Iranian Journal of Pediatrics
Volume:30 Issue: 6, Dec 2020

Context: 

The metabolic effects of Lactobacillus reuteri DSM 17938 administration in the treatment of functional chronic constipation are unknown.

 The purpose of this review is to investigate the function of L. reuteri DSM 17938 in bowel movements and stool consistency in children and adults diagnosed with functional chronic constipation.

 Five electronic databases were used to search for the English version of Randomized Controlled Trials (RCTs) published between 2000 and 2018 that investigated the metabolic functions of 4–8 weeks of a dietary L. reuteri DSM 17938 intervention in children and adults diagnosed with functional chronic constipation. The risk of bias was evaluated in eligible studies, and a random-effects model was used to perform a meta-analysis for qualitative and quantitative analyses.

 Five high-quality RCTs involving 737 participants were included in the review. L. reuteri DSM 17938 supplementation was effective in increasing bowel movements (mean difference = 1.12; 95% CI 0.85, 1.39, P < 0.00001) in patients with functional chronic constipation. However, no significant differences in stool consistency from baseline were observed following L. reuteri DSM 17938 supplementation (0.98; 95% CI 0.66, 1.44, P = 0.90).

 There were significant differences in bowel movements between the experimental and placebo groups, and no significant differences in stool consistency. In addition, there were no adverse effects of the L. reuteri DSM 17938 treatment reported. These results demonstrate the beneficial effects of L. reuteri DSM 17938 in functional chronic constipation patients in comparison with placebo.

Preschool children with obstructive sleep apnea-hypopnea syndrome (OSAHS) experience a potentially lethal sleep disorder disease. Early surgical resection of OSAHS is critical for children’s growth and development. Tonsil adenoidectomy is an essential treatment technique for OSAHS. However, laryngeal trauma caused by surgery leads to agitation due to pain during recovery, accompanied by other symptoms such as unstable vital signs and postoperative anxiety. Little research has been done on the treatment and care of postoperative agitation and respiratory complications in children with OSAHS. Therefore, exploring a better-personalized care method is essential for reducing the incidence of respiratory complications during anesthesia recovery in children with OSAHS and the smooth recovery of the child.

The study aimed to investigate the respiratory complications and agitation of childhood OSAHS in the anesthesia recovery period after surgery and suitable nursing care methods.

A total of 200 children with OSAHS were randomly divided into the routine care group (Group A, n = 100) and the personalized nursing group (Group B, n = 100). Personalized nursing included postoperative bleeding care, psychological care, infusion care, and pain care. Patients’ demographic and clinical data were collected. A CO2 laser-assisted modified uvulopalatopharyngoplasty (UPPP) was performed after the induction of general anesthesia. Children were extubated and transferred to the recovery room after the surgery. The nurses closely monitored the children’s agitation, oxygen saturation, and spontaneous breathing every 15 min within one hour in the recovery room. The respiratory frequency and amplitude, ECG changes, blood pressure, hospitalization time, and economic costs were recorded.

The incidences of agitation and respiratory obstruction were significantly lower in Group B than in Group A in the recovery room (P < 0.05). Blood pressure and heart rates were significantly higher, and oxygen saturation was lower in Group A at 15 min, 30 min, and 45 min (all P < 0.05), but the difference disappeared 60 min after surgery (P > 0.05). The hospitalization time and expenses of Group B were significantly lower than those of Group A (P < 0.05).

Personalized nursing care during postoperative anesthesia recovery can reduce the incidence of agitation and respiratory obstruction, lower blood pressure and heart rate, and accelerate postoperative recovery in children with OSAHS. Our study discovered a suitable nursing method for OSAHS children after general anesthesia to improve patients’ recovery and reduce economic costs.

Apert Syndrome is one of the severe forms of craniosynostosis syndromes. Here we present the first case of 20 weeks fetus with temporal lobe abnormalities with a scalp cyst in fetal MRI.

