Journal of Comprehensive Pediatrics

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Journal of Comprehensive Pediatrics is the official publication of the IR Society of Pediatrics (ISP) and a peer-reviewed medical journal that is published quarterly. It is informative for all practicing pediatrics including the general medical profession.

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Fecal Calprotectin and the Complications of IgA-mediated Vasculitis: A Cohort Study
(Brieflands, 2024-08-31) Kosar Asna Ashari; Hosein Alimadadi; Payman Sadeghi; Vahid Ziaee
Background: Immunoglobulin A (IgA)-mediated vasculitis, previously known as Henoch-Schönlein Purpura (HSP), is the most common vasculitis in children. It affects the skin, joints, gastrointestinal (GI) system, and kidneys. Calprotectin is a calcium-binding protein mainly found in neutrophils and macrophages, and its levels increase in settings of inflammation. Objectives: We conducted a study to investigate the role of calprotectin in prediction of HSP complications. Methods: In this cohort study, patients diagnosed with HSP by EULAR/PRINTO/PRES criteria and admitted to two referral children’s hospitals in Tehran, Iran, were enrolled. Fecal calprotectin levels were checked at the beginning of the presentation, and the patients were followed for GI and renal manifestations. Results: Out of the 100 patients who began to participate, 47 were eventually enrolled (25% girls). The age range was 2 to 18 years, with a mean of 6.5 ± 2.9 years. Hematuria was found in 21% and proteinuria in 17%. The Mann-Whitney test found an association between calprotectin and blood in stool (P = 0.03). No association was found between calprotectin and abdominal pain, sonography findings, hematuria, or proteinuria. The Pearson correlation test found a positive correlation between calprotectin level and leukocyte count (P = 0.003), neutrophil count (P = 0.002), and CRP (P = 0.03). Conclusions: Positive blood in stool was associated with fecal calprotectin levels in HSP, but hematuria and proteinuria were not. Considering the high cost of the calprotectin test, monthly follow-up with urine analysis appears to be a more logical approach. Neutrophil count and CRP were found to correlate with calprotectin levels, highlighting the nature of calprotectin as an acute inflammatory marker elevated during the acute phase of HSP disease.
The Effect of Music Therapy on the Pain Level of 3 to 6-year-old Children Undergoing Wound Repair by Suturing and Their Parents' Anxiety in the Emergency Department: A Randomized Controlled Trial
(Brieflands, 2024-06-29) Masoumeh Bakhshandeh; Masoumeh Bagheri-Nesami; Mohammadali Heydarigorji; Abolfazl Hoseinnataj
Background: Music can serve as a passive distraction to reduce pain and anxiety. Due to the limited number of studies in this field, a study was designed and implemented to determine the effect of music therapy on the pain level of 3 - 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Objectives: This study aimed to examine the effect of music therapy on the pain level of 3 to 6-year-old children undergoing wound repair by suturing and their parents' anxiety in the emergency department. Methods: The present study is a parallel, controlled, randomized clinical trial. Sixty children aged 3 to 6 years referred to the emergency room for sutures were included in the study. In the test group, music was played on a mobile phone from the time the child entered the outpatient operating room until the end of the procedure and discharge. In the control group, children were sutured as usual. The behavioral reactions of both groups were assessed using Wong-Baker's pain scale before washing the wound, immediately after the injection of lidocaine, and at the end of the suture. The abbreviated Spielberger Situational Anxiety Questionnaire was used to measure parents' anxiety before washing the wound and at the end of the suture. These measures were recorded by the researcher. Results: Comparing the mean (standard deviation) of pain before washing the wound in the test group (9.90 ± 0.44) and the control group (9.97 ± 0.258) showed no statistically significant difference (P = 0.311). Using the GEE model, the average pain score immediately after lidocaine injection and at the end of the suture decreased by 1.77 and 4.9 units, respectively, compared to the phase before washing the wound (P < 0.001). The average anxiety of parents before washing the wound was 21.05 ± 2.59 in the test group and 21.05 ± 2.09 in the control group, showing no statistically significant difference (P = 0.801). Conclusions: Based on the results of this study, there was no statistically significant difference between the two groups in terms of children's pain and parents' anxiety. However, clinically, the average levels of children's pain and parents' anxiety in the intervention group decreased at all three times. Music therapy seems to be effective in the emergency department during painful procedures.
Clinical Scoring Systems in Cystic Fibrosis – What Are the Options for Developing Countries?
