Iranian Journal of Pediatrics
Volume:30 Issue: 3, Jun 2020

Gastroschisis is an abdominal wall defect that is managed by surgical reduction of herniated bowel into the abdominal cavity and abdominal wall reconstruction. Loss of abdominal domain is the main challenge that may complicate the process of gastroschisis management.

This article is about innovative manure called total bowel washing (TBW) that may improve the outcome of gastroschisis primary repair.

All neonates with gastroschisis who met the study inclusion criteria between 2006 - 2019 were enrolled and divided into two groups of conventional and TBW method of gastroschisis management. In TBW group, bowls were washed with warm saline and after a gentle enterolysis, the whole gastrointestinal tract was irrigated via a gastric tube and evacuated completely from thick meconium until the watery stool started to come out of anus slightly. Primary abdominal wall closure was performed after loop by loop bowel reduction. Gastroschisis management outcome was compared between the two groups.

15 neonates were allocated in each group. Demographic and anthropometric variables were compared and any significant difference wasn’t reported between the two groups. We observed a significantly better outcome in terms of faster GI rehabilitation, shorter time to oral feeding tolerance, less need to silo placement and shorter NICU and hospital stay in TBW method. Operation time was slightly longer in TBW group while the difference was not significant statistically.

Total bowel washing and complete evacuation of gastrointestinal tract from thick meconium will increase the success rate of primary repair and improve the outcome of gastroschisis management.

Along with lack of studies that systematically address the transfusion requirements and triggers in acute leukemia, no study to date has addressed the blood product use with respect to ongoing chemotherapy (CT) in pediatric acute lymphoblastic leukemia (ALL) patients.

This study was therefore designed to evaluate total erythrocyte, random platelet and apheresis platelet suspension requirement in pediatric ALL patients in relation to ongoing CT protocols.

A total of 146 pediatric patients with ALL were included in this retrospective study. Data on patient demographics, CT protocol, amount and efficacy of blood product use (erythrocytes, apheresis platelet and random platelet), and survival during CT were retrieved from hospital records.

The average amount of erythrocytes, apheresis platelets and random platelets received by 146 ALL patients from the date of diagnosis were 14 (3 - 78) bags, 9 (1 - 97 bags and 11 (1 - 83) bags, respectively. Protocol 1b augmented was associated with the highest amount of erythrocyte use (P < 0.001), while no significant difference was noted in apheresis platelet and random platelet use with respect to CT regimens. Erythrocyte transfusion was associated with a more marked increase in hemoglobin (Hb), erythrocyte (RBC), leukocyte (WBC), lymphocyte and neutrophil counts as compared with apheresis platelet and random platelet infusions, while protocol 2 was associated with higher Hb (P = 0.017) levels after erythrocyte transfusion.

Our findings indicate a great amount of blood product transfusion to be required in children with ALL under CT and emphasize the likelihood of transfusion need and efficacy of transfusion to alter with respect to ongoing CT regimen. The need in patients using augmented BFM protocol 1 b was highest, and albeit the need of blood and blood product transfusions vary within patients, the anticipated median need for blood products at diagnosis and at various blocks of treatment may be helpful for the blood banks, doctors of the respective pediatric hematology-oncology centers to plan as patients are treated.

Reconstruction of ventral penile skin, in midshaft and distal hypospadias is problematic in many cases of severe ventral dysplasia. So we plan to use the tailored preputial skin island flap (PSIF) to cover the ventral defect.

In this prospective cohort study 224 boys with midshaft and distal hypospadias associated with sever ventral dysplasia were operated from March 2009 until January 2016. The large U-shaped bare area which exposed on the ventrum after release of curvature was quilted by the PSIF as a patch. In each case, the variable size of the flap was required. The prepuces without the predominant artery were excluded from the study due to poor vasculature. The patients followed for 8 months to 7years.

Flap ischemia developed in 7 initial cases (3.125%), all of which subsequently faded. Some degree of ischemic discoloration was encountered at margins of the flap (12 cases, 5.3%), which resolved spontaneously. In 5 out of 224 patients (2.23 %), the flap persisted as a hypertrophied area of skin in the long-term follow-up. All of them needed to be corrected surgically. Near normal appearing penile skin was accomplished in the majority of patients during the follow-up. However, lack of the median raphe in the ventrum was evident in all.

Tailored preputial skin island flap, as a native tissue to cover the exposed large bare area on the ventrum in cases of the distal and mid hypospadias with severe ventral dysplasia may improve the appearance and adequacy of the penile skin. It provides room for full erection and improves the patient’ s perception of body image and self-esteem.

Adolescent smoking is a major health care concern which calls for a more in-depth study of the factors affecting this pediatric disease. We aimed to determine the prevalence of tobacco use among Chilean adolescents aged 13 - 14 and its association with family and school factors.

This was a cross-sectional analytical study. Data from the Eleventh Chilean National Study of Drugs in the School Population 2015 were used (n = 11,791). School and family variables of parental control were evaluated and analyzed by the chi-Square test and a multivariate logistic regression model. Data were processed with the STATA V. 14.0 software at the α = 0.05 level of significance.

