International Journal of Pediatrics
Volume:11 Issue: 116, Aug 2023

The prevalence of Retinopathy of Prematurity (ROP) is rising in Iran. We aimed to evaluate the clinical and demographic characteristics of ROP infants who need treatment, the type of treatment, and the complications in the years 2018 to 2022.
This is a cross-sectional study. We evaluated the patient’s electronic medical records from 2018 to 2022. The required data was extracted from the registry dataset, including demographics, clinical characteristics of infants who required treatment, and the type and severity of treatment-related complications.
From 10,159 infants referred to the retinopathy of prematurity clinic from the beginning of 2018 to 2022, 5008 subjects (49.29%) were suffering from ROP, among whom 416 (8.3%) patients needed treatment for ROP. The mean ± Standard Deviation (SD) of birth age and birth weight were 28.66 ± 2.24 weeks and 1227.24 ± 375.97 grams. While most of our patients (742 eyes, 96.4%) underwent Intravitreal Bevacizumab (IVB) injection as the treatment modality, laser photocoagulation was performed for 25 eyes. Four eyes received pars plana vitrectomy treatment. The recurrent disease occurred in 23 patients (44 eyes). Birth age, birth weight, and the time of oxygen therapy were significantly different between the treatment responders and the neonates who experienced the recurrent disease.
In this study, we showed that the birth age and weight of neonates who experienced a relapse were significantly lower. Besides, the results of treatment with IVB injection were satisfactory, with a relatively low recurrence rate and minimal complications.

The aim of this study was to investigate the relationship between motor skills and language skills in mentally retarded children. The secondary purpose of this study was to expand the evidence based on previous studies by examining the possible relationships between motor, cognitive and linguistic developmental domains that were performed in mentally retarded children with different IQs.
The present study was descriptive and correlational. 39 children with mental retardation, including 21 girls and 18 boys, participated in the study. After obtaining the parents’ written consent, the Children's Communication Checklist-Persian (CCC-Persian) and the Intelligibility in Context Scale (ICS) were completed. Then, an occupational therapist carefully evaluated the gross and fine motor skills of all of these children by the Lincoln-Oseretsky Test. The psychologist then evaluated the rational age and nonverbal IQ of these children by the Goodenough test.
There was a positive and significant correlation between the language and the fine motor skills, as well as, the score of the CCC-Persian and fine motor (P <0.05). In addition, there was a positive and significant relationship between the score of the Goodenough test with the speech, syntax, social interactions, the CCC-Persian, and the ICS scores (P <0.05).
It is expected that improving motor skills increases language and speech skills in mentally retarded children and vice versa. Therefore, paying attention to movement therapy and art therapy has an effective role in strengthening speech and language skills in these children.

Intrauterine Growth Restriction (IUGR) is a common obstetrical diagnosis associated with high risks of perinatal mortality and morbidity. Some studies have suggested that either sildenafil or melatonin may improve IUGR outcomes; but we found no evidence on the effects of concomitant sildenafil and melatonin therapy on IUGR fetuses. Therefore, the aim of the present study was to investigate whether simultaneous intake of melatonin and sildenafil can be more effective in alleviating IUGR outcomes. Patients with idiopathic IUGR referred to Yasuj Women's Clinic during 2019 and 2021 were enrolled in the current double-blind, randomized clinical trial. Out of 140 participants, a total of 120 pregnant women were included, 100 pregnant women with confirmed IUGR (gestational age between 26 to 32 weeks) were randomly assigned into four groups as fellows: sildenafil group (25 mg three times a day), melatonin (3 mg three times a day), sildenafil plus melatonin, and placebo. The patients received the drugs for at least 4 weeks. Doppler ultrasound was used to evaluate some outcomes on factors such as fetal weight, systolic/diastolic (S/D), PI, and RI of the umbilical, cerebral and uterine arteries. Neonatal outcomes (anthropometric characteristics of the infant, Apgar scores, meconium aspiration, and NICU admission) were also recorded. S/D of the middle cerebral artery was lower in the sildenafil plus melatonin subjects than in the other groups (p< 0.05). Sildenafil plus melatonin significantly increased infant weight and decreased the risks of preeclampsia and hospitalization compared to other treatments (p < 0.05). The results confirmed that the concomitant prescription of melatonin and sildenafil increases birth weight, normalizes middle cerebral artery indices, and reduces the incidence of preeclampsia and neonatal hospitalization for IUGR. Therefore, Melatonin plus sildenafil can be a simple and economic treatment for IUGR.

