Iranian Journal of Pediatrics
Volume:32 Issue: 1, Feb 2022

 Cytomegalovirus (CMV) is a highly specific herpes virus spreading only from person to person. Valganciclovir (VGCV) and ganciclovir (GCV) are effective in the treatment of neonatal congenital CMV infection.

 This study aimed to compare the curative effects of VGCV and GCV among neonates with CMV infection and evaluate their effects on hearing.

 A total of 48 neonates with congenital CMV infection admitted to Huaian Maternal and Child Health Care Hospital, China, were selected from January 2016 to December 2019 and randomly divided into two equal groups of intervention and group (n = 24 each). While the control group received intravenous injection of GCV, the intervention group received oral VGCV. After a 6-week course of treatment, polymerase chain reaction (PCR) was applied to detect the CMV load in both urine and blood. We used the ELISA method to detect the serum CMV-IgM expression level before and after treatment. Moreover, we compared the positive rates of CMV-DNA and CMV-IgM, hyperbilirubinemia, retinitis, hepatosplenomegaly, thrombocytopenia, neutropenia, as well as the results of hearing screening and brainstem auditory evoked potentials (BAEP).

 Before treatment, there was no statistical difference in blood/urine CMV-DNA expression level and positive expression rates of blood/urine CMV-DNA and CMV-IgM between the groups (P > 0.05). After treatment, blood/urine CMV-DNA expression and the positive expression rates of blood/urine CMV-DNA and CMV-IgM significantly decreased in both groups compared to before treatment (P < 0.05), but there was no statistical significance between the two groups (P > 0.05). Before treatment, there was no significant difference in hearing abnormality rates between the control (50%) and intervention (62.5%) groups (P > 0.05). After treatment, both the control (20.83%) and intervention (29.17%) groups had significantly decreased hearing abnormality rates, and the difference was statistically significant compared with before treatment (P < 0.05), but the difference between the two groups was not statistically significant (P > 0.05). After treatment, the results of comparing BAEP showed that both groups had no statistically significant differences in the number of neonates with normal hearing, mild hearing loss, moderate to severe hearing loss, severe hearing loss, and extremely severe hearing loss (P > 0.05). Before treatment, both groups had no statistically significant differences in the number of neonates with hyperbilirubinemia, retinitis, hepatosplenomegaly, thrombocytopenia, and neutropenia (P > 0.05). After treatment, while the number of neonates with hyperbilirubinemia, retinitis, hepatosplenomegaly, and thrombocytopenia decreased, neutropenia cases increased, and the difference before and after treatment was statistically significant (P < 0.05); however, the difference between the two groups was not statistically significant (P > 0.05).

 VGCV is similar to GCV in the treatment of neonatal congenital CMV infection, but the oral route of administration of VGCV is more acceptable among neonates.

 Substance abuse treatment is challenging in pregnancy, and methadone maintenance therapy (MMT) is a therapeutic choice. Methadone can cross the placenta and is poorly secreted in breast milk. Given these inconsistent findings of methadone effect on neonatal outcomes, this study was done to investigate the results in neonates of mothers treated with methadone in Mashhad.

 In this retrospective cohort study, mothers referring to two academic hospitals of Mashhad University of Medical Sciences, Mashhad, Iran were studied. Three groups were considered: MMT, other drug abusers, and healthy control. Maternal information, including demographic characteristics, fertility characteristics, and methadone treatment-related characteristics, and neonatal information, including demographic characteristics and neonatal outcomes, were assessed.

 Overall, 122 pregnant women with a mean age of 29.14 ± 4.44 years were studied in three groups: control (n = 59), MMT (n = 32), and other drug abusers (n = 31). Baseline characteristics (mothers’ age, residence, chronic hypertension, preeclampsia, diabetes, heart disease, thyroid disease, and other diseases) were not different between the three groups. The highest history of miscarriage was seen in other drug abusers (35.5%) (P = 0.023). The mean weight, height, and head circumference of neonates in the control group were significantly higher than the MMT group (P < 0.001), and in the MMT group was higher than in the other drugs abusers (P < 0.001). The highest prevalence of malformations (16.1%) and hospitalization in the NICU (51.6%) was observed in infants of other drug abusers. After adjusting for confounding variables, the odds ratio (OR) of low-birth-weight infants was 13.7 in the MMT group and 1946 in the other drugs group compared to the healthy control group. The OR of neonates less than 50cm in height was 11.4 in the MMT group and 22.5 in the other drugs. Besides, the OR of neonates less than 35cm was 4.7 in the MMT group and 7.3 in other drugs.

