Iranian Journal of Pediatrics
Volume:32 Issue: 6, Dec 2022

 This study was carried out to systematically evaluate the efficacy and safety of pre-exchange transfusion (pre-ET) albumin infusion on neonatal hyperbilirubinemia.

 A comprehensive search of relevant studies from EMBASE, Medline, Cochrane Register of Controlled Trials, ClinicalTrials.gov, China National Knowledge Infrastructure, Wei Pu Information, Wan Fang Data, and Chinese Biomedical Literature Database was conducted from inception to December 2021. Two different authors screened the titles, abstracts, and full texts of the articles. The quality of the included trials was assessed independently by two different authors according to the Cochrane Collaboration’s Risk of Bias. The data were analyzed and compiled using Review Manager software (RevMan version 5.3).

 In total, four studies enrolling 195 neonates were included in this review. The quality of the included studies was deemed fair to good. The meta-analysis showed that pre-ET albumin infusion was superior to exchange transfusion (ET) alone for reducing the need for repeating ET (risk ratio (RR) = 0.25, 95% confidence interval (CI): 0.09 - 0.72, I-squared (I2) = 8%; fixed effects model) and shortening the duration of phototherapy (PT) (mean difference (MD) = -11.46 hours, 95% CI: -16.56 to -6.36, I2 = 93%; random effects model (REM)). No significant differences were detected between the two groups for post-ET total serum bilirubin (TSB) at 6 hours (MD = -3.51 mg/dL, 95% CI: -7.93 - 0.93, I2 = 97%; REM) and 12 hours (MD = -4.21 mg/dL, 95% CI: -9.08 - 0.65, I2 = 99%; REM). None of the patients developed acute bilirubin encephalopathy in any of the trials. No death prior to hospital discharge was reported in any trials, and no adverse effects were observed in intervention groups.

 Based on four studied trials, pre-ET albumin infusion appears to be safe and effective in reducing the need for repeating ET and shortening PT duration. These potential benefits, including the reduction of post-ET TSB, need to be revalidated in future trials using rigorous methodology.

Context:

 Access of adolescents to key reproductive health services (KRHS) has been emphasized; however, how to provide it has not been addressed. This study aimed to propose a bioethics framework to justify at-risk child/adolescent access to KRHS without parental consent.

Evidence Acquisition: 

First, articles and documents were searched using the age of consent laws, reproductive health, and ethical/legal standards phrases with AND/OR separators in PubMed and Web of Science using the Google Scholar search engine in English. After a concise review of the age of consent in child/adolescent-related laws, at-risk child/adolescent access to KRHS without parental consent was justified using major ethical and legal principles and standards.

 Given the different purposes and nature of harm preventive services, in the first part, the authors argue that considering the age of consent for at-risk adolescents’ access to KRHS is a limiting and inefficient factor, and KRHS could be provided for the at-risk adolescent with his/her own assent. In the second part, the authors argue that in decision-making for at-risk adolescents’ access to KRHS, the best interest standard is applicable on the ground of harm standard. Regarding the sociocultural context of the community, after assessing the seriousness of the harm and the threshold of intervention, practical steps are taken toward reducing or removing harm and choosing the option that best promotes adolescents’ interests.

 Regarding the existence of restrictive laws, the suggested framework can be applied in different communities as a bioethics policy guide for legislation and appropriate actions of adolescents’ healthcare professionals.

 We aimed to test the hypothesis that using lung ultrasound (LUS) to assess the severity of transient tachypnea in newborns can predict the mode of respiratory support that will be needed.

 We conducted a prospective study on late-preterm and term infants at more than 34 weeks of gestation. LUS was performed on admission by an investigator, and basic demographic data, LUS scores, respiratory mode and parameters were measured after admission. A receiver operator curve was utilized to assess the ability to predict the respiratory mode that would be needed. A correlation analysis was performed between the LUS scores and the artery blood gas results.

