parents of hospitalized children. The process of screening titles, abstracts, and full texts, as well as data extraction, was then carried out. Results: Out of 246 retrieved studies, 12 studies that met the inclusion criteria were included. Family-centered interventions were implemented in the form of empowerment programs, virtual communication (social networks, video contact), and active parental participation. The psychological outcomes investigated included anxiety, stress, resilience, self-efficacy, and caregiving burden. The results of the qualitative synthesis showed that family-centered care interventions significantly reduced anxiety (n=6 studies), stress (n=4), and caregiving burden (n=2), and also increased resilience (n=3) and self-efficacy (n=3) in parents of hospitalized children. Conclusion: Family-centered care interventions appear to be an effective strategy for improving the psychological outcomes of parents of hospitalized children. Integrating these interventions into nursing care protocols can help promote the health of both parents and children. Conducting studies with larger sample sizes and stronger methodologies is recommended to strengthen the evidence. Keywords: Family-Centered Care, Parents, Hospitalized Child, Psychological Outcomes, Systematic Review

The Effectiveness of Parent Empowerment Programs on Motor and Social Skills in Children with Autism Spectrum Disorder: Systematic Review
پرستاری
Fatemeh Jooya 1 ℗, Neda Pashaei 2, Mohammad Nouri 2, Mobina Ghane Mobarakeh 3 ©
1 MSc student of pediatric nursing, Department of nursing, School of nursing and midwifery, Aliabad Katul Branch, Islamic Azad University, Golestan, Iran.
2 Department of Nursing, Urmia Branch, Islamic Azad University, Urmia, Iran
3 MSc student of pediatric nursing, Department of nursing, School of nursing and midwifery, Khorasgan Branch, Islamic Azad University, Isfahan, Iran
Abstract: Introduction: Autism Spectrum Disorder (ASD) is characterized by persistent deficits in social communication and interaction, alongside restricted and repetitive patterns of behavior. Children with ASD often exhibit delayed motor development and impaired social skills, which can hinder functional independence and peer engagement. Parent empowerment programs, designed to equip caregivers with skills, knowledge, and strategies, have emerged as a promising approach to address these developmental challenges by extending therapeutic interventions into the home environment.This systematic review aimed to evaluate the effectiveness of parent empowerment programs in improving motor and social skills in children with ASD. Methods: A systematic search adhering to PRISMA guidelines was conducted across PubMed, Scopus, Web of Science, and the Cochrane Library, covering studies published from January 2010 to March 2025. Keywords included “autism spectrum disorder,” “parent empowerment,” “motor skills,” and “social skills.” Inclusion criteria comprised randomized controlled trials (RCTs), quasi experimental studies, and pre post intervention studies involving children with ASD aged 3–12 years. Studies lacking measurable outcomes in motor or social domains were excluded. Methodological quality was assessed using the Joanna Briggs Institute (JBI) critical appraisal tools, and findings were synthesized narratively due to heterogeneity in interventions and outcome measures. Results: A total of 18 studies involving 1,245 participants met the inclusion criteria. Interventions included structured parent training workshops, home based activity modules, and telehealth coaching. Eleven studies reported significant improvements in gross and fine motor skills (standardized mean difference [SMD] = 0.45; 95% CI: 0.28–0.62), while 14 studies demonstrated enhanced social interaction and communication (SMD = 0.53; 95% CI: 0.34–0.72). Programs incorporating both in person and remote components yielded the greatest gains. Conclusion: Parent empowerment programs show moderate to strong evidence in improving motor and social skills in children with ASD, reinforcing their role as a cost effective adjunct to professional therapy. Integration into pediatric rehabilitation services and further high quality RCTs are recommended to optimize program design and scalability. Keywords: Autism Spectrum Disorder, Parent Empowerment, Motor Skills, Social Skills, Pediatric Intervention.

The effectiveness of training nurses in reducing hospital infections in the neonatal intensive care unit (NICU) of Amir al-Momenin A. Genaveh Hospital in 1403
پرستاری
مرجان فروردین 1 © ℗, فریده مختاری 2
1 دانشجوی کارشناسی ارشد پرستاری دانشگاه علوم پزشکی بوشهر
2 سوپروایزر آموزش سلامت بیمارستان امیرالمومنین (ع) گناوه
Abstract:

 عفونت های بیمارستانی (Nosocomial Infections) به ویژه در بخش مراقبت ویژه نوزادان (NICU) یکی از چالش های جدی سلامت جهانی محسوب می شوند؛ زیرا نوزادان به دلیل سیستم ایمنی نارس و استفاده از تجهیزات تهاجمی مانند ونتیلاتور، در معرض خطر بالای ابتلا به عفونت هستند. بر اساس گزارش سازمان جهانی بهداشت، شیوع عفونت های بیمارستانی در NICU بین ۴.۳ تا ۲۵ درصد متغیر است که در کشورهای در حال توسعه شیوع بالاتری دارد. در ایران نیز مطالعات نشان داده اند که عفونت های وابسته به ونتیلاتور در NICU تا ۲۸ درصد شیوع داشته و عامل افزایش طول مدت بستری و هزینه های درمانی می باشند. آموزش مستمر پرستاران و تأکید بر بهداشت دست از جمله مهمترین راهکارهای پیشگیری است که به موجب دستورالعملهای وزارت بهداشت ایران و سازمان جهانی بهداشت مورد تأکید قرار گرفته است. هدف این پژوهش، بررسی تأثیر آموزش های دوره ای پرستاران بخش NICU بیمارستان امیرالمؤمنین ع گناوه در سال ۱۴۰۳ بر کاهش عفونتهای بیمارستانی و شناسایی الگوهای شایع انتقال عفونت با تمرکز بر ونتیلاتور و بهداشت دست بود. این مطالعه توصیفی-تحلیلی با شرکت ۲۰ پرستار زن با سابقه کاری ۱ تا ۱۲ سال انجام شد. آموزشهای هدفمند کنترل و پیشگیری از عفونت هر ۶ ماه یکبار برگزار شد. تعداد موارد عفونت در دو دوره ۶ ماهه قبل و بعد از آموزش با استفاده از داده های مرکز کنترل عفونت مقایسه گردید. یافته ها نشان داد آموزش های مکرر باعث کاهش موارد عفونت از ۱۲ مورد به ۷ مورد در ۶ ماه دوم شد. ونتیلاتور و تماس چشمی شایعترین مسیرهای انتقال عفونت بودند. بهبود رعایت بهداشت دست و استانداردهای استریل تجهیزات توسط پرستاران نقش مهمی در کاهش این عفونت ها داشت. نتیجه گیری این است که آموزش مستمر پرستاران NICU و تأکید بر بهداشت دست نقش محوری در کاهش عفونت های بیمارستانی دارد و توصیه میشود این برنامه ها به طور منظم ادامه یابد تا سلامت نوزادان بهبود یابد. کلمات کلیدی: عفونت بیمارستانی، بخش مراقبت ویژه نوزادان، آموزش پرستاران، بهداشت دست، ونتیلاتور، پیشگیری از عفونت

The effects of the Crohn’s Disease Exclusion Diet (CDED) alone versus CDED plus Partial Enteral Nutrition (PEN) on gut microbiome composition in pediatric CD patients 
پرستاری
ژاله پریزاد 1 © ℗
1 دپارتمان گوارش و کبد کودکان، بیمارستان مرکز طبی کودکان، دانشگاه علوم پزشکی تهران، تهران، ایران.
Abstract: Background: Crohn’s disease (CD) is a chronic inflammatory bowel condition characterized by relapsing inflammation and microbial dysbiosis. Diet-based therapies have emerged as promising adjuncts in pediatric CD management. However, limited evidence exists on how different dietary strategies affect gut microbiome composition. This study aimed to compare the effects of the Crohn’s Disease Exclusion Diet (CDED) alone versus CDED plus Partial Enteral Nutrition (PEN) on gut microbiome composition in pediatric CD patients. Methods: In this randomized controlled trial, 60 children with mild-to-moderate CD were assigned to either a CDED-only group or a CDED+PEN group. Gut microbiota composition was assessed using quantitative PCR before and after the 8-week intervention. Results: After 8 weeks, both groups exhibited significant increases in Faecalibacterium prausnitzii, with the CDED+PEN group demonstrating a significantly greater increase compared to the CDED group alone (p  0.001). In the CDED+PEN group, levels of Bifidobacterium and Lactobacillus also rose significantly, whereas in the CDED-only group, Bifidobacterium slightly decreased and Lactobacillus showed only a modest increase. Moreover, Escherichia coli and Fusobacterium were observed exclusively in the CDED+PEN group, leading to marked between-group differences. Changes in Clostridium leptum and Ruminococcus were minimal and not statistically significant between or within groups. These findings suggest a synergistic effect of CDED when combined with PEN in modulating the gut microbiome toward a more anti-inflammatory profile. Conclusion: The CDED+PEN intervention led to more pronounced improvements in gut microbial composition than CDED alone, particularly through increased beneficial bacteria and reduced pro-inflammatory taxa. 

The Efficacy of Tranexamic Acid in Reducing Blood Loss and Transfusion Requirements in Pediatric Congenital Heart Surgery: A Systematic Review
پرستاری
Sedighe Hananni 1, Bahador Pourdel 2 ©, Erfan Rajabi 2 ℗, Seyed Abolfazl Hosseini 2, Amirali Alizadeh 3
1 Senior Expert in internal surgical nursing, instructor, operating room department, faculty of paramedicine, Iran university of medical sciences, Tehran, Iran
2 MSc of Perioperative Nursing, Student Research Committee, School of Allied Medical Sciences, Iran University of Medical Sciences, Tehran, Iran
3 Research Center for Evidence-Based Health Management, Maragheh University of Medical Sciences, ‎Maragheh, Iran‎
Abstract: Introduction: Children with congenital heart disease (CHD) face a significant risk of considerable blood loss during and post-surgery, requiring blood transfusions that may increase morbidity and mortality rates. Tranexamic acid (TXA), an antifibrinolytic agent, is widely employed in adult cardiac surgery; however, its effectiveness and safety in pediatric populations are still ambiguous. This systematic review evaluated the evidence concerning the effectiveness of TXA in reducing blood loss and the necessity for transfusions in pediatric patients undergoing congenital heart surgery. Methods: This review complied with PRISMA guidelines. MEDLINE (via PubMed), Embase, CENTRAL and Web of Science were comprehensively searched from the databases' inception until May 2024. The terms included "tranexamic acid," "antifibrinolytics," "pediatric," "congenital heart surgery," "cardiopulmonary bypass," "blood loss," and "transfusion." The randomized controlled trials (RCTs) and observational cohort studies assessed TXA in comparison to placebo or standard care in patients aged 18 years or younger. The exclusion criteria included case reports, reviews and studies involving adult patients or different antifibrinolytic agents. We employed Cochrane RoB 2 for randomized controlled trials and ROBINS-I for observational studies to assess bias. We employed narrative synthesis and random-effects meta-analysis to determine the aggregated risk ratios (RR) or mean differences (MD) along with 95% confidence intervals. Results: From 1,245 records, 15 studies (10 randomized controlled trials and 5 cohort studies) comprising 1,827 pediatric patients were selected. The dosing protocols for TXA and the complexity of patients varied among studies. Tranexamic acid (TXA) significantly reduced 24-hour postoperative blood loss (mean difference: -7.2 mL/kg; 95% confidence interval: -10.1 to -4.3; 8 studies, n=712) and the likelihood of patients requiring a packed red blood cell transfusion (risk ratio: 0.72; 95% confidence interval: 0.61 to 0.85; 7 studies, n=642), benefiting the TXA cohort. No significant increase in adverse events, especially seizures or thrombosis. Conclusion: This systematic review indicated that tranexamic acid significantly reduces blood loss and the need for transfusions in pediatric patients with congenital heart disease, without increasing short-term thrombotic or neurological complications. These findings support the utilization of TXA in at-risk populations. Due to the significant variability in dosing protocols, there is a necessity for additional high-quality, large-scale randomized controlled trials (RCTs) to standardize, enhance and validate the long-term safety of tranexamic acid (TXA) in neonates and infants with complex congenital heart disease.

The Impact of Bundled Care Interventions in Pediatric Nursing
پرستاری
Maedeh Nasirifar 1 © ℗
1 Master’s Student in Medical-Surgical Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Introduction: Bundled care interventions refer to a set of standardized, evidence-based actions implemented simultaneously and systematically to address a specific clinical problem. Unlike individual interventions, each of which may have limited impact, their combination in the form of a “care bundle” yields maximum effectiveness. Implementation typically involves several steps: protocol development, nurse training, adherence monitoring and documentation, and continuous feedback to the care team. In pediatric care, bundles are especially applied in preventing ventilator-associated pneumonia, central line-associated bloodstream infections, reducing unplanned extubations, and managing delirium. Given the unique vulnerability and varied conditions of hospitalized children, adopting bundled interventions as a standardized and comprehensive approach is of critical importance. The aim of this narrative review is to examine the effectiveness of bundled care interventions in pediatric nursing across various hospital settings. Methods: This review was based on studies published between 2015 and 2025. Sources included PubMed, Wiley, ScienceDirect, and Google Scholar. Search keywords were “Bundled Care Intervention,” “Pediatric,” “Bundles Care,” “Nursing Care,” “Patients,” “Children,” combined with Boolean operators (AND, OR). The search strategy included full text, titles, and abstracts. Inclusion criteria were English-language studies focusing on hospitalized children, implementation of bundled care interventions, and reporting of clinical or nursing outcomes in units. Findings: Evidence indicates that bundled care has been effective in multiple areas, including reducing catheter- and line-associated infections, minimizing complications of mechanical ventilation, and improving pain management in children with various conditions. Bundles have also been associated with decreased mortality in pediatric sepsis, improved outcomes in children with congenital heart disease, and reduced ventilator-related complications such as pneumonia. Overall, these interventions shorten hospital stays and enhance overall health outcomes among hospitalized children. By emphasizing preventive and comprehensive actions, care bundles not only reduce complications and hospitalization duration but also improve patient and family safety and satisfaction, while standardizing the care process. Key factors in successful implementation are consistent adherence, continuous education, and data-driven feedback. Most studies report that improved adherence is directly associated with significant reductions in adverse outcomes. However, heterogeneity of bundle components and limited multicenter pediatric trials remain important limitations. Conclusion: Bundled care interventions are recognized as effective tools in improving nursing care quality and reducing hospital-acquired infections in hospitalized children. This review highlights that training of care teams and adherence to bundles are key to success. Investment in nurse education, family engagement, and infrastructure for adherence monitoring provides the greatest benefits for pediatric patient outcomes. 

The impact of nursing managers' intervention strategies on patient safety in children's hospitals
پرستاری
الهه شمسی 1 © ℗, یاسمین مولوی طالقانی 2
1 کارشناس هماهنگ کننده ایمنی بیمار
2 کارشناس مسئول واحد بهبود کیفیت
Abstract:

 مقدمه : تاثیر سیاست گذاری مدیران پرستاری بر کیفیت زندگی پرستاران بر هیچ کس پوشیده نیست . ضمناً مطالعات متعددی به اهمیت چالش‌های سلامت روان و رفاه پرستاران کودکان و چگونگی تأثیرگذاری این عوامل بر ایمنی بیماران تحت مراقبت آنها اشاره دارد . هدف: این مطالعه با هدف تجزیه و تحلیل تاثیر استراتژی‌های مداخله‌ای مدیران پرستاری بر سلامت روان پرستاران کودکان و در نهایت اثرگذاری این عوامل بر ایمنی بیماران تحت مراقبت آنها انجام شده است. روش‌شناسی: این مطالعه به روش مروری انجام شده است و از دستورالعمل‌های PRISMA پیروی می‌کند. جستجوی جامعی در شش پایگاه اطلاعاتی PubMed Scopus، Scholar google ، Web of Science، Medline و Embase و با کلید واژگان اصلی انجام شد. ارزیابی کیفیت مطالعات با استفاده از روش ترکیبی(MMAT) انجام شد . یافته ها : با جستجوی کلید واژگان 12 مقاله بازیابی شد که پس از اعمال معیارهای ورود، پنج مطالعه از چین، ایالات متحده ، مجارستان، کلمبیا و عربستان سعودی مورد بررسی قرار گرفتند. عوامل کلیدی شناسایی شده متاثر از استراتژی های مدیران پرستاری موثر بر کیفیت زندگی پرستاران کودکان شامل حجم کاری بالا، محیط کاری نامناسب، منابع محدود و روابط بین فردی پرتنش، عدم حمایت، الگوهای شیفت نامنظم، نقش‌های طاقت‌فرسا و فشار مالی بودند. این عوامل به طور قابل توجهی با افزایش استرس، فرسودگی شغلی، اضطراب و افسردگی در بین پرستاران کودکان مرتبط بودند. بررسی ها نشان داد : مدیریت حجم کار و پرورش منابع روانشناختی مانند خودکارآمدی پرستاران تاثیر قابل توجهی بر افزایش عملکرد حرفه‌ای آنها و کاهش خطا دارد . نتیجه گیری : مداخلات مؤثر باید شامل نسبت‌های قابل مدیریت پرستار به بیمار، تخصیص کافی منابع، تقویت فرهنگ کاری حمایتی، برنامه‌ریزی انعطاف‌پذیر، حمایت هدفمند از پرستاران ارشد و بهبود جبران خسارت مالی باشد.با پرداختن به عوامل محیطی و شناختی، سازمان‌های مراقبت‌های بهداشتی می‌توانند انتظار حفظ استانداردهای بالای مراقبت را از پرستاران کودکان داشته باشند. توصیه می‌شود که استراتژی‌های مداخله‌ای هدفمند مدیران پرستاری بر اساس عوامل مؤثر شناسایی شده تدوین شوند . چنین استراتژی‌هایی می‌تواند شامل افزایش فرصت‌های توسعه حرفه‌ای، بهبود حقوق و دستمزد مالی و ایجاد یک محیط کاری حمایتی باشد. مدیران پرستاری با ادغام استراتژی‌های ایجاد تاب‌آوری روانی در ابتکارات توسعه حرفه‌ای ، اعتماد به نفس و عملکرد پرستاران را تحت فشار تقویت می کنند و ایمنی بیماران تحت مراقبت آنها را بهبود می بخشند . کلمات کلیدی: استراتژی‌های مداخله‌ای ، ایمنی بیمار ، چالش‌های سلامت روان، پرستاران کودکان

The relationship between attachment and needs of mothers of children with chronic physical illness.
پرستاری
محمد ارشدی بستان آباد 1 ©, حسین نامدار ارشتناب 2, حسین معماری بناب 3 ℗
1 دانشیار پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
2 استاد روان پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
3 کارشناسی ارشد پرستاری کودکان
Abstract:

 چکیده زمینه: بیماری های مزمن در کودکان، باعث ایجاد اضطراب در مادران می شود و ممکن است ارتباط مادران و فرزندان را مختل کند. همچنین بستری شدن کودک در بیمارستان نیازهای بسیاری را برای مادران ایجاد می کند که با وجود سال‌ها ترویج مراقبت خانواده‌محور، نیازهای مادران هنوز به‌طور جامع برآورده یا درک نشده است که در نهایت می‌تواند استرس و اضطراب مادران کودکان مبتلا به بیماری‌های مزمن را افزایش بدهد و باعث اختلال در روابط بین کادر پزشکی به‌ویژه پرستاران و مادران شود. این رابطه آشفـته و اسـترس و اضـطراب موجـود می تواند بر دلبستگی مادران تأثیر بگذارد. این مطالعه با هدف تعیین ارتباط بین دلبستگی و نیازهای مادران کودکان مبتلا به بیماری مزمن جسمی انجام گرفت. روش کار: در این مطالعه توصیفی همبستگی، 173 نفر از مادران دارای کودک با بیماری مزمن جسمی بستری که به صورت در دسترس از کل بخش های بستری بیمارستان کودکان مردانی آذری تبریز از مرداد1402 تا دی 1403 انتخاب گردیدند، شرکت نمودند. جمع آوری داده ها با استفاده از پرسشنامه های اطلاعات دموگرافیک، دلبستگی مادر به کودک(MPAS) و نیازهای والدین(NPQ) انجام شد و تحلیل داده ها به وسیله نرم افزار spss21 و با استفاده از آزمون های آمار توصیـفی، همبـستگی پـیرسون، تی تست مستقل ، آزمون آنوا و آزمون تعقیبی توکی انجام گردید. یافته ها: براساس نتایج، میزان دلبستگی مادران(73/10) و نیازهای تامین شده آنان(62/33) بیشتر ازحد متوسط و مـی باشــد و بین نمره کل دلبستگی با نیازهای مادران(P= 0.14, r = 0.11) ارتباط آماری معنی داری وجود ندارد اما بیــن کیفیـت دلبستـگـی با نـیـاز(P = 0.03, r = 0.22) همبستگی معنی دار مثبت ضعیفی مشاهده گردید. نتیجه گیری: بر اساس نتایج مطالعه بین تامین نیازهای مادران و میزان دلبستگی ارتباط معنی داری وجود ندارد اما رفع نیازهای مادران می تواند بر کیفیت دلبستگی تاثیرگذار باشد. این مطالعه با کد اخلاق IR.TBZMED.REC.1402.226 به تایید کمیته اخلاق دانشگاه علوم‌پزشکی تبریز رسیده است. واژگان کلیدی: بیماری مزمن، دلبستگی، نیاز، مادر 

The relationship between attachment and receipt of family-centered care in mothers of children with chronic physical illnesses
پرستاری
حسین معماری بناب 1 © ℗, حسین نامدار ارشتناب 2, محمد ارشدی بستان آباد 3
1 کارشناسی ارشد پرستاری کودکان
2 استاد روان پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
3 دانشیار پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
Abstract:

 چکیده زمینه: امروزه علیرغم پیشرفت در درمان بیماری های مزمن در کودکان، کیفیت زندگی آنها هنوز ناشناخته است که باعث ایجاد اضطراب در مادران می شود و ممکن است روابط مادران و فرزندان را مختل کند. همچنین بستری شدن کودک در بیمارستان نیازهای بسیاری را برای مادران ایجاد خواهد کرد. با وجود سال‌ها ترویج مراقبت خانواده‌محور، نیازهای مادران هنوز به‌طور جامع برآورده یا درک نشده است که می‌تواند استرس و اضطراب مادران کودکان مبتلا به بیماری‌های مزمن را افزایش داده و باعث اختلال در روابط بین کادر پزشکی به‌ویژه پرستاران و مادران شود. این رابطه آشفـته و اسـترس و اضـطراب موجـود می تواند بر دلبستگی مادران تأثیر بگذارد. این مطالعه با هدف تعیین ارتباط بین دلبستگی و فرآیند مراقبت خانواده محور در مادران کودکان مبتلا به بیماری مزمن جسمی انجام گرفت. روش کار: در این مطالعه همبستگی، 173 نفر از مادران دارای کودک با بیماری مزمن جسمی بستری که به صورت در دسترس از کل بخش های بستری بیمارستان کودکان مردانی آذری تبریز از مرداد1402 تا دی 1403 انتخاب گردیدند، شرکت نمودند. جمع آوری داده ها با استفاده از پرسشنامه های اطلاعات دموگرافیک، دلبستگی مادر به کودک، درک از فرآیند مراقبت خانواده محور انجام شد و تحلیل داده ها به وسیله نرم افزار 21spss و با استفاده از آزمون های آمار توصیـفی، همبـستگی پـیرسون، t-testمستقل ، آزمون Anova و آزمون تعقیبی Tukey انجام گردید. یافته ها: بـراساس نتایج، میـزان دلبستگی مـادران بیشتـر ازحـد متوسـط و میـزان مراقبت خانواده محـور انــجــام شــده کمـتر ازحـــد متوســـط مـی باشـــد. و بیـــن نمـره کـل دلبـستگی با فرآیند مراقبت خانواده محور(P = 0.01, r = 0.19) همبستگی مثبت وجود دارد. نتیجه گیری: بر اساس نتایج مطالعه حاضر انجام مراقبت های خانواده محور بر میزان دلبستگی مادران به کودکان دارای بیماری مزمن جسمی تاثیر گذار می باشد. این مطالعه با کد اخلاق IR.TBZMED.REC.1402.226 به تایید کمیته اخلاق دانشگاه علوم‌پزشکی تبریز رسیده است. واژگان کلیدی: بیماری مزمن، دلبستگی، مراقبت خانواده محور، مادر 

The relationship between receiving family-centered care and the needs of mothers with children with chronic physical illnesses.
پرستاری
حسین نامدار ارشتناب 1 ©, محمد ارشدی بستان آباد 2, حسین معماری بناب 3 ℗
1 استاد روان پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
2 دانشیار پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی تبریز
3 کارشناسی ارشد پرستاری کودکان
Abstract:

 چکیده زمینه: بیماری های مزمن در کودکان، باعث ایجاد اضطراب در مادران می شود همچنین بستری شدن کودک در بیمارستان نیازهای بسیاری را برای مادران ایجاد می کند که با وجود سال‌ها ترویج مراقبت خانواده‌محور، نیازهای مادران هنوز به‌طور جامع برآورده یا درک نشده است که در نهایت می‌تواند استرس و اضطراب مادران کودکان مبتلا به بیماری‌های مزمن را افزایش بدهد. این مطالعه با هدف تعیین ارتباط بین دریافت مراقبت خانواده محور و نیازهای مادران کودکان مبتلا به بیماری مزمن جسمی انجام گرفت. روش کار: در این مطالعه توصیفی همبستگی، 173 نفر از مادران دارای کودک با بیماری مزمن جسمی بستری که به صورت در دسترس از کل بخش های بستری بیمارستان کودکان مردانی آذری تبریز از مرداد1402 تا دی 1403 انتخاب گردیدند، شرکت نمودند. جمع آوری داده ها با استفاده از پرسشنامه های اطلاعات دموگرافیک، درک از فرآیند مراقبت خانواده محور(MPOC-20) و نیازهای والدین(NPQ) انجام شد و تحلیل داده ها به وسیله نرم افزار spss21 و با استفاده از آزمون های آمار توصیـفی، همبـستگی پـیرسون، تی تست مستقل ، آزمون آنوا و آزمون تعقیبی توکی انجام گردید. یافته ها: براساس نتایج، نیازهای تامین شده مادران(33/62) بیشتر ازحد متوسط و میزان مراقبت خانواده محـور انـجــام شــده(36/70) کمـتر ازحــد متوســط مـی باشــد. همچـنین بین نیازهای مادران با دریافت مراقبت خانواده محور(P 0.001, r = 0.63) همبستگی معنی دار مثبت متوسطی وجود دارد. نتیجه گیری: بر اساس نتایج مطالعه حاضر انجام مراقبت های خانواده محور در رفع هـر چـه بیشـتر نیاز های مادران می تواند تاثیر گذار می باشد. این مطالعه با کد اخلاق IR.TBZMED.REC.1402.226 به تایید کمیته اخلاق دانشگاه علوم‌پزشکی تبریز رسیده است. واژگان کلیدی: بیماری مزمن، مراقبت خانواده محور، نیاز، مادر 

The Roadmap of Breastfeeding in Iran: From Policy-Making to Implementation in the Health Sector
پرستاری
زهرا شه کلاهی 1 © ℗, زهرا خاکدل جلودار 2
1 گروه پرستاری، دانشکده پرستاری، دانشگاه علوم پزشکی فسا، شماره تماس: 09395043279
2 مرکز تحقیقات مدیریت اقتصاد سلامت، گروه مدیریت خدمات بهداشتی و درمانی، دانشکده مدیریت و اطلاع رسانی پزشکی، دانشگاه علوم پزشکی اصفهان. شماره تماس: 09144566695
Abstract: Introduction: Breastfeeding is considered one of the main pillars of infant and maternal health, and effective policies in this area can contribute to reducing mortality, improving public health, and promoting equity. Given the crucial role of nurses, managers, and healthcare personnel in advancing these policies, the present study examines the evolution of breastfeeding policies in Iran, their alignment with global standards, and their implementation within the healthcare system. Methods: This scoping review was conducted using the PRISMA-ScR framework. Studies published between 2010 and 2024 were searched in reputable databases including PubMed, Scopus, Science Direct, Web of Science, ProQuest, SID, and MagIran, and were reviewed and analyzed based on inclusion and exclusion criteria. Studies were selected for review if they examined breastfeeding policies or strategies at the national level in the Islamic Republic of Iran, with a focus on policies promoting, supporting, or protecting breastfeeding. Additionally, studies analyzing the alignment of Iran's breastfeeding policies with global frameworks or the World Health Organization were considered. Results: A total of 330 articles were retrieved, of which 11 duplicates were removed, and 18 studies were reviewed. The results showed that Iran has made significant progress in promoting breastfeeding through the implementation of Baby-Friendly Hospital Initiatives, educational interventions, and national surveys. However, implementation gaps still exist, particularly in integrating policies into healthcare systems, ensuring managerial accountability, and addressing structural and equity-related barriers. Conclusion: To achieve full alignment with global standards, Iran needs to institutionalize breastfeeding policies within healthcare systems, strengthen intersectoral support structures, and establish mechanisms for continuous policy evaluation and implementation. Keywords: Breastfeeding, policy, Exclusive breastfeeding, Health Policy, Iran. 

The Role of Artificial Intelligence and Machine Learning in the Future of Pediatric Nursing: A Review of the Application of AI in Early Disease Diagnosis and Prediction of Treatment Outcomes in Children
پرستاری
Kousar Soltani 1 ©, Mahsa Cheraghi 2 ℗, Maryam Rangrazi 3
1 Kousar Soltani Msn Student in Nursing, School of Nursing and Midwifery , Hamadan University of Medical Sciences, Hamadan, Iran
2 ,Mahsa Cheraghi Msn Student in Nursing, School of Nursing & Midwifery, Tehran University of Medical Sciences, Tehran, Iran
3 Maryam RangraziNursing student, Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
Abstract:

 مقدمه: ادغام هوش مصنوعی (AI) و یادگیری ماشین (ML) پتانسیل بالایی در زمینه پزشکی، به ویژه تشخیص و مدیریت بیماری‌های مزمن در کودکان و نوجوانان نشان داده است. این بررسی سیستماتیک به منظور تحلیل جامع و سنتز تحقیقات در مورد کاربرد AI برای نظارت، هدایت و کمک به بیماران pediatric با بیماری‌های مزمن انجام شده است. با توجه به افزایش شیوع بیماری‌های مزمن مانند دیابت، آسم و بیماری‌های کلیوی در کودکان، AI می‌تواند ابزارهای نوینی برای بهبود مراقبت‌های شخصی‌سازی‌شده، پیش‌بینی نتایج و حمایت از تصمیم‌گیری‌های بالینی ارائه دهد. این مطالعه بر روندهای نوظهور تمرکز دارد تا چشم‌اندازی برای آینده‌پژوهی در پرستاری کودکان فراهم کند. روش کار این بررسی سیستماتیک بر اساس راهنمای PRISMA انجام شد. جستجو در پنج پایگاه الکترونیکی اصلی (Medline, Scopus, PsycINFO, ACM, Web of Science) شناسایی مقالات مرتبط صورت گرفت. مطالعات اصلی، چکیده‌های کنفرانس و proceedings که بر کاربردهای AI در مراقبت از بیماری‌های مزمن pediatric تمرکز داشتند،آورده شدند. معیارهای ورود شامل مطالعات منتشرشده از سال ۲۰۱۵ تا ۲۰۲۵، با تمرکز بر کودکان و نوجوانان (۰-۱۸ سال) بود. دو پژوهشگر مستقل داده‌ها را استخراج کرده و اختلافات را از طریق بحث حل کردند. داده‌های استخراج‌شده شامل روش AI، طراحی مطالعه، جمعیت، مداخله و نتایج اصلی بود. ارزیابی کیفیت مطالعات با ابزارهای استاندارد مانند AMSTAR-۲ انجام شد. در نهایت، ۳۱ مطالعه واجد شرایط بودند که عمدتاً بر داده‌های retrospective تکیه داشتند. یافته‌ها: کاربردهای AI متنوع بودند و شامل طبقه‌بندی بیماری (مانند بیماری کلیوی مزمن با دقت ۹۲%)، پیش‌بینی نتایج (مانند تاخیر در کاهش کراتینین پس از پیوند کلیه) و حمایت تصمیم‌گیری (مانند رعایت راهنماهای آسم) می‌شدند. AI در تحلیل سلامت روانی، مانند استفاده از نمونه‌برداری صوتی یا داده‌های رسانه‌های اجتماعی برای پیش‌بینی نتایج درمانی، عملکرد خوبی نشان داد. ابزارهای مبتنی بر AI مانند اپلیکیشن‌های انسولین برای دیابت نوع ۱ و روبات‌های humanoid برای مدیریت دیابت، پذیرش بالایی در میان کاربران داشتند. اکثر مدل‌ها بر داده‌های retrospective آزمایش شدند و عملکرد بالایی گزارش کردند، اما مطالعات prospective محدود بودند. نتیجه‌گیری :هرچند AI پتانسیل بالایی در مراقبت از بیماری‌های مزمن کودکان دارد، اکثر مطالعات پروژه‌های تحقیقاتی کوچک‌مقیاس هستند. نیاز به پیاده‌سازی‌های بالینی prospective برای اعتبارسنجی اثربخشی در دنیای واقعی وجود دارد. ملاحظات اخلاقی، تأثیرات فرهنگی و نگرش ذی‌نفعان باید در تحقیقات آینده ادغام شوند. این بررسی نشان می‌دهد که AI می‌تواند نقش حمایتی مهمی در پرستاری کودکان ایفا کند، اما نیازمند توسعه بیشتر است. کلمات کلیدی :هوش مصنوعی؛ یادگیری ماشین؛ کودکان و نوجوانان بیمار مزمن؛ پرستاری کودکان؛ مدیریت بیماری‌های مزمن

The role of augmented reality technology in improving self-management of Pediatrics asthma
پرستاری
Maedeh Nasirifar 1 ℗, Pegah Matorypour 2 ©
1 Master's student in medical Surgery, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
2 PhD in Nursing, Assistant Professor, Department of medical Surgery Nursing, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran p-matourypour@tums.ac.ir
Abstract: Introduction: The emergence of new technologies, including text-message-based interventions, smartphone applications, and augmented reality (AR) has facilitated the introduction of effective treatment methods in clinical settings. Augmented reality, as a delivery method for asthma self-management education, may provide a new, exciting, and effective way to provide asthma education to children and serve as a message for health professionals to start reviewing inhaler devices. The aim of this narrative review is to examine the impact of augmented reality (AR) in the management of children's respiratory problems. Method: The databases PubMed, Sciencedirect, Wiley, and the search engine Google Scholar were searched in January 2025. The keywords and phrases used for the search were: “augmented reality technology”, “pediatric”, and “asthma”, using the Boolean operators AND, NOT, and OR in different combinations. Studies from 2015 to 2025 were included. A total of 2,419 initial records were retrieved. After screening and applying inclusion and exclusion criteria, 12 studies were finally selected for data extraction and pooling of findings. Findings: To speed up treatment, technologies such as augmented reality may offer an innovative and low-cost solution. Several areas of asthma self-management can be improved with the use of digital technology, including disease disparities, medication adherence, patient-physician communication, patient-to-patient education, and passive monitoring of patient characteristics and behaviors that can enable timely intervention. Reviews of delivered health care education have identified effectiveness for outcomes such as improved knowledge, adherence to medications or treatment, and improved clinical care. AR may be an effective strategy for providing education to parents with low literacy levels and is an important area that needs to be addressed, as it is associated with poorer asthma control and less adherence to asthma treatment. Children's greater adoption of the latest technologies can make new technologies easier for them to apply than for older populations and help increase treatment compliance in pediatric populations who have a lower understanding of disease and treatment in traditional medical care. Conclusion: AR appears to be an acceptable method for providing asthma education to children. Although some challenges in the use of AR were identified, the results were mostly positive. Future designs of asthma education interventions should focus on further research into feasibility, usability, barriers, and facilitators of behavior change to ensure the successful implementation and adoption of AR in clinical settings. Keywords: Augmented reality, self-management, asthma, children

The Role of Digital Parenting Practices in Mitigating Screen Addiction and Enhancing Psychological Well-being in Children: An Integrative Review
پرستاری
Ali Karamoddin 1 ℗, Ali Dayyabi 1, Farnoosh Tajik 2 ©
1 Student Research Committee, Semnan University of Medical Sciences, Semnan, Iran
2 1-Nursing care research center, Semnan University of medical sciences, Semnan, Iran,2- Department of Pediatric and Neonatal Nursing, School of Nursing and Midwifery, Semnan University of Medical Sciences, Semnan, Irann
Abstract: Background: The proliferation of digital devices has transformed children’s daily lives, offering educational and social benefits. However, excessive screen exposure has been associated with negative outcomes, including problematic media use, screen addiction, emotional disturbances, and behavioral difficulties. Parental mediation plays a central role in shaping children’s digital experiences. This review aimed to evaluate the role of digital parenting practices in mitigating screen-related harms and enhancing psychological well-being in children. Method: A systematic review was conducted on studies published between January 2020 and August 13, 2025. Databases searched included PubMed/MEDLINE, Embase, Scopus, Web of Science Core Collection, Cochrane CENTRAL, and CINAHL. The search strategy combined controlled vocabulary (MeSH) and free-text terms related to parent-child relations, parental mediation, screen time, internet addiction, gaming disorder, and child mental health. Eligible studies were English-language, peer-reviewed, and full-text, addressing the impact of parental mediation on children’s digital behaviors and psychological outcomes. Two independent reviewers screened studies, extracted data, and appraised risk of bias using standardized tools. Results: 1. Active Mediation: Open discussions about digital content improved children’s critical thinking, reduced problematic media behaviors, and enhanced emotional regulation. 2. Autonomy-Supportive Dialogue: Guidance while respecting children’s input promoted self-regulation, resilience, and fewer behavioral problems. 3. Guided Co-Use: Shared screen activities (e.g., co-playing games) strengthened parent-child bonding, improved social-emotional development, and lowered screen addiction risk. 4. Restrictive/Technical Controls: Limits, monitoring, and filters reduced overall screen time; however, effects on psychological well-being were inconsistent, and excessive restrictions could increase resistance or reduce digital competence. 5. Parental Digital Literacy Training: Structured programs increased parental confidence, improved mediation practices, and indirectly supported children’s behavioral and emotional outcomes. Conclusion: Evidence supports promoting active, relational and informed digital parenting to mitigate screen related harms and enhance child well-being. Parents should be equipped with digital literacy skills, adaptive strategies, and reflective guidance, while future research explores long-term impacts and culturally sensitive interventions. Keywords: Parenting; Internet addiction; children; Screen time.

