Iranian Journal of Pediatrics
Volume:33 Issue: 6, Dec 2023

Context: 

The use of functional magnetic resonance imaging (fMRI) in the evaluation of children’s brains is becoming increasingly popular. However, due to the high number of publications, it’s nearly impossible to read all the related articles and become aware of the crucial elements or the best approach to invest time and effort in this field.

Our goal was to gain a better overall understanding of fMRI publications and to use this information in policy and management contexts to make more efficient decisions.

Data were downloaded from Scopus from the 1990s to the end of 2021 based on the theme of fMRI in pediatrics. The retrieved research articles were analyzed with the Bibliometrix package in R software.

From 8,544 documents written by 25,697 authors, the USA is by far the most productive country with a total of 3,609 publications. However, regarding the average article citations, Sweden is at the top of the list, with 77.79 average citations. Important themes include emotion, autism spectrum disorders, attention-deficit/hyperactivity disorders, and childhood maltreatment.

The results of the present study on fMRI research in the field of pediatrics will be helpful for professionals to visually understand the pediatric modes and trends in fMRI.

Respiratory distress is the most often encountered problem in preterm infants and the most frequently encountered reason for neonatal intensive care unit (NICU) admission. It can develop into respiratory failure and cause high morbidity and mortality. Noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), was the first line for neonates with respiratory distress. The progression of respiratory distress to respiratory failure in neonates with NCPAP (NCPAP failure) increases the need for mechanical ventilation on the first day of life. With limited resources, clinical observation is critical to predict prognosis and golden time for referral. Downesscores are the accurate and easiest measurement that is used to determine the severity and monitoring of respiratory distress in neonates. However, in Indonesia, there has still been no study that showed an effect of the increment of Downes score in 24 hours and the risk of NCPAP failure.

This study aimed to measure the association of Downes score at birth, ages 2, 6, 12, and 24 hours, and the risk of NCPAP failure in the first 72 hours using survival analysis.

This prospective observational cohort study included all neonates with 28 - 36 weeks gestation born at Hasan Sadikin General Hospital, Bandung, Indonesia, within March to May 2019, with respiratory distress and NCPAP as respiratory support. Clinical monitoring was conducted using Downes score at birth, 2, 6, 12, and 24 hours of age. The time of NCPAP failure in the first 72 hours was also obtained. Survival analysis with Kaplan-Meier and Cox regression was used to determine the association.

This study analyzed 121 neonates at 72 hours with an overall survival rate of 70.2% and a mean survival time of 61.1 hours. Neonates born 28< 32 weeks and birth weight 1000 - 1499 g had the lowest survival (54.5% and 56.9%). Downes score 4 at birth and 2 and 6 hours had lower survival than Downes score < 4 (67.7%, 60.5%, and 52.7%). The risk of NCPAP failure in 72 hourswas increased with a higher Downes score at 2 hours (hazard ratio [HR] = 1.86 [95% confidence interval [CI]: 1.3 - 2.6, P < 0.001), 6 hours (HR = 1.67 [95% CI: 1.2 - 2.2], P < 0.001). Downes score  4 at 2 hours (3.26 times, P = 0.030) and 6 hours (2.44 times, P = 0.014) had a high risk of NCPAP failure in 72 hours.

The increase in Downes score was associated with a high risk of NCPAP failure at 72 hours of age in preterm neonates with respiratory distress. Two to six hours of monitoring of the Downes score should be considered a critical time for referral.

The coexistence of a metabolic or genetic disease can complicate the course of an atrial septal defect device closure.

The database of our hospital was searched for patients who had undergone atrial septal defect (ASD) device closure and had concurrent metabolic and genetic diseases. Out of 188 such patients, 11 were identified.

This cohort study included 11 patients with type 1 diabetes mellitus, insulin resistance, mitochondrial diseases, rickets, Seckel syndrome, Alagille syndrome, cystic fibrosis,Downsyndrome, andCrigler-Najjarsyndrometype II. The patients were followed for a median of 4 years. Two patients experienced thromboembolic events. One procedure failed as the device was embolized. Large devices with a waist circumference greater than 1.5 times the body weight were used in 3 patients. One patient died 19 days after the procedure due to multi-organ failure, which was not related to device closure.

