Iranian Journal of Pediatrics
Volume:33 Issue: 3, Jun 2023

This study aimed to systematically evaluate the effectiveness of a clinical nurse specialists training program in Zhejiang Province, China, from participants’ perspectives.

This cross-sectional study was conducted with 209 PICU nurse specialists who participated in the training program from 2016 to 2021. All participants completed an online questionnaire two years after graduation. We collected their demographic characteristics and their development status after the training (e.g., continuous improvement of core competence, research skills, and promotion). Chi-squared test was applied to assess the differences in effectiveness across subgroups.

In total, 209 (87.8%) out of 238 nurses responded to the survey among whom 73.7% launched new projects in their hospital after training and 75% published research articles in peer-reviewed journals. Also, 32.4% received promotions, and 67% participated in ICU-related continuing education programs. Based on multivariate regression analysis, the execution of new projects was closely related to the nurse’s position and the level of their working hospitals. The job title and position were associated with publication, research performance, promotion, and continuing education.

The nurse specialists of the PICU carried out a set of new projects implanting new skills that they had learned from the training program. Their core competence was improved, including theoretical knowledge and operation skills, teaching capacities, and scientific research abilities. Many trainees published papers, applied for research grants, got promotions, and had further opportunities for continuing education.

School timings could influence teens’ sleeping patterns by interrupting their sleep or the timing of light can shift their biological clock. The COVID-19 pandemic has altered teens’ sleeping schedule making it important to analyze the effects of long-term social distancing on adolescents’ sleep and mood.

This study analyzes the effects of long-term social distancing, due to the COVID-19 pandemic, on their sleeping patterns and mood.

In this cohort study, data from the 2018 – 2020 Korea Youth Risk Behavior Web-based Survey (KYRBS) were used to compare teens’ sleep patterns in 2020 with those in 2018 – 2019. The primary outcomes of this study were the sleep duration and sleep time of adolescents throughout the week, between 2018 and 2019, and in 2020. The secondary outcomes were the teens’ mood, health perception, and sleep satisfaction, including differences in total sleep time and sleep discrepancies between weekends and weekdays.

Around 58 – 63 thousand students were surveyed each year, and the participation rate was 94.9 – 95.6%. After exclusion, 132,839 teens participated in the survey. From 2018–2020, the height and body weight of the participants did not change. After adjusting for participants’ sex and school year, it was found that more teens felt happy, fewer teens experienced sadness and desperation, and fewer teens had suicidal thoughts in 2020, compared with the previous two years. They also slept 10 minutes later (9.743 (95% confidence interval 7.954 - 11.530)), with wake-up times of 3 – 5 minutes later on weekdays (4.684 (3.449 - 5.919)). On weekends during social distancing, they slept 16 minutes later (15.721 (14.077 - 17.366)), with wake-up times of 12 minutes later (12.309 (10.393 - 14.225)). Although they slept five minutes less on weekdays (-5.059 (-6.817 to -3.301)) and three minutes less on weekends (-3.413 (-5.419 to -1.407)), their overall sleep satisfaction increased, and differences in sleep duration between weekdays and weekends decreased in 2020.

During social distancing, themoodand sleep efficiency of teens improved. In the future, once the COVID-19 pandemic subsides, online classes can be included in the curriculum of school systems to ensure healthy sleep patterns in teenagers.

The global spread of coronavirus disease 2019 (COVID-19) has reached pandemic proportions. Attempts to control its spread have included a range of early screening and triage measures developed in several nations and areas.

This study aimed to determine how to prioritize pediatric fever patients to limit the time they had to wait for a consultation and, therefore, the potential of worsening and crises under the burden of COVID-19.

The triage and emergency care process of children in the Fever Clinic of Children’s Hospital of Zhejiang University School of Medicine, Zhejiang, China, within 2019 - 2020 included flow charts, guidance signs, publicity materials, noon and night articulation, and emergency calls. To enhance the management of pre-consultation and triage, the incidence of adverse event injuries was tallied, and satisfaction surveys were conducted. The prevalence of infectious diseases was characterized by demographic and seasonal factors, and the chi-square test was employed to test for differences between groups.

From January 2019 to December 2020, four peak periods were observed in each year, namely February, July, September, and December in 2019 and March, June, September, and December in 2020. The peak of common respiratory virus infection was seasonal; however, a significant increase (2 = 52.17; P < 0.001) in the case of patients who needed emergency care was observed secondary to fever. The patients within the age range of 1 - 3 years were more in need of emergency care than any other age group (54.70%; 99/181). The most common disease requiring emergency care was febrile convulsions (55.2%). No infectious diseases were missed or underreported during the study period, and no medical personnel was infected.

An effective pre-consultation assessment and triage management system and streamlined workflow are of great importance in safeguarding acute patients while preventing infectious diseases.

