Iranian Journal of Pediatrics
Volume:31 Issue: 3, Jun 2021

Context:

 Pediatric acute liver failure (PALF) is a disease with high mortality, characterized by a multisystem disorder and acute liver dysfunction.

 A systematic review and meta-analysis of prognostic studies is necessary to summarize the general prognostic factors for PALF. Also, these factors can contribute to the development of a new prognostic model.

 An electronic literature search was conducted systematically in PubMed, Embase and Cochrane databases to identify prognostic factors of pediatric acute liver failure and evaluate outcomes, including spontaneous survival, death without LT, and undergoing LT. Prospective or retrospective cohort designs were included. The methodological quality of studies was analyzed and scored, using the QUIPS tool. Also, a meta-analysis was performed to calculate the pooled odds ratio (OR) of the factors

 1465 citations were identified, 30 studies were reviewed, and 16 studies were included in the meta-analysis. The indicators extracted from the studies were divided into four categories: (1) general markers, (2) bio-markers, (3) scoring systems, and (4) treatments. Several prognostic factors were associated with the poor outcomes, including etiology (indeterminate disease and drugs), INR, ammonia, ALT levels, AST levels, bilirubin, albumin, severe HE (grade 3/4), sex (male), lactate. In addition, ammonia, bilirubin, albumin, AST levels, severe HE (grade 3/4) and etiology (indeterminate disease, drugs, metabolic disease) were associated with death (no LT).

 Etiology, ammonia, bilirubin, albumin, AST levels, severe HE (grade 3/4) were found associated with the poor outcomes or death (without LT) of PALF. Although these factors may contribute to the new prognostic model, they must be considered with caution. Further prognostic studies of PALF with larger cohorts are also needed.

 The vasoactive-ventilation-renal (VVR) score is a disease severity index for predicting outcomes of pediatric patients receiving cardiac surgeries. We investigated whether the VVR score on admission can predict the length of stay (LOS) in the pediatric intensive care unit (PICU) in children diagnosed with heart failure (HF).

 Medical records were reviewed for pediatric HF cases between January 2010 and December 2016. We calculated the VVR score using the electronic data, including measurements obtained at the time of admission and analyzed the correlation between the VVR score and prolonged LOS (PLOS). A PLOS was defined by a longer stay than the median duration for the surviving cases.

 A total of 113 pediatric HF cases were reviewed, of which 96 cases were finally included in the study. The median [IQR] LOS was 12 [6, 22] days. The use of a mechanical ventilator and extracorporeal membrane oxygenation (ECMO) were associated with PLOS. The area under the curve (AUC) of the vasoactive-inotropic score (VIS), VVR score, lactic acid level, and brain natriuretic peptide (BNP) for evaluating the association with mechanical ventilator or ECMO use was 0.682 (P = 0.006), 0.823 (P < 0.001), 0.683 (P = 0.006), and 0.783 (P < 0.001), respectively. In multivariable logistic regression analysis, the VVR score was the only significant parameter for predicting PLOS.

 The VVR score on admission to the PICU is predictive for mechanical ventilator or ECMO use, which correlates with a PLOS. Therefore, the VVR score at PICU admission in children with HF is a useful LOS marker.
 

 Recently, the correlation between necrotizing enterocolitis (NEC) and packed cell transfusion (PCT) has been identified. Evidence shows that 25 - 35% of NEC cases are associated with PCT.

 this study aimed to determine the association between PCT and feeding tolerance in healthy preterm newborns.

This clinical trial was performed on preterm infants, admitted to the neonatal intensive care unit (NICU) of Mofid Children's Hospital, Tehran, Iran, from April 2017 to May 2018. A total of 70 healthy premature infants (birth weight < 1500 g and gestational age < 32 weeks) with enteral feeding, who required PCT, were included in this study. The eligible infants were divided into two groups by block randomization. In the intervention group (n = 35), breastfeeding was withheld only during PCT and then continued as usual. On the other hand, in the control group (n = 35), feeding was performed as usual, regardless of PCT. Feeding tolerance within the first 72 hours post-transfusion was compared between the two groups. Sick newborns were excluded from the study. Data analysis was performed in SPSS version 20.

