Journal of Pediatrics Review
Volume:5 Issue: 2, Apr 2017

Context: Symptoms of methadone poisoning, as one of the most dangerous types of poisoning, are very serious in children.
The aim of this study was to describe causes and clinical symptoms of methadone poisoning in children admitted to hospitals in Iran.
Data Sources: Relevant studies published in national and international journals before January 29, 2016 were identified by studying the available databases, including PubMed, Web of Sciences, Google Scholar, Scopus, SID, Iranmedex, MagIran, and Irandoc.
Study Selection: After excluding duplicate, irrelevant, and low-quality articles, relevant papers were entered into the meta-analysis. The prevalence, mean, and standard deviation of methadone poisoning symptoms in children were statistically analyzed, using Stata version 11, and causes of methadone poisoning were presented in tables.
Data Extraction: Studies with unknown sample sizes, abstracts without access to full text, articles with quality assessment scores below 15.5, and studies carried out on non-Iranian populations were excluded from the meta-analysis.
During the initial advanced search, 1594 articles were identified. After quality assessment, 12 papers were found eligible for the final systematic review and meta-analysis, based on the inclusion and exclusion criteria. The reported symptoms included drowsiness, vomiting, apnea, cyanosis, seizure, ataxia, and delirium. In the meta-analysis, prevalence of symptoms in referred patients was estimated at 44% (0.95% confidence interval, 0.288 to 0.609). The causes of poisoning in children included accidental feeding by parents, storage of drugs in inappropriate containers, parental addiction, and low educational level of parents.
It is important to keep methadone in a suitable container away from children. Also, it is essential to focus on educating parents on health issues of their children.

Context: Resent reviews have shown that about 18% of all child cancers are leukemia. Track of the survival rate can help researchers improve quality of life of patients through improving screening or discovery of better treatments.
This review aimed at estimating the 5-year survival rates and associated factors of childhood leukemia in Iran.
Data Sources: We carried out a systematic review through search of relevant studies published in English (PubMed, Scopus, Google scholar, and ISI) and Persian databases (Magiran, Medlib, SID, and Iran Medex).
Study Selection: The study included all epidemiologic studies that estimated survival rate in children with leukemia in Iran during years 2002 to 2015, and a standardized manner was used for extraction of information.
Data Extraction: The entire text or summary of all searched articles was extracted and then, related articles were selected, and irrelevant ones were excluded. Fixed and random effects models were calculated by the STATA using standard meta-analysis methods. Heterogeneity was assessed by I² statistics.
The overall 5-year survival rate in patients with childhood leukemia in Iran was 0.65 (95% CI, 0.62 to 0.67, 10 studies), in the acute lymphoblastic leukemia (ALL) subtype was 71.0% (95% CI: 68.0 to 74.0), and in the acute myeloid leukemia (AML) subtype was 46.0%. Results of the meta analysis showed significant poor survival with relapse (heart rate (HR) 1.59, 95% confidence interval (CI) 1.27 to 1.98) and white blood count (WBC) counts ≥ 50,000 (HR 2.92, 95% CI 1.23 to 4.60).
The results showed that 5-year survival rates in patients with AML were lower than patients with ALL. The results of this meta analysis strongly support the need for future research, action, and guidance for clinicians to improve health-related quality of life and outcomes for children with leukemia.

