Iranian Journal of Pediatrics
Volume:29 Issue: 6, Dec 2019

Adolescents frequently skip breakfast for a variety of reasons. We investigated associations between lifestyle, emotional state, and breakfast consumption in adolescents.

Data from 62276 adolescents were derived from the 13th Korean Youth Risk Behavior Web-based Survey (KYRBS), conducting from June 1, 2017 to June 30. The adolescents were drawn by stratified multistage clustered samples from 400 middle schools and 400 high schools. Breakfast skipper was defined as those who ate breakfast less than 2 days per week.

Among 62276 participants, 19658 (31.5%) were breakfast skippers. Compared to those who were steady eaters, those who skipped breakfast were younger and shorter, had a poorer academic performance, poorer parent education status, and lower family economic status. Compared to steady eaters, those who skipped breakfast regularly also tended to be more overweight and obese, participate in exercise less frequently, and report increased stress, depressive mood, suicidal ideation, and suicide attempts. Skipping breakfast was also associated with increased levels of smoking and alcohol consumption compared to steady eaters.

Skipping breakfast is associated with an adverse effect on adolescent health and well-being, especially in regard to suicide attempts. Public and parental education on the benefits of eating breakfast in adolescents is recommended.

The purpose of this study was to investigate CYP21A2 mutations in Iranian congenital adrenal hyperplasia (CAH) patients.

In 25 patients, the first PCR was done to distinguish the gene from the pseudogene (identification of chimeras). Then, second PCR was performed in the patients who had not chimeras, followed by complete exons and introns of CYP21A2 sequencing to distinguish the mutations.

Complex alleles comprising three compound heterozygote mutations were identified; p.I173N/exon 6 cluster (15.7%), p.I173N/exon 6 cluster/p.V282L (47.3%) and IVS2-13A>C, G/exon 6 cluster/p.V282L (5.2%). In order to confirm the accuracy of mutations, the parents of the patients were also analyzed. In each family, one of the parents had a heterozygote variant (p.I173N/p.V282L) and the other had exon 6 cluster heterozygote variant without any symptoms of the disease. Two different mutations in the heterozygous state, exon 6 cluster (10.5%) and exon 6 cluster/p.V282L (5.2%) and p.G110Efs the 8 nucleotide deletion in exon 3 (5.2%), I173N in the heterozygote state (10.5%). A high frequency of variants was found in CYP21A2, including: rs6477 (56%), rs6468 (8%), rs6474 (12%), rs6472 (16%), rs6473 (16%), rs6446 (16%), rs61338903 (32%) and rs193922546, rs530758070, rs11970671, rs61732108, rs778403992, rs1058152 and rs562025438 (each 4%).

The present study showed that the compound heterozygosity and complex alleles are the most frequent cause of congenital adrenal hyperplasia in Iranian population. Patients’ clinical manifestations were correlated with mutated alleles and the residual activity of 21-hydroxylase enzyme. Based on diversity of mutations in CAH patients of this study, whole CYP21A2 gene sequencing would be preferential approach in analyzing CAH patients in our population.

Perinatal asphyxia is the third-leading (23%) cause of neonatal death worldwide. Even in cases where it is not fatal, it can lead to hypoxic injury to the brain, heart, lungs, liver, gut and kidneys. Perinatal asphyxia is especially likely to cause neurodevelopmental deficits.

In the present study, we aimed to evaluate miR-210 expression in the peripheral blood of asphyxiated neonates and to explore the connection between miR-210 expression and neurological diseases in perinatal asphyxia.

Peripheral blood samples were obtained, and clinical characteristics (sex; mode of delivery; 5 and 10 minutes Apgar scores and neonatal behaviour neurological assessment (NBNA), white blood cell (WBC), procalcitonin (PCT) and blood gas analysis scores) were recorded for 42 asphyxiated neonates and 41 healthy controls. The miR-210 expression in the peripheral blood was determined using quantitative real-time PCR (qPCR). Statistical analysis was used for predicting the relationship between miR-210 expression and other indicators associated with the diagnosis of asphyxia. Bioinformatics analysis was performed for exploring the biological function of miR-210.