The Role of Gamification in Enhancing Treatment Adherence Motivation in Children with Cancer: A Systematic Review
پرستاری
Mehrangiz Ghabimi 1 ©, Navaz Emadi 2 ℗
1 Student Research Committee, Birjand University of Medical Sciences, Birjand, Iran
2 Department of E-learning in Medical Education, Center of Excellence for E-learning in Medical Education, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: : Introduction Childhood cancer poses significant challenges that affect both physical and psychological aspects of treatment adherence. Gamification—integrating engaging and interactive elements—has gained recognition as a promising tool to enhance compliance, reduce anxiety, and improve patient cooperation. Serious digital games foster a sense of control, minimize stress, and encourage active participation in medical routines. This systematic review examines the impact of gamification on adherence to treatment in pediatric oncology. Methods : A comprehensive search was conducted across Web of Science, PubMed, Scopus, and Google Scholar, between 2010 to 2025. The search included the keywords "gamification," "pediatric," "neoplasm," and "compliance." Studies meeting inclusion criteria were independently reviewed, extracting data related to treatment adherence, stress reduction, patient engagement, and digital dependency issues.The PRISMA checklist guided study selection, and the ROBIS tool was used for quality assessment of articles. Results : A total of 18 studies were analyzed. Among them, 14 studies (77%) demonstrated a significant improvement in adherence rates, whereas 4 studies (23%) emphasized gamification’s role in reducing anxiety and stress among pediatric cancer patients. A study involving 24 children revealed that 80% showed an increased willingness to continue treatment, and 75% of children aged 6–12 demonstrated improved self-care behaviors such as hygiene, nutrition, and rest. Moreover, knowledge assessments before and after game-based interventions indicated that children’s understanding of cancer and its treatment improved notably. Further comparative analysis revealed that three studies addressed concerns about excessive screen dependency, indicating that some children developed a habit of prolonged mobile phone use due to digital interventions, potentially affecting social engagement and real-world interactions. Serious digital games like Pets vs Onco and mobile applications such as HomeTown played a crucial role in enhancing treatment compliance through interactive education, health reminders, and structured learning tools. Experts suggest that while gamification is effective, its implementation should include measures to mitigate digital overuse in young patients. : Conclusion Gamification-based interventions in pediatric oncology significantly enhance treatment adherence, reduce stress, and improve self-care routines. However, concerns related to screen dependency warrant further investigation to optimize digital strategies. Integrating interactive education, entertainment-driven therapy, and psychological support strengthens treatment engagement and patient-provider communication. Future research should refine gamified approaches to balance therapeutic benefits with reduced digital reliance, ensuring long-term effectiveness. Keywords: gamification, pediatric, neoplasm, compliance, treatment adherence 

The Role of Gut Microbiome in Neurobehavioral Disorders in Children: A Systematic Review with Focus on Pediatric Nursing Care and Rehabilitation
پرستاری
شیوا فرجام 1 ©, نحله پرندآور 2 ℗
1 کارشناس پرستاری، فارغ التحصیل دانشگاه علوم پزشکی جهرم، جهرم، ایران
2 کارشناس ارشد مامایی، سرپرست کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی جهرم، جهرم، ایران
Abstract:

 هدف: پژوهش‌های اخیر نشان داده‌اند که محور روده–مغز نقش اساسی در رشد عصبی و رفتاری کودکان ایفا می‌کند. میکروبیوم روده، فراتر از نقش گوارشی، در توسعه عملکرد مغزی، تنظیم خلق‌وخو و رفتار کودکان اهمیت دارد. اختلال در تعادل میکروبیوم روده (دیس‌بیوزیس) در سال‌های اولیه زندگی با اختلالات روان‌رفتاری مرتبط است. هدف این مطالعه مروری، بررسی شواهد علمی پیرامون نقش میکروبیوم روده در توسعه رفتاری–عصبی کودکان و تحلیل پیامدهای بالینی آن در مراقبت‌های پرستاری و نقش پرستاری در پیشگیری، شناسایی زودهنگام و توانبخشی می‌باشد. روش‌کار: در این مرور نظام‌مند، مقالات منتشرشده بین سال‌های ۲۰۱۵ تا ۲۰۲۴ در پایگاه‌های PubMed، Scopus و Web of Science جستجو شدند. مجموعاً ۲۹۸ مقاله شامل ۲۱۵ مقاله مشاهده‌ای و ۸۳ مقاله مداخله‌ای با کیفیت بالا وارد مطالعه شدند. معیارهای ورود شامل پژوهش‌های مرتبط با میکروبیوم روده و اختلالات عصبی–رفتاری کودکان زیر ۱۸ سال بود. کیفیت مقالات با استفاده از چک‌لیست CASP و معیارهای معتبر روش‌شناسی ارزیابی شد و شامل طراحی مطالعه، مشخص بودن جمعیت، تعریف متغیرها، کنترل سو‌گیری و صحت داده‌ها بود. استانداردهای گزارش علمی و اصول اخلاقی رعایت شدند. یافته‌ها: شکل‌گیری و توسعه میکروبیوم سالم در سال‌های ابتدایی زندگی تحت تأثیر نوع زایمان (طبیعی یا سزارین)، نوع تغذیه (شیر مادر یا شیر خشک)، مصرف آنتی‌بیوتیک‌ها و شرایط محیطی مانند سبک زندگی قرار دارد. عدم تعادل میکروبیوم روده در نوزادی و کودکی می‌تواند خطر اختلالاتی مانند طیف اوتیسم، بیش‌فعالی/نقص توجه (ADHD)، اضطراب، اختلال خواب، مشکلات رفتاری و نوسانات خلقی را افزایش دهد. مداخلاتی مانند تغذیه با شیر مادر و مصرف پروبیوتیک‌ها و پری‌بیوتیک‌ها می‌توانند تمرکز، تعامل اجتماعی، ثبات هیجانی و مهارت‌های شناختی کودکان را بهبود دهند. از منظر مراقبت پرستاری، این یافته‌ها اهمیت آموزش والدین درباره سبک زندگی و تغذیه سالم، پایش مصرف آنتی‌بیوتیک‌ها و داروهای مؤثر بر میکروبیوم، شناسایی زودهنگام علائم رفتاری غیرطبیعی و مشارکت در برنامه‌های توانبخشی فردمحور را برجسته می‌سازد. پرستاران با دانش میکروبیوم می‌توانند در طراحی مداخلات پیشگیرانه و ارجاع به‌موقع کودک به تیم‌های درمانی چندرشته‌ای نقش مؤثری داشته باشند. نتیجه‌گیری: میکروبیوم روده نقش مهمی در رشد رفتاری–عصبی کودکان دارد. پرستاران با بهره‌گیری از این دانش در پیشگیری، غربالگری و توانبخشی اختلالات روانی کودکان مؤثرند. تقویت نقش پرستاران در آموزش والدین، مراقبت فردمحور مبتنی بر میکروبیوم و ارجاع به‌موقع، علاوه بر ارتقای کیفیت زندگی کودکان، موجب کاهش بار روانی و مالی خانواده‌ها و سیستم سلامت شده و چشم‌اندازی عملی برای بهبود سلامت روانی نسل آینده فراهم می‌کند. این نتایج می‌تواند مبنایی برای طراحی راهبردهای بالینی و پژوهش‌های آینده در پرستاری کودکان باشد.

The role of oxytocin in the treatment of autism spectrum disorder in children: A review study
پرستاری
مطهره نقی زاده عباس آباد 1 © ℗
1 دانشجوی کارشناسی ارشد پرستاری کودکان، کمیته تحقیقات دانشجویی، دانشگاه علوم پزشکی رفسنجان، رفسنجان، ایران
Abstract:

 -زمینه و اهداف اختلالات طیف اوتیسم (ASD) از جمله اختلالات رشدی عصبی هستند که با نارسایی در تعاملات اجتماعی، ارتباطات کلامی و غیرکلامی و الگوهای رفتاری تکراری مشخص می‌شوند. امروزه اختلال طیف اوتیسم در سراسر جهان و ایران از شیوع بالایی برخوردار است. با وجود پیشرفت های قابل توجه در زمینه شناخت علل و علائم اوتیسم، هنوز درمان قطعی جهت بهبود اکثر علائم آن وجود ندارد. اکسی توسین به عنوان یک نوروپپتید میتواند از طریق ارتباط با بسیاری از سیستم های نوروترانسمیتری در مغز بر بهبود توجه، حافظه و یادگیری ارتباطی اثر بگذارد. این مطالعه با هدف بررسی نقش داروی اکسی توسین در درمان اختلال طیف اوتیسم کودکان انجام شد. -مواد و روش‌ها در این مرور ساده، جستجو با استفاده از کلید واژه های فارسی اوتیسم،کودک اوتیستیک، اکسی توسین و درمان و معادل انگلیسی آنها در عنوان و چکیده مطالعات و در پایگاه های بین المللی و ملی PubMed, ScienceDirect, SID, Magiran و موتور جستجوگر Google Scholarصورت گرفت. در جستجوی اولیه 148 مقاله به دست آمد. در نهایت با توجه به معیار های ورود (فول تکس، مقالات 5 سال اخیر و انتشار به فارسی/انگلیسی) و معیار های خروج (کامنت، نامه و مطالب خاکستری) و حذف موارد تکراری و انطباق با هدف،11 مطالعه وارد تجزیه و تحلیل شدند. -یافته ها کودکان مبتلا به اوتیسم با انجام گونه ای از رفتارها (تکراری کلیشه ای، تعاملی و آسیب رسان) میکوشند تا از این راه سیستم عصبی خود را در جهت تحریک حسی برانگیخته کنند و یا برعکس. اکسی توسین از راه تنظیم هومئوستاتیک و تضعیف حسی، این ساختار را به ویژه از نظر خودتحریکی، کنترل میکند. از سمتی این رفتارها ممکن است به دلیل مشکلات اضطرابی و پاسخ به استرس باشد که سبب ایجاد یک پاسخ ستیز و گریز اشتباه می شود. به نظر می رسد با توجه به نقش اکسی توسین در کاهش مقدار استرس و اضطراب و نقش دیگر آن در تضعیف حسی میتواند در فرایند مهار و کاهش رفتار های فرد مبتلا به اوتیسم کمک کننده باشد. -نتیجه‌گیری استفاده از داروی اکسی توسین به صورت اسپری درون بینی میتواند رفتارهای چالشی کودکان مبتلا به اوتیسم را بهبود بخشد. بنابراین با توجه به نقش حیاتی هورمون اکسی توسین در جهت تنظیم تعاملات اجتماعی، اجرای ساز و کار مناسب جهت استفاده از این دارو و یا ترکیب آن با سایر روش‌های درمانی و رفتاری جهت بهبود رفتاری کودکان مبتلا به اوتیسم حائز اهمیت است. -کلمات کلیدی اوتیسم، کودک اوتیستیک، اکسی توسین، درمان 

The Role of Play Therapy and Art Therapy in Reducing Post-Traumatic Stress in School-Aged Children: Systematic Review
پرستاری
Somayyeh Ahmadi 1 ℗, Negin Sedighi 2, Fakhr Al-Sadat Mirjalili 3, Zohreh Shayegh 4 ©
1 Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
2 BSC of Nursing, Bone Marrow Transplant Department , Shahid Sadoughi Hospital, Yazd, Iran
3 BSC of Nursing, Pediatric Oncology Department , Shahid Sadoughi Hospital, Yazd, Iran
4 Msc of Midwifery, High-Risk Pregnancy Department , Shahid Sadoughi Hospital, Yazd, Iran
Abstract: Introduction: Post traumatic stress disorder (PTSD) in school aged children can result from exposure to traumatic events such as accidents, abuse, natural disasters, or witnessing violence. PTSD in this age group is associated with emotional dysregulation, academic decline, social withdrawal, and long term mental health risks. Play therapy and art therapy, as developmentally appropriate and expressive interventions, enable children to process trauma through symbolic and creative activities, thereby reducing symptom severity and improving emotional resilience.This systematic review aimed to evaluate the effectiveness of play therapy and art therapy in reducing PTSD symptoms among children aged 6–12 years. Methods: Following PRISMA guidelines, a comprehensive literature search was conducted in PubMed, Scopus, Web of Science, and the Cochrane Library, covering January 2010 to April 2025. Keywords included “play therapy,” “art therapy,” “post traumatic stress disorder,” “children,” and “school aged.” Randomized controlled trials, quasi experimental studies, and pre post designs evaluating these therapies were included. Studies without validated PTSD outcome measures or non school aged populations were excluded. Methodological quality was appraised using the Joanna Briggs Institute (JBI) checklist. Due to heterogeneity in intervention designs and assessment tools, a narrative synthesis was undertaken. Results: Seventeen studies, involving 1,032 participants, met the inclusion criteria. Intervention durations ranged from 6 to 12 weeks, with sessions delivered in school, community, or clinical settings. Twelve studies reported significant reductions in total PTSD symptom scores (pooled standardized mean difference [SMD] = −0.58; 95% CI: −0.74 to −0.42). Improvements were most notable in re experiencing and avoidance subscales. Programs combining both play and art therapy modalities yielded the greatest overall effect. Conclusion: Evidence suggests that play therapy and art therapy are effective, child friendly interventions for reducing PTSD symptoms in school aged children. Their integration into trauma focused pediatric mental health services may facilitate recovery and enhance psychosocial functioning. Further large scale RCTs are needed to determine optimal program length, setting, and therapeutic components. Keywords: Play Therapy, Art Therapy, Post Traumatic Stress Disorder, School Aged Children, Pediatric Mental Health. 

The Role of Trauma-Informed Care in Pediatric Nursing During Disasters: A Systematic Review
پرستاری
Farkhonde 1 © ℗
1 M. Sc. student of Medical-Surgical Nursing, Students’ Scientific Research center, Tehran University of Medical Science, Tehran, Iran.
Abstract: Introduction: Children are especially vulnerable during disasters and need particular attention and care. Crisis management is a key challenge in pediatric emergency nursing, involving both rapid medical response and attention to the emotional needs of children and their families. Effective crisis care requires evidence-based strategies informed by psychology, child development, and family-centered approaches. Pediatric emergencies require specialized care due to the unique physiological and psychological characteristics of children. Healthcare providers need specific skills to respond effectively to urgent pediatric crises.Trauma-Informed Care (TIC) is a vital framework in pediatric crisis care that emphasizes understanding the widespread impact of trauma on children. TIC shifts the focus from blaming the child to understanding their experiences, promoting empathy and more effective support during crises. Therefore, this study proposed to determine the role of trauma-informed care in pediatric nursing during disasters. Search Method: A review was performed independently based on the PICO criteria and aligned to the research objective and based on the PRISMA checklist and using PubMed, CINAHL, Medline, Web of Science, SID databases Google Scholar search engine, and Boolean operators. The time limit between 2020 and 2025 was determined using the MESH keywords “"trauma-informed care"”, “nurse”, “disaster”, “crisis”,” children” and “pediatric”. After checking the entry and exit criteria and critically evaluating the quality of the selected articles, a total of 12 articles were included in the study. Results: TIC creates a safe environment where children feel secure. Practitioners identify trauma signs and involve children in their care to help them regain control during crises. TIC is essential for ensuring patients’ physical and emotional safety. TIC can enhance children’s resilience. Lack of TIC in pediatric healthcare may cause significant harm, particularly through retraumatization when children’s experiences are overlooked. Conclusion: Broad implementation of TIC supports effective crisis response and mitigates adverse effects in future traumatic events. TIC appears to improve all facets of children’s emotional and behavioral wellbeing. Adverse childhood experiences significantly affect children’s overall growth and health, with these impacts persisting into adulthood. Implementing a trauma-informed care framework across various healthcare settings is essential to prevent long-term negative outcomes through supportive interventions. Pediatric nurses are encouraged to employ strategies that emphasize patient autonomy, safety, active listening, and shared decision-making to avoid retraumatization and promote healing. Keywords: trauma-informed care, nurse, crisis, disaster, children, pediatric 

The Role of Virtual Reality on Pain, Fear, and Anxiety During Port Catheter Placement in Pediatric Oncology Patients: A Systematic Review
پرستاری
Mahsa Khedmatizare 1 © ℗, Zahra Kafshgar 1, Arghavan Namdari 1
1 MSc Student of Medical-Surgical Nursing, Students' Scientific Research Center, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Introduction: Port catheter placement in pediatric oncology patients is a common invasive procedure often accompanied by significant pain, fear, and anxiety. Non-pharmacological methods, particularly virtual reality, have recently gained attention as adjunct tools for pain reduction and enhancement of the patient experience. This systematic review was conducted with the objective of examining the role of virtual reality in alleviating pain, fear, and anxiety in pediatric oncology patients during port catheter placement. Materials and methods: A systematic review was conducted in accordance with PRISMA guidelines. Comprehensive searches were performed in PubMed, Scopus, Web of Science, and Google Scholar for studies published between 2020 and 2025. The search targeted articles employing the keywords “Virtual Reality”, “VR”, “Pain”, “Anxiety”, “Fear”, “Port Catheter”, “Implantable Venous Access Device”, “Pediatric”, “Children” and “Oncology”. Studies were included if they: (1) involved pediatric oncology patients undergoing port catheter placement, (2) applied virtual reality interventions, and (3) reported outcomes related to pain, fear, or anxiety. Exclusion criteria were: non-randomized designs, reviews, case reports, and non-English studies. A total of 212 records were retrieved. After removing duplicates and screening titles and abstracts, 24 articles remained for full-text review. Finally, six randomized controlled trials met eligibility criteria and were included in the analysis. Results: Recent randomized controlled trials have demonstrated that virtual reality significantly alleviates pain and anxiety in patients. Additionally, the interactive and game-based characteristics of virtual reality are instrumental in reducing fear and fostering cooperation among pediatric patients. Emerging evidence further supports the use of virtual reality as an effective adjunctive intervention in outpatient clinical settings for the reduction of patient stress and pain. This systematic review ultimately highlights that virtual reality constitutes a safe and efficacious modality for enhancing the treatment experience of pediatric oncology patients undergoing port catheter placement, thereby helping to alleviate procedural-related concerns. Conclusion: Virtual reality technology, as a novel, safe, and non-pharmacological intervention, has shown considerable promise in alleviating pain, fear, and anxiety in pediatric oncology patients undergoing port catheter placement. The utilization of this technology has the potential to enhance the cohesiveness of the patient’s therapeutic experience and improve the overall quality of care. However, given the limitations in the existing body of research, there is a critical need for more extensive and methodologically robust studies to establish and refine practical and clinical guidelines for its effective application. Keywords: Virtual reality, Pain, Fear, Anxiety, Port catheter, Pediatric, Oncology

Title: The Role and Effectiveness of Play Therapy in Improving the Physiotherapy Experience of Children: A Systematic Review
پرستاری
فاطمه اعتمادی نیا 1 ©, نگین جواهری عفیف 2 ℗
1 Master's student in pediatric Nursing, Student Research Committee, Faculty of Nursing and midwifery, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Student of Physiotherapy, School of Rehabilitation Sciences, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract: Background and Aim: Children, due to their developmental and psychological characteristics, often experience anxiety, resistance, and reduced cooperation during physiotherapy sessions. These conditions can complicate the treatment process and decrease the effectiveness of interventions. Play therapy, as a child-centered and innovative approach, is applied to reduce fear and anxiety and enhance cooperation in therapeutic settings. This study aimed to systematically review the existing evidence on the role and effectiveness of play therapy in improving children’s physiotherapy experience. Methods: A comprehensive search was conducted in PubMed, Scopus, Web of Science, and Google Scholar using related keywords including Play Therapy, Physiotherapy, Children, Pediatric Rehabilitation. This review was designed and implemented based on PRISMA guidelines. Articles published between 2015 and 2025 that investigated play therapy interventions during or alongside pediatric physiotherapy sessions were included. In the initial search, 868 articles were identified. After removing duplicates and screening titles and abstracts, 83 articles underwent full-text review. Finally, 13 eligible studies were included in the analysis. Results: The reviewed studies indicated that play therapy, whether in the form of traditional motor and interactive activities or through modern technologies such as digital games and virtual reality, significantly reduced anxiety and perceived pain, enhanced cooperation and motivation, and improved functional outcomes of children during physiotherapy sessions. Conclusion: Available evidence suggests that integrating play therapy into pediatric physiotherapy can improve the therapeutic experience and functional outcomes of children. Given the limited sample sizes and heterogeneity of study designs, future research with stronger methodologies and long-term follow-up is recommended.

Unstable Self-perception in children with cancer 
پرستاری
فاطمه ولی زاده 1, فاطمه سپهوند 2 © ℗, محمد امرایی 3
1 دکترای پرستاری. استادیار، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران کارشناسی ارشد پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
2 کارشناسی ارشد پرستاری کودکان، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
3 کارشناس پرستاری، دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی لرستان، خرم آباد، ایران
Abstract:

 مقدمه: سرطان دوران کودکی باعث ایجاد موقعیت‌های آسیب‌زای جسمی و روحی می‌شود. این امر می تواند مشکلاتی را برای رشد و توسعه ادراک از خود در کودکان ایجاد کند. این مطالعه با هدف تبیین تجربیات کودکان مبتلا به سرطان در مورد ادراک از خود انجام شد. مواد و روش‌ها: این مطالعه کیفی یک مطالعه تحلیل محتوا با شرکت 21 کودک، اعضای خانواده و متخصصان بهداشت بود که به روش هدفمند انتخاب شدند. داده ها از طریق مصاحبه های فردی و زوجی، بحث های گروهی متمرکز و یادداشت های میدانی جمع آوری شد. تجزیه و تحلیل داده ها با استفاده از تحلیل محتوا و همزمان با جمع آوری داده ها بر اساس گام های پنج گانه الو و کینگاس انجام شد. دقت و استحکام تحقیق با استفاده از معیارهای گوبا و لینکلن تضمین شد. یافته‌ها: در مجموع 400 کد از تجزیه و تحلیل داده‌ها به‌دست آمد و با مقایسه مستمر کدها، مضامین اصلی خودپنداره ناپایدار و مضامین تصویر تحریف شده بدنی(خود فیزیکی) و خود شخصی متزلزل (خود شخصی) انتزاع شد. نتیجه گیری: تصویر بدنی و هویت کودکان و نوجوانان مبتلا به سرطان به راحتی تحت تأثیر تغییرات جسمی و تجربیات ناشی از بیماری و درمان آن قرار می گیرد . عدم ثبات کودک در ارزیابی ودرک از خود منجر به یک خودپنداره ناپایدار و هویت نامشخص خواهد شد که می¬تواند به طور قابل توجهی بر رفاه و فرآیند سازگاری آنها تأثیر گذار باشد. توجه به احساسات کودک، کمک به او برای فهمیدن تغییرات، تقویت نقاط قوت و مثبت اندیشی، تعیین اهداف کوتاه مدت قابل دستیابی و فراهم کردن حمایت معنوی می‌تواند راهی برای تقویت خودپنداره و تصویر بدنی مثبت در این کودکان باشد. 

Using Air Cushion in the Prevention of Occipital Pressure Ulcer in Children Undergoing Heart Surgery
پرستاری
Azita Matinpour 1 © ℗, Sedigheh Khanjari 2
1 Tabriz University of medical science
2 : Department of Pediatric Nursing, Nursing Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran.
Abstract:

 زمینه و هدف: بیماری قلبی مادرزادی یکی از علل اصلی مرگ و میر در سال اول زندگی کودکان است. یکی از مهم‌ترین عوارض پس از جراحی قلب در این بیماران، ایجاد زخم فشاری به‌ویژه در ناحیه پس‌سری سر است که می‌تواند منجر به درد، عفونت و طولانی شدن مدت بستری شود. بنابراین پیشگیری از این عارضه اهمیت بالایی دارد. هدف از این مطالعه، بررسی اثر استفاده از بالش بادی در پیشگیری از زخم فشاری پس‌سری در کودکان تحت جراحی قلب باز بود. روش‌ها: این مطالعه یک کارآزمایی بالینی تصادفی بود که بر روی ۱۳۵ کودک ۰ تا ۱۲ ساله تحت عمل قلب باز در دو مرکز قلب تبریز و تهران انجام شد. کودکان به صورت تصادفی به دو گروه مداخله و کنترل تقسیم شدند. گروه مداخله از بالش بادی استفاده کردند که دارای سیستم پمپاژ متناوب بود و با ایجاد موج‌های ۳ تا ۴ سانتی‌متری فشار را کاهش می‌داد. این بالش‌ها با ابعاد ۳۰ تا ۴۰ سانتی‌متر، ضدآب و ضدحساسیت بودند و روی آن‌ها پوشش نخی قرار داشت. گروه کنترل از روش‌های معمول برای قرار دادن سر استفاده کردند. ارزیابی زخم فشاری با استفاده از مقیاس‌های NPUAP و Braden Q انجام شد و داده‌ها با آزمون‌های آماری شامل کی‌دو، فیشر، تی مستقل، من-ویتنی و تحلیل کوواریانس بررسی شدند. نتایج: در گروه کنترل، میزان بروز زخم فشاری پس‌سری پس از جراحی ۳۸.۷٪ بود، که روز اول به ۷۱٪ و روز دوم به ۶۷.۷٪ رسید. در مقابل، در گروه مداخله هیچ زخم فشاری مشاهده نشد. پیش از جراحی، تفاوت معنی‌داری بین دو گروه وجود نداشت، اما پس از جراحی و در روز دوم، نمرات زخم فشاری در گروه مداخله به‌طور معنی‌داری بهتر از گروه کنترل بود (P=0.002). نتیجه‌گیری: استفاده از بالش بادی متناسب با سن و وزن کودکان می‌تواند به عنوان یک روش مؤثر و ایمن برای پیشگیری از زخم فشاری پس‌سری در کودکان تحت جراحی قلب باز به کار گرفته شود و می‌تواند از عوارض ناشی از این زخم‌ها، از جمله درد، عفونت و طولانی شدن مدت بستری جلوگیری کند.

Using the Internet of Things (IOT) in improving the management of chronic diseases
پرستاری
الهام میراحمدی 1 ©, امیرمحمد فراتی 2 ℗, محمد مهدی فداییان 3
1 گروه پرستاری و مامایی، واحد علوم پزشکی سمنان، دانشگاه آزاد اسلامی، سمنان، ایران
2 دانشجوی کارشناسی پرستاری، واحد علوم پزشکی سمنان، دانشگاه آزاد اسلامی، سمنان، ایران
3 دانشجوی کارشناسی پرستاری، واحد علوم پزشکی سمنان، دانشگاه آزاد اسلامی، سمنان، ایرانا
Abstract:

 چکیده اینترنت اشیا (IoT) با بهره‌گیری از حسگرهای هوشمند و شبکه‌های ارتباطی، تحولی بنیادین در مدیریت بیماری‌های مزمن همچون دیابت، نارسایی قلبی و بیماری انسدادی مزمن ریه (COPD) ایجاد کرده است. این فناوری از طریق پایش لحظه‌ای علائم حیاتی (مانند فشار خون، قند خون و ضربان قلب) و انتقال داده‌ها به پلتفرم‌های ابری، امکان نظارت مستمر و مراقبت از راه دور را فراهم می‌سازد. شواهد پژوهشی نشان می‌دهند که IoT با کاهش نیاز به مراجعات حضوری، به‌ویژه در بیماران ساکن مناطق محروم، نه‌تنها هزینه‌های درمان را کاهش می‌دهد، بلکه کیفیت زندگی بیماران را نیز بهبود می‌بخشد. روش: این مطالعه به‌صورت مرور روایتی انجام شد. جستجوی مقالات در پایگاه‌های معتبر از جمله PubMed و ScienceDirect در بازه زمانی ژانویه ۲۰۱۰ تا ژوئیه ۲۰۲۵ صورت گرفت. کلیدواژه‌های مورد استفاده شامل «Internet of Things»، «Chronic Disease»، «Remote Monitoring» و معادل‌های فارسی آن‌ها بود. معیار ورود، مقالات اصیل و مروری مرتبط با کاربرد اینترنت اشیا در مدیریت بیماری‌های مزمن نظیر دیابت، نارسایی قلبی و COPD بود که متن کامل آن‌ها در دسترس قرار داشت. پس از غربالگری، مطالعات واجد شرایط انتخاب و داده‌ها به روش تحلیل موضوعی مرور شدند. یافته‌ها: مرور مطالعات منتشرشده نشان می‌دهد که اینترنت اشیا در محورهای زیر اثربخش بوده است: کن تشخیص زودهنگام: سیستم‌های هشدار خودکار از تشدید بیماری جلوگیری می‌کنند. یم پایبندی به درمان: یادآوری مصرف دارو و تنظیم دوز بر اساس داده‌های لحظه‌ای بیمار. 3. مدیریت بیماری‌های خاص: از جمله پایش مداوم سطح گلوکز در دیابت و میزان اکسیژن خون در COPD. نتیجه‌گیری: با وجود مزایای گسترده، چالش‌هایی همچون امنیت داده‌ها، استانداردسازی دستگاه‌ها و پذیرش بیماران وجود دارد. با این حال، ادغام IoT با یادگیری ماشین و کلان‌داده‌ها در حوزه‌هایی نظیر سرطان و بیماری‌های قلبی، دقت پیش‌بینی و مدیریت درمان را افزایش داده است. بنابراین IoT پتانسیل تبدیل شدن به ستون فقرات مراقبت‌های سلامت شخصی‌سازی‌شده را دارد، اما تحقق این ظرفیت مستلزم همکاری نزدیک متخصصان پزشکی، مهندسان فناوری و سیاست‌گذاران سلامت برای غلبه بر چالش‌های فنی و اخلاقی است. کلمات کلیدی: اینترنت اشیا، بیماری‌های مزمن، مراقبت از راه دور، پایش سلامت، فناوری پزشکی 

 Prevalence and Diversity of Parasitic Infections Among Kindergarten Children: A Cross-Sectional Study
پژوهشگران جوان

Sara Ardalannasab 1 ℗, Somayyeh Ahmadi 1, Abuzar Ghorbani 2, Bahman Rahimi Esboei 3 ©
1 Student Research Committee, Mazandaran University of Medical Sciences, Sari, Iran
2 Savadkoh Health and Medical Services Center, Sari, Mazandaran, Iran
3 3 Department of Parasitology, School of Medicine, Mazandaran University of Medical Sciences, Sari,Iran
Abstract: Introduction:Intestinal parasitic infections (IPIs) disproportionately affect children in low-resource settings, where poor sanitation and contaminated environments increase transmission risks. Kindergarten-aged children are particularly vulnerable, with IPIs contributing to malnutrition and developmental impairments. While school-aged populations have been well-studied, data on kindergarten children especially urban-rural disparities remain limited. This study assessed IPI prevalence, species distribution, and risk factors in this vulnerable group to inform targeted interventions like deworming and sanitation programs. Methodology:This cross-sectional study assessed the prevalence and risk factors of intestinal parasitic infections (IPIs) among 10,237 kindergarten children (aged 3–6 years) in urban (n = 6,005) and rural (n = 4,232) settings. Stool samples were analyzed using direct wet mount microscopy (saline/iodine) and the Kato-Katz technique (WHO egg-count thresholds for Ascaris, Trichuris, hookworms). Quality control included re-examination of 10% of slides by an expert parasitologist and daily equipment calibration. Statistical analysis (SPSS v25) employed chi-square tests and logistic regression, reporting adjusted odds ratios (AORs) with 95% confidence intervals (CIs; p 0.05). Ethical approval was obtained, with written parental consent and free treatment for infected children. Results:The overall prevalence of IPIs was 9.026% (924/10,237), with rural areas exhibiting significantly higher rates (11.27%, 476/4,232) than urban areas (7.46%, 448/6,005; p 0.05). Blastocystis spp. (383 cases; 41.5%), Hymenolepis nana (243; 26.3%), and Enterobius vermicularis (164; 17.7%) were the most prevalent species, respectively. Notably, 8.0% of infected children (74 cases) had multi-infections. The diversity of parasites was higher in rural settings, reflecting potential differences in sanitation and access to healthcare. Conclusion: This study highlights the substantial burden of IPIs in kindergarten populations, particularly in rural regions, driven by socioeconomic and hygiene-related factors. Targeted interventions, deworming programs, health education, and improved sanitation are urgently needed to reduce morbidity. Ethics Approval: IR.MAZUMS.REC.1403.24271 

Bridging the Divide: A Systematic Review of Telehealth's Impact on Healthcare Access for Individuals with Down Syndrome
پژوهشگران جوان

آرمیتا پاک 1 © ℗, ستاره کرد 1, الهه مهدویان 1
1 دانشگاه علوم پزشکی تهران
Abstract: Introduction: Down syndrome (DS) is the most common chromoonal disorder that causes slow mind. People that have DS find it hard to get good health care as they are often too far away, have trouble talking to people and often do not get good care. Today there are new ways of care with technology. But we do not know if this new way will work for people with DS. In this paper we look at how health care with technology can help people with DS get the health care they need. Search Strategy: A broad search of the papers was done through four online databases (PubMed, Scopus, Web of Science, and Google Scholar) from the start till May 31, 2025. The search plan used MeSH terms and related keywords. The process of picking studies used a two-step process with Rayyan.ai, with three people looking at the titles, abstracts and the full text. Results: The search found 406 articles that could be relevant; 39 studies met the rules for being in the review. Most studies were from rich countries and had anywhere from 3-123,024 people in them. The most common video call type was video call platforms,then mobile health apps.The main types of care were speech and language therapy , early help, and exercise programs. On average, tech worked well and people liked it .The results showed clear change: 23% fewer visits to ER, more people saw special doctors (67% to 89%) and speech was clearer in 76% of people. Conclusion and Discussion: This review shows strong proof that using the internet can help people with DS get better care and do better in their lives. It can help with talking, getting over pain and keeping safe. Future work should look at how well these tools work over time, see if they can be used in parts of the world where people have little money, and learn how to design help so that these tools can give more help to individuals with Down syndrome. These trials show that apps can be a life-long buddy for those old help ways. 

Emerging Technologies and Childhood Vaccination Coverage: A Systematic Review
پژوهشگران جوان

Fatemeh Souri 1 ℗, MohammadHossein Sahami Gilan 2, Negar Farajzadeh Dehkordi 3 ©
1 ¹MSc in Pediatric Nursing, AK.C.,Islamic Azad University, Aliabad Katoul
2 Department of Geriatric Nursing, Faculty of Nursing and Midwifery, Ilam University of Medical Sciences, Ilam, Iran.
3 Nursing and Midwifery Care Research Center, Faculty of Nursing and Midwifery, Health Department, Isfahan University of Medical Sciences, Isfahan, Iran.
Abstract: Introduction: Achieving and sustaining elevated vaccination rates remains a significant challenge in various regions. Recent advancements in technology, including mobile applications, telemedicine, and blockchain, have demonstrated potential in enhancing immunization rates by addressing issues related to accessibility, monitoring, and patient engagement. This systematic review aims to evaluate the effectiveness of innovative technological interventions in increasing childhood vaccination coverage. Methods: This systematic review adhered to PRISMA guidelines to ensure transparency. A comprehensive search was conducted for English-language articles published between January 1, 2019, and April 28, 2025, utilizing keywords such as "Vaccination Coverage," "Child," "Technology," and "Blockchain" across databases including PubMed, Web of Science, and Scopus. From an initial pool of 125,874 articles, 39,276 duplicates were eliminated. Following the application of inclusion criteria (human studies, free full text, observational studies, and randomized controlled trials) and exclusion criteria (non-English articles and animal studies), a total of 24 studies were selected for analysis. Results: The reviewed studies indicate that technological interventions significantly enhance vaccination outcomes. Mobile applications that provide reminders and educational content have increased immunization coverage by 10% to 22% (p 0.05). Telemedicine systems have facilitated remote consultations, resulting in a 5% to 10% improvement (95% CI: 3%-12%). Furthermore, blockchain applications have improved data transparency and reliability, with adoption rates rising by 8% (p 0.01). Overall, these emerging technologies have enhanced vaccine tracking, strengthened caregiver interactions, and reduced missed immunization opportunities by up to 25% (p 0.05). Conclusion: Emerging technologies present substantial opportunities for enhancing child immunization programs. Mobile health and telehealth have effectively addressed traditional barriers, while blockchain technology improves data security and fosters trust. Nonetheless, challenges such as inadequate infrastructure, data privacy concerns, and regulatory hurdles remain. Future research should focus on scalable, user-centered solutions to ensure equitable access. Keywords: Vaccination Coverage, Children, Technology, Mobile Applications, Telemedicine. 

