Iranian Journal of Pediatrics
Volume:31 Issue: 2, Apr 2021

Conflicting results have been reported in the literature concerning the relationship between salivary nitrous oxide concentration and dental caries in children. Metaanalysis studies aim to combine different studies and reduce the difference between the parameters by increasing the number of studies involved in the analysis process.

Accordingly, this meta-analysis study aimed at determining the relationship between salivary nitrous oxide concentration and dental caries in children.

Databases were searched using the keywords “nitric oxide”, “salivary”, “Caries”, “DMFT Index”, “children”, “early childhood caries” and OR, AND and NOT operators. Quality assessment was then performed based on the Newcastle-Ottawa scale (NOS) checklist. The standardized mean difference (SMD) of DMFT, dmft, and salivary nitric oxide (NO) concentration was estimated.

Seven studies made a comparison between the mean salivary NO concentration in children with dental caries and that in the control group. In four studies, the mean salivary NO concentration in children with dental caries was lower, as compared to that in the control group. This difference was significant in all four studies. Also, the mean standardized difference of the salivary NO index was also estimated to be -0.11 (CI 95%: -1.77, 1.55).

This meta-analysis study demonstrated that salivary NO concentration was not significantly related to dental caries. Moreover, since salivary NO concentration is affected by various factors, it is not sufficient to determine the likelihood of the incidence of caries.

There are reports about cardiac surgery in patients with trisomy 18. However, total cardiac repair with bypass is limited in those patients.

We aimed to evaluate palliative cardiac surgery and compare it to total cardiac repair in patients with trisomy 18.

Retrospectively, 11 patients’ medical records were reviewed. The patients were grouped as palliative surgery (3 patients), total repair followed by palliative surgery (6 patients), and one-stage total repair (2 patients). A total of 17 cardiac surgeries in all patients consisted of nine palliative surgeries and eight total cardiac repairs with bypass. The cumulative survival and post-operative outcomes including complications were investigated.

Eleven patients underwent 17 cardiac surgeries in total. Four patients survived, with a median age of 827.5 days. The survivors consisted of two after one-stage total repair and two after total repair followed by palliative surgery. No survivors were found after only palliative surgery. When post-operative outcomes after palliative surgery in nine patients were compared to those after total cardiac repair in eight patients, there were no differences in operative mortality, postoperative intensive care unit stay, and hospital stay. No differences in post-operative complications were found.

For post-operative outcomes and survival, palliative surgery in patients with trisomy 18 was not different from total cardiac repair with bypass but involved a difficult postoperative course including various complications similar to those after total repair with bypass.

This study aimed to seek the approaches of parents in medical management of their children with rheumatic disorders during the COVID-19 outbreak.

This cross-sectional study was conducted based on an online questionnaire survey at Children’s Medical Center Hospital of Tehran University of Medical Sciences, Tehran, Iran. The participants were selected based on their institutional records. The questionnaires contained questions covering all the basic information related to the patients and their parents, as well as the approaches that parents had taken to manage the rheumatic disease of their children during the outbreak of COVID-19.

A total number of 125 valid questionnaires were collected. Based on our results, 13 out of 129 parents had discontinued their children’s medicines due to COVID-19 concerns, 4 had respiratory disease symptoms but 9 had not any signs of pulmonary involvements. Thus, the overall response rate was calculated 89.6%. However, among the symptomatic cases 19 out of 23 rheumatoid cases had continued to take their routine medications, and the response rate among this group was obtained 82.6%. Among these 13 cases, 7 children had worsened symptoms; however 6 had no changes in the disease symptoms. Seventy-six out of 125 children had been visited by a doctor in the last 2 months, while the remaining 49 cases did not. Twenty-three children (18.4%) had respiratory disease symptoms in the last two months, 19 of whom (82.6%) had continued their rheumatic drugs, but 4 (17.3%) had stopped. Only 3 of 125 children had confirmed COVID-19 infection.

None of the parents who had visited a pediatric rheumatologist during this time had discontinued their children’s medicines. Therefore, close contact with doctors or online consultation could benefit them during the COVID-19 era.

This study compared the success rate of atrial septal defect device closure in children with and without balloon sizing during the procedure.

This four-year, combined retrospective and prospective study was performed at a single center. All participants underwent transcatheter closure under transthoracic echocardiography and the success rate was analyzed considering the effect of balloon sizing.

Eighty-eight patients with a mean age of 6.48 ± 3.32 years were enrolled. Balloon sizing was performedor in 39 (44%) patients. It didn’t change the success rate compared to 49 (56%) patients without balloon sizing. Likewise, age and sex had no effect on thesuccess rate. However; the failure rate was higher in patients with larger defects.

The study demonstrated that balloon sizing did not influence the success rate of atrial septal defect device closure, and a precise measurement by echocardiography can be as successful as balloon sizing.

Chest X-ray (CXR) is known as the most common radiography used for adult and pediatric patients worldwide. Improper X-ray field collimation can result in excessive radiation dose on non-thoracic organs in chest radiographs.

This study was to investigate X-ray field collimation quality in neonatal chest radiography.