 The mean gestational age, birth weight, and postnatal age of the neonates were 30.13 weeks, 1245.71 g, and 17 days in the intervention group and 29.97 weeks, 1169.43 g, and 15.46 days in the control group, respectively; there was no significant difference between the two groups. Except for pre-transfusion hemoglobin and hematocrit levels, other characteristics of the two groups were similar. Feeding tolerance was reported in 32 (91.2%), 33 (94.73%), and 34 (97.1%) newborns at 24, 48, and 72 hours post-transfusion in both groups, without any significant difference. There was no significant difference between neonates with and without feeding tolerance in either of the groups.

 According to the present results, withholding feeding during PCT is not necessary in healthy preterm neonates with a good general condition, and continued breastfeeding seems to be a safe option.

 Many studies have found that the academic success of school-age children is proved to be in close relation with regular and healthy nutrition.

 This study aims to investigate the relationship between breakfast quality and academic success of refugee primary-school children.

 After scanning 24 schools in the city center, 384 students who were refugee Syrians from primary schools in Mardin city center were included. In addition to the demographic characteristics of the individuals, breakfast habits of these students were investigated.

 In this study, 91.6% of the children stated that they have breakfast habits. The reasons for skipping breakfast among students of all levels can be listed as being late for school (67.8%) and not liking to have breakfast (18.8%). The breakfast quality index (BQI) score was low in both boys and girls and all age groups. According to this marked value, all age groups had poor nutrition in terms of breakfast. Although girls showed a significant difference in all age groups (P = 0.046), this difference was not significant among boys (P = 0.671). The number of students with a breakfast quality score higher than 8 was very low. It was observed that boys had the highest academic success with the lowest breakfast quality score. The breakfast quality score of girls with the best academic success ranged between 4 - 7 points.

 It was observed that academic success was linked to having breakfast habit, and students had breakfast habit performed relatively better in school compared to those who did not.
 

 Medication adherence is one of the most important challenges in chronic diseases.

 In this study, we investigated medication adherence prevalence among children with chronic liver diseases.

 A total of 160 children with chronic liver disease were enrolled in our study. We evaluated medication adherence using the 8-item Morisky Medication Adherence Scale (MMAS-8) and classified them based on the scores (score < 6 = low adherence, scores 6 - 8 = medium adherence, and > 8 = high adherence). Logistic regression recognized final influencing variables on adherence.

 Of 160 patients, 84 (52.5%) were female, and the mean age of patients was 11.2 ± 4.4 years. Also, 56 participants (35%) were high adherers, and 66 (41.25%) were low adherers. The most common reason for low adherence was forgetfulness in 37 patients (23.13%) and low access to medication in 21 subjects (13.13%). In multivariate logistic regression, age, housing status, and underlying disease were significantly associated with medication adherence.

 Almost half of the children with chronic liver disease demonstrated low medication adherence. Age, housing status, and underlying disease were significantly associated with medication adherence. We should implement programs to reduce medication non-adherence among children with chronic liver disease.
 

 Topical fluoride products such as varnishes prevent dental caries by limiting demineralization and antibacterial properties. The structural and metabolic characteristics of cariogenic microorganisms are different from each other. Also, the formulation properties, concentration, and release behavior of fluoride vary in different varnishes.

 In this study, we investigated the antibacterial effects of three types of common fluoride varnishes against two cariogenic bacteria of Streptococcus mutans (S.M.) and Lactobacillus acidophilus (L.A.).