(Brieflands, 2013-11-30) Brenda Morrow
Cystic fibrosis (CF) is recognized as a serious, life-limiting autosomal recessive inherited condition, affecting multiple organs. Improvements in both diagnosis and management of CF has led to the recognition of a range of phenotypes, from mild to severe, with varying rates of disease progression. Pulmonary disease is still the main predictor of morbidity and mortality associated with CF (1). There are currently nearly 2000 recognized cystic fibrosis trans-membrane regulator (CFTR) mutations.
Adrenal Insufficiency as a Cause of Loss of Consciousness: A Case Study
(Brieflands, 2014-05-31) Fahimeh Soheilipour; Mohammad Ahmadi; Fatemeh Jesmi
Introduction: The current study introduces a case with adrenal insufficiency that was suspected to have congenital adrenal hypoplasia because of undescended testis and failure to thrive due to muscle involvement. Case Presentation: The patient was a 34-month-old boy who had loss of consciousness, hypotension, hypoglycemia, hyponatremia and hyperkalemia with severe failure to thrive, hyper pigmentation of mucosa, hypotonia and no hypospadias. He was resistant to serum therapy and responded to hydrocortisone. Laboratory study elucidated elevated levels of adrenocorticotropin (ACTH) and muscle enzymes, decreased serum cortisol levels. Discussion: Adrenal hypoplasia congenita is a differential diagnosis for adrenal insufficiency. Undescended testis, especially in absence of hypospadiasis, is a clue to diagnose and treat this lethal disease.
Abnormal Findings in Brain CT Scans Among Children
(Brieflands, 2014-05-01) Mahnaz Haghighi; Mohammad Hadi Baghery; Faride Rashidi; Zahra Khairandish; Mehrab Sayadi
Background: CT scan is one brain imaging method, being used to a greater extent than the past. Objectives: This study aimed to investigate the prevalence of abnormal findings in brain CT scans among children as well as the reasons for brain CT scan requests. Patients and Methods: In the present case series, demographic information and CT scan reports of 167 patients referred to Taba Radiology Center in Shiraz from April 2010 to August 2011 were collected. The major complaints of the patients were gathered through phone contacts. Descriptive statistics and Pearson chi-Square tests were used. P < 0.05 was considered statistically significant. Results: Among the 167 patients, 84 (50.3%) were males and the average age of the patients was 12.5 ± 4.7 years. Twenty patients (11.98%) had abnormal CT scans. The most prevalent abnormal findings were arachnoid cyst in 4 (20%), cerebral hemorrhage in 3 (15%), atrophic change in 3 (15%), hydrocephaly in 3 (15%), and congenital underdevelopment in 2 (10%) cases. The most common major complaints included headache in 73 (60.8%), head injury in 14 (11.5%), and seizure in 12 (10%) patients. Only 2.7% of the patients with headaches showed abnormal findings in CT scans, compared with 17% of patients with other complaints; this difference was significant (P = 0.013). Conclusions: Headache, seizure, and trauma are the main reasons for CT scan requests. About 12% of the brain CT scans were abnormal. Being knowledgeable about the indications of imaging, unnecessary imaging can be prevented, and consequently, its risks can be minimized.
Changing Management of Kawasaki Disease
(Brieflands, 2014-08-01) Francesco Vierucci; Andrea Azzarelli; Rossana Gualtierotti; Raffaele Domenici
This article does not have an abstract.
Acylated Ghrelin, Growth Hormone and IGF-1 Levels in the Cord Blood of Small for Gestational Age Newborns
(Brieflands, 2016-11-30) Nastaran Khosravi; Farhad Abolhasan Choobdar; Nasrin Khalesi; Arash Bordbar; Bagher Larijani; Zahra Arab; Mitra Nourbakhsh
Background: Ghrelin is a pleiotropic hormone that regulates feeding and energy balance and stimulates growth hormone release. Ghrelin also exerts developmental and organizational effects during prenatal life. Objectives: The aim of this study was to determine ghrelin levels in cord blood of small for gestational age (SGA) infants and its association with GH (growth hormone) and IGF-1 levels (insulin-like growth factor-1). Methods: Cord blood sample was obtained from 31 SGA and 25 appropriate for gestational age (AGA) infants. Acylated ghrelin, GH, and IGF-1 levels were measured by enzyme-linked immunosorbent assay. Results: No significant differences were observed in ghrelin and GH concentrations between SGA and AGA infants. However, IGF-1 levels were significantly lower in SGA infants. Cord blood ghrelin was negatively correlated with the infants’ birth weight (r = -0.33, P = 0.013); on the other hand, IGF-1 level was positively correlated with birth weight (r = 0.43, P = 0.002). Conclusions: IGF-1 has the most significant effect on intrauterine growth. Acylated ghrelin is detectable in cord blood and correlated with birth weight, suggesting a role in intrauterine development, but its level is not affected by intrauterine growth retardation.