The prevalence of tobacco use at some time during life was 36% with onset age of 11.4 ± 3.6 years. Girls smoke proportionally more than boys (40.5% and 31.5%, respectively). Parental monitoring decreased use and acted as a protective factor (OR: 0.41, 95%CI: 0.375 - 0.468); likewise for good school performance (OR: 0.52, 95%CI: 0.475 - 0.584). In turn, running away from school raises the risk of smoking (OR: 2.34, 95%CI: 2.03 - 2.72).

There is a feminization of cigarette use, and the risk of cigarette smoking increases considerably among adolescents who run away from school. However, parental control and school performance are powerful protective factors against early tobacco use.

Coronary heart diseases (CAD) and their risk factors are among the major causes of death in Iran. Since these risk factors begin to develop early in life, it is vital to diagnose those newborns at high risk of CAD.

The present study investigated the umbilical cord blood lipid profile of term and preterm neonates.

In this cross-sectional study, the lipid profiles of 292 neonates, of which 276 were term and 16 preterm, were examined at a teaching hospital.

The lipid profile results of total cholesterol, triglycerides, high density lipoprotein, and low density lipoprotein were 69.8, 34.9, 23.6, and 31.5 in term neonates and 80.5, 25.5, 25.1, and 38 in preterm neonates, respectively.

According to the current paper, the lipid profiles of eastern Iranian neonates were similar to those reported in global studies. Moreover, except for triglycerides in the female neonates, lipid profiles were significantly higher among the male neonates.

Human coronavirus NL63 (HCoV-NL63) is a new respiratory virus associated with acute respiratory infection in children. Infection with this virus is usually accompanied by upper and lower infections of the respiratory tract in adults.

In a retrospective study, we investigated the incidence of coronavirus infection in children under the age of five years.

We collected 138 specimens (nasal and throat swabs) from children less than five-years-old with acute respiratory infection from October 2018 to December 2019. Then, HCoV-NL63 was investigated using real-time PCR.

Out of 138 samples, 33 (23.9%) were positive for coronavirus NL63, including 21 (63.6%) male samples and 12 (36.4%) female samples. There was no significant correlation between gender and positivity for coronavirus infection (P > 0.05). However, the association of clinical symptoms with the virus was statistically significant (P < 0.05).

This study was conducted for the first time in Kerman Province. In this study, the frequency of coronavirus NL63 was evaluated among children with acute respiratory infection with a highly sensitive method, real-time PCR. The prevalence of this virus was 33%, which was more frequent than in similar studies.

Previous research on sleep debt has neglected considering sleep duration on weekdays as a contributing factor.

This cross-sectional study investigated the relationship between sleep debt and mental health in school-age adolescents, taking weekday sleep deficits under consideration.

We identified 1,392 students who had provided data on sleep duration from the 2016 - 2017 for Korea National Health and Nutrition Examination Survey (KNHANES). A stepwise multivariate logistic regression analysis was used to examine the independent effect of sleep debt on perceived stress or depressive mood.

Individuals with poor mental health sleep less on weekdays, resulting in more sleep debt. Final regression models that were adjusted for potential covariates revealed that poor mental health was associated with shortened sleep on weekdays but was not associated with overall sleep debt.

Our result suggests that efforts should be made to lengthen sleep on weekdays, not on weekends, to lower stress or depressive mood among adolescents.

Preoperative anxiety is a very important factor in pediatric surgery; 40% - 60% of children experience a high level of anxiety in the preoperative period.

Given the need for anxiety control in children and considering that limited studies have been conducted in this regard, this research was performed to compare the effect of oral zolpidem and midazolam on level of preoperative anxiety in children.

In a prospective double-blind randomized controlled trial, 56 cases were randomly divided into two groups of 28 participants. A group underwent zolpidem premedication and the other underwent midazolam premedication. The level of preoperative and postoperative anxiety was measured by MYPAS SCORE checklist and compared.

The study comprised 56 patients (19 girls and 37 boys) aged between 3 - 9 years. The mean score of anxiety in the group receiving midazolam was 63.80 in pre-test and 32.61 in post-test (P < 0.001). The mean score of anxiety in the group receiving zolpidem was 62.49 in pre-test and 30.94 in post-test (P < 0.001). Mean anxiety in the patients of zolpidem group was lower than that in midazolam group (P < 0.001).

Our results show that both zolpidem and midazolam reduce preoperative anxiety, however, the preoperative anxiety was significantly decreased after taking zolpidem in comparison withmidazolam. Zolpidem is a hypnotic drug with rapid onset and short duration of action, whichmight be an alternative premedication formidazolam in pediatric anesthesia, particularly when the reduced anxiety and child cooperation are needed.

Premature infants suffer from many problems due to the lack of evolution of the digestive system, and early onset of intestinal feeding prevents these complications. Probiotics have been used to prevent intestinal disorders in preterm infants due to their many benefits.

