Iranian Journal of Pediatrics
Volume:32 Issue: 5, Oct 2022

 One of the most common childhood abnormalities is constipation, typically affecting about 1 - 30% of children worldwide.

 This study aimed to compare the effect of psyllium seed husk powder versus polyethylene glycol with and without probiotics on constipation in children.

 A total of 144 children in the age range of 2 - 12 years with acute functional constipation who met the inclusion criteria were included in this study. The subjects were randomly divided into four equal groups (n = 36 each). The first group received polyethylene glycol (A), the second group received polyethylene glycol with probiotics (B), the third group received psyllium (C), and the fourth group received psyllium with probiotics (D). Finally, the number of bowel movements and painless bowel movements were examined after three weeks.

 After three weeks, the effects of polyethylene glycol with and without probiotics on the number of bowel movements and painless bowel movements were significantly different than psyllium with and without probiotics (P = 0.001). While no significant difference was observed between treatment groups A and B (P = 0.9), there was a significant difference between treatment groups C and D (P = 0.01).

 Polyethylene glycol had a greater effect on improving the symptoms of constipation in children compared to psyllium. Although fortification of polyethylene glycol with probiotics had no significant effect, fortification of psyllium with probiotics improved the symptoms of constipation in children compared to psyllium alone.

A 6-year-old boy was referred to our hospital because of the stiffness of both knees, which had commenced two years ago and gradually progressed to both hips, ankles, elbows, fingers, and toes. He occasionally had arthralgia with no complaint of joint swelling. He had a long face, a prominent forehead and chin, and a short neck. There was a limitation in the range of motion in all appendicular joints with stiffness and deformity.

Skeletal survey images revealed central beaking and a bullet shape appearance in the cervical and lumbar vertebra, tapering of iliac wings, deformity of the femoral head, and short sacral length. A +3 glycosaminoglycan (GAG) excretion was detected in the urine test, but genetic analysis revealed Mucolipidosis type III.

The diagnosis of metabolic diseases should be considered whenever there is joint stiffness without any evidence of inflammation. Mucopolysaccharidoses and Mucolipidoses are progressive storage disorders with many clinical and radiological characteristics.

There is little data about the surgical outcomes of different procedures in children.

We aimed to compare the difference in three-year surgical outcomes between laparoscopic sleeve gastrectomy laparoscopic sleeve gastrectomy (LSG) and one-anastomosis gastric bypass one-anastomosis gastric bypass (OAGB) in children undergoing these procedures.

A total of 96 children aged ≤ 19 years were listed for bariatric surgery to be included in this prospective study. Demographic characteristics, such as age and gender, and anthropometric indices, including height, weight, body mass index, waist circumference, and hip circumference, as well as postoperative complications, were recorded. The participants underwent LSG and OAGB by the same surgical team. The variables were compared between the groups at baseline and 1, 3, 6, 12, 24, and 36 months after surgery.

At follow-up, the OAGB group had a higher waist circumference after 1 and 3 month(s) (P = 0.011 and 0.005, respectively) and higher hip circumference 3 months after surgery (P = 0.035). Time significantly affected the trend of changes in weight, body mass index, waist circumference, and hip circumference (P < 0.001). There were no cases of postoperative complications.

Our experience showed that LSG had better outcomes after three months, while LSG and OAGB had favorable outcomes on the weight and body mass index (BMI) of children with morbid obesity until three years after surgery.

Patent ductus arteriosus (PDA) stenting was invented particularly for congenital heart diseases with ductal-dependent pulmonary blood flow, and newer techniques are constantly being introduced.

In this study, we investigate the one-year results of this procedure and describe some of our periprocedural considerations.

The neonates with pulmonary atresia and ventricular septal defect (VSD) who underwent PDA stenting in our center from February 2016 to December 2019 were included in this retrospective study. Spo2 and McGoon ratios were recorded before and a year after stenting and compared to each other.

