Iranian Journal of Pediatrics
Volume:30 Issue: 2, Apr 2020

The coronavirus disease 2019 (COVID-19) outbreak initiated in Wuhan, China and has spread rapidly all around the world and labeled as a pandemic with almost 168,000 infected cases and 6,500 deaths globally up to March 16, 2020. It is believed that children are less likely than adults to be infected with COVID-19. In this review, we discuss different aspects of COVID-19 infection in pediatrics. COVID-19 in pediatrics occurs in the early stages of its outbreak at a high rate with a family cluster pattern mainly. Children infected with COVID-19 are mostly asymptomatic carriers and the main potential causes of the spread and transmission of the disease in communities. Asymptomatic children with no underlying disease or red flags should follow home isolation protocols. Children with red flags, comorbidities and risk factors or those with severe pneumonia must be admitted to the hospitals. Children’s hospitals should be equipped with the acute respiratory diseases ward, quarantine rooms, and intensive care unit to protect other patients and health care staff during the COVID-19 outbreak.

Korean children are often treated in Intensive Care Units (ICUs) rather than in Pediatric Intensive Care Units (PICUs). However, pediatric critical care (PCC) in ICUs, other than in PICUs, may have effects on patient’s outcome.

To compare the PCC outcomes of pediatric patients in the PICU with the outcomes of pediatric patients in other ICUs.

This is a retrospective study of pediatric patients treated in ICUs. The participants of this study were children aged < 18 years who were admitted to the ICUs from the Pediatric Department of Seoul St. Mary’s Hospital from April 2009 to June 2017. Patients with hemato-oncologic diseases or those needing postoperative care were excluded.

Among the 429 ICU cases, 306 were PICU and 123 were ICU patients. The age (18 months vs. 26 months; P = 0.104) and male sex ratio (57% vs. 54%; P = 0.587) were not significantly different between PICU and other ICU patients. PICU patients (73%) were commonly admitted from another hospital compared with ICU patients (63%, P = 0.043). The pediatric index of mortality -3 score was not significantly different between the PICU and ICU patients (-4.3 vs -4.1; P = 0.128); the ICU and hospital length of stay were 5 days vs 5 days (P = 0.357) and 11 days vs 11 days (P = 0.317); and the mortality rate was 4% vs 11% (P = 0.008), respectively. Respiratory and neurologic complications were 5% vs 11% (P = 0.021) and 4% vs 2% (P = 0.282), respectively. The risk of mortality was higher for ICUs patients (odds ratio = 2.56; 95% CI = 1.11 - 5.87), adjusted for source of ICU admission, and type of ICU.

Pediatric patients treated in a PICU had a lower mortality compared to those treated in other ICUs.

Biliary atresia is a rare distractive cholangiopathy in childhood and the most common cause of liver transplantation in pediatrics. Present study is the first report of biliary atresia and its incidence and outcome from northwest of Iran.

In this retrospective cohort study, all patients with biliary atresia admitted to the Tabriz Children’s Hospital from March 2006 to March 2016were included. Demographical, clinical and preclinical data of all patients are extracted from the hospital records. Information about the outcome after Kasai portoenterostomy was gathered by reviewing the progress notes or by phone call from the parents. The Mann-Whitney U and chi-square or Fisher’s exact tests were used for comparison of continuous and categorical variables respectively. Survival curves and tables, Kaplan-Meier method and Cox regression were used for survival analysis.

The incidence rate of biliary atresia was 1/13280 live births. Isolated form of biliary atresia was seen in 85.1% of cases. Splenic malformation was not observed in our patients. The rate of successful Kasai Portoenterostomy was 42.9%. Survival analysis showed that 1, 2, 3, 5, and 10-year native liver survival rate was 73%, 56%, 54%, 40% and 31%, respectively. Median overall survival rate was 36 months [95%CI: 2.89 - 69.1]. Successful Kasai Portoenterostomy and clearance of jaundice was the only factor that affected survival rate.

The incidence rate of biliary atresia in Northwest of Iran was lower than that in other Asian countries. Like other Asian countries, spleen anomaly was rare in our patients. The success of Kasai Portoenterostomy and survival rates of our cases were lower than that in other Asian countries.

Inflammatory bowel diseases (IBD) can adversely affect children in many different ways. Health-related quality of life (HRQOL) involves all aspects of life quality, along with physical or mental perceptions of health, which could exert an overall effect on an individual’s health. The IMPACT-III questionnaire is a well-established and validated tool for evaluation of the HRQOL in children with IBD.

The objective of this work was to translate this tool into Persian so it could be utilized in Iran.