Enhancing Primary School Students’ Road Safety through Traffic Education
پژوهشگران جوان

مهسا رباط جزی 1 © ℗, فاطمه فرج تبار 1
1 دانشجو کارشناسی بهداشت مدارس، کمیته پژوهشی دانشجویان، دانشکده بهداشت و ایمنی، دانشگاه علوم پزشکی شهید بهشتی، تهران، ایران
Abstract:

 زمینه و هدف: حوادث ترافیکی یکی از اصلی‌ترین علل آسیب و مرگ‌ومیر کودکان، به‌ویژه در مسیر مدرسه، هستند. کودکان به دلیل محدودیت‌های جسمی و شناختی، قد کوتاه، توجه محدود، ناتوانی در برآورد سرعت و فاصله وسایل نقلیه و رفتارهای ناگهانی، در معرض خطر بالای تصادفات قرار دارند. آموزش فرهنگ ترافیک و رفتارهای ایمن، توانایی کودکان در عبور ایمن از خیابان را افزایش داده و نقش مهمی در کاهش حوادث دارد. این مرور سیستماتیک با هدف بررسی اثر آموزش ترافیک، نقش نظارت بزرگسالان و تأثیر زیرساخت‌های شهری بر ایمنی دانش‌آموزان ابتدایی انجام شد. روش: مطالعات منتشرشده بین سال‌های ۲۰۱۰ تا ۲۰۲۴ در پایگاه‌های PubMed، Scopus، Web of Science و Google Scholar بررسی شدند. این مرور شامل پژوهش‌های تجربی، نیمه‌آزمایشی، کیفی و تحقیقاتی بود که از فناوری‌های نوین آموزشی مانند بازی‌های دیجیتال، واقعیت مجازی و محیط‌های شبیه‌سازی‌شده بهره برده‌اند. داده‌ها بر اساس تأثیر آموزش، ویژگی‌های محیطی، نقش والدین و نظارت بزرگسالان دسته‌بندی و تحلیل شدند. نتایج: آموزش فرهنگ ترافیک، از طریق روش‌های سنتی، بازی‌های آموزشی و محیط‌های تعاملی مجازی، توانایی کودکان در تشخیص خطر، رعایت قوانین و رفتار ایمن را بهبود می‌بخشد. مطالعات نشان دادند که نظارت بزرگسالان، همراهی در عبور و آموزش عملی می‌تواند رفتارهای پرخطر کودکان را کاهش دهد، هرچند تضمین‌کننده ایمنی کامل نیست. ویژگی‌های محیطی شامل نوع خیابان، گذرگاه‌های برجسته، پیاده‌روها، علائم ترافیکی و لباس‌های روشن یا شب‌نما، بر رفتار کودکان و ادراک ایمنی والدین مؤثر هستند. فناوری‌های نوین مانند واقعیت مجازی و بازی‌های جدی (serious games) امکان تمرین مهارت‌ها در محیطی امن، جذاب و شبیه‌سازی‌شده را فراهم می‌کنند و یادگیری عملی و واکنش‌های واقعی کودکان را بهبود می‌دهند. علاوه بر این، تجربه‌های دیجیتال موجب افزایش مشارکت، تمرکز و انگیزه یادگیری شده و مهارت‌های مسئولیت‌پذیری اجتماعی و تصمیم‌گیری ایمن را تقویت می‌کنند. نتیجه‌گیری: ترکیب آموزش فرهنگ ترافیک، نظارت مؤثر والدین و بهبود زیرساخت‌های شهری، راهبردی چندبعدی و مؤثر برای ارتقای ایمنی دانش‌آموزان ابتدایی در مسیر مدرسه است. استفاده از فناوری‌های تعاملی و بازی‌های آموزشی، فرآیند یادگیری را عملی و جذاب ساخته و احتمال رفتارهای پرخطر را کاهش می‌دهد. این یافته‌ها می‌توانند راهنمای طراحی برنامه‌های آموزشی، سیاست‌های ایمنی شهری و مداخلات پیشگیرانه باشند و زمینه را برای تحقیقات آینده در بهبود ایمنی کودکان و توسعه ابزارهای نوآورانه آموزشی فراهم کنند.

Recovery Through Creativity: The Role of Art Therapy in Pediatrics Affected by Disasters 
پژوهشگران جوان

Erfan Yousefzadeh 1 © ℗, Motahare Rafiezade 1
1 Student Research Committee, School of Nursing and Midwifery, Guilan University of Medical sciences, Rasht, Iran.
Abstract: Introduction: Disasters, defined as unforeseen events exceeding capacity of the local community to handle. Disasters are a leading cause of mental health disorders worldwide, often causing long-lasting psychological effects. Pediatric represent a highly vulnerable group, with disaster-related trauma exerting profound short and long-term effects on emotional, cognitive, social and psychological development. Art therapy, a psychotherapy approach that uses creative expression such as drama, music, drawing, Dance, coloring, and traditional cultural performances offers a promising way to help pediatric cope with these challenges. Therefore, this review aimed to synthesize evidence on the effectiveness of art therapy for pediatric affected by disasters. Method: A narrative review was conducted on studies published between 2020–2025. Literature searches were performed in PubMed, ScienceDirect, and Google Scholar using MeSH keywords: (“Art Therapy”) AND (“Disasters” OR “Natural Disasters”) AND (“Child” OR “Pediatrics”). Inclusion criteria comprised English-language, full-text articles evaluating art-based therapeutic interventions among pediatric exposed to disasters (natural hazards and pandemic crises). Exclusion criteria removed non-English studies, inaccessible texts, and those focused exclusively on adults or mixed samples without pediatric subgroup data. Screening proceeded in two phases (title/abstract, full-text), and reference lists were hand searched for additional sources. Extracted data captured study design, intervention modality, and reported mental health outcomes Results: The reviewed studies consistently highlight the positive impact of art therapy and creative interventions on pediatric affected by disasters. Out of nine studies, eight demonstrated significant benefits, such as reductions in PTSD and anxiety symptoms, improvements in psychological well-being, sleep quality, resilience, coping skills, and the ability to express traumatic experiences safely. One study did not directly measure clinical outcomes but emphasized the role of art in empowering pediatric to share their experiences and contribute to disaster risk reduction. However, studies suggest that art therapy doesn’t have the same level of effectiveness for all psychiatric disorder. The results showed that drama therapy contributed more to reducing PTSD symptoms, while music therapy contributed more to reducing general anxiety disorder (GAD) symptoms. Overall, the evidence suggests that art therapy is a feasible, culturally adaptable, and effective approach in mitigating trauma and supporting recovery in pediatric affected by disasters. Conclusion: The reviewed studies suggest that art therapy is an effective approach to reduce trauma-related symptoms in pediatric affected by disasters. Therefore, incorporating art-based interventions into post-disaster care programs is recommended to support pediatrics’ psychological recovery and well-being. Keywords: Art Therapy, Disasters, Pediatrics, Child 

Systematic Review: Digital Parenting, Internet Addiction, and Nomophobia in Children and Adolescents
پژوهشگران جوان

مهدی محمودزاده 1 © ℗, ثنا خلیل زاده ضیاء 2, محمد محمودزاده 3
1 Department of Pediatric Nursing, Student Research Committee, Khoy University of Medical Sciences, Khoy, Iran
2 Pediatric Nursing, Faculty of Nursing and Midwifery, Urmia University of Medical Sciences, Urmia, Iran
3 Students Research Committee, School of Nursing and Midwifery, Ardabil University of Medical Sciences, Ardabil, Iran
Abstract: Introduction: The rapid integration of digital technology into the lives of children and adolescents has significantly transformed family dynamics and parenting approaches, raising critical concerns about internet addiction and nomophobia—the fear of being without a mobile device. Methods: This systematic review synthesizes evidence from studies published between 2019 and 2024, retrieved via PubMed, Scopus, and Web of Science. It focuses on the impact of digital parenting strategies on internet addiction and nomophobia among individuals aged 6–18. Of the 110 identified articles, 14 met the inclusion criteria, examining parenting practices, internet use behaviors, and associated psychological outcomes. Results: The findings indicate that structured digital parenting—encompassing consistent supervision, guidance, and transparent communication—protects against maladaptive internet use. In contrast, permissive or inconsistent approaches correlate with higher addiction risk. Internet addiction in adolescents is strongly associated with academic decline, emotional disturbances, and social withdrawal, with key predictors including insufficient parental oversight, peer pressure, and preexisting psychological vulnerabilities; interventions that actively involve parents in prevention and treatment yield the most significant benefits. Nomophobia rates have risen sharply, particularly after the COVID‑19 pandemic, paralleling increased smartphone and internet consumption, and are closely linked to internet addiction patterns; children and adolescents who experience minimal parental guidance and spend prolonged unsupervised time online appear most vulnerable. Conclusion: The reviewed literature emphasizes that educational programs targeting parents and young people, and systematic screening for problematic technology use in schools and healthcare settings, can mitigate harmful outcomes. Furthermore, cultural considerations, levels of technological literacy, and family structure variations must be integrated into intervention design to ensure relevance and effectiveness. Digital parenting represents a dynamic, evolving framework that must adapt alongside technological advancements. Equipping parents with the skills to establish clear usage rules, promote healthy digital behaviors, and maintain open, trust‑based communication can substantially reduce the prevalence and impact of internet addiction and nomophobia in pediatric populations, safeguarding future generations' mental health, academic performance, and social well‑being.

The Impact of Auditory Interventions on Stress in Preterm Infants: A Review Study
پژوهشگران جوان

Reyhaneh Omidvar 1 ℗, Naghmeh Razaghi 2 ©
1 1. MSc Student in Neonatal Intensive Care Nursing, School of Nursing and Midwifery, Mashhad University of Medical Sciences, Mashhad, Iran
2 2. Assistant Professor of Nursing Education, Department of Pediatrics, School of Nursing and Midwifery, Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract: Introduction Hospitalization is a stressful experience for neonates, even in the absence of painful procedures. Exposure to stress from invasive interventions has been associated with reduced growth of white and subcortical gray matter. Therefore, understanding neonatal stress responses and their effects on neurodevelopment is crucial. Auditory interventions have emerged as a promising non-pharmacological strategy to reduce stress in preterm infants. This study aimed to review the effects of auditory stimuli on stress modulation in preterm neonates. Materials and Methods A narrative review was conducted focusing on studies examining auditory interventions and their impact on neonatal stress. PubMed, Google Scholar, and ScienceDirect databases were searched using the keywords “stress,” “preterm,” and “sound stimulation.” The search included studies published between 2010 and 2024 and was limited to English-language randomized controlled trials (RCTs). Out of 56 initially retrieved studies, 15 met the inclusion criteria and were analyzed in detail. Results Auditory interventions in preterm neonates included exposure to live music, white noise, maternal voice, lullabies, maternal heartbeat, and familiar voices. These interventions positively affected stress reduction and improved physiological indicators such as heart rate, respiratory rate, and oxygen saturation. Combined auditory stimuli involving maternal voice (talking, reading, or singing) showed greater effectiveness compared to other interventions, resulting in increased oxytocin levels, decreased Neonatal Infant Stressor Scale (NISS) scores, and reduced salivary cortisol during painful or stressful procedures. No adverse effects were reported; however, appropriate selection and individualization of auditory stimuli remain critical. Discussion and Conclusion Exposure to soothing sounds can enhance relaxation, reduce pain perception, and modulate physiological and autonomic nervous system functions. Auditory interventions stimulate endocrine responses, promoting endorphin and serotonin release, thereby increasing comfort and reducing pain. These strategies represent a feasible, non-invasive approach to support preterm infants’ neurodevelopment and overall well-being in neonatal intensive care settings. Keywords: Auditory Interventions - Preterm Infant -Stress 

The impact of telehealth education on parental care ability and postoperative nutritional status of infants after congenital heart disease surgery: A systematic review study
پژوهشگران جوان

پرنیان سمیعیانی 1 © ℗, ثریا حسین پور 2, امیرحسین خاکباز 3
1 دانشجو کارشناسی ارشد پرستاری سلامت جامعه دانشگاه علوم پزشکی تهران
2 دانشجو کارشناسی ارشد پرستاری کودکان دانشگاه علوم پزشکی تهران
3 دانشجو کارشناسی ارشد روان پرستاری دانشگاه علوم پزشکی تهران
Abstract: The impact of telehealth education on parental care ability and postoperative nutritional status of infants after congenital heart disease surgery: A systematic review study Introduction: Congenital heart disease (CHD) is a major cause of infant morbidity worldwide. Infants undergoing CHD surgery often face postoperative complications and malnutrition, while their parents struggle with caregiving due to limited knowledge. Telehealth education offers an effective way to support families by enhancing parental caregiving skills and reducing their burden. This study aimed to investigate the impact of telehealth education on parental care ability and postoperative nutritional status of infants after CHD surgery. Methods and Materials: This systematic review study search was conducted using the following databases: CINAHL, Cochrane Library CENTRAL, Scopus, PubMed, SID databases and Google Scholar was used to search for gray literature. The search was conducted beginning to July 2025, using the keywords" congenital heart disease", " nutritional status,", " telehealth education", " care ability " in both Persian and English languages. The inclusion criteria involved RCTs and quasi-experimental studies relevant to the current study. Exclusion criteria included commentaries, observational studies, reviews, and conference papers. Two independent reviewers conducted the screening and data extraction The quality assessment tool for studies with diverse design was used for quality assessment, and the PRISMA guidelines were followed for reporting. Results: Of a total 504 studies were identified; after screening the titles and abstracts and removing duplicates (N=48), 24 studies were selected for full-text review. Out of these, 5 RCTs (3) and quasi-experimental (2) studies that met the PICOTS criteria were included in the study. Studies have shown that parents are the primary caregivers for infants with congenital heart disease (CHD) after hospital discharge, facing challenges in feeding and care. Telehealth education significantly improves parental caregiving ability and reduces caregiver burden by providing essential information on CHD, postoperative care, family feeding, and complication management. This approach had a significant positive impact on infants' overall condition, including improvements in weight, hemoglobin, and albumin levels. Compared to traditional follow-up, telehealth better supports families in managing postoperative care and enhances infants’ nutritional status. Conclusion: Providing telehealth education to facilitate home feeding and to provide care guidance for infants after CHD surgery can greatly improve the ability of parents to provide care. Thus, infants can obtain better feeding and care, and their nutritional status can be effectively improved. Key words: Congenital heart disease ; Nutritional status; Telehealth education; Care ability 

The Role of Family Involvement in Improving Health and Quality of Life in Hospitalized Children: A Systematic Review
پژوهشگران جوان

مهسا احمدی 1 © ℗, مبینا حسین فخر آبادی 2, نازنین حصاری 2
1 1. Student Research Committee, Department of midwifery, Faculty of nursing and midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
2 Instructor, Department of Midwifery, Faculty of Nursing and Midwifery, North Khorasan University of Medical Sciences, Bojnurd, Iran
Abstract: Background: Active family involvement in the care of hospitalized children is increasingly recognized as a vital factor that improves clinical outcomes, emotional well-being, and overall quality of life. This partnership supports parents, reduces their stress, and creates a positive healing environment. Objective: This systematic review examines how family participation impacts the physical health, psychological well-being, and quality of life of hospitalized children. Methods: We conducted a thorough search across major scientific databases including PubMed, Scopus, Web of Science, Google Scholar, Cochrane Library, Embase, CINAHL, PsycINFO, and ProQuest from 2015 to 2025. Using keywords such as “family-centered care,” “family involvement,” “quality of life,” “hospitalized children,” and “pediatric nursing,” we gathered relevant original research articles in English that examined the effects of family participation in care on children aged 0 to 18 years. Non-research articles and animal studies were excluded. From an initial pool of approximately 1,200 articles, after removing duplicates and screening titles and abstracts, we reviewed 400 full-text articles,290 studies were included in the final analysis. Data were extracted focusing on physical and psychological health outcomes, parental stress, family satisfaction, length of hospital stay, and quality of life, and analyzed descriptively. Results: Findings consistently show that family involvement leads to faster recovery, shorter hospital stays, and improved well-being in children. Parents experienced reduced anxiety and greater caregiving confidence. Strong communication between families and healthcare teams played a crucial role. Barriers included some healthcare staff’s reluctance and lack of institutional support, which can be addressed through education and policy changes. Conclusion: Family involvement is an effective approach to enhance health outcomes and quality of life for hospitalized children. Healthcare systems should widely adopt family-centered care models to benefit both patients and their families. Key words: family-centered care, family involvement, quality of life, hospitalized children, and pediatric nursing 

The Use of Digital Health Tools to Enhance Treatment Adherence and Quality of Life in Adolescents with Cystic Fibrosis a systematic review article
پژوهشگران جوان

ثریا حسین پور 1 © ℗, پرنیان سمیعیانی 2
1 دانشجوی کارشناسی ارشد پرستاری کودکان ، دانشگاه علوم پزشکی تهران
2 دانشجوی کارشناسی ارشد پرستاری سلامت جامعه ، دانشگاه علوم پزشکی تهران
Abstract: Background : Cystic fibrosis (CF) is a hereditary progressive disease characterized by thick mucus in the lungs and digestive system, causing respiratory and gastrointestinal complications. Adolescents with CF face complex and demanding treatments including inhaled medications, airway clearance physiotherapy, exercise, and nutritional support, all requiring consistent adherence for optimal health. However, adherence often declines during adolescence, which can worsen health outcomes and reduce quality of life (QoL). Digital health tools have emerged as promising supports by providing accessible, personalized, and interactive methods to aid self-management and improve adherence. With rapid advances in technology and increasing adoption in CF care, it is vital to evaluate their effectiveness in this vulnerable population. Methods : A systematic review was conducted by searching PubMed, Scopus, and Web of Science for studies published in the last ten years. The review focused on digital health interventions to improve treatment adherence or quality of life in adolescents (10–19 years) with cystic fibrosis. Eligible designs included RCTs and quasi-experimental studies. Studies without adolescent data, non-digital interventions, or lacking adherence/QoL outcomes were excluded. Two independent reviewers screened studies and extracted data on intervention type, study design, sample size, outcomes, and follow-up. Study quality was assessed using standardized tools, and PRISMA guidelines were followed. Results : Digital health tools generally enhanced treatment adherence. Platforms like CF Health Hub combined digital adherence monitoring with behavioral support, increasing adherence rates and reducing hospital admissions. Mobile apps featuring gamification and scheduling aids also showed positive engagement and adherence outcomes, though evidence quality varied. Quality of life findings were less consistent. Some studies reported modest improvements in physical activity, self-management skills, and self-efficacy through digital exercise programs, symptom tracking, and peer support forums. However, validated QoL scores often revealed limited or no significant change, potentially due to short study durations or waning user engagement. Challenges include maintaining long-term use, integrating digital tools into clinical workflows, addressing privacy concerns, and tailoring interventions to adolescent developmental and psychosocial needs. Conclusion : Digital health tools offer potential to improve treatment adherence and possibly quality of life in adolescents with cystic fibrosis. While evidence supports better adherence, sustained engagement and significant QoL improvement remain challenges. Future work should focus on developing personalized, comprehensive digital solutions co-designed with adolescents and evaluated in long-term studies to maximize clinical and quality-of-life benefits. Keywords : Digital Health Tools, Treatment Adherence, Quality of Life, Adolescents, Cystic Fibrosis 

Therapeutic Positioning as a Nursing Intervention in the NICU: A Narrative Review of Evidence and Clinical Applications
پژوهشگران جوان

ملینا عبدی 1 ©, فرزانه خوش اخلاق 1 ℗, عهدیه حقگوی نیر 1, نسیم احمدوند 1
1 دانشکده پرستاری، دانشگاه علوم پزشکی البرز، کرج، ایران
Abstract: Background and Aim Preterm infants, due to the immaturity of their organ systems, are at high risk of physiological instability, feeding difficulties, and developmental delays. Therapeutic positioning and Kangaroo Mother Care (KMC), as cornerstones of developmental care in the NICU, can potentially improve clinical outcomes. This narrative review aimed to synthesize evidence from 2018–2025 on the effects of positioning and KMC on the physiological, nutritional, and developmental outcomes of preterm infants. Methods A comprehensive search was conducted in PubMed, Scopus, Web of Science, SID, and Magiran. Two independent reviewers screened titles/abstracts and full texts, with disagreements resolved by a third reviewer. Inclusion criteria encompassed original studies (randomized, observational, or crossover), systematic/scoping reviews, and qualitative research focusing on clinical positioning (supine, side-lying, prone—particularly semi-elevated side-lying), supportive devices, and KMC. Given the narrative design, no meta-analysis was performed, and greater analytical weight was assigned to higher-quality evidence. Sample sizes of key studies ranged from 6 to 60 infants. Findings Developmentally supportive positioning was associated with improved oxygen saturation (SpO₂), reduced heart rate (HR) fluctuations, fewer apnea/bradycardia episodes, and enhanced quiet sleep. Semi-elevated side-lying during bottle-feeding improved milk intake and reduced respiratory pauses/choking episodes (small samples; n≈6–20). Prone positioning under NICU monitoring improved oxygenation, reduced respiratory distress, and in some studies was linked to faster weight gain (occasionally not statistically significant in small samples). Daily KMC sessions ≥90 minutes enhanced vital sign stability, reduced stress, improved sleep, and promoted weight gain, with emerging evidence suggesting modulation of skin and gut microbiome. Positioning aids (nesting, soft pads) were associated with higher SpO₂, lower HR, and reduced stress scores. Conclusion Therapeutic positioning and KMC are simple, low-cost interventions that enhance the quality of neonatal intensive care. Standardization of protocols, training for nurses and parents, and regular evaluation are recommended. Multicenter randomized controlled trials with adequate sample sizes are needed to confirm long-term benefits. Keywords: Therapeutic Positioning; Preterm Infants; Neonatal Intensive Care Units; Kangaroo Mother Care; Bottle Feeding; Suck–Swallow–Breathe Coordination

Types of gut microbiota in children with ADHD and adopting nutritional policies
پژوهشگران جوان

الناز سپهری اردکانی 1, طیبه شجاع الدینی اردکانی 2, یاسمین کشاورزی پور 1 ©, پرنیا سادات محمودیان 1 ℗
1 دانشجوی کارشناسی بهداشت عمومی،واحد میبد،دانشگاه آزاد اسلامی،میبد،ایران
2 دانشجوی دکترای تخصصی بهداشت باروری،کمیته تحقیقات دانشجویی،دانشکده پرستاری و مامایی دانشگاه علوم پزشکی تهران،ایران مربی گروه مامایی واحد میبد،دانشگاه آزاد اسلامی میبد،ایران
Abstract:

 بررسی انواع گونه‌های میکروبیوتای روده در کودکان مبتلا به اختلال کم توجهی_بیش فعالی الناز سپهری اردکانی؛ طیبه شجاع الدینی اردکانی؛ پرنیا سادات محمودیان؛ یاسمین کشاورزی پور زمینه و هدف: ADHD یکی از پیچیده‌ترین چالش‌های سلامت کودکان محسوب می‌شود که از تعامل چند عاملی میان عوامل ژنتیکی،محیطی و زیستی ناشی می‌شود.تغییر در ترکیب میکروبی روده می‌تواند با تاثیرگذاری بر مسیرهای عصبی،ایمنی و متابولیکی، موجب تغییر در رشد مغزی، انتقال دهنده‌های عصبی، تغییرات رفتاری و تنظیم هیجانی شود.لذا این مطالعه مروری با هدف تعیین انواع گونه‌های میکروبیوتای روده در کودکان مبتلا بهADHD انجام گرفته است. مواد و روش‌ها :این مطالعه مروری با استناد به پایگاه‌های علوم پزشکی نظیر SID، MagIran، PubMed، Google Scholar، Scopus، Web of Science، Uptodate و با بررسی ۳۵ مقاله که از بین آنها ‌۶ مقاله مروری سیستماتیک، ۱ مقاله مروری سیستماتیک متاآنالیز، ۲ مقاله متاآنالیز و ۱ مقاله کوهورت مورد بررسی و تحلیل قرار گرفت. یافته‌ها:نتایج مطالعات نشان داد که ارتباط دوطرفه بین میکروبیوم روده و سیستم عصبی مرکزی در محور روده_مغز وجود دارد و در ADHD که یک بیماری عصبی_رشدی با شروع زودرس است ترکیب میکروبیوم روده تغییر می‌کند بنابراین تغییر در انتقال‌دهنده‌های عصبی نیز رخ خواهد داد که در این میان، اختلال در سیستم سروتونین، نورآدرنالین و دوپامین به عنوان اتیولوژی ADHD شناخته شده است.گونه‌های باکتریایی روده که درADHD دستخوش تغییر کاهشی میشوند شامل فکالی‌باکتریوم، Coprocola، بازیدیومایکوتا، باکتریوئید اواتوس، فیرمیکوت‌ها، اکتینومایسس و کورینه‌باکتریوم می باشد.باکتری هایی که در افراد مبتلا به ADHD تغییر افزایشی خواهند داشت نیز شامل اسکومایکوتا،انتروکوک ها، کاندیدا،کوپروکوکوس،آلیستیپس، کولسینلا، کلوستریدیالیس Fusobacteroum, Veillonella, Parvula, Odoribacter, Eggerthela, Firmicutes, Actinobacteria, Ralstonia, AFipia, Dialisterspp می باشد.در ارتباط با بیفیدوباکتریوم از شاخه اکتینوباکتریا و باکتری‌های خانواده پورفیروموناداسه در ADHD نتایج مطالعات ضدونقیض بوده و برخی تغییر کاهشی و برخی؛ دیگر تغییر افزایشی میزان آن را در کودکان ADHD گزارش کرده‌اند. نوع میکروبیوتای غالب روده که در نوجوانان مبتلا به ADHD گزارش شده است، از جنس Neisseria ازخانواده Neisseriaceae می باشد. نتیجه‌گیری:نتایج مطالعات نشان می‌دهد که اگرچه گونه‌های غالب در کودکان مبتلا به ADHD مشخص هستند اما شیوع برخی از گونه‌های میکروبی؛ نیاز به بررسی‌ بیش تر دارند ؛تغییر میکروبیوم در طول دوره کودکی و نوجوانی نیز دیده می شود که می‌تواند یک چالش جدی در درمان این بیماران باشد. واژگان کلیدی: ADHD،میکروبیوتای روده،گونه‌های میکروبی،اختلال کم‌توجهی_بیش‌فعالی

Comparison of the Effectiveness of EMLA Cream, 2% Lidocaine Gel, and Ice Bag on Pain Intensity Caused by Venipuncture in Children Aged 6-12 Years
neonatology
اکرم همتی پور 1 © ℗
1 دانشگاه علوم پزشکی آبادان، آبادان، ایران
Abstract:

 زمینه و هدف قرار دادن کاتتر وریدی یکی از رایج ترین اقدام مراقبتی تهاجمی است که توسط پرستاران انجام می شود وجود درد در کودک به هنگام انجام این اقدام می تواند، تاثیرات مخربی بر جسم، روح و روان وی داشته باشد.، روش های متعددی برای کاهش درد پیشنهاد شده است. با توجه به نتایج متفاوت درتاثیر روش های ضد درد موضعی، این مطالعه ای با هدف تعیین تأثیر کرم املا و ژل لیدوکائین 1درصد و کیسه یخ بر دردناشی از رگ گیری کودکان 6-21 ساله انجام شد. روش بررسی در این کارآزمایی بالینی264 کودک، تحت عمل جراحی الکتیو، با داشتن معیارهای ورود وخروج انتخاب و با روش تصادفی سازی بلوکی به 0 گروه 04 نفرتقسیم شدند. دراین مطالعه شدت درد توسط خود گزارش دهی بیمار و پرستاران منتخب حین تعبیه راه وریدی و ضمن کاربرد کرم املا، ژل لیدوکائین 1 درصدو کیسه یخ با استفاده از مقیاس عددی درد )NAS )و مقیاس رفتاری که شامل 5 معیار برای رفتار کودک بود اندازه گیری شد. دامنه نمرات درهر دو مقیاس بین صفر تا24 ثبت شده است که صفر عدم وجود درد را بیان میکند. اطلاعات جمع آوری شده با استفاده از شاخص های پراکندگی، آزمون کروسکال والیس، کای دو برای مقایسه مقیاس عددی درد و رفتاری بین گروه ها با استفاده از نرم افزار آماری -16SPSS استفاده شده است. یافته ها میانگین سن افراد شرکت کننده 0/07±2/07سال، جنس 84 نفر )54 درصد( کودکان مذکر بوده است. نتایج نشان داد که میانگین شدت دردبر اساس مقیاس عددی درگروه کنترل4±/08 ،0 کرم امال±4/05 ،4/7 ژل لیدوکائین±2/28 1/8 و کیسه یخ ±/60 1/64به ترتیب در مقیاس رفتاری نیز در گروه کنترل ،5/2±1/58 کرم امال 2/42 ± ،2/3 ژل لیدوکائین2/30 ± 0/43 و کیسه یخ 2/50 0/±43 بود. همچنین بین گروه ها از نظر مقیاس عددی درد و رفتاری تفاوت آماری معناداری وجود دارد ) 4/442 P )به طوری که از نظر هر دو مقیاس گروه مداخله با کرم املا کمترین میزان درد را بیان کردند. نتیجه گیری نتایج مطالعه حاضر نشان داد استفاده از هر سه روش، کرم املا، ژل لیدوکائین، سرمای موضعی باعث کاهش درد درانجام رگ گیری شده است و کرم املا با کاهش درد بیشتری نسبت به دو روش دیگر همراه بوده است. بنابراین می توان توصیه می شودکه به طور روتین یک ساعت قبل از رگ گیری کرم Emla در محل مورد نظر استعمال شود. کلیدواژ ه ها کودکان، درد ، کرم بی حسی املا، کیسه یخ، ژل لیدوکائین 

Bridging Genomics and Precision Medicine in Pediatric Epilepsy: A Promising Approach to Classification and Management Challenges
neonatology
Sima Binaafar 1 ℗, Ali Rashidi-Nezhad 2 ©
1 1) University of Applied Sciences & Technology, Tehran, Iran
2 2) Maternal, Fetal and Neonatal Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Timely seizure control and preservation of neurodevelopment are particularly critical in infants and children. High-throughput technologies, such as exome sequencing (ES), have transformed the management of genetically determined epilepsy requiring rapid intervention. These technologies enable personalized medicine to improve outcomes by avoiding trial-and-error therapies, facilitating targeted interventions, and often reducing the need for invasive procedures. In parallel classifying diseases into specific groups not only guides clinical decision-making but also addresses parents’ need for a clear and definitive label for their child’s condition, helping them understand and manage the disorder. Despite these advances, disease naming and classification remain complex, particularly when establishing a straightforward diagnostic and management plan. This complexity arises from the sophisticated nature of genes, as both protein structural features and the extent of protein–protein interactions determine involvement in multiple biological pathways, resulting in heterogeneous clinical phenotypes. Consequently, classifying related disorders strictly into a single category—such as neurometabolic diseases, channelopathies, or ciliopathies—is challenging, as a single gene-associated disorder may present features spanning multiple categories simultaneously. Therefore, careful attention to exome sequencing (ES) findings, guided by the molecular potential of each gene, assists clinical management. This includes consideration of even minor patient complaints, as well as proactive, periodic evaluations based on the gene’s functional profile—such as preventive cardiac assessments and non-routine, minimally invasive biochemical tests—before the onset of clinical symptoms. Integrating molecular and clinical genetic diagnostics with individualized medical care facilitates more effective management, enhances overall patient outcomes, and supports a continuous and valuable collaboration between the genetics team and clinicians. Keywords: Epilepsy, Exome sequencing, Personalized medicine, Precision medicine

Thalassemia in Pediatrics: Pathophysiology, Diagnosis, and Advances in Therapeutics
neonatology
Kazem Ghaffari 1 ℗, Shaban Alizadeh 2 ©
1 Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Department of Basic and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Background: Thalassemia represents one of the most common inherited hemoglobinopathies worldwide, with a particularly high prevalence in pediatric populations across the Mediterranean, Middle East, and South Asia. The disease is characterized by impaired synthesis of globin chains, leading to ineffective erythropoiesis, chronic hemolysis, iron overload, and multiorgan complications. Pathophysiology: In children, β-thalassemia major is the most severe form, manifesting with profound anemia, bone marrow expansion, and growth retardation. The underlying molecular defects involve diverse genetic mutations affecting β-globin chain production. Secondary complications, including endocrine dysfunction, cardiac failure, and hepatic damage, are largely attributable to transfusion-related iron overload. Diagnosis: Advances in diagnostic approaches, including molecular genetic testing and next-generation sequencing, now allow earlier and more precise detection, complementing traditional hematological indices and hemoglobin electrophoresis. Prenatal and neonatal screening programs have played a pivotal role in reducing disease incidence in high-risk regions. Treatment Advances: While regular blood transfusions and iron chelation therapy remain the mainstay of management, recent innovations have transformed the therapeutic landscape. Improved oral iron chelators have enhanced compliance and outcomes, while hematopoietic stem cell transplantation offers a potential cure in selected pediatric patients. Emerging therapies, including gene addition/editing strategies and novel pharmacologic agents such as luspatercept, hold promise for altering the natural course of disease. Conclusion: Thalassemia in children remains a major global health challenge; however, rapid advances in molecular diagnostics, supportive care, and curative strategies are reshaping prognosis. Future directions focus on expanding curative options, optimizing individualized treatment, and improving access to novel therapies in resource-limited settings.

"Effectiveness of Pain Relief Methods Used in Neonates Admitted to Neonatal Intensive Care Units of Ardabil Teaching Hospitals in 2024"
neonatology
پوران اخوان اکبری 1 © ℗, مهدی حیدرزاده 1, الهام عبداله زاده مهلانی 1
1 دانشگاه علوم پزشکی اردبیل
Abstract: Background: Preterm neonates admitted to Neonatal Intensive Care Units (NICUs) are often exposed to stress and painful interventions. Proper pain management is recommended to enhance growth, development, and health promotion in neonates. This study aimed to determine the effectiveness of pain relief methods used in neonates admitted to NICUs of Ardabil teaching hospitals. Methods: A total of 150 neonates hospitalized in the NICUs of Ardabil teaching-treatment centers were studied by convenience sampling. Neonatal pain scores caused by each painful procedure were calculated before and after applying pain relief methods using the Persian version of the standardized NPASS tool. The degree of pain relief provided by the methods was then evaluated and compared. Data were analyzed using SPSS version 23. Findings: During tracheal suctioning and intubation procedures, midazolam showed significant pain score reduction. In procedures such as vital signs check, chest X-ray (CXR), CPAP, and heel stick, pain scores before and after swaddling were significantly different (p 0.05). For tape removal and nasopharyngeal suction, swaddling, breastfeeding, and pacifier use were effective. In venous blood sampling, differences in pain scores before and after swaddling and breastfeeding interventions were significant. For arterial blood sampling and blood glucose measurement, swaddling and sucrose interventions significantly reduced pain scores. During venous catheterization, swaddling, sucrose, breastfeeding, and pacifier interventions all showed significant pain relief. Conclusion: This study highlights the importance of pharmacologic approaches for moderate to severe pain in neonates. The choice of pain relief method should be tailored to the type and intensity of the procedure. Targeted use of midazolam for invasive procedures, and use of swaddling, breastfeeding, pacifier, and sucrose individually or in combination for less invasive procedures, can effectively reduce pain in neonates admitted to NICUs. These findings emphasize the need for evidence-based comprehensive pain relief protocols in NICUs. Keywords: Pain, Infant, Pain Relief, Intensive Care units 

A Case of Schimke Immunoosseous Dysplasia in an Iranian Boy: Diagnostic Clues from Refractory Karyotyping
neonatology
Mahmood Noori-shadkam 1 ℗, Mahdieh Yavari 2, Zahra Sadr 3, Mahta Mazaheri 3 ©
1 Comprehensive Research Institute for Maternal and Child Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
2 Dr. Mazaheri’s Medical Genetics lab, Yazd, Iran
3 Department of Medical Genetics, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
Abstract: Background: Schimke immunoosseous dysplasia (SIOD) is a rare autosomal recessive multisystem disorder due to biallelic variants in SMARCAL1, characterized by growth failure, skeletal dysplasia, immunodeficiency, and renal involvement. In populations with consanguineous marriages, genomic evaluation plays a pivotal role in diagnosing multisystem pediatric conditions that may elude conventional testing. Methods: A 4-year-old Iranian boy from a consanguineous family was referred for genetic evaluation. His prenatal course was notable for intrauterine growth restriction (IUGR) secondary to poor placental perfusion; he was born at 34 weeks and required a 35-day neonatal admission for jaundice. Clinical features included visual impairment and craniofacial dysmorphism (low-set ears, micrognathia, prominent forehead, upturned eyelashes). Conventional cytogenetic analysis repeatedly failed due to absence of metaphase cells, and chromosomal breakage testing was reported as normal. Whole exome sequencing (WES) was subsequently performed. Results: WES identified a homozygous missense variant in SMARCAL1 (NM_014140.4:c.1682GA, p.(Arg561His)), classified as likely pathogenic and consistent with autosomal recessive SIOD. Following the molecular diagnosis, immunologic evaluation revealed lymphocyte deficiency, providing a plausible explanation for the inability to obtain metaphases in standard karyotype cultures. Conclusion: This case illustrates how SIOD can present with neonatal complications, dysmorphic features, and immunodeficiency that interfere with routine cytogenetic assays. Genomic testing (WES) was decisive in establishing the diagnosis. The report underscores the necessity of early comprehensive genetic evaluation in complex pediatric cases—particularly in consanguineous populations—where conventional laboratory methods may be inconclusive. Further functional studies and broader case series are needed to expand understanding of genotype–phenotype correlations in SIOD.

A Dose-Response Analysis for Assessing the Effect of Massage Therapy in the Treatment of Neonatal Jaundice
neonatology
Fatemeh Shahbazi 1 © ℗, Marjan Shahbazi 2
1 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
Abstract: Abstract Background: The effectiveness of massage therapy in the treatment of neonatal jaundice has been established in previous literature, but how much the level of massage can reduce the mean of bilirubin in neonates with jaundice is a question that has been addressed in this review. Methods: Four electronic databases, including Cochrane, PubMed, Scopus, and Web of Science, were searched for relevant literature. For the dose-response association between massage therapy and treatment of neonatal icterus, we conducted a meta-analysis using the random-effects model. For any level of intervention, we calculated the overall mean difference (MD) with 95% confidence intervals (CI). Results: Twenty studies were included in our meta-analysis. There was a positive and significant increasing dose-response trend between massage therapy and the mean reduction of bilirubin in neonates with hyperbilirubinemia as follows: 50 minutes massage during the experiment -0.36 (95% CI: -0.67, -0.06; I2 = 66%), 50-60 minutes massage during the experiment -0.41 (95% CI: -0.95, 0.13; I2 = 84%), and ≥101 minutes massage during the experiment -1.20 (95% CI: -1.63, -0.78; I2 = 83%). The heterogeneity across studies was mild to moderate. Conclusions: The presence of a dose-response relationship favors the causal relationship between massage therapy and reduction of neonatal jaundice. Keywords: Massage Therapy; Dose-Response; Jaundice; Neonate.

