International Journal of Pediatrics
Volume:11 Issue: 113, May 2023

Causes of visual impairment among children vary worldwide. While there is a scarcity of such data, this study aims to describe the profile of a large cohort of visually impaired children. In addition, it will provide evidence to advocate the importance of the provision of low vision services to children and improve referrals for such services.

A retrospective study reviewed the profile of visually impaired children who attended a multidisciplinary vision rehabilitation service in the period of 2011-2021. Recorded data included demographics, clinical attributes (Binocular best-corrected distance visual acuity BCVA, near visual acuity, contrast threshold, causes of visual impairment, the presence of concurrent disability or disorder, whether the child was underweight or premature at birth), and the prescribed low vision aids. Data were analyzed using SPSS 20.0.

Demographic and clinical records of 443 children (54% boys and 46% girls; median age 6 years) were analyzed. The median best corrected binocular distance visual acuity and contrast threshold were significantly improved from 0.86LogMAR to 0.62LogMAR and from 25% to 10%, respectively. The main source of referral to the association was ophthalmologists (35.5%) followed by schools/kindergartens (33%), whereas the least frequent source of referral was pediatricians (1.6%). The major causes of visual impairment were retinopathy of prematurity and cortical visual impairment.

visual functions were improved with the appropriate low vision aids, which explains the necessity for early referral of children to low vision services. Awareness training for pediatricians is important regarding the need for early detection and timely referral of visually impaired children. There is also a need for an awareness campaign about the causes and risk factors of retinopathy of prematurity.

Fear and anxiety before entering the operating room are significant issues in pediatric anesthesia. Given that the venipuncture process is accompanied by separation anxiety, and the ease of use of intranasal premedication versus intravenous, rectal, or intramuscular methods, and considering the risk of aspiration during oral delivery in children, the purpose of this study was to compare and contrast the anti-anxiety and sedation effects of intranasal midazolam and intranasal ketamine as a premedication in pediatric hernia repair surgery.

This was a double-blind randomized clinical trial involving 36 participants aged 1 to 6 years who underwent hernia repair surgery in Bu Ali Hospital between 2020 and 2021. The child was transferred to the operating room after 30 minutes of evaluating the effects of the drug and recording the related data. In the operating room, data from an electrocardiogram device, arterial oxygen saturation level, and blood pressure were all checked. At 5 minute intervals, the patient's hemodynamics were checked and recorded. The time from the beginning to the end of anesthesia was recorded.

This study included 36 patients (18 in each group). The average age and weight of the patients were 37.71 ± 21.73 months (range = 1-72 months) and 14.60 ± 4.26 kg (range = 6.5-25 kg), respectively. Independent t-tests showed no significant difference between the two groups. Heart rate and blood pressure were measured in two groups (ketamine and Midazolam) but no significant difference was observed among the three stages (before premedication, before anesthesia, and after intubation) (P>0.05). The relationship between qualitative outcomes was analyzed using Chi-square test but no significant difference was observed.

the current study showed that there is no statistically significant difference between intranasal ketamine and midazolam in terms of effectiveness and side effects.

The goal of this project was to assay the prevalence of fecal carriage of ESΒL-producing Enterobacteriaceae (ESΒL-PE), and to identify the risk factors for carriage in neonates hospitalized in a Neonatal Intensive Care Unit (NICU) of an educational therapeutic hospital (Vali-e-Asr) of Birjand city, east of Iran.

Rectal swabs were taken from 200 neonates at the beginning of hospitalization, every week in case of hospitalization and at the time of discharge. Bacterial isolates were identified using different biochemical experiments. Screening of ESΒL-PE was first done by phenotypic test (DD test) and then antibiotic resistance genes were detected by PCR assay.

In our research, 42 Enterobacteriaceae were obtained from 200 neonates. The total prevalence rate of neonatal rectal carriage of ESΒL-PE was 42/200 (21%), mostly Escherichia coli, 18 (42.8%). blaCTX-M and blaCTX-M-15 were the most prevailing β-lactamase-encoding genes recognized by PCR tests. Intestinal carriage of ESβL among neonates displayed a statistically significant relationship with the use of the mechanical ventilation (p=0.025), APGAR score (p=0.005) and gestational age (weeks) (p=0.044).

