International Journal of Pediatrics
Volume:10 Issue: 107, Nov 2022

This bibliometric analysis and visualization aimed at depicting bibliometric indicators of papers published globally in pediatrics during the recent three decades.

Using Web of Knowledge database, all papers published on pediatrics during 1990-2020 were retrieved. Bibliometric data on paper type, language, and publishing year, and publishing journal, country of origin, affiliated institutes, and subject areas were extracted. Using visualization techniques in VOSviewer software package, the collaboration / co-authorship networks, co-citation maps and keyword co-occurrence maps were depicted.

Top hot papers were mainly on childhood overweight and obesity, cerebral palsy, and body-mass index. David Isaacs, Prem Puri and Anne were the top most productive authors. Seetha Shankaran from Wayne State University, USA, ranked first in citation counts. Top publishing journals were Pediatric Research, Pediatric Blood and Cancer and Pediatrics, respectively. Highly-productive countries were the USA and UK, respectively. Among research areas, neurosciences neurology, oncology and surgery were heavily considered and had top h-indices, respectively. Five subject clusters focused on diseases, metabolism, neurology, psychiatry and immunology. These clusters cover all main research areas in the field, each with its own research methodologies and highlighted keywords.

Global research on pediatrics found its way and ever-increasingly develops as its bibliometric indicators clearly show.

Premature rupture of membrane (PROM) is an important problem among pregnant women, which leads to maternal and neonatal morbidity. This study was done to compare the efficacy of azithromycin with erythromycin on the pregnancy length and the neonatal adverse effects in mothers with PROM.
In this open-label randomized clinical trial, 194 pregnant women with PROM who referred to Akbarabadi Hospital were enrolled and randomly assigned to two groups. Group I received oral Azithromycin (1 gr/orally, Abidi Company,  Iran ) + Ampicillin 2 gram  IV (Abidi Company, Iran)  every six hours for 48 hours; then, only Amoxicillin 500 mg every eight hours for five days. and group II received intravenous Erythromycin (Abidi Company, Iran) 400 mg every six hours for seven days + Ampicillin 2 grams IV every six  hours for 48 hours, then Amoxicillin 500 mg every six hours for five days. Finally, the pregnancy length and neonatal adverse effects or neonatal outcomes were compared between the two groups.
There was no significant difference between the groups in mean of pregnancy length (32.5 versus 32.6 weeks, respectively, p=0.757)  Also the frequency ofIntraventricular hemorrhage, Necrotizing enterocolitis, Respiratory Distress Syndrome sepsis, icter, oxygen demand, ICU admission, duration of hospitalization in the NICU, and mortality in neonate were the same between the groups. The mean of patient satisfaction (by self-report) was 9.8 and 9.5 in group I and II, respectively (P=0.001).
It can be concluded that oral azithromycin and intravenous erythromycin have the same effect on increasing the duration of pregnancy and reducing neonatal complications in women with PROM. But azithromycin was associated with greater satisfaction and its use is recommended.

The factors affecting children’s growth and development have been discussed in various research studies. This study evaluates the association between growth and development of under 12-month-old children in Iran. This cross-sectional study uses the Ages & Stages Questionnaire (ASQ) data and demographic characteristics in the child's health records of 15,885 Iranian children in Arak city up to March 2017. The impact of growth disorder, type of delivery, preterm birth, at birth weight/height/head circumference, gross motor, problem-solving, personal-social, communication, and fine motor on the participants’ head circumference/weight/height was assessed. Unadjusted analyses were done using independent sample t-test, Pearson correlation test and one-way analysis of variance. Multiple multivariate regression was utilized for adjusted effects. P-values less than 0.05 were considered statistically significant. Head circumference was associated with growth disorder, type of delivery, and preterm birth. Children with known and unknown growth disorders had 610.19 and 160.58 grams less weight than those without any growth disorder. Gross motor and personal-social aspects of ASQ were found to be associated with weight at the age of 12-month old. Height at 12-months was affected by growth disorder, gross motor, personal-social, communication, and fine motor. Results of this study show that cesarean type of delivery, preterm birth, and low birth weight are the impacting factors associated with negative children growth trends and lower developmental status at the age of 12 months.

