Iranian Journal of Pediatrics
Volume:34 Issue: 2, Apr 2024

Exclusive breastfeeding (EBF) for up to 6 months postpartum provides numerous benefits to both mother and child. Despite these advantages and the recommendation for EBF during the first 6 months postpartum, the global prevalence of EBF is on the decline. The method of delivery is one of the many factors that influence EBF rates. Enhanced Recovery After Cesarean Section (ERACS) has been shown to improve breastfeeding rates in comparison to the standard Cesarean section.

The purpose of this study was to investigate the association between ERACS and non-ERACS delivery methods with EBF and the early initiation of breastfeeding (EIBF).

This cross-sectional study involved a minimum of 96 subjects for each category. Non-ERACS delivery was categorized into vaginal delivery and standard Cesarean section. The success rates of EBF at 0, 1, 3, and 6 months were evaluated using an exclusive breastfeeding questionnaire, which demonstrated a Cronbach's Alpha of 0.931, indicating a high level of reliability (≥ 0.60). The association between the variables was analyzed using the chi-square test.

The study identified a significant association between the method of delivery and EBF (P = 0.036), with vaginal delivery having a Relative Risk (RR) of 1.286 (0.858 - 1.927) and standard Cesarean section an RR of 1.679 (1.156 - 2.437) for not engaging in EBF for 6 months in comparison to ERACS. Furthermore, a significant association was observed between delivery methods and EIBF (P < 0.001), with an RR of 1.190 (0.717 - 1.967) for vaginal delivery and an RR of 2.667 (1.762 - 4.035) for standard Cesarean section for not initiating breastfeeding early compared to ERACS.

There is a significant association between ERACS and non-ERACS delivery methods with both EBF and EIBF. Both vaginal delivery and standard Cesarean section are associated with a higher risk of not engaging in exclusive breastfeeding at 6 months and not initiating breastfeeding early, compared to ERACS.

The neonatal mortality rate (NMR) is a crucial indicator of a country’s population health

This study aims to assess the rates and causes of NMR in West Azerbaijan.

This population-based cross-sectional study utilizes data from the Child Mortality Surveillance System (CMSS) spanning from 2013 to 2022. The study population comprised all neonates (< 28 days old) with permanent residency in any of the 17 cities within the West Azerbaijan province who died within the stated period. Mortality rates, both all-cause and cause-specific, were determined per 1 000 live births for the years 2013, 2016, and 2022.

The investigation covered 3 689 reports of neonatal deaths (< 28 days old) from 2013 to 2022. Of these, 53% were males, with an average gestational age of 31.85 ± 5.56 weeks. Over 72% of the deaths occurred in preterm infants, and 69% were linked to cesarean section deliveries. Perinatal prematurity was the leading cause of death during the periods examined, with rates of 32.3%, 35.2%, and 36.8% in 2013, 2016, and 2022, respectively. The distribution of neonatal mortality across the province was uneven, with Poldasht city experiencing the highest mortality rates and Shot city the lowest (9.13 and 2.89 per 1 000 live births, respectively).

West Azerbaijan province has achieved the Health-related Sustainable Development Goal (SDG-3) of reducing neonatal mortality to below 12 deaths per 1 000 live births by 2030. Nonetheless, significant disparities in NMR persist across the province. Further epidemiological research and the development of targeted health programs are essential to address areas with elevated mortality rates.

Infantile colic is a prevalent issue within the first three months of life. Research indicates that children of mothers who suffer from migraines are more than twice as likely to experience colic.

The aim of this study was to explore the association between a history of maternal migraines and the occurrence of infantile colic.

A case-control study involving 154 infants who visited the Rafsanjan Pediatric Clinic in 2022 was conducted. The participants were selected through convenience sampling and categorized into two groups based on the Wessel criteria for colic: Infants with colic (n = 77) and those without (n = 77), ensuring they were matched for age and sex. Data were collected using a questionnaire designed by the researchers, which gathered information on the mother and infant’s age, the infant’s sex, number of pregnancies, gestational age, birth weight, method of feeding, paternal history of migraines, and maternal fulfillment of the International Headache Society’s migraine criteria.

The analysis revealed that a history of maternal migraines was significantly more common in infants with colic than in the control group (Odds Ratio [OR]=6.17, P < 0.001). Further, multivariable logistic regression analysis, after adjusting for potential confounders, indicated that a maternal history of migraines increased the likelihood of infantile colic fivefold (OR = 5.008, 95% confidence interval: 2.258 to 11.104, P < 0.001).