 In this in vitro study, antibacterial effects of MI varnish [containing calcium phosphopeptide-amorphous calcium phosphate (CPP-ACP)], Polimo (containing xylitol), and FluoroDose varnishes were evaluated using disc diffusion method via measuring the diameter of the inhibition zone. The antibiotics of erythromycin and ampicillin were used as the positive control of the test. Analysis of variance (ANOVA) and post hoc tests were applied to compare the mean of non-growth zone diameter in the studied groups. Data were analyzed by SPSS 16. The statistical significance level was determined as P-value < 0.05.

 The antibacterial effect of each varnish was optimal against both bacteria. In comparison, the mean diameter of the inhibition zone in MI varnish was significantly (P-value=0.019) higher than Polimo and FluoroDose brands on S.M.; however, this difference was not statistically significant for L.A. Furthermore, Polimo and FluoroDose varnishes showed similar antimicrobial effects against these bacteria.

 The use of these varnishes seems to be suitable for preventing tooth decay. MI varnish is preferable because of its higher antibacterial properties.

Hypospadias is a congenital anomaly on the penis, in which the meatal orifice opens ventrally and proximal to the tip of the penis. In this regard, two common treatment methods are tubularized incised-plate urethroplasty (TIP) and the Mathieu incised-plate (MIP) technique. The present study aimed to compare the early and long-term outcomes of TIP and MIP among patients with distal penile hypospadias.

The study was also to evaluate the postoperative functional outcome of hypospadias over a long-term follow-up.

Fifty-nine patients were randomly selected and assigned to two groups (TIP (n = 31) and MIP (n = 28)). Demographic information, preoperative findings, and postoperative complications were collected from the two groups. The Hypospadias Objective Scoring evaluation (HOSE) questionnaire and uroflowmetry were obtained to evaluate the long-term outcome of hypospadias repair.

The success rates of the surgical TIP and MIP techniques were 71.0% and 82.1%, respectively. Postoperative complications in the TIP group were three (9.7%) distal UCF and four (12.9%) meatal stenosis. In the MIP group, two (7.1%) and three (10.7%) patients suffered from distal UCF and meatal stenosis, respectively. Moreover, 89.3% of the patients in the MIP group and 80% of the patients in the TIP group had acceptable HOSE. Regarding the uroflow rates in the MIP group, 12% and 58% of the participants were below the 5th percentile and above the 25th percentile, respectively. Concerning the uroflow rates of TIP, 32% of the patients were below the 5th percentile, and 18% of the participants were above 25th percentile.

Although there have been some reports on the superiority of TIP, we found these two techniques at approximately equal levels with a slightly higher success rate for the MIP regarding the early outcomes. With the exception of the long-term outcomes in cosmetic and functional evaluation, MIP is superior to TIP.

 Vulvovaginitis is a common infection in prepubertal girls, which is partly caused by bacterial infection. According to the literature, Haemophilus influenzae is one of the most common bacterial causes of vulvovaginitis in children. However, few studies with large sample sizes have delved into this issue.

 To determine the prevalence of Haemophilus influenzae vulvovaginitis in prepubertal girls and detect the antimicrobial resistance of H. influenzae strains isolated from vulval specimens.

 The isolates of H. influenzae from the vulval swabs of prepubertal girls with vulvovaginitis were received from The Children’s Hospital, Zhejiang University School of Medicine, during 2016 - 2019. The vulval specimens were inoculated on Haemophilus selective chocolate agar, and antimicrobial susceptibility tests were performed by the disk diffusion method. Moreover, β-lactamase was detected using Cefinase disc.