A 34-year-old woman at 19 weeks of pregnancy presented with normal first trimester scan and with acrocephaly, mild ventriculomegaly (10.5 mm), hypertelorism, and mitten glove syndactyly of hands of the fetus in second trimester ultrasound scan. Also a scalp cyst without calvarial bone defect was found. One week later, fetal brain MRI on 1.5 T scanner confirmed 2D ultrasound findings. Also bilateral temporal lobe overconvolution and low set ears were detected by MRI. These imaging features strongly suggested Apert or a related craniosynostosis syndrome. Amniocentesis result revealed the heterozygous FGFR2 gene mutation consistent with Apert syndrome.

Fetal MRI and ultrasound are complementary tools for full evaluation of different aspects of a syndromic condition in fetus that is very important for proper genetic testing and counseling.

 Organic lesions, including brain tumors, should be suspected in boys with precocious puberty. However, it is not usually suspected in children with early puberty.

 Here we present an extremely rare case of rapidly progressing early puberty with basal ganglia germinoma coupled with three-prime repair exonuclease 1 (TREX1) variant. This was a 10-year-old-boy with borderline mental retardation and rapidly progressing puberty. Physical examination revealed 10 mL testes (Tanner stage 3 for genital development), and his bone age was that of a 12-year old boy. Laboratory findings showed abnormally elevated serum β-human chorionic gonadotropin (23.0 mIU/mL; reference, 0-10 mIU/mL), and suppressed LH level (<0.07 mIU/mL) with high testosterone (4.61 ng/mL; reference, 0.1-0.32 ng/mL). Magnetic resonance imaging revealed irregular enhancement in bilateral basal ganglia, and stereotactic biopsy confirmed germinoma. Whole exome sequencing was performed, and the pathogenic variant of TREX1 (TREX1:c.G832A) was revealed.

 This is the first case report of rapidly progressing early puberty caused by germinoma of bilateral basal ganglia associated with pathogenic variant of TREX1.

Cardiac neoplasms are not common in the pediatric population, and most of the reported cases in the literature are benign. Despite their benign nature, however, cardiac neoplasms may lead to hemodynamic instability and arrhythmias.

Our study aimed to review the natural history, diagnosis, pathological features, and outcome of pediatric patients with cardiac tumors presenting to a tertiary pediatric cardiac center over an 8-year period.

This retrospective observational study reviewed and analyzed the hospital records and data of pediatric patients diagnosed with cardiac tumors over an 8-year period (2007 - 2015).

During the period covered by the study (2007 - 2015), a total of 62975 pediatric in and out patients were referred to our tertiary cardiac center for cardiac evaluation. Cardiac tumors were identified in 41 patients, in 35 of whom tumor types were recognized. Rhabdomyomas were the most common tumors, followed by fibromas and myxomas. Fourteen patients underwent surgical management (either total or partial resection), and 4 patients received chemotherapy. Associated congenital heart diseases, except for the patent foramen ovale, were detected in12 patients.

While almost all our findings were compatible with previous data, we had a comparatively large number of undetermined tumors. Therefore, a better understanding of the imaging characteristics of cardiac tumors is needed for a better diagnosis of tumor types via noninvasive modalities.

 The prevalence of asthma is higher in icteric babies. It is thought that eosinophilia and asthma are complications of phototherapy rather than hyperbilirubinemia.

 Since there is little data in this regard, we evaluated the relationship between phototherapy and the level of eosinophils in this study.

 In this cross-sectional prospective study, we assessed icteric neonates admitted to the neonatal and intensive care unit of Children’s Medical Center of Tehran during 2017 - 2018. Laboratory data including serum bilirubin and count of blood cell differentiation for eosinophils, before, during, and after phototherapy besides demographic data like age, gender, gestational age, and duration of phototherapy were collected.