Applications of artificial intelligence in neonatal treatment: A systematic review
neonatology
زهرا جعفری 1 © ℗
1 استادیار دانشکده پرستاری و مامایی، دانشگاه علوم پزشکی ایران، تهران، ایران.
Abstract:

 کاربردهای هوش مصنوعی در درمان نوزادان: یک مرور سیستماتیک زمینه و هدف: هوش مصنوعی (AI) به‌عنوان یکی از تحولات بنیادین در علوم پزشکی، پتانسیل بالایی در بهبود تشخیص، درمان و مراقبت از نوزادان دارد. هدف این مرور سیستماتیک، شناسایی کاربردهای هوش مصنوعی در درمان نوزادان، چالش‌ها و نتایج بالینی مرتبط است. روش‌ها: جستجوی سیستماتیک در پایگاه‌های PubMed، Scopus، Web of Science و Cochrane Library برای مقالات منتشرشده بین سال‌های ۲۰۱۰ تا ۲۰۲۵ انجام شد. معیار ورود شامل مطالعات بالینی و مداخله ای مرتبط با کاربرد هوش مصنوعی در درمان نوزادان بود. یافته‌ها: از میان ۱٬۴۵۲ مقاله شناسایی‌شده، ۷۸ مطالعه معیارهای ورود را داشتند. بیشترین کاربردها در زمینهٔ تشخیص بیماری‌های نادر، پیش‌بینی پاسخ به درمان در نوزادان، مدیریت نوزادان متولد از مادران دیابتی و معتاد، حمایت تصمیم‌گیری در مراقبت‌های ویژه نوزادان و ادامه حیات گزارش شد. نتیجه‌گیری: هوش مصنوعی می‌تواند نقش کلیدی در ارتقای کیفیت درمان نوزادان ایفا کند، اما همچنان نیازمند شفافیت الگوریتم‌ها، کاهش سوگیری داده‌ها، و تضمین عدالت در دسترسی است. کلیدواژه: هوش مصنوعی، کاربرد، درمان، نوزادان

Artificial Intelligence Perspectives on HIV: Opportunities and Challenges
neonatology
Farzaneh Malekpour 1 © ℗
1 kashan university of medical science,medical microbiology phd
Abstract:

 هوش مصنوعی (Artificial Intelligence) به‌عنوان یکی از مهم‌ترین دستاوردهای علمی قرن بیست‌ویکم، توانسته است ابعاد مختلف زندگی بشر را تحت تأثيرقراردهد.ویروس نقص ایمنی اکتسابی (HIV) یکی از مهم‌ترین چالش‌های سازمان بهداشت جهانی طی قرن هاي اخیر بوده است. علی‌رغم پیشرفت‌های قابل توجه در حوزه درمان و پیشگیری، هنوز تشخیص به‌موقع، مدیریت داده‌های بالینی و طراحی وبه کارگیری درمان‌های شخصی‌سازی‌شده از مسائل اصلي در این حوزه محسوب می‌شوند.هوش مصنوعی به‌عنوان ابزاری نو، قابلیت اين را دارد که با تحلیل حجم عظیمی از داده‌های پزشکی و زیستی(big data)، راهکارهای جدیدی برای مقابله باويروسHIV ارائه دهد.مدل‌های محاسباتی هوش مصنوعي می‌توانند ساختار ویروس و موتاسيون هاي احتمالی آن را شبیه‌سازی کرده و روند تولید داروهای ضدویروسی راسرعت بخشند. همچنين تحلیل داده‌های ژنتیکی بیماران،هوش مصنوعي می‌تواند دارو و دوز مناسب برای هر فردراپیشنهاد دهد.هوش مصنوعی قادر است الگوهای مقاومت ویروس در برابر داروها را شناسایی و از درمان ناموفق جلوگیری کند.ويروسHIV دارای نرخ بالايی ازجهش است و پیش‌بینی دقیق آن حتی برای الگوریتم‌های پیشرفته نیزسخت و دشوار است.دیدگاه هوش مصنوعی، HIV نه تنها یک بیماری، بلکه یک مسئله‌ی داده‌ای پیچیده است که نیازمند مدل‌های پویا و خودیادگیر است. با توسعه سیستم‌های هوشمند، می‌توان به سمت تشخیص زودهنگام‌تر، درمان مؤثرتر و حتی پیشگیری گسترده‌تر از ويروسHIV حرکت کرد. همکاری میان پزشکان، دانشمندان علوم داده و متخصصان اخلاق زیستی، مسیر آینده را مشخص خواهد ساخت.

Associated Etiologies of Enuresis in 5-to-15-Year-Old-Children
neonatology
Saeedeh Yaghoubi 1 ℗, Simin Sadeghi Bojd 2 ©
1 Associate Professor of Pediatric Infectious Disease, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Professor of Pediatric Nephrology, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract: Background:Enuresis is one of the most common problems in children with physical and psychological complications that can disturb their social relationships. The main objective of this study is to evaluate the relationship between enuresis and its associated etiologies in children aged 5 to 15 years in Zahedan. The study further contributes to an early realization of the parents of children with enuresis-associated problems. Methods:Following a descriptive design, 200 children (5 to 15 years old) suffering from enuresis referred to nephrology and psychiatric clinics in Zahedan in 2019 were recruited. Data were analyzed using SPSS software. Results:Of 200 children with enuresis, 134 (67%) were girls, and 66 (33%) were boys. Also, 174 (87%) were aged 5 - 10 years, and only 26 (13%) were 10 to 15 years old. Birth weight of 172 (86%) children was 2500 - 4000 g, 20 (10%) were 2500g, and only 8 (4%) were 4000 g. Fecal incontinence was observed in 99 cases (49%), and 101 (51%) did not have fecal incontinence. Attention deficit hyperactivity disorder (ADHD) was found in 80 (40%) cases. For 144 (72%) children, we found no stress, and 56 children (28%) had stress. Urinary tract infection was observed in 142 children (71%). According to imaging studies, 34 children (17%) with enuresis had congenital kidney abnormalities and 166 (83%) had no kidney problems. Conclusions:The significant etiologies typically found in the onset of enuresis and its exacerbation can be controlled or treated. Since the complications of enuresis have not been properly clarified for families, it is of crucial importance to increase awareness about this health problem.

Benign Paroxysmal Vertigo of Childhood - BPVC
neonatology
عطیه یامی 1 © ℗
1 دانشجوی کارشناسی ارشد شنوایی شناسی دانشگاه علوم پزشکی تهران
Abstract:

 مقدمه: سرگیجه وضعیتی خوش‌خیم دوران کودکی (Benign Paroxysmal Vertigo of Childhood - BPVC) یک اختلال نورولوژیک شایع ولی اغلب ناشناخته در کودکان است که با حملات مکرر و ناگهانی سرگیجه بدون علائم عصبی پایدار همراه است. این اختلال معمولاً در سنین ۲ تا ۷ سالگی بروز می‌کند و با رشد کودک تمایل به بهبود خودبه‌خودی دارد. آگاهی از این بیماری برای جلوگیری از تشخیص‌های اشتباه و اقدامات تشخیصی غیرضروری اهمیت بالایی دارد. روش بررسی: این مطالعه به روش مروری (Review Article) با استفاده از مقالات منتشرشده در پایگاه‌های PubMed، Scopus، و Google Scholar بین سال‌های 2000 تا 2024 انجام شد. کلیدواژه‌های مورد استفاده شامل "Benign Paroxysmal Vertigo of Childhood ” و “migraine in children” بودند. مقالات پس از بررسی کیفیت و ارتباط، تحلیل و طبقه‌بندی شدند. یافته‌ها: BPVC معمولاً با حملات کوتاه‌مدت سرگیجه، عدم تعادل، تهوع، رنگ‌پریدگی و گاهی نیستاگموس همراه است. دوره‌های سرگیجه اغلب بدون هشدار رخ داده و پس از چند دقیقه خودبه‌خود بهبود می‌یابند. معاینات نورولوژیک و آزمون‌های تصویربرداری بین حملات معمولاً طبیعی هستند. اکثر کودکان سابقه خانوادگی یا علائم همراه با میگرن را نشان می‌دهند و در آینده در معرض ابتلا به میگرن هستند. درمان خاصی برای BPVC وجود ندارد و مدیریت حمایتی و اطمینان‌بخشی به خانواده‌ها رویکرد اصلی محسوب می‌شود. بحث: ارتباط قوی BPVC با میگرن کودکی، زمینه‌ای برای بررسی‌های بیشتر پاتوفیزیولوژیک ایجاد کرده است. اگرچه مکانیسم دقیق بروز BPVC به طور کامل مشخص نیست، اما اختلال عملکرد موقتی سیستم وستیبولار یا مسیرهای مرتبط با میگرن فرضیه غالب در مطالعات اخیر است. تشخیص صحیح بر پایه شرح حال دقیق و حذف سایر بیماری‌ها، از جمله صرع، اختلالات مخچه‌ای و ضایعات فضاگیر مغزی انجام می‌شود. نتیجه‌گیری: BPVC یک اختلال خوش‌خیم ولی بالینی مهم در کودکان است که نیازمند شناخت دقیق توسط پزشکان عمومی، متخصصان اطفال و نورولوژیست‌های کودکان می‌باشد. آموزش والدین درباره سیر طبیعی و بی‌خطر بودن بیماری، کلید اصلی در مدیریت آن است. پیگیری بالینی و در صورت نیاز ارجاع به نورولوژیست برای ارزیابی بیشتر در موارد غیر تیپیک توصیه می‌شود. 

Children's Mask-Wearing Behaviors and the Factors that go along with them during the COVID-19 Pandemic
neonatology
Saeedeh Yaghoubi 1 ℗, Gholamreza Soleimani 2 ©
1 Associate Professor of Pediatric Infectious Disease, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
2 Professor of Pediatric Infectious Disease, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
Abstract: Background and Objective: Based on WHO, mask wearing may prevent coronavirus disease 2019 (COVID-19) transmission. The aim of the present study was to investigate the prevalence of mask wearing and its related factors in Zahedan, southeastern Iran. Methods: This cross-sectional study was carried out to investigate mask wearing in 408 children aged 2 to 18 years who were referred to specialized pediatric clinics at Zahedan University of Medical Sciences in Zahedan, Iran. The study ran in 2021-2022, and participants or their parents were asked about age, gender, number of children in the family, father's and mother's occupation, father's and mother's education, and family socioeconomic status. The SPSS 20 with a significance level of 0.05 was used to analyze the data. Findings: The rate of mask wearing was 61.52%. Of the children who adhered to wearing masks, 57.77 % wore three layers, 94.42% wore well-fitting masks, and 65.34 % changed their masks at least three times per day. About 53.50% of the parents of the children who refused to wear masks did not believe in this behavior, and the others had economic problems. Mask-wearing was significantly influenced by all socio-demographic factors (p 0.001). Conclusion: It was found that 62% of the children wore masks. The majority of children who adhered to wearing masks used three layers, were adapted and changed masks at least three times per day. The majority of those who refused to wear masks did not believe in this treatment. Socio-demographic factors had a significant impact on mask wearing.

Comparative Effects of Jadenu® and Exjade® in Beta Thalassemia Major: Patient Satisfaction, MRI T2*, Ferritin, and Biochemical Profiles
neonatology
Kazem Ghaffari 1 ℗, Mahya Mobinikhaledi 2 ©
1 Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran / Department of Basic and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran / Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Faculty of Medicine, Arak University of Medical Sciences, Arak, Iran
Abstract: Background: Deferasirox (DFX) is an oral iron chelator administered once daily, with established dose-dependent efficacy in patients with thalassemia major (TM). The film-coated tablet formulation (Jadenu®) was introduced to address tolerability issues and poor palatability associated with the dispersible tablet formulation (Exjade®). This study aimed to compare the two formulations with respect to patient satisfaction, convenience, serum ferritin levels, biochemical indices, and cardiac/hepatic iron burden assessed by MRI T2*. Methods: A randomized controlled study was conducted on 62 patients with TM, aged 2 years, requiring chelation therapy for iron overload. Participants were allocated to receive either Exjade® (n = 32) or Jadenu® (n = 30). Clinical and laboratory evaluations included serum ferritin, liver function tests [alkaline phosphatase (ALK), alanine aminotransferase (ALT), aspartate aminotransferase (AST)], and cardiac/hepatic MRI T2* measurements at baseline and after 12 months. Patient-reported satisfaction and convenience were assessed using structured questionnaires. Results: Patients receiving Jadenu® reported significantly greater satisfaction with taste compared to Exjade® (53.3% vs. 12.5%, p = 0.001). Similarly, convenience of administration was rated higher among Jadenu® recipients (40.0% vs. 28.1%, p = 0.047). No statistically significant differences were observed in cardiac MRI T2* values between the two groups (p = 0.851). Conclusion: Jadenu® demonstrates improved acceptability due to enhanced palatability and simplified administration, with fewer gastrointestinal tolerability concerns compared to Exjade®. Improved patient satisfaction may enhance adherence to therapy and thereby mitigate long-term complications of iron overload, particularly cardiac and hepatic morbidity. These findings support the clinical preference for Jadenu® in routine management of thalassemia major.

Corticosteroid Monotherapy for Non-Cardiac MIS-C: A Safe and Effective Strategy from an Iranian Cohort
neonatology
Fatemeh Moradi 1 ℗, Mohammad Saeed Sasan 2 ©, Mohammad Hassan Aelami 2, Veda Vakili 3
1 Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Community Medicine, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Background: Multisystem Inflammatory Syndrome in Children (MIS-C) is a severe, post-infectious hyperinflammatory complication of SARS-CoV-2. International guidelines recommend intravenous immunoglobulin (IVIG) combined with corticosteroids as first-line therapy. However, IVIG is costly and often in short supply, particularly in resource-limited settings. This study describes the clinical findings, treatment patterns, and outcomes of MIS-C patients from a large tertiary center in Iran, with a focus on evaluating outcomes for patients treated with corticosteroid monotherapy. Methods: This retrospective, observational study analyzed medical records of children diagnosed with Multisystem Inflammatory Syndrome in Children (MIS-C) at Akbar Children’s Hospital, Mashhad, Iran, from 2020 to 2021. Out of 179 discharged patients, 84 met the CDC case definition for MIS-C. Participants received either intravenous immunoglobulin (IVIG) with or without corticosteroids (62 patients) or corticosteroids alone (21 patients). Statistical analyses included the Mann-Whitney U test and Fisher's Exact Test, with significance set at p 0.05. Results: Over 21 months, 179 children were discharged with final diagnosis of MIS-C. Upon re-examination ,84 patients (46.9%) matched CDC criteria. Based on the immunomodulatory therapy administered, the study population consisted of 62 patients who received IVIG with or without corticosteroids and 21 who received corticosteroids alone. The cohort revealed two distinct phenotypes. The IVIG group exhibited a cardiodominant presentation (87.1% cardiac involvement), while the steroid-alone group was younger, had more comorbidities (38.1% vs. 6.5%, p0.001), and presented with prominent gastrointestinal, respiratory (38.1%), and neurologic (38.1%) symptoms. Mortality was comparable between groups (8.1% vs. 9.5%, p=1.000). Strikingly, no patient in the steroid-alone group had residual cardiac abnormalities at follow-up versus 35.5% in the IVIG group (p=0.001). The overall clinical profile showed high rates of gastrointestinal (98.8%) and cardiac (75.9%) involvement. Conclusion: In this cohort, corticosteroid monotherapy was associated with favorable outcomes in MIS-C patients without severe initial cardiac involvement. The findings support the feasibility of phenotype-directed, resource-aware treatment strategies in settings with limited access to IVIG.

Early Skin-to-Skin Contact in the First Hour of Life and Breastfeeding Success: A Systematic Review
neonatology
Fayazi Arefeh 1 © ℗, Kahani Vida 2
1 Neonatologist , Saveh University of Medical Sciences, Saveh , Iran
2 Neonatologist , khoy University Of Medical Sciences, khoy , Iran
Abstract: Background: Early skin-to-skin contact (SSC) in the first hour after birth is proposed to enhance breastfeeding outcomes, yet evidence synthesis is required. Objective: To systematically review the effect of SSC during the first postnatal hour on breastfeeding initiation and success. Methods: Following PRISMA guidelines, PubMed, Scopus, Cochrane Library, and Web of Science were searched up to June 2023. Randomized controlled trials (RCTs) and systematic reviews examining SSC (60 minutes after birth) and breastfeeding outcomes were included. Risk of bias was assessed using Cochrane RoB2. Results: Thirteen studies (9 RCTs, 4 systematic reviews; 1,200 mother–infant dyads) met inclusion criteria. Most RCTs demonstrated significantly higher rates of first latch success, breastfeeding self-efficacy, and exclusive breastfeeding during hospitalization and early postpartum among dyads receiving immediate SSC versus routine care. Meta-analyses confirmed increased odds of successful breastfeeding initiation (OR ≈ 2.7, 95% CI: 1.9–3.6). Performance bias was unavoidable due to the nature of the intervention, but other risk domains were generally low. Conclusion: Immediate SSC within the first postnatal hour consistently improves breastfeeding initiation and exclusivity. Integration of SSC into delivery room practice should be considered a standard of care. Further research is needed in cesarean deliveries and preterm populations. Keywords: Skin-to-skin contact; breastfeeding initiation; exclusive breastfeeding; randomized controlled trial; systematic review

Effect of music therapy on behavioral and physiological neonatal outcomes: A systematic review and dose-response meta-analysis
neonatology
Marjan Shahbazi 1 © ℗, Fatemeh Shahbazi 2
1 Department of Occupational Therapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
2 Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran
Abstract: Background Previous studies have documented the effectiveness of music therapy in improving adverse neonatal outcomes in premature infants. However, this review aims to address the question of how long listening to music can enhance these neonatal outcomes. Methods To conduct this dose-response meta-analysis, we searched the PubMed, Scopus, Web of Science, and Cochrane Library databases. The inclusion criteria comprised randomized clinical trials that investigated the effects of music therapy on improving adverse neonatal outcomes. Preterm infants were defined as those born between 27 and 37 weeks of gestation, as fetuses are known to respond to auditory stimuli starting at the 27th week of pregnancy. The initial search was performed on January 28, 2024, and there were no restrictions on the time frame for the search. Ultimately, we employed a two-stage random effects model using the “drmeta” package in Stata software to perform this dose-response meta-analysis. Results In total, 30 articles (1855 participants) were identified for inclusion in our meta-analysis. According to pooled analysis with each minute increase in music therapy, the means of respiratory rate, pain score, SBP, DBP, behavioral score, and body temperature decrease by 35.3 beats per minutes, 15.3 VAS, 30.7 mmHg, 8.9 mmHg, 2.7, and 0.27°C. On the other hand, with each minute increase in listening to the music, the mean of O2 saturation, heart rate and sleep duration increase 1.7%, 89.2 beats per minutes and 5.081 minutes per day, respectively. Conclusion Music therapy improves the neonatal outcomes of O2 saturation, heart rate, respiratory rate, sleep duration, body temperature and systolic and diastolic blood pressures. Therefore, the existence of a dose-response relationship can indicate a causal relationship between music therapy and the improvement of neonatal outcomes.

Effect of Sensory Play-Based Intervention on Food Fussiness in Preschool Children: A Pilot Study
neonatology
Mona Nemaizadeh 1 ℗, Bahareh Imani 2 ©
1 Department of Nutrition Sciences, Varastegan Institute for Medical Sciences,Mashhad, Iran
2 Department of medical Sciences, University of Medical Sciences, Mashhad, Iran
Abstract: Food fussiness is one of the most common feeding difficulties in early childhood and has been linked to both inadequate nutrient intake and risk of obesity. Traditional interventions often fail to address the sensory and behavioral roots of picky eating. Sensory play-based therapy, which incorporates food exploration through touch, smell, and playful interaction, has been proposed as a promising approach. This study aimed to evaluate the effectiveness of an 8-week sensory play-based intervention on reducing food fussiness and improving eating behaviors among preschool children. Methods: A quasi-experimental study was conducted on 30 children aged 18–36 months (mean age 27.4 ± 5.6 months), recruited from a community nutrition clinic. Inclusion criteria were: refusal of multiple food textures, limited dietary variety, and parental concern regarding picky eating. Exclusion criteria included medical or developmental disorders affecting feeding. The intervention lasted 8 weeks and consisted of: • Weekly in-person group workshops (1 hour, play-based exposure to foods). • Daily home-based sensory play activities, provided to parents through structured guidelines. Parental compliance was monitored by weekly logs. Outcome measure: The Children’s Eating Behaviour Questionnaire (CEBQ) was administered at baseline and after 8 weeks. Subscales analyzed included Food Fussiness (FF), Food Responsiveness (FR), and Enjoyment of Food (EF). Anthropometric measures (weight-for-age, BMI-for-age percentile) were recorded. Data were analyzed using paired t-tests. Statistical significance was defined as p 0.05. Results: Of the 30 enrolled participants, 28 completed the study (dropout rate 6.6%). At baseline, mean Food Fussiness scores were 4.2 ± 0.6. After the intervention, Food Fussiness significantly decreased to 2.8 ± 0.7 (p 0.001). Enjoyment of Food increased from 2.9 ± 0.5 to 3.8 ± 0.6 (p = 0.002). Food Responsiveness showed a modest but significant improvement (3.1 ± 0.7 vs. 3.6 ± 0.8, p = 0.04). Parents reported reduced mealtime conflict and increased willingness of children to self-feed. Anthropometric data showed no significant changes in BMI-for-age percentile (baseline: 75.6 ± 14.2 vs. post-intervention: 74.8 ± 13.7, p = 0.32), suggesting behavioral improvements occurred without adverse growth effects. Conclusion: Discussion and Conclusion This pilot study demonstrates that an 8-week sensory play-based intervention can significantly reduce food fussiness and improve positive eating behaviors in toddlers. While changes in BMI were not observed, improvements in food acceptance and mealtime interaction suggest sensory strategies may complement standard nutritional counseling. Larger randomized controlled trials are warranted to confirm these results and assess long-term effects.

Evaluation of Sagittal Balance in Pediatric Lateral Spine Radiographs: A Descriptive Cross-Sectional Study
neonatology
رضوانه عرفانی فر 1 © ℗
1 Student Research Committee, Zahedan University of Medical Sciences, Zahedan,Iran.
Abstract: Sagittal balance plays a critical role in maintaining the physiological alignment and biomechanical stability of the spine. Accurate assessment of sagittal parameters during childhood can aid in the early detection of postural abnormalities and structural spinal disorders. This study aimed to evaluate sagittal balance parameters—including lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), and sagittal vertical axis (SVA)—in healthy pediatric lateral spine radiographs.

Evaluation of the Effects of Incorporating Long-Acting Subcutaneous Insulin Into the Standard Treatment Protocol for Diabetic Ketoacidosis in Children
neonatology
ویکتوریا چگینی 1 © ℗, فاطمه صفاری 2, ونوس چگینی 3
1 Qazvin University of Medical Science , Assistant Professor of Pediatrics critical Care
2 Professor of Pediatric Endocrinology & Metabolism, Qazvin University of Medical Sciences
3 Qazvin University of Medical Sciences, Associate Professor of Laparoscopic Surgery
Abstract: Background: Despite the progress made in the treatment of type 1 diabetes, the incidence of diabetic ketoacidosis (DKA) in children is still increasing, and its management requires hospitalization in the pediatric intensive care unit (PICU). It is important to find a new and low-risk treatment method to shorten the recovery time from DKA. Objectives: This study aimed to evaluate the effectiveness and safety of integrating two different types of long-acting subcutaneous insulin into the standard treatment for DKA in children. Methods: An open-label randomized clinical trial was designed with three parallel arms. Each group consisted of 36 individuals. The study was conducted in the PICU, and comprehensive monitoring was performed throughout the process. Patients aged between 2 and 15 years were randomly assigned to one of three treatment groups: Group 1: Standard treatment alone (control group); Group 2: Standard treatment plus one type of long-acting subcutaneous insulin (Detemir); Group 3: Standard treatment plus another type of long-acting subcutaneous insulin (Glargine). The dose administered was 0.5 units per kilogram of body weight, given subcutaneously within 4 hours (as soon as possible) from the diagnosis of DKA. The impact of the intervention on the recovery time from DKA and the potential complications were investigated in all groups. Results: The analysis revealed a significant disparity in the mean recovery time among the treatment groups (P = 0.008). Specifically, the post-hoc test indicated that the Detemir arm exhibited a significantly shorter recovery time from DKA than the standard arm (P = 0.011). However, it is important to note that there were no significant differences in the occurrence of common complications among the three study groups. Conclusions: Based on the findings, it appears that incorporating specific types of long-acting subcutaneous insulin into the standard treatment of DKA in children leads to a reduction in the resolution time of the acute phase of ketoacidosis. Importantly, this approach does not introduce additional complications. Consequently, it has the potential to optimize resource allocation and enhance patient care by freeing up beds in the PICU. Keywords: Children, Diabetic Keto acidosis , Diabetes Type 1, Pediatric Intensive Care Unit, Insulin Analogues, Basal Insulin , Clinical Trial

Evaluation of the phototherapy effect on serum electrolytes in term neonates with jaundice 
neonatology
Narges Kalhor 1 © ℗, Alireza Saadati 2, Masoud Hassanvand Amouzadeh 3, Sara Afshari 4
1 Otorhinolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
2 Department of Pediatrics, Faculty of Medicine, Qom University of Medical Sciences, Qom, Iran
3 Neuroscience Research Center, Qom University of Medical Sciences, Qom, Iran
4 Department of Dermatology, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Abstract: Introduction: One of the most prevalent disorders requiring medical attention or hospitalization for neonates is neonatal jaundice. It is estimated that jaundice affects 80% of preterm and 60% of term neonates. The rise of indirect (non-conjugated) hyperbilirubinemia is toxic and harmful to the central nervous system and may lead to kernicterus, which is a permanent and severe damage to nervous system. Treatments like phototherapy or blood exchange may be required to treat indirect hyperbilirubinemia. Despite being a nearly safe form of treatment, phototherapy can nevertheless have negative effects on the developing infants. Studies have shown that phototherapy can affect the balance of water and electrolytes and renal function through different pathways. Method: This research is a retrospective cohort analysis of newborns at Hazrat Masoumeh Children's Hospital who received phototherapy between April 2018, and the end of March 2023. The study population was established by going over the records of newborns treated with phototherapy for jaundice between April 2018, and the end of March 2023, in accordance with the inclusion and exclusion criteria. From the neonates' medical records, data on their demographics, serum levels of potassium, sodium, BUN, and creatinine before and after phototherapy were taken, and statistical analysis was done on the results. Findings: Based on the inclusion and exclusion criteria, the study included the files of 249 newborns in total. Based on an analysis of laboratory measurements, the neonates' serum bilirubin level was 4.24 ± 24.02. When the newborns were admitted to the hospital, none of them exhibited serious electrolyte imbalances. 136.41 ± 4 sodium and 0.6 ± 4.35 potassium were the average levels, respectively. Following 48 hours of phototherapy, the average potassium level was 0.9 ± 4.2 and the average sodium level was 6 ± 135.84. Following 48 hours of phototherapy, the investigated population's average potassium and salt levels dropped. However, there was no statistically significant difference. (p value was calculated for sodium changes equal to 0.24 and for potassium level changes equal to 0.31.) Conclusion: This study investigated the impact of intensive phototherapy on electrolyte abnormalities in term newborns with bilirubin levels greater than 20 mg/dL. Following 48 hours of phototherapy, there was a slight decrease in potassium and sodium levels, but not significant. Furthermore, there was no correlation observed between the decrease in electrolyte levels with data from laboratory tests conducted before hospitalization, sex, weight, height, or mode of birth. Keywords: neonatal jaundice, sodium, potassium 

Growth Patterns in Preterm Children: Catch-Up Growth, Wasting, and Obesity Risk from the PERSIAN Birth Cohort
neonatology
Golnaz Rezaeizadeh 1 ℗, Hossein Poustchi 2, Maryam Sharafkhah 3, Seyede Shahrbanoo Daniali 3, Navid Danaei 4, Amir Houshang Mehrparvar 5, Mohammad Javad Zare Sakhvidi 6, Hamid Hakimi 7, Zahra Mohammadi 2, Mohammad Ali Mansournia 8 ©, Roya Kelishadi 3
1 Digestive Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
2 Liver and Pancreatobiliary Diseases Research Center, Digestive Diseases Research Institute, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Paediatrics, Child Growth and Development Research Center, Research Institute for Primordial Prevention of Noncommunicable Disease, Isfahan University of Medical Sciences, Isfahan, Iran
4 Semnan University of Medical Sciences, Semnan, Iran
5 Shahid Sadoughi University of Medical Sciences, Yazd, Iran
6 Yazd University of Medical Sciences, Yazd, Iran
7 Rafsanjan University of Medical Sciences, Rafsanjan, Iran
8 Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Background Childhood growth impairment, often due to undernutrition, increases long-term health risks. Preterm infants are especially vulnerable and require early support. Catch-up growth helps, but its optimal timing is unclear. This study examines preterm growth patterns to identify those at risk and guide intervention. Methods Using PERSIAN Birth Cohort data from four Iranian cities, we examined how preterm birth affects height-for-age (HAZ), weight-for-age (WAZ), weight-for-height (WHZ), BMI-for-age (BMI-Z), stunting, wasting, underweight, and obesity. Preterm status: term (≥37 weeks), late (34–36), moderate (32–33), very/extremely (32 weeks). Growth effects were assessed via Generalized Estimating Equations. Quantile regression examined preterm birth's effect across BMI-Z quantiles. Findings Among 9,015 pregnant Iranian women enrolled, 7,169 neonates were followed at 2–60 months. Preterm births were 11.0%: 8.8% late, 1.3% moderate, and 0.5% very/extremely preterm. By 36 months, both late and moderate preterm children showed catch-up in HAZ, and by 48 months, in WAZ, with no significant differences in stunting or underweight risk compared to full-term peers. In contrast, very/extremely preterm children had persistent HAZ and WAZ deficits and remained at higher risk of underweight, though stunting risk was no longer elevated. WHZ and BMI-Z declined with increasing prematurity and remained lower through 60 months. Preterm birth was associated with higher odds of wasting and lower BMI-Z, with no significant difference in obesity risk. Interpretation Preterm children face persistent growth challenges, including an increased risk of wasting, despite similar HAZ and WAZ to full-term peers. These findings highlight the need for early, targeted nutritional interventions to prevent wasting and support optimal growth. 

Impact of IBD Medications During Pregnancy on Maternal and Child Health: A Systematic Review and Meta-Analysis
neonatology
امیرمحمد عزیزپور 1 ℗, آروین صالحی 1, امیررضا صفری 1, امیرکسری شاهین‌زاده 1, نازنین صدیقی 1 ©
1 Medical Student, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Backgrounds: Inflammatory bowel disease (IBD) impacts pregnant women, raising concerns about medication safety. This systematic review and meta-analysis aimed to assess the association of IBD medications with pregnancy and neonatal outcomes. Methods: We systematically searched major databases (PubMed/MEDLINE, Embase, Web of Science, Scopus, and the Cochrane Library) from inception to June 9, 2025. Eligible cross-sectional, case-control, and cohort studies comparing pregnant IBD patients receiving IBD-related drugs with unexposed controls were included. Subgroup analyses were conducted based on drug categories (biologics, immunomodulators, corticosteroids, 5-aminosalicylic acid (5-ASA), and a combination of biologics and immunomodulators). Results: Thirty-three studies were included. Biologics showed higher risk of spontaneous abortion (OR = 1.59, 95% CI [1.07, 2.36]), preterm birth (OR = 1.23, [1.03, 1.48]), hypertension (OR = 1.91, [1.15, 3.17]), LBW (OR = 1.32, [1.01, 1.74]), while reducing GD risk (OR = 0.79, [0.67,0.94]). Immunomodulators were linked to increased stillbirth (OR = 1.84, [1.26, 2.69]), while having a protective effect against GD (0.85, [0.74,0.99]). Combination therapy increased the risk of preterm birth (OR = 1.46, [1.11, 1.91]) and CMs (OR = 1.57, [1.01, 2.43]). Corticosteroids resulted in an increased risk of preterm birth (1.76, [1.30, 2.37]) and LBW (OR = 1.93, [1.33, 2.81]), while reducing the risk of CMs (OR = 0.62, [0.42, 0.80]). 5-ASA showed an increased risk of stillbirth (OR = 5.26, [2.29, 12.05]). Overall, these five medication groups contributed to an increased risk of preterm birth (OR = 1.29, [1.15, 1.45]). No significant relationship was found between these medications and SGA, low Apgar score, newborn antibiotic use, infections, NICU admission, and hospitalization.No significant relationship was found with small for gestational age (SGA), low Apgar score, newborn infections, antibiotic use, NICU admission, and hospitalization. Conclusion: IBD medications in pregnancy are associated with varied perinatal outcomes depending on drug class. These findings highlight the importance of personalized treatments, considering both disease control and pregnancy and fetal safety.

Investigating the relationship between economic, social and demographic factors affecting infant mortality in Isfahan University of Medical Sciences during 2022
neonatology
مریم کاظمی 1 © ℗
1 معاونت بهداشت دانشگاه علوم پزشکی اصفهان
Abstract:

 میزان مرگ و میر نوزادان از جمله گویاترین شاخص های توسعه جوامع است. تأمین، حفظ و ارتقاء سطح سلامت نوزادان به عنوان یک گروه آسیب پذیر در خدمات بهداشتی درمانی جایگاه ویژه ای دارد. این مطالعه با هدف بررسی ارتباط عوامل اقتصادی، اجتماعی و جمعیت شناختی موثر بر مرگ و میر نوزادان دانشگاه علوم پزشکی اصفهان در سال 1401 انجام شد. روش تحقیق، مطالعه توصیفی تحلیلی بود و ضمن انجام عملیات میدانی در مواردی از مصاحبه غیر ساختارمند استفاده گردید. در این پژوهش از نظریه های ارتباط توسعه اجتماعی اقتصادی با میزان مرگ و میر، موسلی و چن، انتقال اپیدمیولوژی، توسعه تکنولوژی پزشکی و نظریه تحلیلی دونالد دبليو ماتسون و همكاران استفاده شد. جامعه آماری شامل 427 نفر نوزاد بود که در 27 شهرستان تحت پوشش دانشگاه علوم پزشکی اصفهان زندگی کرده و در سال 1401 فوت شده بودند. در این مطالعه از روش کل شماری استفاده گردید. داده های آماری از سطح معاونت بهداشتی اصفهان و شهرستان ها با استفاده از فرم های آماری و مصاحبه با خانواده ها جمع آوری، سپس در نرم افزار SPSS20 وارد و علاوه بر محاسبه فراوانی با استفاده از آزمون های آماری تجزیه و تحلیل گردید. یافته های پژوهش نشان دهنده آن است که بین سن مادر هنگام تولد کودک، سن کودک هنگام فوت، چندقلویی و محل فوت با علت مرگ و میر نوزادان ارتباط وجود دارد لیکن بین تحصیلات و شغل والدین، فاصله سنی والدین، رتبه تولد، نوع زایمان، جنس، محل سکونت و ملیت با علت مرگ نوزادان ارتباط معناداری مشاهده نشد. کلید واژه ها: مرگ و میر، نوزادان، جمعیت شناختی 

Investigating the Role of Antioxidant Status in Neonatal Congenital Heart Disease: A Comparative Analysis of Serum Vitamin E Levels
neonatology
دکتر فرزانه معزی 1 ©, دکتر عاطفه کریمی 2 ℗
1 هیات علمی

Abstract: Background: Congenital heart disease (CHD), the most common congenital anomaly, affects 5–6 per 1,000 live births. While only 15% of cases have known causes, maternal risk factors—including diabetes, poor nutrition, and hyperhomocysteinemia—are implicated. Hyperhomocysteinemia, which is partly modifiable by folic acid, may disrupt fetal development through oxidative stress and gene dysregulation. Vitamin E, a key antioxidant, is essential during embryogenesis; however, both deficiency and excess have been linked to an increased risk of CHD. This study investigates the association between neonatal serum vitamin E levels and CHD, aiming to clarify its potential etiologic role and inform preventive or therapeutic strategies. Methods: This case-control study, conducted in 2021 at Ayatollah Mousavi Hospital in Zanjan, Iran, compared serum vitamin E levels in 36 neonates with congenital heart disease and 36 healthy controls. Infants aged 1–28 days were included based on clinical and diagnostic criteria. Frequency matching was used for gestational age and sex. Vitamin E levels were measured using HPLC. Data were analyzed with SPSS 26 using appropriate non-parametric tests. Ethical approval and parental consent were obtained by institutional guidelines. Results: This study included 72 neonates (36 with CHD and 36 healthy controls), matched by gestational age (median: 38.0 weeks; P = 0.134) and sex (P = 0.629). No significant differences were observed between groups regarding serum vitamin E levels (7.05 vs. 7.85; P = 0.477), parental consanguinity (8.3% vs. 16.7%; P = 0.478), or maternal disease history (30.6% vs. 25%; P = 0.599). These findings suggest no association between serum vitamin E levels or selected demographic variables and the presence of congenital heart disease. Conclusion: This study found no significant difference in serum vitamin E levels between neonates with congenital heart disease and healthy controls. The findings suggest that vitamin E deficiency is not a major contributing factor to the development of CHD in neonates. Further studies are recommended to clarify the potential role of vitamin E in cardiac embryogenesis. Keywords: Neonates, Congenital heart disease, Ventricular septal defect, Atrial septal defect, Vitamin E 

microcephaly caused by maternal hyperphenylalaninemia
neonatology
سعید انوری 1 © ℗
1 Social Security Organization
Abstract: Maternal hyperphenylalaninemia, most commonly due to phenylketonuria (PKU), can have severe teratogenic effects on the developing fetus if not properly managed. Approximately 1%of patients with PKU may remain clinically asymptomatic even without treatment. this individuals usually have milder forms of the disease, with relatively low levels of phenylalanine in their blood and no severe neurologic damage. One of the most significant neurological outcomes is microcephaly, a condition characterized by an abnormally small head and brain size, often associated with intellectual disability and developmental delay. Phenylketonuria is an autosomal recessive disorder resulting from a deficiency of the enzyme phenylalanine hydroxylase, leading to the accumulation of phenylalanine (Phe) in the blood. While dietary management allows individuals with PKU to lead relatively normal lives, elevated maternal phenylalanine levels during pregnancy can cross the placenta and affect fetal development, even if the fetus does not have PKU. Microcephaly in infants born to mothers with uncontrolled hyperphenylalaninemia is believed to result from the toxic effects of high phenylalanine on brain development. Phenylalanine competes with other large neutral amino acids for transport across the blood-brain barrier, disrupting normal protein synthesis and neurotransmitter production. This disruption is especially harmful during early gestation when the brain is rapidly developing. The severity of microcephaly and other complications, such as congenital heart defects, intrauterine growth restriction, and intellectual disability, is directly related to the level of maternal phenylalanine during pregnancy. Studies have shown that maintaining maternal blood phenylalanine levels between 120–360 μmol/L significantly reduces the risk of microcephaly and other fetal abnormalities. To prevent such outcomes, it is essential that women with PKU follow a strict low-phenylalanine diet before conception and throughout pregnancy. Early diagnosis, regular monitoring, and dietary compliance are crucial for optimal maternal and fetal health. We want to introduce a patient resulting from uncontrolled maternal phenylketonuria. 