This study aimed to compare the quantitative and qualitative components of IOTN index in determining the orthodontic treatment needed in High school students in Ahvaz, Iran.
This cross-sectional study was performed on 356 students aged 15-18 years. The samples were selected by cluster stratified method and the information was collected using IOTN index and clinical examinations. Statistical data were obtained using the descriptive analysis and chi-square test (P <0.05).
The findings showed that 51.94% of males and 80.5% of females had no or little treatment need, 17.94% of males and 3% of females had moderate and 30.12% of males and 16.5% of females had severe or extreme treatment needs. Regarding the aesthetic component of (AC), based on the student’s point of view, 76.5% of males and 98.8% of females had no or little need, 15.2% of males and 1.3% of females had moderate need and 8.3% of males and 0% of females had severe or extreme treatment need. According to the dentist's opinion, 93.6% of males and 90% of females had no or little need, 5.1% of males and 4.5% of females had moderate needs, 1.3% of males and 5.5% of females had definite needs for treatment. Comparing the DHC and the AC showed that the DHC-based orthodontic treatment need is higher.
Occlusion-based judgment is more accurate and less complex. Aesthetic-based judgment is descriptive, indefinite, and individualized, and depends on a variety of social, psychological, cultural, and ethnic factors, and is more complex. Therefore, in order to achieve a better quality of life, it is recommended to consider the aesthetic and appearance-related factors based on the patient's opinion.

When serum level of 25-hydroxy vitamin D [25(OH) D] decreases, intact Parathormone (iPTH) level increases compensatory. This study aimed to determine the cut off value for iPTH level in 2-14-year-old children with vitamin D (VD) deficiency.
This cross-sectional study was performed on 153 children aged 2-14 years old who referred to the endocrinology clinic of Amirkola Children's Hospital for growth assessment. Census sampling was conducted from January 2016 to June 2017 according to the eligibility criteria including height and weight above the percentile of 3% of growth charts and normal serum of calcium level (>8.5 mg/dl). Laboratory parameters such as serum calcium, 25(OH) D and iPTH levels were assessed. The children were divided into three groups based on serum levels of 25(OH) D as mild, moderate and severe VD deficiency. The Receiver Operating Characteristic (ROC) curve was used to analyze the cut-off point of iPTH and 25(OH) D. P-Value< 0.05 was considered significant.
The mean VD and iPTH levels in children were 11.8 ± 4.59 ng/ml and 28.3 ± 13.3 pg/ml, respectively. At the iPTH serum level of 23.5 pg/ml, with a sensitivity of 66.1%, there was a possibility of moderate to severe VD deficiency. In the severe deficiency group, at the iPTH serum level of 23.5 pg/ml and above, with a sensitivity of 78.9%, there was a possibility of severe VD deficiency. The cut-off point of 25(OH) D and iPTH, at the serum VD level ≤10 ng/ml were determined.
The results of the present study showed that the cut-off value for iPTH in children with VD deficiency is serum level of 25OHD≤10ng/ml.

Serum chloride disorders are common in critically ill patients and appear to be associated with worse outcomes in patients. However, less attention has been paid to the amount of chloride in critically ill patients.  This study aims to determine the frequency of serum chloride disorders and their possible association with disease outcomes in all children admitted to the pediatric intensive care unit (PICU).
This prospective study was performed on all patients admitted to the PICU of Akbar Children Hospital, Mashhad, Iran, from April 2019 to April 2020. Serum chloride levels were recorded daily on the first, second, and third days of the PICU stay. Statistical analyses were carried out using SPSS software (Version 24, SPSS Inc., Chicago, IL, USA) through one-way analysis of variance test, and Chi-square test in the significance level of α=0.05.
In this study, no significant relationship was observed between serum chloride levels and patients’ final status (P≥0.05). Serum Chloride level on the first day of PICU admission was significantly correlated with the length of PICU stay (r= 0.258, P= 0.029). There was no significant relationship between serum chloride levels and the patients’ need for mechanical ventilation on any of the three days (P≥0.05).
According to the results, serum chloride level can be considered as an indicator of the length of the PICU stay.

