Lama Charafeddine

Ages and Stages Questionnaires: Adaptation to an Arabic speaking population and cultural sensitivity

BACKGROUND Early detection of developmental delay is essential to initiate early intervention. The Ages and Stages Questionnaires (ASQ) correlate well with physicians assessment and have high predictive value. No such tool exists in Arabic. AIMS Translate and test the applicability and reliability of Arabic translated Ages and Stages Questionnaires (A-ASQ) in an Arabic speaking population. METHODS 733 healthy children were assessed. ASQ-II for 10 age groups (4-60 months) were translated to Arabic, back translations and cultural adaptation were performed. Test-retest reliability and internal consistency were evaluated using Pearson Correlation Coefficient (CC) and Cronbachs alpha (Cα). Mean scores per domain were compared to US normative scores using t-test. RESULTS A-ASQ, after culturally relevant adaptations, was easily administered for 4-36 months age groups but not for 4-5 year old due to numerous cultural differences in the later. For the 4-36 month age groups Pearson CC ranged from 0.345 to 0.833. The internal consistency coefficients Cα scores ranged from 0.111 to 0.816. Significant differences were found in the mean domain scores of all age groups between Lebanese and US normative sample (p-value <0.001) with some exceptions in gross motor, fine motor and personal social domains. CONCLUSION A-ASQ was easily translated and administered with acceptable internal consistency and reliability in the younger age groups. It proved to be culturally sensitive, which should be taken into consideration when adapting such tool to non-western populations.

A complex breastfeeding promotion and support intervention in a developing country: study protocol for a randomized clinical trial.

BackgroundBreastfeeding has countless benefits to mothers, children and community at large, especially in developing countries. Studies from Lebanon report disappointingly low breastfeeding exclusivity and continuation rates. Evidence reveals that antenatal breastfeeding education, professional lactation support, and peer lay support are individually effective at increasing breastfeeding duration and exclusivity, particularly in low-income settings. Given the complex nature of the breastfeeding ecosystem and its barriers in Lebanon, we hypothesize that a complex breastfeeding support intervention, which is centered on the three components mentioned above, would significantly increase breastfeeding rates.Methods/DesignA multi-center randomized controlled trial. Study population: 443 healthy pregnant women in their first trimester will be randomized to control or intervention group. Intervention: A “prenatal/postnatal” professional and peer breastfeeding support package continuing till 6 months postpartum, guided by the Social Network and Social Support Theory. Control group will receive standard prenatal and postnatal care. Mothers will be followed up from early pregnancy till five years after delivery. Outcome measures: Total and exclusive breastfeeding rates, quality of life at 1, 3 and 6 months postpartum, maternal breastfeeding knowledge and attitudes at 6 months postpartum, maternal exclusive breastfeeding rates of future infants up to five years from baseline, cost-benefit and cost-effectiveness analyses of the intervention. Statistical analysis: Descriptive and regression analysis will be conducted under the intention to treat basis using the most recent version of SPSS.DiscussionExclusive breastfeeding is a cost-effective public health measure that has a significant impact on infant morbidity and mortality. In a country with limited healthcare resources like Lebanon, developing an effective breastfeeding promotion and support intervention that is easily replicated across various settings becomes a priority. If positive, the results of this study would provide a generalizable model to bolster breastfeeding promotion efforts and contribute to improved child health in Lebanon and the Middle East and North Africa (MENA) region.Trial registrationCurrent Controlled Trials ISRCTN17875591

Association of Pre-Pregnancy Body Mass Index and Gestational Weight Gain with Preterm Births and Fetal Size: an Observational Study from Lebanon