Pediatric Sacrococcygeal Teratoma: A 12-Year Clinical Experience from Mofid Children’s Hospital
neonatology
Fatemeh Mahdavi Sabet 1 ℗, Parinaz Alizadeh 2, Noosha Samieefar 3, Zahra Taheri 4, Amir-Hossein Lashkarbolouki 5, Mehdi Sarafi 6 ©
1 School of Medicine, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
2 Neonatal Health Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 Network of Interdisciplinary in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
4 Student Research Committee, Faculty of Pharmacy, Tehran Medical Sciences Branch, Islamic Azad University, Tehran, Iran
5 Student Research Committee, Babol University of Medical Sciences, Babol, Iran
6 Pediatric Surgery Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: Background: Sacrococcygeal teratoma (SCT) is the most common extragonadal germ cell tumor in neonates and infants. While many cases are benign, SCTs can undergo malignant transformation or recur after surgery, posing significant challenges for long-term care. We aimed to review a 12-year experience with pediatric SCT at a single tertiary center in Tehran, Iran, to evaluate outcomes and identify factors associated with recurrence. Method: We reviewed records of 24 pediatric patients who underwent SCT resection between January 2011 and January 2023. Demographic, diagnostic, treatment, and follow-up data were collected. Survival outcomes, including progression-free survival (PFS) and overall survival (OS), were estimated using the Kaplan–Meier method, with group comparisons performed by the log-rank test. Results: Of the 24 patients, 17 (70.8%) were female. The median age at diagnosis was 11 months, and only one case (4.2%) was detected antenatally. Mature teratoma was the most common histology (58.3%), followed by yolk sac tumor (29.2%). Malignancy was significantly associated with late diagnosis (1 year; 54.6% vs. 7.7% in 1 year, p = 0.023). Among 17 patients with follow-up, recurrence occurred in 7 (41.2%), most commonly as yolk sac tumor (71.4%). The median PFS for the entire cohort was 26.4 months. Patients with yolk sac tumors demonstrated a shorter median PFS (9 months) compared with those with mature teratomas (26.4 months), although this difference represented a nonsignificant trend (p = 0.37). Only one patient (4.2%) died during follow-up. Conclusion: Our findings highlight a low antenatal detection rate and a delayed median age at diagnosis in this cohort. Late presentation was strongly associated with malignant SCT. The high recurrence rate and poor prognosis of yolk sac tumors underscore the need for early recognition, complete resection, and vigilant long-term surveillance, recommended for at least three years regardless of initial histology. Keywords: Sacrococcygeal teratoma; Pediatric germ cell tumors; Yolk sac tumor; Pediatric oncology 

Prevalence of Restless Legs Syndrome (RLS) in children with thalassemia major in Ali Asghar Hospital in Zahedan, Iran
neonatology
Saeedeh Yaghoubi 1 ℗, Majid Naderi 2 ©
1 Associate Professor of Pediatric Infectious Disease, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran
2 Professor of Pediatric hematology, School of Medicine,Children and Adolescents Health research center, Research institute of cellular and Molecular Science in Infectious Diseases, Zahedan University of Medical Sciences, Zahedan, Iran.
Abstract: Introduction: Thalassemia major is one of the most debilitating chronic and inherited diseases caused by impaired hemoglobin production. To improve the quality of life in the long-term treatment of thalassemia patients, it is necessary to pay special attention to sleep-related disorders such as restless legs syndrome. The present study, thus, attempts to determine the frequency of restless legs syndrome in children and adolescents with thalassemia major. Methods: This study was performed on 302 patients with thalassemia major with an age range of 5-20 years in Ali Asghar Hospital in Zahedan in 2018. After obtaining the patients’ consent and their information including age, sex, underlying disease, history of drug use, Insomnia, splenectomy, oral and injectable iron depletion, and serum ferritin levels, as well as restless legs syndrome were recorded. Then the data were analyzed by SPSS statistical software. Chi-square and T-test were used to compare the data. Results: The results of this study revealed that the prevalence percentage of Restless Legs Syndrome in children and adolescents with thalassemia major was 17.2%. In addition, it had a direct and significant relationship with vitamin D (p-value=0.008) and calcium (p-value0.001) intake by patients; and it was higher in patients with Insomnia (p-value=0.004). However, there was no significant relationship between this syndrome and the age, underlying disease, the use of cardiac drugs and growth hormone, splenectomy, iron depletion or serum ferritin level. (p-value0.05) Conclusion: Due to the high prevalence of RLS in patients with thalassemia major, especially in patients with a history of vitamin D and calcium intake, screening for RLS is necessary. In this way, taking medical measures can help improving the quality of life among these patients.

Psychological Outcomes of Pediatric Burn Injuries: A Narrative Review
neonatology
مائده امین الرعایا 1 © ℗
1 دانشکده علوم رفتاری و سلامت روان. دانشگاه علوم پزشکی ایران(انستیتو روانپزشکی تهران).تهران.ایران.
Abstract: Introduction Burn injuries are among the most severe traumatic events a child can experience and are a common cause of emergency hospital presentations. Advances in paediatric burn care have improved survival, yet psychological sequelae remain a significant concern. Children and adolescents may experience anxiety, post-traumatic stress, depression, and other emotional or behavioural challenges following a burn. This narrative review aims to synthesize current evidence on the psychological outcomes of paediatric burn injuries and to explore factors influencing mental health post-injury. Methods A literature search was conducted in Informit Health, Medline, Embase, and PsycINFO for studies published between 2010 and 2024 Eligible studies included empirical, peer-reviewed research reporting psychological outcomes of hospitalised children and adolescents (≤18 years) after burn injuries. Both quantitative and qualitative studies were included, with data extraction focusing on mental health diagnoses, anxiety, depression, stress, post-traumatic symptoms, coping, resilience, quality of life, and self-concept. Study quality was appraised using established tools, and findings were synthesized narratively. Findings Forty-five studies met inclusion criteria. Across studies, paediatric burn patients were found to be at elevated risk for psychological difficulties, particularly anxiety and traumatic stress. Younger children, girls, and those with severe burns or greater parental distress were more vulnerable. Qualitative studies highlighted the emotional impact of hospitalization, procedural pain, and scarring, emphasizing both internalizing (e.g., anxiety, withdrawal) and externalizing behaviours (e.g., aggression). Evidence for depression, self-harm, and suicidality was mixed, with fewer studies exploring these domains. Notably, coping strategies, parental support, and access to psychological care were important factors influencing recovery. Discussion and Conclusion Paediatric burn injuries represent a high-risk context for the development of psychopathology. Narrative synthesis suggests that psychological recovery is influenced by child characteristics, burn severity, and family support. Clinical care should integrate psychological assessment and support alongside physical treatment, ideally involving mental health professionals in the care team. Future research should focus on long-term outcomes and under-researched domains such as self-harm, resilience, and quality of life. Overall, this review underscores the importance of holistic aftercare to optimise mental health outcomes in children and adolescents following burn injuries. Keywords: paediatric burns, psychological outcomes, anxiety, post-traumatic stress, coping, resilience

Relationship between Physical Activity and Demographic Factors with Overweight/ Obesity among Adolescents in Yazd, Iran
neonatology
Majid Karandish 1 © ℗, Maryam Azhdari 2, Ali Mohammad Hadianfard 3, Hassan Mozaffari-Khosravi 4
1 Nutrition and Metabolic Diseases Research Center, and Department of Nutrition, School of Allied Medical Sciences, Ahvaz Jundishapur University of Medical Sciences, Ahvaz,
2 Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
3 Department of Health Information Technology, School of Allied Medical Science, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran.
4 Department of Nutrition, School of Public Health, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
Abstract: Introduction: The prevalence of overweight or obesity (OW/OB) has increased dramatically through the globe and is a public health problem in many countries. Understanding the contributing factors can be helpful for effective management of this problem. The aim of present study was evaluating the relationship between physical activity and demographic factors with OW/OB among adolescents in Yazd, Iran. Material and Methods: Participants of this cross-sectional study were 510 students aged 12-16 years in Yazd, Iran. The general information, anthropometric measures and indices, physical activity (PA), and sedentary behaviors (SB) (screen time (ST) and homework time (HT)) were collected by interview based on standard questionnaires. Findings: There was a high prevalence of SB 2h/day (97.6), ST 2h/day (70.3%), overweight or obesity (40%), abdominal obesity (36.9%), physical inactivity (29.8%) among the students. The younger age (p = 0.014), no access to the yard (p 0.001), family size ≤ 2 (p = 0.023), passive transportation (p = 0.001), the highest school days' HT (p = 0.033) and SB (p = 0.021), and the highest weekends' HT among the students were the risk factors for OW/OB. The highest PA level was associated with a lower risk of OW/OB (p 0.001). Compared to the normal weight students, OW/OB spent more time on school days and weekdays for ST (P 0.001), HT (P 0.001, P = 0.005) and SB (P 0.001), respectively. OW/OB students showed a higher weekends' ST (p 0.001) and lower HT (p = 0.048) than normal-weight students. Conclusion: The prevalence of SB, ST, OW/OB, and physical inactivity were common. The school days and weekends' HT, the school days' SB and HT, age, PA, and access to the yard, family size, and passive transportation were related to the greater chances of OW/OB among the students. Keywords: Physical activity, demographic factors, overweight, obesity, adolescents. 

The Impact of War Trauma on the Mental Health of Children with Asthma: A Systematic Review 
neonatology
مائده امین الرعایا 1 © ℗
1 دانشکده علوم رفتاری و سلامت روان. دانشگاه علوم پزشکی ایران(انستیتو روانپزشکی تهران).تهران.ایران.
Abstract: Introduction War is a major stressor for children, with profound effects on those with chronic respiratory conditions such as asthma. Factors associated with conflict, including psychological stress, inadequate hygiene, and exposure to polluted environments, increase the risk of allergic diseases and exacerbate existing respiratory conditions. Limited and delayed access to medical care further worsens these challenges¹. Substandard shelters, overcrowding, insufficient resources, and poor sanitation contribute to deteriorating health. Children with asthma are particularly vulnerable to these conditions and stress, placing them at higher risk of exacerbations and complications. Identifying children with uncontrolled or undiagnosed asthma is critical to implement preventive strategies and targeted management to reduce disease progression². Delayed diagnosis, severe asthma cases, frequent exacerbations, and comorbidities may reflect the negative impact of conflict. Limited access to healthcare and medication shortages are directly linked to wartime conditions¹. Objective This study aimed to examine the impact of war-related trauma on the physical and mental health of children, particularly those with asthma, and to assess the association between armed conflict and the worsening of chronic respiratory and psychiatric conditions. Environmental and familial factors influencing health deterioration were also evaluated. Methods This systematic review included 38 studies examining the effects of war on asthma and mental health in children. An initial search identified 124 articles, of which 38 met inclusion and quality criteria. Both qualitative and quantitative studies reporting respiratory and psychological outcomes were included. Data were extracted from PubMed, Web of Science, Scopus, and other databases. Articles were selected based on relevance, scientific quality, and inclusion criteria. Keywords included Asthma, Children, War / Armed conflict, and Mental health. Findings Asthma prevalence in shelters was approximately 8.5%, consistent with ISAAC and WHO-GARD estimates². Children with uncontrolled asthma had poor quality of life, low inhaled corticosteroid use, and incorrect inhaler technique. War and displacement exposed children to new triggers, including odors, secondhand smoke, stress, and chemicals. Nighttime symptoms were the most sensitive asthma indicator; 44.2% of undiagnosed children reported nocturnal symptoms, and 35.1% showed PTSD signs². Additional risk factors included indoor cooking, PM2.5 exposure, cleaning agents, secondhand smoke, and poverty². Conclusion War-related trauma adversely affects asthma control and mental health in children, increasing the risk of psychiatric disorders and functional impairments. Family support, medical access, and environmental management can mitigate these effects. Comprehensive psychosocial and educational programs for children with asthma in conflict zones are urgently needed.

The Missing Data: Why We Need Better Information on NK Cell Therapy for Kids with GVHD
neonatology
Zahra Taghinejad 1 © ℗
1 Phd candidate of hematology and transfusion medicine, department of hematology and transfusion medicine, faculty of medical sciences, Tarbiat modares university. Tehran, Iran
Abstract: Background: Allogeneic hematopoietic cell transplantation (HCT) is a curative intent therapy for many pediatric life-threatening conditions but is significantly limited by graft-versus-host disease (GVHD). Natural Killer (NK) cell-based immunotherapy represents a promising frontier for preventing or treating GVHD, yet the landscape of dedicated pediatric clinical research in this area remains poorly defined. Methods: To evaluate the clinical trial activity for NK cell therapies in pediatric GVHD, we conducted a comprehensive search of ClinicalTrials.gov on July 5, 2025. We identified interventional studies specifically investigating NK cell infusions for GVHD in pediatric populations. Results: Our initial search yielded only four international trials. Upon detailed review of eligibility and enrollment data, one study was excluded for lacking pediatric participants. Of the three remaining trials that enrolled pediatric patients, none had resulting data publicly available on ClinicalTrials.gov or through published manuscripts on PubMed or google scholar. This critical gap prevents any assessment of safety, efficacy, or feasibility outcomes for NK cell therapy in this vulnerable population. Conclusion: There is a profound scarcity of clinical research and a critical lack of data reporting for NK cell therapies in pediatric GVHD. The absence of publicly available results from completed trials severely hinders scientific progress and clinical application. This review highlights this urgent unmet need and calls for a concerted effort to prioritize robust, well-reported pediatric trials and ensure the timely dissemination of their findings to guide future therapeutic strategies.

The Role of Artificial Intelligence in Telemedicine for Children with Chronic Diseases: A Narrative Review
neonatology
Aryan Shhini 1 ©, Samaneh Naeimi 2 ℗, Ferial Salehnia 3
1 Student Research Committee, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, Iran,
2 Dept. of Psychiatric Nursing, Abadan University of Medical Sciences, Abadan, Iran
3 Student Research Committee, Abadan University of Medical Sciences, Abadan, Iran
Abstract: Background: Chronic diseases remain the leading cause of mortality worldwide, accounting for over 74% of global deaths. Children suffering from chronic conditions, along with their families, represent a particularly vulnerable population facing numerous challenges throughout the disease trajectory. According to the World Health Organization, approximately 15% of children globally are affected by various chronic illnesses, significantly impacting their quality of life. The treatment and rehabilitation of these children is a long-term process, necessitating continuous monitoring even after hospital discharge. In this context, telemedicine has emerged as an innovative approach to provide timely, remote care. The integration of Artificial Intelligence (AI) into pediatric nursing has further enhanced the effectiveness of telemedicine by enabling personalized treatment recommendations and real-time decision support. This review aims to explore the applications of AI in telemedicine for children with chronic illnesses. Methods: This narrative review synthesized published studies on the applications and challenges of AI in telemedicine. A comprehensive literature search was conducted using PubMed, Scopus, and Google Scholar databases for articles published since 2022. The search strategy included keywords such as "artificial intelligence," "telemedicine," "pediatrics," "AI," and "chronic diseases." result: The reviewed studies revealed that AI contributes significantly to three major domains: monitoring, clinical guidance, and assistance. AI algorithms, through the analysis of remote monitoring data, facilitate more accurate assessments, predict disease trajectories, and enable individualized treatment plans. The implementation of AI-driven telehealth technologies has shown promising outcomes in managing conditions such as stuttering, autism, cerebral palsy, type 1 diabetes, cancer, and hematologic disorders. Reported benefits include improvements in physical and psychological outcomes, enhanced self-care capabilities, reduced parental anxiety, and an overall better quality of life for pediatric patients. Conclusion: Despite the limited number of studies in this field, existing evidence suggests that AI plays a pivotal role in enhancing remote care for children with chronic diseases. As AI technology continues to advance, its integration into pediatric healthcare services holds the potential to significantly improve care quality, expand access to specialized services, and support families in managing complex conditions more effectively. Keywords: Artificial Intelligence; Telemedicine; Pediatrics; AI; Chronic Diseases

Urinary Neutrophil Gelatinase‑Associated Lipocalin as Prognostic Biomarker in Pediatric Idiopathic Nephrotic Syndrome 
neonatology
Mahboube Bahroudi 1 ℗, Noosha Samieefar 2, Omid Ghaderi 1, Alireza Irani 3, Mastaneh Moghtaderi 1 ©
1 Pediatric Chronic Kidney Diseases Research Center, Gene, Cell & Tissue Research Institute, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
2 Network of Interdiscplinarity in Neonates and Infants (NINI), Universal Scientific Education and Research Network (USERN), Tehran, Iran
3 Shahid Beheshti University, Tehran, Iran
Abstract: Background: Idiopathic nephrotic syndrome (INS) is the most common childhood glomerular disorder. Neutrophil gelatinase‑associated lipocalin (NGAL) has shown promising results in predicting steroid response in nephrotic patients. This study aims to determine urinary NGAL level sensitivity and specificity in children with INS, as a prognostic factor for predicting steroid response. Materials and Methods: In this case-control study, 83 nephrotic children from one to fifteen years old were enrolled, from January 2021 to January 2022. Urine samples were collected in the first episode or relapse of nephrotic syndrome, prior to steroid or alternative treatments. NGAL level was measured by ELISA according to the manufacturer's instructions. Results: Of the 83 patients, 21 (25.6%) developed steroid resistance. According to the results of this study, a statistically significant relationship was observed between urinary NGAL level and corticosteroid resistance (p-value0.05), and the NGAL/Cr level with a cut-off point of 13.6, with a sensitivity of 90.4% and a specificity of 73.5% is in favor of corticosteroid resistance. Conclusion: The higher level of urinary NGAL/Cr is associated with the level of resistance to corticosteroids in nephrotic syndrome, and as its level increases, the probability of response to corticosteroids in this disease decreases. 

Vestibular disorders in children with otitis media 
neonatology
عطیه یامی 1 © ℗
1 دانشجوی کارشناسی ارشد شنوایی شناسی دانشگاه علوم پزشکی تهران
Abstract:

 مقدمه: اوتیت میانی یکی از شایع‌ترین بیماری‌های دوران کودکی است که می‌تواند علاوه بر تأثیرات شنوایی، عملکرد سیستم دهلیزی و تعادل را نیز تحت‌تأثیر قرار دهد. اختلالات تعادلی ناشی از اوتیت میانی، به‌ویژه در مراحل حساس رشد حرکتی کودک، ممکن است منجر به تأخیر در مهارت‌های حرکتی درشت، عدم تعادل، و ناتوانی در هماهنگی حرکات شود. با وجود شیوع بالای این بیماری، نقش آن در بروز اختلالات تعادلی کمتر مورد توجه قرار گرفته است. روش بررسی: این مطالعه به روش مرور روایتی (Narrative Review) انجام شد. مقالات منتشرشده در پایگاه‌های PubMed، Scopus، Embase و Google Scholar بین سال‌های 2000 تا 2024 مورد بررسی قرار گرفتند. کلیدواژه‌های مورد استفاده شامل" Vestibular disorders in children ", "otitis media in children "بودند. پس از ارزیابی کیفیت، 38 مقاله جهت تحلیل نهایی انتخاب گردید. یافته‌ها: بررسی‌ها نشان می‌دهند که کودکان مبتلا به اوتیت میانی (به‌ویژه نوع افیوژن‌دار) ممکن است دچار اختلال عملکرد موقتی یا مزمن در سیستم وستیبولار شوند. این وضعیت می‌تواند موجب ناپایداری در تعادل، اشکال در راه رفتن، حرکات ناهماهنگ، و حتی افزایش احتمال زمین خوردن شود. آزمون‌هایی نظیر vHIT، VEMP، و آزمون تعادل پویای کودک (Pediatric Balance Scale) در تشخیص این اختلالات مؤثر هستند. اختلالات تعادلی معمولاً هم‌زمان با اختلال شنوایی هدایتی مشاهده می‌شوند و در موارد مکرر اوتیت، تأثیر بیشتری بر رشد حرکتی کودک می‌گذارند. بحث: اوتیت میانی، به‌ویژه در نوع مزمن یا با افیوژن مکرر، می‌تواند موجب کاهش تحریک دهلیزی شده و اثر منفی بر سیستم تعادلی داشته باشد. این اختلالات تعادلی ممکن است خفیف و گذرا یا مزمن و پایدار باشند. در کودکان خردسال که در مراحل کلیدی تکامل حرکتی قرار دارند، چنین نوساناتی در عملکرد وستیبولار می‌تواند آثار طولانی‌مدت بر هماهنگی و فعالیت‌های روزمره داشته باشد. درمان دارویی یا جراحی اوتیت (مانند قرار دادن لوله تهویه) در برخی موارد می‌تواند موجب بهبود تعادل شود، هرچند ارزیابی و مداخلات توانبخشی برای بازیابی عملکرد تعادلی نیز ضروری است. نتیجه‌گیری: اختلالات تعادلی ناشی از اوتیت میانی، یک پیامد کمتر شناخته‌شده اما بالینی مهم است که می‌تواند بر رشد حرکتی و کیفیت زندگی کودکان تأثیر بگذارد. غربالگری تعادل در کودکان مبتلا به اوتیت مکرر یا مزمن باید به عنوان بخشی از ارزیابی بالینی در نظر گرفته شود. همکاری میان پزشکان گوش و حلق و بینی و کودکان، شنوایی‌شناسان و فیزیوتراپیست‌های کودکان می‌تواند در شناسایی زودهنگام و درمان به‌موقع این اختلالات مؤثر باشد.

what is REM behavior disorder?
neonatology
Khatereh Khamenehpour 1 © ℗
1 Qazvin univesity of mrdical science , Qazvin , IRAN
Abstract: Sleep is divided into four stages: Stages 1, 2, REM sleep, and REM sleep.In REM sleep, there are rapid eye movements, but the body is paralyzed and only the diaphragm muscle is active.While the brain is active, you dream even if you don't remember it in the morning.If during this stage of sleep you act out your dream like an actor and make physical movements, you are suffering from REM behavior disorder.Children under the age of three are unable to describe their dreams, so this rare disease is more commonly diagnosed in children over the age of three.To diagnose this disease, you must use an online polysomonogerphy test.With a sleep test, increased muscle tone during REM sleep and a video of the person's movements during REM sleep can be seen, and the disease can be definitively diagnosed.Diagnosing this rare disease in children is very important because this disease in children is secondary to brain disorders such as brain tumors and multiple sclerosis in children, or hereditary and acquired neurodegenerative brain diseases.In addition to treating the underlying causes, medications that suppress sleep can also be used for treatment. However, these symptoms may be symptoms of the underlying disease Therefore, the doctor's accuracy in diagnosing the disease and referring the child to a pediatric sleep fellowship for sleep testing will be lifesaving for the child. 

Investigating the rational use of intravenous immunoglobulin (IVIG) in Tabriz Children's Hospital: : A Cross-Sectional Study
Immunology
Forouzan Abbasgholizadeh 1 ℗, Afshin Qarekhani 2 ©, Zana Zarei 2, Mahnaz Sadeghi Shabestari 2
1 Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran./ Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz, Iran.
2 Department of Clinical Pharmacy, Faculty of Pharmacy, Tabriz University of Medical Sciences , Tabriz, Iran.
Abstract: Introduction: Intravenous immunoglobulin (IVIG) plays a controversial role in the treatment of various types of diseases. Therefore, careful examination of its consumption pattern is necessary due to not only its limited resources and high prices, but also repeated non-approved uses without sufficient clinical evidence. Unfortunately, there is not enough information about its use in Iran, particularly in the field of children. Objectives:The present study was designed to examine the pattern of IVIG use in patients admitted to one of the university centers (Tabriz Pediatric Hospital). Additionally, the data were compared to the International standard guidelines. Method: This descriptive study was conducted in a cross-sectional and prospective methodology. Patients who received IVIG from December 2023 to May 2024 were selected from different departments of Tabriz Children Hospital and enrolled the study. The information collected in this study include patient demographics, indications, drug use regimen, side effects and prescribing specialists. According to standard guidelines the user IVIG in this study was in three main groups, FDA approved, Off-labeled with support and Off-labeled without support. Results: Among 117 included patients with the mean age of 7 years old, IVIG was given to 79 patients (67.5%) by FDA approved indications. Furthermore, 2356.5g IVIG was used during this study with an estimated cost of 3534750000 Iranian Rials, whereas 4% of which related to inappropriate indications. Immunologists (53%) and neurologists (22.2%) were the most frequent prescribers, and the leading indications for IVIG use was Primary immunodeficiency (47.8%). Moreover, 6.8% of patients experienced systemic adverse reactions during IVIG administration. Conclusion: Although, the major use of IVIG in this study has been according to the standard guidelines, but in limited cases it was prescribed for inappropriate indications. Therefore, it seems that regional collaborative strategy to monitor IVIG use according standard protocol in institutes is necessary. Keywords: Intravenous Immunoglobulin, Rational prescription, Drug Use Evaluation

Immunization data management by use of electronic registration system in Iran
Immunology
Seyed Mohsen Zahraei 1 © ℗, Parisa Hodaei 2
1 Center for Communicable Disease Control, Ministry of Health and Medical Education, Tehran, Iran
2 Private Clinic
Abstract: In 1983, the National Immunization Committee was established within the Ministry of Health. By 1984, vaccination became an integral part of the country's Primary Health Care (PHC) network. Although childhood vaccination existed before the Islamic Revolution, there was no organized system to ensure equal access for all children. In 1984, the national immunization coverage stood at only 35%. However, through organized planning, investment in infrastructure, and the recruitment and training of human resources, vaccination coverage rapidly increased. By 1993, over 95% of children had received the third dose of the DTP vaccine. Iran has a century-long history of vaccine production. The Pasteur Institute of Iran and the Razi Vaccine and Serum Research Institute, have produced a lot of EPI vaccines including BCG and hepatitis B, OPV, Measles, Measles-Rubella, Measles-Mumps-Rubella, DT, and Td. Currently, over 18,340 health houses in rural areas and about 7,000 urban health posts provide vaccination services throughout the week. Through the maternal tetanus vaccination program and the promotion of safe deliveries, Iran achieved neonatal tetanus elimination status in 1995. Prior to this, neonatal tetanus accounted for one-quarter of all neonatal deaths. The establishment of electronic health systems and internet access for health houses in rural areas has been a significant step toward enhancing public health programs. All services provided at urban and rural health centers are now recorded in children's electronic health records. This has enabled more accurate and efficient management of immunization data. Cases of delayed attendance (over three days) are identified through the electronic system, and follow-up phone calls are made to families to encourage timely visits. However, the existence of multiple platforms (SIB, SINA, NAB, and PARSA) without proper integration has complicated program monitoring. Currently, efforts are underway to develop a unified and cohesive network. In 2024, a dedicated software system for managing health network equipment and assets—including all administrative and technical tools, such as cold chain equipment—was implemented. The system requires regular and accurate data entry. Using the information collected through this platform, the modernization and upgrading of the cold chain can be carried out with greater precision. 

Assessment of the Diagnostic Value of Major Cardiac Defects through Ultrasound in the First Trimester and Its Correlation with Increased Nuchal Translucency, Tricuspid Regurgitation, and Abnormal Ductus Venosus Flow
cardiology
Enayatollah Noori 1 ℗, Abotaleb Mohammadi 1 ©
1 Department of Pediatrics, School of Medicine, Hazrat-e Fateme Masoume Hospital, Qom University of Medical Sciences, Qom, Iran
Abstract: Congenital heart defects (CHDs) are a leading cause of mortality and morbidity in neonates. Early detection is crucial for timely intervention and improved outcomes. This study investigated the diagnostic value of first-trimester ultrasound in detecting CHDs and its correlation with increased nuchal translucency (NT), tricuspid regurgitation (TR), and abnormal ductus venosus (DV) flow. Methods: This cross-sectional study included all pregnant women who underwent first-trimester screening ultrasound between 2017 and 2024 by an obstetrician or radiologist at Forghani Hospital and were referred for fetal echocardiography at 16-18 weeks gestation at Hazrat Masoumeh Hospital, Qom, Iran. All cases underwent postnatal neonatal echocardiography. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of increased NT, TR, and abnormal DV flow in detecting CHDs were calculated. Results: The sensitivity, specificity, PPV, and NPV of increased NT for detecting CHDs were 74.7%, 98.3%, 90.9%, and 94.7%, respectively. For TR, these values were 71.9%, 97.7%, 87.5%, and 94.1%, respectively. For abnormal DV flow, the values were 82.2%, 95.1%, 78.5%, and 96.1%, respectively. The diagnostic accuracy of NT, TR, and abnormal DV flow for detecting CHDs was 94.1%, 93.1%, and 92.8%, respectively. Conclusion: Targeted fetal ultrasound in the first trimester is a valuable diagnostic tool for detecting CHDs. Early detection can contribute to improved neonatal outcomes.

Dilated Coronary Sinus without LSVC Due to Direct Tricuspid Regurgitation Jet
cardiology
Mojtaba Gorji 1 © ℗
1 pediatric cardiology departement , CMC of excellence , TUMS
Abstract: Dilated Coronary Sinus without LSVC Due to Direct Tricuspid Regurgitation Jet: A Pediatric Case Report Gorji Mojtaba , Pediatric cardiologist in TUMS,Children's Medical Center of Excellence Abstract We present the case of a child with a dilated coronary sinus (CS) in the absence of a persistent left superior vena cava (LSVC) and without anomalous pulmonary venous drainage into the CS. No tricuspid stenosis or significant right atrial hypertension was noted. Echocardiography demonstrated that the direct impact of the tricuspid regurgitation (TR) jet onto the CS orifice accounted for the marked CS dilatation. This case highlights an unusual mechanism of CS enlargement in pediatric patients. Case Presentation A 6m old boy with murmur was referred for evaluation of possible congenital heart disease. Transthoracic echocardiography revealed a markedly dilated coronary sinus without evidence of LSVC or anomalous pulmonary venous connection to the CS. There was no tricuspid stenosis and no elevation of right atrial pressure. Color Doppler and spectral imaging showed moderate-to-severe tricuspid regurgitation with the regurgitant jet directly striking the CS orifice. Imaging Findings - Echocardiography: Dilated CS , no LSVC seen; normal pulmonary venous return; TR jet directed toward CS ostium. Discussion Coronary sinus dilatation is most commonly caused by LSVC and then elevated right atrial pressure or anomalous venous return. In this case, none of these etiologies were present. Instead, the direct mechanical effect of a tricuspid regurgitant jet on the CS ostium likely produced the dilatation. Awareness of this rare mechanism is important to avoid misdiagnosis of LSVC or other anomalies. Conclusion This case underscores an unusual cause of CS dilatation in the pediatric population, emphasizing the role of careful echocardiographic assessment to identify hemodynamic rather than anatomical causes. Keywords Coronary sinus dilatation, tricuspid regurgitation, LSVC, pediatric cardiology, echocardiography 

Evaluation of the relationship between Left Ventricular Cardiac Output and subsequent neurodevelopment in neonates with hypoxic ischemic encephalopathy admitted to Educational and treatment hospitals in Qom 2022
cardiology
سارا افشاری 1 ℗, مسعود حسن وند عموزاده 2 ©, ابوطالب محمدی 3, نرگس کلهر 4
1 Department of Dermatology, School of Medicine, Iran University of Medical Sciences (IUMS), Tehran, Iran
2 Department of Pediatrics, Neuroscience Research Center, School of Medicine, Qom University of Medical Sciences, Qom, Iran.
3 Department of Pediatric Cardiology, Qom University of Medical Sciences, Qom Iran.
4 1Otorhinolaryngology Research Center, Amir Alam Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Abstract:

 زمینه تحقیق: دوران انتقال از زندگی داخل رحمی به زندگی خارج رحمی می‌تواند با دوره‌های هیپوکسی یا ایسکمی همراه شود که منجر به اختلال چند سیستمی از جمله سیستم عصبی و قلبی و عروقی می‌شود. شواهد اولیه از اختلال عملکرد میوکارد در نوزادان مبتلا به آسفالوپاتی هیپوکسیک ایسکمیک (HIE) به دنبال آسیب هیپوکسیک-ایسکمیک ممکن است نشانگری برای خطر بیشتر آسیب عصبی شدید در آینده باشد و تشخیص مشکلات قلبی می‌تواند در پیش‌بینی عوارض عصبی و تکامل بلندمدت بیماران مؤثر باشد. هدف: در این مطالعه ما ارتباط شاخص‌های اکوکاردیوگرافی به خصوص برون‌ده قلبی بطن چپ با تکامل عصبی متعاقب در نوزادان مبتلا به آسفالوپاتی هیپوکسیک ایسکمیک را بررسی کردیم. روش مطالعه: در این مطالعه نوزادان مبتلا به HIE بستری شده در بیمارستان‌های آموزشی-درمانی شهر قم در ساعت اول تولد تحت اکوکاردیوگرافی قرار گرفته و شاخص‌های قلبی بررسی شدند. سپس وضعیت تکاملی کودکان با پرسشنامه ASQ-3 در ۲، ۴ و ۶ ماهگی در پنج حیطه سنجیده شد. پس از جمع‌آوری اطلاعات، آنالیز آماری بر روی نتایج به‌دست آمده انجام شد. نتایج: در این مطالعه ۶۶ نوزاد پسر (۷۱.۷ درصد) و ۲۶ نوزاد دختر (۲۸.۳ درصد) مورد بررسی قرار گرفتند. میانگین سن مادران ۵.۶ سال و میانگین سن حاملگی ۳۶.۹۱ ± ۲.۵ هفته بود. میانگین وزن نوزادان ۲۸۲۹.۹ گرم بود. میانگین AV در نوزادان مورد مطالعه ما ۷.۱۴ میلی‌متر، میانگین AOVTI 11.9 سانتی‌متر، میانگین ضربان قلب ۱۳۲ ،LVEF 56 درصد و میانگین TAPSE 1.22 سانتی‌متر بود. در بررسی پنج حیطه ASQ، بیشترین میزان ارجاع در نوزادان در دو ماهگی در حیطه حرکات ظریف، در چهار ماهگی در حیطه برقراری ارتباط و در شش ماهگی در حیطه حرکات ظریف بوده است. همچنین در مطالعه ما نتایج نشان داد که خروجی بطن چپ به تفکیک حیطه‌های ASQ در ۴ و ۶ ماهگی در کودکان مبتلا به HIE کمتر از سایر گروه‌ها بود. نتیجه‌گیری: مطالعه ما در نوزادان مبتلا به HIE تغییرات شاخص‌های اکوکاردیوگرافی را نشان می‌دهد و این تغییرات در پیش‌بینی تغییرات تکاملی این نوزادان مؤثر می‌باشد و نشان‌دهنده نقش این یافته‌ها در درک بهتر درگیری قلبی در نوزادان مبتلا به HIE می‌باشد. کلیدواژه‌ها: آسفالوپاتی هیپوکسیک ایسکمیک، آسیب عصبی، برون‌ده قلبی بطن چپ

The Role of Artificial Intelligence in Diagnosis and Prognosis of Kawasaki Disease: A Cross-Sectional Study in Mashhad, Iran
cardiology
Zinat Heidari 1 © ℗, Abrorreza Malek 2
1 Department of Clinical Pharmacy, Mashhad University of Medical Science, Mashhad, Iran
2 Department of Pediatrics, Mashhad University of Medical Science, Mashhad, Iran
Abstract: Introduction: Kawasaki Disease (KD) is a leading cause of pediatric acquired heart disease globally, with diagnostic challenges and unpredictable prognosis. Early detection and risk stratification are critical to prevent complications. Recent advancements in Artificial Intelligence (AI) offer promising tools for enhancing diagnostic accuracy and prognostic assessment. This study aims to evaluate the application of AI algorithms in diagnosing KD and predicting its outcomes in a tertiary hospital setting. Materials and Methods: This retrospective cross-sectional study included 250 children diagnosed with KD at Akbar Hospital, Mashhad, Iran, between 2018 and 2023. Demographic, clinical, laboratory, and echocardiographic data were collected. AI models, including machine learning classifiers such as Random Forest, Support Vector Machine, and Neural Networks, were trained to recognize patterns associated with KD diagnosis and to predict cardiac complications such as coronary artery dilation. Data was split into training and testing sets (70/30), with model performance evaluated using accuracy, sensitivity, specificity, and area under the ROC curve. Results: The AI models demonstrated high diagnostic accuracy, with the Neural Network achieving an accuracy of 92%, sensitivity of 90%, and specificity of 93%. For prognosis prediction, models successfully identified children at higher risk of coronary artery involvement with an accuracy of 88%. Key clinical and laboratory variables influencing AI predictions included elevated C-reactive protein, erythrocyte sedimentation rate, and serum sodium levels. The models outperformed traditional diagnostic criteria in sensitivity and allowed for early risk stratification. Conclusion: AI algorithms show significant potential in improving the accuracy and timeliness of Kawasaki Disease diagnosis and prognosis prediction. Implementing AI-based tools in clinical practice could enhance early detection, enable personalized treatment plans, and reduce cardiovascular complications. Further prospective studies are warranted to validate these findings and facilitate integration into routine pediatric care.

Serum Vitamin B12, Vitamin D, and Zinc Status in Pediatric Diabetes and Their Association with Diabetic Retinopathy: A Narrative Review
endocrinology
Hossein Hosseini 1 © ℗
1 Student Research Committee, Urmia University of Medical Sciences, Urmia, Iran
Abstract: Background: Diabetic retinopathy (DR) is a leading microvascular complication of diabetes mellitus and is increasingly seen in children and adolescents due to rising rates of type 1 (T1DM) and type 2 diabetes (T2DM). Micronutrients such as vitamin B12, vitamin D, and zinc are essential for retinal vascular integrity, oxidative stress regulation, and homocysteine metabolism. Deficiencies in these nutrients have been implicated in DR pathophysiology in adults, but pediatric data are limited and inconsistent. This review summarizes current evidence on serum vitamin B12, vitamin D, and zinc in pediatric diabetes and their links to DR. Methods: A systematic search was conducted in PubMed, Scopus, and Web of Science for studies published from January 2000 to April 2025. Search terms were applied to titles and abstracts combining “Type 1 Diabetes Mellitus,” “Type 2 Diabetes Mellitus,” or “Pediatric Diabetes” with “Vitamin B12,” “Vitamin D,” or “Zinc,” and “Diabetic Retinopathy.” Studies were eligible if they included participants younger than 18 years with T1DM or T2DM, reported serum measurements of at least one of the micronutrients, and assessed DR using established diagnostic criteria. Exclusions were the absence of serum biomarker data, lack of DR assessment, non-human studies, case reports, and reviews. Two reviewers independently screened records; of 312 identified, 27 were reviewed in full, and 11 met all criteria. Results: Current evidence on micronutrients and DR in pediatric diabetes is limited but growing. Most studies report high prevalence of vitamin D deficiency in children with diabetes, with some linking low levels to early retinal changes, though findings are inconsistent. Vitamin B12 deficiency may increase microvascular risk via elevated homocysteine and oxidative stress, but pediatric data are sparse. Evidence on zinc is mixed, with some studies showing antioxidant and anti-angiogenic effects, while others find no association. Heterogeneity in diagnostic criteria, assays, and populations likely contributes to inconsistent results. Conclusion: Available literature suggests a possible but incompletely defined role of vitamin B12, vitamin D, and zinc deficiencies in pediatric DR. Larger, longitudinal studies with standardized definitions and confounder adjustment are needed. Until then, routine monitoring and timely correction of these micronutrients may be a reasonable preventive approach.