 Totally, 163 neonates (52.1% male and 47.9% female) with a mean age of 5.49 ± 4.01 days, enrolled in the study. The prevalence of term neonates was 81% and 19% were preterm. The mean of serum total bilirubin was 17.91 ± 3.37 mg/dL. Compared to the mean value of eosinophils before phototherapy, this value in the first (P = 0.001) and second (P < 0.001) days were significantly higher. In female neonates, there was a significant increase in eosinophils in the first (P = 0.001) and second (P < 0.001) day of the post-treatment period. However, in male subjects, this increase was significant only in the second day after phototherapy (P = 0.001). In neonates less than one week of age, this count was significantly increased on the first (P = 0.003) and second (P < 0.001) day after phototherapy. In cases with hemolytic hyperbilirubinemia, eosinophils count before phototherapy and the second day was significant (P = 0.006). The mean of eosinophils in first and second days after phototherapy was not correlated with the severity of hyperbilirubinemia but there is a significant negative correlation between the mean total bilirubin of patients with mean eosinophils before phototherapy.

 Our findings showed that there was a significant relationship between hyperbilirubinemia and its therapeutic phototherapy with an increasing level of peripheral eosinophils count in neonates.

 Sleep pattern is one of the most important issues which can affect mental development in adolescents.

 This study was designed to asses sleep pattern and its relationship with depression in order to obtain information for planning interventional programs and health promotion in adolescents.

 This was a cross-sectional study conducted on high school students in Hamadan, Iran in 2019. Mean age of the students was 16.53 ± 0.69 years (Min - Max: 15 - 19), and 290 (50.3%) students were girls. Samples were selected by multiple cluster sampling method in which 576 students were enrolled in the study. Two standard, valid and reliable self-reported questionnaire was used for recording sleep pattern (PSQ) and depression (Beck). After data collection, SPSS was used for data analysis. All P values less than 0.05 were considered as significant.

 Nearly 70% of the adolescents had problems in some subscales of sleep disorder included in mental quality of sleep, delay in falling asleep and daily dysfunction. Among them in 10% sleep duration was less than 5 hours and in 69% usual bedtime was after midnight (24 o’clock). Severe sleep problem in boys and students with fine educational status was more than others (P value < 0.001) and there was a statically significant correlation between sleep disorder and depression score (Pearson correlation: r = 0.42; P < 0.001) and in students with severe sleep disorder, 48.9% were severely depressed.

 Problems in mental quality of sleep was notable in Iranian adolescents, almost half of them had some degree of depression symptoms. Being boy and having severe problem in sleep pattern were predictors for depression. This information might be applied for well-being as well as physical and mental development interventional programs such as sleep health screening and adolescents and their parents’ educational programs in adolescents’ health promotion sector.

Context:

 Childhood obesity has become one of the most concerning public health issues and several innovative strategies are being applied to tackle the issue. Reformulation of children-oriented food products may play a role in improving childhood obesity. However, there is not sufficient evidence that shows the effectiveness of this policy. This paper provides a systematic review of the evidence to examine the efficacy of food product reformulation on calorie intake and weight modification of children with obesity.

Evidence Acquisition:

 A comprehensive literature search was undertaken for different types of studies. PubMed, Cochrane Library Database, EMBASE and SCOPUS were referred to as the source of literature.

 Seven thousand four hundred and three results were entered into our study for screening and evaluation. Our study showed that there was no clear evidence that supported the effectiveness of this intervention. However, some bodies of literature show calorie intake reduction, but no weight modification.

 Although there is enough evidence to show that reformulation may promote healthy dietary patterns, its impact on weight status is not convincing. Long term running intervention needs to be applied to examine the possible implications of food reformulation policy on the weight status of the children.

 Visual impairment can hinder achieving developmental markers in children. Various studies have examined the effectiveness of play therapy in children with visual impairment. However, lack of a comprehensive review study that examined the characteristics and overall effectiveness of these interventions, led to conducting of the present study.

 This study aimed to provide strong evidence on the characteristics and efficacy of play therapy interventions in children and adolescents (0-21 years) with visual impairment.