 The mean age at the first LUS examination was 1.22 ± 0.81 hours on admission. Significant differences (P < 0.05) were revealed among the three groups in the left anterior area, right lateral area, left lateral area and total LUS scores. The LUS scores in the NRS group were lower than those in the other groups. The infants with NIV and MV were more likely to have higher LUS scores (P < 0.05). The LUS scores were negatively correlated with the PaO2 results (r = -0.25, P = 0.073), positively correlated with the PaCO2 results (r = 0.41, P = 0.003), and significantly correlated with SaO2 (r = 0.35, P = 0.015). LUS scores of > 6 (AUC = 0.85, P < 0.001) show the requirement of respiratory support in newborns.

 We conclude that LUS scores are correlated with the severity of transient tachypnea of the newborn and can predict an infant’s required respiratory support.

 Periventricular/intraventricular hemorrhage (PVH/IVH) has a major impact on neurodevelopment due to its complications and sequelae.

 This study aimed to determine the frequency of neurosonographic examination and the length of the monitoring period in children diagnosed with PVH/IVH.

 This clinical observational analytical retrospective cohort study was performed on 102 children diagnosed with PVH/IVH. The examinations were done on the third, seventh, fourteenth, and twenty-first days after birth and then in the fourth and sixth weeks and the third and sixth months after birth. The results of the examinations performed over time were subjected to the kappa measure of agreement test, with a significance threshold of 0.05, to determine the period when the most significant changes occur in the patient’s condition, as well as to determine the optimum frequency of the examination.

 There was statistically significant agreement between the results of all the examinations performed in the observed moments (P < 0.0005). However, it is indicative that the agreement was excellent for the fourth week (kappa agreement was more than 0.85), followed by the sixth week that was very good (kappa agreement was 0.79); however, the agreement for the sixth week and the third month was very small (kappa agreement was less than 0.1). Also, there were no major changes (kappa agreement between results from the third and sixth months was 0.88).

 The first neurosonographic examination should be conducted in the first 7 days after birth, and the control examination should be conducted at the age of 4 - 6 weeks. If a pathological finding is observed, the examination is repeated after the specified period until a stationary finding is observed. After the third month, no new changes in the finding are observed.

 Critically ill paediatric patient (CIPP) care may be required in the adult intensive care unit (aICU) of hospitals in cases where there is no paediatric intensive care unit (pICU) or when the pICU bed capacity is insufficient.

 This is a retrospective evaluation of CIPPs who were accommodated in aICUs over the last 10 years to determine the type of hospital admission, indications for hospitalization, presence of comorbidities, treatments, causes of mortality, and effects of these parameters on mortality.

 We retrospectively analysed the medical records of 600 patients aged 28 days to 17 years who had been cared for at least 24 hours in aICUs between 2011 and 2021.

 The average age of the CIPPs ((252 female (42%), 348 male (58%)) was 6 (7.4 ± 5.4) years. The mortality rate was 14.7%, and trauma (31.8%) was the most common cause of mortality, followed by respiratory diseases and septic shock. The independent risk factors found to be associated with mortality were as follows: Lower age, admission to ICUs from emergency departments of hospitals, higher Pediatric Risk of Mortality III and Pediatric Logistic Organ Dysfunction II scores, duration of hospital stay and of mechanical ventilation, vasopressor/inotropic agent requirement in the first 24 hours, higher total transfusion requirement, presence of nosocomial infection, thrombocytopenia, and lower haemoglobin level.

 It is important to achieve the best results and better outcomes for CIPPs in pICUs. However, a significant proportion of CIPPs currently hospitalized in aICUs are admitted with trauma. A close follow-up of mortality scores and clinical parameters in the early period of CIPP care in the aICU is critical as some mortality risk factors are preventable.

 There is a relative lack of information about the consequences of antibiotic therapy during pregnancy or the first postnatal days on brain development, function, and subsequent issues.

 This study investigated the correlation between antibiotic therapy and the timing of complete oral feeding in premature neonates admitted to the Neonatal Intensive Care Unit.

 In this descriptive-retrospective study conducted in Mahdieh Hospital in Tehran, the duration of antibiotic therapy and the date of complete oral feeding tolerance were obtained through electrical patient records. Antibiotic exposure was divided into three categories: Less than 24 hours, between 3 and five days, and more than five days.

