Iranian Journal of Pediatrics
Volume:32 Issue: 4, Aug 2022

Context:

 Dental caries is a complication affecting the health of society, so it is vital to manage. Most children with early childhood caries (ECC) are believed to undergo anemia, altered physical growth patterns, and low weight.

 This study aimed to evaluate the relationship between dental caries and iron deficiency anemia (IDA) in children.
Evidence Acquisition: The medical subject headings (MeSH) and non-MeSH were applied to choose the search terms. English language case-control studies assessing blood factors associated with IDA in children with and without dental caries were potentially eligible. Two independent researchers carried out an electronic search to retrieve studies published in the English language on Scopus, ProQuest, PubMed, and Web of Science databases in October 2020. Initially, 494 articles were obtained. Of them, 17 were eligible for inclusion, of which eight studies were eliminated. The meta-analysis was done using the comprehensive meta-analysis software (version 2, Biostat). The forest plots estimated the mean difference and depicted the results of the meta-analysis. The Egger's and Begg's tests assessed the publication bias.

 A significant difference was observed in serum ferritin levels between the case and control groups, with a mean difference of -0.230 (95% confidence interval (CI): -0.446 to -0.015; P value = 0.008). Blood hemoglobin and mean corpuscular volume (MCV) levels indicated significant mean differences of -0.991 (95% CI: -1.813 to -0.169) and -0.807 (95% CI: -1.336 to -0.279), respectively (P value < 0001). In the case group, all three blood parameters were significantly lower.

 Hemoglobin, serum ferritin, and MCV levels are lower in children with dental caries than in caries-free children.

Autism spectrum disorder (ASD) is a neurodevelopmental disorder with 2 main symptoms of social and communication deficits and stereotyped behaviors. Pretend play and theory of mind (ToM) have an essential role in a child’s cognitive and social development.

In this study, different variables of pretend play with levels of ToM were examined in 2 groups of typical children and children with autism.

In this case-control observational study, 45 typical children and 18 children with autism aged 5 to 7 years participated. For both groups, the ToM test was performed to measure the levels of ToM, and the child-initiated pretend play assessment (ChIPPA) was performed to analyze the pretend plays in both groups. Both tests were performed directly on children, and the scores were recorded by the examiner.

The results showed a significant positive relationship between the total score of ToM and pretend play. In children with autism, there was no difference between the ToM scores regarding age (P > 0.05). There was also a significant relationship between the levels of ToM, percentage of elaborate pretend actions (PEPA), and the number of object substitutions (NOS; P < 0.001). The scores of the ToM and pretend play levels of children with autism and typical children were significantly different (P < 0.001).

Based on the findings, the ToM and pretend play levels were lower in ASD children than in typical children. In addition, children who had higher PEPA scores and better NOS had higher ToM scores.

Child growth assessment serves as a tool for assessing children's health and nutritional condition. Longitudinal studies have statistical power in inspecting growth changes.

This study aimed to examine the longitudinal growth differences and determinants of children's body weight in Ethiopia.

Longitudinal data were obtained from the Young Lives cohort study conducted in Ethiopia from 2002 to 2016. The study involved 1,665 Ethiopian children who were followed from age 1 to 15 years. The obtained data were analyzed using a fractional polynomial mixed-effect model.

Children's weight gain followed non-linear trajectories. There were considerable differences in children's body weight across different regions of Ethiopia. Children in Addis Ababa, Oromiya, and SNNPR had much faster weight growth than Tigray children. There was no substantial difference in the children's rate of weight gain between Tigray and the Amhara region. Boys had a faster rate of change in weight gain than girls.

Controlling for other factors, gender, residence, region, parental education, household size, wealth, and mother's age had significant influences on the longitudinal weight growth of children. However, safe drinking water, sleeping time, and father's age were not related to the weight trajectory over time.