 Our literature searching was done with English and Persian keywords obtained from Mesh in the Cochrane, PubMed, Scopus, Web of Science, Magiran, Iran Medex, Iranian Archive for Scientific Documents Center (IASD), Iranian National Library (INL), Google and Google Scholar, until 2020. The selection process of articles was according to PRISMA. Text data was analyzed by convention content analysis. Additionally, the modified Downs and Black Checklist was used to assess the quality of primary studies.

 From 1763 articles, finally nine were analyzed which met the inclusion criteria. The major findings were presented in the categories of on participants, implementation, measurements, and efficacy of interventions. All subjects were with visual impairment, without severe physical or cognitive impairment. Play interventions were done by children, or with operational children and their caregivers or parents. Play therapy interventions were in two forms of computer/video based game and child-therapist/parent based game, which were conducted in different settings resembling home, school, or sport camp conditions. Data were gathered by observation of researchers and reports of children using different questionnaires. All of the interventions were effective in improving cognitive, visual, physical, communicative and vestibular skills of the children.

 Despite the comprehensive efficacy of play therapy intervention in children with visual impairment, few studies have been conducted in this field. Considering multi-biases such as missing control of confounders, more high quality standard studies are needed to further evaluate the effectiveness of play therapy in children with visual impairments.

 Appropriate and accurate easy access tools are necessary to overcome complications from malpositioned line tips of peripherally inserted central catheters (PICCs) in critically ill neonates. Ultrasound is a radiationless, cost-beneficial, and time-saving method that allows medical personnel to manipulate the line and correct possible malposition of this tip. In addition, it reduces the need for a second radiography.

 We compared the effectiveness of sonography with radiography for confirmation of the line tip placement.

 This prospective descriptive-analytical study was conducted in the Neonatal Intensive Care Unit (NICU) in Tehran Children’s Medical Center (tertiary level), Tehran, Iran. Neonates who were candidates for PICC implantation according to the ward’s protocol were enrolled in the study. Radiography and sonography were performed after catheter insertion by a radiologist blinded to the preliminary radiographic reports. The results of both methods were compared and interpreted by statistical analysis using the chi-square and Pearson correlation tests.

 A total of 90 infants, 45 (50%) males and 45 (50%) females, were assessed. We noted that 17 (18.8%) cases had malpositioned tips according to the radiographs. Malpositioning of the line tips were identified in 21.1% of cases by sonography (P ≤ 0.05), which indicated a higher accuracy for sonography compared to radiography. Both methods were appropriately correlated regardless of the underlying variables. Sonography had a sensitivity of 100% and specificity of 89.5%, a positive predictive value (PPV) of 97.3%, and a negative predictive value (NPV) of 100%.

 Our findings show that sonography can be a more accurate, safer bedside tool, with fewer complications compared to radiography in PICC tip placement determination in neonates. Multi-center studies with increased sample sizes should be performed to confirm replacement of radiography by sonography as the gold standard test for confirmation of PICC tip positioning.

 One of the most critical criteria in making ready an infant for discharge from the neonatal intensive care unit (NICU) is full oral feeding attainment.

 The present study aimed at investigating the effectiveness of cue-based feeding in preterm infants.

 A randomized clinical trial study was designed to compare 37 preterm infants at a gestational age of ≤ 34 weeks in the cue-based feeding group (n = 18) and the scheduled feeding group (n = 19). All participants were evaluated by the Preterm Infant Oral Feeding Readiness Assessment Scale (PIOFRAS) and Early Feeding Skill (EFS) scale in four different stages. Outcome measures were weight (grams per day), duration of full oral feeding achievement, duration of hospitalization, postmenstrual age (PMA), and the score of PIOFRAS and EFS. A P-value of less than 0.05 has been considered statistically significant.

