International Journal of Pediatrics
Volume:11 Issue: 112, Apr 2023

Admission to the pediatric intensive care unit (PICU) is compulsory for children with a severely complicated form of COVID-19, who are hemodynamically unstable. Our study determined the degree to which our PICU preparedness measures impacted patient outcomes and infection control management within the PICU of Minia University Hospital in Egypt.

179 pediatric patients, admitted to the PICU isolation unit with suspected or confirmed diagnosis of COVID-19, were studied retrospectively. We conducted descriptive analyses on the patients' characteristics and outcomes and the basic concepts and procedures for PICU readiness are discussed.

The patients ranged in age from one month to sixteen years, with an average age of 8.60±4.84 years, 44.69 % of whom were males. Fever, shortness of breath, and cough were the most common symptoms on admission. The most common comorbidities were neurological disorders, heart disease, and respiratory disease, with percentages of 27 %, 25 %, and 23 %, respectively. Overall, mortality was 22.9 %. Only 21 (0.5%) of the hospital's healthcare staff were infected. The infection did not spread to other non-COVID parts of the hospital.

Our PICU strategies and preparation ensured adequate prevention of infection spreading to other units and HWCs, as well as lowering mortality and improving COVID-19 patients’ outcomes.

Viral infection during pregnancy induces pro-inflammatory cytokines and increases the level of IL-6, which as a measure of the inflammation of the mother's immune system is effective on the development of the brain of the fetus and increases the rate of mental disorders of the fetus. The possible effect of the mother's COVID-19 on children, if any, is still unknown. Therefore, this study was conducted with the aim of investigating and comparing the consequences of neurodevelopment and growth at the age of 6 months in infants among mothers with/without exposure to COVID-19 during pregnancy in Birjand, 2021.

A total of 161 pregnant women with PCR-positive coronavirus and 181 pregnant women without infection were selected by simple random sampling. Demographic characteristics including age, occupation, education, gender, nationality, sex of babies, along with data related to the neurodevelopmental status of infants by the use of ASQ questionnaire were extracted and entered into SPSS 16 software. For descriptive statistics, Mean, standard deviation, and frequency distribution tables were used, and inferential analyses were conducted by the use of Chi-square, t-test, and analysis of variance at a significance level of less than 0.05. The disturbance was equal / lower than 1 SD in each of ASQ-3 score domains.

In this cohort study, demographic characteristics in the exposed and unexposed groups were not significantly different. There was no statistically significant difference between the average score of the ASQ_3 questionnaires as well as the average score in the areas of communication, gross motor, fine motor, problem-solving, and social personality among infants born from mothers with and without COVID-19. Also, there was no significant difference in the incidence of disorders in different fields of neurodevelopment, except for the field of establishing communication between the two groups of exposed and unexposed. On the other hand, cesarean delivery was significantly higher in pregnant mothers with COVID-19 during pregnancy. However, there was no significant relationship between the incidence of COVID-19 and the rate of premature delivery, and low birth weight neonates. In addition, the severity and time of the corona infection during pregnancy did not have any significant effect on the neurodevelopment of infants with intrauterine exposure to COVID-19.

According to the results of the study, infection with COVID-19 does not increase the incidence of developmental disorders in 6-month-old infants. Furthermore, it does not increase low

Vaccination of children against COVID-19 in Iran was conducted for children 5-12 years on July 22, 2021, with PastoCovac and Sinopharm. This study aimed to evaluate the side effects following the administration of vaccines in children.

This descriptive-analytical study was performed on 394 children aged 5-12 years who were referred to health centers in Bojnurd, Iran, and received PastoCoVac or Sinopharm COVID-19 vaccines from March to July 2022. After receiving the first dose of the vaccine, in health centers, the children's parents filled out sections of a COVID-19 vaccine questionnaire that included sociodemographic and clinical characteristics of children. After that, other sections of the questionnaire related to side effects following vaccination were filled out by parents of children at different time intervals after receiving the first or second dose of vaccines.

