Journal of Comprehensive Pediatrics
Volume:14 Issue: 4, Nov 2023

 Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Patients with repaired TOF (rTOF) expose to moderate to severe pulmonary regurgitation (PR), right ventricular (RV) dysfunction, and RV failure. Although cardiac magnetic resonance (CMR) provides details of RV function and structure, an electrocardiogram (ECG) is accessible and inexpensive.

 We aimed to assess the correlation between clinical symptoms and ECG parameters with CMR findings.

 This cross-sectional study assessed the patients with rTOF who underwent CMR between May 2020 and September 2022 in Imam Reza Hospital. The signs and symptoms of rTOF were assessed, and a pediatric cardiologist interpreted ECG parameters. We considered CMR findings, clinical symptoms, and ECG parameters with CMR findings in rTOF. In addition, fragmented QRS (fQRS), the additional spikes within the QRS complex, was used to indicate conduction disturbance due to myocardial scar or fibrosis. Data were analyzed by SPSS version 18.

 Among 42 patients with rTOF, 20 patients were male. Although the QT correction (QTc) had a significant correlation with CMR parameters, fQRS showed a positive correlation with right ventricular ejection fraction (RVEF) less than 47% (OR 2.06, 95% CI 1.45 - 2.93; P-value = 0.005), right ventricular end-diastolic volume (RVEDV) more than 150 mL/m2 (OR 4.4, 95% CI 2.03 - 9.5; P-value = 0), and right ventricular end-systolic volume (RVESV) more than 80 mL/m2 (OR 2.83, 95% CI 1.59 - 5.04; P-value = 0). We found a murmur in the clinical examination of 64.3% of patients. Our results showed that tachycardia and tachypnea were the most common signs in these patients. Surgery at a young age was significantly correlated to lower ascending aortic volume, right pulmonary artery size, left pulmonary artery size, right atrium and left atrium volume, and main pulmonary artery flow.

 Compared to other ECG parameters, fQRS could strongly predict RVESV, RVEDV, and RVEF as the right heart indexes. Besides, repair surgery at a younger age reduces the possibility of needing pulmonary valve replacement surgery at older ages. Therefore, clinicians should consider these issues in patients.

 Neonatal and pediatric health have a great share in global health programs. However, the neonatal mortality rate still shows unacceptable figures and statistics worldwide.

 To investigate the timing and causes of neonatal death.

 In this retrospective descriptive study conducted in neonatal care units of Mahdiyeh Hospital in Tehran, Iran, the census sampling method was used to include all the medical records of the expired neonates during 2015-2020. Neonatal and maternal demographics and health complications were recorded. Descriptive statistics such as mean, standard deviation, frequency, and associations were analyzed to compare factors recorded as causes of neonatal death and its timing. A P-value of < 0.05 was considered significant.

 Out of 24049 live births, 755 neonates had expired (3.1%). The expired neonates' average birth weight was 1616 ± 905 grams, and 35.9% weighed under 1000 grams. Most (80.8%) expired neonates were preterm (30.9 ± 4.8 gestational weeks), and the most common causes of neonatal death were prematurity (23.6%), congenital anomaly (19.9%), respiratory distress syndrome or RDS (19.5%), sepsis (13.2%), and asphyxia (7%). Most (60.7%) neonates died between the second and seventh days of birth.The following conditions were associated with an early-period neonatal death rather than a later-period: multiple births (OR = 2.8), normal vaginal delivery (OR = 2.03), low-birth-weight, diabetic mothers, neonatal heart disease, neonatal neurological diseases, RDS, asphyxia, familial marriage, and intrauterine growth restriction (IUGR) (P < 0.05). Being male (P = 0.005) or being multiple births (P < 0.0001) were associated with a higher risk of death. While 57% of mothers delivered through Cesarean section, among the expired neonates, 66.9% were delivered through Cesarean section. In expired neonates, Apgar scores were low in the first (5.71) and fifth (7.27) minutes of birth.

 Our study showed that prematurity, congenital anomaly, RDS, sepsis, and asphyxia were the most prevalent causes of death among expired neonates, respectively. Preterm birth and low birth weight were prevalent among expired neonates.
Conducting regular similar studies periodically is important to identify, manage, and reduce neonatal mortality rates as an indicator of health promotion in the country.

 Nephrotic syndrome (NS) is a common disease in children with many consequences for their health, particularly when the disease is severe, accompanied by frequent recurrences, and must be treated with high-dose, long-term corticosteroids.