Hypoxic-ischemic encephalopathy (HIE) is a leading cause of mortality and morbidity in neonates. Head cooling is considered the standard treatment that reduces mortality and morbidity by decreasing the adverse effects of the disease. Some medicines having neuroprotective properties may be beneficial in treating HIE.

We aimed to evaluate the effect of erythropoietin (EPO) on short-time outcomes in newborns with HIE.

This study was conducted on 62 newborns with moderate to severe HIE hospitalized in Fatemieh Hospital, affiliated with Hamadan University of Medical Sciences, Hamadan, Iran, from 2019 to 2020. Eighteen patients who received head cooling plus 1000 IU/kg/d EPO were considered the intervention group and compared with 44 neonates who received only head cooling alone. Short-term outcomes, including length of stay (LOS), thrombocytopenia, seizure, need for mechanical ventilation, multiple anticonvulsant drugs, and in-hospital mortality, were compared between the groups using SPSS version 22.

The mean LOS was 21.2 ± 9.6 and 21.5 ± 12.3 days (P = 0.927), thrombocytopenia occurred in 27.8% and 34.1% (P = 0.629), and 84.1% - 88.9% of newborns required mechanical ventilation (P = 1.0). The seizure was observed in 93.2 -94.4% of newborns (P = 0.29), and multiple anti-seizure drugs were required in 35.3% and 48.9% of EPO and control groups retrospectively (P = 0.66). The mortality rate was significantly different between the EPO and control groups (11.1% vs 44%; P = 0.02).

High-dose EPO can reduce the mortality rate of neonates with HIE when used in addition to head cooling compared to head cooling alone.

Diagnosis of childhood pulmonary tuberculosis (TB) is often based on clinical features in combination with radiologic findings because of paucibacillary nature of the disease in children. It may be difficult to make a clinical diagnosis because of the overlapping clinical features of pulmonary TB and community-acquired pneumonia (CAP). On computed tomography (CT) scanning, the presence of typical LAP can suggest TB as a possible cause.

To compare the features of mediastinal LAPs between two patient groups based on contrast-enhanced chest CT.

A total of 45 pulmonary patients with TB and 38 patients with CAP (aged ≤ 18 years) were enrolled in this retrospective study. The presence and CT features of lymph node involvement and the incidence of associating parenchymal/pleural findings were analyzed in two groups.

All patients with TB and 36 of the 38 patients with CAP had at least one mediastinal LAP. There was no significant difference between the two groups according to the incidence of lymph node and multiple site involvement and also involved lymph node stations (P > 0.05). However, lymph node size was larger in the TB group (P = 0.04). Twenty-two percent of patients with TB had mediastinal LAP without parenchymal/pleural involvement.

Although the lymph node size was larger in TB group than in CAP group, CT features of mediastinal lymph node involvement overlapped between two groups. Nevertheless, mediastinal LAP without parenchymal/pleural involvement on CT is seen in a significant number of TB patients.

Acute leukemia is one of the most common malignant tumors in children, and it is mainly treated with a combination of chemotherapy and hematopoietic stem cell transplantation. At present, there are many problems with these treatments, such as significant adverse reactions, quick acquisition of drug resistance, and early recurrence. There are no reports on the treatment of leukemia by the mitophagy pathway. Therefore, exploring new ways to treat leukemia has become an urgent task for the effective treatment of leukemia.

This study aimed to explore the role of the mitochondrial autophagy-mediated apoptosis pathway in deferoxamine (DFO)-induced apoptosis of HL-60 cells and provide an additional experimental basis for the clinical treatment of leukemia with DFO.

Through cell viability detection, Hoechst 33342 staining, and annexin V-APC/7-AAD double staining, we proved that DFO could induce apoptosis in HL-60 cells. Through the determination of intracellular reactive oxygen species (ROS) levels, western blot detection of the mitochondria-related proteins, heat shock protein 60 (HSP60), nip-like protein X (NIX), translocase of inner mitochondrial membrane 23 (TIMM23), translocase of the outer mitochondrial membrane member 20 (TOMM20), quantitative real-time polymerase chain reaction (PCR) detection of the RNA levels of NIX, microtubule-associated protein 1 light chain 3 (LC3), and TIMM23, we demonstrated that DFO induced mitochondrial autophagy in HL-60 cells.