Our results showed that the incidence of vaccine side effects in children aged 5-12 years varies between 24%-37%, depending on the type and dose of vaccine. The most common side effects after getting the first and second doses of vaccines were injection site pain and swelling, fever, fatigue, and myalgia. No serious side effects were reported, and almost all side effects were resolved within a few days without special treatment.

It can be concluded that the incidence of side effects following COVID-19 vaccination in children aged 5-12 years varies depending on the type and dose of the vaccine. However, no serious side effects were reported, and most were resolved within a few days without special treatment. These findings suggest that the vaccination of children against COVID-19 is generally safe and well-tolerated.

Antihistamines are the most common drugs used for treating allergic rhinitis. They, significantly, reduce nasal symptoms by blocking the action of a chemical cytokine called histamine.  This study aimed to compare cetirizine and desloratadine's efficacy and adverse effects in children with allergic rhinitis.

This randomized single-blinded clinical trial was conducted on 400 children with allergic rhinitis, aged 6-12 between February and September 2022. The patients were randomized to receive cetirizine or desloratadine for four weeks. We recorded the symptoms and adverse effects at the baseline and four weeks after starting the intervention.

A total of 248 patients completed the study: 109 patients (47 female, 62 male) in the cetirizine group and 139 patients (53 female, 86 male) in the desloratadine group. The scores related to symptoms of allergic rhinitis before starting the drugs and after 4-week therapy were not significantly different between the two treatment groups (p= 0.1, p= 0.7, respectively). Cetirizine had more side effects than desloratadine in the treated patients (p = 0.02).

This study showed that cetirizine and desloratadine improved symptoms of children with allergic rhinitis; however, there was no significant difference in the efficacy of these two drugs.  Desloratadine caused fewer side effects in patients after 4 weeks of treatment.

During the pandemic of COVID-19, Healthcare Workers (HCWs) have been at the forefront of infection; they could also carry the disease to the others. In this cross-sectional study, HCWs in five hospitals of Mashhad University of Medical Sciences were included from 20 March to 21 July, 2020. HCWs were divided into two categories of frontline and second-line. The checklist was researcher-made and was on the basis of WHO risk factors regarding COVID-19, MERS and SARS. The participants were analyzed. The participants were asked, via phone call, to answer questions in 3 sections of demographics, probable risk factors, and clinical manifestations. The need for Personal Protective Equipment (PPE) and its availability were also evaluated. From among 534 HCWs included in this study, 197(57.6%) were females; most of them were nurses, and the mean ± SD age was 36.02 ± 8.5 years. Eighteen HCWs were hospitalized due to the severity of disease, most of whom were front-line HCWs. Malaise (78.7%), fever (68.1%) and gastrointestinal symptoms (63.7%) were the most common manifestations in the participants. Smoking (OR=0.078, P=0.001) and underlying diseases (OR=2.19, P=0.025) were known as the factors predicting HCWs hospitalization. Being smoker and participating in intubation procedure were independent predictors of hospitalization in HCWs. Frontline HCWs had a significantly higher risk of COVID-19 infection, as compared to the second-line group. Although adequate supplies of PPE are necessary, they do not completely mitigate high-risk

Surgical placement of ventriculoperitoneal (VP) shunt constitutes the most common surgical treatment for hydrocephalus in pediatric patients. However, complications of VP shunt surgery are associated with increased mortality and morbidity. We aimed to investigate the results of ventriculoperitoneal shunt placement surgery in pediatric patients.

This is a single-center retrospective study performed from the 21st of March 2018 to the 21st of March 2022 in the neurosurgery ward of Akbar pediatric hospital, Mashhad, Iran. All pediatric patients undergoing ventriculoperitoneal shunt placement surgery with hydrocephalus were evaluated and followed.

In total, 192 patients, including 107 males (56.6%), with a mean age of 58.85 ± 41.16 months, were studied. The mean follow-up period was 26.53 ± 13.61 months. Hydrocephalus was idiopathic in the majority of patients (86.5%). The most frequent indication for surgery was brain tumor (47.7%). Cognitive, verbal, and motor development were normal in 84.5%, 72.7%, and 41.8% of cases. Shunt infection and dysfunction occurred in 8.8% and 18.2% during the follow-up period, respectively. The overall mortality rate was 23.4%.