The miR-210 expression was noted to be 1.8-fold higher in the peripheral blood of asphyxiated neonates than in healthy controls (P < 0.01). The area under curve (AUC) of miR-210 expression in the receiver operating characteristic (ROC) curve was > 0.7 (AUC = 0.746, P = 0.0002). For examining the association between miR-210 and autism or epilepsy, 670 putative miR-210 targets involved in neurological processes were explored; of these targets, 102 and 26 targets were significantly associated with autism and epilepsy, respectively. These results suggest the involvement of miR-210 in neurological and cardiovascular injury associated with asphyxia, but is primarily related to neurological processes.

The expression of miR-210 could be used as an indicator to diagnose neonates with asphyxia, which may help in identifying some neurological and cardiac diseases that cannot be diagnosed during traditional neonatal health screening. In addition, it could provide early prevention and treatment for asphyxiated neonates.

Continuous distending pressure (CDP) is considered as standard care in neonates with decreased pulmonary compliance. Concerns regarding the implementation of non-invasive CDP in a respiratory cycle in order to establish an optimal level of functional residual capacity (FRC) abound in the related literature. Examples include how to manage gas leakage in the interface, no imposed increased work of breath (WOB) on patients and prevention of applying trans-pulmonary pressure levels leading to metabolic acidosis. Following the development of autoflow hardware, pressure control (PC) respiratory pattern was defined in the field of mechanical ventilation (MV) in order to compensate for gas leakage in interface or compensate for pressure drop and increased CDP pressure level in respiratory phases of inspiration and expiration.

The study aimed at decreasing WOB in neonates with RDS using pressure control-nCPAP.

This study was a retrospective clinical trial performed on 70 neonates weighing about 1000 grams with RDS. Participants were randomly assigned into two respiratory support groups based on the use of pressure limited nCPAP (PL-nCPAP) and pressure control nCPAP (PC-nCPAP). Each group consisted of 35 infants compared in terms of their demographic characteristics, duration of non-invasive respiratory support, rapid shallow breathing (RSB) index, ventilator’s WOB, need for MV, need for surfactant administration, chronic lung diseases, pneumothorax, intra-ventricular hemorrhage (IVH) and death.

No significant difference was observed between the mean time of non-invasive respiratory support and the need for MV, between the incidence of pneumothorax and IVH and also between the mortality rate and degree of involvement in chronic lung diseases in the two groups. The mean respiratory ventilation rate of ventilator’s WOB in PC-nCPAP group was significantly higher than that of PL-nCPAP group. The mean RSB index was also significantly higher in PL-nCPAP group than in PC-nCPAP group. Finally, the mean of surfactant administration in PL-nCPAP group was significantly higher than that in PC-nCPAP group.

In this study, ventilator’s WOB in PC-nCPAP group, which was significantly higher than that of PL-nCPAP group, can be explained by significantly higher RSB index in PL-nCPAP group and significantly lower mean surfactant prescription in PC-nCPAP group.

Henoch-Schönlein purpura (HSP) is the most widespread systemic small-vessel vasculitis of childhood. Limited information exists about the epidemiology, allergen and laboratory bio-markers reflecting HSP disease phases in Northwestern China.

To comprehensively evaluate the epidemiology, allergen and laboratory bio-markers reflecting HSP disease phases for the first time in this region.

We retrospectively evaluated 135 HSP patients and 86 controls aged ≤ 14 years admitted to the Children's Hospital of Gansu Province between January 2016 and December 2017. Epidemiological profiles, clinical characteristics and laboratory biomarkers of both inflammation and activated coagulation were analyzed for each HSP patients and controls. The monocyte-to-lymphocyte ratio (MLR), neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) were calculated based upon the results of routine blood tests performed during hospital stay of the patients.

In total, 77 patients had arthritis, 46 had gastrointestinal involvement and 15 had renal involvement. The most common predisposing factors were upper and lower respiratory tract infections, allergies and seasonal variation. Frequency of renal involvement was significantly higher among patients older than 7 years but lower with a positive rate of allergens. The average levels of C-reactive protein, white blood cells (WBC), neutrophils, platelets, D-dimer, fibrin degradation product (FDP), NLR and PLR among patients were significantly increased compared with the control group. Sensitivity and specificity were highest for neutrophil counts, while the area under the curve (AUC) for platelet count was highest. Patients with gastrointestinal involvement had significantly higher WBC, neutrophil count, D-dimer and FDP levels than those without. Sensitivity, specificity and AUC were highest for neutrophil counts. Increased D-dimer levels were significantly associated with gastrointestinal involvement and renal involvement.