The Factors Affecting Exclusive Breastfeeding in 6 Month-Old Infants: A Population-Based Case-Control Study
(Brieflands, 2019-12-18) Monavar Afzal Aghaee; Ehsan Mosa Farkhani; Hamidreza Bahrami Taghanaki; Najmeh Mohajeri; Fatemeh Tavakoli; Sima Barid Kazemi
Background: Exclusive breastfeeding contributes to the health and survival of the newborn. Many factors influence this behavior. Objectives: This study aimed to identify the related determinant factors. Methods: In this case-control study 8130 cases that did not have exclusive breastfeeding at 6 months of age were matched with 53266 people from control group. The two groups were compared in terms of risk factors such as sex, birth rank, weight, height and head circumference, type of delivery, maternal age, hypothyroidism in the infant, mother’s disease, mother’s educational level, job and breastfeeding at night. Bivariate and multivariate logistic regression was applied to determine the association between independent variables and non- exclusive breastfeeding. Results: Ninety % of mothers had exclusive breastfeeding their infants. In multivariate analysis low birth weight (AOR = 2.37; 95% CI: 1.45 - 3.86), head circumferences < 32.5 cm (AOR = 1.84; 95% CI: 1.11 - 3.06), cesarean section (AOR = 2; 95% CI: 1.45 - 2.75), older age (AOR = 1.59; 95% CI: 1.44 - 1.75), being employed (AOR = 1.31; 95% CI: 1.12 - 1.46) and no breastfeeding at night (AOR = 199; 95% CI: 1.48 - 2.69) remained in the final model after adjusting for confounding variables. Conclusions: planning interventions aimed at knowledge promotion, encouraging vaginal delivery, paying attention to employed mothers and mothers without breastfeeding at night could be beneficial in improving exclusive breastfeeding among mothers.
Comparison of Tissue Transglutaminase and Anti-Endomysial Antibody Tests in Diagnosis of Celiac Disease
(Brieflands, 2019-12-16) Mohammad Sobhani Shahmirzadi; Ahmad Sohrabi
Background: Although initially considered as a digestive tract disease, celiac disease (CD) can cause problems and complications in most other organs. Common serologic tests for the diagnosis of CD include anti-tissue transglutaminase (tTG) and anti-endomysial Ab (EMA). A more recent test includes anti-deamidated gliadin peptide. Objectives: This study aimed to compare the values of tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes in patients with a definitive diagnosis of CD. Methods: Patients suspected of CD referring to a Gastrointestinal Pediatric Clinic were evaluated for CD using IgG and IgA for tissue transglutaminase and endomysial antibodies and total IgA. Endoscopy and biopsy were done based on the CD diagnosis protocol. The demographic data of children were recorded in a questionnaire and then analyzed. Results: Of the 54 patients diagnosed with CD, 29 were females and 25 were males. TTG-IgA had the highest positivity rate. Tests based on IgA were more positive than IgG tests. More than one test was positive in 81.5% of the patients. All four tests were positive in 16 patients. In 18.5 percent of patients, just one test was positive. In the latter group, TTG-IgA was positive in four patients. The coefficient of agreement between EMA-IgA and TTG-IgA was 0.435, which was statistically significant. Conclusions: We suggest tissue transglutaminase and endomysial antibodies in A and G Immunoglobin subtypes for the diagnosis of CD. In this method, the diagnostic sensitivity of CD is high and in the next step, endoscopy and sampling can increase the specificity value. If the tests are not available, preferable tests are IgA subtype antibodies.