 Although the neonates of mothers who used methadone had a higher rate of inappropriate intrauterine growth indices than control group, methadone consumption compared to other drugs had significantly reduced unacceptable outcomes in neonates. Increased gestational age and reduced preterm delivery risk were observed in methadone-treated mothers.

 This study aimed to evaluate outcomes, prognosis, and safety associated with the timing of surgical ligation for patent ductus arteriosus (PDA) in extremely premature infants (EPI).

 We reviewed the clinical data of 44 EPI (gestational age at birth 26.8 ± 0.67 weeks; birth weight 997 ± 152 g) who received surgical ligation for hemodynamically significant PDA (hsPDA) in the Neonatal Intensive Care Unit (NICU) of the Seventh Medical Center of PLA General Hospital in China between January 2021 and December 2014. We compared the general characteristics, underlying diseases, postoperative surgical complications, and prognoses in two groups of patients who received early ligation (≤ 14 days after birth) and late ligation (> 14 days after birth).

 The gender, gestational age at birth, birth weight, Apgar score, postoperative surgical complications, rates of bronchopulmonary dysplasia (BPD), retinopathy of prematurity, necrotic enterocolitis, periventricular leukomalacia, total hospitalization, and medical costs of both groups were compared. According to the results, the late ligation group had a higher rate of severe BPD (66.3% cf. 35%) and required significantly longer time to reach total enteral feeding and weaning of respiratory support compared with the early ligation group.

 In EPI with hsPDA, for whom medical treatment failed or is contraindicated, early surgical closure of the ductus arteriosus can promote earlier total enteral feeding, shorten the duration of mechanical ventilation, and reduce the rates of severe BPD.
 

 T helper type 2 (Th2) cells are critical cellular elements in allergic rhinitis. Interleukin-33 (IL-33) produces Th2-related cytokines and binds to the ST2 receptors. This is expressed strongly in mastocytes and discerningly in Th2 cells. Through Th2 cells, IL-33 may also have partly involved in immune responses.

 This study aimed to measure the IL-33 serum levels in children suffering from allergic rhinitis and investigate its relationship with the disease.

 This case-control study was conducted on a population with the age range of 7-18 years, who referred to the Pediatric Clinic of the Shahid Beheshti Hospital in Kashan, Iran, in 2017. The study sample encompassed 57 patients with allergic rhinitis (case group) and 57 subjects with no allergic rhinitis (control group). The ELISA assay was used to measure the serum level of IL-33 in the case and control groups. Allergic rhinitis was diagnosed by a pediatric immunologist considering the patient’s history and the guidelines set out by the Allergic Rhinitis and its Impact on Asthma (ARIA). All study data were analyzed with SPSS software version 22.

 There were significant differences between the two groups in terms of age (P = 0.001), gender (P = 0.0144), family history of atopy (P < 0.001), symptoms duration (P < 0.001), and comorbidities (e.g., atopic dermatitis and asthma) (P < 0.001). Furthermore, compared to the control group, the case group exhibited significantly higher IL-33 serum levels (P < 0.001).

 The high serum levels of IL-33 exhibited in patients with allergic rhinitis indicate its involvement in the pathogenesis of the concerned disease.

 Acute lymphoblastic leukemia (ALL) is among the most prevalent type of hematologic malignancy in children. The Children’s Oncology Group protocol recognizes methotrexate (MTX) as a therapy for this problem in children, despite its several complications. The relationship between MTX toxicity and ATP-binding cassette subfamily B member 1 (ABCB1) SNPs in ALL children patients has been investigated in many studies.

 Regarding the controversial findings reported by these studies, the present work aims to evaluate Methotrexate toxicity and its association with ABCB1 Genetic Polymorphism in ALL pediatric patients.

 Blood samples were collected from pediatric ALL patients. Next, DNA was extracted and polymerase chain reaction (PCR) was conducted using 300 μMol/μL of direct primers in 50 µL as the ultimate volume. ABCB1 gene was amplified using the PCR technique, and 0.5% agarose gel electrophoresis was used to identify reaction products. Afterward, the PCR fragments’ length was proved by observing through UV-transilluminator. Finally, liver and blood toxicity was studied in all cases under treatment with MTX.