The first report of epidemiologic characteristics of HSP in children in this area enriches the HSP epidemiological data of China. Exposure to allergens should be reduced in patients aged approximately 7 years and renal involvement should be carefully monitored in patients aged > 7 years. WBC count, neutrophil, D-dimer and FDP levels are better than conventional infection markers. Particularly, D-dimer is an independent predictor on HSP patients with gastrointestinal involvement and renal involvement.

Oral azithromycin is recommended as anti-inflammatory therapy for patients with cystic fibrosis (CF) 6 years of age and older to improve lung function and reduce exacerbations.

We evaluated the short-term efficacy and safety of nebulized azithromycin as anti-inflammatory therapy in children with CF chronically infected with Pseudomonas aeruginosa.

In a randomized prospective study, children aged 8 - 18 years with clinically stable CF and FEV1 25% - 75% predicted with no recent use of oral, intravenous or inhaled antipseudomonal antibiotics and azithromycin were randomized to receive either nebulized azithromycin (70 mg daily) or oral azithromycin 3 times per week for 28 days. Primary endpoint was changes in pulmonary function (FEV1). Secondary outcomes included changes in Pseudomonas aeruginosa (PA) colonization characteristics (count, phenotype), quality of life and weight.

A total of 280 patients were screened, of whom 60 were found eligible. Forty five patients (25 in the nebulized group) and 20 in the oral group) completed the study. After 28 days of treatment, nebulized azithromycin was significantly associated with improvements in FEV1 % predicted, quality of life measure and weight. Also PA count was significantly decreased. Importantly, improvements of FEV1 % predicted, quality of life, weight and the decline in PA count were statistically significantly greater with nebulized azithromycin compared with oral azithromycin. No significant difference was observed in PA phenotype in either treatment arms.

Nebulized azithromycin is associated with a significant improvement in lung function, PA count, quality of life and weight in clinically stable CF children with chronic PA infection. The improvements observed were greater compared with oral azithromycin. Nebulized azithromycin could be suggested as a new therapeutic strategy for this life-limiting disease. Further clinical trials with novel nebulizer formulation of azithromycin and large number of participants are needed to further assess the efficacy, safety and sustained effect of this new therapeutic approach in children with CF.

The purpose of treatment of children with autism is to help them to acquire functional skills in routine life and to control behaviors that are disruptive.

In this study, the safety and efficiency of cerebrolysin was determined by childhood autism rating scale (CARS) on behavioral, verbal and nonverbal developments of children with autism referred to children’s medical hospital clinic of neurology.

In a quasi-experimental study, 36 children with autism were enrolled and the effect of cerebrolysin on their behavioral, nonverbal and verbal development was determined by CARS questionnaire fulfilled before and one month after complete intervention.

All evaluated items except level and consistency of intellectual response had favorable reduction in scores of CARS questionnaire (P = 0.001). The total score decreased from 40.6 to 36.1 showing 11.1% improvement. Despite the efficiency of cerebrolysin observed in this study, its partial use may be limited by the large number of intramuscular injections, i.e. nine per months. Sustained release formulation may alleviate this limitation, if this therapy proves to be beneficial in future studies.

According to the obtained results, the safety and feasibility of cerebrolysin administration could be considered and be effective on behavioral, nonverbal and verbal development in children with autism.

Ovarian torsion as a surgical emergency needs an urgent operation. According to the researches, ovarian saving in ovarian torsion in the adult population has considerable success. But this study has not yet been performed in the pediatric age group in Iran.

This is a prospective study extending from 2017/1/20 to 2018/9/22. In this period 18 patients (4 - 13 years old) were diagnosed by ultrasonography and abdominal CT scan. In all of the patients, tumor markers were checked preoperatively and detorsion and fixation with ovarian cyst biopsy was done. One of the patients in spite of normal tumor marker had a malignant pathology (dysgerminoma) that was removed from the study. The patients were followed 3 months after operation by ultrasonography.

Ultrasonography was useful in the diagnosis of ovarian torsion in 82/4% of cases. Ovarian torsion was more prevalent in the right side and there was no relation between the cyst size, presentation symptom, the number of twistings, reversibility of the discoloration of the ovary and the intraoperative findings. Ultrasonography showed that the volume of the affected ovary reached the noninvolved ovary in 3 months.

According to this study detorting and preserving the torsioned ovaries is effective, even in necrotic cases.