 In this study, 4142 vulval specimens were received during four years, of which 649 H. influenzae isolates had been isolated from 642 girls aged 6 months-13 years, with a median of 5 years. The peaks of isolates were observed from April to July in the vulval isolates. In general, the ampicillin resistance rate was 39.1% (250/640), 33.2% of strains (211/636) were β-lactamase-positive isolates, and 6.6% strains (42/635) were β-lactamase-negative ampicillin-resistant" (BLNAR)) isolates. The resistance rates of H. influenzae isolates to amoxycillin-clavulanic acid, ampicillin-sulbactam, cefuroxime, ceftriaxone, cefotaxime, meropenem, levofloxacin, sulfamethoxazole-trimethoprim, azithromycin, and chloramphenicol were 26.4%, 21.8%, 24.8%, 1.7%, 1.0%, 0.2%, 0%, 47.7%, 10.2%, and 1.1%, respectively. MDR was noticed in 41 persons (6.4%) out of the 642 H. influenzae isolates, with the most prevalent MDR phenotype of ampicillin-sulfamethoxazole-trimethoprim-azithromycin resistance.

 Clinicians should noticed that H. influenzae is a common bacterial cause of vulvovaginitis in children, and laboratories should routinely cover Haemophilus culture media for vulval specimens. The Ampicillin resistance of H. influenzae should also be considered in clinical management.

 Cardiac catheterization is a useful method for determining the anatomy and pressure in cardiac vessels and chambers. The use of anesthesia methods with minimal hemodynamic and respiratory effects can increase diagnostic accuracy.

 Since there are a few exclusive pediatric angiography centers, scarce studies have been done in this area. Accordingly, this study determined the effects of intermittent positive pressure ventilation (IPPV) versus spontaneous ventilation on cardiorespiratory parameters in less than one-year-old pediatric patients undergoing angiography with general anesthesia.

 In this interventional study that was performed as a double-blind, randomized clinical trial, 60 children younger than one year were enrolled. The pulmonary, renal, hepatic, and metabolic background diseases, previous cardiac and thoracic surgery, requiring over two ketamine doses, and receiving sedative or anti-convulsant therapeutics were excluded. The patients were randomly assigned to two groups, including IPPV and spontaneous ventilation. Their vital signs were also recorded before and after anesthesia induction and needling, as well as during measurements of pulmonary parameters and systemic blood pressure. All measurements were done by a single operator using the same device for each variable.

 It was seen that SPO2, as well as PCO2 after anesthesia had significant alterations among the study variables. Nausea and vomiting, pain, and agitation were not different across the groups (P-value > 0.05).

 In this study, we found that IPPV and spontaneous ventilation have the same effects on respiration. Both techniques can be used in children with different cardiovascular catheterization conditions to increase accuracy and reduce alterations in cardiopulmonary parameters.

 Transient tachypnea of the newborn (TTN) is a common but mild respiratory problem seen in late preterm and term newborns. However, it may sometimes cause severe morbidity.

 Therefore, biomarkers that can predict TTN severity may aid the clinician in determining the need for intensive care. Our aim was to identify whether blood gases and complete blood count parameters could be utilized to predict the severity of TTN.s

 We retrospectively examined the medical records of newborns (> 37 weeks gestation, > 2000 grams) diagnosed with TTN who were hospitalized in the Neonatal Intensive Care Unit (NICU) of Karabuk University Faculty of Medicine, Training and Research Hospital, Karabük/Turkey between June 2019 and June 2020. Patients were grouped according to the length of stay in the NICU. Group 1 included patients that did not require NICU monitoring after 48 hours, and group 2 included patients who continued to require NICU monitoring after 48 hours. Blood gases and complete blood count parameters were compared between the two groups.

 During the study period, 91 newborns were hospitalized in the NICU due to respiratory distress. Thirty-nine patients who did not meet the inclusion criteria were excluded. Gestational age and birth weight were significantly lower in group 2 (P < 0.05). There were no significant differences between the groups in terms of leukocyte count, hemoglobin level, mean platelet volume (MPV), and platelet count. Partial carbon dioxide pressure (PCO2) was significantly elevated, and base excess (BE) was significantly greater in group 2.

 We determined a relationship between a prolonged stay in NICU and the levels of PCO2 and BE among patients hospitalized with a diagnosis of TTN. Therefore, PCO2 and BE values may be valuable to determine the prognosis of TTN in the early period. Despite being one of the most common causes of intensive care admission in the newborn population, there is limited data on the diagnosis, treatment, and prognosis of TTN; thus, we believe that our results will shed light on this problem.
 