This study confirms a significant association between maternal migraines and infantile colic, suggesting that maternal migraines could be a risk factor for colic in infants.

Chronic diarrhea in children poses a significant clinical challenge and can lead to adverse health outcomes. Among various causes, fat malabsorption is particularly concerning, as it may lead to inadequate nutrient absorption, malnutrition, and impaired growth. Prompt and precise diagnosis is crucial for implementing effective treatments.

The goal of this study is to utilize deep learning to create a superior diagnostic tool that exceeds traditional methods, facilitating the early identification of fat malabsorption in children suffering from chronic diarrhea.

In a preliminary study involving 100 pediatric patients, 25 machine learning algorithms were evaluated. The convolutional neural network (CNN) was identified as the most effective and subsequently refined through hyperparameter tuning.

The CNN model exhibited exceptional performance, attaining a test accuracy of 97% and an area under the curve (AUC) score of 99.4%. These results underscore its reliability in accurately identifying cases of fat malabsorption.

This research represents noteworthy progress in pediatric gastroenterology, merging deep learning techniques with medical expertise to develop a dependable and rapid diagnostic tool. This innovative method promises significant improvements in detecting fat malabsorption, potentially transforming clinical practices and enhancing patient outcomes in children with chronic diarrhea.

Spontaneous pneumomediastinum (SPM) is a rare and benign self-limiting condition characterized by the presence of air in the mediastinum without an apparent cause. Boerhaave syndrome, on the other hand, is a rare condition caused by spontaneous esophageal perforation due to severe vomiting. Themediastinum is a complex anatomical region housing vital organs, making clinical comprehension challenging.

There is no established approach to diagnosing and treating children with SPM. Despite similarities in the presence of air in the mediastinum, SPM and Boerhaave syndrome are distinct entities. However, the primary challenge for patients is ruling out esophageal perforation. We aimed to highlight this rare issue by presenting the results of our patient series to guide further examination in pediatric patients with mediastinal air.

We included twenty-four pediatric patients diagnosed with SPM between 2014 and 2022. Demographic and clinical characteristics, diagnostic procedures, treatments, and follow-up details were retrospectively recorded.

The mean age of the twenty male and four female patients was 14 years. Common triggers included coughing (45%), increased physical exertion (33%), and retching/vomiting (8%). All patients experienced chest pain, with additional symptoms such as dyspnea (50%), neck pain (30%), and dysphagia (12%). Symptoms resolved within two days of hospitalization. Patients were often misdiagnosed and received inappropriate treatment at other centers before being transferred to our hospital. A fluoroscopic esophagogram conducted within an average of 22 hours from admission revealed no abnormalities. Oral feeding was withheld for an average of 28 hours. The mean duration of symptom-free hospitalization without treatment was 32 hours.

It appears that emergency department physicians may lack familiarity with pneumomediastinum. Surgeons’ concerns about missing Boerhaave’s syndrome may lead to unnecessary tests, prolonged fasting, and hospital stays for patients with SPM.

 Cystic abdominal masses are relatively prevalent in the pediatric population. Ultrasound (US) often serves as the initial imaging modality for evaluating these lesions, assisting in diagnosis, and guiding clinical decisions.

 This study aimed to delineate the characteristic US features of intra-abdominal cystic lesions not arising from the liver, spleen, or kidney in children and to assess their diagnostic value for providing definitive diagnoses.

 Conducted in the radiology department of pediatric hospitals affiliated with Mashhad University of Medical Sciences from 2019 to 2022, this cross-sectional study examined 104 children with cystic abdominal lesions. Patient demographic data and US characteristics were documented. Definitive diagnoses were established through histopathological reports, surgical outcomes, or clinical follow-up. The accuracy of US findings was evaluated against these definitive diagnoses, with the sensitivity and specificity of US features for various intra-abdominal cystic lesions being calculated.

 The most frequent cystic lesions identified were perinatal ovarian torsion (22.1%) and duplication cysts (18.2%). Ultrasound achieved a sensitivity and specificity of 82.61% (95% CI = 0.6 - 0.94) and 100% (95% CI = 0.94 - 1), respectively, in diagnosing perinatal ovarian torsion and 89.47% (95% CI = 0.65 - 0.98) and 94.11% (95% CI = 0.86 - 0.97) in diagnosing duplication cysts. In 80.8% of the cases, the initial US diagnosis corresponded with the final diagnosis.