Mechanical ventilation impairs oxygenation and increases intrapulmonary shunt. Positive end-expiratory pressure (PEEP) slows derecruitment, improves lung function but can compromise hemodynamics.

To asses slow PEEP titration effect on intrapulmonary shunt, oxygenation and hemodynamics in preschool children on mechanical ventilation under general anesthesia.

This was a single tertiary care center an open-label, randomized parallel group controlled clinical trial. Study included 70 children, 3 - 7 years, ASA I and II, under general anesthesia for non-cardiothoracic surgery. Children were randomly allocated either to receive PEEP titration 5 - 11 cmH2O 20 minutes before the end of anesthesia (intervention group) or to be ventilated until the end of anesthesia with constant positive end-expiratory pressure of 3 cmH2O (control group). Main outcome measures were changes in oxygenation index (PaO2/FiO2) and alveolar-arterial gradient (P(A-a)O2) between and within groups and changes in systolic blood pressure (SBP), mean arterial pressure (MAP) and heart rate (HR) in interventional group during PEEP trial.

Seventy children were recruited and analyzed. P(A-a)O2 and PaO2/FiO2 improved in interventional group comparing to control as consequence of PEEP titration (ΔPaO2/FiO2 -30.3 vs. 0.52; P < 0.001; ΔP(A-a)O2 6.7 vs. -1.0; P < 0.001) and within interventional group before and after PEEP titration (PaO2/FiO2 522.0 vs. 552.3; P < 0.01; P(A-a)O2 20.1 vs. 13.3; P < 0.001). Hypotension and bradycardia were not documented.

Slow PEEP titration up to 11 cmH2O improves oxygenation, reduces intrapulmonary shunt without causing hemodynamic instability in preschool children during general anesthesia.

The neonatal mortality rate has continually decreased over time; however, some surviving infants may die after the neonatal period due to complications.

Objective of this study was to provide evidence to support more medical care for infants during the post-neonatal period (> 28 days to < 100 days after birth).

Multi-center retrospective survey. Fourteen hospitals in china between January 1, 2004 and December 31, 2013. A total of155463 infants aged 0 - 1 year were enrolled in the survey. Among them, 959 died. Data from hospitalized infants younger than 1 year of age were collected. Mortality and its etiology during the neonatal, post-newborn, and modified infant (100 days to 1 year) period were evaluated.

The total infant mortality was 6.16%. Significant differences were found in the mortality rate in the three periods (10.1% vs 6.9% vs 2.6%, P = 0.000). The three main causes of death were pneumonia, congenital heart disease (CHD), and premature-associated disease (PAD) during the post-newborn period. Moreover, four major diseases simultaneously occurring during the three periods (PAD, pneumonia, sudden infant death syndrome, and CHD) showed an inverse “U” shape change from the neonatal period to the modified infant period, with the highest mortality rate occurring during the post-newborn period (P < 0.001).

Differences in mortality and the associated etiology during early life indicate that more medical attention should be paid to the post-newborn period. Further study is needed to better understand its clinical significance.

Glypican-4 is an adipose tissue-originated cytokine which enhances insulin signaling through direct interaction with the insulin receptors.

The aim of this study was to analyze the relationship between obesity and serum glipican-4 levels in adolescents.

Our study was carried out on 80 volunteer adolescents, 49 were obese patients and 31 were healthy normal weight control cases. The adolescents with a body mass index (BMI) of 95% percentile and over were defined as obese in terms of age and sex. The Enzyme-Linked Immuno Sorbent Assay kit was utilized for the assessment of Glypican-4 in serum. Laboratory assays (glypican-4, glucose, urea, creatinine, AST, ALT, total cholesterol, triglyceride, HbA1c, insulin, HOMA-IR), age, sex and BMI were compared amidst the groups. Correlations between glypican-4 levels and laboratory factors were analyzed in the obese adolescent group.

The average age of the research participants was 13.2 ± 1.8 years. The mean BMI was 27.1 ± 5.1 kg/m2. Of the 49 obese adolescents, 41 were insulin resistant, and 8 did not have insulin resistance. The levels of glypican-4, BMI, AST, ALT, HbA1c, triglyceride, HOMA-IR and insulin were notably higher in the obese group than the control group (P < 0.05). In obese group, no statistically remarkable relationship was found between glypican-4 levels and other parameters (P > 0.05).

We found high serum glypican-4 levels in obese adolescents. We suggest that glypican-4 levels may be increased in order to reduce insulin resistance in obese adolescents.