 In the present study, 81 children with ALL (36 females and 45 males) with a mean age of 6.32 ± 3.08 years old were examined. The ABCB1 1199 G->A gene mutation frequency and the ABCB1 3435 C->T gene mutation frequency was 4.9 and 70.4%, respectively. The results showed no statistically significant difference between leukopenia, gastrointestinal toxicity, renal toxicity, hepatotoxicity, anemia, thrombocytopenia, and neutropenia in cases having homozygous heterozygous ABCB1 3435 C->T and ABCB1 1199 G->A mutant polymorphisms than those having ordinary polymorphism.

 Overall, it seems that C3435 T, G1199A, and ABCB1 are not significant MTX toxicity markers in pediatric ALL cases.

Biallelic variants in the pancreas-specific transcription factor 1A (PTF1A) gene are a rare cause of permanent neonatal diabetes. We report a case of neonatal diabetes with unique clinical manifestations. The clinical diagnosis of the affected infant was confirmed by insufficient endocrine and exocrine pancreas activity; however, the pancreas was normal in imaging. Molecular analyses identified a novel homozygous single nucleotide variant (Chr10, g.23508441T > G), affecting a highly conserved nucleotide within a distal enhancer of the PTF1A gene. The literature review showed that most of these patients had IUGR and imaging evidence of pancreatic agenesis or hypoplasia. We suggest that pancreatic imaging and evaluation of exocrine pancreas function can help early confirmation of the diagnosis in patients with permanent neonatal diabetes.

The association between the thyroid echo pattern and thyroid function has an important impact on the diagnosis and treatment of thyroid diseases in children.

The present study aimed to compare thyroid parenchymal echogenicity with thyroid function tests and evaluate the value of a thyroid ultrasound (US) in predicting thyroid function parameters in the pediatric population.

A total of 434 children (age range: 5 - 18 years; mean age: 13.18±3.42 years) were categorized into two groups based on the thyroid parenchymal appearance on the US as subjects with homogeneous (group 1) and heterogeneous (group 2) echo patterns. Thyroid-stimulating hormone (TSH), free triiodothyronine (fT3), free thyroxine (fT4), thyroglobulin antibody (Tg-Ab), and thyroperoxidase antibody (TPO-Ab) levels were evaluated and compared between the two groups.

The levels of TSH, fT3, fT4, Tg-Ab, and TPO-Ab were significantly different between the two groups (P < 0.0001). All thyroid function tests were within normal ranges in 73.4% (168/229) and 14.6% (30/205) of children with homogeneous and heterogeneous echo patterns, respectively. The homogeneous thyroid gland on the US had 73.8% sensitivity in predicting normal TSH and 100% sensitivity in predicting normal fT3 and fT4. The sensitivity for predicting negative Tg-Ab and TPO-Ab were 78.7 and 85.3%, respectively.

The current study compared the homogeneous and heterogeneous thyroid echo patterns with the thyroid function tests in children. The obtained results confirmed the value of the thyroid US in predicting thyroid function in the pediatric population.

Multisystem inflammatory syndrome in children (MIS-C) was first warned by the National Health Service in England following coronavirus disease 2019 (COVID-19) pandemic.

We aimed to evaluate the clinical and laboratory findings of MIS-C to be used for timely diagnosis and preventing possible complications.

This descriptive study was conducted on 47 patients under 21 years old diagnosed with MIS-C.

We found that 25 (53.2%) patients were male, and the median age of participants was 5.58 years. The most common clinical manifestations were fever, rash, conjunctival injection, mucous membrane changes, periorbital edema, gastrointestinal symptoms, respiratory distress, tachycardia, and swollen hands and feet. C-reactive protein and erythrocyte sedimentation rate were elevated in 85 and 45.5% of cases at presentation, respectively. Chest X-ray (CXR) was performed for all cases, and a computed tomography (CT) scan was carried out for patients with severe pulmonary symptoms or abnormal CXR. The results of most CT scans were normal. Decreased myocardial function in echocardiography was detected in more than half of the cases. All patients received intravenous immunoglobulins, and more than 90% received steroids as co-administration therapy or second-line treatment.

According to our findings, simultaneous fever, diarrhea, vomiting, and limb or periorbital edema is a key feature for MIS-C diagnosis. Moreover, the evidence of COVID-19 should be assessed in suspected cases of toxic shock syndrome or Kawasaki disease due to highly similar manifestations of these two diseases with MIS-C secondary to COVID-19.