 Ultrasound exhibits commendable sensitivity and specificity in identifying intra-abdominal cysts not originating from the liver, spleen, or kidneys in children, demonstrating its effectiveness in the diagnostic evaluation of these lesions.

 This study seeks to evaluate the precision of ultrasonography in confirming orogastric tube placement among neonates in a Chinese neonatal intensive care unit (NICU).

 Radiological assessments initially gauged tube placement, followed by confirmation through ultrasonography. The agreement between the two methods was assessed using Cohen's kappa statistic, while diagnostic performance was analyzed through sensitivity and specificity calculations.

 Out of 156 orogastric tubes, 85.3% were accurately placed in the stomach according to radiological assessment, with ultrasonography confirming 88.5% of stomach placements. Accuracy rates were 67.3% for radiological evaluation and 60.3% for ultrasonography in determining the accurate position. The agreement assessment demonstrated a sensitivity of 68.6% and a specificity of 46.3%.

 While ultrasonography shows promise in reliably verifying orogastric tube placement in newborns, it does not entirely substitute current radiological assessments. Further research is essential to discern the optimal clinical utility of ultrasonography.

There are several studies regarding perforations after intravenous immunoglobulin (IVIG) infusion; however, the risk factors are not defined yet.

The present study aimed to investigate gastrointestinal complications in newborns regarding the reported immunoglobulin A (IgA) levels in IVIG preparations.

This retrospective chart review was conducted on term newborns who received IVIG therapy in two centers in Istanbul. The study included patients with IVIG-associated gastrointestinal bleedings, necrotizing enterocolitis (NEC), and intraabdominal perforations without any underlying diseases and recorded demographic data (gestational age, birth weight, and gender) and the IgA levels in the IVIG preparations. Infants born below 35 gestational weeks were excluded as they were more likely to have NEC.

A total of 71 patients received IVIG therapy, and 15.5% (n = 11) developed major gastrointestinal system (GIS) complications. A total of 36 patients were born ≥ 35 gestational weeks, and gastrointestinal perforation or bleeding occurred in 22.2% (n = 8) of these patients. Two patients died before surgery due to aggressive disease progression. None of these patients had any gastrointestinal symptoms before IVIG therapy or any predisposing factors for gastrointestinal perforation. All patients were on spontaneous breathing and enteral feeding without intolerance. The IgA level content of the IVIG preparations was related to the major GIS complications with strong evidence, and the safe threshold resulted in 14 mg/dL in receiver operating characteristic (ROC) analysis in the present study group.

Higher IgA levels in IVIG preparations might be a risk factor for gastrointestinal perforation and bleeding in term newborns. Clinicians should be aware of this potential complication when using IVIG therapy in term newborns and closely monitor for signs and symptoms of major gastrointestinal complications.

In Iran’s newborn hearing screening (NHS) program, OAE and AABR are administered to early identify hearing impairment in the primary health care (PHC) system.

The aim of this study was to conduct a cost-effectiveness analysis of this program integrated into Iran’s health system.

We examined the cost-effectiveness of AABR and OAE screening procedures in infants less than 1 month old. TreeAge 2022 software was used for cost-effective modeling. In this study, QoL and QALY were considered as the outcome measures. To evaluate the robustness of the modeling results, we used one-way sensitivity analysis. A ± 20% variation was utilized to determine target variables and estimate the costs per identification.

In 2022, a total of 1,106,072 babies were born in Iran, of whom 1,006,293 underwent hearing impairment screening (coverage rate: 90.97%). Overall, 3,359 of the newborns screened were diagnosed with hearing problems, indicating a mean prevalence of 3.3 per 1000 births. The ICER was equal to 3297.2 US PPP (Purchasing Power Parity) per QALY. According to our results, the dominant cost-effective strategy for hearing impairment screening was OAE plus AABR. After 1000 iterations, the second cost-effective strategy was found to be OAE alone, according to Monte Carlo simulation modeling.

In this study, we evaluated the cost-effectiveness of the NHS program for detecting hearing impairment in over a million births in Iran. A two-step screening approach, including OAE and AABR, was found to be the dominant cost-effective strategy to identify newborns with hearing impairment.

Neural tube defects are prevalent malformations of the central nervous system in infants, often fatal, and considered global medical-social problems. Due to National Laws fortifying wheat flour in the bread industry, 100% of the population of this province has consumed wheat flour enriched with folic acid since June 2007.

This study aimed to determine the prevalence of neural tube defects following the fortification of flour with folic acid in the north of Iran.