BACKGROUND Pre-pregnancy body mass index (BMI) and gestational weight gain (GWG) are reported to impact the preterm birth (PTB) rate and newborn size. Most studies have been conducted in developed countries, although PTB and adverse pregnancy outcomes are more frequent in the developing world. The aim of this study is to elucidate the association of pre-pregnancy BMI and GWG on the occurrence of PTB and sub-optimal fetal size in Lebanon. METHODS This is a retrospective cohort study using a hospital-based register covering 35% of births in Lebanon between 2001 and 2012. Data were collected on 170 428 pregnancies from 32 hospitals using medical records and interviews. RESULTS After adjusting for confounders, underweight women had increased odds of having very preterm [odds ratio (OR) 1.58, 95% confidence interval (CI) 1.16, 2.14], preterm (OR 1.42, 95% CI 1.28, 1.58), and small for gestational age (SGA) (OR 1.50, 95% CI 1.37, 1.63) neonates. When BMI was analysed with GWG, only SGA remained significant in underweight women with low GWG. For all BMI groups, low GWG was protective against large for gestational age (LGA) and high GWG increased the odds of LGA. GWG, both low (OR 1.25, 95% CI 1.15, 1.35) and high (OR 1.43, 95% CI 1.32, 1.55) increased the risk of PTB in normal weight women. The same result was obtained for overweight women. CONCLUSIONS High GWG increased the risk of LGA for all groups and PTB in normal weight and overweight women, whereas low GWG increased the risk of SGA and PTB. Given that there are not many studies from middle income/developing countries on patterns of weight gain during pregnancy, findings from this study may help with pre-conception counselling with emphasis on the importance of an optimal pre-pregnancy BMI and appropriate weight gain during pregnancy.

Validation of the Arabic Version of the Iowa Infant Feeding Attitude Scale among Lebanese Women

Background: There is need in the Arab world for validated instruments that can reliably assess infant feeding attitudes among women. The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has consistently shown good reliability and validity in different cultures and the ability to predict breastfeeding intention and exclusivity. Objective: This study assessed the psychometric properties of the Arabic version of the IIFAS (IIFAS-A). Methods: After translating to classical Arabic and back-translating to English, the IIFAS-A was pilot tested among 20 women for comprehension, clarity, length, and cultural appropriateness. The IIFAS-A was then validated among 170 women enrolled in a breastfeeding promotion and support clinical trial in Lebanon. Results: The IIFAS-A showed acceptable internal consistency reliability (Cronbach’s α = 0.640), with principal components analysis revealing that it is unidimensional. The 17 items had good interitem reliabilities ranging between 0.599 and 0.665. The number of breastfed children was the only predictor of the overall IIFAS-A score in a multivariate stepwise regression model (β = 1.531, P < .0001). Conclusion: The 17-item IIFAS-A is a reliable and valid instrument for measuring women’s infant feeding attitudes in the Arab context.

In‐hospital Neonatal Mortality and the Role of Consanguinity

BACKGROUND Consanguinity which increases the risk of genetic disorders has been implicated at times in infant mortality. The aim of this study was to determine the association between consanguinity and in-hospital mortality in newborns. METHODS Data was collected prospectively on all births from 26 hospitals in Lebanon from January 2004 to December 2008 and admitted to the National Collaborative Perinatal Neonatal Network. Secondary analysis was done on 65,402 singletons, after exclusion of stillbirths, infants of multiple gestation and infants of second cousin progeny. RESULTS In-hospital mortality was 6.7 per 1000 live births (439/65,402). The rate of first cousin marriage was 9.9%. Consanguinity was significantly associated with in-hospital mortality (odds ratio 2.4; 95% confidence interval (CI): 1.8, 3.1); consanguinity remained a significant predictor of mortality (odds ratio 1.8 [95% CI: 1.2, 2.9]) after adjusting for maternal age and education, crowding index, history of abortion, prenatal care, mode of delivery, gender, birthweight and apgar score at 5 minutes. CONCLUSIONS This association of consanguinity with in-hospital mortality points to potential genetic factors leading to this increased risk. Designing public health interventions, including raising the awareness and taking into consideration such risks in neonatal mortality studies are indicated.