Our study provides valuable insights into the prevalence of complications and outcomes of VP shunt surgery in pediatric patients with hydrocephalus in northeastern Iran. Further research is warranted for developing measures to prevent or reduce the prevalence of these complications.

The aim of this study was to evaluate the prevalence of Cardiovascular Disease (CVD) risk factors in 6-18-year-old students in Birjand, east of Iran.

This cross-sectional study was performed on 4182 students, including 2086 females and 2096 males, in two age groups of 6-11 and 12-18 years. In order to pinpoint overweight and obesity in them, the percentiles presented by the Centre for Diseases Control (CDC) were applied. Percentiles equal to or greater than 90 were considered as high blood pressure or abnormal. Fast blood sugar over 100 mg/dl, total cholesterol over 200 mg/dl, LDL over 130 mg/dl, HDL over 40 mg/dl and triglyceride more than 100 mg/dl and 130 mg/dl for ages of 6-9 and 10-18 years, were regarded as abnormal values. Data was analyzed by SPSS Software (V. 16), using T-test and X2 at the significance level of 0.05.

The prevalence of selected CVD risk factors for the age groups of 6-11 and 12-18 years were 9.5% and 7.3% for overweight, 9.2% and 8.2% for obesity, 15.7% and 16.3% for abdominal obesity, 11.2% and 4.6% for diastolic hypertension, 21.8% and 10.1% for systolic hypertension, respectively. The prevalence rates were found to be ,respectively, 4.7% and 7.5% for high blood glucose, %13.4 and 6.1% for high cholesterol, 8.5% and 3.5% for high LDL, 15.3% and 14% for high triglycerides, and 11.3% and 24.7% for low HDL levels, in the two age groups of 6-11 and 12-18 years.

This study shows a high prevalence of CVD risk factors in children and adolescents of Birjand.

Children with specific learning disorders (SLDs) experience social-academic problems, mainly due to higher behavioral and emotional abnormalities, as compared to normal children. The present study aimed to investigate the effects of computer-based rehabilitation therapy on anxiety and attention in children with SLDs.

The statistical population included students with SLDs in Dezful (Iran) during the 2021–22 academic year. The convenience sampling technique was employed to select 30 students, who were then equally assigned to an experimental group and a control group (i.e., 15 participants per group). This quasi-experimental research adopted a pretest-posttest control group design. The experimental group received the computer-based cognitive rehabilitation therapy in Captain's Log (two 50-minute weekly sessions), but during this time, the control group received no intervention and was put on the waiting list. The research instruments included the Children's Anxiety Scale and Test of Variables of Attention. Data were analyzed using the analysis of covariance via SPSS-26. The significance level of the study was considered to be α=0.05.

The mean and standard deviation (±SD) of the posttest scores of anxiety and attention were, respectively, 45.13±8.99 and 88.07±9.78 in the experimental group and 72.00±7.15 and 64.67±9.85 in the control group. The results revealed a significant difference between the experimental and control groups (P<0.001). According to the findings, computer-based rehabilitation therapy improved anxiety and attention in children with SLDs.

Hence, this therapy can alleviate anxiety and enhance attention in children with SLDs to help them improve their academic achievement and social relations.

Contamination of medical equipment and environmental surfaces with microorganisms plays a significant role in the transmission and spread of hospital infections. Considering the deaths and costs caused by hospital infections, it is necessary to take appropriate measures to prevent the spread of infection, such as cleaning and disinfection. The purpose of this study was determining the status of hospital infections before and after using the air and surface disinfectant device known as nocospray which applies dry mist technology and hydrogen peroxide solution.

This cross-sectional study was conducted in two 6-month periods at Dr. Sheikh Children's Hospital, in Mashhad, between 2021 and 2022. All patients who were hospitalized for more than 48 hours and had a hospital infection were included in the study. In the second 6 months, a Nocospray disinfection device was used to disinfect surfaces and equipment. Nosocomial infection was determined according to clinical symptoms and blood, urine and tracheal tube cultures in both 6-month periods and the results of the two periods were compared.