 The duration of full oral feeding achievement was shorter in the cue-based feeding group (3.55 ± 1.24 vs 6.68 ± 2.00, P < 0.001). Infants were discharged earlier in the cue-based feeding group (15.55 ± 5.38 vs 27.10 ± 7.90, P < 0.001). The mean score of PIOFRAS only on the day of discharge in the cue-based feeding group was more than the scheduled feeding group (32.61 ± 1.14 vs 31.90 ± 0.87, P = 0.03). The score of EFS in each dimension was inconsistent in each stage, and differences were observed between two groups in the full oral feeding stage.

 Although PIOFRAS and EFS demonstrated no difference significantly in most of the stages of achievement in oral feeding between the cue-based feeding group and the scheduled feeding, the process of attainment of oral feeding and discharge from the hospital was more rapid in the cue-based feeding group.
 

 Upper urinary tract dilation, the most common urological manifestation of the Wolfram syndrome (WS), is mainly non-obstructive and secondary to other components of the disease such as diabetes insipidus. Misdiagnosis of the type of the hydroureter in Wolfram patients and encountering them as obstructive uropathies has led to ineffectual surgeries such as ureter re-implantation. Based on previous studies drainage related ultrasonography (DRUS) is a beneficial means of distinction between obstructive and non-obstructive hydroureters.

 To avoid unnecessary interventions in patients with WS by detecting hydroureters’ types using DRUS.

 Seven patients (14 ureters) with a mean ± SD age of 24.43 ± 4.25 months who were diagnosed with WS were included in this retrospective study. The definite diagnosis of the non-obstructive type of hydroureter was assessed by appropriate imaging modalities. The maximum diameter of these 14 ureters, before (D1) and after (D2) 3 hours of catheterization were observed by ultrasonography. Values were recorded as D ratio ( [(|D1 - D2|)/D1] × 100) and the cutoff point of 22% for D ratio was set to discriminate the subtypes of the hydroureter.

 Measurement of maximum diameter of ureter prior to catheterization indicated a mean ± SD diameter of 20.64 ± 2.73 mm; decreasing to 11.07 ± 2.64 mm after 3 hours of catheterization which indicates a significant decrease. Mean D ratio of 14 hydroureters was 45.95 ± 13.01% which indicated significantly higher percentage than 22%, revealing that hydroureters’ type in WS is non-obstructive.

 DRUS is a useful method for the assessment of the hydroureter’s type in WS and it could prevent performing unnecessary surgeries in WS patients.

 Obstructive sleep apnea-hypopnea syndrome (OSAHS) can impact multiple organ systems in children.

 To investigate the effects of OSAHS on T-lymphocyte subgroups and natural killer (NK) cell activity in the peripheral blood of affected children.

 A total of 85 children with OSAHS were enrolled into an experimental group (OSAHS) and 76 healthy children were placed in a control group (CON) to compare peripheral blood levels of CD3+, CD4+, CD8+, and NK cell activity using flow cytometry. Meanwhile, their polysomnography results were monitored to analyze the correlation between T-lymphocyte subgroups/NK cell activity and lowest pulse oxygen saturation (LSaO2)/apnea-hypopnea index (AHI).

 Compared to the CON group, the CD3+ percentage in the OSAHS group showed no significant difference (65.98 ± 6.54 vs 64.36 ± 5.32; P > 0.05), but the CD4+ percentage, CD4+/CD8+ ratio, and NK cell activity decreased markedly (33.52 ± 3.04 vs 35.26 ± 3.68,1.29 ± 0.14 vs 1.43 ± 0.26, and 11.47 ± 4.58 vs 12.69 ± 2.36, respectively; P < 0.05). In addition, the CD8+ percentage increased significantly (26.18 ± 4.76 vs 24.36 ± 2.32; P < 0.05). Linear regression analysis indicated that the CD3+ percentage was not related to LSaO2/AHI (P > 0.05), but the CD4+ and CD8+ percentages, CD4+/CD8+ ratio, and NK cell activity were linearly related to LSaO2 and AHI (P < 0.05).