This descriptive-analytical study examined all neural tube defect cases in Golestan province, northern Iran, from March 2016 to March 2018. Data on the parent's age, ethnicity, mother's education, residency, and types of neural tube defects were recorded for each subject.

The prevalence rate of NTDs was 1.04 per 1000 births. The highest frequency was observed in the Turkmen ethnic group, with a prevalence rate of 1.251 per 1000 births. Geographically, most cases were in the West of Golestan province, with a prevalence rate of 1.876 per 1000 births. Additionally, the highest prevalence of NTD in Kalaleh City was reported as 1.67 per 1000 births. Among NTD cases, the highest frequency was related to mothers aged less than 35 years (82.72%).

The prevalence of neural tube defects during 2016 - 2018 has increased compared to the previous study conducted in this region from 2006 - 2009. Future studies should investigate the reasons behind this increase.

 In contemporary healthcare systems, there is a growing emphasis on promoting self-care, patient empowerment, and informed decision-making. The creation of health information content is recognized as a vital tool for enhancing the health literacy of patients.

 This study aimed to explore the components of children's health information in radiology centers to develop a model for producing health information content tailored to their needs.

 This qualitative exploratory case study involved 71 participants, including 25 children aged 6 - 14 years, 25 parents of children aged 0 - 14 years, and 23 staff members (radiology technicians and doctors) from the Radiology Department at Children's Medical Center Hospital in Tehran, Iran. Semi-structured and in-depth interviews were conducted to collect data, which were then analyzed using qualitative content analysis and selective-axial coding.

 The developed model comprised two main dimensions: Health information content and health information format. The dimension of health information content included process information, emotional information, and self-regulating information. The dimension of health information format encompassed various formats such as informational brochures, books, educational animations, applications, and oral explanations.

 Creating health information content that aligns with children's interests and preferences can enhance their cooperation and participation in radiology examinations.

 The complexity of studying secondary burn wound healing in children arises from the varying ability of skin tissue regeneration across different ages. Despite advancements, there are still gaps in our understanding.

 This study aimed to explore factors influencing wound healing in children with second-degree burns to guide clinical treatment and nursing practices.

 We conducted a retrospective analysis of children with second-degree burns treated in our burn surgery department from January 2020 to December 2022. Based on the events per variable (EPV) rule, 220 children were included. They were categorized based on the quality of wound healing 14 days post-admission (good or poor), evaluated by the healing rate and scar formation. Children's clinical data were extracted from medical records for analysis. Binary logistic regression identified factors associated with poor healing outcomes in second-degree burns.

 Among 220 patients with secondary burns, 166 (75.46%) experienced good wound healing, while 54 (24.54%) had poor outcomes. The Hosmer-Lemeshow test indicated a good model fit (χ2 = 9.739, P = 0.28). Significant variables included burn area (odds ratio [OR] = 1.217, 95% confidence interval [CI] = 1.109 - 1.335, P < 0.05), number of drug changes (OR = 1.902, 95%CI = 1.392 - 2.599, P < 0.05), white blood cell count (OR = 1.076, 95%CI = 1.008 - 1.150, P < 0.05), neutrophil count (OR = 1.080, 95%CI = 1.018 - 1.146, P < 0.05), and neutrophil ratio (OR = 1.040, 95%CI = 1.002 - 1.081, P < 0.05).

 Effective treatment and nursing of children with second-degree burns should prioritize managing large burn areas and high levels of inflammatory markers. Additionally, minimizing drug changes during the nursing process can enhance wound healing in children.

 Neonatal benign pneumoperitoneum (NBPP) is an uncommon condition often characterized by abdominal distension. It necessitates differential diagnosis to distinguish it from pneumoperitoneum caused by perforation and peritonitis, which may lead to an exploratory laparotomy with negative outcomes. In this document, we summarize the cases of NBPP treated at our hospital over the past decade and review relevant literature to offer insights into the diagnosis and treatment of this disease.

 We report on three cases of NBPP, all of which presented with abdominal distension. Two of the cases were managed conservatively, while one underwent exploratory laparotomy. No evidence of perforation or other significant findings was observed during the surgery. All three patients survived.

 In cases of suspected neonatal pneumoperitoneum, it is essential to consider NBPP as a differential diagnosis and closely monitor disease progression to prevent misdiagnosis. NBPP can often be managed conservatively, although it is crucial to vigilantly observe any changes in vital signs throughout the treatment. Further research is needed to elucidate the etiology and pathogenesis of this disease.