 A total of 340 neonates aged 30 to 37 weeks were reviewed. In 2.9% of neonates, no antibiotics were prescribed, and 62.1% received antibiotics for less than five days and 35% for more than five days. There was a significant inverse correlation between the duration of antibiotic therapy and neonatal weight when complete oral feeding tolerance occurs. When taking complete oral feeding, neonates who took antibiotics for more than five days weigh less than neonates in the other two groups. However, there was no significant correlation between the duration of antibiotic therapy and the duration of oral feeding. There was a significant correlation between the type of antibiotics and the duration of his/her oral feeding. Thus, the duration of oral feeding was longer in neonates who had taken cefotaxime, amikacin, and vancomycin than other antibiotics. Yet, there was no significant correlation between the type of antibiotic and the process of neonatal weight gain.

 The findings of the present study showed that the type of antibiotics and the duration of antibiotic therapy are correlated to neonatal feeding, neonatal weight, and neonate's one-minute Apgar score.

 Eosinophilic esophagitis (EoE) is a disease involving the esophagus due to an immune system reaction and has clinical symptoms similar to gastroesophageal reflux disease (GERD). Currently, the only definitive way to diagnose this disease is the endoscopy and biopsy of the esophageal tissue.

 In this study, we investigated the diagnostic value of ultrasound to differentiate EoE from GERD and normal patterns. In addition, we assessed the possibility of replacing ultrasound with an invasive endoscopic method for the diagnosis and follow-up of EoE.

 This cross-sectional study was conducted on 4-12-year-old children in three groups of definitely diagnosed GERD, EoE, and healthy controls. Each group consisted of 30 participants who were evaluated for ultrasound parameters. The obtained values were compared between groups. The sensitivity and specificity of ultrasound findings were determined by receiver operating characteristic curve analysis.

 Ultrasound findings, including wall thickness and distensibility of the cervical and abdominal esophagus, gastric wall thickness, and cervical esophagus diameter had significant differences between the three groups. The EoE group had the highest mean ± SD abdominal esophageal wall thickness of 2.73 ± 0.66 mm, gastric wall thickness of 4.30 ± 0.79 mm, and cervical esophageal wall thickness of 2.32 ± 1.21 mm. The GERD group had the lowest mean ± SD cervical esophagus diameter and distensibility of the abdominal esophagus. On the other hand, this group had the highest mean distensibility of the cervical esophagus. The highest area under the curve (AUC) for discriminating EoE from controls were 0.83 and 0.80 for gastric wall thickness and abdominal esophageal wall thickness, respectively. Moreover, the highest AUCs for discriminating EoE from GERD were 0.80 and 0.71 for gastric wall thickness and cervical esophageal wall thickness, respectively.

 Although the mean of ultrasound findings in the EoE group was significantly different from the control and GERD group, the ability to discriminate EoE from the control and GERD groups was moderate (0.70<AUC<0.90). Therefore, ultrasound has only moderate value for diagnosing and following up on children with EoE and GERD.

 Improving surgical and interventional modalities for treating congenital heart disease has increased these children’s life expectancy, leading to increased cognitive and behavioral problems.

 This study compared executive function between surgically and interventionally treated congenital heart disease children and their age-matched controls.

 In this retrospective cross-sectional study, we enrolled 30 children treated with surgery, 30 interventionally treated patients, and 30 healthy controls. These participants were compared in the executive function domains by the Stroop test, trail making test, cancellation test, visual and auditory memory span test, and behavioral problems using the parental form of strengths and difficulties questionnaire.

 Executive function in memory span and sustained attention was lower in the surgical group than in the intervention group (P < 0.05). Both groups had lower flexibility, memory recall, simple and complex working memory, visual attention, and simple and complex selective attention performance (P < 0.05). The effect of behavioral problems on daily life was higher in surgical patients than in the intervention group (P < 0.0001). Both groups of patients had higher emotional, conduct, and communication problems than the control group (P < 0.0001).

 Interventionally treated patients had better performance than surgically treated patients. Regardless of disease severity or treatment, patients with congenital heart disease had poor performance than normal subjects and suffered from behavioral disorders affecting their daily lives. Therefore, it is essential to include diagnostic and therapeutic interventions for treating these patients’ executive function and behavioral problems.