In patients with metabolic or genetic diseases, this procedure may be complicated by factors such as small patient size, hypercoagulation, organ failure (cardiac, renal, or hepatic), vascular abnormalities, and issues with anesthesia or transesophageal echocardiography. It is recommended that careful attention be given to the specific challenges associated with each disease. The utilization of large devices can be considered safe, particularly in patients beyond 4 years of age.

Appendiceal carcinoid tumors are uncommon in children and are usually found incidentally during histopathological examination after appendectomy.

The aim of this study was to investigate the clinicopathologic characteristics and long-term outcomes of appendiceal carcinoid tumors in children.

Patients under 18 years old with a diagnosis of appendiceal carcinoid tumor were analyzed. Demographical, clinical, radiological, surgical, and pathological data and long-term outcomes were evaluated.

A total of 10 (0.64%) appendiceal carcinoid tumors were found in 1562 appendectomy specimens. The mean age of children with appendiceal carcinoid tumors was 12.6 years, and the male-to-female ratio was 2:3. Tumor localization was at the tip of the appendix in 9 (90%) patients. Seven (70%) tumors were smaller than 1 cm, while 3 (30%) tumors were between 1 and 2 cm. The depth of tumor penetration reached the subserosa in 8 (80%) patients and the mesoappendix in the remaining 2 (20%) cases. Surgical margins were intact in all patients, and no additional surgery was performed. The patients were followed up for an average of 42.4 months, and no recurrence was detected.

Appendiceal carcinoid tumors usually have nonspecific clinical-radiological findings and are almost always detected incidentally during the histopathological analysis of appendectomy specimens resected due to acute appendicitis. According to histopathology results, close follow-up and advanced surgical and medical treatments should be considered when necessary. Although the survival of patients is good, the possibility of colorectal malignancies should not be overlooked during follow-up.

Limb-girdle muscular dystrophy (LGMD) is a bothersome muscle disease associated with weakness of the shoulder and pelvic girdle.

The study aimed to determine the genetic diversity and relative frequency of various forms of LGMDin Iranian children.

In this descriptive research, 60 children referred to the neurology or emergency department of the Pediatric Medical Center were studied from April 2019 to April 2020. Additional tests (muscle biopsy and genetic testing) were performed to confirm the diagnosis of LGMDs. Quantitative data such as disease level, motor, respiratory, and cardiac functions, and molecular data underwent statistical analysis.

A total of 41 patients with a mean age of 11.1 were studied. Twenty-two patients were diagnosed with genetic tests and 19 with muscle biopsies. Also, there were 26.8% cases of alpha sarcoglycanopathy, 24.4% beta sarcoglycanopathy, 17.1% gamma sarcoglycanopathy, 7.3% calpainopathy, 7.3% dysferlinopathy, 7.3% dystroglycanopathy, 7.3% titinopathy, and one case of laminopathy. Among genetically confirmed individuals, 27.3% had SGCB mutation, and 18.2% had SGCA mutation. A significant relationship was seen between the mutation type and creatine phosphokinase (CPK) levels (P < 0.05).

The prevalence of alpha and beta sarcoglycanopathy phenotypes in the study population showed that the severity of clinical involvement may be predicted by SGCB gene mutation and sarcoglycan expression.

Adropin is a bioactive protein that maintains energy balance through the metabolism of glucose and lipids. Adropin is associated with blood pressure, endothelial function, and glucose metabolism, according to reported studies. High blood pressure is one of the complications of obesity.

Our study investigated the relationship between adropin levels and systolic and diastolic blood pressure in obese adolescents.

