Journal of Comprehensive Pediatrics
Volume:14 Issue: 3, Aug 2023

 Type 1 Diabetes Mellitus (T1DM) is a chronic disease that requires complicated therapies. The coronavirus disease 2019 (COVID-19) pandemic has caused lockdown restrictions, compromising access to medical care, including T1DM management. Poor medication adherence may affect the quality of life (QoL) and glycemic control.

 This study analyzed the association among QoL, medication adherence, and glycemic control in T1DM patients during the COVID-19 pandemic.

 This study recruited T1DM patients aged 5 - 18 who regularly visited the pediatric endocrinology outpatient clinic. The PedsQL 3.2 and the diabetes management questionnaire (DMQ) were used to measure QoL and medication adherence. In addition, glycemic control was measured based on HbA1c levels. All data were analyzed using SPSS version 17, and correlations between variables were analyzed using Spearman or Pearson correlation tests.

 Twenty-five children and adolescents with a mean age of 141.1 months (± 36.7) were included in this study. The mean HbA1c level was 10.7 mg/dL (± 2.4). Around 19 (76%) participants had already experienced diabetic ketoacidosis (DKA). There was no significant correlation between QoL and medication adherence or HbA1c level (P = 0.220, r = - 0.254; P = 0.753, and r = - 0.066, respectively).

 Our study’s QoL and medication adherence of T1DM children was relatively good even though the HbA1c was still high. However, numerous factors affect QoL and medication adherence in T1DM children other than HbA1c level.

Context:

 Atopic dermatitis is among the most common chronic diseases in children, with increasing prevalence.

 This study evaluated the relationship between the microbial composition of nasal nares and atopic dermatitis severity.
Study Selection: This meta-analysis included all types of studies (experimental and observational) on nasal colonization of pediatrics (age ≤ 19 years old) with a diagnosis of AD confirmed by a physician. The following search strategy was used in the databases: Atopic dermatitis AND (nasal OR nares).

 Twenty-two studies were included in our analysis. Nine studies compared the odds of S. aureus nasal colonization between AD pediatrics and non-AD healthy controls. In 13 studies, there was no control group. Subgroup analysis was performed on eight studies regarding AD severity in pediatrics with positive nasal colonization of S. aureus. Pooled analysis showed that S. aureus was colonized in 38% of the pediatrics with mild AD, 50% with moderate AD, and 22% with severe AD. The random-effects model showed that the odds of nasal colonization of S. aureus were significantly higher in AD pediatrics than in non-AD healthy controls (OR: 2.52; 95% CI (1.60, 3.97); I2 = 72%).

 The nasal cavity of pediatric AD patients was more colonized with Staphylococcus aureus than in healthy children. More studies on children with severe AD are needed to accurately prove the role of S. aureus colonization in the severity of atopic dermatitis.

 Family-centered care (FCC) is widely accepted as a care model and is a basic core principle of pediatric nursing.

 This study aims to investigate pediatric nurses’ perceptions and practices toward FCC in selected governmental hospitals and assess the relationship between age, academic level, and pediatric nurses’ perceptions.

 This cross-sectional study was carried out on 102 pediatric nurses. A survey containing socio- demographic information sheet and an FCC questionnaire will be distributed to pediatric nurses from January 2022 to March 2022.

 The findings show that the overall mean score of the pediatric nurses toward FCC is 3.38 ± 0.10, indicating modest perceptions and practices toward FCC. The dimension stipulating “Family is the constant” has the highest score (3.56 ± 0.78), while the dimension stipulating “Parent-to-parent support” has the lowest score (3.26 ± 0.86). Besides, there are no correlations between participants’ age, academic level, and overall FCC.

 This study gives insight into FCC employed in designing policies and interventions in several healthcare settings in Jordan. Importantly, such insights might raise positive perceptions and practice among pediatric nurses toward FCC.

 Chronic granulomatous disease (CGD) is a primary hereditary immunodeficiency condition caused by a defect in the nicotinamide adenine dinucleotide phosphate (NADP) oxidase complex. Recurrent infections and inflammatory complications with a narrow bacterial and fungal spectrum characterize CGD. Acute inflammatory and infectious complications are vexing and fatal for them. Therefore, managing CGD with prophylactic antibiotics and antifungal agents is essential.

