International Journal of Pediatrics
Volume:11 Issue: 115, Jul 2023

Down syndrome is one of the most common causes of intellectual disabilities in children. The birth of a baby requires a positive adaptation of the family to new changes, especially when the child has a disability such as Down syndrome. When a child with Down syndrome is born, parents experience many conflicting emotions and feel inadequate. Therefore, it is important to examine the needs of these parents with issues related to living with a child with Down syndrome, as well as the factors that affect the needs.
This is a descriptive-analytical research conducted cross-sectionally on 172 parents of families with children aged 1-19 with Down syndrome who were covered by the welfare organization of Guilan province. Simple random sampling method without placement was used in sampling for this research. The data collection tools were Glaser's Basic Needs Questionnaire to measure needs and a researcher-made questionnaire of related factors. Data were analyzed using Kolmogorov-Smirnov, Wilcoxon, Friedman, Mann-Whitney, Kruskal-Wallis and Spearman correlation coefficient tests in IBM SPSS Statistics version 26.
The findings of this research showed that there was a weak significant negative relationship between the need for survival and the need for freedom (P=0.001 and r=0.245). There was no significant correlation between the scores of the need for recreation and the need for strength (P=0.534 and r=0.048). There was a statistically significant difference between the scores of the parents of children with Down syndrome in Glasser's basic needs scale (P<0.001). A statistically significant difference was observed between the scores of the need for power according to the educational level of the parents (P=0.007), and a statistically significant difference was also observed between the scores of the need for power according to the level of the parents' income (P=0.011).
The findings of this study show that the performance of families who face fewer needs and receive higher levels of social support is better than those of the families who face multiple needs and receive limited social support.

Since its announcement as a pandemic, COVID-19 has been shown to be associated with more severe outcomes among pregnant women. Infected mothers may develop Intrauterine Growth Retardation (IUGR), stillbirth, premature labor, and Disseminated Intravascular Coagulation when carrying a child (DIC). The present study aimed to estimate the risk of severe COVID-19 and its correlation with adverse neonatal outcomes among pregnant women.
This was a population-based, retrospective cohort study of all pregnancies with a live birth or fetal death in Mashhad, Iran, from February 20, 2020, to June 21, 2020, on 460 patients who tested positive for COVID-19. The assessed neonatal outcomes included preterm birth, IUGR, stillbirth, severe neonatal asphyxia, and neonatal death. Modified Poisson and multinomial logistic regression models were used to derive relative risk estimates.
460 patients identified with COVID-19 during pregnancy were assessed in the study. Overall, the most prevalent complication was preterm birth, with a total of 119 (25.9) cases. In multivariable analysis, the risk of preterm labor, low birth weight, severe neonatal asphyxia, ICU-admitted mother, the length of hospitalization> 7 days and IUGR were significantly increased in the Stillbirth. The risk of global preterm birth had also significantly increased in the Stillbirth group compared to the other group (91.7% versus 23.7%, aOR = 3.66, 95% CI [8.85- 165.87], p < 0.001).
Along with the possibility of more severe COVID-19 infection among pregnant women, five complicated outcomes were described in the present study, including preterm birth, IUGR, stillbirth, severe neonatal asphyxia, and neonatal deaths as risk factors of COVID-19 infection in pregnancy.

There is insufficient information regarding whether epileptic manifestations, in the absence of seizures, contribute to the development of autism symptoms. Electroencephalography (EEG) is the most widely used tool for diagnosing epileptic brain activity. Despite the possibility of the simultaneous manifestation of epilepsy with autism, it cannot be accurately said that epileptic activity, in the absence of seizures, contributes to the emergence of autism symptoms. Therefore, it is important to investigate the prevalence of epileptic activity in non-epileptic people with autism. The purpose of this research was to examine the EEG of autistic patients without a history of clinical seizures to determine anomalies.
The studied population consisted of children between 1 and 18 years of age with autism who had referred to the neurology clinic of the hospital and the neurology office in 2022. Cases with a history of clinical seizures were excluded from the study.
A total of 50 children were studied. The results of 64% of EEG cases showed anomalies. A significant relationship was found between birth type and EEG result. As, in natural delivery, 77% of the results of EEG had anomalies (p=0.048). EEG results showed anomalies in 61% of people who did not have problems at birth and 71.4% of those who had problems at birth.
This study showed that a significant percentage of children with autism spectrum disorder and no history of clinical seizures have abnormal EEGs that should be investigated in terms of manifestations related to epilepsy.

limited studies have been conducted on the effect of synbiotics supplementation on Type 1 Diabetes Mellitus (T1DM). The current study aimed to evaluate the impacts of synbiotic supplementation on glycemic parameters, lipid profile, and vitamin D levels in children with T1DM. In this double-blind, randomized controlled trial, 86 T1DM patients aged 4-18 were randomly divided into two equal groups. One group received insulin and a synbiotic supplement once daily for 12 weeks; another group received insulin and a placebo. FBS (fasting blood sugar), HbA1C (hemoglobin A1c), triglycerides, cholesterol, HDL (High-density lipoprotein), LDL (low-density lipoprotein), and vitamin D levels were measured at the beginning and end of the study in both groups. The trend of FBS, HbA1C, triglycerides, cholesterol, HDL, LDL, and vitamin D changes was not significant over time in both groups. Based on the analysis of covariance, the means of FBS and HbA1C were lower in the intervention group (p=0.048 and 0.025, respectively). However, no significant changes in triglycerides, cholesterol, HDL, LDL, and vitamin D levels were observed between the two groups (p= 0.291, 0.291, 0.952, 0.140, and 0.557, respectively). It's suggested that insulin treatment in combination with synbiotic supplementation could improve FBS and HbA1C in T1DM children but had no effects on lipid profile and vitamin D levels.