The study was conducted with a total of 88 adolescents, 45 females and 43 males, aged 10 - 18 years. The mean age of the participants was 13.79 ± 1.98 years. Participants were divided into two groups: ”obese” (n = 61) and ”control” (n = 27). Adolescents with a body mass index (BMI) above the 95% percentile for age, gender, and race were defined as ”obese.” The control group comprised adolescents with a body mass index between the 5th and 85th percentiles. A sample was taken from the forearm pit of the subjects after fasting for at least 12 hours for the determination of glucose, insulin, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), C- reactive protein (CRP), total cholesterol, low-density lipoproteincholesterol (LDL-cholesterol), high-density lipoprotein- cholesterol (HDL- cholesterol), triglyceride, thyroid-stimulating hormone (TSH), free T4 (fT4), and 25-hydroxyvitamin D3. In both groups, systolic and diastolic blood pressures were assessed using an aneroid manometer and a suitable cuff after subjects had rested for at least 10 minutes in the outpatient clinic. The following formula determined the homeostatic model of assessment for insulin resistance (HOMA-IR): fasting insulin (uIU/mL)  fasting glucose (mg/dL) /405. An enzyme-linked immunosorbent assay (ELISA) kit was used to measure adropin levels.

The insulin, HOMA-IR, AST, ALT, GGT, CRP, triglyceride, and LDL-cholesterol levels of adolescents in the obese group were statistically significantly higher than those in the control group (P < 0.05). HDL-cholesterol and 25-hydroxyvitamin D3 levels of adolescents in the obese group were statistically significantly lower than those of the control group (P < 0.05). There was no statistically significant difference between groups in glucose, urea, creatinine, total cholesterol, TSH, fT4, and adropin levels (P > 0.05). In the obese group, there was an inverse and statistically significant correlation between adropin level and diastolic blood pressure (P: 0.029; P < 0.05).

We found an inverse relationship between adropin levels and DBP but no relationship between adropin levels and SBP in obese adolescents.

Branch pulmonary artery stenosis presents as either an isolated disease or in association with congenital heart diseases (in 2 - 3% of cases). Balloon angioplasty (BA) and stent implantation (SI) are two percutaneous methods that are commonly used to treat this condition. We compared the outcomes of these 2 methods in children and adolescents with isolated branch pulmonary artery stenosis.

Pediatric patients with severe branch pulmonary artery stenosis who were referred to our center and underwent transcatheter insertion via either BA or SI between 2010 and 2019 were studied. Patients’ demographic data, including age, gender, and body weight, were recorded. Standard procedures for BA and SI were applied. Post-procedure angiography and echocardiographic parameters were determined and compared between the 2 groups. Patients who were followed up for at least 2 years were selected for this study, and comparative evaluations were performed during the follow-up.

Forty patients with a median age of 2.1 years and a median weight of 10 kg were enrolled in the study, of whom 25 and 15 underwent BA and SI, respectively. The trans-stenotic pulmonary artery pressure gradient significantly reduced immediately after both procedures, but there was no significant difference between the BA and SI groups in terms of pulmonary artery pressure gradient early after the procedures (P-value = 0.014). There was a significant decline in the peak right ventricular pressure after both procedures. Restenosis occurred more frequently in the BA group. In the BA group, patients under one year old and weight lower than 10 kg had a lower restenosis recurrence rate, evidenced by echocardiographic measurements, compared to those with a weight over 10 kg. Three patients (12%) in the BA group needed balloon reinsertion.

Immediate therapeutic success was similar between BA and SI in patients with branch pulmonary artery stenosis. Re-stenosis occurred more often in the BA group; however, the chance of re-stenosis was lower among patients weighing less than 10 kg over a 2-year follow-up.

Demonstration of high agreement between structural abnormalities identified on magnetic resonance imaging (MRI) and physiologic abnormalities identified on electroencephalography (EEG) could benefit the assessment of epileptic focus in childhood seizures.

The present study aimed to assess the agreement between abnormal findings on brain MRI and long-term monitoring (LTM) by EEG as the standard protocol in children with abnormal focal epileptic discharges in LTM.

This cross-sectional study was performed on 95 children who suffered from seizures with evidence of focal epileptic discharges in LTM who were referred to the Children’s Medical Center in 2017. All patients were also concurrently evaluated by MRI. All MRIs were evaluated twice, before and after receiving the EEG results.

In this study, 59 out of 95 patients with abnormal LTMhad concurrently abnormal MRI findings. The diagnostic agreement between the MRI and LTM in discovering abnormal findings was found to be high (86.4%) with a kappa correlation coefficient equal to 0.79.

About two-thirds of patients with abnormal LTM findings had concurrent abnormal MRI features with high agreement between the two. Thus, MRI and EEG can be valuable in predicting epileptic focus in drug-resistant patients who need surgery.