The long and painful process of wound healing, which requires special attention and makes it difficult to carry out daily activities, necessitates a combination of medical interventions which speed up wound healing and prevent injury exacerbation. This study aimed to investigate the combined effect of licorice, coriander, gallnut, sagebrush, Withania coagulans, and Pistacia atlantica subsp. kurdica on healing and repair of burn wounds.
A total of 48 mature Balb/c mice were used in this experiment, which were divided into four groups of 12. Hydroalcoholic extracts were prepared from mentioned plants. An artificial metal tool with a rod and a flat circular head of 1 cm in diameter was used to create a wound 1 cm in diameter in the dorsal region of the mice. Then, the animals were randomly euthanized and fixed in 10% formalin solution on days 4, 7, 10, and 14. Data was analyzed using ImageJ and SPSS software.
Inflammation and infiltration of neutrophils and lymphocytes were decreased significantly more in the treated group with the plant extract 10% SP than the control groups on days 10, 4, 4 and 14 (p. value < 0.001). The number of fibroblasts followed by collagen production, regeneration of epithelium and new hair follicles at the wound edges significantly increased in the 10% extract and 5% SP treated group on days 10 and 14 (p. value < 0.001). These parameters had a significant increase on day 14 even compared to the group treated with 5% extract and silver sulfadiazine (p. value < 0.001).
According to the results of this study, the used combined extract accelerated the wound healing process BALBmice.

The aim of this study was to investigate the effects of physical activity level on psychosocial distress among children during the COVID-19 pandemic, considering the mediating role of resilience.
The participants included 384 children aged 10 to 12 years (mean age of 11.10±0.73 years). Data was collected using standard questionnaires. Spearman correlation test and structural equation method were employed for analyzing the data.
Level of students’ physical activity was lower than the average (1.90), and psychosocial distress of our sample was higher than normal (49.77). The results showed that physical activity had significant effects on psychosocial distress (8.25) and resilience (10.17). In addition, resilience had a significant effect on psychosocial distress (5.98). Finally, resilience acted as a significant mediator in the association between physical activity and psychosocial distress (P<0.001).
These findings propose that physical activity can be assumed as an essential variable in coping with severe conditions during the COVID-19 pandemic.

Cerebral palsy (CP) is the most common type of permanent movement and postural disorder in children leading to contractures, deformities, and activity limitations. Quality of life is considered as an outcome variable to evaluate the effectiveness of interventions for children with CP. In this study, we aimed to examine how the quality of life is related to gross motor functions, manual abilities, and cognitive functions in children with CP. This research was a cross-sectional study on 200 children with CP aged 4-12 years selected through non-probability sampling. Quality of life, gross motor ability, hand function, and cognitive level were assessed using Cerebral Palsy Quality of Life Questionnaire (CPQOL), Gross Motor Function Classification System scale (GMFCS), Manual abilities Classification System Scales (MACS) and SPARCLE (Study of Participation of Children with Cerebral Palsy Living in Europe) scale. The results demonstrated that the CPQOL subscales was significantly correlated with the gross motor functioning (reference: GMFCS level one, p <0.05), manual ability (reference: MACS level one, p <0.05) and cognitive level in these children (reference: cognitive level >70, p <0.05). A poor performance child with CP has the potential to report poor QOL and it seems that a child with high level of performance has the potential to report better QOL. This needs more evidence for elaboration.

