Journal of Pediatric Perspectives
Volume:12 Issue: 121, Jan 2024

Since the beginning of COVID-19 pandemic, several studies have reported increased type 1 diabetes (T1D) and severe diabetic ketoacidosis (DKA) in children. Recent studies have linked viruses to T1D due to their autoimmune nature. SARS-CoV-2 infection may cause hyperglycemia and DKA. In this study we aimed to evaluate the incidence of DKA in pediatric patients with T1D during the initial COVID-19 pandemic and the years preceding it. The present study is a retrospective observational investigation conducted at Minia University Hospital's Pediatric Intensive Care Unit (PICU). Children diagnosed with T1D who recently had SARS-CoV-2, as validated by laboratory testing with the RT-PCR method, were included in the study. The cases referred to during the period from March 2020 to February 2022, which coincided with the pandemic, were compared with those newly diagnosed with diabetes and presented with DKA from March 2018 to February 2020, the pre-pandemic phase. Comparisons were made on the incidence, frequency, and diagnostic criteria. During the pandemic period, we admitted 212 cases of new‐onset T1D. Of these, 159 (75%) patients had DKA, and 53 (25%) had hyperglycemia. Comparing the pre-pandemic with the pandemic period, we noted that the number of children identified with T1D had risen from 4.99/100,000children per year in pre-pandemic periods to 8.46 /100 000 PY in the pandemic period with an incidence rate ratio (IRR) of 6.25 (95% CI 2.90 to 7.83); p<0.0001. COVID-19 pandemic has caused a rise in the number of children with newly diagnosed diabetes, and more people with newly diagnosed diabetes are now presenting with severe DKA.

Attention Deficit/Hyperactivity Disorder (ADHD) is one of the most common psychiatric disorders that cause major complications in children, and it is essential to identify the best treatment method especially during COVID-19 pandemic. Therefore, the aim of this study was to discuss the effects of mindful parenting-based telepsychology on behavioral symptoms of ADHD children during COVID-19 outbreak.
This randomized clinical trial was conducted on parents with ADHD children. All mothers underwent eight 45-min-sessions of mindful parenting-based telepsychology, administered once a week. Child Behavior Checklist (CBCL) was evaluated before, immediately after, and 2 months after the intervention.
We did not find significant differences in the following subscales of CBCL: anxious/depressed, depressed, somatic complaints and thought problems, after and 2 months after the intervention between the two groups (P>0.05). While, after the intervention, social problems (11.65 ± 3.03 vs. 14.55 ± 1.93, P=0.001), attention problems (9.65 ± 2 vs. 11.25 ± 1.8, P=0.034), rule-breaking behavior (14.15 ± 2.15 vs17.35 ± 2.85, P=0.002), aggressive behavior (14.25 ± 2.19 vs. 19.75 ± 3.66, P<0.001), and total score of CBCL (90.55 ± 5.56 vs. 106.5 ± 8.81, P<0.001) were found to be significantly lower in the intervention group as compared to the control group; and they remained significantly lower in the intervention group, after a 2-month follow up (P<0.05).
Mindful parenting-based telepsychology significantly improves symptoms in children with ADHD from the parents' point of view. This type of training can also lead to an improvement in parent-child relationships, and so can be suggested as necessary for parents.

Factors like low-protein diet may impose Phenylketonuria (PKU) patients to impaired skeletal disease. The present study assessed the status of Bone Mineral Density (BMD) among PKU patients on a low-protein diet.
A cross-sectional study was conducted (Tehran, Iran, 2019). Patients aged ≥ 4 years old with a definite diagnosis of PKU on a low-protein diet were included. BMD values of the lumbar spine and femoral neck were assessed. The primary objective was assessing femoral and lumbar BMD status in PKU patients.
Forty-one PKU patients entered the study. The mean BMI was 20.712±4.833 Kg/m2. The mean bone age was significantly lower than chronological age (10.9 vs. 12.4 years; P=0.008). The results showed a bone mass reduction in 23.1% of all patients.  A significant correlation was observed between lumbar and femoral BMD values (P=0.001; r=0.516). Most patients (about 77%) had lumbar Z-scores>-1 and 10.3% showed Z-scores in the range of osteoporosis. Age (P=0.004) and age at diagnosis (P=0.002) were the influencing factors on BMD status. The results showed a significantly inverse correlation between BMD lumbar levels with the patient’s chronological age (P=0.016), age of PKU diagnosis (P=0.002), and phenylalanine level (P=0.025)
The results delineated impaired skeletal status among PKU patients on a low-protein diet. Lumbar Z-score values inversely correlated with the patient’s chronological age, age at PKU diagnosis, and phenylalanine level. Hence, early PKU diagnosis and treatment during neonatal period, as well as controlling phenylalanine concentration may improve BMD status.