Mask ventilation is one of the most important aspects of managing and maintaining a patient’s airway. Performing good mask ventilation can avoid the need for intubation.

This study aimed to compare the ventilation quality of two different mask-holding techniques in infants: The three-finger grip and the three-finger grip plus the newly-devised submental maneuver.

This double-blind, randomized controlled trial included 90 infants under 1 year of age undergoing elective surgery under general inhalation anesthesia in Tehran Children’s Medical Center. Each patient was randomly allocated to one of the interventional groups, and general anesthesia was induced using one of the mask-holding techniques before intubation. Demographic data for each patient was collected. Expired tidal volume (VTE) was assessed quantitatively by the Drager machine and then classified into three groups of quality of breath flow as either good (5 - 7 mL/kg), fair (3 - 5 mL/kg), or bad (< 3 mL/kg).

In this study, VTE was shown to be statistically significantly better in the submental maneuver compared with the three-finger grip. Good, fair, and bad qualities were recorded for 30, 15, and 0 patients in the three-finger grip group and 39, 6, and 0 patients in the submental maneuver group, respectively (P = 0.025). Classifying patients into four groups of body mass index (BMI), 10 - 14, 15 - 19, 20 - 24, and 25 - 29, we compared VTE between the two techniques within each group. The results showed that in the BMI group of 20 - 24, the quality of breath flow was statistically significantly better in the submental maneuver (P = 0.047).

Adding the submental maneuver to the three-finger grip seems to provide better expired tidal volume in infants. Also, it seems that in children with higher BMI and larger submental soft tissue, the submental maneuver provides better ventilation quality than the three-finger grip.

We aimed to establish and validate diagnostic models for distinguishing bacterial/viral infections among sepsis neonates and also a model for prognostic evaluation.

Training data sets (cohorts) of neonatal sepsis patients were derived retrospectively from 2017 to 2019, and the verifying sets were followed up from 2019 to 2021. The backward elimination method of logistic regression was used in identifying the optimum feature combination by adding all potential factors to the regression equation.

The current study established 3 models. For distinguishing bacterial sepsis patientsandbacterial culture-negative patients, we found Y=1.930+0.105X1+0.891X2-1.389X3-0.774X4 (Y symbolizes the status of bacterial infectious sepsis, X1 is age increase, X2 is intra-amniotic infection (mother), X3 is vomiting sign, and X4 is cough sign). Similarly, for distinguishing bacterial infectious sepsis patients and bacterial/viral double-positive patients, we found Y=2.918+1.568X1+1.882X2-0.113X3-2.214X4-2.255X5-2.312X6 (Y means the bacterial/viral double-positive status, X1 is IL-6 increase, X2 means CRP increase, X3 means age increase, X4 means high fever sign, X5 is cyanotic sign, and X6 is HGB increase). For predicting hospital days as one of the prognoses, we found Y=-1.993+0.073X1+1.963X2+0.466X3-0.791X4-0.633X5 (Y means worse prognosis, which is hospital days longer than 7 days, X1 means age increase, X2 means intra-amniotic infection (mother), X3 is IL-6 increase, X4 is convulsion with unconsciousness, and X5 is cough sign). Then, the ROC curves of the models from the verifying cohort indicated that all of the 3 models had good performance among sepsis children.

Two diagnostic models and one prognostic model were established for clinical reference from the current first-step analysis with excellent model performance, which could be suggested as new useful diagnostic tools and a therapeutic strategy guiding marker for neonatal sepsis in the future.

Each year, an estimated 15 million pre-term births occur worldwide, with the incidence of pre-term labor on the rise globally. Complications arising from pre-term labor are a leading cause of mortality among children under the age of 5. Despite this, there has been limited research on the trend of pre-term labor in Iran.

This study aimed to assess the trend of pre-term labor and identify influencing factors on pre-term labor in Arak city, Iran, from 2005 to 2019.

We analyzed a total of 89 307 live birth cases in Arak city from 2005 to 2019. The trend of pre-term labor over this study period was evaluated using statistical analysis software packages, specifically SPSS version 25. Linear trend analyses, as well as univariate and multivariate logistic regression analyses, were performed for statistical analysis.

