Razi Journal of Medical Sciences

fa تاثیر مصرف خوراکیِ آبِ بر بهبود علایم بالینی شیرخواران ِمبتلا به کولیک شیرخواران و کریستالوری که در سال‌های ۱۳۹۶ و ۱۳۹۷ به بیمارستان حضرت علی اصغر (ع) مراجعه نموده‌اند Effect of hydrotherapy on alleviating the clinical presentations of infants referred to Ali-Asghar Children Hospital afflicted with crystalluria and infantile colic in years 2017-2018 نوزادان Neonatology پژوهشي Research زمینه و هدف: کولیک گریه‌ی بی‌وقفه شیرخوار است که بیش از سه ساعت در روز و بیش از سه روز در هفته و حداقل سه هفته طول بکشد. کولیک در 25-5 درصد از شیرخواران دو هفته تا چهارماهه دیده می‌شود و تشخیص آن با رد شدن سایر عوامل گریه می‌باشد. کولیک موجب اختلال شیردهی، مراجعات پزشکی مکرر یا آزار کودک می‌شود. در سه یا چهار ماهگی بهبود می‌یابد اما ممکن است تا یک‌سالگی ادامه یابد. کریستالوری، درماتیت آتوپیک، وجود خون در مدفوع بر سیر کولیک موثرند. درمان کولیک دارویی جز اطمینان‌بخشی به والدین ندارد. در موارد حاد دی‌سیکلومین و گریپ میکسچر تجویز می‌شوند که عوارض جانبی دارند. آب‌درمانی به دلیل سادگی و عدم عوارض در کولیک مفید است. روش‌کار: این پژوهش کارآزمایی بالینی تصادفی دوسوکور با سه‌گروه درمانی است. در این مطالعه 152 شیرخوار مراجعه کننده به درمانگاه نوزادان بیمارستان علی‌اصغر (ع) با استفاده از کارت‌های تصادفی در گروه مداخله (102 نفر) و در گروه کنترل (50 نفر) قرارگرفتند. بعد از انجام آزمایشات، 38 نفر از گروه مداخله کریستالوری داشتند که بعنوان گروه کریستالوری بررسی شدند. شیرخواران سه دوره درمان شدند. گروه کنترل ̨ درمان‌ روتین و گروه مداخله تحت آب‌درمانی قرار گرفتند. تجزیه و تحلیل داده‌ها با نرم افزار SPSS 25، آزمون‌های chi – square Test، (Cochran's test)، nominal regression logistic و رگراسیون خطی و McNemar's test انجام شد. سطح معنی‌داری 05/0 در نظر گرفته شد. یافته‌ها: نتایج نشان داد جنسیت، وزن تولد، وزن در مدت پیگیری، هفته تولد، نوع شیر، سن، سابقه بستری و مصرف آنتی‌بیوتیک، درماتیت آتوپیک و خون در مدفوع تاثیر معنی‌داری در کولیک ندارد. آب‌درمانی (001/0 >p) در کاهش درد و کریستالوری تاثیر داشت. سرعت کاهش درد در گروه مداخله نسبت به گروه کنترل واضحا بیشتر بود. نتیجه‌گیری: آب‌درمانی درد کولیک و کریستالوری را کم می‌کند. Background & Aims: Infantile colic occurs in 5-25% of infants. The etiology of colic is generally unknown. Chronic and recurrent abdominal pain is one of the most common reasons for which infants are referred to specialized clinics. Infantile colic is defined as episodes of continuous crying for more than three hours per day and more than three days per week which lasts longer than three weeks. This excessive crying may cause short-time anxiety and depression in mother and increase level of stress and fatigue in both parents. Paroxysms of continuous crying is directly related with severe maternal psychological maladjustment, postpartum depression and early breast feeding cessation. It may also lead to frequent pediatric visits, maternal smoking, improper use of anti-reflux medications, child abuse such as shaken baby syndrome and requesting too much and often unnecessary laboratory tests which is four times more than normal condition. Less than 5% of infants suffering from excessive and inconsolable crying have some organic complications such as crystalluria, atopic dermatitis, bloody stool, history of hospitalization and antibiotic administration, constipation, gastroesophageal reflux disease, lactose intolerance, cow’s milk protein allergy, neonatal migraine and cerebrovascular coagulopathies. Maternal smoking may increase the risk of infantile colic. But it has been shown that type of feeding doesn’t have any significant impact on the incidence of colic. Birth complications may be related with infantile colic. Colic diagnosis is made by exclusion of more critical causes. Colic treatment is often non-interventional and it includes giving reassurance to parents and different soothing strategies such as using pacifier, swaddling the infant with bent legs, massaging with special oils and using special noise. It is not still clear if these measures are more effective than placebo. Yet there is no drug of choice for treatment of colic according to safety and efficacy. Crystalluria is also another benign common problem of infancy which is defined as presence of sediments in the urine and it may present with abdominal pain. It can be the side effect of antibiotic administration and may be ameliorated by water consumption. Many studies had been performed on infantile colic and its management, but there is no study to evaluate the effect of hydrotherapy on infantile colic or crystalluria. This study has been performed to evaluate the impact of hydrotherapy on infantile abdominal pain relief, due to its simplicity low cost and positive results in reduction of those mentioned pains. Methods: This study is a double blind randomized clinical trial performed on 152 infants between two weeks and 4 months of age who referred to Ali-Asghar children hospital clinic because of infantile colic between 2017-18. The informed consent was obtained from the parents of each infant before participating in the study. 