Pelvic Floor Biofeedback Therapy in Pediatric Voiding Disorders: A Literature-Based Review of Efficacy and Clinical Integration
Nephrology
Nastaran Maghbouli 1 © ℗
1 Tehran university of medical sciences
Abstract: Background: Voiding disorders, including dysfunctional voiding and bladder-bowel dysfunction (BBD), represent a significant portion of pediatric urology referrals. These conditions, often rooted in pelvic floor dyssynergia, can lead to urinary incontinence, recurrent urinary tract infections, and psychosocial distress. Pelvic floor biofeedback therapy has emerged as a non-invasive, behaviorally oriented intervention aimed at retraining pelvic floor musculature and improving voiding dynamics. Objective: To evaluate the current evidence supporting pelvic floor biofeedback therapy in the management of pediatric voiding disorders and to identify best practices for clinical implementation. Methods: A structured literature review was conducted using PubMed, Scopus, and Web of Science databases. Studies were included if they assessed biofeedback-assisted pelvic floor muscle training in children aged 4–16 years with non-neurogenic voiding dysfunction. Outcomes of interest included symptom resolution, urodynamic improvement, and patient adherence. Results: Twelve studies met inclusion criteria, with moderate methodological quality (mean PEDro score: 5.3). Biofeedback therapy, when combined with behavioral modification and pelvic floor physical therapy, demonstrated significant improvements in urinary continence, reduction in post-void residuals, and normalization of uroflow patterns2. A randomized trial by Jacobsen et al. showed that biofeedback-assisted pelvic floor muscle training led to sustained symptom relief and improved quality of life metrics in children with dysfunctional voiding3. Importantly, biofeedback alone was less effective than when integrated into a multidisciplinary approach. Conclusion: Pelvic floor biofeedback therapy is a valuable adjunct in the treatment of pediatric voiding disorders, particularly when embedded within a structured, multidisciplinary care model. While further high-quality randomized trials are needed, current evidence supports its integration into standard practice for children with non-neurogenic dysfunctional voiding and BBD. References: 1. Ladi-Seyedian et al. Current Urology Reports, 2019. Review of pelvic floor physical therapy vs. biofeedback 2. Tremback-Ball et al. Journal of Pediatric Rehabilitation Medicine, 2018. Systematic review on biofeedback in BBD 3. Jacobsen et al. Journal of Pediatric Urology, 2021. Efficacy of biofeedback-assisted pelvic floor training 

Treatment of hypernatremia
Nephrology
Zahra Pournasiri 1 © ℗
1 Zahra Pournasiri,Associate professor of Pediatric Nephrology,Pediatric Nehrology Research Center,Research Institute for Children's Health,Shahid Beheshti University of Medical Sciences,Tehran,Iran
Abstract: **Management of Hypernatremia in Children: A Contemporary Perspective** Hypernatremia, defined as a serum sodium level above 145–150 mmol/L, poses significant risks in pediatric patients, particularly infants and those with limited access to fluids ([Royal Children's Hospital][1], [Medscape][2]). In children, it is frequently hospital-acquired and arises from insufficient free-water availability, gastrointestinal losses, or underlying illnesses ([Medscape][2], [Royal Children's Hospital][1]). **Initial Stabilization:** Immediate resuscitation with isotonic fluids (e.g., 0.9% NaCl) is crucial for restoring circulating volume and perfusion ([BioMed Central][3], [Medscape][4]). Once hemodynamic stability is achieved, the correction of hypernatremia must proceed cautiously to avoid cerebral edema and neurological sequelae ([NCBI][5], [Royal Children's Hospital][1], [BioMed Central][3]). **Calculating Water Deficit:** Estimation of free-water deficit is typically based on total body water (\~60% of body weight in children) and the serum sodium target (\~145 mEq/L), using established formulas ([Medscape][4], [NCBI][5]). **Fluid Strategies and Correction Rate:** Fluid choice depends on the scenario: * Hypotonic fluids (e.g., 0.45% or 0.2% NaCl or dextrose-containing solutions) are preferred for gradual sodium reduction ([Medscape][4], [BioMed Central][3]). * In cases of sodium overload, sodium-free solutions such as 5% dextrose or loop diuretics may be indicated ([Medscape][4]). Historically, guidelines have recommended limiting sodium reduction to less than 0.5 mEq/L per hour—or 10–12 mEq/L per day—to minimize cerebral edema risk ([Royal Children's Hospital][1], [Medscape][4], [NCBI][5]). Close monitoring of sodium levels every 2–4 hours is advised ([NCBI][5], [Royal Children's Hospital][1]). **Emerging Evidence on Correction Speed:** A large, recent retrospective cohort study from a pediatric center in Melbourne examined 358 children (402 hypernatremia episodes). It found that more rapid correction (0.5 mmol/L per hour) was not associated with increased neurological complications, cerebral edema, seizures, or mortality. Interestingly, slower correction was linked to longer hospital stays ([PMC][6], [PubMed][7], [Lippincott Journals][8]). **Special Population – Neonates:** In neonates with significant hypernatremic dehydration (e.g., serum sodium 150 mEq/L), a prospective observational study (2025) implemented a standardized protocol using saline resuscitation followed by maintenance fluids tailored to the sodium level. Time to normalization varied by severity, ranging from under 48 hours to up to 6 days; neurological outcomes were favorable with only one seizure reported, and normal development after follow-up ([Brieflands][9]). **Conclusion:** In pediatric hypernatremia, management must balance careful correction of sodium with restoration of volume. Traditional guidance advocates slow correction, but recent evidence suggests that 

Intestinal Parasitic Infections among Immunocompromised and Healthy Children in Iran
Infectious
Mohammad Taghi Ahady 1 © ℗, Maedeh Rahimi Khademlou 2, Asma Irani 2, Roghayyeh Jahani Janiyar 2, Bahereh Rasooli 2, Aylin Mosavi 2
1 PhD of Medical Parasitology, Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
2 Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
Abstract: Introduction: Intestinal parasitic infections represent a significant source of morbidity among pediatric populations in developing nations, particularly among immunocompromised individuals, where the progression of the disease often manifests in severe and occasionally life-threatening forms. The heterogeneous geography and socio-economic factors prevalent in Iran contribute to disparate patterns of infection among children exhibiting immune deficiencies. The main objective of this study was to determine the prevalence of intestinal parasitic infections among immunocompromised and healthy children under 15 years of age in Iran. Methods: Following PRISMA guidelines, a systematic search was conducted across PubMed, Scopus, SID, Iran Medex, and Web of Science for research articles published from 2010 to 2025, utilizing search terms such as “intestinal parasites,” “immunocompromised children,” “Iran.” and names of specific protozoa and helminths. A total of fifty-seven studies focusing on immunocompromised children and forty-five studies on healthy children fulfilled the inclusion criteria and were subsequently analyzed. Results: Immunocompromised pediatric populations—specifically those exhibiting selective IgA deficiency, common variable immunodeficiency (CVID), severe combined immunodeficiency (SCID), human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS), nephrotic syndrome, and those undergoing organ transplantation—demonstrated a significantly elevated prevalence of intestinal parasitic infections in comparison to their healthy counterparts. The most frequently identified parasites included Giardia lamblia (28–45% in immunocompromised individuals versus 10–15% in healthy children), Cryptosporidium spp. (18–38% versus 3.8% in general pediatric populations of Iran), Blastocystis hominis (10–20% relative to ~7%), Entamoeba histolytica (8–15% against 2–5%), and Strongyloides stercoralis (5–12% contrasted with 1%). The prevalence rates were notably highest in regions such as Sistan and Baluchestan (Giardia, Entamoeba), Khuzestan (Giardia, Blastocystis), Fars (Cryptosporidium, Strongyloides), as well as in Tehran and Isfahan, where associations with HIV/CVID-related infections were observed. Selective IgA deficiency was particularly correlated with increased incidences of giardiasis and cryptosporidiosis. Conclusion: Immunocompromised children in Iran are at markedly increased risk for intestinal parasitic infections, shaped by both immunological and geographical determinants. Strategies such as molecular-based screening, parental education, improved hygiene, and early diagnosis of immune disorders are critical for reducing morbidity in this population. Keywords: Immunocompromised Children, Iran, Intestinal Parasitic Infections, Healthy Children 

Management of TB in pediatrics 
Infectious
Mohsen Mohammadi 1 © ℗
1 Non-Communicable Pediatric Diseases Research Center, Health Research Institute, Babol University of Medical Sciences, Babol, IR Iran .
Abstract: Management of tuberculosis in pediatrics The standard regimen consists of: The intensive phase with 3-4 drugs (isoniazid, rifampin [also known as rifampicin outside the United States], and pyrazinamide, with or without ethambutol) for 2 months. The continuation phase with isoniazid plus rifampin for 2-10 months. The recommended duration varies by age and clinical presentation. Give continuation phase regimen for 2 months in children aged 3 months to 16 years with nonsevere pulmonary TB or tuberculous peripheral lymphadenitis, without HIV infection or severe acute malnutrition or history of TB treatment in previous 2 years. Give continuation phase regimen for 4 months for most other forms of TB. Give continuation phase regimen for 10 months for tuberculous meningitis or osteoarticular tuberculosis. For treatment of drug-resistant TB: Treatment options are determined by the resistance pattern of the causal organism in patients with multidrug-resistant TB (MDR TB) or extensively drug-resistant TB (XDR TB). MDR and XDR TB should be managed in consultation with an infectious disease/tuberculosis expert. For children and adolescents aged 3 months to 16 years: The intensive phase consists of isoniazid, rifampin, pyrazinamide, and ethambutol for 2 months. The continuation phase consists of isoniazid plus rifampin for 4 months. If tuberculosis meningitis is presumed or confirmed: The preferred treatment is a 12-month standard-dose treatment regimen, consisting of and intensive phase with isoniazid, rifampin, pyrazinamide, ethambutol for 2 months and a continuation phase with isoniazid plus rifampin for 10 months. For all other forms of extrapulmonary TB (excluding peripheral lymph node TB, tuberculosis meningitis, and osteoarticular TB), use a 6-month treatment regimen consisting of an intensive phase with isoniazid, rifampin, and pyrazinamide, with or without ethambutol for 2 months and a continuation phase with isoniazid plus rifampin for 4 months. 

Notes on the Human Papillomavirus (HPV) Vaccine in Pediatrics 
Infectious
Shirin Sayyahfar 1 © ℗
1 Research Center of Pediatric Infectious Diseases, Institute of Immunology and Infectious Diseases, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
Abstract: Notes on the Human Papillomavirus (HPV) Vaccine in Pediatrics HPV vaccines are approximately 97% immunogenic, with higher immunogenicity in those aged 9 to 15 years than in those aged 16 to 26 years. The vaccine is most effective when administered before any exposure to the virus types, significantly reducing the prevalence of infection with the vaccine virus types, as well as reducing anogenital warts and cervical precancers caused by the vaccine virus types. According to the AAP, the HPV vaccine should be administered to all children aged 9 to 12. if not administered by age of 26, it should be administered following catch up guidelines. It may be administered from age 27 to 45, based on the individual's circumstances and consultation. If vaccination begins before age 15, two doses spaced 6 to 12 months apart are enough. If started after age 15, three doses should be administered at 0, 1-2, and six months. If the vaccination series was completed with the 2- or 4-valent vaccine, there is no recommendation for an additional dose of the 9-valent vaccine. If a person has been previously exposed to the virus, is currently infected, has anogenital warts or cervical lesions or abnormal Pap test results, there is no contraindication to receiving the vaccine. In fact it is recommended to prevent other virus types in the vaccine. This vaccine can be administered alongside other live and non-live vaccines. Because this vaccine is non-live, it can be administered to immunocompromised patients, but it must be administered in 3 doses at any age. Side effects of this vaccine are minor and include local reactions such as pain, swelling, and redness at the injection site as well as systemic reactions such as fever, headache, malaise and fatigue. Cases of syncope and fainting have been reported during vaccination, so individuals should be monitored for at least 15 minutes after the injection. They should remain in a sitting or lying position to prevent injury in case of syncope. This vaccine should not be administered during pregnancy due to insufficient information. However, a pregnancy test is not required before administration. Vaccination is safe during breastfeeding. The only absolute contraindication to this vaccine is an immediate hypersensitivity reaction to the vaccine or its components, as well as to yeast, as this vaccine is produced in yeast. 

Pediatric Burden of Seasonal Influenza and the Impact of Vaccination: A Structured Review
Infectious
Maryam Hassanzad 1 © ℗, Ali Valinejadi 2, Leila Mohammadpour 3
1 MD, Professor of Pediatric Pulmonology, National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
2 PhD, Khomein University of Medical Sciences, Khomein, Iran
3 National Research Institute of Tuberculosis and Lung Disease (NRITLD), Shahid Beheshti University of Medical Sciences, Tehran, Iran
Abstract: Background: Seasonal influenza remains a leading cause of severe respiratory illness in children worldwide. Each year, 3–5 million cases of severe influenza occur, resulting in up to 650,000 respiratory deaths—with a disproportionate burden on children under 5 years of age. Beyond the clinical toll, pediatric hospitalizations drive substantial economic costs through extended stays, intensive care use, antimicrobial therapy, and school absenteeism. Objectives: This review specifically targets the pediatric dimensions of seasonal influenza by: Characterizing epidemiological patterns in children; Evaluating vaccine effectiveness in reducing pediatric morbidity and healthcare utilization.; and Presenting tailored recommendations for pediatric influenza prevention in the 2025–2026 season. Methods: A systematic search of peer‑reviewed literature, clinical trial registries, and pediatric health‑organization guidelines was performed. We extracted age‑stratified data on incidence, hospitalization and ICU admission rates in children, vaccine effectiveness against severe pediatric outcomes, and pediatric influenza–associated mortality. Vaccine composition and pediatric dosing schedules from bodies such as the American Academy of Pediatrics were also examined. Results: Epidemiology in Children: Children  5 years experience hospitalization rates as high as 44.1 per 10,000, representing the peak burden across all age groups. In pediatric cohorts, vaccination lowers risk of severe illness by up to 75 %, PICU admissions by up to 74 %, and emergency‑department visits by up to 50 %. Children with underlying conditions see mortality risk cut by over 50 %. Raising vaccination coverage by just 5–15 % among school‑aged children could cut overall influenza cases by more than 10 % and avert tens of thousands of pediatric hospitalizations annually. Universal vaccination for all children ≥ 6 months is strongly endorsed, with priority on those  5 years, those with chronic diseases, and pediatric healthcare providers. The proposed quadrivalent vaccine includes A/Victoria/4897/2022 (H1N1), A/Croatia/10136RV/2023 (H3N2), B/Austria/1359417/2021 (Victoria lineage), and B/Phuket/3073/2013 (Yamagata lineage). Conclusion: Targeted pediatric vaccination remains the cornerstone strategy to mitigate seasonal influenza’s clinical and economic burden. Expanding delivery in schools, community clinics, and non‑traditional settings—and achieving high uptake among young children—are critical to reducing pediatric hospitalizations, PICU admissions, and mortality.

Re-emergence and Epidemiologic Patterns of Giardiasis in Iranian Children: Drug-Resistance Concerns, Water-Scarcity Challenges, and Targeted Control Strategies 
Infectious
Mohammad Taghi Ahady 1 © ℗, Kimia Heydari Tajadod 2, Maryam Ghasemi 3, Paniz Taraz 3, Seyyedeh Mohadeseh Dorostkar 3, Alireza Rahimzadeh 3, Mohadeseh Javadzadeh Damirchy 3
1 PhD of Medical Parasitology, Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
2 Pediatrician, Department of Pediatrics, Ardabil University of Medical Sciences, Ardabil, Iran
3 Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
Abstract: Introduction: Giardiasis, caused by Giardia lamblia, is a significant protozoal intestinal infection globally and a major contributor to pediatric morbidity in Iran. The infection's impact on children includes steatorrhea, malabsorption, growth retardation, and potential cognitive impairments. Recent environmental challenges, such as water scarcity and climate-related population shifts, coupled with concerns about treatment failures and emerging drug resistance, underscore the need to understand the current epidemiological landscape of giardiasis in Iran. This study aimed to determine the regional prevalence of giardiasis among Iranian children from 2010 to 2025, compare prevalence between healthy and immunocompromised groups, evaluate associated clinical outcomes, and propose strategic control measures. Methods: A systematic review following PRISMA guidelines was conducted, analyzing studies published between 2010 and 2025 from databases including PubMed, Scopus, Web of Science, SID, and MagIran. We included studies that reported on prevalence, molecular typing, clinical outcomes, or treatment responses in the Iranian pediatric population. Data extracted included geographic location, study year, participant characteristics (healthy, immunocompromised), diagnostic methods (microscopy, EIA, PCR), prevalence rates, Giardia genotypes, and clinical manifestations. Results: Sixty-two studies met the inclusion criteria. The analysis revealed pediatric giardiasis prevalence of 10.6% (95% CI: 9.6–11.5%). Higher prevalence rates, nearing 28–30%, were found in provinces like Sistan & Baluchestan and Khuzestan, as well as in rural areas of Fars and Kerman. Conversely, some urban outpatient cohorts, such as those in Shiraz, showed a much lower prevalence (1%). Immunocompromised children, including those with HIV, transplant recipients, or primary immunodeficiencies, exhibited a considerably higher prevalence, reaching up to 39% in some series. Molecular analysis identified assemblages A (subtype AII) and B (BIII/BIV) as the dominant strains. Clinically, 20–60% of symptomatic cases presented with acute or chronic diarrhea, and there was an increased risk of stunting and wasting in children with early-life infections. While treatment responses to metronidazole and tinidazole were variable, a lack of comprehensive national surveillance for antimicrobial resistance was identified. Environmental factors like water scarcity and climate-driven internal migrations were consistently associated with increased prevalence in multiple regional studies. Conclusion: Giardiasis persists as a significant, regionally concentrated etiology of pediatric enteric disease in Iran. Environmental stressors and particularly vulnerable subpopulations (immunocompromised children) exacerbate the burden of disease. It is recommended to enhance molecular diagnostics, establish sentinel surveillance (incorporating treatment outcome monitoring), invest in water, sanitation, and hygiene (WASH) systems resilient to drought, and implement targeted screening and treatment strategies in high-risk populations. Keywords: Giardiasis; Children; Iran; 

Strain-Specific Behavior of Mycobacterium tuberculosis in Interruption of Autophagy Pathway in Human Alveolar Type II Epithelial A549 Cells
Infectious
Nasim Ebrahimi Fard 1 © ℗, Shima Hadifar 2
1 Department of Mycobacteriology and Pulmonary Research, Pasteur Institute of Iran, Tehran
2 Tehran, Iran; 2Microbiology Research Center (MRC), Pasteur Institute of Iran
Abstract: Background: Autophagy induction has been shown to differ in magnitude depending on the mycobacterial species. However, few studies have investigated the specific autophagic capacity of different Mtb strains in ATs.This study aimed to elucidate the host autophagic response to different Mtb strains in ATs responsible for TB in the capital of Iran, Tehran. Methods: A549 cells were infected with three different Mtb clinical isolates (Beijing, NEW1, and CAS1/Delhi) and the reference strain H37Rv. Following RNA extraction, the expression of eight ATG genes, four mycobacterial genes, and three miRNAs was evaluated using quantitative RT-PCR. Results: The results revealed that all four strains influenced the autophagy pathway in various ways at different magnitudes. The Beijing and H37Rv strains could inhibit autophagosome formation, whereas the CAS and NEW1 strains induced autophagosome formation. The expression of genes involved in the fusion of autophagosomes to lysosomes (LAMP1) indicated that all the studied strains impaired the autophagolysosomal fusion; this result is not unexpected as Mtb can block the autophagolysomal fusion. In addition, the Beijing and H37RV strains prevented the formation of autophagic vacuoles, besides mycobacterial targeting of lysosomes and protease activity. Conclusion: This preliminary study improved our understanding of how Mtb manages to overcome the host immune system, such as autophagy, and evaluated the genes used by specific strains during this process. This study provides valuable insights into the strain-specific mechanisms of Mycobacterium tuberculosis in modulating host autophagy. By identifying how prevalent clinical isolates in Tehran differently regulate autophagosome formation and autophagolysosomal fusion, the findings offer a foundation for developing adjunct therapies that enhance autophagy and overcome bacterial immune evasion. Moreover, understanding these differences supports precision medicine approaches in tuberculosis treatment and guides future research on host–pathogen interactions across diverse Mtb lineages. Further studies with a large number of Mtb strains, encompassing the other main Mtb lineages, are inevitable. DOI: 10.52547/ibj.3586

The most prevalent parasitic diseases of children in Ardabil, Iran
Infectious
Mohammad Taghi Ahady 1 © ℗, Aysan Asadian 2, Darya Pourasad 2, Maryam Mohammadpour Kalkhoran 2, Hasti Hosseini 2, Ailar Abyari 2, Parend Ashoori Lati 2
1 PhD of Medical Parasitology, Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
2 Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
Abstract: Introduction: Parasitic diseases are considered one of the most important public health problems in Iran. Ardabil province, due to its specific climatic and geographical conditions, shows a specific epidemiological pattern of these diseases. The aim of this systematic review was to identify the most common parasitic diseases in children in Ardabil and compare them with other provinces of the country. Methods: A systematic review of the scientific literature was conducted using PubMed, Scopus, Web of Science, SID, Magiran, and IranMedex databases, covering publications from January 2010 to February 2025. Search terms included Ardabil, children, parasite, intestinal parasites, visceral leishmaniasis, Giardia, helminths, and protozoa. Of 64 retrieved articles, 11 studies met the inclusion criteria following a rigorous screening process. Eligible studies were restricted to peer-reviewed, ISI-indexed, or nationally accredited scientific journals. Results: (1) Toxocariasis: A pediatric ELISA survey in Ardabil County reported a seroprevalence of 14%. Rates were significantly higher among rural children (24.4%) compared with their urban counterparts (8.65%), and higher in boys (15.3%). This prevalence surpasses the national average of approximately 9.3%. (2) Visceral Leishmaniasis (VL): A province-wide survey (2019–2021) identified a VL seroprevalence of 5.16 per 1,000 at-risk children. The majority of confirmed cases occurred in Meshgin-Shahr (87.5%), followed by Ardabil city (12.5%), with about 78% of cases in children under 5 years of age. This age-specific disease burden and geographic clustering parallel patterns reported in northwest Iran. (3) Intestinal Protozoa: Spatial and temporal analyses highlighted Giardia lamblia as the predominant intestinal pathogen, particularly concentrated in Ardabil city. Giardia lamblia reported prevalence in Ardabil city ranged from 8.4%–14.6%, higher in rural areas. Blastocystis hominis prevalence between 7.1%–12.3% among school children in Parsabad and Meshgin-Shahr. National Comparison: Ardabil’s pediatric VL distribution (focused in Meshgin-Shahr with a strong disease burden in children under five) resembles that of Iran’s northwestern endemic belt. Similarly, the 14% pediatric toxocariasis prevalence in Ardabil exceeds the national mean of 9.3%. Conclusions: Toxocariasis and visceral leishmaniasis remain the most significant parasitic diseases affecting children in Ardabil. The regional toxocariasis prevalence is notably higher than the national average, while Giardia lamblia continues to be the leading intestinal protozoan of concern. Public health strategies should emphasize rural-focused screening and control of toxocariasis, including deworming of stray dogs and strengthening community hygiene education. Standardized, school-based surveys are also recommended to refine prevalence estimates for Giardia and Cryptosporidium among children. Keywords: Ardabil; Children; Visceral leishmaniasis; Toxocariasis; Giardiasis, Epidemiology 

Unprecedented Eosinophilia in Fatal Infant Visceral Leishmaniasis: Immunopathological Mechanisms and Clinical Implications
Infectious
امیر ارشیا بهشتی 1 © ℗
1 کمیته تحقیقات دانشجویی، دانشکده پزشکی، دانشگاه علوم پزشکی اردبیل
Abstract:

 لیشمانیوز احشایی (VL) معمولاً با ائوزینوپنی به دلیل سرکوب مغز استخوان تظاهر می‌کند. ائوزینوفیلی پارادوکس در VL بسیار نادر است و گزارش‌های محدودی در ادبیات وجود دارد و اهمیت پیش‌آگهی آن نامشخص است. این پژوهش یک مورد کشنده لیشمانیوز احشایی را در یک نوزاد 9 ماهه ایرانی گزارش می‌کند که با ائوزینوفیلی شدید (پیک: 2180 سلول/میکرولیتر، 18.2% از WBC) تظاهر یافت که یکی از بالاترین شمارش ائوزینوفیل ثبت شده در ادبیات لیشمانیوز احشایی اطفال را نشان می‌دهد. بیمار علی‌رغم درمان مناسب با آمفوتریسین B ، دچار نارسایی سریع چندعضوی شد. بررسی مغز استخوان همزمان آماستیگوت‌های لیشمانیا و نفوذ قابل توجه ائوزینوفیلی را نشان داد. پروفایل ایمونولوژیک افزایش IL-5 (847 pg/mL)، IL-13 (156 pg/mL) و IgE کل (2840 IU/mL) را نشان داد که حاکی از پاسخ ایمنی غیرطبیعی Th2-غالب است. در این تحقیق سعی بر مرور نظام‌مند ادبیات موارد ائوزینوفیلی مرتبط با VL را با پیروی از راهنماهای PRISMA انجام شود و پارامترهای ایمونولوژیک را با استفاده از assayهای multiplex سایتوکاین و فلوسایتومتری تجزیه و تحلیل کردیم. مرور ادبیات 12 مورد گزارش شده ائوزینوفیلی مرتبط با VL را در سطح جهانی طی سه دهه شناسایی کرد. مورد ما شمارش ائوزینوفیل ثبت شده را (95% CI: 2010-2350/μL) را نشان می‌دهد و یکی از جوان‌ترین بیماران گزارش شده با این فنوتیپ نادر است. تجزیه و تحلیل سایتوکاین پروفایل التهابی متمایز IL-5/IL-13-محور (نسبت IL-5/IFN-γ: 36.8) مرتبط با بدتر شدن سریع بالینی را آشکار کرد. ائوزینوفیلی شدید در VL نوزاد نمایش غیرشایعی است که ممکن است با پیامدهای نامساعد همراه باشد. این یافته بینشی در مورد ایمونوپاتوژنز VL ارائه می‌دهد و اهمیت پیش‌آگهی بالقوه‌ای را نشان می‌دهد که نیاز به بررسی بیشتر دارد.

Vaccination in Immunocompromised Children
Infectious
Shaghayegh Ashraf Talesh 1 © ℗
1 Assistant Professor of Pediatric Infectious Disease
Abstract: Vaccination in Immunocompromised Children Vaccination is a cornerstone of preventive medicine, significantly reducing morbidity and mortality from infectious diseases. However, immunocompromised children—those with primary immunodeficiencies, cancer, organ transplants, or HIV—face unique challenges in achieving vaccine-induced immunity. Balancing safety and efficacy is critical in this population, as their immune systems may not respond adequately to standard vaccination protocols, and live-attenuated vaccines may pose risks. Immunocompromised children are at heightened risk for vaccine-preventable diseases due to impaired immune responses. Inactivated vaccines, such as those for influenza, pneumococcus, and hepatitis B, are generally safe but may yield suboptimal immunogenicity. For example, studies show that children undergoing chemotherapy for leukemia have reduced seroconversion rates to influenza vaccines, necessitating booster doses or alternative strategies. Conversely, live-attenuated vaccines, like measles-mumps-rubella (MMR) or varicella, are contraindicated in severely immunocompromised patients due to the risk of vaccine-associated disease. The Advisory Committee on Immunization Practices (ACIP) recommends avoiding these vaccines in children with T-cell deficiencies or those on high-dose immunosuppressive therapy. Tailored vaccination schedules are essential. For instance, children with HIV may receive MMR if their CD4 counts are above a specific threshold, as determined by age-specific guidelines. Post-transplant patients often require revaccination due to waning immunity, with inactivated vaccines administered 6–12 months after transplantation, depending on immunosuppression levels. Additionally, household contacts of immunocompromised children should be fully vaccinated to provide herd immunity, reducing the risk of exposure to pathogens like pertussis or measles. Emerging research explores novel approaches, such as adjuvanted vaccines or mRNA platforms, to enhance immunogenicity in this group. For example, mRNA COVID-19 vaccines have shown promise in immunocompromised populations, though booster doses are often required. Clinicians must weigh vaccine timing, disease risk, and immune status, often consulting specialists to optimize schedules. In conclusion, vaccinating immunocompromised children demands individualized strategies to ensure safety and efficacy. Ongoing research and updated guidelines are vital to improving outcomes in this vulnerable population, protecting them from preventable infections while minimizing risks. 

Approach to Abnormal Liver Function Tests in Children
Gastroenterology
Dr. Hossein Saneian 1 © ℗
1 Isfahan university of medical science
Abstract: Approach to Abnormal Liver Function Tests in Children: Dr. Hossein Saneian, Pediatric Gastroenterologist Isfahan Medical School September 2025 The liver is a multifactorial organ that is involved in a number of vital excretory, synthetic, and metabolic functions. Although the term 'liver function test' is commonly used, it is not accurate because many tests, such as transaminases, do not measure liver function. Therefore, these tests should be referred to as 'liver enzyme tests', and 'liver function tests' should be the term used to measure the synthetic functions of hepatocytes, such as serum albumin and prothrombin time. In addition, common biochemical tests may be normal in a patient with liver disease (compensated cirrhosis) or abnormal in a healthy liver. This article reviews the various aspects of liver function tests and the approach to abnormal liver function tests. Abnormal liver tests are most often found in asymptomatic patients, as many routine screening test panels now include them. On the other hand, patients can have baseline fluctuations in serum aminotransferase levels. In a large population-based cross-sectional study, more than 30% of adults with abnormal LFTs had normal tests upon retesting. The sensitivity and specificity of serum aminotransferases, which are used to differentiate between individuals with and without liver disease, depend on the cutoff values chosen to define an abnormal test. There is wide variation among laboratories in what is considered the upper limit of normal for alanine aminotransferase (ALT). The optimal cutoff value for ALT should be less than the upper limit of normal (ULN) used by many laboratories. The most sensitive cut-off for ALT in adults is 29 for men (29 to 33), 26 for boys, and 22 for women and girls (19 to 25). Levels above these values should be evaluated for underlying liver disease. Most patients identified using lower cut-off values have only mild liver disease or no identifiable cause for the abnormal laboratory values. There are limitations to LFTs, including: 1- A normal liver function test (LFT) does not guarantee that the patient is free of liver disease (e.g., compensated cirrhosis). 2- These tests are not specific for liver function. 3- These tests do not usually provide a specific cause, but are indicative of a liver disorder. Therefore, the clinical significance of any abnormal liver function test (LFT) must be interpreted on an individual patient basis. Tests that evaluate liver function can be divided into five categories: 1- Those that 

Association of autoimmune pancreatitis with Raghib syndrome
Gastroenterology
Asma Javid 1 © ℗
1 Iran University of Medical Sciences
Abstract: Key Clinical Message Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis scarcely found in children. Raghib syndrome is a rare congenital heart defect known as persistent left superior vena cava (LSVC) draining into the left atrium. Total signs of Raghib syndrome in AIP case accompanied by an IgG4-­ related disease were described. Abstract Autoimmune pancreatitis (AIP) is a form of chronic pancreatitis scarcely found in children. Raghib syndrome is a rare congenital heart defect known as persis- tent left superior vena cava (LSVC) draining into the left atrium. Here, we de- scribe Raghib syndrome in AIP case accompanied by an IgG4-­ related disease (AIP/IgG4RD). A 13-­ year-­ old boy presented with a 3-­ month history of fever and abdominal pain. The laboratory findings showed SGOT and SGPT, ALP was in- creased, while amylase and γ- ­ GT were normal. Immunoglobulins were normal, except for IgG. Endosonography, spiral CT of the abdomen, and cholangiopancre- atography showed an enlargement of the pancreas. Contrast echocardiography discovered opacification of the coronary sinus and left atrium. Transesophageal echocardiography for LSVC revealed a dilatation in the coronary sinus, indicating persistent LSVC. Following the injection of agitated saline into the left antecu- bital vein, bubbles entered both left and right atria in LSVC. It is reasonable to exclude some of these rare disorders as Raghib syndrome, in cases that will be started on medications like corticosteroids, which increases the susceptibility to thromboembolic events.

Constipation in pediatrics
Gastroenterology
Azizollah Yousefi 1 © ℗
1 Associate Professor of Pediatrics Gastroenterology Iran University of Medical Sciences
Abstract: Constipation is the most common gastrointestinal disorder in children, with a global prevalence of 14.4% based on Rome IV criteria. The prevalence of constipation in Iranian children varies across studies, but it's generally considered high. Studies report prevalence rates ranging from 15.64% to 43% . Constipation in children is usually functional constipation without an organic cause. Organic causes of constipation in children, which include Hirschsprung disease, cystic fibrosis, and spinal cord abnormalities, hypothyroidism, electrolyte imbalance (hypercalcemia, hypokalemia) , food allergy commonly present with red flag signs and symptoms. history and physical examination can diagnose functional constipation using the Rome IV diagnostic criteria. Rome IV diagnostic criteria • Two or fewer defecation in the toilet per week • At least one episode of fecal incontinence per week • History of retentive posturing • History of painful or hard bowel movements • Presence of a large fecal mass in the rectum • History of large diameter stools that can obstruct the toilet Red Flags for Pediatric Constipation • Constipation from birth or within the first few weeks of life • Delayed passage of meconium (the first stool) beyond 48 hours after birth • Ribbon-like stools • Abdominal distension and vomiting • Abnormal anal examination • Failure to thrive • Failure to respond to standard treatment • Neurological abnormalities Treatment Treatment of constipation in children often involves parenteral education , dietary changes, increasing fluid intake, and establishing a regular toileting routine. There are four general steps in treatment of constipation in children. • Disimpaction (for children with a large rectal stool mass or fecal incontinence) • Prolonged laxative treatment and behavioral therapy to achieve regular evacuation and avoid recurrent constipation • Dietary changes (primarily increasing fiber and fluid content) to maintain soft stools • Gradual tapering and withdrawal of laxatives as tolerated The goal of therapy is the passage of soft stools, ideally once per day and no less than every other day. Weeks to months and sometimes years of laxative and behavioral therapy may be necessary before this goal is achieved 

Gall Stone In Children
Gastroenterology
Abolfazl Iranikhah 1 © ℗
1 Associate Professor in Pediatric Gastroenterolgy, Qom University of Medical Sciences
Abstract: 1. Introduction Pediatric gallstone disease is emerging as a significant clinical challenge with a noticeable increase in prevalence over recent decades. Traditionally considered rare in childhood, gallstones are now frequently associated with rising pediatric obesity, metabolic disorders, and long‐term use of total parenteral nutrition. In addition to common presentations such as right upper quadrant pain, the disease can manifest with jaundice and nonspecific abdominal symptoms, underscoring the need for heightened clinical vigilance3. 2. Etiology and Risk Factors Several factors contribute to gallstone formation in children. Changes in bile composition, alterations in gallbladder motility, and nutritional exposures are critical in the development of cholesterol stones, whereas pigment stones are typically linked to chronic hemolysis or infections3. Obesity, which increases the risk factor for metabolic syndrome, plays a predominant role by altering bile cholesterol saturation and gallbladder contractility. Other contributing elements include cystic fibrosis and hemolytic disorders. In several studies, an increased body mass index (BMI) among pediatric patients has been clearly associated with an elevated prevalence of gallstones5. 3. Diagnostic Evaluation The primary tool for diagnosing pediatric gallstones is abdominal ultrasound due to its non-invasive nature and reliable detection of cholelithiasis4. Ultrasound can provide valuable information concerning stone quantity, size, gallbladder wall thickening, and the presence of fluid collections. When further anatomical detail is required, particularly in complex cases, magnetic resonance cholangiopancreatography (MRCP) offers enhanced visualization of the biliary tree without the need for sedation5. Additionally, laboratory evaluations help in differentiating bile duct obstruction, cholecystitis, and other abdominal disorders. 4. Management Strategies Therapeutic interventions in pediatric gallstone disease range from conservative management with ursodeoxycholic acid when indicated, to surgical approaches. Minimally invasive laparoscopic cholecystectomy is the preferred treatment for symptomatic patients, especially in cases manifesting complications such as recurrent cholecystitis or biliary pancreatitis5. Tailored strategies that incorporate weight management, dietary modifications, and regular physical activity are also essential components of long-term management to reduce recurrence and associated metabolic risks. 5. Conclusion Pediatric gallstones are an evolving problem driven largely by the obesity epidemic and associated metabolic and hematological disorders. Early diagnosis is facilitated by ultrasound and, when necessary, MRCP, while management centers on minimally invasive surgery and lifestyle interventions. The integration of thorough preoperative imaging, individualized risk assessment, and postoperative follow-up is critical to optimize outcomes and prevent recurrence

Gastroesophageal Reflux in Children
Gastroenterology
Mahnaz Sadeghian 1 © ℗
1 Mahnaz Sadeghian Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
Abstract: Gastroesophageal reflux (GER) is one of the most common reasons for primary care visits and referrals to pediatric gastroenterology. Normal, physiologic reflux is a finding seen in up to 60% of infants, which decreases to 5% by one year of age. Up to 25% of infants regurgitate≥4 times a day. The data on pediatric populations older than 12 months are limited, with a prevalence determined to be 0.84 per 1000. it is important to distinguish between physiological regurgitation (spitting) and pathologic GERD. In GERD, there is an additional symptom, such as heartburn, epigastric pain, vomiting, inconsolable crying, hematemesis, feeding refusal, hoarseness, wheezing, disturbed sleep, and failure to thrive. Several risk factors, diseases, and abnormalities can contribute to GERD in infants. Congenital GI disorders, such as congenital diaphragmatic hernia, omphalocele, gastroschisis, esophageal atresia, and intestinal malrotation, cystic fibrosis and obesity Have been reported. The diagnostic approach varies based on the child's age and reported symptoms. Initially, the child's history and physical examination findings are evaluated to identify symptoms or warning signs associated with GERD. If GERD is suspected, lifestyle changes should be considered, such as thickened feedings, dietary modifications, postural adjustments, weight loss, and avoiding secondhand smoke, overfeeding, and eating before bedtime. Progress should be monitored, and if symptoms resolve by 12 months of age, no further workup is required. If symptoms do not improve, further evaluation is necessary to rule out other disorders. This evaluation may include an upper GI barium study, ultrasound, esophageal manometry, a trial of proton pump inhibitors (PPIs), scintigraphy, esophagogastroduodenoscopy, esophageal pH monitoring, and multichannel intraluminal impedance (MII). Non-pharmacological treatments are essential for managing GER and GERD in infants and children, focusing on conservative measures and dietary adjustments. Psychological interventions can significantly aid in managing GERD symptoms, particularly in children whose symptoms are exacerbated by stress or anxiety. There are two primary categories of pharmacologic treatments for GERD: (1) Acid-suppressing agents; and (2) Prokinetic medications. surgery is often considered for children who have not responded to medical management, particularly those with neurologic impairments, where GERD can significantly impact their quality of life. 