A total of 213 chest radiographs of neonates from three hospitals were analyzed for collimation quality assessment in a retrospective study. Accordingly, ideal imaging field (IIF) and current imaging field (CIF) were initially defined. The margins of the IIF included acromioclavicular (AC) level to lower costal margin (i.e. top to bottom) and one centimeter beyond the broadest area of the chest on each side (that is, right to left). The CIF size was also defined as the square borders of collimators.

The findings revealed that the area of the CIF was 1.65 ± 0.39 times to the ideal imaging firlddd (IIF) for three hospitals, suggesting that collimation quality in neonatal chest radiographs was not accurate and it had defects. According to the results, acceptable collimation percentage (36.6%) in Hospital A was more than that in two other centers, and the given center also provided the lowest radiation due to the exposure of non-thoracic structures to primary beams.

It was concluded that training radiographers and using patient immobilization devices and stabilizers were important points that could reduce radiation exposure to non-thoracic organs in pediatric CXR.

Blood exchange transfusion (ECT) therapy is an essential part of the modern health care for high-risk icteric neonates.

Therefore, this study sought to examine the effectiveness of monitoring sodium disorders and the required interventions indicating the overall state of health of hospitalized jaundiced neonates.

This prospective analytic study was performed on 49 neonates diagnosed with severe jaundice undergoing screened exchange blood transfusion from November 2018 to May 2019. Serum sodium ion concentrations testing was performed before the exchange, then 1 - 3 hours later, and again 24 hours after receiving ECT, using a sensitive ELISA kit in a laboratory. Using the newest version of SPSS 24 software program, the association between different numerical variables was calculated by a repeated-measure ANOVA test. P < 0.05 criterion was set as the threshold of significance.

Out of the total 49 neonates, 24 (48.5%) were girls and 25 (51.5%) were boys, of which 93.9% and 6.1% were term and pretermborn neonates, respectively. The average birth weight was 2843 ± 267/510 g and the mean period of hospital stay was 4.55 ± 2.399 days. The various causes of severe neonatal jaundice of all the hospitalized cases were 45% unknown, 43% combined ABO and Rh incompatibility, 10% breastfeeding pattern, and 2% G6PD deficiency. A continual fall in serum sodium was observed following banked blood exchange (P < 0.05). However, these reversible changes were outside the expected normal range. Despite a diminished sodium concentration, the mean sodium levels were within the laboratory reference range of serum (137 - 142 mEq/L) in all the three measured duration times. Moreover, variation in the amount of serum sodium was associated with an unknown underlying cause that led to neonatal jaundice (P = 0.04) and this difference did not reach statistical significance in terms of birth weight, gestational age, and other causes accounting for high bilirubin (P > 0.05).

Given these facts, it was concluded that neonatal jaundice was significantly associated with post-exchange serum sodium changes within the laboratory reference range of serum.

Patients with congenital heart disease (CHD) are more prone to thromboembolism. Aspirin is the most commonly used medication around the world to prevent thrombosis in cardiovascular diseases.

This study aimed to define the frequency of aspirin resistance in pediatric patients with CHD and to evaluate the correlation of clinical and laboratory parameters with aspirin resistance.

The study population consisted of 103 patients using aspirin, including 53 cases of cyanotic CHD and 50 cases of noncyanotic CHD. Platelet aggregation was measured by the AggreGuide A-100 ADP Assay.

The prevalence of aspirin resistance was 36.9% in children with CHD. Although aspirin resistance in cyanotic CHD patients (41.5%) was higher than in non-cyanotic patients (32%), the difference was not statistically significant (P = 0.414). There was no significant association between aspirin responsiveness or resistance and the patient’s sex, age, duration of aspirin use, and concomitant medication use. Comparison of the laboratory data of aspirin-responsive and -resistant patients showed no significant difference between these groups, except for albumin (P = 0.032) and serum fibrinogen (P = 0.0001) levels. The fibrinogen level and thromboembolism history were independent risk factors for aspirin resistance. Also, there was a significant correlation between platelet aggregation in peripheral blood smears and aspirin resistance (P = 0.0001).

Our findings suggest that measurement of the serum fibrinogen level and platelet aggregation in blood smears may be the first step to predict aspirin resistance.

This study aims to define S. pneumoniae serotypes in children hospitalized with an invasive pneumococcal disease from March 20, 2012 to March 10, 2013 by polymerase chain reaction (PCR) method.

Specimens from cerebrospinal fluid and blood were collected from children aged one month-18 years with suspected invasive pneumococcal infection admitted to Mofid Children’s Hospital and other regional hospitals. Multiplex PCR with 13 groups of primers were used to detect 33 serotypes of S. pneumoniae in positive blood and cerebrospinal fluid cultures. Out of 563 samples, 83 S. pneumoniae isolates were identified. Sixty-seven samples were typeable.

The results showed that serotypes 3 (21.7%), 23F (13.2%), and 19F (10.8%) were the most prevalent serotypes. Sixteen samples (19.3%) were non-typeable by Multiplex PCR method. The 13-valent pneumococcal vaccine provides the highest coverage (66.23%), followed by the 10-valent vaccine (34.9%) and, lastly, the 7-valent vaccine (33.71%).