Context: Survival after allogeneic hematopoietic stem-cell transplantation (HSCT) for children with hematologic malignancies including acute lymphoblastic leukemia (ALL) continues to improve in part due to advancement in HLA typing and enhanced supportive care. Despite improved outcomes with HSCT, the decision to offer it in first remission (CR1) in children with ALL remains a topic of debate and uncertainty. This review aims to discuss the role of HSCT in CR1 for children with high-risk subsets of ALL in the current era.
Evidence Acquisition: A thorough review of the literature was performed using electronic databases: PubMed, Google Scholar, and bibliographies. Studies focusing on high-risk subsets of ALL (Primary Induction Failure, Severe Hypodiploidy, Philadelphia-chromosome positive ALL, T-Cell ALL, Infant ALL, ALL with persistent minimal residual disease (MRD), and Philadelphia-like ALL) were included. Publications in non- English language were excluded.
Based on our review of the current literature, HSCT should be considered in first remission for patients with primary induction failure, severe hypodiploidy, T-cell ALL with poor response, high-risk infant ALL, and persistently positive MRD. In contrast, HSCT in CR1 may not be warranted for patients with early T-cell progenitor ALL or Philadelphia-chromosome positive ALL. Further data are needed to make specific recommendations regarding Philadelphia-like ALL.
As our understanding of high-risk leukemia biology continues to develop, the role of HSCT in ALL CR1 will need to be revisited.

Context: In the past 20 to 30 years, the area of pediatric interventional cardiology has had noteworthy development. Technological revolutions have significantly progressed management of cardiovascular disease in both children and adults with congenital heart disease (CHD). This article reviews the current indications, techniques and complications of interventional therapy for CHD.
Evidence Acquisition: Training and publications in this field are rare. Overall, 64 article from January 1953 to February 2014 were studied. A total of 26 articles were involved in pediatric evaluation.
There have been several catheter-based interventions for congenital heart disease. Percutaneous intervention in pediatric cardiac disease has been established in the past 2 to 3 decades. There are currently devices accepted for percutaneous closure of ASDs, patent ductus arteriosus (PDAs), and muscular ventricular septal defects (VSDs). The period of percutaneous valve implantation is just beginning, and the next few years may bring about advances in miniaturized valve distribution methods to allow insertion in smaller children.
Completely prepared catheterization laboratory, surgical holdup, and extracorporeal membrane oxygenation support capabilities must be accessible at any center to achieve interventional cardiac catheterization. Additional understanding of normal history of interventions more than 2 decade post process, novel strategies and methods will certainly lead to an increase in the methods for managing of congenital heart disease.

Context: Substance abuse has remained a worldwide issue for many years and in recent decades there has been a major growth in the number of individuals consuming opioids. Several studies have discovered that young kids who have been exposed to opioids develop greater damages in overall intellectual capabilities and neurobehavioral functions than non-exposed children.
Evidence Acquisition: The purpose of this study was to evaluate the surviving texts on the incidence of challenging behavior among kids due to prenatal medication contact. Overall, out of 84 identified manuscripts, 18 were established to consider intellectual, psychomotor, and behavior consequences in opioid-exposed infants, precollege and college children when matched with healthy no-opioid-exposed controls.
The results indicate that children exposed to opioid in utero may be cognitively affected over time, even once located in stable families on an actual early age. Somewhat, susceptibilities seem to rise by age for girls, and the unprotected boys persist behind non exposed boys entirely through infancy and into college age. Therefore, there looks to be a constant deleterious consequence of factors associated with prenatal medication contact over time.
The results indicate children exposed to opioid in utero may be cognitively affected over time, even once located in stable families on an actual early age. The natural susceptibilities of prenatally drug-exposed children can affect initial intellectual skills which yet again are extremely associated with advanced mental capabilities. It is feasible that pre- and postnatal genetic susceptibilities and ecological issues cooperate in a transactional method through the child’s lifespan.

Context: Zika virus (ZIKV) is an arbovirus of the family Flaviviridae. This virus, which is transmitted by mosquitoes, usually affects children and causes self-limited diseases, associated with fever, maculopapular rash, conjunctivitis, arthralgia, and myalgia. There is a significant relationship between ZIKV infection and central nervous system disorders in infants. In this study, we aimed to review neurologic manifestations of ZIKV infection in infants.
Evidence Acquisition: We searched the following Mesh terms in scientific databases: “Zika virus”, “infants”, “children”, “neurologic manifestations”, and “congenital infection”. Electronic databases including Google Scholar, Science Direct, PubMed, Web of Science, Scientific Information Database, and Scopus were searched from 2000 to 2016.
The literature review showed a probable relationship between ZIKV infection and prevalence of microcephaly in newborns. Besides microcephaly, other central nervous system abnormalities included abnormal gyral arrangement, decreased brain parenchymal volume, cortical atrophy and malformation, cerebellar hypoplasia, and delayed myelination of the brain stem.
Vertical transmission of ZIKV in pregnant women is associated with intrauterine infection and brain malformations in the developing fetus, including microcephaly, calcification, cortical displacement, ventriculomegaly, and white-matter abnormalities.