 We present a 23-month-old infant with a chief complaint of recent lymphadenopathy diagnosed with CGD. Two months later, she was hospitalized with uncontrolled fever and lung involvement while receiving prophylactic treatment with trimethoprim/sulfamethoxazole. A mass-like consolidation was seen in her radiography evaluation. Based on the biopsy and bronchoalveolar lavage (BAL) pathology report, pulmonary mucormycosis was confirmed. Two weeks after starting the standard treatment regimen with amphotericin B, the patient’s symptoms improved. She was discharged in good general condition with oral voriconazole and trimethoprim/sulfamethoxazole and referred to do hematopoietic stem cell transplantation (HSCT).

 Mucormycosis in CGD is not a common infection and usually infects patients with impaired cell-mediated immunity, hematological malignancies, steroid treatment, and diabetes. Patients with CGD are vulnerable when treated with a high dose of immunosuppressant medications. In our case report, the patient was infected with mucormycosis despite not receiving immunosuppressant medications and having no history of hematologic malignancies or diabetes. Our patient also had a mass-like consolidation in her radiological result, a rare feature of pulmonary mucormycosis involvement in CGD patients.

Context: 

Hyperbilirubinemia is a common cause for diagnostic work-up and therapeutic intervention in neonates and needs a convenient, quick, and safe treatment modality. Phototherapy is the most common treatment for neonatal jaundice; however, complementary treatment is still needed. Despite the identification of the enzymatic pathways of bilirubin catabolism, few pharmacological interventions have been found to be effective in reducing bilirubin, along with traditional phototherapy. This review was conducted to evaluate recent pharmacotherapies as adjuvants to phototherapy for the treatment of neonatal indirect hyperbilirubinemia (IHB).

Evidence Acquisition: 

This study was carried out through a literature search with the keywords of Infant, Newborn, and Indirect Hyperbilirubinemia, combined with Drug Therapy, in PubMed, Scopus, International Statistical Institute, Web of Science, Cochrane, and Embase databases. This study included relevant articles (i.e., randomized controlled trials, observational studies, guidelines, and reviews) written in English and published between 2012 - 2022.

 This narrative review first assessed the relevant articles to define IHB and its etiology. Then, the efficacy and side effects of recent pharmacologic agents as adjuvants to phototherapy were discussed. Additionally, this study reviewed the efficacy and safety of drugs prescribed to neonates to prevent jaundice.

 The best drug for adjuvant pharmacotherapy, in addition to phototherapy, for neonatal jaundice has not still been identified. The use of probiotics, prebiotics, synbiotics, and ursodeoxycholic acid (UDCA) in adjuvant to phototherapy has been recently increasing, and beneficial results were observed in most studies. The use of agar, charcoal, fibrate, and phenobarbital had a minor therapeutic role in recent years. There were conflicting results about the efficacy of herbal agents in neonatal jaundice. The use of intravenous immunoglobulin (IVIG), metalloporphyrin, and albumin is also limited to severe or immune-related IHB cases. The prescription of the aforementioned drugs sometimes had different results. Therefore, further research in this regard is necessary.

 Growing evidence suggests a higher occurrence of overweight and obesity in children diagnosed with phenylketonuria (PKU), yet the exact cause is still unknown.

 The objective is to address the prevalence of overweight and obesity in children with PKU.

 In our cross-sectional study, we included 47 children with PKU who were receiving care at the nutritional clinic of the National Nutrition Institute. We conducted anthropometric assessments, which involved measuring weight, height, and BMI. Additionally, we performed biochemical evaluations, including measurements of fasting total cholesterol (TC), low-density lipoprotein (LDL) cholesterol, high-density lipoprotein (HDL) cholesterol, very low-density lipoprotein (VLDL) cholesterol, and triglycerides. Moreover, we assessed fasting blood sugar levels.

 In the study group, 57.44% were males, and 42.55% were females, with no significant gender difference observed. Malnourished children exhibited significantly higher phenylalanine (PHE) levels. Most participants (n = 26, 55.3%) were overweight or obese. A positive and significant correlation (rs = 0.6, P = 0.01) was found between PHE levels and fasting blood sugar levels.

 Children with PKU have a high prevalence of overweight and obesity, emphasizing the importance of obesity screening in this population.

 Gestational diabetes mellitus (GDM) can cause diastolic dysfunction and asymmetric ventricular septal hypertrophy in infants of gestational diabetic mothers (IGDMs). Ventricular thickness can affect QT interval and other QT parameters.

 This study aimed to evaluate and compare the duration of QT, corrected QT (QTc), QT dispersion (QTD), and echocardiographic indices in two groups of neonates of mothers with and without GDM.