In collaboration with the developer of IMPACT-III, a standardized translation and validation process was undertaken. Assessment steps included (1) translation of IMPACT-III into Persian; (2) assessment of the clarity and wording of the tool; and (3) ascertain the reliability and validity of the adapted instrument using a test-retest assessment. Patient scores were evaluated within four domains (social performance, body image, emotional and physical dimensions) and analysis undertaken with SPSS (version 16). The study was completed in Mashhad and Tehran University of Medical Sciences, Iran, between June 2014 and Jan 2015.

IMPACT-III total score in patients with inactive disease was significantly higher than patients with active disease (P < 0.001) consistent with better quality of life. The IMPACT-III total score did not differ according to gender or socio-economic status (P > 0.05). Children with ulcerative colitis had higher IMPACT-III scores than the children with Crohn disease (P = 0.001).

This study indicates convincing validity and reliability for the four-factor IMPACT-III scores regarding HRQOL in children with IBD. The Farsi version of this tool can now be utilized for clinical and research applications.

Millions of children and families suffer from child abuse worldwide.

This study aimed to investigate the related variables for different types of child abuse and their perpetrators.

This was a cross-sectional study that was conducted on high school students in Hamadan, Iran in 2016. Samples were selected by multiple cluster sampling method in which 571 students were enrolled in the study. A standard, valid and reliable self-reported questionnaire was used for recording child abuse and another part for demographic variables and perpetrators of child abuse (including: parents or other relatives, teachers, friends or classmates, strangers). After data collection, SPSS V. 21 software was used for data analysis. All P values less than 0.05 were considered as significant.

The most common types of neglect were students' discomfort and lack of welfare at home (51.0%), attention ignorance to students' demands (46.6%), and parent’s excessive expectations (39.2%). In physical abuse domain, corporal punishment conducing abrasion and burns scare (51.8%) was in top of the list and the most common forms of psychological abuse were parent’s strict behaviors (25.7%), insulting and disrespecting the students (25.4%) and humiliation of them (24.9%). Psychological and physical abuse in girls and private schools were significantly higher than others (P < 0.001). There was significant relationship between psychological abuse and smoking or substance experience in adolescents (P < 0.001). Addicted and low educated parents were reported as perpetrators for all kinds of abuse.

Understanding related variables and perpetrators of child abuse could raise the society perspectives about the importance of the subject and help decision makers for intervention programming aimed at reducing child abuse.

 Obesity is an independent risk factor for the development of atherosclerosis and arterial malformations.

 The purpose of this study was to investigate the effect of 12-week high-intensity interval training (HIIT) vs. continuous Aerobic training on pre-atherosclerotic and anti-atherosclerotic biomarkers levels in obese and overweight children.

 This study was approved by the Research Ethics Committee of Kermanshah University of Medical Sciences. Forty-five obese and overweight children (age: 11.06 ± 0.98 years, BMI: 25.12 ± 1.28 kg/m2) were randomly assigned to a HIIT group (n = 15, 3 sessions per week, 100% - 110% MAS intensity), aerobic group (n = 15, 3 sessions per week, 40% - 70% HRR intensity) and control group (no exercise, n = 15), which participated in the study for 12 weeks. Physical, physiological and blood variables measured at the beginning and end of the 12-week study. Descriptive statistics used to describe the variables and inferential statistics were used to data analysis

 The results showed a significant increase in serum levels of salusin-α and NO in both training groups, but the contribution of HIIT was more significant in the intergroup review. Also, the levels of salusin-β, body weight, BMI, %BF, WHR and TG/HDL ratio were significantly decreased in both training groups, which were more significant in the HIIT group.

 According to our findings, the use of HIIT seems to be considered as an important factor in preventing chronic diseases of passive lifestyle for obese and overweight children. Therefore, to improve cardiometabolic health in obese and overweight children, we recommend regular physical activity with greater emphasis on HIIT.

 We evaluated the brain computed tomography (CT) scan findings of children with abnormal neurologic recovery during the postoperative period for corrective/palliative congenital heart surgery.

 This study was conducted at a referral educational pediatric hospital from May 2015 to May 2016. We included patients with congenital heart disease (CHD) who underwent corrective/palliative cardiac surgery presenting with abnormal neurologic recovery in the early postoperative period. We recorded the demographic data, past medical history, surgery details, type of neurological disorders leading to a brain CT scan, and postoperative coagulopathy.