In 26 neonates, PDA stenting was performed; 20 procedures (77%) were successful, and six procedures (23%) were unsuccessful. Two of these unsuccessful cases died during the procedure, and two of them died as a result of neonatal sepsis following the procedure. A total of 18 PDAs (70%) were accessed via the axillary artery, 6 (23%) via the femoral artery, and 2 (7%) via the antegrade inferior vena cava route. The comparison between the results before and one year after stenting revealed the increase of O2 saturation from 53.78 ± 7.35 to 84.33 ± 6.5 (P-value = 0.032) and McGoon ratio from 1.16 ± 0.25 to 1.65 ± 0.34 (P-value = 0.041). Additionally, we discussed some technical considerations of PDA stenting, including the access point, management of pulmonary artery bifurcation stenosis, stent diameter, stenting of long and tortuous PDAs, thrombosis, and anticoagulation.

Ductal stenting increases SpO2 and McGoon ratio and could be a less-invasive option for securing pulmonary blood circulation. However, further studies are required to advance PDA stenting techniques for specific anatomical features.

Constipation is one of the most common complaints in children. Guidelines on functional constipation recommend digital rectal examination (DRE) when constipation is suspected. However, diagnosis of megarectum by ultrasonography would differentiate children with constipation from those with dysfunctional defecation.

In this research, we evaluated the utilization of ultrasonography to measure the diameter of rectal ampulla for the diagnosis of functional constipation.

In this study, 94 patients < 14 years old diagnosed with functional constipation were included. Patients were examined by both DRE and ultrasonography before and after a conventional stool softener treatment.

The diameter of the rectal ampulla was significantly wider in patients with large stool mass in DRE than in patients with normal digital rectal exams. There was a significant relationship between fecal incontinence and pre-treatment DRA. By increasing the severity of fecal incontinence, the average DRA in patients increased significantly. Additionally, there was a significant statistical difference between the patient’s DRA before and after treatment. Finally, the relationship between constipation and DRA adjusted model showed that the risk of abnormal DRA was 3.1 times larger in patients with three and four symptoms than in patients with two symptoms and this relationship was statistically significant.

Ultrasonography can be a suitable replacement for DRE; however, further investigations are required.

There are insufficient studies on clinical and environmental factors that affect the use of emergency medical services (EMS) in pediatric patients.

We sought to identify the clinical characteristics of pediatric patients transported to the emergency department (ED) by EMS and meteorological factors affecting the use of EMS.

We reviewed the medical records of patients younger than 19 years who visited the ED from January 2005 to December 2019.

The rate of EMS use was higher among older patients [adjusted odds ratio (aOR): 1.12; 95% confidence interval (CI): 1.11 - 1.13] and increased with disease severity (aOR: 0.35; 95% CI: 0.33 - 0.37 for KTAS and aOR: 0.73; 95% CI: 0.70 - 0.77 for GCS). The rate of EMS use was higher in patients with injury than in those with disease (aOR:3.47; 95% CI: 3.15 - 3.83). Compared with winter, the summer season was a risk factor for EMS use (aOR: 1.36; 95% CI: 1.08 - 1.72). Precipitation greater than 40 mm per day increased the risk of EMS use (aOR: 1.31; 95% CI: 1.03 - 1.72), as did higher concentrations of O3 and NO2 (aOR per 0.001 ppm: 1.006; 95% CI: 1.001 - 1.011 for O3 and aOR per 0.001 ppm: 1.02; 95% CI: 1.01 - 1.03 for NO2, respectively).

Several clinical characteristics, meteorological factors, and air pollutants might increase the risk of EMS use among pediatric patients.

Age estimation is of great importance in many medical fields and dentistry. It is also extensively used in archeology, criminology, and forensic medicine. Considering the importance of dental age estimation, this study was designed.

This study aimed to evaluate the accuracy of Demirjian and Willems methods for estimating the dental age of 7 - 15-year-olds population of the north of Iran. We also modified the Willems method for this population and compared the results of the modified and original Willems methods.

In this cross-sectional, descriptive, analytical study, a total of 1320 panoramic radiographs in the age range of 7 - 15 years, were examined. Dental age was determined by the Demirjian and Willems methods and compared with the chronological age. Next, a formula based on the Willems method was formulated. Finally, the results of the modified and original Willems methods were compared.

