Journal of Comprehensive Pediatrics
Volume:12 Issue: 3, Aug 2021

Patients with chronic diseases and their caregivers are at risk for mental disorders, such as depression and anxiety.

This study aimed to investigate the prevalence of depression and anxiety symptoms among cystic fibrosis (CF) patients and their parent caregivers in Iran.

This descriptive-analytical cross-sectional study was carried out on 96 participants, including 60 patients and 36 parents. The Hospital Anxiety and Depression Scale was used to measure the depression and anxiety in this study. The research site was the Pediatric Respiratory Diseases Research Center of the National Research Institute of Tuberculosis and Lung Diseases in Tehran, Iran. SPSS software (version 22) was used to examine and analyze the raw data.

The prevalence of anxiety in patients with amean incidence of 12.17% was higher than that in parents with amean incidence of 11.81%. Moreover, the prevalence of depression in patients and parents (10.58%) was almost similar. In the patients’ group, there was a direct and significant relationship between the duration of diagnosis with depression and anxiety; nevertheless, there was an inverse and significant relationship between the patient’s age and anxiety. In the parents’ group, there was a significant inverse association between age and depression, as well as between the duration of diagnosis and anxiety. However, there was no significant relationship between anxiety and depression, neither in the parents’ group nor in the patients’ group.

The high prevalence of depression and anxiety symptoms among CF patients and their parents indicates the poor mental state of these individuals, which requires planning and implementation of psychological interventions for this group.

Neonatal hypoxic-ischemic encephalopathy (HIE) is one of the most common causes of cerebral palsy.

We aimed to compare the serum levels of total L-carnitine in newborns with HIE and Transient tachypnea of the newborn and to determine the correlation between associated demographic data, associated changes in laboratory findings, and outcome in cases with HIE.

This comparative, prospective, and observational study was conducted at the Neonatal Intensive Care Unit (NICU) of Assiut University Children Hospital. All the cases of perinatal asphyxia and TTN admitted to the NICU during 2016 - 2018 were included.

It was found that the serum level of total L-carnitine decreased in both HIE (I) and TTN (II) cases, but the difference was not significant (5.51 ± 1.30 µmol/L in group I vs. 6.22 ± 2.56 µmol/l in group II). Male factor with changes in the serum sodium level (132.63 ± 9.30) and abnormal serum creatinine level (1.4 [0.7 - 15.0]) were significantly related to the outcome of HIE cases.

The serum level of total L-carnitine declined in both HIE and TTN cases. Male factor with changes in serum sodium level and abnormal serum creatinine level were significantly related to the mortality of cases with HIE.

The aim of this study was to evaluate the effect of high-flow nasal cannula (HFNC) after early extubation on children undergoing cardiac surgery.

This randomized controlled clinical trial was performed among 92 children aged 1 to 24 months undergoing cardiac surgery from March 5 to August 30, 2020, in a pediatric post-cardiac surgery intensive care unit (ICU). The patients were randomized to receive either HFNC or conventional oxygen therapy after extubation. Arterial blood samples were collected after anesthesia induction, after the end of the surgery, at the time of entering the ICU while they were intubated, 6 hours after entering the ICU, before removing the endotracheal tube, immediately after extubation, as well as 1, 6, 12, 24, and 36 hours after extubation. The patients were compared regarding PaCO2, PaO2/FiO2 ratios, respiratory failure, need for reintubation, development of atelectasis, pneumothorax, pleural effusion, and length of ICU stay.

The patients were similar regarding demographic characteristics, the duration of surgery, and mechanical ventilation (P > 0.05). On the first and second days after the surgery, the mean modified radiologic atelectasis score (m-RAS) was lower in the HFNC group compared to the conventional oxygen therapy group (P < 0.05). The frequency of respiratory failure did not differ in the groups before and after the surgery (P > 0.05). PaCO2 was lower in the HFNC group than in the control group after extubation (P < 0.001). PaO2/FIO2 ratio was significantly higher in the HFNC group one hour after extubation and afterward in comparison to the control group (P < 0.001). The need for re-intubation (P < 0.013) and the length of ICU stay (P < 0.001) were significantly lower in the HFNC group compared to the control group.

It was found that HFNC could improve the respiratory parameters and reduce postoperative pulmonary complications in infants following a congenital heart surgery.