 Esophageal atresia and tracheoesophageal fistula (EA/TEF) is a known correctable anomaly of the esophagus, and its prognosis depends on multiple factors. Studies investigating the EA/TEF post-operative outcomes among the Iranian population are limited to small sample sizes, and the current prevalence of coexisting anomalies and predictors of poor prognosis in the Iranian population is still unclear.

 This study aimed to investigate the predictors of in-hospital mortality in neonates with EA/TEF at our center within a 12-year period.

 In this retrospective cohort study, we investigated neonates with EA/TEF admitted/referred to a tertiary referral center in Tehran, Iran, from March 2008 to April 2020. Neonates with chromosomal anomalies or age > 10 days at operation date were excluded. Baseline characteristics, associated anomalies, type of EA, and transmission distance were compared in the study population. We followed the neonates for incurring in-hospital mortality.

 We included 233 neonates in the final analysis. The mean age at operation was 3.1 ± 1.7 days, and 111 (47.6%) cases were female. The most common EA type was type C (proximal esophageal atresia with distal fistula), with a prevalence of 94.4%. In this cohort, 23 (9.9%) cases had vertebral anomalies, anal atresia, cardiovascular malformations, trachea-esophageal fistula, renal and limb anomalies (VACTERL) association, and 29 (12.4%) cases died during the in-hospital course. Moreover, neonates with lower birth weight, gestational birth weight < 37 weeks, other coexisting anomalies, cardiovascular defects, and non-VACTERL anomalies were at higher risk of in-hospital mortality. In contrast, EA types and transmission distance did not increase the mortality risk. Furthermore, we measured a cut-off value of < 2575.0 g for birth weight to predict in-hospital mortality with 65.5% sensitivity and 61.3% specificity.

 Lower birth weight, prematurity (< 37 weeks), and coexisting anomalies, especially cardiovascular defects, were associated with an increased risk of in-hospital mortality in neonates after EA/TEF repair surgery.

 Zinc and vitamin D are essential factors required for growth. Recently, studies have shown a possible link between serum zinc and vitamin D levels.

 This study was designed to evaluate this link and its possible affecting growth factors in children and adolescents in Iran.

 This cross-sectional study was performed on the data obtained from children aged 2 to 18 years old referring to a growth assessment clinic for routine growth follow-ups in the city of Shiraz from April to August 2019. A total of 454 children who were checked for 25-hydroxyvitamin D and zinc simultaneously were included.

 Vitamin D was negatively correlated with body mass index (BMI) z-scores, while zinc was positively correlated with vitamin D and height z-scores. Subjects with vitamin D levels ≤ 8.6 ng/mL were 2.081 times as likely to have a zinc deficiency. Vitamin D insufficiency was significantly higher in overweight and obese children. Mean vitamin D and zinc levels were significantly lower, and vitamin D insufficiency was significantly higher in boys than girls. While mean zinc levels were significantly lower in short children, the prevalence of zinc deficiency was not statistically different between short and normal height statures.

 Very low vitamin D levels are likely to be accompanied by zinc deficiency, possibly caused by malnutrition and the modulatory effect of serum vitamin D on zinc absorption. Unlike zinc deficiency, vitamin D insufficiency is much more prevalent in Iranian children than in children from other countries. Vitamin D and zinc are associated with BMI and height z-scores, respectively.

 Mechanical ventilation (MV) is among the most common therapeutic modalities in pediatric intensive care units (PICU), which works based on a defined ventilation mode. Nowadays, conventional and alternative modes including adaptive pressure control (APC) and non-APC modes are frequently employed. Although MV can be helpful in many cases, it may cause some complications resulting in significant morbidity and mortality.

 This study aimed to investigate the demographic features and complications of mechanically ventilated children in a PICU in Iran, as well as to compare different ventilation modes.

 A retrospective case-control study was conducted in PICUs of children’s medical center hospital - a tertiary referral pediatric hospital.