The Demirjian method overestimated the chronological age by 0.49 years (0.57 for girls and 0.36 for boys), and the Willems method overestimated this age by 0.07 years (0.03 for girls and 0.14 for boys), too. The mean error of the modified Willems method was zero for the total sample, although for most age subgroups, the modified method was more erroneous than the original method. Demirjian method had larger overestimations for girls than for boys, whereas the opposite was found for the Willems method.

The Demirjian and Willems methods both overestimated the chronological age. However, the overestimations were smaller in the Willems method. Based on the findings, the original Willems method was the preferred choice for age estimation.

Accurate information on the causes of child mortality is required to achieve Millennium Development Goal 4 (MDG4). The causes of child mortality are used to assess the pattern of diseases and make health policies. The accuracy of these mortality statistics depends on the proper completion of death certificates.

The study aimed to measure the sensitivity and positive predictive value (PPV) of death certificates obtained from the hospital information system (HIS) in a children's specialized hospital in Iran.

This cross-sectional study assessed death certificates of 580 children of 1-59-month-old died in the hospital from 2011 to 2018. Pediatricians identified the minor and major errors and the underlying causes of death (COD). A misclassification matrix was used to measure agreement, sensitivity, and PPV using multiple causes obtained from death certificates and pediatrician reviews.

The HIS had a sensitivity of 43.27% and a PPV of 39.37%. The highest sensitivity was 73.33% for kidney diseases and urinary tract infections, and the lowest sensitivity was 18.18% for diarrhea and dehydration. The HIS had the highest PPV for accidents and injuries and the lowest PPV for diarrhea and dehydration (65.63% and 20.69%, respectively). The most identified underestimation and overestimation numbers were related to "respiratory disease and pneumonia" and "cardiac arrest", respectively.

A large proportion of CODs in death certificates were registered inaccurately. The mortality statistics should be used with caution for planning and policy-making.

Tranexamic acid (TXA) is an inexpensive therapy effective at minimizing perioperative blood loss and transfusion. However, it remains underutilized due to safety concerns. Cleft lip and cleft palate are among the most frequent congenital anomalies, accounting for 65% of head and neck anomalies, and 15000 neonates are born with these anomalies annually.

This study aimed to investigate the effect of preoperative intravenous TXA on hemorrhage in patients undergoing cleft palate reconstruction surgery in the Khatam Al-Anbia Hospital, Zahedan, Iran.

This clinical trial was conducted on 60 patients undergoing palatoplasty in the Khatam Al-Anbia Hospital. The patients were randomly assigned into two groups: TXA receivers and controls. Data were collected using information forms and then analyzed using SPSS ver. 22.

The mean age of the participants was 21.42 ± 9.46 months, and of the 60 patients, 31 were boys, and 29 were girls. The mean bleeding volume was 11.73 ± 4.42 milliliter in the TXA receiving group and 17.36 ± 4.99 milliliters in the control group, and the mean duration of surgery was 41.90 ± 8.00 and 49.93 ± 11.37 minutes in the TXA receiving and control groups, respectively. The mean PT, PTT, and Hb were not significantly different before and after surgery in the two groups.

Tranexamic acid causes a significant reduction in the duration of surgery and mean bleeding volume in palatoplasties, but it has no effects on PT, PTT, and Hb levels before and after surgery.

 New parameters called the pelvis-cortex (P/C) ratio, and percentage of pelvic improvement (PI) in the anteroposterior diameter (APD) are used for patients with ureteropelvic junction obstruction who have undergone pyeloplasty. Early improvement in these ultrasonic parameters can prevent isotope scanning for a successful repair.

 The data of pediatric patients (age range: 0 - 14 years) who underwent open pyeloplasty in Mofid Children Hospital pediatric surgery ward from 2017 to 2021 with follow-up longer than 12 months were analyzed retrospectively. This study encompassed only those children whose ultrasound and Technetium-99m diethylene triamine pentaacetic acid (DTPA) renal information were available before and after surgery.