Controlling the respiratory complications of anesthesia in children is one of the most challenging situations. The present study aimed to compare intravenous and inhalation anesthesia in respiratory adverse events in children under 7 with upper respiratory tract infection (URTI). All children with URTI referring to Labbafinejad hospital in Tehran for emergency surgery were randomly divided into two groups. The first group received Total Intra-Venous Anesthesia (TIVA) inducer and maintenance, and the second group received inhalation (Sevoflurane). The two groups were compared in terms of respiratory events at different times Laryngeal Mask Airway (LMA) implantation time, interoperation, LMA removal, and recovery). There were significant differences between the groups (p-value < 0.05) (1) before induction in terms of using respiratory sub-muscles, (2) during LMA implantation in terms of oxygen saturation percentage, stridor, cyanosis, laryngospasm, bronchospasm, and the presence of breath hold, (3) during LMA removal in terms of oxygen saturation percentage, cyanosis, laryngospasm, and bronchospasm, (4) after LMA removal in terms of stridor, cyanosis, the use of respiratory sub-muscles, persistent cough, and breath hold, and (5) in the Post-Anesthesia Care Unit (PACU) in terms of stridor and persistent cough. in children with URTI, who have undergone emergency surgery, due to less PRAE in the intravenous method with Propofol, the use of TIVA method can reduce the risk of related adverse events.

Shigella is a gram-negative, facultative anaerobic, nonperforming, nonmotile and rod-shaped bacterium that causes mucoid bloody diarrhea, known as dysentery or shigellosis. This study aimed to determine the prevalence of Shigella species and the antibiotic resistance pattern of Shigella species isolated from children with acute diarrhea in Bandar Abbas Pediatric Hospital, south of Iran. This descriptive and retrospective study was conducted based on the patients’ information in their checklists, including age, gender, Shigella culture results, Shigella species, cessation of fever, city of residence, duration of symptoms before hospitalization, antibiotic use in the previous two weeks, degree of fever at the time of hospitalization, vomiting, convulsions, dehydration, death, frequency of diarrhea, and loss of blood in feces. Out of 162 patients, 82 (50.62%) were females, and 80 (49.38%) were males. Cultures of 46 patients (28.39%) were infected with Shigella flexneri species, 6 patients (3.72%) with Shigella boydii species, and 56 patients (34.58%) with Shigella sonnei species. Tetracycline had the highest rate of resistance (88.8%), and ciprofloxacin had the lowest resistance (7.41%). The pattern of common Shigella species has changed from S. flexneri to S. sonnei in recent years. The pattern of antibiotic resistance among these species is also changing; so regular investigation of the prevalence of different species and their drug resistance pattern is necessary to make a correct decision about the appropriate treatment.

Type 1 diabetes mellitus results from autoimmune destruction of the insulin-producing beta cells in the islets of Langerhans in pancreas. It is one of the most common chronic diseases in childhood. This process occurs in genetically susceptible subjects and is probably triggered by one or more environmental agents. Viral agents especially enteroviruses are under special focus as the environmental triggering factors and many studies all around the world have evaluated their role in the pathogenesis of type 1 diabetes. As the prevalence of viral infections varies in different geographical regions, this study was planned to evaluate the frequency of enterovirus infection in the population of diabetic children in North East of Iran. 35 children between 1 to 18 years who were newly diagnosed with type 1 diabetes were investigated for enterovirus RNA using RT-PCR in their serum and stool, and 31 nondiabetic children who were also negative for other autoimmune disorders were also evaluated. Enterovirus RNA RT-PCR was negative in serum of all case and control samples. Stool samples were also negative in the case group and only one stool sample was positive in the control group. The patient was totally asymptomatic and had received polio vaccine 2 weeks before. Results of this study show that presence of enterovirus RNA at the time of the clinical presentation of diabetes is not common in our population of diabetic patients and more extensive studies are needed to establish a relationship.

