Iranian Journal of Pediatrics
Volume:31 Issue: 4, Aug 2021

Bronchopulmonary dysplasia (BPD) is a common severe respiratory problem in premature infants, and imaging information has important reference value for its diagnosis. Recently, lung ultrasonography (LUS) has been successfully used for the diagnosis and differential diagnosis of neonatal lung diseases (NLDs), but the study of the diagnosis of BPD is still rare.

The purpose of this study was to investigate the ultrasonographic characteristics of BPD and its value for the diagnosis and differential diagnosis of premature infants’ BPD.

From January 2015 to December 2019, 25 premature infants diagnosed with early-stage BPD and 32 infants diagnosed with late-stage BPD according to their medical history, clinical manifestation, and chest X-ray were included in this study. The LUS examinations were performed on each infant. The LUS findings were recorded and compared with those of 40 premature infants without lung diseases.

The gestational age of 25 early-stage BPD infants was 26+1 – 31+6 weeks, and their birth weight was between 730 and 1,810 g. The gestational age of 32 late-stage BPD infants was 26 - 32 weeks, and their birth weight was 750 - 1,760 g. The gestational age of 40 control infants was 25+6 - 32+1 weeks, and their birth weight was 810 - 2,050 g. There was no difference in the proportion of primary lung diseases (including RDS, TTN, pneumonia, etc.) between the three groups. The proportions of infants receiving invasive and/or noninvasive respiratory support at admission in the three groups of early BPD, late BPD, and normal control were 20/25 (80.0%), 26/32 (81.2%), and 33/40 (77.5%), respectively, with no significant difference (P > 0.05). The mechanical ventilation duration over one week in three groups was 15/20 (75%), 21/26 (80.7%), and 24/33 (72.7%), respectively, with no significant difference (P > 0.05). Nonspecific pleural line abnormalities were seen in all early and late BPD patients (100%), alveolar-interstitial syndrome (AIS) in 16 cases (64%) of early BPD and 32 cases of late BPD infants (100%), pleural insect erosion-like change (PIE-like change) in two cases of early-stage BPD infants (8.0%) and 20 cases (62.5%) of late-stage BPD infants, and air vesicle signs (AVS) only in 17 cases of late-stage BPD infants. The sensitivity and specificity of PIE-like change for the diagnosis of late-stage BPD were 62.5 and 92.0%, respectively, and the sensitivity and specificity of AVS for the diagnosis of late-stage BPD were 53.1 and 100%, respectively.

Lung ultrasonography is not specific for the diagnosis of early-stage BPD, but has a high reference value and specificity for the diagnosis of late-stage BPD when combined with obvious pulmonary fibrosis and pulmonary vesicle formation, which is mainly manifested by AIS, PIE-like change, and AVS.

Mycoplasma pneumoniae pneumonia (MPP) is common in pediatric patients. Many studies showed that recurrent respiratory tract infections (RRTIs) are common in the year following treatment of MPP in infants, but the factors associated with the occurrence of RRTIs are rarely reported. Therefore, the present study aimed to identify these factors.

This retrospective observational study included infants (< one year) who were clinically treated for MPP from January 2015 to December 2018. Clinical features and relevant data were collected on admission. The cases of the occurrence of RRTIs and the presence of related factors after one year of follow-up were investigated by questionnaires. The questionnaires contained the number of upper respiratory infections, tracheobronchitis, and pneumonia, the titers and course of MP-IgG and positive IgM antibody, eczema, pet ownership, interior decoration, inhaled or ingested allergens, exposure to environmental tobacco smoke, and gastrointestinal function. Independent significant risk factors for RRTIs were identified using binary logistic regression.

A total of 300 MPP cases were included, among which RRTIs occurred in 134 (44.7%) cases in the year following MPP treatment. Binary logistic regression analysis showed that a history of prematurity (OR = 6.336, 95% CI: 2.337 - 17.116, P ≤ 0.001), a history of exposure to inhaled or ingested allergens (OR = 2.527, 95% CI: 1.289 - 4.956, P = 0.007), and co-infection involving Chlamydia pneumoniae (OR = 2.787, 95% CI: 1.145 - 6.784, P = 0.024) were significantly and positively associated with RRTIs after MPP, while age (OR = 0.894, 95% CI: 0.825 - 0.970, P = 0.007) showed a negative correlation with RRTIs.

RRTIs in the year following clinical treatment of MPP in infants are relatively common and significantly associated with the patient’s age, history of prematurity, history of exposure to inhaled or ingested allergens, and C. pneumoniae co-infection. Thus, these factors should be carefully assessed in pediatric MPP cases to predict the risk of RRTIs and appropriately manage the patient.

Otoacoustic emissions (OAEs) and auto-auditory brainstem response (AABR), as two safe and equally accurate techniques, are used for hearing screening among newborns. However, the screening time of such tests is under debate.

The present study aimed to assess the correlation between examination day and the referral rate of secondary hearing screening among non-high-risk newborns.

A retrospective review of secondary hearing screen data collected from June 2012 to June 2019 was conducted on infants who had no confirmed risk factors introduced by the Joint Committee of Infant Hearing 2007 (JCIH).