Themeanpercentage of pre-term labor incidence during the first, second, and third 5-year periods was 8.9%, 10.3%, and 12.1%, respectively. Multivariate logistic regression analysis showed an increasing trend in pre-term labor incidence, even after adjusting for confounding factors (P < 0.001).

The observed increasing trend in pre-term labor incidence indicates the necessity for a comprehensive preventive strategy. This strategy should focus on identifying high-risk pregnancies and implementing effective interventions. The increasing incidence of pre-term labor in Arak city highlights the necessity for preventive measures to reduce the burden of this condition.

Monitoring regional cerebral oxygen saturation (rScO2)andhemodynamic stability (eg,meanarterial blood pressure [MABP]) in high-risk premature infants is crucial to enhance daily clinical practices in neonatal intensive care units (NICUs).

This study aimed to investigate potential differences between oxygen saturation measurements obtained via near-infrared spectroscopy (NIRS) and pulse oximetry (PO).

This pilot study enrolled20verylow-birth-weight (VLBW) prematureneonates through a non-random, available sampling approach. We gathered maternal and fetal demographic data along with clinical characteristics of the neonates. The study focused on assessing tissue and cerebral oxygenation using PO and NIRS. We specifically monitored changes in mean rScO2 and MABP at various time points: before, during, and 5 and 10 min after the administration of surfactant injection (SI) via the endotracheal tube.

The mean gestational age, neonatal birth weight, and Apgar scores at 1 and 5 min after birth were 28.44 ± 2.57 weeks, 1063 ± 246 g, 6.05 ± 2.57, and 7.94 ± 1.79, respectively. No significant differences were observed between mean rScO2 values measured by NIRS and PO before (P = 0.631), during (P = 0.722), and 5 min after (P = 0.783) SI. However, a significant difference between PO and NIRS-based rScO2 values was found 10 min after SI (96.95% vs 75.0%; P = 0.04). Additionally, there was no significant correlation between mean rScO2 and MABP recorded before, during, and after SI.

There were no differences in oxygen saturation measurements (recorded by PO) and rScO2 values (recorded by NIRS) before, during, and immediately after SI. Therefore, using PO in NICUs to assess cerebral oxygenation, autoregulation, and hypoxia appears both reasonable and cost-effective. Further multicenter studies are needed to validate the practical advantages and cost-effectiveness of NIRS as an emerging monitoring system.

Fiberoptic bronchoscopy is currently the most commonly used invasive examination method in clinical practice.

This study aimed to assess the impact of esketamine administration during fiberoptic bronchoscopy on the occurrence of negative postoperative behavioral changes (NPOBCs) in children.

Ninety children undergoing fiberoptic bronchoscopy were enrolled and randomly assigned to 3 groups: the control group (group C, n = 30), treatment group 1 (group D1, n = 30), and treatment group 2 (group D2, n = 30). Group C received intratracheal surface anesthesia and sevoflurane inhalation, along with an intravenous injection of 5 mL of normal saline. Group D1 received intratracheal surface anesthesia and sevoflurane inhalation in addition to an intravenous injection of 0.5 mg/kg of esketamine diluted to 5 mL. Group D2 received intratracheal surface anesthesia and sevoflurane inhalation, with an intravenous injection of 0.75 mg/kg of esketamine diluted to 5 mL.

The incidence of NPOBCs was lower in groups D1 and D2 compared to group C at 1, 7, 14, and 30 days after the examination (P < 0.05). The pediatric anesthesia emergence delirium (PAED) scores were lower in groups D1 and D2 than in group C, with group D2 scoring lower than group D1 (P< 0.05). Groups D1 and D2 had a longer time to awaken than group C (P< 0.05), with group D2 having a longer time than group D1. The face, legs, activity, cry, and consolability (FLACC) scores in groups D1 and D2 were significantly lower than in group C, and group D2 had a lower score than group D1 (P < 0.05). The incidence of adverse reactions was lower in groups D1 and D2 compared to group C, and the rate was even lower in group D2 than in group D1 (P < 0.05).

Administration of esketamine at a dose of 0.75 mg/kg may yield better clinical outcomes.