Intestinal Parasites and Theta Brainwave Changes in Children
(Brieflands, 2020-10-17) Massomeh Davoudi; Raheleh Rafiei Sefiddashti; Ahmadreza Meamar; Somayeh Toreyhi; Ramtin Hadighi
Background: Parasitic diseases are one of the health problems in all societies, especially in developing countries. Infection with parasites, especially in children, can be associated with learning disorders, malnutrition, anaemia, and physical disorders. On the other hand, an abnormal increase in the theta brainwave amplitude may also be one of the causes of mental slowness and disability in children’s learning, decentralization, or attention deficit hyperactivity disorder (ADHD). Objectives: In this study, we assessed the possible effects of intestinal parasites on brainwave changes in children in Karaj Health centers. Methods: A stool examination was done to separate healthy and infected children. Then, using a diagnostic interview and electroencephalography, the theta-wave was recorded in both groups. Results: From 69 children who participated in this study, 8.7% were infected with one or more intestinal parasites. Around 14.49% of all children had a high theta wave, but the interesting point was that 100% of infected children had a high theta brainwave (P value = 0.001). In contrast, only 6.34% of healthy people had high theta waves. Conclusions: In this study, there was a significant relationship between parasitic infection and brain wave changes. Parasitic diseases may alter brainwaves with unknown mechanisms and affect the ability and activities of the brain.
Conference Abstracts: 16th Congress of Pediatric Emergencies and Common Diseases, Tehran, Iran (14 - 18 December 2020)
(Brieflands, 2021-02-28) Mohammad Mehdi Nasehi
This article does not have an abstract.
Conference Abstracts: 17th Congress of Pediatric Emergencies and Common Diseases, Tehran, Iran (12 - 17 December 2021)
(Brieflands, 2022-02-28) Mohammad Mehdi Nasehi
This article does not have an abstract.
Breast Milk Docosahexaenoic Acid and Neonatal Outcome in Preterm Infants: A Cross-sectional Study
(Brieflands, 2022-02-28) Farnaz Naserly; Minoo Fallahi; Saleheh Tajalli; Mohammad Kazemian; Mahmoud Hajipour; Beheshteh Olang; Shamsollah Noripour
Background: The usual intake of fish products is not common in Iranian mothers. Objectives: Regarding the significant effect of this nutrient material on neonatal outcomes, we aimed to evaluate the breast milk docosahexaenoic acid (DHA) level in mothers with preterm delivery. Methods: This cross-sectional study was done in 67 mothers with gestational age lower than 36 weeks during 2018 - 2019. Breast milk samples of 5 - 10 milliliters were evaluated by gas chromatography for DHA level. Then, the correlation between the breast milk DHA levels and neonatal outcomes was assessed. Results: A total of 67 mothers were eligible in the study. The mean gestational age and birth weights were 31.54 ± 4.44 weeks and 1707.85 ± 595.83 g, respectively. The mean DHA, as a percentage of total breast milk fatty acids, was 0.29 ± 0.0127%. Statistical analysis showed no significant relationship between the breast milk DHA level and gestational age, birth weight, maternal age, delivery mode, neonatal growth index, and neonatal complications. The relationship between the intake of food materials rich in DHA and breast milk level was not statistically significant. Conclusions: We concluded that the breast milk DHA level of mothers with preterm delivery was acceptable, although it revealed no significant correlation with maternal factors and neonatal outcomes.
Cornelia de Lange Syndrome: A Case Report with a Novel Congenital Heart Disease Association
(Brieflands, 2022-11-30) Mohammad D. Allugmani; Mazen K. El-Harbi; Mohammad S. Khoshhal; Najia Alrabghy; Sabreen Almutery; Abdulsalam D. Alawfi; Hany M. Abo-Haded
Introduction: Cornelia de Lange syndrome (CdLS) is a rare non-hereditary syndrome. The key diagnosis is unique facial features, limb anomalies, and growth retardation. Cardiac defects with gastrointestinal and genitourinary anomalies may be associated. Case Presentation: This is a case of neonatal CdLS that we think is interesting due to its association with a novel congenital heart complex. Conclusions: Patients with CdLS have a high incidence of congenital heart disease (CHD), so a cardiologic study of all of these patients is suggested.