Considering the lack of studies to investigate the effect of atropine administration on delirium incidence in a postanesthesia care unit (PACU) in children, this study was conducted with the aim of investigating the effect of atropine administration on delirium incidence and other complications in children undergoing surgery.

The present double-blind, randomized clinical trial was conducted on 70 children aged 1 - 6 years that were candidates for lower abdominal surgery. The patients were assigned to two groups, each consisting of 35 patients. Before induction of anesthesia, 0.02mg/kgof atropineand0.02mg/kgof normal saline were administered intravenously in the first (atropine)andsecond (control) groups, respectively. Patients’ mean arterial blood pressure (MAP), heart rate (HR), and incidence of complications after surgery were recorded.

The results of the present study revealed that the two groups had no significant difference in terms of the mean MAP in any of the studied times (P-value> 0.05). However, themeanHRduring surgerywassignificantly higher in the atropinegroupcompared with the control group (P-value < 0.05). In addition, although the incidence and severity of delirium in the atropine group were insignificantly higher than that of the control group, respiratory complications such as decreased saturation and laryngospasm were lower in the atropine group compared with the control group (P-value > 0.05). The volume of suctioned secretions in the atropine group, with a mean of 6.26 ± 2.47 cc was significantly lower than its volume in the control group, with a mean of 14.57 ± 4.27 cc (P-value < 0.001).

According to the findings of the present study, although the administration of atropine slightly increased delirium incidence, it could reduce the incidence of respiratory complications and secretions after surgery. However, more studies are required to make a more definitive conclusion in this respect.

The relationship between vitaminDand primary monosymptomatic nocturnal enuresis (PMNE) is still controversial.

This study aimed to investigate the relationship between different vitamin D levels with the development and severity of PMNE.

A case-control study of 534 children (267 children with PMNE as the case group and 267 healthy children without enuresis as the control group), aged 6 - 15 years old, was conducted in two tertiary primary care hospitals, Tehran, Iran, from 2015 to 2021. The participants’ demographic characteristics and vitamin D status were evaluated in both groups. The relationship between vitamin D levels with enuresis and its severity was studied as the main outcome measures. Multiple logistic regression models were utilized for statistical analyses to assay the odds ratio at a confidence interval of 95%. In this study, P < 0.05 were set as the significance level.

Vitamin D levels significantly differed between the two groups (18.58 ± 9.83 ng/mL and 30.23 ± 10.62 ng/mL, respectively; P < 0.001). After adjusting for confounders, vitamin D was significantly associated with enuresis (< 20 ng/mL, OR 3.07, 95% CI 1.9 - 4.95, P = 0.0001; 20 - 30 ng/mL, OR 2.72, 95% CI 1.47 - 3.67, P = 0.0001). Adjusted OR with 95% CI concerning the history of parental enuresis was 15.03 (95% CI 1.88 - 19.6, P = 0.01). The prevalence of vitamin D deficiency and insufficiency in the PMNE subjects were 107 cases (40.1%) and 109 cases (40.8%), respectively, and the prevalence values in the control group were 57 cases (21.3%) and 71 cases (26.6%), respectively (P < 0.05). Furthermore, the participants with higher frequencies of bedwetting represented lower vitamin D levels (severe, 10.6 ± 1.23 ng/ mL; moderate, 19.46 ± 1.21 ng/mL; mild, 26.8 ± 2.61 ng/mL, P = 0.0001).

According to the finding of this study, parental history, and the participants’ vitamin D status were significant risk factors for the PMNE development. Vitamin D levels were significantly lower in the PMNE children. The prevalence of vitamin D deficiency and insufficiency was significantly higher in the enuretic subjects. Children with higher frequencies of bedwetting represented lower vitamin D levels.

The people worldwide have been affected by severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) infection since its appearance in December, 2019. Kawasaki disease-like hyperinflammatory shock associated with SARS-CoV-2 infection in previously healthy children hasbeenreported in the literature, whichisnowreferred to as a multisysteminflammatorysyndromein children (MIS-C). Some aspects of MIS-C are similar to those of Kawasaki disease, toxic shock syndrome, secondary hemophagocytic syndrome, and macrophage activation syndrome.

This study reported an 11-year-old boy with MIS-C presented with periorbital and peripheral edema, abdominal pain, elevated liver enzymes, severe right pleural effusion, moderate ascites, and severe failure of right and left ventricles.

Due to the increasing number of reported cases of critically ill patients afflicted with MIS-C and its life-threatening complications, it was recommended that further studies should be carried out in order to provide screening tests for myocardial dysfunction. Adopting a multidisciplinary approach was found inevitable.

Inborn errors of metabolism (IEMs) comprise over 1,000 disorders. Wide geographical and racial variations in the global birth prevalence and their inheritance patterns have been reported by epidemiological studies.