 In this case-control study, 76 term neonates were enrolled. The case group (n = 38) included IGDM, and the control group (n = 38) included neonates born to healthy mothers. The QT, QTD, and QTc were calculated based on electrocardiographic results. Ejection fraction (EF), interventricular septal thickness at the end of diastole (IVSTD), left ventricular end-diastolic diameter (LVEDD), left ventricular end-systolic diameter (LVESD), and left ventricular posterior wall thickness (LVPWT) were evaluated by performing echocardiography, and the two groups were compared regarding them. Data were analyzed using SPSS version 21.

 In this study, neonates' mean age and weight were 4.18 ± 1.3 days and 3418.16 ± 549.24 grams, respectively. As for the gender of neonates, 68.4% in the case group and 47.4% in the control group were female. The two groups had no significant difference regarding age, weight, and sex (P > 0.05). Minimum QTc (QTc min) was significantly higher in the case group (P = 0.046). Considerably lower EF and higher IVSTD were found in the case group (P = 0.011 and P = 0.05 respectively). In univariate analysis, echocardiographic parameters were not the predictors of QTD (P > 0.05); in multivariate analysis, however, QTD was significantly correlated with LVEDD (P = 0.001) and LVESD (P = 0.015).

 A higher proportion of septal hypertrophy was detected in IGDMs compared to infants of the healthy mothers without any correlation with ECG indices. This involvement was accompanied by relatively decreased EF verified by echocardiography. Most ECG findings, including QTD values, had no linear relationship with echocardiographic parameters except for LVEDD and LVESD.

 In February 2020, a novel coronavirus caused a pandemic affecting children and adults with different presentations and outcomes.

 The current study aimed to provide descriptive values regarding the clinical and laboratory profiles of children suspected of coronavirus disease 2019 (COVID-19). This purpose was achieved by studying all presentations, whether clinical or laboratory, typical or atypical, of suspected COVID-19-affected children at the peak of the third wave in a large tertiary hospital.

 This cross-sectional study enrolled 404 children with suspected COVID-19 who were tested in the Emergency Room of Abu El-Reesh Japanese Hospital, Cairo, Egypt, during the study period, which was from March 2021 to the end of October 2021. According to age, the patients were divided into four groups, including those under 2 years, the early childhood group (2 - 6 years), the late childhood group (6 - 12 years), and those over 12 years. The enrolled cases met the diagnostic criteria for COVID-19 according to the Egyptian Ministry of Health protocol.

 In this study, 58 out of 404 tested children were positive for COVID-19 (14%), with a higher male predominance (n = 230/404, or 56.9% of the study group). The median age of the study participants was 1.6 years. Out of all presentations, the non-respiratory ones predominated and had the upper hand. It represented 62.9% (254/404) of the total presentations of the enrolled children. Among the non-respiratory manifestations, gastrointestinal ones were predominant (n = 63). Thrombocytopenia, leucopenia, and pancytopenia were significantly higher in children with non-respiratory manifestations than in those with respiratory manifestations.

 Children might have atypical manifestations of COVID-19 infections. The non-respiratory system could predominate in children. Thrombocytopenia could be a laboratory marker for COVID-19 infection, especially in those with predominant non-respiratory manifestations. Respiratory manifestations in children could be a guide for other systemic affections.

 Non-alcoholic fatty liver disease (NAFLD) occurs with the pathological accumulation of fat in the liver and is one of the most common liver disorders worldwide among adults and even children. Obesity is a risk factor for NAFLD.

 Considering the increasing prevalence of obesity in Iran and worldwide, this study was conducted to determine the prevalence of NAFLD and its related factors in overweight and obese students of schools in Tehran, Iran.

 This cross-sectional study was performed on 115 overweight and obese students [body mass index (BMI) ≥ 25] with an age range of 7 - 17 years. Eligible individuals were classified into two groups with and without NAFLD. Liver ultrasonography and measurement of serum parameters, including fasting blood sugar, lipid profile, and liver enzymes, were performed. Next, the demographic and anthropometric characteristics were compared between the two groups.

 Out of 115 studied students, 71 subjects were boys (61.7%). The results showed that the mean BMI in patients with fatty liver was significantly higher than in individuals without fatty liver (P = 0.03). According to our findings, the mean total cholesterol in NAFLD patients was significantly higher than in the group without NAFLD (P = 0.008). The univariate logistic regression model results for measuring factors related to fatty liver in students showed a significant positive correlation between male gender, BMI, total cholesterol, aspartate aminotransferase, and alanine aminotransferase.

 NAFLD is a substantial problem in school children and correlates with elevated BMI. Therefore, the measurement of BMI can be used as a useful predictor and screening tool for NAFLD in school children.