 OSAHS can affect the cellular immunity of children. The AHI and LSaO2 may be involved in cellular immunity function.

 Sleep pattern is one of the most important issues which can affect mental development in adolescents.

 This study was designed to asses sleep pattern and its relationship with depression in order to obtain information for planning interventional programs and health promotion in adolescents.

 This was a cross-sectional study conducted on high school students in Hamadan, Iran in 2019. Mean age of the students was 16.53 ± 0.69 years (Min - Max: 15 - 19), and 290 (50.3%) students were girls. Samples were selected by multiple cluster sampling method in which 576 students were enrolled in the study. Two standard, valid and reliable self-reported questionnaire was used for recording sleep pattern (PSQ) and depression (Beck). After data collection, SPSS was used for data analysis. All P values less than 0.05 were considered as significant.

 Nearly 70% of the adolescents had problems in some subscales of sleep disorder included in mental quality of sleep, delay in falling asleep and daily dysfunction. Among them in 10% sleep duration was less than 5 hours and in 69% usual bedtime was after midnight (24 o’clock). Severe sleep problem in boys and students with fine educational status was more than others (P value < 0.001) and there was a statically significant correlation between sleep disorder and depression score (Pearson correlation: r = 0.42; P < 0.001) and in students with severe sleep disorder, 48.9% were severely depressed.

 Problems in mental quality of sleep was notable in Iranian adolescents, almost half of them had some degree of depression symptoms. Being boy and having severe problem in sleep pattern were predictors for depression. This information might be applied for well-being as well as physical and mental development interventional programs such as sleep health screening and adolescents and their parents’ educational programs in adolescents’ health promotion sector.

 Respiratory tract infections (RTI) are common complications of primary nephrotic syndrome (PNS) and influence the outcomes of PNS. The pathogenic spectrum and their susceptibility to antibiotics in RTI change over time, which increases the difficulty of treatment.

 To improve the curative effect of RTI in children with PNS, we conducted a cross-sectional retrospective study in 2740 children with PNS to study the etiologic features of RTI seen in PNS children.

 Totally 2740 children with PNS hospitalized during 2010 - 2014 were enrolled in this study. Respiratory specimens were collected for the detection of pathogens using current laboratory diagnostic tests. The cases were divided into community-acquired respiratory tract infection (CARTI) and hospital-acquired respiratory tract infection (HARTI) as well as upper respiratory tract infection (URTI) and lower respiratory tract infection (LRTI) to analyse the etiologic features.

 Among 2162 cases of PNS with RTI, 2095 cases were CARTI (96.90%), and 67 cases were HARTI (3.10%). The most common pathogen in CARTI was Coxsackie virus, followed by Mycoplasma pneumoniae, respiratory syncytial virus, and Streptococcus pneumoniae, while the most common pathogen in HARTI also was Coxsackie virus, followed by respiratory syncytial virus, Mycoplasma pneumoniae, and Streptococcus pneumoniae. There was significant difference in the positive rates of Pseudomonas aeruginosa and Candida albicans between CARTI and HARTI. The distribution of pathogens differed between URTI and LRTI in children with PNS. The positive rates of most pathogens were lower in URTI than LRTI. Generally, the isolation rate of extended-spectrum β-lactamase (ESBL) producing bacteria was relatively low. In CARTI, the sensitive rates of Gram-negative ESBL producing bacteria to carbapenems, amoxicillin/clavulanate potassium, ampicillin/sulbactam, and ciprofloxacin were more than 90.00%, while Gram-positive ESBL producing bacteria were sensitive to glycopeptides, linezolid, macrodantin, mupirocin-HL, and amoxicillin/clavulanate potassium.

 In children with PNS, the etiology differed between CARTI and HARTI as well as URTI and LRTI. Therefore, it is necessary to differentiate these features for empirical therapy. If the pathogen is bacterial, amoxicillin/clavulanate potassium could be the first choice before sputum culture results are available.