A total of 198 cases of nosocomial infections were observed, 121 cases (61%) of which were related to the first 6 months. The death rate in the second 6 months decreased by 1.65% compared to the first 6 months. Among children of different ages, the age range of 1 to 4 years accounted for the highest number of hospital infections. And the highest rate of infection was related to the intensive care unit.

This study showed the positive effect of surface and air disinfection devices (Nocospray) in reducing the incidence of hospital infections and mortality.

Recently, many research studies with equivocal results, have found Neonatal Sepsis (NS) biomarkers and focused on single regions. Therefore, the aim of this study was to evaluate serum and urine C - Reactive Protein (CRP), Mean Platelet Volume (MPV) and Neutrophil/ Lymphocyte Ratio (NLR) as diagnostic values in NS.

This case-control study was performed on 147 cases (79 overweight or obese children and 68 normal weight children). For evaluating quality of life, the original version of the PedsQL, quality of life questionnaire, was used.

This descriptive-analytical research analyzed Shahid Beheshti Hospital’s probable NS patients. All individuals got a complete blood count, white blood differential, CRP, blood culture, and urine culture. Data was analyzed by SPSS v24.

The data indicated that NS infants had substantially higher mean serum levels of MPV (10.63 ± 1.03 vs. 8.63 ± 0.96, P<0.001), NLR (2.08 ± 1.24 vs. 1.01 ± 0.5, P<0.001), and CRP (12.97 ± 5.09 vs 5.83 ± 2.6 and 9.61 ± 3.25 vs 4.9 ± 3.4, P<0.001).The optimum cut-off points for serum and urine CRP, NLR, and MVP were 10, 6.7, 1.2, and 9.5. The highest Area under the Curve (AUC) was detected in MPV (0.909), and the other AUC for serum and urine CRP and NLR were 0.872, 0.831, and 0.804, respectively. Serum CRP had the lowest sensitivity (73.3%) among urine, NLR, and MPV. Serum CRP had the best specificity, Positive Predictive Value (PPV), and Negative Predictive Value (NPV), identified as 96.7 %, 88%, and 90%, respectively.

Sepsis increases MPV, serum and urine CRP, and NLR in neonates. MPV and serum CRP may detect NS early.

This study is conducted to compare the pregnancy rate among patients with embryo transfer using the conventional experimental method with those using measurement of uterine length with transvaginal ultrasound before transfer in freeze ART cycles. In this cohort study, all participants were subjected to the cycle of ovulation stimulation according to the antagonist protocol; consequently, after oocyte recovery, the embryos were frozen following the next cycles. If they were ready, they were subjected to the cycle of endometrial preparation with estradiol protocol. In case of having one to three embryos of good quality (based on the patients’ selection), they were placed in two groups of embryo transfer using the conventional method (clinical touch) or embryo transfer after measuring the length of the uterus with transvaginal ultrasound. Then, all patients were treated with vaginal progesterone and oral estradiol; two weeks later, a pregnancy test was performed, and if it was positive, they were followed up for ultrasound and pregnancy outcomes. Statistical analysis was performed using Student's t-test and Chi-square or Fisher's exact test in SPSS 16 software. A significance level of less than 0.05 was considered. There are no statistically significant differences between the two groups in variables such as the type of stimulation, the type of gonadotropin, the number of retrieved eggs, the number of transferred embryos, the thickness of the endometrium, the length of the uterus, and easy or difficult transfer. Although the pregnancy rate was higher in the group of ET with measuring the length of the uterus (38.5% versus 34.0%), this difference was not statistically significant (p=0.681). The use of the embryo transfer method using transfer guidelines which were guided by transvaginal ultrasound and determining the location of the embryo deposition by experienced doctors does not increase the fertility rate in ART cycles compared to using the traditional and blind method in Iran. At the same time, it is necessary to examine other advantages of using this method.