Our findings highlighted the importance of consistent screening for resistant ESΒL-PE among neonates (especially preterm newborns) and minimizing invasive ventilation whenever possible.

Chemotherapy, as one of the most important treatments for cancer, may lead to complications such as anxiety and changes in children's sleeping habits. The present study aimed to evaluate the effectiveness of sand play therapy in improving anxiety and sleep habits of children with leukemia undergoing chemotherapy.

This quasi-experimental study was conducted on 80 children with leukemia undergoing chemotherapy. The participants were randomly assigned into a control group and an intervention group admitted to Abi Talib (AS) Hospital in Zahedan, southeast Iran, in 2020. Data collection tools included a demographic information questionnaire and the Revised Children's Manifest Anxiety Scale (RCMAS), and Children's Sleep Habits Questionnaire (CSHQ). The questionnaires were completed by the primary caregivers of the children, before and one week after the end of the intervention. Data analyses were performed through SPSS26 software, using independent-t, paired-t, and chi-square tests. The significance level in this study was set at (0.05).

Mean age of the children was 9.35±1.44 years in the intervention group and 9.48±1.57 years in the control group. Based on the results, sandplay therapy significantly reduced anxiety and poor sleep habits in the intervention group (P<0.001).

The findings showed that sandplay therapy can be used as a non-pharmacological and effective treatment method to reduce the complications caused by chemotherapy in children with cancer.

The most prevalent form of systemic vasculitis in children is Henoch–Schönlein Purpura (HSP), also known as IgA vasculitis, with different manifestations. This study was performed to assess the clinical course of Henoch–Schönlein purpura in south east of Iran.
The clinical data of 221 children under age 18 years who were diagnosed with HSP at Ali Ebne Abi Taleb hospital in Zahedan, Iran, was analyzed for a ten-year period. Clinical manifestations, laboratory measures and different types of treatments were recorded from the patients’ profiles with some useful additional information. Skin purpura, acute arthritis or arthralgia, gastrointestinal involvement, and renal involvement were the criteria for examination. Data description was performed by the use of SPSS 23.00.
Mean age of the patients was 7.37 ± 3.19 years at diagnosis and 51.13% of them were girls. About 23.8% and 98.6% of the patients had a history of upper respiratory infections and palpable purpura, respectively. Fever was detected in 25.2% of the children.  About 28.5% had vomiting and 13.6% had diarrhea. Renal involvement was observed in 130 children. During the course of the disease, 53.8% received prednisolone and 21.7% received pulse methylprednisolone due to severe GI symptoms or renal involvement. Non-Steroidal Anti-Inflammatory Drugs (NSAIDs) were administered to 19.45% of the patients.
The patients' sex ratio was close to 1:1, though girls slightly outnumbered boys. Most HSP patients had Joint symptoms, GI symptoms and renal involvement. Arthralgias were the initial manifestations. Multicenter prospective studies with a larger number of patients are recommended to confirm the results.

This study aimed to assess whether weight gain predicts the outcome of childhood leukemia.

This is a cohort study on patients with leukemia aged 2 to 19 years. Data was gathered by a form consisting of age, sex, baseline and final weight, height, Body Mass Index (BMI), and poor outcome (mortality plus occurrence). We used the Receiver Operator Characteristic (ROC) curve and the Area under the Curve (AUC) to define the cut-off points. Data analysis was performed in SPSS software version 19.

114 patients enrolled in the study, including 68 (59.6%) boys and 46 (40.4%) girls. Ten patients (8.7%) died, and 14 (12.2%) experienced a recurrence. Overall, 16 (14.1%) patients had poor outcomes. In this study, most patients had annual weight gain (95.6%), and all had height gain. AUC of weight and height gain at the diagnosis and the end regarding poor outcome were 0.672 and 0.718, respectively. The cut-off points of weight and height gain for poor outcomes were 1.2 % per month (14.5% annual weight gain, and 0.32 % per month (3.8% annual height gain), respectively. Besides, 60% of patients with weight loss had poor outcomes, and the results revealed that weight loss of more than 12% per year causes poor outcomes.