We found that serotypes 3, 23F, and 19F accounted for almost 46% of invasive pneumococcal isolates. As per relatively high coverage of prevalent serotypes, PCV13 should be considered for routine childhood vaccination programs.

Wilson’s disease (WD) is a hereditary autosomal recessive disorder caused by pathogenic variants within the ATP7B gene. Early diagnosis of WD is important but it can be difficult in pediatric clinical practice because of varied presentations. Fortunately, with the development of genetic testing, molecular analysis of the ATP7B gene is helpful in the early diagnosis of WD. Hepatogenous diabetes (HD) is defined as a state of impaired glucose regulation caused by chronic liver disease. Here we report a child with WD with HD.

A 4-year-old girl was admitted to our hospital with diarrhea for two months. On admission, urine glucose was 4+, fasting glucose was 2.6 mmol/L, and postprandial blood glucose was 7.2 mmol/L. Further clinical manifestations and laboratory tests showed coagulation dysfunction, hemolytic anemia, and cirrhosis. After admission, she developed hepatic encephalopathy. Significant abnormal glucose metabolism was later detected, but by then, hypoglycemic convulsions had taken place. The final diagnosis of WD was confirmed by detection of mutations in the ATP7B gene. Genetic sequencing revealed compound heterozygous mutations in ATP7B, including c.2975C>T, p.Pro992Leu and c.3809A>G, p.Asn1270Ser. On day 40 of admission, the patient underwent successful orthotopic liver transplantation. Her liver function, blood glucose levels, and coagulation test results returned to normal one month after the liver transplantation. The symptom of diarrhea was also relieved after surgery. Her abnormal glucose level in hospital was considered to be HD.

Blood glucose levels must be carefully monitored in Wilson’s disease. Moreover, genetic sequencing provides an accurate and minimally invasive diagnostic tool for WD.

Despite the considerable incidence of acute respiratory tract infections (ARTI) among children in Henan province, detailed epidemiological information is limited.

Following a retrospective design, the current study aimed to analyze the epidemiological trends of respiratory pathogens in children hospitalized at Henan Children’s Hospital.

A total of 11306 children (age range, 4 days to 15 years) diagnosed with ARTI admitted to Henan Children’s Hospital from March 1, 2019, to February 29, 2020, were enrolled. Nasopharyngeal swabs, alveolar lavage fluid, or sputum samples were analyzed for the presence of 12 pathogens via a multiplex-PCR assay based on the Genetic Analyzer platform. Data of 11306 samples were eligible for analysis.

The total positive rate was 78.1% (8831/11306). Of 8831 positive samples, 7017 (79.5%, 7017/8831) had a single pathogen and 1814 (20.5%, 1814/11306) had multiple pathogens. Human rhinovirus was the most common pathogen (25.4%, 2874/11306), followed by mycoplasma (18.1%, 2050/11306) and human respiratory syncytial virus (15.8%, 1783/11306). There was no significant difference concerning the positive rate of respiratory pathogens between boys and girls (χ 2 = 0.286, P = 0.593). Children were more likely to be infected in autumn and winter than in spring and summer (9722 vs. 1584, respectively).

Human rhinovirus and mycoplasma were the most commonly detected pathogens. The positive rate of chlamydia was independent of the season, while positive rates of other pathogens were season-related. The positive rate of influenza A (H1N1) was independent of age, while for other pathogens, it was age-dependent. This study demonstrated species-level information on the pathogens, which can improve the prevention and treatment of hospitalized children with ARTI.

Nowadays with advanced improvement in NICUs, more preterm infants are surviving with more risks related to ROP.

The aim of the present study was to collect ROP risk factors and design data mining techniques to suggest a predictive ROP treatment-requiring model.

A cross-sectional study was carried out in an Iranian hospital (2014 - 2018). The population study consisted of 76 preterm neonates with ROP diagnosis. Of all, retinopathy was treated in 35 cases and others had not received any treatment associated with retinopathy. The pre-set questionnaire was used to extract the risk factors leading to treatment-requiring retinopathy. Then specific softwaremodels were designed for predicting ROP treatment-requiringmodel. In order to compare the performance of datamining methods, several performance metrics such as accuracy, precision, sensitivity, specificity, and F-measure have been used.

Seventy neonates with ROP entered the study. Results have shown that among four models, Naive Bayes had the best performance with the highest accuracy (87.14), precision (96.43), sensitivity (77.14) and F-measure (85.71). Confusion matrix for Naive Bayes classifier showed that positive predictive value and negative predictive value were 0.7714 and 0.9714, respectively. Overall 87.14% of all data were correctly classified. Moreover, of all data mining techniques, decision tree model could indicate understandable findings as follow; if oxygen therapy continues more than 16 days or blood infusion is > 6 units of packed cells then patients need treatment.

The results of the present study have demonstrated that data mining techniques could be effectively implemented in ROP screening programs.