 A total of 67 patients meeting inclusion criteria were registered. The mean age at operation was 30 ± 37.44 months. The mean pelvic APD before surgery was 33.93 mm. The mean kidney cortex diameter before surgery was 5.26 ± 2.07 mm. The mean P/C ratio before surgery was 7.56 ± 4.38. The mean preoperative split renal function was documented at 42.23%. The mean follow-up duration was 32 months. The mean APD 3 months after surgery was 18.1 mm. The mean kidney cortex diameter 3 months after surgery was 6.72 mm. The mean P/C ratio 3 months after surgery was 3.09. The PI in APD 3 months after surgery was 43.29%. The mean APD 6 months after surgery was 15.43 mm. The mean kidney cortex diameter 6 months after surgery was 7.24 mm. The mean P/C ratio 6 months after surgery was 2.8. The mean PI in APD 6 months after surgery was 50.83%. The mean postoperative tracer clearance half-time in diuretic renography was 20.77 minutes. In receiver operating characteristic curve analysis, it was observed that PI in APD > 12% in 3 months after surgery versus DTPA 6 months after surgery could predict successful pyeloplasty with sensitivity, specificity, and area under the curve (AUC) equal to 98.44%, 66.67%, and 0.87, respectively. The PI in APD > 26% 6 months after surgery versus DTPA 6 months after surgery could strongly predict successful pyeloplasty with sensitivity and specificity of 100% and AUC of 1.

 This study identified that PI in APD > 26% at 6 months after surgery can strongly predict successful pyeloplasty and is a strong predictor of surgical outcome. Unnecessary repeated nuclear scans 6 months after surgery can be avoided using the aforementioned parameter.

 Sepsis is one of the major causes of disability and death in the pediatric population globally. Although metastasis-associated lung adenocarcinoma transcript 1 (MALAT1) has been reported to be associated with the survival of adult patients with sepsis, its prognostic value in children has not been identified.

 The present study aimed to evaluate the role of MALAT1 in the prognosis of severe sepsis in children.

 A total of 60 children with severe sepsis were included in this research. Serum level of MALAT1 was assessed at baseline, and the survival data were recorded during a follow-up of 28 days. These participants were categorized into high or low MALAT1 groups based on the median value. Multivariate Cox regression was performed to explore the association of MALAT1 level with the survival of pediatric patients with sepsis after controlling for potential confounding factors.

 The 28-day mortality rate of severe sepsis was 35%. The expression of MALAT1 in the non-survivors was significantly higher than in the survived patients (P < 0.01). The multivariate Cox proportional hazards model, showed that a higher MALAT1 expression was associated with a higher risk of mortality in patients with severe sepsis (HR = 6.70; 95% CI: 1.65 - 27.2; P < 0.01).

 According to our results, MALAT1 might be a promising marker for predicting the prognosis of severe pediatric sepsis.

The recent pandemic is caused by the new coronavirus (COVID-19). The disease primarily affects adults but can also affect children of all ages, including infants. It is not known what the prevalence of this disease is in children, but it is evident that the severity of symptoms in children and infants is less than in adults.

Fifteen neonates with COVID-19 were reported in this paper who were hospitalized in neonatal intensive care units. Five of the neonates were preterm, and all of them tested positive for PCR. The most common symptom was respiratory distress. During their hospitalization, five neonates died.

The results of this study indicate that clinical manifestations, laboratory findings, and radiological findings are less severe in infants than in other ages. Consequently, it can be predicted that the prognosis for infants will generally be favorable.

Foreign bodies (FBs) in the external auditory canal (EAC) are common in pediatric otorhinolaryngology. Although clinicians have tried many methods and tools to treat these patients, removing the spherical FBs embedded deep in EAC is still a challenge. Occasionally successful removal of such FBs requires local or general anesthesia.

Here, we developed a simple and novel 3-dimensional (3D) printing tool to successfully treat a child suffering from a spherical FB in EAC. The child received no further treatment, and no complications developed afterward.

It is challenging to remove spherical FBs in EAC. We developed a tiny, safe, and cheap tool to treat a child with such a FB in EAC. The clinical outcome was satisfactory.