Is Simplicity Enough? A Comparison of Logistic Regression and Artificial Intelligence in Predicting Complications of Caustic Ingestion
Gastroenterology
Mehran Rostami Varnousfaderani 1 ℗, Seyed Saeed Hashemi Nazari 2, Mahmoud Hajipour 3, Shahin Shadnia 4, Naghi Dara 5, Koorosh Etemad 6 ©
1 Student Research Committee, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
2 2Professor of Epidemiology, Clinical Research Development Center, Imam Hossein Educational Hospital, Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 3Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
4 4Professor of Clinical Toxicology, Department of Clinical Toxicology, School of Medicine, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
5 Associate Professor in Pediatric Gastroenterology, Pediatric Gastroenterology, Hepatology and Nutrition Research Center, Research Institute for Children’s Health, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
6 Professor of Epidemiology, Department of Epidemiology, School of Public Health and Safety Promotion and Injury Prevention Research Center, Shahid Beheshti University of Medical Sciences
Abstract: Introduction : Accidental or deliberate ingestion of caustic substances in children is a serious health problem that can lead to acute and chronic gastrointestinal complications. This study aimed to evaluate clinical and endoscopic findings for predicting chronic complications in these patients. Method and materials: This was a retrospective–prospective cohort study of children with caustic ingestion admitted to Mofid Children’s Hospital, Tehran, between 2016 and 2024. Data were obtained from the national registry of pediatric endoscopy procedures, hospital medical records, and parental follow-up. A total of 360 children were included. Inclusion Criteria: 1- Children (18 years old) with confirmed caustic ingestion hospitalized at Mofid Children’s Hospital, Tehran, between 2016-2024 2-Availability of complete clinical and endoscopic records (or confirmed through parental follow-up) Exclusion Criteria: 1- Patients with incomplete records or missing follow-up data 2-Patients with underlying congenital esophageal or severe comorbid diseases 3-Patients with incomplete treatment or lost to follow-up Predictive models were built using binary logistic regression and machine learning algorithms, including Random Forest, Support Vector Machine, K-Nearest Neighbors, and Artificial Neural Networks, implemented in Python. The study was approved by the Ethics Committee of Shahid Beheshti University of Medical Sciences (IR.SBMU.PHNS.REC.1402.254). Results: Of the 360 children, 118 (32.8%) developed chronic gastrointestinal complications. The mean age was 3.42 ± 2.96 years. In multivariable logistic regression, the type of ingested substance (alkaline vs. acidic) and initial endoscopic findings (particularly necrosis in oral and/or oropharyngeal mucosa) were significantly associated with outcomes. Among predictive models, logistic regression outperformed more complex algorithms, achieving an accuracy of 76.4% and an AUC of 0.807. Conclusion: In studies with a high number of potential confounders and strong correlations among predictors, simpler models such as logistic regression may outperform more complex algorithms. Our findings highlight the importance of model selection based on data characteristics rather than algorithmic complexity. Keywords: Caustic ingestion, Machine learning, Complications, Endoscopy, Iran 

بی احترامی به رفلکس گاستروکولیک و بروز یبوست در کودکان و نوجوانان
Gastroenterology
دکتر محمدرضا اسماعیلی، استاد، فوق تخصص گوارش و کبد کودکان 1 © ℗
1 مرکز تحقیقات بیماریهای غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل
Abstract:

 بی احترامی به رفلکس گاستروکولیک و بروز یبوست در کودکان و نوجوانان دکتر محمدرضا اسماعیلی، استاد، فوق تخصص گوارش و کبد کودکان مرکز تحقیقات بیماریهای غیرواگیر کودکان، پژوهشکده سلامت، دانشگاه علوم پزشکی بابل یبوست فانکشنال در کودکان و نوجوانان از شیوع نسبتا بالایی برخوردار است . عوامل متعددی می‌توانند در شروع و شکل گیری این مشکل نقش زیادی داشته باشند نظیر : قطع شیرمادر ، گرفتن کودک از پوشک ، تغییر مکان دفع مدفوع با رفتن به مهدکودک و مدرسه. یکی از مکانیسم هایی که بعضی از این عوامل می‌توانند با تاثیر گذاری بر آن سبب یبوست فانکشنال شوند ، عدم توجه و واکنش به موقع فرد به رفلکس گاستروکولیک است . این رفلکس فیزیولوژیک متعاقب خوردن مواد غذایی در دستگاه گوارش اتفاق می افتد که در طی آن بعد از وعده های غذایی و اتساع معده و با شکل گیری پیام های ناشی از آن و تولید نوروپپتد هایی موثر بر حرکات روده (خصوصا کولون) منجر به تخلیه بهتر معده و دفع راحت تر مدفوع میشود. عوامل موثر بر تغییرات این رفکس از یک طرف با افزایش تحریکات سبب اسهال (نظیر سندروم روده تحریک پذیر ) و از طرفی دیگر با کاهش آن و عدم واکنش لازم و به موقع فرد به این رفلکس ، سبب بروز یبوست ( نظیر یبوست فانکشنال ) میشوند. بعضی از مصادیق عدم‌توجه و بی احترامی یا واکنش به موقع به رفلکس گاستروکولیک در کودکان که در بروز یبوست موثرند شامل موارد زیر هستند: نخوردن صبحانه، نداشتن فرصت کافی بعد از خوردن غذا برای دفع مدفوع مانند عجله در رفتن به مدرسه ، نبود امکانات مناسب برای اجابت مزاج خصوصا در مهدکودک و مدارس ، خوردن غذا بویژه وعده های اصلی در حین بازی های کامپیوتری و صرف زمان زیاد برای این بازی ها و اختلالات خلقی. آگاه نمودن کودکان و نوجوانان ، والدین و مربیان در استفاده درست و به موقع از این رفلکس فیزیولوژیک می‌تواند در کاهش شیوع یبوست ‌و درمان آن تاثیر بسزایی داشت. کلید واژه : رفلکس گاستروکولیک، یبوست ، کودکان 

Apophysitis in children
Rheumatology
Mojgan Faraji Goodarzi 1 © ℗
1 Lorestan University of Medical Sciences
Abstract: Apophysitis in children Mojgan Faraji Goodarzi Pediatric Rheumatologist, Lorestan University of Medical Sciences Apophysitis is an inflammation or stress injury to the growth plate where a muscle or tendon attaches to it. It is commonly seen in active, growing children and adolescents. Apophysitis is usually caused by repetitive activities like running, jumping, and throwing but can also occur as an acute injury with a fall or rapid, powerful movement. The most common types of apophysitis are Sever’s Disease, Osgood Schlatter’s Disease, Iliac crest apophysitis, Sinding-Larson-Johansson syndrome and Iselin’s Disease. Osgood-Schlatter disease is an apophysitis of the proximal tibial tubercle at the insertion of the patellar tendon. Sever’s Disease is inflammation on the growth plate at the insertion of the Achilles tendon that is located on the posterior inferior aspect of the calcaneus. The most common risk factors for apophysitis are periods of rapid growth and also repetitive activities in young athletes who play sports or perform activities such as running, jumping, or throwing. Apophysitis will usually presents with pain that worsen with activity and improves with rest. There is almost always local tenderness at the site of the apophysis. A “bump” may be seen. It sometimes causes limping. Common sites include the knee, heel, elbow, hip, and pelvis. A physician may make the diagnosis of apophysitis by history, physical examination, and x-rays. An X-Ray can be ordered if there is a need to differentiate it from an acute avulsion. The mainstay of treatment is controlling the pain and inflammation, initially by reducing the activity in sports, gym, or free play. The patients are advised to have “relative rest” for 1-2 weeks. NSAIDs may be of benefit for a short course (1 week). Another treatment is Intermittent ice applied to the area. In severe cases, a short period of absolute rest and/or immobilization of the body part may be necessary with using cast, Braces or medical equipment. Surgery is rarely necessary. Rehabilitation or special exercises may be necessary prior to returning to sports. Key words: Apophysitis, Sever’s Disease, Osgood Schlatter’s Disease 

Efficacy and Safety of Ginger Supplementation in Juvenile Idiopathic Arthritis: A Triple-Blind Randomized Study
Rheumatology
Zinat Heidari 1 © ℗, Abdolreza Malek 2, Mahsa Bozorgvar 1
1 Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Pediatrics, Mashhad University of Medical Science, Mashhad, Iran
Abstract: Introduction: The aim of this study was to investigate the effect of ginger supplementation on treatment responses in children with oligoarticular juvenile idiopathic arthritis (oligo-JIA). Materials and Methods: A total of forty children between the ages of 6 and 16 years with oligo-JIA were randomly assigned to receive either a ginger capsule (containing 250 mg of powdered Zingiber officinale rhizomes) or a placebo twice daily for three months, along with standard treatment. The response to therapy was measured using the American College of Rheumatology Pediatric 30, 50, 70, and 90 response criteria (ACR-Pedi 30, 50, 70, and 90) after three months of supplementation. Results: ACR-Pedi 30, 50, 70, and 90 responses were significantly higher among those receiving ginger supplement (p 0.001, p 0.001, p 0.001, and p =0.001, respectively). Both groups tolerated the treatment effectively, with no serious adverse reactions reported. Only two participants (one from each group) developed mild skin rashes localized to the chest and face. Overall, the incidence of side effects was not significantly different between groups (p = 0.55). Conclusion: In this study, ginger supplementation improved ACR-Pedi 30, 50, 70 and 90 responses in pediatric patients with oligo-JIA. Given its safety profile and anti-inflammatory and immunomodulatory properties, ginger supplementation may enhance therapeutic responses. However, due to certain limitations within our study, further research is essential to confirm these promising findings.

Accessibility of emergency care for traumatic children in emergency departm
PICU
Amir Hossein Jafari-Rouhi 1 ℗, Leila Vahedi 2 ©
1 Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract: Background: Emergency care of traumatic children is an important health topic. The aim was to evaluate the accessibility of emergency care for traumatic children in terms of management equipment, cause defects, and familiarity of medical staff with training programs. Methods: This descriptive-analytical study evaluated the emergency departments of all general hospitals in East Azerbaijan province during 2018, based on a checklist with 4 sections and 20 items, rated according to Likert scale from very high (scored 3) to very low (scored 0). For a score less than 3, defect causes were explained in 7 categories. The staff training certificates were considered for early and advanced pediatric life support in an emergency situation. The staff’s training certificates in terms of early and advanced resuscitation of children were also surveyed. Data was analyzed by SPSS 21. Results: From among 20 emergency hospitals, more than 50% were equipped with adequate airway instruments. All of the emergency departments were provided with oxygen therapy equipment, but more than 70% had no chest tube and ventilator fit for children. More than 70% of them had cardiac monitoring and a sphygmomanometer for pediatric patients; however, less than 50% had a blood transfusion set and a urinary catheter. Only two hospitals had held early and advanced pediatric resuscitation workshops for their staff. Conclusions: This study showed that 19 (95%) of emergency departments had the potential for early diagnosis and treatment of traumatic children. However, only 2 (10%) of the emergency staff had enough work experience in this issue. It is necessary to implement training programs for the familiarity of medical staff with pediatric early and advanced life support in emergency departments. 

“Assessment of Injectable Acetaminophen Utilization Patterns in Akbar Hospital, Mashhad: A Drug Utilization Evaluation”
PICU
Ghazaleh Elahabadi 1 ℗, Asiyeh Jandaneh 1, Sepideh Elyasi 1 ©
1 . Department of Clinical Pharmacy, School of Pharmacy, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: English Abstract Objective: Acetaminophen is the most widely used analgesic and antipyretic in both Iran and worldwide. The extensive use of this drug, particularly in its injectable form, in healthcare centers and hospitals imposes significant costs on the country’s healthcare system. The relatively low side effects and physicians’ insistence on reducing any type of fever are among the main reasons for the overprescription of acetaminophen. This study aimed to evaluate the usage pattern of injectable acetaminophen in Akbar Hospital, Mashhad. Methods & Materials: This prospective cross-sectional study was conducted from April to December 2024 on 200 hospitalized patients at Akbar Hospital, Mashhad, who had received at least one dose of injectable acetaminophen. Demographic data, information regarding dosage and intervals, the preservative used in the drug formulation, renal and liver function based on clinical and laboratory findings, side effects, and drug interactions with injectable acetaminophen were recorded. The collected data were then analyzed using SPSS version 25. Results: The findings indicate that many patients (86%) had indications for non-injectable forms of acetaminophen. Furthermore, all children under the age of two received acetaminophen containing benzyl alcohol, despite the prohibition of its use in this age group. In most cases (81.5%), the dosage and intervals of drug administration were appropriately applied. In all patients with renal and hepatic insufficiency, the dosage reduction and increased administration intervals of acetaminophen were adhered to. Nineteen cases (8.5%) of category C drug interactions with injectable acetaminophen were recorded. Additionally, nine cases of precautionary use of acetaminophen were reported. No serious adverse effects caused by this drug were observed in any of the patients. Conclusion: Given the irrational use of injectable acetaminophen in the majority of hospitalized patients at Akbar Hospital and the importance of rational drug use, it appears necessary to establish and adhere to a guideline for prescribing injectable acetaminophen. Ultimately, improving the awareness and knowledge of physicians and nurses regarding the various methods of acetaminophen administration can enhance treatment outcomes and prevent unwanted side effects. Keywords: Injectable acetaminophen, children, intensive care, drug utilization evaluation

Association of end-tidal and venous carbon dioxide in intubated children
PICU
Amir Hossein Jafari-Rouhi 1 © ℗, Leila Vahedi 2
1 Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract: Introduction: The end-tidal CO2 pressure (PetCO2) monitoring which is a non-invasive method than PvCO2 (venous pressure of carbon dioxide), could determinate a graph depicting the carbon dioxide concentration in blood. The aim of this study was to investigate the correlation between PetCO2-PvCO2 in ventilated children. Methods: All children intubated in the PICU of Children hospital Tabriz, Iran from 2019 to 2020 using the census method were assessed in terms of initial diagnosis, age, sex, PetCO2, and PvCO2 during a prospective cross-sectional study. Associations between variables were calculated for total patients and patients in the subgroups. Descriptive statistics were used to describe the quantitative analysis of data and the Pearson correlation coefficient and Linear Regression Test were used for the evaluation of the relationship between variables and for assessing the predictive values of PvCO2 using SPSS.26. A P value 0.05 was considered statistically significant. Results: Out of 61 samples, 42 (68.9%) patients were males with a median age of 48 months. The mean of PetCO2 and PvCO2 were 20.3 ± 8.5 and 43 ± 12.3 mm Hg, respectively. The correlation of PetCO2-PvCO2 was significant in total patients (P value = 0.003, r = 0.379) and group 1 (P value = 0.009, r = 0.374). Furthermore, the results presented the predictive values of PvCO2 for PetCO2 while for one unit increase in the PvCO2 variable, PetCO2 could increase 0.372 units (P value = 0.005, Slope b = 0.24, Beta coefficient = 0.372). Conclusion: In most intubated children, PetCO2 may estimate the ventilation and change concentrations of CO2. It is necessary that the sample size of future studies will become large due to the weak correlation. Keyword: Association, children, end-tidal, venous carbon dioxide 

Evaluation of the nutritional status of children with sepsis admitted to pediatric intensive care units (PICU)
PICU
Sina Azarli 1 © ℗, Taha Safaripour 1, Fatemeh Roudi 2, Ali Chamani 3, Gholamreza Khademi 4, Majid Sezavar 4, Mohsen Nemati 2
1 Student Research Committee of Mashhad University of Medical Sciences, Mashhad, Iran
2 Department of Nutrition, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
3 Department of Clinical Nutrition Sciences, Mashhad University of Medical Sciences, Mashhad, Iran.
4 Department of Pediatrics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract: Introduction: The nutritional status of patients plays an important role in prognosis and clinical outcomes, as malnutrition prolongs hospitalization, increases complications, and even mortality. Timely nutritional assessment and implementation of appropriate interventions not only improve quality of life but also reduce healthcare costs. This is of greater importance in the PICU, as sepsis is one of the most common causes of hospitalization and mortality in children, and simultaneous attention to infection control and nutritional management can have a significant impact on improving outcomes. Methods: This was a cross-sectional study conducted at Akbar Children's Hospital in Mashhad from 2023 to 2024. Those who met sepsis criteria were included in the study. The weight-for-height z-score (World Health Organization (WHO) Global Database) was applied for the assessment of the patients’ nutritional status upon admission to PICU. Statistical analysis of data was performed using SPSS version 22 software. Results: The number of 54 people included includes 29 boys and 25 girls. Thirty-seven of the 54 children were in a normal state, 10 were in a state of moderate malnutrition, and 7 were in a state of severe malnutrition. The majority of the study population had a normal nutritional status. Conclusion: The majority of hospitalized children had a normal nutritional status; however, specific local nutritional interventions are needed for the remainder, to inform decision-making. Local evidence-based protocols were used to guide more effective interventions. Keywords Critical illness, Pediatric Intensive care unit, Nutrition assessment, Nutrition support, nutritional adequacy 

Optimizing Fluid Therapy in Pediatric Patients with Failure to Thrive: Balancing Hydration and Electrolytes
PICU
Mehrnaz Olfat 1 © ℗, Masoud Mohammadpour 2
1 Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran
2 Division of Pediatric Intensive Care, Department of Pediatrics, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
Abstract: Failure to thrive (FTT) in children is a common pediatric challenge with significant implications for growth, development, and overall health. Fluid therapy is an essential component of management, as hydration and electrolyte balance are closely linked to nutritional rehabilitation. Children with FTT may present with dehydration, poor oral intake, or metabolic instability, and their limited reserves make them particularly sensitive to both underhydration and fluid overload. Careful assessment of hydration status, weight trends, and serum electrolytes should guide therapy. Maintenance fluid requirements are best calculated using actual body weight, with ongoing adjustments for illness, fever, or gastrointestinal losses. Electrolyte supplementation, especially with potassium and phosphate, may be required and should be titrated carefully to avoid complications such as arrhythmias or refeeding syndrome. While intravenous fluids are necessary in acute care settings, oral or enteral routes should be prioritized whenever possible to support both hydration and caloric intake. Close monitoring of clinical status, urine output, and biochemical markers is essential to ensure safe and effective therapy. Ultimately, fluid management in FTT should not be considered in isolation but integrated into a comprehensive care plan that addresses nutrition, growth monitoring, and the underlying cause of poor weight gain. For general pediatricians, understanding the principles of fluid therapy in FTT is vital to supporting recovery and promoting long-term healthy development.

Rapidly progressing necrotizing fasciitis with chickenpox infection: A case series
PICU
Fereshteh Moshfegh 1 © ℗
1 pediatric intensivist, Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
Abstract: Introduction: Varicella usually resolves without complications. However, there is a risk of necrotizing soft tissue infections such as necrotizing fasciitis (NF) that can complicate the management. Case series: Case 1 was a 5-year-old male who developed widespread vesicular lesions and fever, diagnosed as varicella. His condition worsened as he presented with abdominal distension and pain, leading to hospitalization for suspected toxic shock syndrome. Computed tomography (CT) of the chest and abdomen revealed features consistent with NF, prompting extensive debridement and subsequent vacuum-assisted closure (VAC) therapy. After several surgical revisions he underwent skin grafting and was eventually discharged home. Case 2 was a 4.5-year-old male with no significant medical history, who presented with generalized fever, neck pain, and rapidly spreading skin rashes. He subsequently developed severe acute idiopathic scrotal edema and extensive ecchymosis, requiring immediate hospitalization. Broad-spectrum antibiotics were started. He underwent emergent wide debridement of the ecchymotic areas. The pathology analysis confirmed necrotic tissue, and cultures were positive for bacteria and fungi. He underwent repeated debridement. The last debridement was followed by uncontrollable hemorrhage, and he passed away. Conclusion: While varicella is generally a mild disease, life-threatening complications such as necrotizing fasciitis can occur.

Association between Serum Lactate Level and Hospital Outcome in Children with Multi-Trauma
Emergency
Amir Hossein Jafari-Rouhi 1 ℗, Leila Vahedi 2 ©
1 Tuberculosis and Lung Diseases Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
2 Road Traffic Injury Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
Abstract: Background: Trauma is an important cause of disability and death in young people. This study aimed to investigate the association between serum lactate level and in-hospital mortality in multi-traumatic children. Method: In this cross-sectional study, all children with multi-trauma admitted to the emergency department in Shohada and Imam Reza hospitals of Tabriz/Iran were evaluated from 2018 to 2020. At the time of admission to the emergency department, serum lactate, PRISM (Pediatric risk of mortality) score, and other findings as well as outcome were checked and correlated with the outcomes for all patients. Patients were classified into two groups (based on outcome) and six groups (based on lactate levels) to evaluate associations between results. The Chi-square test, independent samples t-test, ANOVA, and multivariate logistic regression test were performed in SPSS.22. Pvalue0.05 and OR with 95% confidence interval were considered statistically significant. Result: Out of 110 admitted children, 10 (9%) died in hospital. Mean lactate level was 3.2 mmol/l and 85 patients (77.2%) had lactate level2 mmol/l (millimoles). The initial blood lactate level was directly correlated with mortality. This relationship was confirmed even after adjusting for variables such as the PRISM score (OR = 1.27; 95% CI, 1.19-1.35; P 0.001). Multiple regression study showed that a high lactate level (OR =1.17; 95% CI, 1.07-1.29; P=0.001), high PRISM score (OR = 1.15; 95% CI, 1.11-1.20; P0.001), and low albumin level (OR =0.92; 95% CI, 0.88-0.96; P0.001) were independent risk factors for mortality. Conclusion: High blood lactate level was an independent factor in the increase of mortality rate in the emergency department.

The Epidemiological Pattern of Childhood Injuries and Accidents among Iranian Children: A Systematic Review
Emergency
SeyedehMozhgan Heidari 1 © ℗
1 Pediatric Department, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Abstract Background: Injuries caused by accidents are the primary causes of disability, permanent deformities, and death in children. This study aimed to determine the epidemiological pattern of childhood accidents and injuries and their related factors among Iranian children. Materials and Methods: In this systematic review, a systemic search of online databases (Medline, EMBASE, Scopus, Web of Science, Cochrane Library, CIVILICA, SID, Magiran, and Google Scholar search engine) was conducted for related studies with no time limit up to June 2022, using the related Mesh keywords. Two reviewers evaluated the quality of eligible studies and carried out the selection procedure. Results: Nine studies (from 2005 to June 2022) with an overall sample size of 20,591 were selected. Of the total accidents, 70% occurred at home. The highest incidence of accidents among children was between 16% and 40%, and the mean age of accident victims was 2.5±1.5 years, with the highest in boys (59.4%). The most frequent causes of accidents were traffic accidents (53.4%), followed by physical injury (50.7%), falling (44.3%), and swallowing (22%). Also, 93.3% of accidents occurred in urban areas. There was a significant relationship between gender, age, type of house, place of accident, parental higher education, season, and injury types (p 0.05). Conclusion: The results showed that 70% of accidents for children happened at home. The most frequent accident was traffic accidents, followed by physical injury, falling, and swallowing. It appears that almost all home accidents can be prevented by education. Therefore, developing educational and preventive policies is essential to achieve better standards of road transportation and reduce home accidents and injuries in Iran. Key Words: Accident, Children, Iran, Injury, Pattern.

A mild and transient case of Influenza-Associated Encephalopathy in a child: Diagnostic and Clinical Challenges
Neurology,Psychiatry,Physical medicine
Solmaz Aziz-ahari 1 ©, Seyedeh Rojina Mortazavi 2 ℗
1 Assistant professor of pediatric neurology , Firouzabadi Hospital ,Iran University of Medical Sciences,Tehran-Iran
2 Medical intern, School of Medicine, Iran University of Medical Sciences, Tehran-Iran
Abstract: Background: Influenza-associated Encephalopathy (IAE) is a rare but serious complication of influenza infection, predominantly affecting children. While most reported cases present with moderate to severe neurological symptoms, mild and self-limiting forms remain under-recognized. Case Presentation: We report the case of a previously healthy 9-year-old boy who presented with fever, lethargy, behavioral changes, and two episodes of focal seizures without awareness during the course of an influenza-like illness. Laboratory evaluations were notable for leukopenia and elevated D-dimer levels. Neuroimaging revealed a medial right temporal arachnoid cyst, and cerebrospinal fluid (CSF) analysis showed mild pleocytosis with positive Influenza A PCR. Electroencephalography was normal. The patient was managed with intravenous antibiotics, antiviral therapy, and supportive care. His symptoms resolved rapidly without neurological sequelae, and he made a complete recovery. Conclusion: This case highlights a rare, mild, and transient presentation of IAE in a school-aged child. Awareness of such atypical and self-limiting forms can assist clinicians in timely diagnosis and avoid unnecessary interventions. Influenza-associated neurological symptoms should be considered even in the absence of severe systemic or respiratory manifestations.

Acute Leukoencephalopathy with Restricted Diffusion (ALERD) in a 10-Month-Old Infant Secondary to Severe Dehydration
Neurology,Psychiatry,Physical medicine
Solmaz Aziz-ahari 1 © ℗, Ramin Zare Mahmoudabadi 2
1 Pediatric department, Firoozabadi hospital,Iran University of Medical Sciences
2 Pediatric Intensive Care Unit, Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran
Abstract: Title: Acute Leukoencephalopathy with Restricted Diffusion (ALERD) in a 10-Month-Old Infant Secondary to Severe Dehydration Abstract: Background: Acute Leukoencephalopathy with Restricted Diffusion (ALERD) is a rare but clinically significant neurological syndrome in infants, often following severe systemic illness such as gastroenteritis and dehydration. Early recognition of characteristic radiologic features is critical for timely management. Case Presentation: We report a previously healthy 10-month-old infant who presented with severe dehydration and metabolic acidosis after several days of vomiting and diarrhea. On admission, the patient was lethargic and hypotonic, with multiple generalized tonic–clonic seizures, dystonic limb posturing, orofacial dyskinesia (lip smacking), decreased consciousness, and visual disturbances. Physical examination, including ocular assessment, was normal. Routine laboratory investigations, including CSF analysis, CBC, HPLC, MS/MS, and urine organic acids, were all within normal limits. Brain MRI demonstrated bilateral symmetric hyperintensity of the dentate nuclei with diffusion restriction and mild occipital cortical involvement, consistent with ALERD. The patient was managed in the pediatric intensive care unit with intravenous levetiracetam, empirical antimicrobials (later discontinued), IVIG, pulse corticosteroids, and mitochondrial cocktail. Neurological deficits improved gradually: seizures resolved, dystonia and hypotonia subsided, and visual fixation returned. Follow-up MRI showed complete resolution of dentate lesions with minimal residual occipital changes. At one-month follow-up, the patient had fully recovered with no residual deficits. Conclusion: This case highlights ALERD secondary to severe dehydration in an infant. Awareness of this reversible syndrome and its characteristic MRI findings is essential for guiding treatment and avoiding unnecessary long-term interventions. Keywords: ALERD, infant encephalopathy, bilateral dentate nuclei, gastroenteritis, dehydration, reversible neurological deficit

Management Strategies for Pediatric Status Epilepticus
Neurology,Psychiatry,Physical medicine
Mehran Beiraghi Toosi 1 © ℗
1 Rare Pediatric Neurological Diseases Research Center, Mashhad University of Medical Sciences, ‎Mashhad, Iran
Abstract: Background: Status epilepticus is a neurological emergency in children, defined by continuous seizure activity or recurrent seizures recurrent seizures without recovery. Its successful management requires a prompt, systematic, and staged therapeutic approach to prevent irreversible neurological injury. The choice and sequence of antiseizure medications (ASMs), particularly after first-line treatment fails, are critical to achieving rapid seizure termination. Methods: Here, we review current evidence and expert consensus from international guidelines on the pharmacologic management of pediatric status epilepticus. It examines the efficacy, safety, and practical considerations of treatment strategies across the emergent, urgent, and refractory phases of care. Results: A standardized, stepwise protocol is fundamental to effective treatment. The initial approach for emergency treatment involves administering Benzodiazepines. For refractory cases, second-line agents such as Fosphenytoin, Phenobarbital, Levetiracetam, and Valproic acid are central to urgent control therapy, with selection often influenced by patient-specific factors and institutional preference. The management of super-refractory status epilepticus necessitates intensive care support for the administration of continuous anesthetic infusions and even immunomodulators such as corticosteroids or Anakinra. Concurrently, a diligent search for and treatment of the underlying etiology is imperative for long-term management. Conclusion: The optimal treatment of pediatric status epilepticus involves the immediate application of a sequential pharmacologic protocol integrated with comprehensive supportive care. This approach maximizes the potential for rapid seizure cessation while minimizing complications. Ongoing research is essential to further refine agent selection and improve outcomes for this vulnerable population. Keywords: Status Epilepticus, Seizure, Children, Treatment 

New Approaches to Managing Picky Eating in Children
Neurology,Psychiatry,Physical medicine
Bahareh Imani 1 © ℗
1 MASHHAD UNIVERSITY OF MEDICAL SCIENCES- DEPARTMENT OF PEDIATRICSMASHHAD-IRAN
Abstract: New Approaches to Managing Picky Eating in Children Dr.Bahareh Imani Associate professor of university-pediatric nutrition fellowship-Department of pediatrics- Mashhad university of medical sciences-Iran Picky eating is a common concern among parents and healthcare professionals, often peaking in early childhood. While many children outgrow this phase, persistent picky eating can affect a child's growth, nutrient intake, and family mealtime dynamics. Recent approaches emphasize a shift from pressure-based strategies to more child-centered and evidence-based interventions. One of the most promising strategies is responsive feeding, which focuses on creating a supportive mealtime environment. This involves recognizing a child's hunger and satiety cues, offering a variety of foods without coercion, and promoting a positive relationship with food. Studies have shown that children are more likely to try new foods when they feel in control and are not forced to eat. Another innovative approach is the use of food chaining, a technique that introduces new foods based on a child's accepted preferences. For example, if a child enjoys chicken nuggets, a parent might gradually introduce homemade breaded chicken with similar texture and flavor, eventually expanding to other protein-rich foods. Probiotic supplementation has also gained attention in recent years. Some strains, such as Lactobacillus reuteri, have shown potential in improving appetite and digestion, which may indirectly reduce picky behaviors. Behavioral therapies, including parent training and play-based exposure, are also showing promise. These programs teach caregivers how to model healthy eating, reduce mealtime stress, and create structured opportunities for food exploration. Digital tools, such as mobile apps and interactive games, are now being integrated into picky eating treatment plans. These tools engage children in fun, food-focused activities that encourage curiosity and reduce anxiety around unfamiliar foods. As research advances, it is becoming clear that managing picky eating requires patience, personalization, and a positive environment. Rather than focusing on what a child won’t eat, new methods emphasize celebrating small wins and building a healthy food journey over time.

Novel isolated 1p36.33 duplication with developmental disorder, epilepsy and dysmorphic features 
Neurology,Psychiatry,Physical medicine
Bita Barazandeh Shirvan 1 ℗, Mehran Beiraghi Toosi 1 ©, Atieh Eslahi 2, Majid Mojarrad 3, Masoome Alerasool 2
1 Rare Pediatric Neurological Diseases Research Center, Mashhad University of Medical Sciences, ‎Mashhad, Iran.
2 Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
3 Department of Medical Genetics, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Abstract Background: The 1p36 chromosomal region is prone to copy number variations (CNVs) including common deletion alterations and few duplication variants both with high probability of complex chromosomal rearrangement. This study reports a novel isolated duplication of 1p36.33 in a patient presented with developmental delay, seizure and dysmorphic features. It also discusses the implications for diagnostic molecular testing and genetic counseling. Methods: Whole-genome oligonucleotide-based array comparative genomic hybridization (array-CGH) was utilized to identify the CNV, which was validated through quantitative real-time PCR (qPCR). In silico analysis guided by ACMG criteria provided insights into the interpretation of the CNV. An extensive diagnostic workup, including blood work, MRI, EEG, and echocardiogram was employed to uncover the underlying pathology in our patient. Results: The 2.236 Mb duplication in the 1p36.33p36.32 region (nucleotide positions 834,101 to 3,070,509) was identified in our patient. Following ACMG guidelines, this CNV was classified as pathogenic. Keywords: Developmental delay, facial dysmorphism, 1p36.33 duplication, Array CGH. 

Ophthalmologic manifestations in Patients with Neuro-metabolic Disorders
Neurology,Psychiatry,Physical medicine
Maryam Kachuei 1 © ℗, Parvaneh Karimzadeh 2, Hesam Seyedsaleh 3, Fatemeh Abdi 4
1 Department of Pediatric Neurology, Ali Asghar Children’s Hospital, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
2 Pediatric Neurology Department, Pediatric Neurology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
3 School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
4 Department of Ophthalmology, Eye Research Center, The Five Senses Institute, Rassoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran.
Abstract: Abstract Purpose: We aimed to present the ophthalmic manifestations of neuro-metabolic disorders. Methods: Patients who were diagnosed with neuro-metabolic disorders in the Neurology Department of Mofid Pediatric Hospital and Firoozabadi Hospital in Tehran, Iran, between 2022 and 2024 were included in this study. Disorders were confirmed using clinical findings, neuroimaging, laboratory data, and genomic analyses. All enrolled patients were assessed for ophthalmological abnormalities. Results: A total of 112 patients with metabolic disorders and ophthalmologic findings were included. Mitochondrial disease was the most common diagnosis with pigmentary retinopathy . Conclusion: Ophthalmological consultation and assessment is essential in patients with neurometabolic disorders 

Psychological Factors and Atopic Dermatitis: A Narrative Review of the Bidirectional Relationship
Neurology,Psychiatry,Physical medicine
Nader Arbabi 1 © ℗
1 Islamic azad university Qom medical science
Abstract: Psychological Factors and Atopic Dermatitis: A Narrative Review of the Bidirectional Relationship Introduction Atopic dermatitis (AD) is a chronic, relapsing inflammatory skin disease characterized by intense itching, dry skin, and a compromised skin barrier. It typically starts in early childhood and is often linked to other allergic conditions like asthma and hay fever. While allergies are a key cause, AD also has a strong, bidirectional connection with psychological distress, including anxiety and depression. This review explores the clinical and biological aspects of this complex relationship. Methods This narrative review gathered information from major scientific databases like PubMed, Scopus, and Google Scholar. The search used keywords such as "atopic dermatitis," "stress," "anxiety," "depression," "brain-skin axis," "inflammation," and "bidirectional relationship." Articles published up to 2024 focusing on the psychological and physiological links in AD, as well as those examining stress, inflammatory skin diseases, and neuro-immunological mechanisms, were included. Discussion The Brain-Skin Connection There's a strong link between skin conditions and the central nervous system (CNS), partly because both originate from the same embryonic layer, the ectoderm. This shared origin helps explain their mutual influence on health and disease. Additionally, skin plays a vital role in body image, and how someone perceives their body can significantly impact their mental well-being. Stress and Underlying Mechanisms of Inflammation Stress and psychological distress can affect the autonomic nervous system and the hypothalamic-pituitary-adrenal (HPA) axis. This can lead to increased production of inflammatory chemicals in the body while reducing anti-inflammatory hormones like glucocorticoids. Stress also boosts inflammatory mediator production through both the CNS and the peripheral nervous system (PNS). Clinical studies consistently support this physiological link between stress and inflammation. Research shows that even stress during or after pregnancy, including postpartum depression, can be associated with AD. Various family, financial, and emotional stressors experienced by children or their families can also influence the course of AD. Psychological stress and distress are even considered factors in the progression of allergic diseases, known as the Atopic March. Conclusion Atopic dermatitis isn't just an inflammatory skin condition linked to other allergies. Beyond the roles of allergy and barrier dysfunction, stressors are crucial in both its onset and worsening. Therefore, effective AD treatment and management must include careful attention to the patient's psychological well-being. 