 We aimed to determine the effect of birth weight on complete response to corticosteroids in children with NS.

 Two hundred and ninety-two children with NS aged 1 - 18 years were included in the present cross-sectional study. The children followed up from 2010 to 2021 at Ali-Ibn-e-Abitaleb Hospital, Zahedan, Iran. Data were obtained by reviewing medical records for results and completing a parental self-reported questionnaire for birth-related information. For the analysis, SPSS 23 was applied with P < 0.05 as a significance level.

 In the steroid-resistant (28.9%) group, low birth weight (LBW) was significantly higher than in the steroid-sensitive (10.5%) group (P = 0.001). A two-way logistic regression report showed that birth weight (P = 0.04, OR = 0.58, 95% CI: 0.34 - 0.99) and number of recurrences (P = 0.001, OR = 4.60, 95% CI: 2.91 - 7.27) were both significantly associated with the development of steroid resistance.

 In patients with NS, there was a significant association between LBW, higher relapse rates, steroid resistance, and thus poorer patient outcomes.

 Patients with beta-thalassemia (BT) are more prone to infections than others, especially when they have some risk factors. Some reports showed the lower severity of Coronavirus disease 2019 (COVID-19) infection in this population.

 In this study, we aimed to determine the serological status of COVID-19 in BT patients.

 This cross-sectional study was conducted in September 2020-February 2021 at Ali-Asghar Children's Hospital, Iran. All major and intermedia β-thalassemia patients dependent on blood transfusion were enrolled in this study. Demographic information, including age, gender, thalassemia type, history of splenectomy, and blood type, were recorded in a checklist. Moreover, the patients were asked about their exposure to COVID-19, and the related symptoms, such as cough, fever, headache, and anosmia, in the last six months. The enrolled cases were examined for anti-COVID-19 IgM and IgG to determine the serological status against this virus.

 The positive IgG and IgM tests against COVID-19 were in 35.7% (25/70) and 20% (14/70) of cases, respectively, while 42.9% (30/70) were either IgM- or IgG-positive. Among the serologically positive cases, six had a history of at least one symptom suspicious of COVID-19. These six included one fever, two coughs, one anosmia, one dyspnea, and one cough and anosmia. Only one of the patients was hospitalized (1%) with fever and dyspnea. No Intensive Care Unit admission or mortality was reported.

 It seems that COVID-19 is more likely to be mild or asymptomatic in patients with BT.

Context: 

Hypothyroidism describes an endocrine disorder that occurs when the thyroid gland cannot secrete adequate thyroid hormones. Congenital hypothyroidism refers to a lack of thyroid hormone among newborns.

Evidence Acquisition: 

The ISI Web of Sciences, Scopus, PubMed, and Google Scholar databases were reviewed for relevant articles published from 2000 to 2022.

 Congenital hypothyroidism, occurring in approximately one in 2,000 to one in 4,000 newborns, ranks among the most frequent causes of intellectual disability that can be prevented. The screening of newborns, confirmation assessments, interpretation of thyroid function tests accurately, prompt and therapeutic treatment, and regular follow-up contribute to a very good neurocognitive outcome later in life. Since the timely diagnosis of congenital hypothyroidism is critical in preventing mental retardation, clinicians must be kept abreast of this disorder and educate nursing and medical students regarding accurate interpretations of diagnostic testing and the recognition of associated symptoms. Most newborns with congenital hypothyroidism present no symptoms, even though their TSH or T4 levels are likely to have fluctuated significantly. As a result, congenital hypothyroidism was rarely detected in newborns before the introduction of neonatal screenings.

 We provide an overview of the etiology, epidemiology, manifestation, diagnosis, and treatment of congenital hypothyroidism based on the latest studies.

 Vitamin D is a multifunctional hormone essential in the immune system. Vitamin D deficiency may increase the disease burden in patients with COVID-19.

 We investigated the effect of vitamin D administration as an adjunctive therapy on treating children with COVID-19.

 Children with confirmed or probable COVID-19 who were admitted to 17th Shahrivar Hospital in Rasht from October 2022 to April 2023 were selected by random sampling method. They were divided into two groups by random blocks: the intervention group with vitamin D administration and the placebo-controlled group. The patient data were recorded and analyzed, including age, sex, and the required clinical and laboratory information, including the time required to recover from fever and respiratory distress and the length of hospitalization.