Bronchiectasis in Children: A Case Series Study from Iran
(Brieflands, 2007-06-30) Soheila Khalilzadeh; Mohammad Reza Boloorsaz; Nooshin Baghaie; Shahin Hakimi; Ali Akbar Velayati
Background: Bronchiectasis in childhood is still one of the most common causes of childhood morbidity in developing countries. The management of these patients remains problematic, and there are few studies of long-term outcome. The aim of this retrospective study was to define the general characteristics, underlying causative factors, radiologic and laboratory findings of bronchiectatic patients.Materials and Methods: Forty-six patients with bronchiectasis, who had referred to National Research Institute of Tuberculosis and Lung Disease (NRITLD) in Iran, were reviewed during a 6-year period (1999-2005). General characteristics and underlying causes were recorded from the medical reports.Results: Mean age of patients was 12.39 ± 4.1 years at presentation. Forty-six percent were females and 54% were males. The most common clinical symptom was chronic productive cough. According to HRCT-Scan results, RML and lingula were the main affected regions. The most common etiology of bronchiectasis was idiopathic followed by cystic-fibrosis and mucociliary dyskinesia. Four patients with CF expired due to pulmonary insufficiency.Conclusion: In conclusion, bronchiectasis remains a disease of concern to pediatricians, particularly in developing countries. Infections are still important causes of bronchiectasis, and clinical improvement can be achieved by appropriate medical and supportive treatment. Although medical treatment is the mainstay of management, surgery should be considered in selected patients.
Comparison of Intramuscular Injection of Single-Dose Ceftriaxone and Oral Amoxicillin in Acute Otitis Media in Children
(Brieflands, 2007-12-31) Ali Akbar Rahbarimanesh; Houshang Akhtarharari; Peiman Salamati; Afshin shirkani
Background: The present study evaluated efficacy of a single injection of ceftriaxone 50mg/kg IM in comparison with a 10- day treatment course with oral amoxicillin 50mg/kg/d in 3 divided doses for acute otitis media in children. Materials and Methods: A randomized clinical trial was performed on 110 children between 5 months to 12yr who randomly were divided in to ceftriaxone group (n=54) and amoxicillin group (n=56) as case and control groups, respectively. Results: Demographic data and clinical manifestations of patients were similar in both groups. Forty-eight (88.9%) and 51 (91%) patients were cured in case and control groups, respectively. There was no significant different in response to therapy between the two group (p
Evaluation of Parental Stress and Quality of Life Among Iranian Parents of Hearing-Impaired Children with Cochlear Implantation History: A Cross-sectional and Descriptive-Correlational Study
(Brieflands, 2024-02-29) Atena Hakimzadeh; Seyedeh Narjes Mousavizadeh; Amirhossein Shafighi; Fereshteh Javaheri Tehrani
Background: Hearing impairment (HI), as the most prevalent sensorineural impairment, can affect both children and their families' quality of life (QOL) by its remarkable consequences, like parental stress (PS). It is a type of stress that parents perceive following their parent-child interactions, alongside the children's mental, physical, or developmental disturbances. Objectives: Considering the significant catastrophic consequences of HI in both children and their families' QOL, the current cross-sectional and descriptive-correlational study was conducted to investigate the relationship between PS and QOL among Iranian parents of hearing-impaired children with cochlear implantation (CI) history. Methods: A total of 80 parents of HI children with CI history participated in the current cross-sectional and descriptive-correlational study based on the inclusion criteria and simple random sampling. Therefore, their PS and QOL were evaluated using the "Questionnaire of Clinical and Demographic Information", the "Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF)," and the "36-Item Short Form Survey (SF-36)." Eventually, SPSS version 26 was utilized to analyze the obtained data. Results: Most of the 80 participants were female (85.0%), housewives (58.8%), and had bachelor's degrees (35.0%). Moreover, PS and QOL in parents of HI children with CI history were relatively low (X- = 67.42, P < 0.05) and relatively satisfactory (X- = 70.12, P < 0.05) respectively. Eventually, there was a significant (P = 0.001) and inverse correlation (r = -0.811) between PS and QOL in parents of HI children with CI history. Conclusions: The level of PS in the parents of HI children with CI history had a strong and inverse correlation with their QOL. Also, at the time of the study, the stress level of the parents was relatively low, and their QOL was reported to be relatively satisfactory. Thus, examining the factors affecting PS and QOL will be effective in achieving permanent, stable outcomes.