DFO induced apoptosis and mitochondrial autophagy in HL-60 cells.

This study demonstrated that DFO further induced apoptosis by inducing autophagy in leukemic cells, which provides another experimental basis for the clinical treatment of leukemia with DFO.

Acute respiratory distress syndrome (ARDS) is one of the common causes of death in children hospitalized in the pediatric intensive care unit (PICU). The overall case fatality rate is as high as 25%, and the case fatality rate is higher in severe cases.

This study aimed to analyze the clinical outcomes of extracorporeal membrane oxygenation (ECMO) supportive therapy in children with ARDS.

Sixteen ARDS children (8 boys and 8 girls aged 0.17 to 10 years old, with an average age of 3.25 years) were enrolled in this retrospective observational study. They were admitted to the PICU of a tertiary children’s hospital in China between January 2017 and March 2020. All patients received venous-arterial ECMO (veno-arterial, V-A ECMO) mode and were treated with heparin-coated ECMO-specific intravenous 8 - 19 Fr. catheter. Data were collected from medical records. General characteristics included gender, age, body weight, ventilator use before ECMO establishment, ECMO operation mode, ECMO operation hours, number of fiberoptic bronchoscopy assisted treatments, days on the ventilator after ECMO evacuation, total days on the ventilator, days of hospitalization, pathogen infection, primary disease/underlying disease, complications during ECMO therapy, comparison of monitored values of children 1 hour before and after ECMO establishment, analysis of the causes of complications during ECMO treatment in ARDS children.

The time in 16 cases of ECMO support ranged from 92 to 759 hours, with an average time of 255.13 hours. All patients survived the ECMO treatment, except for 1 case who died due to intracranial bleeding. Monitoring values, such as FiO2, mean airway pressure (MAP), blood pH, partial pressure of carbon dioxide (PCo2), etc., were statistically significantly different before and after ECMO establishment. There were 34 person-time complications during ECMO operation, among which hypertension was the most common. At follow-up (1 month to 3 years, until February 2020), 15 children were found to have good lung function.

Early ECMO-assisted treatment in children with ARDS can improve their survival rate.

Dental caries is one of the most common childhood problems, which is associated with other diseases, such as malnutrition.

This study aimed to investigate the effect of early childhood caries (ECC) treatment on the body mass index (BMI) of children, aged 3 - 6 years.

In this longitudinal case-control study, 96 children, aged 3 - 6 years, were recruited and divided into three groups (n = 32 per group). A questionnaire was completed for each child, and the decayed, missing, and filled Teeth (dmft) index was measured via clinical examination, according to the World Health Organization (WHO) criteria. Anthropometric measurements were performed in each group to assess BMI at baseline and after six months. The first two groups were diagnosed with ECC. For group I, a comprehensive dental treatment was performed under general anesthesia at baseline, while for group II, no treatment was applied during six months. Group III consisted of caries-free children. Data were analyzed using ANOVA, independent t-test, paired t-test, Mann-Whitney U test, and Kruskal-Wallis test (P < 0.05).

The mean and standard deviation of the dmft index were 7.09 ± 2.40, 5.19 ± 1.72, and zero in groups I, II, and III, respectively. The BMI changes after six months were 0.11 ± 0.42, 0.00 ± 0.39, and -0.04 ± 0.64 kg/m2 in groups I, II, and III, respectively. The mean BMI significantly changed in the three groups within six months (P = 0.034). In group I, the BMI changes were significantly greater than the other two groups (P = 0.004).