Congenital heart defects, with a prevalence of 4-8 cases per 1000 births, are one of the most common congenital defects. Tetralogy of Fallot (ToF) is the most common congenital cyanotic disease. There are several techniques for correcting this anomaly and ToF total correction is a routine option. Approximately 40% of patients undergoing ToF, need Pulmonary Valve Replacement (PVR) in the years after primary surgery. In this study, we investigated the predictive factors of PVR in patients with ToF.
The participants included 204 ToF patients who had undergone ToFTC surgery during 2004-2020. Many factors inducing age, sex, weight, pre-ToFTC echocardiographic findings, pre-ToFTC angiographic findings, pre-ToFTC palliative care, type of ToFTC surgery, and echocardiographic features of PVR were extracted and studied.
The mean age at ToFTC was 27.8 months in the PVR group and 58.8 months in ToFTC + PVR group (P < 0.001). Among echocardiographic findings before ToFTC surgery, RV function (P = 0.003), RPA (P = 0.015) and MPA (P = 0.036) were significantly different between the two groups. Valvotomy + VSD Closure surgery were significantly more prevalent among ToFTC patients (P = 0.001); however, Transannular Patch and Monocusp Implantation were done at higher rates among PVR patients. More palliative care before surgery was reported among PVR patients (P = 0.001), but ASD repair was more prevalent in the other group (P < 0.001) which was probably due to two more prevalence of ASD among patients of ToFTC group.
Need for PVR surgery is affected by several factors, including demographic characteristics of patients and characteristics of surgical interventions, along with the anatomical and functional features of the heart.

Cystic Fibrosis (CF) is an autosomal recessive disease that has a negative impact on the quality of life in patients. Various methods for assessing lung function and airway obstruction in patients with CF can be used to diagnose and recognize the progression of the disease.
This is a cross-sectional study with a descriptive approach conducted on 45 CF patients aged 5-18 years. This study investigated the relation between pulmonary disease severity in lung computed tomography (CT) scans, and pulmonary function tests in cystic fibrosis patients referred to our paediatric hospital.
The average age of the patients was 8.33 ± 2.95 years. 73.3% had bronchiectasis with different degrees. In oscillometry (IOS) evaluation, 8.9% had central obstruction, 28.9% had total airway obstruction, 37.8% had peripheral obstruction, and 24.4% had no obstruction. The spirometry results revealed that 53.3% of patients had normal spirometry, 35.6% showed a mild obstruction pattern, and 11.1% had a moderate obstruction. The results obtained from spirometry and IOS revealed that the total resistance in moderate airway obstruction was significantly higher than other resistances, and there was a significant increase in the severity of moderate obstruction of total airway resistance (P=0.022).
Our study showed that CT scan could reveal the complications of cystic fibrosis earlier than pulmonary tests, and it is a reliable tool in evaluating the progress of cystic fibrosis complications and should be considered in the follow-up of patients. Moreover, IOS can help interpret spirometry findings.

Periodic data for determining the DMFT index in 12-year-old children showed that the index had a significant improvement in different periods of its measurement during 25 years after the integration of oral health services in primary health care and was relatively stable. In order to improve this index, it is necessary to provide electronic care and services based on risk assessment of dental caries and attention to MIH in the primary health care systems.

Diabetic nephropathy (DN) is one of the complications of diabetes. The present study was conducted with the aim of determining the prevalence of DN in patients with D1T in Iran.

This meta-analysis and systematic review included the articles published from 2000 to 2022, in domestic (Iran) and international journals. Search keywords included diabetes, type 1 diabetes, D1T, nephropathy, Iran, children, and adolescents, which were searched in Persian and English. The search was conducted by two members of the research team independently and the outcomes were finally approved by the third person who was considered as the manager of the research team. The extracted data was analyzed by CMA3 software.

The overall prevalence of DN was found to be 10% (confidence interval (CI) = 3.4-26.1). The lowest and highest prevalences of DN were found to be reported as 0.04% and 30.8%, respectively.

Considering the high prevalence of DN in patients with T1DM, it is suggested that the necessary preventive measures be taken to reduce the complications of diabetes in these patients

With the rise in life expectancy, there has been an increase in the population with immune deficiency. This necessitates the need to find ways to improve the quality of life and survival rate for these individuals. This review focuses on dietary modifications as a means to boost the immune system. The abstract emphasizes the significance of nutrition and lifestyle changes in supporting immune function. A well-balanced diet, rich in essential nutrients and immune-boosting foods, is crucial. Addressing nutrient deficiencies, engaging in regular physical activity, and managing stress are also important for improving immune health. Individuals with immune deficiencies should seek guidance from healthcare professionals when making dietary changes. Food safety is closely linked to immune health, especially for immunocompromised individuals who have a higher risk of foodborne diseases. Preventing foodborne infections involves implementing food safety management systems and following low microbial diets. While diet is significant, other interventions are also important for individuals with compromised immune systems. Planning a healthy diet for these patients should consider adequacy, balance, calorie control, nutrient density, moderation, and variety. In conclusion, enhancing the immune system and improving the quality of life for individuals with immune deficiencies requires a comprehensive approach that includes dietary modifications, food safety practices, and other lifestyle changes. By implementing these strategies, it is possible to strengthen the immune system and enhance health outcomes for individuals with compromised immune function.

Transcobalamin deficiency as a rare autosomal recessive disorder and methylmalonic acidemia is an autosomal recessive disorder of amino acid metabolism. Based on the common presentation of methylmalonic academia and Transcobalamin deficiency, in this case report, we presented rare cases of Transcobalamin deficiency in children with the primary diagnosis of methylmalonic academia. As the genetic test indicated the definite diagnosis, we fortunately treated our patient based on the genetic result to solve B12 deficiency and it showed promising outcomes.