Of the 2493 newborns included in this study, 2129 cases (85.4%) passed the test bilaterally, and 364 newborns (14.6%) failed the examination. The referral rate of the 1366 newborns taking OAE was 13.1%. Among 1127 newborns taking both OAE and AABR, the referral rate was 16.5%. Moreover, the referral rate of the OAE and OAE+AABR techniques was the lowest in the 42-56-day group.

All newborns with no high-risk factors should be screened for hearing as such we recommend 42 - 56 days after birth as the best re-examination period to reduce the false positive rate and caregivers’ anxiety

The emergence of video laryngoscopy in the management of pediatric airways has been invaluable as it has been known that these patients are prone to airway complications. Video laryngoscopes are proven to improve glottic view in both normal and difficult airways in pediatric patients. The time taken to intubate using these devices is inconsistent.

This study was designed to compare the time to intubate using two common video laryngoscopes, C-MAC® , and GlideScope® , aimed at pediatric patients age 3 - 12 years old.

A Randomized controlled trial was conducted in 65 ASA I or II patients, aged 3 - 12 years old who underwent elective surgery using endotracheal tube. They were divided into group 1 patients who were intubated using C-MAC® video laryngoscope versus group 2 patients who were intubated with GlideScope® video laryngoscope. Laryngoscopists were all anesthetists with experience in both C-MAC® and GlideScope® intubation. Time to intubate and intubation attempts were measured. Any extra maneuver, airway complications, and laryngoscopist satisfaction scores were also recorded.

Total time to intubate was significantly longer in GlideScope® group than in C-MAC® group (P < 0.001). Both devices managed to achieve excellent glottic views. The first pass attempt success rate was similar between both devices. There was no difference between requirement of extra maneuvers to assist intubations. There were also no adverse events associated with all the intubations. The satisfaction score of anesthetists was comparable to each other.

Even though intubation time using GlideScope® is longer, both devices give excellent glottic view, comparable success intubation, and anesthetists satisfaction score.

Early childhood caries (ECC) is an aggressive and multifactorial form of dental caries in children, in which the biomarkers of oxidative stress may increase.

This study aimed to compare the salivary malondialdehyde (MDA) levels in children with early childhood caries (ECC) and caries-free (CF) children.

To this end, 42 ECC children and 42 CF children, aged 4 - 6 years, were randomly selected from the kindergartens of four socio-economically different districts of Isfahan. An unstimulated saliva sample was obtained from children fasting during the past night using the spitting method. In the laboratory, the MDA levels were evaluated spectrophotometrically. An independent-samples t-test was used to examine the differences between the two groups.

The mean salivary MDA level was significantly higher in the ECC group than in the CF group (P = 0.01), and there was no significant relationship between salivary MDA and gender (P = 0.44 in the ECC group, P = 0.30 in the CF group). Moreover, no significant relationship was noticed between MDA with decayed, missing, filled teeth (dmft).

The findings documented a relationship between ECC and MDA as one of the products of oxidative stress reactions. Accordingly, the MDA level of saliva can be a critical indicator in determining the status of caries in children.

Coronavirus disease 2019 caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide, causing a significant public health disaster.

The present study aimed to evaluate the clinical features and laboratory data of neonates born to mothers with COVID19.

A retrospective multicenter cohort study was conducted from March 20 to September 5, 2020, on all neonates born to mothers with positive real-time reverse transcriptase-polymerase chain reaction for SARS-CoV-2 or clinically suspected COVID-19. Neonates enrolled in this study were from five different hospitals affiliated with the Tehran University of Medical Sciences. All the newborns were tested for SARS-CoV-2 using nasopharyngeal swabs during the first 24 - 48 hours of life, and a second-time swabbing was performed as indicated at subsequent visits. All categorical data were manifested as frequency (%), and continuous data were shown as mean ± SD.

Forty-four neonates born to 39 infected mothers were evaluated during the study period. Nineteen women had complications during pregnancy, including hypertensive disorders, gestational diabetes, preterm labor, etc. Besides, 54.5% of the neonates were born preterm. The mean gestational age and birth weight were 35.11 ± 4.01 weeks and 2,567 ± 898 g, respectively. Fifteen (34.1%) neonates were symptomatic at birth, and during the observation, more neonates became symptomatic. Finally, 27/44 (61.3%) neonates became symptomatic, and 17/44 remained asymptomatic. The most common clinical manifestations were respiratory distress (77.7%), followed by fever or hypothermia (18.5%), gastrointestinal problems (14.8%), and neurologic findings (3.7%). Also, the most common clinical feature of eight neonates with positive RT-PCR was respiratory distress, followed by neurologic symptoms, temperature instability, and gastrointestinal disorder, in sequence. Few abnormalities were seen in laboratory findings. Chest Xrays were abnormal in 22.2% of the neonates.

The SARS-CoV-2 infection during pregnancy may cause severe maternal and neonatal morbidities. Neonates with positive SARS-CoV-2 may demonstrate a spectrum of clinical features. The most common feature of neonates born to mothers with COVID-19 was respiratory distress.