According to the results, weight and height gain during the treatment period can be related to a better outcome in children and adolescents with leukemia, irrespective of weight, height, and BMI at the diagnosis. Therefore, anthropometric indices may be associated with outcomes

local indigenous games have been formed in the socio-cultural context of Iran since the past, but their impact on various aspects of human development has not yet been determined. Therefore, this study aimed to examine the effect of Local Indigenous games on Physical Fitness Factors (PFFs) and the perceived fitness of 7–11-year-old boys.
Thirty elementary school boys (Age: 10.2± 0.2) in Aran and Bidgol, Iran, were selected and randomly divided into experimental and control groups. The experimental group played Local Indigenous games for eight weeks, with three training sessions per week and 45 minutes per session. The control group only performed their routine daily activities. Data collection tools included Abadi's perceived physical fitness scale (1988), 10x5 meter running test to measure agility (Paschaleri et al., 2016), long jump test to measure explosive power (Paschaleri et al., 2016), sitting test and reaching to measure flexibility (Paschaleri et al., 2016) and 20-meter running test (Agha Alinejad et al., 2013) to measure speed. Covariance analysis was used to analyze the data.
The results indicated that eight weeks of Local Indigenous games significantly affect boys' PFFs, including agility, speed, flexibility, and explosive power (p <0.05). Moreover, Local Indigenous games had a significant effect on perceived fitness (p <0.05).
According to the results, a course of Local Indigenous games effectively improves PFFs and the perceived fitness of boys aged 7-11 years and could be used as a suitable intervention.

The prevalence of children with overweight and obesity has increased considerably worldwide and these children have been consistently found to have a lower mental and physical health status, which may affect their quality of life. Therefore, the aim of this study was to evaluate the quality of life among 6 to 12-year-old children with overweight and obesity in comparison to children with normal weight.

This case-control study was performed on 147 cases (79 overweight or obese and 68 normal weight children). For evaluating quality of life, the original version of the Pediatric Quality of Life Inventory (PedsQL) was used.

It was revealed that the average physical (32.56 ± 7.07 vs. 30.19 ± 5.68, P=0.026) and emotional (20.31 ± 3.83 vs. 19.01 ± 4.04, P=0.049) performance in the group of normal weight children was significantly higher than in overweight/obese children (p<0.05). However, the total score of quality of life did not differ significantly between the two groups (P=0.287).

These results indicate that in the studied society, children with a normal weight are more socially accepted and have a higher level of self-confidence than their overweight and obese peers. However, due to the lack of difference between the social performance score of these children and that of children with normal weight, it can be concluded that by proper treatments, we can prevent possible future injuries.

One of the most typical reasons for pediatric hospitalization is urinary tract infection. The purpose of this study was to identify the prevalence of urinary tract pathogens and the distribution of antibiotic resistance in children with urinary tract infections referred to Shahid Beheshti Kashan Hospital in 2018–2019. This information would assist physicians in choosing more potent medications.

Children with urinary tract infections were the subject of this cross-sectional study, carried out in 2018–2019 at Shahid Beheshti Kashan Hospital. The presence of an active urine test, a positive urine culture, and clinical symptoms of a urinary tract infection were the inclusion criteria. Data were examined using SPSS 16 software.

Out of the 400 children studied, 153 (38.2%) were males and 247 (61.8%) females. Among 153 boys, 96.1% had undergone circumcision, while 3.9% had not. Gender and UTI bacteria had a significant connection (p=0.023). Escherichia coli had the highest prevalence in female children's urinary tract bacteria. Males were more likely to contract Escherichia coli. Results indicated that ampicillin resistance pattern significantly correlated with gender (p=0.011). Amikacin, an antibiotic, proved most effective against Escherichia coli, the most prevalent pathogen. Escherichia coli also showed the highest level of ampicillin resistance. To combat antibiotic resistance, it is crucial to prescribe medicines in a methodical and scientific manner.

Pediatric urinary tract infections are most likely to be caused by Escherichia coli. This study's isolated bacteria showed a high sensitivity to Amikacin and resistance to Ampicillin, a penicillin beta-lactam antibiotic used to treat UTIs.