 From among 734 cardiac surgeries from May 2015 to May 2016, 40 (5.44%) patients with abnormal neurologic recovery were assessed by brain CT scans. Among them, 55% were male and 45% were female with a mean age of 14.6 months. The most frequent heart anomaly was the transposition of great arteries (27.5%), which is known as the most common cause of cardiac surgery in the first month of life. Seizure (67.5%) was the most common neurologic manifestation and had the highest predictive value for the presence of an abnormal finding in the brain CT scan (91.3%). Intracranial hemorrhage, specifically subarachnoid hemorrhage, was the most frequent underlying pathology in brain CT scans of patients presenting with seizure. The most common findings in brain CT scans included subarachnoid hemorrhage (82.6%), intraparenchymal hemorrhage (26.08%), and ischemic infarction (17.39%). Data showed that a bypass time of over 180 min could significantly increase the probability of abnormal brain CT scan findings (P value = 0.03), particularly intra-parenchymal hemorrhage (P value = 0.016). The presence of coagulopathy concomitant with seizure would significantly increase the possibility of abnormal brain CT scan findings due to an acute neurologic event (P value = 0.049).

 This study showed seizure as the most common neurologic manifestation in the early postoperative period of cardiac surgery and the intracranial hemorrhage as the most common underlying pathology in patients with neurologic symptoms. Seizure in patients with coagulopathy should be considered as a great concern for physicians to evaluate acute neurologic events more precisely.

 Functional immaturity of the gastrointestinal tract in premature infants can cause several problems, leading to feeding intolerance.

 This study aimed to investigate the effect of abdominal massage on the feeding tolerance of neonates with very low birth weight.

 This randomized single-blind clinical open-label trial was conducted on low-birth-weight neonates, who were hospitalized in the neonatal intensive care units (NICUs) of two tertiary university hospitals from March 2016 to March 2017. The neonates were randomly assigned to two groups. In the massage group, massage was applied three times a day, while in the control group, the patients received routine care. The gastric residual volume (GRV), vomiting, defecation frequency, and abdominal circumference were measured before and after massage in the massage group, as well as the control group.

 There was no significant difference between the massage and control groups regarding gender, birth weight, age, feeding mode, and gestational age (P = 0.711, 0.076, 0.082, 0.612, and 0.629, respectively). None of these variables changed significantly in the controls (P = 0.06, 0.264, 0.421, and 0.07, respectively).

 We found that premature infants who received massage therapy experienced a significant decline in GRV, vomiting frequency, and abdominal circumference and a significant increment in the defecation frequency. Therefore, abdominal massage, which results in less abdominal distension and GRV, is recommended prior to enteral feeding for infants with very low birth weight.

Types 2 and 3 Gaucher disease (GD) are neuronopathic forms that are mainly distinguished by the rate of neurological degeneration. All symptomatic children with type 1 or 3 GD should receive enzyme replacement therapy (ERT), whereas the treatment of children with type 2 GD is usually supportive.

We present the case of a 3-month-old Japanese girl diagnosed with neuronopathic GD. She initially presented with failure to thrive and inspiratory stridor. Treatment using ERT was initiated at 5 months of age. Genetic analysis of glucosylceramidase beta (GBA) revealed a compound heterozygous mutation including RecNciI and the novel missense mutation c.1052G > T (p.W351L). Although several clinical improvements were observed, she showed rapid neurological deterioration at 8 months of age.

The patient with the compound heterozygous mutation including RecNciI and c.1052G > T (p.W351L) in GBA presented with clinical symptoms consistent with those of type 2 GD. ERT was initiated at 5 months of age; however, it failed to prevent refractory seizures and neurological deterioration.

Mycoplasma pneumoniae (M. pneumoniae) is an important cause of community-acquired pneumonia (CAP) in children.

This study investigated the epidemiological characteristics of hospitalized children with Mycoplasma pneumoniaepneumonia (MPP) in Hangzhou.

M. pneumoniae 16s rRNA in respiratory tract sample of children was detected by SAT-MP assay from July 1, 2015 to June 30, 2019.

71,965 samples were tested by SAT-MP (simultaneous amplification and testing of Mycoplasma pneumonia) assay, 10206 (14.2%) were positive for M. pneumoniae. The highest positive rate of M. pneumoniae infection in the second half year appeared in 2015 reaching 24.3% and the lowest appeared in 2017 dropping to 9.8%. The detected monthly positive rates of M. pneumoniae infection ranged from 8.2% to 25.5%, with a peak in August. The positive rate of M. pneumoniae infection increased with the age and it reached the peak in children older than 5 years.

This large samples study revealed that the M. pneumoniae positive rate was higher in older hospitalized children and it reached the highest point in summer in terms of prevalence in Hangzhou.

Flexible fiberoptic bronchoscopy (FFB) is known as an important diagnostic and therapeutic modality in the evaluation of respiratory disorders in pediatric population.

The study aims to highlight common indications and risk of complications associated with bronchoscopy in our population.

This retrospective evaluation was performed in all patients that underwent flexible bronchoscopy at Children’s Medical Center (affiliated to Tehran University of Medical Sciences) between April 2011 and September 2016.