Although a significant negative relationship was found between ECC and BMI, oral hygiene and nutritional behavior were the main confounding variables. Based on the findings, treatment of ECC had a significant positive effect on BMI; therefore, it is important for healthcare professionals to identify and treat children at risk.

Foreign body aspiration is a common accident with life-threatening outcomes. Rigid bronchoscopy is considered an effective tool in the diagnosis and treatment of this complication; however, there is still no agreement on the preferred ventilation method for the treatment of patients with foreign body aspiration.

This study aimed to compare the cardiovascular and respiratory outcomes followed by ventilation methods in patients with foreign body aspiration undergoing rigid bronchoscopy.

In this cross-sectional study, the information was recorded from 90 patients’ files, including age, gender, aspirated foreign body, interval from aspiration to referral, signs, and symptoms, comorbidity, bronchoscopic results, ventilation method during the procedure, occurrence of respiratory complications, heart rate, blood pressure, arterial oxygen saturation, length of hospital stay, and mortality of patients. The data were analyzed by SPSS software (version 22). A p-value less than 0.05 was considered statistically significant.

Out of 90 reviewed cases, 57.67% were male, and the mean age was 2.06 ± 1.25 years. The most common aspirated foreign body was peanuts (38.89%). The most common clinical signs were cough (81.11%) and wheezing (51.11%). The most common symptoms were wheezing (54.44%) and decreasing respiratory sounds (46.67%). Bronchoscopy was associated with foreign body extraction in 65.6% of the patients. The relationship between the ventilation method with blood pressure changes, length of hospital stay, cardiopulmonary complications, and oxygen saturation was not significant; however, the cases with spontaneous breathing referred at shorter intervals from aspiration and experienced fewer heart rate changes.

The results of the present study showed no preference between spontaneous and controlled ventilation during rigid bronchoscopy in patients with foreign body aspiration.

Sleep is a central component of brain development. Preterm neonates follow an exclusive sleep-wake rhythm in a way that they can sleep up to 22 hours per day, 70% of which is spent during active sleep. Sleep can create a period of time for the production of active neurotransmitters, which can enhance brain development flexibility.

It is a matter of controversy whether the widespread use of nonsynchronized nasal intermittent positive pressure ventilation (NIPPV) in neonatal intensive care units and the concerns over the use of nonrespiratory support can affect the quantity and quality of the sleep-wake cycle (SWC). Therefore, the current study aimed to compare two types of intervention, nasal continuous positive airway pressure (nCPAP) and NIPPV, during the SWC.

The present randomized controlled trial crossover study was conducted on neonates with 28 - 32 weeks of gestation receiving nCPAP who had been administered surfactant after being diagnosed with respiratory distress syndrome in Shahid Beheshti hospital in Isfahan, Iran, within March 2018 to August 2020. The SWC was monitored using cerebral function monitoring for all study participants.

The present study showed no significant difference between the number of SWCs during nCPAP and NIPPV. The duration of SWCs when participants received nCPAP was significantly higher than when they received NIPPV intervention. Rapid eye movement (REM) sleep duration was significantly longer during nCPAP respiratory support. Furthermore, NonREM sleep duration was significantly longer in nCPAP respiratory support.

Noninvasive respiratory support modes can affect the SWC, with nCPAP being the favored in the present study. Nonetheless, further studies are required to be performed in this regard.

Acute lymphoblastic leukemia (ALL) is a malignancy of the white blood cells characterized by its rapid and aggressive progress that needs immediate treatment. ALL could affect both adults and children. Various patient- and disease-related factors may be involved in ALL patients’ prognosis. Therefore, it is critical to identify important risk factors related to the competing outcomes of patients with ALL.

This study aimed to stratify the risk of outcomes of children with precursor B-cell ALL using demographic characteristics, laboratory characteristics, and extramedullary diseases. To achieve this goal, we used the best competing risks model to make an appropriate decision for children's treatment according to this classification.