 Of 66 patients included in this study, 33 patients were treated with APC modes, whereas 33 patients were treated with non-APC modes. The most common indications for intubation were respiratory failure (53%) and loss of consciousness (13.6%). The mean duration for intubation in patients with and without underlying disorder were 11.7 and 5.2 days, respectively (P-value < 0.01). The means of time for intubation in the APC and non-APC groups were 10 and 11.9 days, respectively (P-value = 0.145). A total of 23 (34.8%) patients had complications, including death, misplacement of the endotracheal tube, atelectasis, unplanned extubation, etc. There was no significant difference between groups regarding the rates of complications, except for atelectasis. Thirteen (19.7%) patients had atelectasis (2 patients in APC group (6%) and 11 patients in non-APC group (33.3%)) (P-value = 0.022). The mortality rate was the same for the both groups (P-value = 1).

 In sum, the most common indication for intubation was respiratory failure. No significant difference was observed among patients treated with the APC, and non-APC modes in terms of the complications occurred, except for atelectasis which occurred more frequently in the non-APC group. Therefore, it was concluded that there was no difference between conventional and alternative modes of mechanical ventilation in terms of morbidity and mortality.

 The purpose of this study was to compare the effectiveness of once-daily versus twice-daily insulin detemir injection in children with type 1 diabetes mellitus (T1DM).

 In this randomized 4-month clinical trial, 60 children aged 33 - 156 months with T1DM were randomly assigned into two groups, once-daily (group 1) and twice-daily (group 2) detemir insulin injection with pre-meal insulin Aspart. The first month of the study was devoted to educating the patients and insulin dose titration. Hemoglobin A1C (HbA1C) measured at the end of the first month and again after the fourth month was considered as the outcome. Hypoglycemia as one of the major complications was defined as blood glucose lower than 70 mg/dL with clinical symptoms or blood glucose lower than 50 mg/dL in the absence of clinical symptoms.

 Mean HbA1C in the fourth month was 8.5% ± 1% in group 1 and 8.5% ± 1.1% in group 2 (P = 0.98). Mean changes in the fourth month compared to baseline were -0.09% (95% CI: -0.47 - 0.3) in group 1, and -0.42% (95% CI: -0.94 - 0.09) in group 2 (P = 0.273). The treatment modification rate was 39% and 15% in groups 1 and 2 (P = 0.02). However, there were no statistically significant differences between the two groups in terms of insulin dose, hypoglycemia, and other complications.

 Twice-daily injections did not change HbA1c in comparison with once-daily injections. However, the lower treatment modification rate in the twice-daily group in the age group of our study was considerable.

 Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited.

 We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far.

 This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure.

 A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block.

 Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.

Mucormycosis is rare in urinary tract infections. Renal mucormycosis is considered in immunocompromised patients and is associated with a high mortality rate. Herein, we presented the first case of a non-invasive fungus ball caused by a Rhizopus species confined to the unilateral kidney in a healthy boy for approximately ten years. The etiology was identified using next-generation deoxyribonucleic acid (DNA) sequencing. The patient recovered completely after nephrectomy without bladder irrigation. Therefore, clinicians must have a high index of suspicion for fungal infections in refractory urinary tract infections. Next-generation DNA sequencing technology can be used for an accurate diagnosis.

 A double aortic arch (DAA) is a congenital anomaly of the aortic arch, which is also the most common type of complete vascular ring. This vascular ring can compress the trachea and esophagus, as well as cause respiratory, gastrointestinal, and cardiac symptoms.

 In the present case report, a 10-year-old boy with recurrent cough, fever, shortness of breath, chest pain, and a history of recurrent respiratory infections was examined. According to the results of bronchoscopic evaluation, he was found to have a localized tracheomalacia. DAA and dextrocardia condition were also confirmed for this patient by performing a computed tomography angiography of the thorax and the three-dimensional reconstruction of CT angiography.

 The diagnosis of double aortic arch may be confused with upper respiratory tract infections or foreign body aspiration. Therefore, it was recommended that a particular attention should be paid to the double aortic arch when evaluating cases of stridor in children with unknown causes or recurrent respiratory infections. CT angiography and cardiac MRI were the diagnostic methods of choice for examining vascular rings.