152 infants with colic, defined as episodes of continuous crying for more than three hours per day and more than three days per week which lasts longer than three weeks, were included in this study. they were visited monthly for three consecutive months. The exclusion criteria were lack of obedience or cooperation of parents in giving water to their infants and not referring their infants for further follow up. All 152 infants were randomized into two groups (intervention and control group). 50 infants were enrolled in control group who only received traditional colic treatment and 102 infants were enrolled in intervention group who received 20 cc/ kg/ day tepid boiled water. After laboratory studies it was shown that 38 infants from intervention group also had crystalluria, so these infants were considered as a special separate subgroup of intervention group for statistical analysis. Blood sodium tests were also requested during all three visits for intervention group, and none of them developed hyponatremia during the study period. Both groups (control and intervention) were matched according to their demographic parameters. Patients information was collected three times during this study in three consecutive visits with monthly intervals in special check lists which include information about: Infants gender, age, gestational age, birth weight, infants weight in each visits, type of feeding, pain intensity, atopic symptoms, bloody stool, result of urine culture, crystalluria, the amount of water intake and response to hydrotherapy. Level of response to treatment was categorized to 4 level, zero (0) means no pain, the level one (1) was considered as abdominal cramp, level two (2) was used for infants who were suffering colic pain during day or during night and level 3 for infants who had colic pain all day lung and round-the-clock. Then response to treatment was measured and compared between different groups. For statistical analysis we used Chi-Square test, Fisher exact test, ANOVA test and logistic regression to control confounders. The intervention group itself was divided into colic group (64 infants) and cristalluria group (38 infants) according to urine analysis. All of the infants in intervention group received water as it was mentioned before. Results: Statistical analysis showed that both control and intervention group were similar according to gender, birth weight, age, gestational age, weight per visit, absence or presence of atopic symptoms, type of feeding, bloody stool and age in first visit. At the second visit the Odds ratio of pain reduction was significantly higher in colic group than control group. But this difference was not statistically significant between cristalluria and control group. At the third visit Odds ratio of pain relief in both colic and cristalluria group was significantly higher than control group (0.96 and 0.89 respectively). After hydrotherapy for one month, the number of infants who had no pain increased to 23 and with continuous treatment the number of pain-free infants reached 57. Also the number of infants suffering pain all day long in colic group decreases from 6 to 1. At the second month of hydrotherapy no infant experienced all day long pain in intervention group. The amount and the rate of pain reduction was also higher in intervention group. Symptoms intensity, History of hospitalization and antibiotic administration were three confounding variables which their effects were controlled using logistic regression. After controlling these parameters there was no significant difference in terms of these variables between two groups. These findings clearly showed that the rate of pain relief in the intervention group was much faster than control group and hydrotherapy was significantly effective in pain relief of colic and crystalluria (p value = 0.001) Conclusion: Hydrotherapy is a very useful method for colic and crystalluria treatment.   آب‌ , کولیک شیرخواران , کریستالهای ادرار Water, Infantile Colic, Urine Crystals 25 38 http://rjms.iums.ac.ir/browse.php?a_code=A-10-5222-1&slc_lang=fa&sid=1 Farhad Choobdar فرهاد چوبدار drchoobdar@gmail.com 3900319475328460060532 3900319475328460060532 No School of Medicine Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Maral Ghassemzadeh مارال قاسم زاده maral.ghassemzadeh1985@gmail.com 3900319475328460060533 3900319475328460060533 Yes Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Rozita Hoseini رزیتا حسینی rozitahoseini@yahoo.com 3900319475328460060534 3900319475328460060534 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران Saharnaz Movassagh Koulankouh سحرناز موثق کولانکوه saharnazmovasaghk@gmail.com 3900319475328460060535 3900319475328460060535 No Iran University of Medical Sciences, Tehran, Iran دانشگاه علوم پزشکی ایران، تهران، ایران