Of 800 bronchoscopies, 574 (71.7%) were performed for diagnostic and 226 (28.2%) for therapeutic purposes. Major indications included radiographic abnormalities (30%), a foreign body or suspected foreign body (28.5% of all FFBs) and stridor or wheezing (25% of all FBB). The incidence of major complications associated with FFBs was 0.87%. The most frequent complication was pneumothorax, followed by lung hemorrhage, and respiratory failure.

Our findings support early intervention and utilization of bronchoscopy in the pediatric population with variable respiratory complaints.

As the 2019 novel coronavirus disease (COVID-19) emerged in China, the parents of hospitalized neonatal patients commonly endure more psychological stress compared to the general population, which probably originated from not staying with their children, inconvenience of daily life, and financial crisis.

We investigated the psychological needs of hospitalized newborns’ parents during the COVID-19 outbreak in Chongqing, China.

The phenomenological method was used to conduct this qualitative research. In-depth interviews were carried out on 14 parents of hospitalized newborns by the same interview based on a semi-structured interview outlines. The interviews were audiotaped, transcribed, and analyzed using Colaizzi’s 7-step analysis method.

All the subjects’ children were admitted to a neonatal ward within the first two weeks of initiating the first-level response to COVID-19 in Chongqing, China. The in-depth interviews identified five themes regarding the parents’ primary psychological needs, which included urgent demand for timely up-to-date information about the children’s condition, demand for psychological and emotional support, reducing the inconvenience caused by the epidemic outbreak, claim for protective information after discharge, demand for financial support.

Based on the parents’ needs, the medical staff should actively communicate with the parents, effectively provide emotional and financial support, and convenience. Such support could be helpful to relieve the parents’ psychological stress.

Fecal calprotectin (FC) measurement has a potential in distinguishing the cause of acute intestinal infections, but its distribution is age dependent.

With this study we wanted to investigate FC values in different age groups of children with acute intestinal infections.

One hundred and three children with acute intestinal infections were enrolled in this study. Seventy two had viral pathogens, 31 bacterial test subjects were divided into 3 groups: ≤ 1 y, 1 - 3 y, 3 - 7 y. Stool samples from test and control subjects (n = 17) were tested for FC with fluorescence enzyme immunoassay.

Viral and bacterial pathogen groups had significantly greater FC concentrations, compared to healthy controls. Overall, bacterial pathogen group presented with greater FC values, compared to viral pathogen group (1299.0 mg/kg vs 297.0 mg/kg, P = 0.002). The cut-off value for acute viral intestinal infections was > 70.0 mg/kg (78.2% sensitivity and 100% specificity), bacterial intestinal infections: > 201.0 mg/kg (88% sensitivity and 100% specificity). There was no difference in FC concentration between bacterial and viral pathogen groups in children under one-year-old (391.0 mg/kg vs 399.5 mg/kg, P = 0.945). Differences were significant comparing bacterial and viral pathogen groups of children from 1 to 3 (316.0 mg/kg vs 1799.75 mg/kg, P = 0.001) and from 3 to 7 years old (99.0 mg/kg vs1299.0 mg/kg, P = 0.04).

FC is a valuable biomarker for distinguishing bacterial and viral pathogens, except for children under one-year-old.

Biliary atresia is a rare distractive cholangiopathy in childhood and the most common cause of liver transplantation in pediatrics. Present study is the first report of biliary atresia and its incidence and outcome from northwest of Iran.

In this retrospective cohort study, all patients with biliary atresia admitted to the Tabriz Children’s Hospital from March 2006 to March 2016were included. Demographical, clinical and preclinical data of all patients are extracted from the hospital records. Information about the outcome after Kasai portoenterostomy was gathered by reviewing the progress notes or by phone call from the parents. The Mann-Whitney U and chi-square or Fisher’s exact tests were used for comparison of continuous and categorical variables respectively. Survival curves and tables, Kaplan-Meier method and Cox regression were used for survival analysis.

The incidence rate of biliary atresia was 1/13280 live births. Isolated form of biliary atresia was seen in 85.1% of cases. Splenic malformation was not observed in our patients. The rate of successful Kasai Portoenterostomy was 42.9%. Survival analysis showed that 1, 2, 3, 5, and 10-year native liver survival rate was 73%, 56%, 54%, 40% and 31%, respectively. Median overall survival rate was 36 months [95%CI: 2.89 - 69.1]. Successful Kasai Portoenterostomy and clearance of jaundice was the only factor that affected survival rate.

The incidence rate of biliary atresia in Northwest of Iran was lower than that in other Asian countries. Like other Asian countries, spleen anomaly was rare in our patients. The success of Kasai Portoenterostomy and survival rates of our cases were lower than that in other Asian countries.