Hospitalization of an infant in an intensive care unit may disrupt the normal process of parent-infant attachment. This study aimed to evaluate the quality of attachment and determine its related factors in parents of infants with respiratory assist devices. This correlational descriptive study was conducted with 180 parents of infants with respiratory assist devices hospitalized in Mofid Children Hospital in Tehran, Iran. The data gathering instrument consisted of a demographic questionnaire and the Parent-Infant Attachment Questionnaire. The data was analyzed through SPSS version 22. The total score of attachment was 57.43+ and among the dimensions of the attachment questionnaire, the quality of attachment had the highest score. Also in parental and infant demographic variables, the previous history of hospitalization, father's age, and unit type were significantly correlated with attachment score. Moreover, regression results revealed that parent–pediatric attachment score of parents of infants admitted to the pediatric intensive care unit is 1.97 units less than that of the parents whose infants were admitted to NICU. And with the increase in father’s age, the rate of the parent–pediatric attachment to the child decreases by 0.19 and the history of the previous hospitalization leads to an increase in attachment to the infant by 3.76 units. Although the overall score of attachment in the parents of pediatrics dependent on the respiratory devices in the present study was undesirable, but the respiratory assisted device did not affect the parent-pediatric attachment score. Therefore, further studies are recommended to more accurately determine the relevant factors of the parent-pediatric attachment.

As a pediatric emergency, febrile convulsion is the most common form of seizure in children in the age range of four months to five years. Therefore, this study aimed to investigate the prevalence of bacterial meningitis among children with simple febrile convulsion.
In this retrospective study, all children aged 6 to 18 months presenting with the first episodes of simple febrile convulsions admitted to Dr. Sheikh and Imam Reza Pediatric Hospitals in Mashhad between 2011 and 2015 were tested for cerebrospinal fluid. Analysis of Age, Gender, cerebrospinal fluid, and cerebrospinal fluid culture was recorded.
From among 1,164 patients, 305 children were enrolled in this study. Out of them, 16 patients (5.2%) reported positive Lumbar Puncture outcomes, one (6.3%) of whom was less than one year old, and 15 (93.7 percent) were more than one year old. Six of these patients had received the MMR vaccine one to three weeks before admission. One of the patients who tested positive for Lumbar Puncture and had a negative cerebrospinal fluid culture was admitted to the hospital with personal consent. Aseptic meningitis was diagnosed with non-positive culture in the other nine patients. No bacterial meningitis was confirmed between the evaluated patients.
It is confirmed that the incidence of bacterial meningitis in simple febrile convulsion is very low. Therefore, the results may recommend avoiding routine Lumbar Punctures in patients with simple febrile convulsion.

When a child is diagnosed with cancer, parents face many logistical and emotional difficulties that can impact their relationship significantly. We aimed to investigate the effectiveness of the couple's communication skills on marital instability, marital adjustment, and the quality of couples with pediatric cancer. The population of this quasi-experimental included all the parents of children with cancer in Ahvaz, Iran, from 2019- 2020. Samples of the study were selected using purposive sampling and randomly divided into two groups; one experimental (communication skills) (n=15), and one control (n=15). Both groups underwent 10 sessions of treatment for one-hour while the control group was not provided with any therapy from the second half of October until the second half of December 2020. The subjects were assessed before and after the treatment using the marital instability index (MII), the Dyadic Adjustment Scale (DAS), and the WHOQOL – BREF Questionnaire. Data were analyzed using SPSS software version 23.0. The total sample included 30 couples, of which 35% were in the age group of 38-34 years, 35% were in the age group of 43-39 years, and 30% were in the age group of 44-48 years. The results of an analysis of covariance showed that training couples in communication skills had significant effects on reducing the parents’ Marital instability (f=88.14; P=0.001), increasing their Marital adjustment (f=13.88; P=0.001), and increasing their quality of life (f=12.93; P=0.001). It seems that training couples in effective communication skills can reduce their marital instability, along with increasing their marital adjustment and quality of life.