Body checking and disordered eating behaviors are common problems among adolescents and young people which can be precursors to eating disorders. The research aimed to examine the effectiveness of group narrative therapy in decreasing body checking and disordered eating behaviors.

This experimental, intervention-control, study was conducted on 920 female 11-16-year-old students selected by multistage random method. They responded to two scales of body checking behaviors and disordered eating behaviors. Among 188 female students who gained one standard deviation above the mean score of the group in both scales, 40 students were randomly divided into the experimental and control groups. Then, the members of the experimental group participated in narrative therapy intervention. After the intervention, both scales were distributed among the experimental and control groups.   Data were analyzed by the use of descriptive statistics and multivariate covariance method.

The results revealed that compared with the control group, narrative therapy significantly reduced body checking and disordered eating behaviors in the experimental group (P<0.01).

According to the findings of the present study, the investigation of effectiveness of narrative therapy on these behaviors can provide valuable implications about the mental health of individuals.

The effect of SPARK physical education program on lung function in cystic fibrosis patients is not yet determined. SPARK (Sports, play and active recreation for kids) includes moving skills, aerobic games, jogging or walking, aerobic dance and jump rope. Regarding the high prevalence of cystic fibrosis and its destructive effects on the lungs, the aim of this study was to evaluate the lung function and quality of life before and after undergoing the SPARK physical education program, in children with cystic fibrosis. In this quasi-experimental study, all patients with cystic fibrosis aged 6-18 years referred to the cystic fibrosis clinic of Dr. Sheikh Hospital in Mashhad, Iran, were enrolled. The patients attended the 12-week SPARK training program (3 sessions per week, each session 45 minutes). The quality of life questionnaire for patients with cystic fibrosis, including self-examination and parental tests, along with spirometry indices (FEV1, FVC, FEV1/FVC, FEF25-75) were filled out before and after intervention for all patients. The mean and standard deviation of patients' age were 9.85±2.67 years, and 65% of patients were female. The FEV1 was significantly different before and after the SPARK physical education program (P=0.03), and the respiratory component of quality of life significantly increased after intervention (P=0.002). The overall score of quality of life from parents’ point of view was 2.87 ± 0.38 which increased to 2.99 ± 0.38 after the intervention. SPARK training program may improve the spirometric parameters in children with cystic fibrosis. It also had a significant effect on improving the patients’ quality of life, especially in the respiratory component.

Since the COVID-19 pandemic began around the world, many studies have been conducted on various aspects of the disease in adults and children, but limited research has been done on blood glucose changes caused by COVID-19. So, this study was conducted to investigate blood glucose changes in children with COVID-19 hospitalized in the pediatric intensive care unit (PICU), comparing it with children hospitalized for other reasons.

This case-control study was performed on 30 COVID-19 children (group 1) during the pandemic and 29 children (group 2) who were admitted to PICU, before the prevalence of COVID-19. The control group was the same as the case group regarding age, sex, length of hospitalization, and treatment measures. Children with metabolic diseases and malignancy were excluded from the study. The data were analyzed by SPSS version 26 using chi-square and independent t-tests.

Out of 59 participants, two patients had low blood sugar (BS), and one had high BS; notably, all three were in group 1. This difference was not statistically significant. Furthermore, 76.7% of children with COVID-19 and 86.2% of the other group had normal BS. The frequency distribution of BS levels in the two groups was not related to the age, gender, and hospitalization period of children.

This study revealed that children with COVID-19 hospitalized in PICU did not have significant BS changes compared to those hospitalized before the pandemic. In addition, gender, duration of hospitalization, and COVID-19 medication did not significantly affect blood sugar changes.