Echocardiography (ECHO) is a non-radiation real-time technique for evaluating Peripherally Inserted Central Catheter (PICC) tips that could overcome the limitations of plain radiographs, including the static and single image and exposing neonates to radiation. This study compared the accuracy of ECHO and radiography for PICC tip positioning in neonates.

This cross-sectional pilot study was conducted in the neonatal intensive care unit (NICU) of the Children's Medical Center in Tehran, Iran. Ultrasonography was used to visualize the end of the catheter in the vessels. After insertion of the catheter, a chest x-ray along with the ECHO was performed by a pediatric cardiologist blinded to the preliminary radiographic reports, and the results were compared and interpreted.

Forty infants with mean gestational ages of 35.4±3.3 weeks were enrolled in this study which was conducted during 12 months, from 2019 to 2020. The radiography results confirmed the correct PICC location in 29 infants (72.5%), which was simultaneously confirmed by ECHO in 28 infants (70.0%). The ECHO results indicated inappropriate placement in 12 infants (30%), and radiographs indicated correct placement in 11 infants (27.5%). This confirmed the higher accuracy of ECHO compared to radiography. ECHO had a sensitivity of 100%, specificity of 96.55%, PPV of 91.67%, NPV of 100%, and diagnostic accuracy of 97.5%. Both methods were appropriately correlated regardless of the demographics characteristics, sex, birth weight, gestational age, and catheter insertion site.

The findings confirmed that ECHO was more accurate than radiography for visualizing PICCs tip placement. ECHO does not require radiation exposure, has fewer complications, and is faster than radiography; thus, it should be considered as an alternative to standard radiography for line tip confirmation.

Periodontal diseases, causing an infection site in the body, may be associated with a wide array of local and systemic diseases and conditions. Due to the high prevalence of periodontal disease in women, this study was conducted with the aim of determining whether periodontal disease during pregnancy is associated with premature delivery and low birth weight of the infants.

In this case-control study, the presence of periodontal disease in 115 mothers with premature birth (before 37 weeks) who had babies weighing less than 2500 grams were compared to 115 mothers with term births (after 37 weeks) and babies weighing over 2500 grams referred to the maternity hospital of Vali-e-Asr Birjand Educational-Therapeutic Center. Periodontal pocket depth, CPITN index, and gingival index were measured for 6 teeth with Ramfjord index. Data analysis was done using SPSS 16 software. The findings were described with mean ± standard deviation and frequency distribution tables; in addition, a comparison between the two groups was made with chi-square and independent t-test.

There was no difference between the two groups in terms of demographic variables. The average depth of the periodontal pocket, gingival index, as well as the index of severity and extent of periodontal disease in the case group were much higher than in the control group and these differences were statistically significant (P<0.05).

Periodontal diseases during pregnancy increase the risk of giving birth to a premature and low birth weight baby. Therefore, it is recommended to pay more attention to the examination and treatment of periodontal diseases in pre-pregnancy care and during pregnancy.

Atopic dermatitis (AD) is one of the skin diseases, which is characterized as a chronic inflammation of the skin with itchy red rashes. This systematic review study was performed with the aim of determining the prevalence of AD in children and adolescents in Iran.

The search keywords included Atopic dermatitis, Child, Children, pediatrics, adolescent, Preschool children, School-age children, eczema, and Iran, in the domestic databases of Iran and international databases. After the initial search of the articles and studying their titles and abstracts, those that did not match the purpose of the research were removed from the study, and then the methodology and results of the papers were studied. Then the data was analyzed using CMA version 3 software.

The results of 30 articles were analyzed. Based on the results, the prevalence of AD in girls was 8.5% (confidence interval (CI) = 5.3-13.4), in boys it was 8.1% (confidence interval (CI) = 5.5-11.7), and the overall prevalence was 7.4% (confidence interval (CI) = 5.3-10.3).

AD is found to have a considerable prevalence among children, though the prevalence found in this study is, generally, lower than those suggested in other studies. Overall, more efforts are necessary to reduce its prevalence.