Post-Discharge Follow-Up of Preterm Infants at High-Risk Neonatal Follow-Up Clinic of a Maternity Hospital
(Brieflands, 2019-11-26) Naeeme Taslimi Taleghani; Minoo Fallahi; Zahra Soltanttooyeh; Ahmad Reza Shamshiri; Mitra Radfar
Background: Recent advances in medical sciences have increased the survival of premature infants. Long-term follow-up is very important for decreasing the consequences of prematurity. Objectives: The present study aimed at investigating common post-discharge problems of premature neonates. Methods: In this prospective descriptive study, we selected preterm infants with a gestational age of < 34 weeks or birth weight of < 2,000 g referring to a high-risk neonatal follow-up clinic of Mahdieh Hospital from 2016 to 2017. Growth indices and other medical problems were evaluated. Results: Of 140 newborns, 51.4% were males. The mean gestational age and birth weight were 30 weeks and 1,366.99 g, respectively. The mean interval between the discharge and the referral time to the clinic was 6.16 days with a range of 1 to 45 days. The maximum number of visits of a patient to the clinic was 18 times. The first visit occurred at 2 - 3 days after the discharge and the oldest age of patients at outpatient visits was 36 months. Although the growth level of most patients at birth was in the 50th percentile of growth charts, the impairment of growth indices was detected after discharge, particularly in neonates with birth weights of < 1,000 g. The rate of exclusively breastfed infants was 17% while 83% were fed by the formula. Re-admission was observed in 26.4%. Infantile colic, gastroesophageal reflux, respiratory allergy, and hypothyroidism were observed in 25%, 22.1%, 3.6%, and 2.9% of the infants, respectively, and 6.6% needed surgical intervention. The rate of late anemia was 45.7%, with 26.4% requiring packed cell transfusion. Conclusions: Our study revealed that the rate of regular post-discharge follow-ups of preterm infants was low. Regarding growth impairments of preterm neonates, special attention to nutrition is recommended after discharge from the hospital. Given the low rate of exclusive breastfeeding of premature infants, comprehensive planning to raise the rate of feeding with breast milk is very important. Regarding the high rate of anemia and the need for packed cell transfusion, paying attention to good nutrition and iron supplementation is crucial after discharge.
Assessment of Blood Pressure in Primary Non-Monosymptomatic Nocturnal Enuresis
(Brieflands, 2018-11-30) Parsa Yousefichaijan; Masoud Rezagholi Zamnjany; Parvin Soltani; Yazdan Ghandi; Mohammad Rafiei; Somayeh Bayat
Background: Enuresis has been defined as bed voiding at least twice a week for more than 3 consecutive months in individuals older than 5 years of age. Increased nocturnal enuresis could be possibly associated with dysfunction of autonomic nervous system. To observe autonomic nervous system function in enuretic children, the current study performed management of blood pressure. Methods: In this study, primary non-monosymptomatic nocturnal enuresis and healthy children were enrolled and blood pressure was measured twice, in the morning and afternoon. Urinalysis, urine culture, and urinary system ultrasound were carried out for the patients. A diary on the daily fluid intake and volume of daily urine was required. Results: The researchers observed that there was a significant difference between age variation (P value = 0.001) gender variation (P value = 0.030), educational level of patients’ mothers and fathers (P value = 0.001) and record of hypertension in the family (P value = 0.001) between case and control groups. Conclusions: In children affected by primary non-monosymptomatic nocturnal enuresis, nighttime Systolic Blood Pressure (SBP) were significantly higher, than healthy children. These circadian blood pressure provisions may reflect pathogenesis of primary non-monosymptomatic nocturnal enuresis and autonomic nervous system dysfunction.
Clinical Application of Neurally Adjusted Ventilatory Assist in Neonates with Respiratory Distress: A Systematic Review
(Brieflands, 2019-05-07) Maliheh Kadivar; Razieh Sangsari; Hamid Soltanalian
Context: Neurally adjusted ventilatory assist (NAVA) is a novel mode of ventilation that coordinates the mechanical ventilator and the patient via electrical impulses of the diaphragm. Using these impulses as neural triggers, the patient’s respiration synchronizes with the ventilator. Ventilation with NAVA has successfully been performed in adults with various lung diseases but the application of NAVA in neonates is a novel issue. Objectives: The aim of this review study was to emphasize the NAVA as a new way of neonatal ventilatory support and the importance of ventilator-neonate synchrony in neonatal intensive care units. Study Selection: Several studies have evaluated NAVA in the neonatal period but we described here the cardinal studies. Therefore, we included studies performing NAVA in the neonatal and pediatric population. Results: The review of 10 studies showed that asynchrony was less frequent when using NAVA than when using the pneumatic modes of ventilation. Most of the studies observed a reduction in peak inspiratory pressure (PIP) and FIO2 with NAVA. A reduction in mean airway pressure and work of breathing and an improvement in gas exchange were also observed in some of the studies. Conclusions: We concluded that according to recent studies, the NAVA should be administered in neonates for better synchronization with ventilator and improving the gas exchange and outcomes.

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