In this retrospective cohort study, 393 patients with ALL were included. ALL with B cell origins (CD20, CD19, CD10, and CD22 positive markers) was differentiated using flow cytometry. Complete remission was defined by a lymphoblast count of less than 5% in the bone marrow, presence of no blasts in cerebrospinal fluid (CSF), as well as complete disappearance of clinical symptoms. Patients with ALL were treated based on Berlin-Frankfurt-Münster (BFM). Competing outcomes were first-relapse and non-relapse mortality, respectively. Risk factors affecting competing outcomes were assessed based on a fully specified sub-distribution model.

Five-year estimates for overall survival and event free survival were 75% (95% CI: 69 - 79%) and 71% (95% CI: 66 - 75%), respectively. Five-year incidence rates for first-relapse and non-relapse mortality in children were 11.4% (95% CI: 8.32 - 15.16%) and 17.6% (95% CI: 13.98 - 21.67%), respectively. Moreover, according to the results, children with WBC > 50000, hemoglobin 8, and tumor lysis syndrome for the first-relapse outcome, and children with central nervous system (CNS) involvement and tumor lysis syndrome for the non-relapse mortality (NRM) outcome were considered as high-risk groups.

We found that extramedullary diseases could have a crucial role in the risk stratification of children with precursor B-cell ALL. Therefore, for a targeted and effective treatment of high-risk children, in addition to chemotherapy, using appropriate PI3K pathway inhibitors, JAK2 pathway inhibitors, and antibody-based immunotherapy is recommended to reduce minimal residual disease and, consequently, mortality rate.

Biotinidase (BTD) deficiency may lead to variable neurologic manifestations. Spinal cord involvement can be an unusual presentation of the late-onset disorder.

We describe a six-year-and-ten-month-old girl with a previous history of recurrent upper respiratory tract infections, frequent falling four years before admission, gradual vision loss, and subacute progressive limb weakness followed by flaccid quadriplegia during admission. The measurements of cerebrospinal fluid (CSF) lactate showed significant elevation. And spinal MRI revealed longitudinally extensive cord involvement, mimicking acquired demyelinating syndrome; however, there was no response to plasma exchange. Profound biotinidase deficiency was confirmed by enzyme assay; the patient revealed dramatic recovery after the biotin prescription. The genetic analysis showed a homozygous missense variant BTD (NM_001370658.1): c.838A>C (p.Asn280His) in exon 4, thereby predicting pathogenic based on the ACMG guidelines. To the best of our knowledge, this is the first Iranian report on BTD deficiency.

In summary, in each patient with longitudinally extensive cord involvement not well responding to the conventional treatment, BTD deficiency should be considered on differential.

Lupus nephritis is common in pediatric systemic lupus erythematosus (SLE). The presence of full-house immunoglobulin deposits is a unique feature for histopathological diagnosis in lupus nephritis. Our case report highlights two cases with antinuclear antibody (ANA) negative full-house nephropathy (FHN), their clinical phenotypes and intermediate long-term renal outcome. A review of the pediatric literature on this clinical entity ensued.

Two girls, aged three and nine years old presented with acute onset of kidney impairment. One needed temporary dialysis support. Both showed hypocomplementemia and biopsies concurred with FHN. Notably, ANA was absent in both patients. They achieved complete remission soon after introducing immunosuppressive therapy and the disease remained quiescent for many years thereafter. ANA remained negative during surveillance.

There have been reports on a possible incomplete form when the characteristic of FHN is seen in isolation. Although natural history of this entity remains uncertain, most literature reports apparent long-term remission following the initial episode. ANA positivity, as an obligatory criterion of diagnosing lupus nephritis (LN), recommended in the new EULAR/ACR 2019 guideline, may raise many uncertainties for this group of patients. There is a need to elucidate whether this should continue to be perceived as part of a lupus continuum or it may be considered a unique clinical entity? Such uncertainties possibly subject the child and his/her caregivers to perpetual mental stress.