 In this study, 60 patients (30 in each group) were evaluated. At the beginning of hospitalization, fever was significantly more observed in the intervention group (90% vs. 53.3%, P = 0.002). The average time required to recover from fever and respiratory distress was less in the intervention group, although this difference was not significant between the two groups (P = 0.591 and P = 0.192, respectively). The hospitalization duration was also similar in both groups, and no complications or death were observed in the two groups.

 Administering vitamin D at a dose of 1000 IU daily showed no significant efficacy for recovering children with COVID-19. Further studies are suggested to investigate the high dose of vitamin D supplementation in treating children with COVID-19.

 Sepsis-associated acute kidney injury (SA-AKI) is an acute kidney injury in the presence of sepsis without other significant contributing factors explaining acute kidney injury (AKI). Circulating syndecan-1, angiopoietin-2, and urinary neutrophil gelatinase-associated lipocalin levels can potentially cause neglected AKI to become acute kidney disease (AKD) and even chronic kidney disease (CKD). Therefore, studying its levels in the early phase of AKI is important, especially in SAAKI.

 This study aims to analyze the levels of syndecan-1, angiopoietin-2, and urine neutrophil gelatinase-associated lipocalin (uNGAL) as other modalities that might detect AKI earlier in children with SAAKI.

 This study enrolled 23 children between one month and 18 years with sepsis. Blood samples were collected from all patients at the baseline, 12, 24, and 48 hours after admission to assess serum creatinine, syndecan-1, angiopoietin-2, and a urine sample was collected to measure uNGAL levels. We used the Wilcoxon signed-rank test to compare each biomarker with the time of measurement and the Mann-Whitney test to compare the levels of biomarkers with the incidence of SA-AKI.

 The highest median value for uNGAL was 78.30 (3.20 - 24098.40) in the 12th-hour measurement; for syndecan was 2.92 (0.06 - 83.00) in the baseline measurement, slightly decreased and continued to increase up to 48 hours, and for Ang-2 was 4159.60 (17.60 - 226428.00) in the 12th-hour measurement. The incidence of SA-AKI based on the pediatric risk-injury-failure-loss-end stage (pRIFLE) criteria were that five children (21.7%) had AKI in the risk/injury phase at baseline, 24-hour, 48-hour observations, and also six children (26.1%) at 12-hour observation.

 There was an increase in levels of syndecan-1 and ang-2 in children with severe sepsis, especially in the first 24 hours.

 Hypertriglyceridemia (HTG) and diabetic ketoacidosis (DKA) are complications of uncontrolled diabetes that may result in significant mortality or morbidity. Hypertriglyceridemia is a rare complication in children, and we report a case of hypertriglyceridemia in a child 12 years old with Diabetic Ketoacidosis.

 We report the case of a 12-year-old patient who was referred to our center with polydipsia, polyuria, lethargy, and weakness. On admission, serum glucose was 300 mg/dL, hemoglobin A1c level was 10.7%, plasma triglyceride (TG) was very high, 13520 mg/dL, and cholesterol was 980 mg/dL. He had DKA with hypertriglyceridemia and acute pancreatitis.

 Insulin and fresh frozen plasma (FFP) injection is a safe, effective therapy for hypertriglyceridemia in DKA and rapidly lowers dangerously high triglyceride levels and prevents untoward complications.

 Obesity is one of the causes of insulin resistance. Although it has been speculated that nettle is probably a safe treatment for insulin resistance, considering the shortage of evidence on its effects, we aimed to assess the effect of nettle extract on insulin resistance and metabolic parameters in obese children.

 In this paralleled-randomized controlled clinical trial, 64 children aged 12-18 years with obesity were randomly divided into two groups. The intervention group received nettle syrup twice a day for 12 weeks in addition to a specific diet, and the control group followed the diet alone. Demographic characteristics and metabolic results, and lipid profile were checked. Data were analyzed by IBM SPSS Statistics Version 24.0, and a P-value < 0.05 indicated statistical significance.

 The results showed that most patients in the groups were girls. In the inter-group analyses, results showed significant differences in terms of FBS (P = 0.043), LDL (P = 0.023), and Homeostatic Model Assessment for Insulin Resistance (HOMA-IR) (P = 0.025) after eight weeks. Although FBS (P = 0.044) had a significant difference in the 12th week and was higher in the intervention group, it was still in the normal range.

 This study revealed that administering nettle syrup can be helpful for patients with obesity with no significant adverse effects, and it considerably reduced LDL, T-Chol, and HOMA-IR. Despite our promising results, further multicenter studies with larger sample sizes in this age group can be beneficial to confirm our results.