Context: Many diseases caused by viral agents are associated with fever and cutaneous manifestations. Viral exanthema is a widespread nonspecific skin rash, commonly characterized by generalized eruption of erythematous macules and papular lesions. Although these rashes are mostly benign and self-limited, some may be serious and life-threatening. Differentiation between severe and benign types is clinically important and life-saving.
Evidence Acquisition: In this narrative review, electronic databases, including Google Scholar, Science Direct, PubMed (including Medline), Web of Science, Scientific Information Database, and Scopus, were searched. We conducted a narrative review of papers published on pediatric viral exanthema during 2000 - 2016. The used keywords included “viral exanthema”, “fever”, and “skin rash”. Articles on skin rash, caused by drug reactions or nonviral exanthema, were excluded.
Different viral agents can cause different types of skin reactions. Cutaneous manifestations and skin rashes can be categorized, based on the form of the rash (macular, papular, vesicular, blistery, petechial, and purpuric) or the general term, which denotes illnesses such as measles-like morbilliform rash, rubella or rubelliform rash, and scarlatiniform rash, a scarlet-fever like infection.
Based on the findings, a systematic approach relying on accurate history-taking and analysis of epidemiological cues and rash characteristics is of great significance.

Context: Oral health status plays an essential role in human health. Recently, enhancement in oral health caries has been noted in both developed and developing countries. Dental caries is still very common among children. Screening and preventive interventions is necessary. The aim of this study was to review the diagnostic and preventive approaches for dental caries in children.
Evidence Acquisition: Searching PubMed, Medline, the Cochrane Library (for 5 recent years from 2011 - 2016), and reference lists for keywords and phrases such as “dental caries in children” and prevention and diagnosis, we included trials and controlled observational studies regarding the diagnosis and preventive techniques for dental caries in children.
We found no study demonstrating the effects of screening by primary care providers on clinical outcomes. In a cohort study, pediatrician examination associated with a sensitivity of 0.76 was reported to identify dental caries in children. The results of the new randomized trials that were confirmed by previous studies showed that the efficacy of fluoride varnish is more than no varnish in reduction of dental caries from 18% to 59%. Some of the trials regarding xylitol had no results regarding the effects on dental caries. New observational studies have shown an association between early childhood fluoride use and enamel fluorosis. There is no evidence on the accuracy of prediction instruments in primary care settings.
We found no direct evidence that reveals that screening by primary care clinicians can decrease early childhood caries. Previous evidences reviewed by the United State Preventive Services Task Force demonstrated that oral fluoride supplementation is effective in decreasing caries incidences, and recent evidences supported the effectiveness of fluoride varnish in higher-risk children.

Candida is one of the common causes of infections in late sepsis of very low birth weight neonates. The outcome ranges from a mild focal disease to a fatal septicemia and multi-organ dysfunction.
Acute renal failure was found in a seven-week-old preterm infant due to bilateral renal fungal balls and hypoplastic renal pelvises. He had previously been treated with courses of broad-spectrum antibiotics for respiratory distress and sepsis during the first weeks of life. The infant did not respond to standard antifungal therapy and needed surgical removal of fungal balls from his kidneys, open nephrostomy tube placement and pyeloplasty.
Obstructive uropathy by fungal balls is rare and acute renal failure as a result of bilateral obstructive uropathy due to fungal balls requires early detection and prompt treatment to salvage the kidney function.