Iran’s Metabolic Registry was launched in March 2017. All patients diagnosed with IEM registered in the Iran Metabolic Registry from 2017 to July 2022 were included in this study.

During the five years, 1,233 patients were recorded in the database. Due to missing data, 320 patients were excluded from the study. Of the 913 registered patients, 402 were female, and 511 were male. The median age of registered patients was 10.3 years (one week to 48.3 years). The most prevalent group of IEMs was amino acid disorders, with 596 (66.6%) patients. The mortality rate of the patients was 36.5%.

This study represents the first report from the IEM registry. A comprehensive registry of IEMs for collecting patient data will help clinicians with more accurate diagnoses of the disorders, monitoring, and follow-up. Furthermore, by estimating the burden of IEMs, the healthcare system and government could accurately assess the medication and equipment needed.

Enuresis is bedwetting that occurs during sleep in children over five years old. If left untreated, it can lead to socialand psychological problems for children and their parents. The role of copeptin in patients with primary monosymptomatic nocturnal enuresis (PMNE) has been reported in several studies. Due to the favorable structural properties of copeptin and the reflection of arginine vasopressin (AVP) concentration, it can be used as an alternative marker for AVP secretion.

This study aims to compare the levels of copeptin in healthy and enuresis children aged 5 - 15 years.

This case-control study was performed on 42 children with primary monosymptomatic enuresis and 42 children without enuresis who were referred to the clinic of Taleghani hospital in Gorgan in 2020. Copeptin levels were measured by the enzymelinked immunosorbent assay (ELISA) method.

Out of 84 patients, an equal proportion of girls (21 patients) and boys (21 patients) participated in both the case and control groups. The age of the children was 8.05 ± 2.46 years, and there was no statistically significant difference between the two groups (P = 0.16). The mean level of copeptin in the case and control groups were 6.7 ± 4.27 and 6.87 ± 8.52 pg/mL, respectively, significantly lower in the case group (P = 0.03). There was a statistically significant difference in the level of copeptin between the boys in the two groups (P = 0.03). Although the mean level of copeptin in the girls in the patient group was lower than that in the control group, this difference was not statistically significant (P = 0.35).

In this study, the mean level of copeptin in PMNE was significantly lower than that in the control group, which suggests it may be considered as a probable biomarker for the prediction of response to treatment with desmopressin, but further study is required to confirm this hypothesis.

Ventriculoperitoneal (V-P) shunt is a common surgery for pediatric patients with hydrocephalus. Migration of the shunt to the scrotum is rare. Its clinical presentation may be silent if the shunt keeps patent. We describe such a case following the implantation of a V-P shunt with scrotal migration, with the tip still kept in the peritoneal cavity with patent function. We will discuss this rare complication and review the literature.

A 28-week-old boy presented preterm-related spontaneous intraventricular hemorrhage and hydrocephalus. The patient underwent surgery via V-P shunt implantation. One month after the operation, V-P shunt migration with the right hydrocele was diagnosed while the tip was still in the peritoneal cavity with a patent function.We adopted a watch-and-wait approach in which outpatient follow-up would be continued until the patient was 1.5 years old, when we would decide whether to perform hydrocele repair and correct the drainage tube malposition or continue follow-up. The patient was alert with good activity and close follow-up.

Ventriculoperitoneal shunt migration with hydrocele in young children is a rare complication after the surgery. Regular follow-up up to 1.5 years old is recommended for patients with the tip in the peritoneal cavity and patent shunt function. Surgical intervention is suggested for cases with tip in the scrotum, shunt kinking, remarkable hydrocele, or hydrocephalus progression. Although V-P shunt migration is uncommon, we should take care of it to find out and solve the problem.

 One of the most challenging operations in children for anesthesiologists and surgeons is foreign body aspiration. Bronchospasm and desaturation may lead to bradycardia and even death.

 The study aimed to evaluate the effect of preoperative dexamethasone and β2 agonist (salbutamol) administration on children who had foreign body aspiration during the rigid bronchoscopy on these undesired complications.

 Children were divided into two groups via random numbers table, independent of their clinical conditions. β2 agonist (salbutamol) (2.5 mg < 20 kg, 5 mg > 20 kg) and dexamethasone (0.5 mg/kg) were administrated to group 1, 30 minutes before the operation. The same agents were administrated to group 2 during anesthesia induction. The occurrence of bronchospasm, desaturation, and bradycardia was evaluated.

 There were 27 children in each group. There was no statistically significant difference between the two groups’ time periods between the onset of the symptoms and procedure (P > 0.05). The two groups were similar in clinical aspects. Clinically, periods of spasm and desaturation were shorter, and patients recovered faster in group 1, but the bronchospasm numbers, desaturation, and bradycardia periods were similar in both groups.

 The results seem statistically similar. Since the periods of spasm and desaturation were shorter, and patients recovered faster in patients with preoperative administration of β2 agonists (salbutamol) and dexamethasone, we may suggest that a larger data set in future studies may lead to more significant results and a better conclusion.