Knowledge of the profile of pediatric discharge against medical advice (DAMA) may help design interventions to reduce its prevalence.

This study aimed to assess the profile of pediatric DAMA at Ekiti State University Teaching Hospital (EKSUTH), Ado-Ekiti, Ekiti State, Nigeria.

This retrospective cross-sectional descriptive study included all pediatric cases of DAMA from January 2012 to December 2018. Relevant information was extracted from the patients’ case notes. Data was analyzed using the statistical package for social sciences (SPSS) version 23.

The overall prevalence of pediatric DAMA was 3.8%. Of the 233 pediatric DAMA with complete information, 127 (54.5%) were males. Severe malaria (27.3%) was the most common diagnosis among DAMA cases at the children emergency ward (CEW), while severe perinatal asphyxia (25.0%) and neonatal sepsis (25.0%) were the most common at the special care baby unit (SCBU). Only 1 (0.4%) patient was enrolled in the National Health Insurance Scheme (NHIS). Moreover, 43 (18.5%) parents took DAMA due to financial constraints, and 55% of the patients had their DAMA form signed by their fathers. In addition, among the patients who referred for follow-up, 11 (4.7%) patients fully recovered, 2 (0.8%) recovered with disability, 1 (0.4%) was readmitted, and 1 (0.4%) died. The highest and lowest DAMA rates were in the months of May and December, respectively. Patients aged under five years old who took DAMA significantly had infectious diseases compared to older age groups (P<0.0001). Also, children from lower socioeconomic class significantly had infectious diseases (P=0.02)

Pediatric DAMA remains a challenging, multifaceted problem in pediatric health care services in our practice location. Increasing NHIS coverage, promoting female education, family empowerment, and home visitation/follow-up on phone may play a role in reducing its burden.

Pain is one of the main side effects of tonsillectomy, especially in the pediatric population.

This study aimed to examine the effects of a local injection of bupivacaine on pain and postoperative nausea and vomiting after tonsillectomy.

In this double-blind clinical trial, we enrolled 96 patients who were referred for elective tonsillectomy to the ear, nose, and throat (ENT) Clinic of Imam Khomeini Hospital in Ahvaz, Iran, from December 2016 to January 2018. The patients were selected by the simple random sampling method on a 1:1 ratio. To analyze the data, Student’s t-test or chi-squared test were used.

Visual analog score measured in the recovery period at 0, 1, 2, 4, 8, 12, and 24 h after surgery was significantly lower in the Bupivacaine group than in the Placebo group (P < 0.001). Nausea was significantly different between the groups at all time, but for vomiting, significant differences between the groups were noted at 0, 1, 2, 4, and 8 h but not at 12 and 24 h after surgery.

Preoperative local injection of 0.5% bupivacaine for tonsillectomy was effective in reducing postoperative pain, and it significantly reduces postoperative nausea and vomiting in children.

In children, vitamin D deficiency can result in the hypertrophy of costochondral junctions and sternal pain.

In this study, we aimed at determining the correlation between children’s vitamin D status and costochondritis.

This cross-sectional study included a control group (100 healthy children) and a study group (100 children with costochondritis). Examination of patients included chest radiography, physical examination, history-taking, electrocardiography, echocardiography, and serum measurement of 25-hydroxyvitamin D, phosphorus, calcium, and alkaline phosphatase. The Chisquare test, Spearman’s correlation test, and independent samples t-test were also performed for analyzing the data.

The groups showed no significant difference regarding age, gender, or body mass index (P = 0.315, P = 0.671, and P = 0.097, respectively). The history of patients experiencing idiopathic chest pain showed cardiac disease in 13% of their families, without report of death in the family. The pain was mainly located in the left precordium (64%), followed by the right precordium and the midsternal region (32% and 18%, respectively). A significantly lower level of 25-OHD was found in the study group than in the control group (P < 0.0001). Based on the findings, the groups were not significantly different regarding the evaluated biochemical parameters, except for alkaline phosphatase (P = 0.007). The results showed that pain duration and episodes were significantly associated with vitamin D insufficiency (r = -0.621, P = 0.002; r = -0.213, P = 0.021, respectively).

Vitamin D insufficiency should be considered in costochondritis. Also, pain duration and episodes have associations with vitamin D insufficiency. This finding emphasizes the necessity of evaluating nutritional parameters in children with non-cardiac chest pain.