The effect of Minocycline on patient with Stress-Induced Childhood-Onset Neurodegeneration with Variable Ataxia and Seizures (CONDSIAS)
Neurology,Psychiatry,Physical medicine
Mehran Beiraghi Toosi 1 © ℗
1 Rare Pediatric Neurological Diseases Research Center, Mashhad University of Medical Sciences, ‎Mashhad, Iran
Abstract: Background: Stress-induced childhood-onset neurodegeneration with variable ataxia and seizures (CONDSIAS) is a progressive neurological disorder for which there is currently no known treatment. Therefore, it is important that we identify a medication that can stop the progression of the disease and improve the patient's condition. Here, we assess the effects of Minocycline on a patient with CONDSIAS syndrome. Methods: We describe a 4-year-8-month-old male with clinical features consistent with CONDSIAS and a homozygous ADPRHL2variant (c.235AC; p.T79P). Comprehensive clinical evaluation, targeted Sanger sequencing were performed . Finally, we assess the effect of Minocycline Results: Following the administration of Minocycline, the patient's regression stopped, and he showed improvement, especially on the motor skills. No adverse effects were observed. Conclusion: Our study revealed that Minocycline may stop the regression of patients with CONDSIAS syndrome. Keywords: ADPRHL2, ARH3, CONDSIAS Syndrome, Minocycline 

The effect of synbiotics in the treatment of drug-resistant epilepsy and the parental burden of caregivers: a single-arm pretest-posttest trial
Neurology,Psychiatry,Physical medicine
Fakhreddin Shariatmadari 1 © ℗, Fakhreddin Shariatmadari 1
1 ark medical university assistant professor pediatric neurology
Abstract: Abstract Background: In patients with drug-resistant epilepsy (DRE), the composition of the gut microbiome changes compared to drug-sensitive patients and healthy individuals. Synbiotics, a mixture of probiotics and prebiotics, aim to improve the balance of bacteria in the gut microbiome. This study aimed to assess the effect of synbiotics on the treatment of DRE and the burden on caregivers. Methods: This one-group pretest-posttest quasi-experimental study was conducted in Arak, Iran. Thirty children with DRE, diagnosed by a pediatric neurologist and meeting the inclusion criteria in 2021-22, were included in the study. In addition to anticonvulsant drugs, infants were administered PediLact at a dose of 5-15 drops per day for eight weeks, and KidiLact at a dose of one sachet per day for eight weeks for children aged 2-15 years. Both PediLact and KidiLact are synbiotics. To investigate the burden on caregivers (parents), the Zarit Caregiver Burden Interview was conducted. In addition, the number of epileptic seizures was assessed from mothers before and immediately after the intervention over one month. Results: The mean age of the participants in the study was 8.6 years (SD: 3.4). Eighteen participants (60%) were boys, and 12 (40%) were girls. The results of the study showed a statistically significant decrease in the mean burden on caregivers, from 34.20 (SD: 14.4) before the intervention to 30.26 (SD: 15.8) after the intervention (P = 0.017). The mean frequency of seizures decreased significantly, from 15.83 (SD: 12.9) before the intervention to 12.73 (SD: 12.8) after the intervention (P = 0.001). Following the intervention, the seizure frequency stopped in two patients, decreased by 50% in six patients, increased in one patient, and remained unchanged in 21 patients. Conclusion: The results suggest that Symbiotics in DRE patients are associated with a lower parental burden of caregivers and seizure frequency. Well-designed randomized clinical trial studies are recommended to generate rigorous causal evidence and conclusions.

Title: Enhancing Function and Quality of Life: Occupational Therapy in Cerebral Palsy
Neurology,Psychiatry,Physical medicine
Saideh Sadat Mortazavi 1 © ℗, Zahra Mortazavi 2
1 Hearing Disorders Research Center, Hamadan University of Medical Sciences, Hamadan, Iran. Student Research Committee, Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
2 . PhD student of Speech Therapy, Tehran University of Medical Sciences, Tehran, Iran. ORCID ID: 0000-0002-6566-1331
Abstract: Background and Objective Cerebral palsy (CP) is the most common cause of childhood physical disability worldwide, with heterogeneous motor and functional challenges. Occupational therapy (OT) plays a pivotal role in enhancing activity and participation. This abstract summarizes the latest evidence (2019–2025) on effective OT interventions for children with CP, emphasizing clinically relevant principles for practice. Methods A targeted review of randomized controlled trials (RCTs), multicenter studies, and systematic reviews was conducted across major databases. Interventions were clustered into: (1) intensive task-specific practice (e.g., CIMT, bimanual training such as HABIT/HABIT-ILE), (2) cognitive strategy-based approaches (CO-OP, goal-directed training), (3) technology-assisted programs (virtual reality, robotics, assistive devices), and (4) home-based and telehealth delivery. Outcomes were mapped to the International Classification of Functioning, Disability and Health (ICF). Results Constraint-Induced Movement Therapy (CIMT) shows strong evidence for improving upper limb function in children with hemiplegic CP, although effect sizes vary across contexts. Bimanual intensive training (HABIT/HABIT-ILE) demonstrates robust improvements in upper limb, trunk control, and participation across multiple RCTs and systematic reviews. Cognitive Orientation to daily Occupational Performance (CO-OP) and goal-directed training enhance achievement of child/family-selected goals, with evidence for transfer to novel tasks. Technology-assisted interventions (VR, robotics) provide small-to-moderate functional gains and caregiver burden reduction, though evidence remains heterogeneous. Dose matters: cumulative practice of \30–40 hours appears to be a threshold for clinically meaningful change. Positive effects on participation outcomes are emerging, but evidence is weaker compared to activity-level measures and requires standardized tools. Conclusions and Implications Effective OT for CP should prioritize intensive, task-specific practice and cognitive strategy training, guided by family-centered goals and a sufficient therapeutic dose. Technology-based interventions can complement conventional therapy, particularly for motivation and access. Future research should address participation-level outcomes, dose–response relationships across age and CP subtypes, and implementation in low-resource settings. Keywords Cerebral palsy; occupational therapy; ICF 

Clinical and Imaging Features of Scimitar Syndrome in a 15-year-old boy: A Case Report
pulmonary disease
Mahdieh Khorashadizadeh 1 © ℗, Sarah Ghahramani 1, Mahdieh Vahedi 1, Amir Behforouz 2
1 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
2 Assistant Professor of Radiology, Department of Radiology, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Horseshoe lung (HL) is an extremely rare congenital pulmonary malformation in which a parenchymal isthmus connects the basal segments of both lungs across the midline. This anomaly is usually associated with other congenital cardiopulmonary malformations, most notably scimitar syndrome, a rare form of partial anomalous pulmonary venous return (PAPVR). The coexistence of HL and scimitar syndrome is particularly unusual and presents with variable clinical manifestations, ranging from asymptomatic incidental findings to severe respiratory and cardiac compromise during infancy or adolescence. We report the case of a 15-year-old previously healthy boy who was admitted after a syncopal episode during sports activity at school. The episode was associated with palpitations, generalized weakness, and transient loss of consciousness. Initial physical examination revealed a cardiac murmur, and transthoracic echocardiography showed right ventricular enlargement with preserved systolic function, mild tricuspid regurgitation, and suspicion of anomalous pulmonary venous drainage. During referral to a tertiary hospital, the patient developed recurrent episodes of hemoptysis, leading to admission to the pediatric pulmonology ward. Chest radiography demonstrated a curvilinear vascular opacity in the right lower lung, mild right lung hypoplasia, and rightward displacement of the heart. Follow-up echocardiography confirmed right heart enlargement, anomalous drainage of two pulmonary veins into the inferior vena cava, a small patent ductus arteriosus, and mild pulmonary hypertension. CT angiography revealed partial anomalous pulmonary venous connection, systemic arterial supply from the abdominal aorta to the right lung consistent with intralobar sequestration, and the presence of a midline parenchymal isthmus characteristic of HL. A ventilation/perfusion scan further confirmed misperfusion of the sequestered segment. The patient initially underwent endovascular embolization of the abnormal systemic arterial supply. However, recurrent hemoptysis developed three weeks later, requiring surgical segmentectomy of the sequestered lung tissue. Subsequently, the patient was evaluated and prepared for corrective open-heart surgery to address the PAPVR. This case illustrates the clinical significance of HL associated with scimitar syndrome, a rare but important combination of congenital anomalies. Clinical presentation varies widely depending on the degree of lung hypoplasia, the extent of anomalous venous return, and associated cardiovascular defects. Advanced imaging techniques such as multidetector computed tomography and cardiac magnetic resonance imaging are essential for accurate diagnosis and detailed anatomical assessment. Management must be individualized, ranging from observation in mild cases to interventional or surgical procedures in patients with severe symptoms, pulmonary hypertension, or recurrent infections. 

Common environmental allergens in asthmatic children: A study on the Northeastern Iranian population
pulmonary disease
Sina Azarli 1 © ℗, Mohammad Mahdi 1, Mohammad Saleh Safavi Shamlou 1, Sara Saadat 2
1 Student Research Committee, Mashhad University of Medical Sciences, Mashhad, Iran
2 Division of Nephrology, Department of Pediatric, Dr. Sheikh Hospital, Mashhad University of Medical Sciences, Mashhad, Iran.
Abstract: Background: There is no precise information on the exposure to different allergens and smoking in asthmatic children. In the present study, we aimed to identify environmental allergens among Iranian asthmatic children. By identifying these allergens, proper management of our asthmatic children can be facilitated. Methods: This cross-sectional study was performed on 557 asthmatic children who were referred to a private allergy clinic between 2003 and 2013. Study information related to baseline characteristics and history of exposure to allergens was extracted from the recorded files at the clinic. Results: Regarding exposure to different allergens, exposure to cigarette smoking was expressed in 20.4%, to opium in 3.8%, to hookah in 2.7%, to lint and wool in 24.2%, and to different birds in 16.7%. Also, exposure to humidity was revealed in 12.2%, dust in 11.8%, dogs, cats, and sheep in 7.2%, heaters and fireplaces in the house in 4.8%, and beetles and other insects in 4.5% of patients. Conclusion: Asthmatic children in our population are exposed to different smokes and allergens. Exposure to passive smoking, especially to cigarette or opium smoke, is common among children. Other common allergens among our asthmatic children include lint, wool, and birds. 

Stridor in Children: Etiology, Diagnosis, and Management
pulmonary disease
Alireza Eshghi 1 © ℗
1 Department of pediatric pulmonology, aliasghar childrens hospital, school of medicine, iran university of medical sciences, tehran, iran
Abstract: Abstract: Stridor is a high-pitched, noisy respiratory sound resulting from partial airway obstruction. In children, it is a common clinical sign that may arise from various etiologies, ranging from benign, self-limiting conditions to life-threatening emergencies. Common causes include viral croup, laryngomalacia, epiglottitis, and foreign body aspiration. A thorough history and physical examination are essential for determining the site and severity of obstruction. Diagnostic tools, such as flexible laryngoscopy, radiographic imaging, and pulse oximetry, can aid in assessment. Management depends on the underlying cause and severity, with priorities including airway stabilization, oxygen supplementation, and specific treatments such as corticosteroids, nebulized epinephrine, or surgical intervention. Early recognition and appropriate intervention are critical to prevent morbidity and mortality. This review summarizes the current evidence on the etiology, diagnosis, and management of pediatric stridor, highlighting key points for clinical practice. Keywords: stridor, children, airway obstruction

Trifid Epiglottis as Part of a Complex Congenital Malformation Spectrum: A Case Report and Literature Review
pulmonary disease
Mahdieh Khorashadizadeh 1 © ℗, Sarah Ghahramani 1
1 Clinical Research Development Unit of Akbar Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
Abstract: Congenital anomalies of the epiglottis are exceptionally rare, with only a few cases described in the literature. Among them, bifid epiglottis has been more frequently reported, often in association with syndromic conditions such as Pallister–Hall and Bardet–Biedl syndromes. Trifid epiglottis, however, represents an exceedingly uncommon entity, with only two previously documented cases. Because of its rarity, the clinical significance of trifid epiglottis remains unclear, yet its potential impact on airway protection, phonation, and feeding makes it a finding of considerable importance in neonates with respiratory or swallowing difficulties. We report the case of a 2-day-old female neonate admitted with abdominal distension, poor feeding, lethargy, and decreased urinary output. On examination, she exhibited polydactyly, cyanosis during crying, and an anteriorly placed anus. Abdominal ultrasonography revealed bilateral dysplastic kidneys with moderate hydronephrosis and hydrometrocolpos. Surgical drainage of hydrometrocolpos was performed, with approximately 50 mL of fluid evacuated, and the urachal tract was ligated. Intraoperatively, the rectum was confirmed to be anteriorly positioned but patent. The patient also had right-sided choanal atresia, which was treated with dilation. Due to persistent respiratory distress and stridor, bronchoscopy was undertaken, revealing a trifid epiglottis, grade 1 interarytenoid notch, and inflamed bronchi with thick secretions requiring therapeutic aspiration and lavage. The vocal cords and trachea were normal. Cardiac evaluation revealed no associated structural heart defects. Following combined surgical and supportive management, the neonate’s condition improved and she was discharged in good general health with close follow-up. This case highlights several important aspects. First, the presence of trifid epiglottis emphasizes the need for meticulous airway evaluation in neonates with unexplained respiratory distress, as such anomalies may be easily overlooked without endoscopic assessment. Second, the coexistence of multiple congenital malformations—including genitourinary, anorectal, and craniofacial anomalies—raises the possibility of an underlying syndromic diagnosis, although definitive genetic testing was not performed in this case. Finally, management of these rare anomalies should be tailored toward stabilization of the airway, relief of obstruction, and prevention of aspiration, while simultaneously addressing life-threatening associated malformations. In conclusion, trifid epiglottis is an exceptionally rare congenital anomaly that may present as part of a complex spectrum of multisystem malformations. Awareness of this entity among neonatologists, pediatric surgeons, and anesthesiologists is crucial, as early recognition and multidisciplinary management can significantly improve outcomes in affected infants

Identification of a High-MAF TagSNP Panel Linked to the PTS Gene for Confirming Prenatal Diagnosis of BH4 Deficiency
Genetics
یاسمن فرهنگ نیا 1 ℗, حسین فهیمی 2, الهام داودی دهاقانی 3 ©
1 1 Department of Molecular and Cellular Sciences, Faculty of Advanced Sciences & Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran. 2 Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran.
2 1 Department of Molecular and Cellular Sciences, Faculty of Advanced Sciences & Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran.
3 2 Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran.
Abstract: Identification of a High-MAF TagSNP Panel Linked to the PTS Gene for Confirming Prenatal Diagnosis of BH4 Deficiency Yasaman Farhangnia1,2 – Hossein Fahimi1, Elham Davoudi-Dehaghani*2 1 Department of Molecular and Cellular Sciences, Faculty of Advanced Sciences & Technology, Pharmaceutical Sciences Branch, Islamic Azad University, Tehran, Iran. 2 Department of Molecular Medicine, Pasteur Institute of Iran, Tehran, Iran. Introduction PTS gene defects can cause tetrahydrobiopterin deficiency, which impairs neurotransmitter production and amino acid metabolism in non-classical phenylketonuria. Given the problems faced by these patients and their families and the inability to treat the disease definitively, prenatal diagnosis is currently the only way to prevent new cases of the disease in families with a history of the condition. In this study, SNPs associated with the PTS gene that can be used for linkage analysis to confirm prenatal diagnosis results were investigated. Method The genomic position of the human PTS gene was first identified using the NCBI-Gene database, based on the human reference genome assembly GRCh38.p14. Subsequently, a one-megabase (1 Mb) flanking region both upstream and downstream of the gene was defined for further analysis. Subsequently, all single-nucleotide polymorphisms (SNPs) within these specified regions were extracted via the UCSC Table Browser. For each region, a total of 10 SNPs with the highest minor allele frequency (MAF) were selected and subjected to analysis through the SNPinfo Web Server to determine tag SNPs. Genetic markers were evaluated and compared using their ALFA-derived MAF profiles from dbSNP. Results Genomic mapping localized the PTS gene to chr11: 112226428- 112233973 (GRCh38.p14). In the 1 Mb upstream flanking region, 4 TagSNPs with high minor allele frequencies were identified including rs12799546 (MAF= 0.36), rs3882890 (MAF= 0.38), rs12804187 (MAF= 0.45), and rs12362038 (MAF= 0.40). The downstream analysis revealed TagSNPs rs2509377 (MAF= 0.43), rs10891427 (MAF= 0.32), rs1369817 (MAF= 0.42), and rs1945110 (MAF= 0.36) with the highest allele frequencies. Furthermore, rs3819331 (MAF= 0.14) was identified as the optimal intragenic TagSNP within the PTS gene. Conclusion The identification of optimal genetic markers for genetic studies requires a meticulous evaluation of marker characteristics, including allele frequency distribution and linkage patterns. This study presents a panel of high-MAF TagSNPs linked to the PTS gene as effective markers for confirming prenatal diagnosis of BH4 deficiency. Future research should expand this framework to diverse population cohorts. Keywords TagSNP, PTS Gene, Minor Allele Frequency, Tetrahydrobiopterin deficiency

Impact of COVID-19 Pandemic on Otolaryngologic Surgeries in Iranian Pediatrics
surgery
Mahtab Rabbani Anari 1 ℗, Fatemeh Mirashrafi 2, Alireza Sharifi 3 ©, Mohammad Hossein Salmani 4
1 Otorhinolaryngology Research Center, Department of Otolaryngology-Head and Neck Surgery, Amir A’lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
2 Otorhinolaryngology Head and Neck Surgery Department, Otorhinolaryngology Research Center, Imam Khomeini Hospital Complex, Tehran University of Medical Sciences, Tehran, Iran
3 Department of Otolaryngology-Head and Neck Surgery, Amir A’lam Hospital, Tehran University of Medical Sciences, Tehran, Iran
4 Qom University of Medical Sciences, Qom, Iran
Abstract: Background: There is no study about the evaluation of incidence rates of tonsillectomy, adenoidectomy, and ear surgeries before and during the coronavirus disease 2019 (COVID-19) pandemic and the impact of pandemic peaks on the incidence rates of these operations in the world, particularly in Iran. Objectives: This study aimed to evaluate the impact of the COVID-19 pandemic on the number of most common otolaryngologic operations in the Iranian pediatric population. Methods: This retrospective study was performed in a referral hospital. The data of target patients over the period of March 21, 2018, to November 22, 2021, were collected. The number of surgeries at the period of any peak plus before and during the COVID-19 pandemic was compared. Results: A total of 6 290 patients from the Health Information System of Amir A’lam hospital, Tehran, Iran, were enrolled. In this study, 52.9% and 46.5% of the patients were male and female, respectively. There were 3 main types of surgeries, such as adenoidectomy, tonsillectomy, and ear surgeries, with mean ± standard deviation (SD) age of 10.20 ± 9.4, 11.45 ± 10.8, and 44.19 ± 14.6 years, respectively. There was a significant difference in terms of the total number of operations between before (n = 5070) and during the COVID-19 pandemic (n = 1220) (P 0.001). The amount of this difference was much greater in tonsillectomy (n = 3736 vs. n = 546) and adenoidectomy (n = 134 vs. n = 21) than in ear surgeries (n = 1200 vs. n = 653). Conclusions: The COVID-19 pandemic significantly reduced the number of most common otolaryngologic surgeries in the Iranian pediatric population. The reason is that the restrictions during the pandemic might have a potential effect on reducing the transmission of tonsil-adenoid gland infection.

Behavior management strategies for pediatric in dental office and scientific criteria for the use of general anesthesia
pharmacology
صدیقه مظفر 1 © ℗
1 استادیار دانشکده دندانپزشکی شاهد
Abstract: Given the advances in the promotion of oral hygiene and the prevention of caries , caries in the primary and permanent dentition are still a major problem. A group of these patients can be controlled by the usual psychological behavioral managements and do proper treatment. Despite access to different behavioral guidance techniques, children’s anxiety during treatment is a major problem, which has a prevalence between 3-43% in different studies. The management of anxious and uncooperative children is a challenge frequently encountered by many dentists in their daily practice. In addition, children with specific medical conditions , such as cerebral palsy , autism,…. are also included in this group. At times, even the most skilled and experienced pediatric dentists may fail to obtain the child’s cooperation during treatment . In such cases , pharmacological behavior management, including various levels of sedation and general anesthesia , are considered . According to the pediatric dentist’s clinical judgment, an appropriate pharmacological behavior management technique may be selected for the child. In this way ,both the child’s physical and psychological well-being are preserved , while ensuring the delivery of high quality dental treatment. 

Drug Resistance in Common Intestinal Parasites of Children in Iran: Novel Therapeutic Strategies
pharmacology
Mohammad Taghi Ahady 1 © ℗, Parend Ashoori Lati 2, Aria Padash 2, Maryam Sadeghi Khiavi 2, Somayeh Hosseini Yousef Abad 2, Sahar Jalali 2
1 PhD of Medical Parasitology, Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
2 Department of Biology, Ard.C., Islamic Azad University, Ardabil, Iran
Abstract: Background and Aim: Drug resistance in intestinal parasites poses an increasing threat to the control and treatment of parasitic diseases, especially in the children as a vulnerable population. This phenomenon challenges the success of disease control programs and highlights the need for new therapeutic strategies. The purpose of this systematic review was to assess the current state of treatment resistance in common intestinal parasites that affect Iranian children and to suggest innovative ways to deal with this problem. Methods: A systematic study was conducted in PubMed, Scopus, Web of Science, SID, and Iran Medex databases using keywords “drug resistance,” “intestinal parasites,” “children,” “Iran,” “mebendazole,” “albendazole,” “pyrantel pamoate,” “metronidazole,” “Giardia,” “Ascaris,” “oxyurid,” “Enterobius,” and “hookworm.” Articles published from 2000 to 2025 that studied drug resistance or treatment efficacy in common intestinal parasites in Iranian children were included. After quality evaluation, 48 articles were chosen for the present study out of the 215 retrieved publications. The information on parasite species, medications taken, drug resistance rates reported were gathered and analyzed. Results: Studies showed that common intestinal parasites in Iranian children are Giardia lamblia, Ascaris lumbricoides, Enterobius vermicularis, and hookworms including Ancylostoma duodenale and Necator americanus. Mebendazole and Albendazole had reduced efficacy in treating Ascaris and hookworms, and Metronidazole for Giardia. Some studies have reported treatment failure rates with mebendazole for Ascaris up to 30% and metronidazole resistance in Giardia up to 20%. Major challenges include the lack of a comprehensive drug resistance surveillance system, and the overdosing of medications. Novel therapeutic strategies, including combination therapies and the development of new drugs, were discussed. Conclusion: There is a significant concern about drug resistance in Iranian Children intestinal parasites. Continuous surveillance of resistance, and implementation of strict adherence to treatment protocols, and enhancement of public awareness are crucial to solve this problem. Drugs like Ivermectin (particularly when used in conjunction with albendazole for certain nematodes), Nitazoxanide, and Tinidazole have become viable substitutes for Giardia in cases where the nematode is resistant to benzimidazoles (albendazole and mebendazole) and nitroimidazoles (metronidazole). Keywords: Drug resistance, Intestinal parasites, Children, Iran, Treatment strategies. 

Assessing breast milk adequacy and ways to increase milk production
Nutrition
محمود راوری 1 © ℗
1 
Abstract: Breastfeeding and human milk are the normative standards for infant feeding and nutrition. Indicators of effective breastfeeding and breast milk adequacy are adequate infant hydration, adequate output and infant weight. Some infants take longer to regain their birth weight. Before deciding that exclusive breastfeeding is inadequate, the health care provider must consider other factors that may contribute to slow weight gain. Nearly all newborns lose weight for the first 2 to 4 days after birth, given the loss of meconium and diuresis. Newborns who are feeding well should not continue to lose weight after lactogenesis 2 and who is nursing effectively should obtain enough milk to begin gaining weight by day 4 or 5 after birth, at a rate of approximately 15 to 30 g per day. If weight loss persists, milk production and transfer should be assessed. In maternal lactation insufficiency the weight change from before to after the feeding is less than 45 g beyond the first few days after birth, this may be a reason for concern. During subsequent breastfeeding beyond the immediate postpartum period, whenever the mother perceives “insufficient milk,” the introduction of supplementary fluids may cause negative feedback on milk production. Strategies to improve breast milk transfer and breast milk production include: • Encourage mother to: Respond to early feeding cues, breastfeed as often as the infant is showing feeding cues, and at least 8 times in 24 hours, Not wait until breasts are feeling hard, engorged, or overfull and ensure that the infant is positioned well and latched effectively (Elicit a mother’s breast milk ejection reflex, have adequate breast milk transfer and help stimulate and/or maintain adequate breast milk production). • Ensure that the mother knows how to: Hand express, Nurse Longer, Double-Nursing and Uses breast compression and switch nursing. 

No to "Iatrogenic child abuse" be a pioneer!
Forensic medicine
امیر عباس بشارتی 1 © ℗, علی فرهمند 2, فاضله کیا 3, حانیه کریمی 4, راضیه حسنوند 5, مهتاب سامی 6, مریم بلاغی اینالو 7
1 متخصص کودکان ـ بیمارستان حکیم - دانشگاه علوم پزشکی تهران
2 دانشجوی  پزشکی مقطع کارورزی- دانشگاه علوم پزشکی ایران -رئیس کمیته مرکزی لایف
3 دانشجوی پزشکی - مقطع کارورزی- دانشگاه علوم پزشکی ایران- عضو کمیته مرکزی لایف
4 دانشجوی همزمان مقطع کاراموزی پزشکی و ارشد اموزش پزشکی-دانشگاه علوم پزشکی ایران-عضو کمیته مرکزی لایف
5 دانشجوی mph شیراز و دانشجوی مقطع کاراموزی پزشکی دانشگاه علوم پزشکی ایران ، H_mba عضو کمیته مرکزی لایف
6 دانشجوی پزشکی - مقطع کارورزی- دانشگاه علوم پزشکی ایران- عضو کمیته مرکزی لایف - عضو تیم کشوری انجمن کشوری ایمسا-ایران
7 دانشجوی پزشکی - مقطع کارآموزی - دانشگاه علوم پزشکی ایران / عضو کمیته مرکزی لایف / عضو تیم کشوری انجمن کشوری ایمسا-ایران
Abstract:

 واضح و مبرهن است که «درد و اضطراب» در کودکان بالای یک ماه در بیمارستان، بخصوص اورژانس به صورت قابل قبولی اداره نمیشود و «پیشگیری» از آن متاسفانه به صورت سیستماتیک انجام نمیشود. در طب مدرن اطفال سالهای متمادی است که امکان پیشگیری و اداره درد و اضطراب در کودکان بالای یک ماه به صورت غیر دارویی و دارویی پرتوکلیزه شده انجام میشود. طرفه آنکه تمام امکانات (ابزار و دارو های لازم) در کشورمان ایران وجود دارد و در دسترس است. متاسفانه بسیاری از ارایه دهندگان خدمت در طب اطفال از وجود و نحوه استفاده از این امکانات اطلاع کامل ندارند و در صورت اطلاع در هیچ ساز و کاری به صورت سیستماتیک پیشگیری از درد و اضطراب کودکان حین راه خدمت ارایه نمیشود. طبق یکی از اصول چهارگانه اخلاق پزشکی، رساندن ضرر به بیمار، زیر پا گذاشتن اخلاق پزشکی محسوب میشود. بنابراین با توجه به اینکه ایجاد درد و اضطراب در کودکان در حالیکه دانش و ابزار جلوگیری از آن وجود دارد و در دسترس هست، نه تنها اخلاق پزشکی را زیر پا میگذارد بلکه با توجه به اینکه گروه هدف کودکان معصوم و بی دفاع هستند، نوعی آزار کودکان محسوب میشود و از آنجایی به قصد ارایه خدمت است میتوان آنرا «آزار ایاتروژنیک کودکان» نامید. ضرورت و اهمیت پیشگیری و اداره درد و اضطراب در کودکان واضح و مشخص است و نیاز به استدلال ندارد و از هر جنبه، امری ضروری، اخلاقی و جزو وظایف ارایه دهندگان خدمت هست که مغفول مانده است وشواهد علمی ثابت شده در حوزه پیشگیری و اداره درد و اضطراب در کودکان سال هاست که موجود است و در بسیاری از کشور ها به صورت روتین استفاده میشود و پروتکل های مربوطه غیر دارویی و دارویی در منابع معتبر به وضوح تبیین شده است، در نتیجه نیازی به پایلوت نیست، بلکه نیاز به اقدام (پایونیر شدن) است. با توجه به مشاهدات عینی برخی مطالعات انجام شده در ایران و خارج از ایران (رفرنس ۱- ۳) احتراز و ترس بی دلیل نزد ارایه دهندگان خدمت در استفاده از روش های فارماکولوژیک وهمچنین بی اطلاعی از عوارض درد به خصوص در اورژانس، چالش هایی هستند که در پیشگیری و اداره درد و اضطراب در کودکان میشوند و راه حل آن آگاهسازی و آموزش همراه پیاده سازی می‌باشد. در این مجال مروری داریم به راه های دارویی و غیر دارویی با تمرکز بر پیشگیری از درد و اضطراب کودکان در محیطهای درمانی. 

Investigation of Clinical Signs of Methadone Poisoning in Children Hospitalized at Shahid Motahari Hospital, Urmia, during the period 2019-2024
Toxicology
Mahnaz Mohamadpouri 1 ℗, Mahsa Salehzadeh Nobari 1, Mir Reza Ghaemi 2 ©, Neda Pashaei Yingejeh 1, Sima Ghanipour Badelbuu 3, Horiyeh Rahimi Gholanji 4
1 Master of Nursing, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
2 Assistant Professor of Allergy and Clinical immunology ,Urmia University of medical sciences ,urmia,Iran
3 Department of Nursing and Midwifery, Urmia Branch, Islamic Azad University, Urmia, Iran
4 Expert of Nursing, Clinical Research Development Unit, Shahid Motahari Educational and Treatment Center, Urmia University of Medical Sciences, Iran
Abstract: Introduction: Poisoning is one of the common causes of referral to emergency departments. Opioids, especially methadone, are among the causes of unintentional poisoning in children, leading to a high number of emergency visits in pediatric hospitals. This study was conducted to evaluate methadone poisoning, clinical signs in affected children. Methods: This descriptive cross-sectional study was conducted using a census method on the medical records of 107 children hospitalized due to methadone poisoning at Shahid Motahari Educational and Treatment Center, Urmia. Data were collected through a checklist containing demographic information and clinical signs. Data analysis was performed using SPSS version 23 with descriptive statistics and frequency percentages. Results: The mean age of patients was 52 ± 41 months, with 62.6% in the age range of 13 to 59 months. About 59.8% of patients were admitted within 12 hours of poisoning, 57% were male, 81.3% of poisonings were accidental, and 64.5% had ingested methadone syrup. Clinical signs included miosis in 72.9%, mydriasis in 4.8%, decreased level of consciousness in 78.5%, seizures in 2.8%, respiratory arrest in 10.3%, bradypnea in 20.5%, cyanosis and oxygen desaturation in 28.9%, aspiration in 4.7%, nausea and vomiting in 41.1%. Cardiac signs were normal in 72.9% of cases, while 19.6% had tachycardia. Intubation was required in 8.4% of patients. Mortality rate was 0.9% (one case), and recovery was achieved in 84.1%. Naloxone injection was administered in 95.7% of cases. Conclusion: Educating parents on preventing accidental methadone consumption, timely referral to treatment centers upon occurrence of poisoning symptoms, and training on proper methadone storage by addiction treatment centers are effective measures in reducing methadone poisoning incidents Keywords: Toxicity - Methadone - Clinical symptoms - Children 

Advancements in Pediatric Hematopoietic Stem Cell Transplantation: Emerging Indications for Expert Professionals
Hematology & Oncology
Hadi Mottaghipisheh 1 © ℗
1 Hematology research center shiraz
Abstract: Advancements in Pediatric Hematopoietic Stem Cell Transplantation: Emerging Indications for Expert Professionals The landscape of pediatric hematopoietic stem cell transplantation (HSCT), continues to evolve with significant expansions in indications beyond traditional applications. Recent advances have refined patient selection criteria, particularly for high-risk hematologic malignancies, and broadened the therapeutic potential of HSCT for non-malignant disorders and solid tumors. Genetic profiling now guides transplantation decisions for hematologic malignancies and identifies patients who benefit most from allogeneic HSCT. HSCT is increasingly recognized as a transformative therapy for non-hematologic disorders in pediatric patients, extending beyond traditional applications in hematologic malignancies and bone marrow failure syndromes. Recent advances have demonstrated the potential of HSCT to modify the natural history of inherited metabolic disorders, severe immunodeficiencies, autoimmune conditions, and even certain solid tumors. For inherited metabolic diseases such as adrenoleukodystrophy (ALD) and mucopolysaccharidoses, allogeneic HSCT can halt disease progression by establishing donor-derived microglial engraftment and enzymatic correction, with long-term survival rates. The application of HSCT has also expanded to autoimmune and inflammatory disorders refractory to conventional therapies. Emerging evidence supports the role of autologous HSCT in severe juvenile idiopathic arthritis and systemic lupus erythematosus, where immunoablation and immune resetting can induce sustained remission in 50% of cases. For neurometabolic conditions such as X-linked lymphoproliferative disease, HSCT can prevent fatal complications by restoring immune function and metabolic homeostasis. Despite these promising applications, significant challenges remain. Transplant-related toxicity and graft-versus-host disease (GVHD) contribute to non-relapse mortality rates of 10-30% in non-malignant disorders, necessitating careful risk-benefit assessment. Access barriers, including socioeconomic factors, perceived mortality risks, and donor availability, further limit utilization, particularly in resource-limited settings. The future integration of gene therapy approaches and international collaborative research efforts promises to further expand and optimize the application of HSCT for children with nonhematologic disorders, ultimately improving survival and quality of life for these vulnerable patients. Hadi Mottaghipisheh M.D. Pediatric hematologist and oncologist Fellowship of pediatric hematopoietic stem cell transplantation Assistant professor of Shiraz university of medical sciences

Beta thalassemia Gene therapy
Hematology & Oncology
Leila Jafari 1 © ℗
1 Pediatric Cell and Gene Therapy Research Centre, Gene, Cell & Tissue Research Institute, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Beta thalassemia, a hereditary blood disorder marked by defective β-globin synthesis, has long imposed a heavy burden of chronic transfusion dependence, iron overload, and diminished quality of life. Although allogeneic hematopoietic stem cell transplantation (HSCT) remains the only definitive cure, its applicability is severely limited by donor availability and associated risks such as graft‑versus‑host disease and long-term immunosuppression In recent years, autologous gene therapy using either gene addition or genome editing has emerged as a transformative alternative. Betibeglogene autotemcel (Zynteglo®) is a lentiviral vector-based gene addition therapy encoding a β‑globin variant (βA-T87Q). Following successful trials, it achieved regulatory approval in the EU (2019) and the US (2022), demonstrating durable transfusion independence in a significant proportion of treated individuals Despite encouraging outcomes, challenges persist including high therapy costs, access limitations, and concerns over insertional oncogenesis Parallel to gene addition efforts, genome editing techniques particularly CRISPR/Cas9-mediated disruption of the BCL11A erythroid enhancer have shown remarkable potential in reactivating fetal hemoglobin (HbF) expression. The CTX001/“Casgevy” platform, developed by CRISPR Therapeutics and Vertex, has achieved sustained HbF upregulation and transfusion independence in early-phase clinical studies, culminating in historic regulatory approvals. Other genome editing approaches including zinc finger nucleases (ZFNs), TALENs, and CRISPR-mediated direct repair of pathogenic point mutations are under active investigation. Preclinical results in patient-derived iPSC and HSPC models have demonstrated high targeting efficiency and minimal off-target effects, heralding a shift toward precision medicine in β‑thalassemia gene therapy Despite transformative progress, key hurdles remain including enhancing delivery efficiency to hematopoietic stem cells, ensuring long-term safety (e.g. minimizing oncogenic risk), reducing conditioning-related toxicity, and overcoming economic and logistical barriers. As gene therapy matures into clinical reality, continued innovation in vector engineering, genome editing modalities, and equitable access frameworks will be paramount in realizing a universal cure for β‑thalassemia 

Checkpoint Inhibition Prior to Allogeneic Stem-Cell Transplantation in Relapsed/Refractory Hematologic Malignancies: Balancing Efficacy and Risk
Hematology & Oncology
Kazem Ghaffari 1 ℗, Shaban Alizadeh 2 ©
1 Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran Department of Basic and Laboratory Sciences, Khomein University of Medical Sciences, Khomein, Iran Student’s Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran
2 Department of Hematology and Blood Transfusion Sciences, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran
Abstract: Background: Relapsed/refractory (R/R) hematologic malignancies remain a major therapeutic challenge, with allogeneic stem-cell transplantation (alloSCT) representing the only curative option for many patients. Checkpoint inhibitors (CPI), including PD-1 inhibitors (nivolumab, pembrolizumab), PD-L1 inhibitors (atezolizumab, durvalumab), and CTLA-4 inhibitors (ipilimumab), have shown significant efficacy in achieving disease control and enabling patients to proceed to alloSCT. Methods: We reviewed current clinical and translational data on the use of CPI as a bridging strategy before alloSCT in R/R hematologic malignancies, focusing on efficacy, safety, and strategies to mitigate transplant-related complications. Results: CPI exposure before alloSCT is associated with high response rates in Hodgkin lymphoma and encouraging disease clearance in other malignancies such as acute myeloid leukemia and myelodysplastic syndromes. However, pre-transplant CPI increases the risk of severe immune-related complications, particularly acute and chronic graft-versus-host disease (GvHD) and non-relapse mortality. Prolonged antibody half-life and residual immune activation are key contributors. Mitigation strategies, including extended washout intervals, use of post-transplant cyclophosphamide (PTCy)-based prophylaxis, and stringent patient selection, have demonstrated potential in reducing toxicity. Conclusion: Checkpoint inhibition prior to alloSCT represents a promising but double-edged therapeutic approach. While CPI can provide a crucial bridge to transplantation by inducing deep remission in R/R patients, the increased risk of post-transplant GvHD necessitates careful timing, optimized prophylaxis, and individualized patient selection. Future prospective trials are essential to define the safest integration of PD-1, PD-L1, and CTLA-4 blockade into the alloSCT pathway.

Innovative therapeutic strategies for GVHD treatment:immunotherapy and cell based therapies
Hematology & Oncology
Dr Vahid Falahati 1 © ℗
1 v.falahati@mahak-charity.org
Abstract: GVHD remains as a serious and life-threatening complications after allogeneic hematopoietic stem cell transplantation (HSCT). It arises when donor T lymphocytes recognize host tissues as foreign and mount an immune response against them. Despite progress in prophylactic strategies and first-line immunosuppressive treatments, steroid-refractory GVHD continues to pose significant clinical challenges. In recent years, advances in immunomodulatory and cell-based therapies have opened new therapeutic avenues and improved outcomes for affected patients. Among the most promising innovations the use of Janus kinase (JAK) inhibitors, particularly ruxolitinib, which block inflammatory signaling pathways and have shown considerable efficacy in patients with steroid-resistant GVHD. In addition, cellular therapies such as T regulatory cells (Tregs) and mesenchymal stromal cells (MSCs) are being explored in clinical trials for their potential to restore immune tolerance and mitigate tissue damage through immunoregulatory mechanisms. Biologic agents targeting specific immune checkpoints and cytokine receptors such as abatacept (CTLA-4-Ig) and anti-IL-6R antibodies further expand the therapeutic landscape in this field. Monoclonal antibodies targeting specific immune receptors such as anti-IL-2R and anti-CCR5 have also shown potential in modulating the alloreactive immune response. Moreover, increasing attention has been paid to the role of the gut microbiome in GVHD pathogenesis. Fecal microbiota transplantation (FMT), aimed at restoring microbial diversity, is emerging as a novel adjunct therapy with encouraging early results. In conclusion, not only the integration of advanced immunotherapies, cell-based interventions, and microbiome-focused treatments marks a transformative era in GVHD management, but also strive to preserve the beneficial graft-versus-leukemia (GvL) effect.