Epilepsy is known as a periodic and severe disturbance in the nervous system, resulting from abnormal discharge of brain cells. Epilepsy is characterized by unexplained seizures, and threatens human life throughout their entire life span. The prevalence of epilepsy is high in early childhood, and declines with the increase in age.
In this study, a meta-analysis was done on the papers published from 2000 to 2023, investigating the prevalence of epilepsy within the age range of 1-20 years. Having a precise report of the studied city, report of prevalence as number or percentage, and report of epilepsy within the mentioned age range were the inclusion criteria for the papers. Any disagreement in fulfilling the criteria was resolved in a meeting by the presence of the three researchers. The search was done across Iranian databases plus ISI, Scopus, PubMed, and Embase with keywords of epilepsy, prevalence, children, adolescents, Iran, epidemiology, and psychiatric disorders.
In the initial search, 1276 papers were found, 28 of which were selected after screening based on inclusion and exclusion criteria, and were analyzed via random method. The prevalence of epilepsy was found to be 2.3 (95%CI: 1.3-3.8). Its Z-value was -13.719, Q-value 2443.036, df (Q) 31, and I-squared 98.731.
The prevalence of epilepsy in Iran is 2.3 (95% CI: 1.3-3.8), which warrants the necessary measures to be taken for its reduction.

Although the invention of more specialized duodenoscopes helped to develop Endoscopic Retrograde Cholangiopancreatography (ERCP) as a Therapeutic Method in children, there is a general perception that ERCP is practically challenging and dangerous in children. This has limited its widespread use in children. The aim of this meta-analysis is to update the previous reviews and evaluate more recent outcomes and complications of therapeutic ERCP among children with HPB disease.

A systematic literature search based on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) was performed in Web of Science, Embase, PubMed, and Cochrane library databases to find and evaluate all articles regarding therapeutic ERCP in children with HPB diseases published from January 2017 to July 2022. The analysis included studies that evaluated patients less than 18 years old undergoing ERCP with the objective of HPB diseases, and had reported the success rate and side effects. The main outcome measures were the success and complication rate of therapeutic ERCP. This meta-analysis was performed using STATA version 16 (StataCorp LP, College Station, Texas).

A total of 10 articles consisting of 1924 ERCP, performed on 958 children, were included. Out of all ERCPs, 96% (95%CI: 96-97, I2:95.8%) were conducted with therapeutic goals. The overall success rate among therapeutic ERCPs was 91% (95CI:90-92%, I2:97.1%) ranging from 65% to 95% among different studies. An overall of 9% (95%CI: 8-10, I2:97.8%) of all therapeutic ERCPs were associated with different adverse effects such as postoperative pancreatitis (6%) and Hemorrhage (1%).

Our analysis suggested ERCP as a safe therapeutic method for pediatric patients suffering HPB patients, having a success rate of 91% and a complication rate of 9%, none of which led to in-hospital mortality.

Aplasia cutis congenital type VI (Bart’s syndrome) has been known as an extremely rare genetic disorder in which there is localized absence of skin, epidermolysis bullosa and nail deformities.

Case report: 

Here, we present a rare case of Bart’s syndrome in a female newborn diagnosed with congenital loss of skin over upper and lower limbs, trunk, neck and face as well as some bullae on them. Moreover, a dilated stomach was observed in radiographic examination. We treated the baby with TPN, systemic antibiotics, and also her wounds were covered by topical ointments. Laboratory tests, along with liver and renal function analyses were normal, and also serologic tests for infection were negative but she died at the age of 4 days.

The association between Bart’s syndrome and pyloric atresia is a highly fatal combination and there is no treatment option to rescue the patients.

This case study reports on an infant presented with strabismus and poor red reflex, suspected of retinoblastoma, and finally diagnosed as a case of Incontinentia pigmenti (IP).

A 7-month-old infant was referred due to poor fixation and abrupt red reflex of the left eye for further evaluation of retinoblastoma. In anterior segment examinations, we found a micro cornea, a relatively shallow anterior chamber, and hypotonia. Fundus examination revealed a total tractional retinal detachment with vitreous membranes. In her skin examination, we discovered diffuse cutaneous linear pigmentation (lines of Blaschko), consistent with Incontinentia Pigmenti (IP).

A wide range of disorders involving the fundus, cause similar signs and symptoms to retinoblastomas, such as leukocoria and poor red reflex, categorized as pseudo retinoblastoma. IP is a dysplastic ectodermal disorder with dominant X-linked inheritance, affecting integumentary, ocular, nervous, and dental tissues, and is responsible for less than 1% of cases of pseudo retinoblastoma. Although rare, achieving early diagnosis for IP is of utmost importance, since not only would it enable clinicians to treat and manage retinal complications, but it would also help them detect potentially fatal neurological issues.