Beta thalassemia intermedia is a group of anemias that are in the middle of the symptoms of beta thalassemia minor and major. Disturbance in the balance of alpha and beta chains causes different symptoms in patients. At one end of the spectrum are patients with mild symptoms, and at the other end the patients who may become dependent on blood transfusion, with difficulties deciding which patient needs blood transfusion and when. This challenge is more significant during pregnancy because blood transfusion at the wrong time and not transfusing when needed can cause complications in both mother and fetus. In this one-year study, a total of 8 pregnant patients with intermedia thalassemia were studied, and according to the Australian guideline, patients with  were not given blood unless they suffered from PHT, massive splenomegaly, IUGR; but patients with   were transfused. Finally, the pregnancy outcome was compared in terms of birth weight and Apgar score; and there was no significant difference. Hb level 7 during pregnancy can be considered safe for preventing unnecessary blood transfusion and their complications. This study can be the onset of a wider study in this field to help gynecologists for patient management.

Gestational Diabetes Mellitus (GDM) is a condition that affects the physiology of the mother and fetus during pregnancy. In addition, it has been shown that it also plays a role in the occurrence and progression of pediatric cancer. Epigenetic changes are one of the risk factors that affect pediatric cancer.  Moreover, hyperinsulinemia and hyperglycemia are among the conditions that can play a role in childhood cancer due to GDM.  In many cases, inflammatory factors activate the NF-κB pathway and lead to inflammation. Furthermore, inhibition of apoptosis inducing factors causes the emergence and proliferation of cancer cells. Also, PI3K/AKT, mTOR, STAT/NF-kB pathways are among the most important pathways involved in the pathogenesis of pediatric cancer. Epigenetic changes, hyperinsulinemia, and hypoglycemia can increase the probability of cancer in children by changing the expression of some genes and signaling pathways. Identifying these pathways can help in the design of treatment strategies and lead to the prevention of cancer and increase the survival of patients.

Patients with Cystic Fibrosis (CF) often have respiratory tract infections and bacterial colonization requiring antibiotic treatment. The use of complementary treatments such as Compound Honey Syrup (CHS) in Persian medicine is increasing in the treatment of diseases. This study aimed to assess the effects of Compound Honey Syrup (CHS) on CF-induced changes in pulmonary symptoms, and Body Mass Index (BMI) in children. In a before/after clinical trial, 44 children aged ≥6 suffering from CF were included. They were referred to Mofid children's Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran, between March 2020 and March 2021. The patients received their standard treatment, plus CHS (prescribed at 5-10 cc dose twice daily according to the weight of children (weight over 30 kg 10 ccs and under 30 kg 5 ccs) for 12 weeks. The Cystic Fibrosis Questionnaire-Revised (CFQ-R) was used to determine the Severity of pulmonary symptoms. Moreover, BMIs were compared before and after CHS intervention. CHS administration for 12 weeks improved daily cough (P=0.000), sputum production (P=0.003), wheezing (P=0.000), difficulty breathing (P=0.002), and night-time cough scores (P=0.004) considerably in CF patients after intervention. Moreover, CHS consumption increased BMI (P=0.000) in these patients. It can be concluded that compound honey syrup can be a safe and effective complementary medicine to improve pulmonary symptoms and nutritional status of cystic fibrosis patients. In order to confirm these results, it is recommended to conduct more studies with larger sample sizes in order to evaluate the effect of CHS on pulmonary symptoms and BMI in cystic fibrosis patients.

accidental ingestion of brimonidine can lead to serious adverse effects, especially in young children. We report the case of a 2.5-year-old child who ingested brimonidine ointment and experienced apnea and coma. The case was a female patient with severe central nervous system depression and apnea as a result of brimonidine ointment ingestion. After administration of oxygen and high doses of naloxone, she improved. Eating the alpha 2 adrenergic compounds is very dangerous for children, and in addition to medical staff, parents should also receive adequate training on this matter.