Bronchopulmonary dysplasia is one of the most common disorders in premature infants and this study aimed to investigate the role of sildenafil in the treatment of neonatal chronic lung diseases.
In a placebo-controlled clinical trial study, a total of 40 neonates were included and randomly divided into control and intervention groups; sildenafil tablets were used at a dose of 2mg per kg for 8 hours in the intervention group and placebo with the same characteristics in the control group. After a period of 10 days, oxygen demand, type of respiratory support, changes in pulmonary artery pressure, Length of hospital stay, and systemic blood pressure changes were measured.
Duration of admission significantly decreased in the intervention group (P value = 0.006). For the neonates in the control group from approximately 11 days after the start of treatment (11/47±9/19) and for those in the intervention group from approximately 8 days after the start of treatment (8/21±3/84), respiratory support with positive pressure was changed to respiratory support with free flow oxygen. No severe systolic or diastolic blood pressure change was observed in any of the groups. Decrease in pulmonary pressure was significantly higher in the intervention group than that in the control group (21/1% and 68/4%, respectively) (P value: 0.003).
The results of the study showed that sildenafil significantly reduced the length of hospital stay, the duration of the need for respiratory support and oxygen administration, and corrected the pulmonary pressure. No specific side effects were found

Congenital heart diseases (CHDs) can cause death and severe disorders in the developmental process of children and, in most cases, are associated with other congenital defects. The current study investigates the prevalence of such defects among infants born in 2019 and 2020. This analytical cross-sectional study was conducted in Ilam province on 91 referred neonates, with the possibility of heart diseases, who were diagnosed with CHDs. Demographic, clinical, and definitive diagnoses of cardiologists were recorded and analyzed in these infants, followed by a 6-month follow-up. Data were analyzed using SPSS software with descriptive statistics, Chi-square test, and correlation coefficients. A total of 91 infants out of 16,064 newborns were diagnosed with CHDs, and the prevalence of heart diseases was 5.9 in every 1000 live births. The most frequent defects were ventricular septal defects (VSDs) and PDA, with prevalence rates of 59.3% and 14.2%, respectively. Among 54 VSDs, mus VSD (n = 39) was the most common form of this disorder. The incidence of CHDs in Ilam province was lower than the global average, which may be attributed to the easier access of several cities to the health centers of the bordering provinces. The highlighted results of this study were the frequency of VSDs and the high rates of muscular VSD compared to membranous VSD.

Osteosarcoma (OS) is an uncommon bone cancer presented by tissue swelling and nonspecific bone pain. In case of distant metastasis, this malignancy commonly invades the lungs. Skip metastasis is an uncommon type of invasion originating from the malignant bone to adjoining bone tissues detected by magnetic resonance imaging (MRI) with high accuracy. Skip metastasis is an uncommon finding in plain radiography of osteosarcoma cases.

In the current study, we have reported a case of juvenile osteosarcoma with multi-focal skip metastasis, detected by simple plain radiography at first assessments. Further imaging and pathology assessment confirmed skip lesions in the background of high-grade chondroblastic osteosarcoma. Despite the recommendations, the patient and his legal guardian did not consent for further follow up and treatment.

Skip metastases are rarely diagnosed by plain radiography in OS cases. This condition is usually diagnosed by magnetic resonance imaging. Here, we reported a neglected and late-diagnosed case of osteosarcoma with skip lesions in a young boy, simply detected by X-ray. The following article concentrates on the importance of detecting these metastases for their correlation with patient’s survival, and describes different imaging modalities for finding them.

Recent reports of febrile and inflammatory syndromes have emerged in communities with high levels of Coronavirus infection. The syndrome has been referred to as Multisystem Inflammatory Syndrome (MIS-C). Herein, we report a case of a 12- year–old boy with MIS-C, who presented initially with enlarged cervical lymphadenitis and retropharyngeal edema.