This study was conducted to measure the efficacy of probiotics on time to reach full intestinal feeds (120 cc/kg/day) in premature newborns.

This study was double-blind randomized clinical trial. Preterm infants born at < 36 weeks and birth weight of 1000 – 2500 gr (n = 58) in 17th Shahrivar Hospital, Rasht, Iran, were randomly assigned into intervention group (oral administration of probiotics) and control group (with normal saline administration). Data were collected using a data form that includes demographic characteristics, time to full intestinal feeding, and the incidence of complications. Data were analyzed by SPSS version 21 using descriptive and analytical statistical tests.

The results of the study showed that the mean and standard deviation time to full intestinal feeding in the probiotic group was 5.7 ± 1.06 days, while in the placebo group was 6.72 ± 1.98 days, which was statistically significant (P = 0.002). There were no significant correlation between study variables and time to full intestinal feeding except mode of delivery (P = 0.029).

Feeding with probiotics is recognized as an effective way to prevent adverse health outcomes in preterm infants. The present study showed that administration of probiotics reduced the time to full feeding. Therefore, it is an effective and inexpensive method to prevent intestinal disorders in newborns.

Over the past decade, following the discovery that developing brain of immature animals was affected by anesthetic agents, the safety of general anesthesia (GA) in early life has been questioned.

We investigated the association between anesthesia exposure in children and ADHD development.

This case-control study was conducted at pediatric psychology clinic of our institution and a pediatric neurology private clinic during 2019. Firstly the responsible resident of anesthesiology separated new ADHD cases. Then a questionnaire was filled out through an almost 10 minute’s telephone interview. Finally, frequency distribution of GA was compared between ADHD cases and controls.

Finally, the data from 210 children were analyzed. Among 105 ADHD cases, 19% had a history of a procedure requiring GA while it was 3.8% in control group. Comparing the two groups a significant difference was observed regarding the age of receiving GA (P = 0.004), gender (P < 0.001), the history of receiving GA (P = 0.001) and the number of anesthesia exposures (P = 0.001). According to logistic regression analysis, male gender (P = 0.001) OR 3.11 (95CI = 1.63 - 5.93) and age (P = 0.003) OR 0.92 (95CI = 0.87 - 0.97) were significant predictors of early exposure to GA and ADHD development.

It was revealed that early exposure to GA might be a risk factor for later developing ADHD. Boys might be more sensitive to the long term adverse effects of anesthetic agents than girls. Further prospective well-planned studies are needed to confirm these findings.

Hypospadias (HS) is one of the most common congenital malformations. Complications of corrective surgery in HS correlate with patients’ opinions on their voiding ability and sexual life as adults. Etiology of HS involves both genetic and environmental factors. GCH1, which belongs to recently identified urothelial genes influencing voiding behavior, encodes rate-limiting enzyme catalyzing the production of tetrahydrobiopterin (BH4). A requirement for BH4, a metabolite structurally related to folic acid and riboflavin, in embryonic development was reported.

The aim of the present study was to investigate the association of selected polymorphic variants of BH4 pathway genes with hypospadias.

We performed an analysis of 6 SNPs of GCH1, PAH and AGMO-DGKB loci in a group of 166 boys with isolated hypospadias and a properly matched control group.

There was no evidence for either allelic or genotypic association with the risk of HS for the tested nucleotide variants (rs12425434, rs7485331, rs17128050, rs8004018, rs17128077, rs2191349). The lack of association with single SNPs was confirmed at the haplotype level. The exhaustive multifactor dimensionality reduction (MDR) analysis revealed no significant interactive effect of polymorphic variants of BH4 pathway genes on HS susceptibility.

The presented results did not support an association between SNPs of GCH1 and PAH and the risk of HS.

Endoscopic therapy has been introduced for vesicoureteral reflux (VUR) treatment from the early 1980s and emerged as the first-line treatment in all grades of VUR. Various materials have been used for the endoscopic suburethral application, and their curative role has been characterized by different potential. In this study, we aimed to summarize the global experience with the various bulking agents used for endoscopic treatment of VUR, especially the cure and complication rates, and review our newly introduced bulking agent.

The current literature and our experience on the outcome of endoscopic treatment with different bulking agents were reviewed.

Various foreign materials have been used for endoscopic suburethral injections, and their success rate has been different from 40 to ≤ 90 percent. Dextranomer/hyaluronic acid copolymer (Dx/HA), currently the most common bulking agent used for VUR resolution, is an artificial material that helps to grow collagen and fibroblasts. Activation of the immune reaction and the formation of granuloma pseudocysts are impediments after the injection of this agent. Therefore, despite the better consequences in comparison to other agents, the use of this material might be associated with the risk of appearance of serious and persistent complications.

Our newly designed decellularized prepuce tissue as a biocompatible tissue-engineered bulking agent, is comparable to Dx/HA regarding low immunoreaction and inflammatory responses with lower price. So, it could be a proper candidate for future randomized clinical trials to investigate the potential of clinical application of the current bulking agent; moreover, it can be an appropriate alternative for Dx/HA.