Leptin is thought to play an important role in Crohn’s disease (CD) pathogenesis and progression. Independent studies have revealed a strong upregulation of leptin expression in the mesenteric fat of CD patients.

This study assessed the relationship between leptin gene polymorphisms and CD susceptibility in a Chinese pediatric population.

A total of 86 patients withCDand 142 healthy controls were recruited for this case-control study. The genotypes of 4 singlenucleotide polymorphisms (SNPs; rs2071045, rs41457646, rs11761556, and rs2167270) in the leptin gene were determined by multiplex polymerase chain reaction (PCR) combined with next-generation sequencing.

We found that leptin rs2167270 had a significantly different distribution of alleles and genotypes between CD patients and healthy controls (G is a risk allele: 83.7% of cases vs 72.5% of controls; odds ratio [OR] 1.947; 95% CI, 1.203-3.151; P = 0.006; GG is a risk genotype: 72.1% of cases vs 53.5% of controls; P = 0.021). Patients with the CC genotype (rs2071045) had a significantly increased risk of early onset of CD (58.3% in A1a vs 31.1% in A1b; P = 0.003). Similarly, patients carrying the G allele (100% in A1a vs 84.1% in A1b; P = 0.015) and GG genotype (100% in A1a vs 71.0% in A1b; P = 0.048) of rs41457646, A allele (93.3% in A1a vs 71.8% in A1b; P = 0.013) and AA genotype (93.3% in A1a vs 47.9% in A1b; P = 0.003) in rs11761556 had a higher risk of early onset of CD. However, there was no significant difference in any of these 4 SNPs between patients with and without perianal lesions, as well as in low and normal body mass index (BMI) patients.

The leptin rs2167270 polymorphism is associated with the susceptibility toCDin a Chinese pediatric population. Leptin rs2071045, rs41457646, and rs11761556 might lead to the early onset of pediatric CD.

Bile acid synthesis disorder is a very rare autosomal recessive disorder, which is mainly diagnosed by detecting mutations in the genes encoding enzymes that are involved in bile metabolism, including
4-3-oxosteroid-5-reductase and 3-
5- hydroxy-C27-steroid oxidoreductase. The enzymatic impairments can result in the accumulation of atypical and hepatotoxic bile acid intermediates, which clinically lead to cholestasis and progress to cirrhosis and hepatic failure. Herein, we describe a case of bile acid synthesis disorder diagnosed using molecular genetic assessment.

A 7-year-old girl is presented with failure to thrive since early in life. She had a history of urinary tract infection at four years of age. The sonography was performed at that time and revealed renal microcalculi. She also had a history of abdominal pain, nausea, and vomiting. She underwent upper endoscopies three times to rule out celiac disease; nevertheless, duodenal biopsies were all reported as normal. Muscle weakness was detected at five years of age and electromyography and muscle biopsy findings were non-specific. She underwent a whole-genome study and was diagnosed with bile acid synthesis disorder (BASD). After six months, she was treated with ursodeoxycholic acid, 250 mg, which led to growth compensation and liver enzyme reduction. No adverse effect was reported during the treatment.

Bile acid synthesis disorder is a rare disorder with non-specific features and several organ involvements. It may take several years to achieve the correct diagnosis. To our knowledge, this is the first genetically confirmed case of bile acid synthesis disorder reported in Iran.

 The coronavirus disease 2019 (COVID-19) dramatically impacts healthcare delivery. Pulmonary diagnostic procedures have had frequent disruptions during this pandemic.

 This study aimed to discover how the COVID-19 pandemic affected pediatric flexible fiberoptic bronchoscopy.

 This retrospective cross-sectional study was carried out on pediatric patients who underwent fiberoptic bronchoscopy at a tertiary pediatric hospital affiliated to Tehran University of Medical Sciences. Procedural analysis was done from 20 March 2019 to 20 February 2020 (the pre-pandemic period) and 20 March 2020 to 20 February 2021 (during the pandemic period). The two groups were compared with regard to bronchoscopic indications and findings.

 Our results from the data registry showed that within (group 1), 290 patients vs. 241 patients from 20 March 2020 till 20 February 2021 (group 2) were admitted to the operation room at least once for bronchoscopy procedures. Although the findings of foreign body aspiration in bronchoscopy were more frequent in group 2, this difference was not significant in the two groups (P = 0.055). The number of cases without abnormality in group 2 was significantly less than in group 1 (P = 0.006). The prevalence of Laryngomalacia was also significantly higher in group 2 (P = 0.000).

 Our results confirmed the reduction of bronchoscopy in children after the COVID-19 epidemic. However, there was no change in the immediate indications for bronchoscopy, and this pandemic had the most significant impact on elective bronchoscopy.