Despite the growing body of research showing the effectiveness of motor interventions for children both physically and cognitively, there is still a lack of sufficient information regarding the effects of different motor programs and finding suitable interventions to improve motor and cognitive skills in early childhood. This study was conducted to investigate and compare the effects of cognitive and metacognitive factors in motor interventions on the motor and cognitive skills of preschool children.
Sixty-six 6-year-old children (32 girls, 34 boys) participated in this study and were randomly assigned to three experimental groups (motor group (7 girls, 10 boys), motor-cognitive group (8 girls, 8 boys), and motor-metacognitive group (7 girls, 9 boys)) along with a control group (10 girls, 7 boys). The participants in all three experimental groups received a motor program specific to their group for 18 sessions. The Bruininks-Oseretsky test of motor proficiency (BOT-2), the Toulouse-Pieron cancellation test (TP), and the Head-Toes-Knees-Shoulders task (HTKS) were used to collect data. Multivariate repeated measures and multivariate analysis of covariance were used for data analysis.
The findings showed that, compared to the control group, the improvement of cognitive skills in the motor-cognitive group was more than that in the motor and motor-metacognitive groups (p < 0.05). Also, the improvement of motor skills in the motor-metacognitive group was more than that in the motor and motor-cognitive groups (p < 0.05).
According to the results obtained, it seems that if motor interventions are combined with cognitive and metacognitive activities, they can have more cognitive and motor benefits for preschool children.

Tuberous Sclerosis Complex is an autosomal dominant heterogeneous disease that mostly affects the skin and nervous system. The goal of this study was to provide a framework for addressing these patients' psychological and behavioral issues, as well as the therapy and management of these aspects.
As a pilot study for this investigation, 25 patients with Tuberous Sclerosis were assessed. The presence of psychological disorders in these patients was assessed using the TAND (Tuberous Sclerosis Associated Neuropsychiatric Disorders) checklist. The checklist was translated into Persian first, then back into English, and finally verified by the designer of the original checklist. Interviews with the patients' parents took place twice a week with the help of a caregiver, and the checklist was used to analyze the data.
A high correlation was found between the parents' (or caregivers') evaluations of the checklist during the first and second distributions (with a Pearson value of 0.99 and P-value of 0.001). The coefficient of correlation for question eight was -0.76, indicating an inverse correlation. According to the parents' evaluation, the two-stage distribution of this checklist had a strong and respectable reliability with a Cronbach's alpha of 0.79.
Parents and faculty members generally view the reliability and repeatability of all questions in a satisfactory manner as complete and credible from a position of solidarity.

Gastroesophageal Reflux Disease (GERD) is common in infants and its treatment remains extremely challenging in this age group. Therefore this study aimed to compare the efficacy and safety of omeprazole and esomeprazole in infants, aged 1-11 months old, presented with GERD.
This double-blind randomized controlled trial was conducted on 80 infants. All patients were randomly divided into omeprazole and esomeprazole treatment groups for four weeks. The signs, symptoms, and disease severity based on the Visual Analog Scale (VAS) of GERD were evaluated after treatment in both groups. The data were then analyzed using the SPSS Statistics software (version 21).
The results of this study did not show significant differences between the mean disease severity based on VAS of both omeprazole- (81.1±55.7) and esomeprazole-receiving (79.1±77.6) groups (p=0.091). However, in each group, the mean disease severity after one month of treatment was significantly lower as compared to baseline (p<0.01). The recovery rates were similar in both groups (75% and 70% for omeprazole and esomeprazole groups, respectively) (p=0.799).
Omeprazole and esomeprazole did not have significant differences in signs, symptoms, and disease severity of GERD, however, we observed a significant reduction in disease severity in both groups indicating that these two drugs could be used interchangeably for the treatment of GERD disorder.

Inflammation has a remarkable role in Acute Respiratory Distress Syndrome (ARDS) pathophysiology. Pentoxifylline is a phosphodiesterase IV inhibitor with anti-inflammatory and anti-thrombotic properties, which has had positive results in rodents with ARDS. Due to the lack of human studies, we designed this clinical trial to evaluate the pentoxifylline effect on ARDS prevention in high-risk pediatric patients.

We included thirty-four children from Akbar hospital’s pediatric intensive care unit (PICU). These patients were highly susceptible to ARDS progression. Using a randomized, double-blind method, 17 patients received pentoxifylline tablets three times a day for a week, while others received placebo tablets at the same interval for seven days. Lung Injury Prediction Score (LIPS), vital signs, pulse oximetry, PaO2, pH, and PaCO2 were measured at baseline and every day for a week period. CRP was assessed at baseline, then on the third and seventh days. Finally, we imported all the data to SPSS software to compare the treatment and placebo groups.

Each placebo and treatment group had seventeen patients who had no statistically significant difference in baseline demographic information or lab data. The variations in LIPS score (P=0.475), CRP (P=0.053), pH (P=0.199), PO2 (P=0.077), PCO2 (P=0.528), Heart rate (P=0.086), Respiratory rate (P=0.512), Diastolic blood pressure (P=0.572), Systolic blood pressure (P=0.517), and SPO2 (P=0.260) were compared between the two groups; and no significant difference was observed.

The results of this clinical trial suggest that pentoxifylline had no prophylactic effect on pediatric ARDS, but for confirmation, further clinical trials with different designs and larger sample sizes are required.