Children with chronic kidney diseases have an increased risk of progression to end-stage renal disease, which would ultimately result in lifelong disability and shortening of lifespan. There is no effective intervention such as renal replacement therapy because of high cost and donor shortage. This study aimed to examine the effect of recommended dietary allowance (RDA) protein on chronic kidney diseases (CKD) children without dialysis to halt the progression of CKD by preventing the deterioration of the renal function. In this observational study, 30 children aged 2 - 18 years at different CKD stages without dialysis were selected as the research sample. Anthropometric measurements (namely weight and height) and laboratory assessments (namely S. creatinine. blood urea, total serum albumin, hemoglobin, serum ferritin, and CCr) were considered at the beginning of the study. Following the intervention using the RDA protein during three- and six-month periods, anthropometric and laboratory assessments were compared using the preliminary data. Weight, weight for age Z score, and body mass index (BMI) significantly increased (P < 0.05) after three and six months, compared to the preliminary data. Moreover, laboratory assessments such as Hb, S. creatinine, blood urea, and creatinine clearance rate significantly improved (P < 0.05) after three and six months of RDA protein intake without dialysis. The growth and renal function improved following the intervention with recommended dietary allowance protein in CKD children without dialysis.

 New Coronavirus disease 2019 (COVID-19) has caused serious health problems worldwide. The disease first started in Wuhan, China, and then resulted in thousands of deaths throughout the world.

 According to data from involved patients, children and neonates include a small proportion of patients with COVID-19. However, in some cases, hospitalization and even death still may occur. In this case report, we described mortality associated with COVID-19 in two pediatrics from Qom city, Iran. One of them presented with severe symptoms that needed high-flow ventilation and admission to the ICU.

 The findings of this report confirm that COVID-19 may cause death in pediatrics, like in adults. Timely diagnosis, precise evaluation of clinical symptoms, and effective treatment of COVID-19-infected children can play an important role in reducing mortality rates.

 Incontinentia pigmenti (IP) is a rarely diagnosed x-linked dominant disease affecting tissues of ectodermal and mesodermal origin such as cutaneous tissues, teeth, eyes, hair, and the central nervous system. Dermatologic manifestations are often the first signs observed in patients diagnosed with IP and are present in nearly all the subjects, but they are less harmful and do not require treatment. Oral manifestations in patients diagnosed with IP might affect both the deciduous and permanent teeth, with tooth shape anomalies and hypodontia, delayed tooth eruption, cleft palate, and high arched palate. These oral abnormalities influence feeding, quality of life (QoL), and self-esteem of the patient but can be successfully corrected by oral rehabilitation.

 Here, we report the case of a female patient, aged 11 years, presenting with dental manifestations such as hypodontia, conical teeth, delayed tooth eruption, narrow and atrophic dental ridge, and also some non-dental findings of IP. Her dental ‎management included oral hygiene instructions, extraction of all unrestorable primary molars, and composite filling of all primary canines.

 A removable space maintainer was constructed for the patient, which resulted in favorable esthetic outcomes, proper re-establishment of mastication, and improved self-esteem.

 Granulomatosis with polyangiitis (GPA) is a kind of anti-neutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV), which involves small-to-medium-sized vessels. Besides, GPA usually involves the upper and lower respiratory tract, and also causes necrotizing glomerulonephritis. The involvement of the heart and gastrointestinal (GI) tract in GPA is unusual, and these are atypical places of this vasculitis.

 A 14-year-old girl with a newly diagnosed GPA after afflicting with COVID-19 infection presented with ST-elevation Myocardial Infarction (MI), GI perforation, and intracranial hemorrhage.

 Although GPA is rare in the pediatric population, it might occur in this age group and could involve multiple organ systems.