Kawasaki disease (KD) involves systemic medium- and small-vessel vasculitides, manifested as acute fever and rash.

To investigate the factors for sensitivity to the initial dose of intravenous immunoglobulin (IVIG) in children with KD.

Clinical data of 222 KD children were retrospectively analyzed. Based on the response to the initial IVIG dose, they were divided into sensitivity and non-response groups. Clinical manifestations, laboratory results, and echocardiographic characteristics were compared between the study groups, and indicators with a significant difference were explored by logistic regression analysis. Receiver operating characteristic (ROC) curves were plotted using independent factors to determine the indicators for non-response.

Of 222 children, 181 (81.53%) were in the sensitivity group and 41 (18.47%) in the non-response group. The incidence rates of ultra-hyperpyrexia and coronary artery disease in the non-response group were significantly higher than that of the sensitivity group (P < 0.05). The percentage of neutrophils, platelet count, and C-reactive protein (CRP) level were higher, and the albumin (ALB) level was lower in the non-response group than that of the sensitivity group (P < 0.05). Increased neutrophil percentage and CRP level, as well as reduced ALB level, were independent risk factors for non-response (P < 0.05). Based on the areas under ROC curves, neutrophil percentage, CRP, and ALB were valuable predictors of non-response, and the cut-off values were 0.725, 78.43 mg/L, and 32.89 g/L, respectively.

Pediatricians should pay attention to possible non-response to the initial dose of IVIG in KD children with the neutrophil percentage of ≥ 0.725, CRP ≥ 78.43 mg/L, or ALB ≤ 32.89 g/L.

Fractures of the middle and distal diaphysis of the forearm are common in children. Conservative treatment is effective in this regard. Some studies have discussed the risk factors and predictive indicators of re-displacement; however, the objects of the study are all fixed with tubular plaster or double sugar splint.

This study was performed to determine the risk factors of re-displacement after closed reduction and double splint plaster fixation of unstable pediatric fractures of the middle and distal diaphysis of the forearm.

This retrospective study was conducted on 57 patients undergoing closed reduction and plaster fixation after unstable diaphyseal fractures of the middle and distal forearm in Wuxi Children’s Hospital of Nanjing Medical University within May 2014 to May 2020. A total of 35 male and 22 female subjects aged 6 - 9 years (average: 7.3 years) participated in this study. They were followed up for more than 6 weeks after fracture healing. According to whether experiencing a secondary displacement within 2 weeks after the fracture, the subjects were divided into two groups, namely displacement, and non-displacement. Gender, age, double fracture, reduction quality, and plaster fixation type were analyzed as relevant, effective factors.

All 57 patients were followed up, and all fractures reached clinical healing standards at the last follow-up. Moreover, 20 and 37 cases were in the shift and non-shift groups, respectively. No statistically significant difference was reported in gender (c2 = 0.168; P = 0.780), age (t = 1.003; P = 0.217), double fracture (c2 = 0.021; P = 1), and plaster fixation type (c2 = 0.416; P = 0.699) between the two groups. The reduction quality (c2 = 7.480; P = 0.025) showed a statistically significant difference. Binary logistic regression analysis showed that reduction quality was a risk factor for fracture relocation providing a predictive value.

Good reduction quality can reduce the risk of fracture displacement.

Children with brain tumors experience potential neurologic complications when are treated with radiotherapy, especially if done frequently under anesthesia.

This study aimed to evaluate the neurologic complications associated with anesthesia in pediatrics treated with radiotherapy under anesthesia.

This cross-sectional study consisted of 133 pediatric patients with a brain tumor who needed anesthesia for performing radiotherapy and were referred to Omid Charity Hospital and Imam Khomeini University Hospital from 2014 to 2020 by the census. Statistical values less than 0.05 were considered significant (P < 0.05).

The patients were in range of 1 - 8 years, and the number of 3,208 anesthesia inductions were conducted for daily radiotherapy. Major complications such as stroke, arrhythmia, tachyphylaxis, and aspiration were not observed. There was a significant relationship between the tumor side, anesthesia, and neurologic complications (P < 0.05). No significant differences were found between demographic data (age, sex, and weight) (P > 0.05).

Anesthesia complications in this study were slight and insignificant. Some were either due to the tumor effect on other vital organs or prior exposure to radiotherapy and chemotherapy. Thus, for providing safe anesthesia, considering the tumor effect on body organs and neurologic complications caused by it can be a great help to reduce anesthesia complications in pediatrics under radiotherapy