Dieulafoy's Lesion in Children

Alis H, 2009, SURG ENDOSC, V23, P1465, DOI 10.1007-s00464-008-0255-8; Dharia T, 2009, GASTROINTEST ENDOSC, V70, P1028, DOI 10.1016-j.gie.2009.06.024; GOENKA AS, 1993, J GASTROEN HEPATOL, V8, P44, DOI 10.1111-j.1440-1746.1993.tb01174.x; GOUGH MH, 1977, BRIT J SURG, V64, P522, DOI 10.1002-bjs.1800640721; Guy RJ, 2001, BURNS, V27, P767, DOI 10.1016-S0305-4179(01)00031-6; Jain R, 2009, ARCH PATHOL LAB MED, V133, P1865, DOI 10.1043-1543-2165-133.11.1865; Koo Young Hun, 2005, Korean J Gastroenterol, V46, P413; Lim Won, 2009, Korean Journal of Internal Medicine, V24, P318, DOI 10.3904-kjim.2009.24.4.318; Linhares MM, 2006, SURG LAPARO ENDO PER, V16, P1, DOI 10.1097-01.sle.0000202191.59322.5f; Marangoni G, 2009, J PEDIATR SURG, V44, P441, DOI 10.1016-j.jpedsurg.2008.09.033; Meister TE, 1998, GASTROINTEST ENDOSC, V48, P302, DOI 10.1016-S0016-5107(98)70197-X; Pitcher GJ, 2002, HAEMOPHILIA, V8, P719, DOI 10.1046-j.1365-2516.2002.00675.x; ROBSON ME, 1994, HISTOPATHOLOGY, V25, P279, DOI 10.1111-j.1365-2559.1994.tb01329.x; ROSSI NP, 1968, ARCH SURG-CHICAGO, V97, P797; Sarin Y K, 1993, Indian Pediatr, V30, P545; Sone Y, 2005, ENDOSCOPY, V37, P449, DOI 10.1055-s-2005-861288; TOOSON JD, 1995, AM J GASTROENTEROL, V90, P2235; VANZANTEN SJOV, 1986, GUT, V27, P213; Wang LC, 2009, PEDIATR NEONATOL, V50, P196, DOI 10.1016-S1875-9572(09)60063-2

Strategic assessment of implementation of neonatal resuscitation training at a national level

Structuring and implementation of an endorsed neonatal resuscitation program (NRP) results in decreased neonatal mortality. This study evaluated the implementation of formal training using the NRP in a private sector context of a middle income country.

Preterm infants exhibited less pain during a heel stick when they were played the same music their mothers listened to during pregnancy

Playing music during painful procedures has shown inconsistent benefits for preterm infants. This study observed preterm infants during a heel stick procedure to assess whether listening to the music their mothers listened to during pregnancy had any impact on their pain and physiological and behavioural parameters.

NeoSeal to Prevent Nasal Injury in Preterm Infants Receiving Oxygen Therapy.

Abstract Purpose: To determine if a foam septum protector prevents nasal injury in preterm infants receiving nasal heated humidified oxygen. Design: A retrospective before and after comparative design was used. Sample: Medical records of 101 preterm infants receiving either nasal continuous positive airway pressure (NCPAP) or nasal intermittent positive pressure ventilation (NIPPV) were reviewed; 50 were in the control group and 51 were in the intervention group that had the NeoSeal septum protector applied. The groups were not different in terms of gender, birth weight, gestational age, days intubated, or on days on NCPAP/NIPPV. Skin condition of nares was scored daily using the Neonatal Skin Risk Assessment Scale (NSRAS). Results: Infants who had the NeoSeal applied had significantly less nasal injuries, OR = 4.08; 95% confidence interval (CI), 1.22–9.59; p = .01. The best predictors of nasal injury were gestational age and whether the NeoSeal was applied or not.

Ophthalmologic Outcomes of Children Born Premature Without ROP: Correlations With Gestational Age and Psychomotor Development

PURPOSE To study ophthalmological outcomes of premature children with no retinopathy of prematurity (ROP) and correlate with neurodevelopmental outcomes. METHODS A total of 69 former preterm infants were evaluated at 2 to 7 years of age. Detailed ophthalmologic examinations were performed. Neurodevelopment was assessed using the Peabody Developmental Motor Scale and Wechsler Preschool and Primary Scale of Intelligence. Another 69 healthy children served as controls. RESULTS The 69 preterm children (38 of 69 boys) and 69 controls (38 of 69 boys) had a mean age of 4.9 ± 1.5 and 4.9 ± 1.4 years, respectively. Compared to controls, preterm infants had vision impairment of 19% versus 1.4% (P = .001), hyperopia of 87% versus 98.5% (P = .21), myopia of 11% versus 1.4% (P = .017), and astigmatism of 39% versus 30.4% (P = .37). Children with any motor disability tended to have worse vision. CONCLUSIONS In the absence of ROP, hyperopia was more common in infants 32 weeks or older who weighed more than 1,500 g at birth; other vision problems were similar in subgroups. This may represent impending myopia in those younger than 32 weeks weighing less than 1,500 g. [J Pediatr Ophthalmol Strabismus. 2017;54(1):32-38.].