Optic neuritis or inflammation of the optic nerve is a frequent cause of acute optic nerve damage in children and adults. Optic neuritis can occur in association with some viruses, such as influenza and mumps viruses. At the end of 2019, a novel coronavirus, known as COVID-19, spread throughout the world. Coronavirus is known to cause optic neuritis in animal models, and several adult cases have been reported up to now, as well. However, to date, no case of optic neuritis has been reported in children with COVID-19.

The patient was an eight-year-old boy referred to our center, complaining of sudden bilateral and progressive blurring of vision with right-eye preference. He had a history of severe headache for three days in the previous two weeks and slight mood disturbance. On physical examination, bilateral disk swelling and significant loss of vision were detected in his both eyes. Magnetic resonance imaging (MRI) of the brain showed bilateral maxillary sinus thickening with mild optic nerves enlargement with slightly hyperintense T2 and mild post-contrast enhancement. No pathologic finding was seen in the brain, and cerebrospinal fluid and other immunologic tests were normal. Due to the patient’s history of headache and outbreak of COVID-19, a nasopharyngeal reverse transcription-polymerase chain reaction (RT-PCR) test for COVID-19 was requested, and a positive result was obtained, confirming the diagnosis of COVID-19 infection. The optic neuritis was treated with pulsed methylprednisolone and the patients’ vision improved.

In this article, we reported an eight-year-old child with optic neuritis and headache in the context of COVID-19. No case of optic neuritis has been reported in children with COVID-19.

Gastric adenocarcinoma is extremely rare in children, and it is typically seen among the elderly in their sixth and seventh decades of life. There are few studies on the clinicalmanifestations, treatment, and prognosis of thismalignancy in children.

In this paper, we describe a 12-year-old girl presented with abdominal pain, anorexia, nausea, and abdominal distension. A high volume of ascites was reported in ultrasound and computed tomography (CT) scan of the abdomen and pelvis. The patient underwent endoscopy and biopsy of the gastric mucosa. The histopathological findings were positive for gastric adenocarcinoma. Unfortunately, the patient died two months after chemotherapy because she was at the advanced stage of the disease.

Although gastric adenocarcinoma is rare in children, it should be considered in patients with persistent upper gastrointestinal symptoms.

In 1962, Renpenning et al. published an article with 20 male patients from three generations with mental retardation. Scientists suggested that the syndrome with mutation mapped to the locus Xp11.2-p11.4 should be called Renpenning syndrome. The deletion/duplication of an AG dinucleotide on proximal Xp in the polyglutamine tract-binding protein 1 (PQBP1) gene causing frameshift in the fourth coding exon was identified as themost frequentmutation in this syndrome. Renpenning syndrome with asymmetric cerebellar hemispheres has not been reported previously.

In this case report, we presented an 11-year-old male with mild developmental delay and mild intellectual disability, microcephaly, dysmorphic face, short stature, and seizures. The following morphological abnormalities were detected: a wide nasal bridge, midfacial hypoplasia, short philtrum, low-set ears, low hanging columella, high palate, and narrow face. Neurological examination showed upper and lower extremities hypotonia with joint hypermobility. The patient had his first seizure at the age of seven, and he experienced a total of 10 seizures by the age 11. A systolic murmur of intensity 2/6 was present, and echocardiography showed chordae tendineae abnormalities in the left ventricle. Brain magnetic resonance imaging (MRI) showed asymmetric cerebellar hemispheres (mild right cerebellar hemisphere hypoplasia). A frameshift mutation in the polar reach domain (PRD) of the PQBP1 gene (c.459-462 delAGAG) was detected by exome sequencing.

We showed the first case of genetically confirmed Renpenning syndrome in Serbia. Our patient had classical clinical manifestations for Renpenning syndrome as a consequence of frameshift mutation in the PRD of the PQBP1 gene. To the best of our knowledge, according to the literature, this is the first patient with Renpenning syndrome with asymmetric cerebellar hemispheres (mild right cerebellar hemisphere hypoplasia).

Since mid-April 2020, infection with coronavirus disease of 2019 (COVID-19) has affected more than 2 million people worldwide. Little is known about the effects of COVID-19 infection on kidney transplant patients treated with immunosuppressive (IS) drugs.

Here, we report three Iranian pediatric kidney transplantation cases who acquired COVID-19 infection and were admitted to Hazrat Ali Asghar Hospital in Tehran, Iran, in March-April 2020 (first wave). They were treated with prednisolone, cyclosporine, and cellcept. All of them had gastrointestinal symptoms, and one patient also had respiratory symptoms. In two patients who had only gastrointestinal symptoms, chest radiographies were considered normal. They did not need the intensive care unit (ICU), ventilator respiratory support, and dialysis due to a temporary increase in serum creatinine and no change in urine volume. Cellcept was stopped and othermedications continued. The patient, who had pulmonary and gastrointestinal symptoms, expressed more severe manifestations that led to ICU admission and dialysis. Prednisolone was increased to a stress dose and the other drugs were discontinued.

Pulmonary manifestations significantly worsen the prognosis compared to gastrointestinal manifestations in pediatric kidney transplants with COVID-19.