Exclusive breastfeeding (EBF), especially during the first six months of life, is one of the primary health indicators in infants.

The present study intended to describe the frequency of EBF in infants and its determinants until six months after birth.

This longitudinal study was conducted on 673 mother-newborn pairs visiting obstetrics and gynecology departments of two main hospitals in Zanjan. Information on the frequency of EBF up to six months, socio-demographic and reproductive information, and attitudes of mothers towards breastfeeding was gathered using questionnaires. Data were analyzed using chi-square test and logistic regression in SPSS.

The proportion of neonates who were receiving EBF at discharge was 95.7%. The EBF proportions in the second week, the first, fourth, and sixth months were 95%, 88.1%, 80.7%, and 77.3%, respectively. The multivariate analysis of data indicated that living in urban areas (P = 0.02), lower education of mothers (P = 0.008), having more than three years of birth interval (P = 0.006), no experience of breastfeeding in mothers (P = 0.01), no prior decision for breastfeeding in mothers (P < 0.0001), and use of artificial nipples (P = < 0.0001) were independently associated with non-EBF.

In this study, despite a high proportion of EBF at discharge, we found that the proportion of EBF reduced during six months. The determinants of non-EBF at six months, including urban and less educated mothers, highlight a need to promote awareness regarding EBF and perform interventions for women at a greater risk for early breastfeeding cessation.

The most common tachyarrhythmias in fetal cases is supraventricular tachycardia (SVT); atrioventricular nodal re-entrant tachycardia (AVNRT) type. Premature delivery, neonatal complications, and mortality following fetal SVT are high, and therefore, require proper management. Hereby, we introduce an AVNRT that was diagnosed in the fetus and adenosine infusion, and propranolol tablets were initially administered, but arrhythmia was not controlled; eventually, the tachycardia was controlled with flecainide tablets. She was discharged with the prescription of propranolol and flecainide tablets. She is currently 18 months old and under follow-up.

Despite the lack of conclusive and proven supporting epidemiologic data about the association between cell phone radiofrequency electromagnetic fields (RF-EMF) and the developing fetus complications, there are frequent discussions about this matter.

A medical student interviewed eligible pregnant women admitted to Al Zahra Hospital, an academic referral hospital in the North of Iran, to fill questionnaires intended to assess maternal demographic data and their attitude towards cell phone use during pregnancy in 2020.

A total of 322 pregnant women with the mean age of 30.12 ± 6.81 years enrolled in the survey, in which 3.1% of them were non-cell phone users, and 6.052% of all did not use a cell phone during the first trimester. Also, 38.81% of them mentioned healthcare providers as the main source of obtaining information, while 40.6% did receive any information. The mean years of cell phone use and the daily hours were 8.26 ± 4.1 and 2.66 ± 2.02, respectively. Also, 64.3% believed that cell phone use poses risks to the fetus, while 26.7% had no idea. A positive association was also found concerning maternal awareness from cell phones harmfulness to the fetus and maternal education, residency, and employment (P < 0.0001).

In this study, the majority of pregnant women believed that cell phone use during pregnancy could be harmful to the fetus; however, most of them were cell phone users with no special consideration even during the first trimester. It seems that the importance of the issue must be revealed to them by more healthcare providers’ interventions.

The novel coronavirus disease 2019 (COVID-19), which was first identified in Wuhan, China, in late 2019, has now spread around the world. It significantly affects the lower respiratory tract, and pneumonia is always present in patients with the severe form of the disease. Many studies have shown that the severity of COVID-19 is lower in pediatric populations. It is important to determine why infants and young children are not severely affected by COVID-19. By increasing our awareness of this disease, we can prioritize our limited health resources. Several theories have been proposed to explain such significant differences between the pediatric and adult populations with COVID-19. Some of them are: (1) the role of angiotensin-converting enzyme 2 (ACE2); (2) cross-immunity with other severe acute respiratory syndrome (SARS)-like viruses; (3) obtunded systemic inflammatory response in children; (4) more efficient T cells in them; (5) interactions of SARS-Coronavirus-2 (SARS-CoV-2) with other viruses in the mucosa of the lungs and airways; and (6) a hypothesis that COVID-19 proteins onslaught the heme on the β-1 chain of hemoglobin. The important thing to keep in mind is that the asymptomatic and mildly symptomatic pediatrics are crucial in the spread of COVID-19.