International Journal of Pediatrics
Volume:11 Issue: 118, Oct 2023

Leukemia is one of the most common malignancies in childhood, accounting for about 40 per million children under the age of 15 years. Acute lymphoblastic leukemia accounts for about 75% of these cases of leukemia. Regarding the improvement in life expectancy and the prolonged life of patients with acute lymphoblastic leukemia, identifying the long-term complications and effects of treatment in patients is necessary. The present applied study is a cohort study based on the case-control method. In order to achieve the purpose of the study, 50 patients who had improved acute lymphoblastic leukemia were selected as a case group; the selections were conducted in a sequential manner in Mofid Children Hospital. 50 other people who had no history of ALL disease were selected as the control group. All information gathering processes including patient history, physical examination, and necessary tests were done by a pediatric hematology oncology subspecialties fellow and trained personnel with full supervision of Pediatric hematologist - oncologist. Blood samples were taken at 10-cc of fasting blood. Blood samples after centrifugation and storage at 20 ° C were used to measure serum fasting blood glucose, triglyceride (Slovak based on serum lipid profile), and insulin levels. All demographic information, BMI, clinical symptoms, laboratory tests, and treatments were recorded in both forms. Data were finally entered into SPSS version 21 and analyzed using the GEE method. the incidence of obesity was significantly higher in patients with ALL as compared with the controls. The risk of obesity in ALL patients was found to be approximately 9 times higher than the controls. In this study 6 (12%) patients in cases and 4 (%8) patients in controls had metabolic syndrome. There was no statistically significant difference between the groups in the incidence of metabolic syndrome, insulin resistance, and visceral obesity. It is suggested that after acute lymphoblastic leukemia treatment in children, in addition to regular follow up for disease recurrence, the patients should be monitored about metabolic syndrome or any of its components, especially weight gain, and obesity.

Inflammatory Bowel Disease (IBD) is a multifactorial disease, posing significant challenges to public health. The aim of this study is to determine the effect of silymarin on the symptom severity in pediatric patients with IBD.

Methods & Materials: 

This randomized clinical trial was conducted on children aged 5-18 diagnosed with IBD referred to the GI clinic at Akbar Children's Hospital in Mashhad. Those who met the inclusion criteria were randomly allocated into either the intervention or placebo group, each group consisting of 20 participants. In the intervention group, silymarin was administered three times daily in divided doses for three months. The control group received a placebo. To assess the efficacy of silymarin, PUCAI and PCDAI were evaluated for all patients at three different time points: before the intervention, during the first visit, and after the intervention. Data were analyzed utilizing the SPSS version 25, with a significance level set at p < 0.05.

The comparison of the disease activity index scores in patients with IBD between the silymarin and placebo groups revealed that during the initial evaluation, no significant difference was observed in the disease activity index score between the two groups before the intervention (p>0.05). However, a statistically significant difference was observed in the disease activity index score between the two groups during the second, and third evaluations (p<0.05).

Positioning of hospitalized premature neonates is important because they often suffer from hypotonia, which can affect their development. Keeping the baby in the right position is one of the duties of nurses, and on the other hand, parents' participation is one of the most effective ways to prevent injuries caused by the hospitalization of premature neonates. Therefore, the present study aimed to determine the effect of bedside nurses’ and mothers’ education on the positioning score of premature infants admitted to NICU (Neonatal Intensive Care Unit). In this pre-post study, 41 nurses and 7 mothers of premature neonates hospitalized in the NICU of Shahid Sadoughi hospital, Yazd, Iran, from May to June 2022, were included. The infants’ positioning score was recorded through the Infant Positioning Assessment Tool (IPAT) on three consecutive days during three stages. Then the nurses and mothers were subjected to an interactive training course, including two theoretical and practical parts for one week, and the positioning score of the infants was re-checked one week and one month after the training. The data were analyzed using Wilcoxon, Friedman, Bonferroni, and Kolmogorov-Smirnov post hoc tests in SPSS software version 24. The results of the present study showed that there was a significant difference among the mean positioning scores of the infants before the education (5.59 ± 2.82), one week after (9.28 ± 2.91), and one month after the education (9.86± 2.64) (P <0.001). Training nurses and mothers can improve the positioning score of premature infants in NICU and provide them with better developmental care. To achieve the ideal level of support for premature infants and better neurodevelopment, it is necessary to continue training and monitoring nurses' performance in this area.

The effectiveness of eradicating Helicobacter pylori infection in improving the symptoms of chronic gastritis has been examined; however, the results of the studies have been contradictory, especially in childhood. This study aimed to compare the clinical effectiveness of sequential Helicobacter pylori eradication treatment and proton pump inhibitor alone in children with chronic Helicobacter pylori-positive gastritis.

This randomized double-blinded clinical trial was conducted on 84 children aged 5 to 15 years suffering from Helicobacter pylori-associated active chronic gastritis. The patients in the experimental group received sequential therapy including omeprazole, amoxicillin, clarithromycin, and metronidazole; and those in the control group only received omeprazole. Before the intervention, and 2 and 4 months after it, the severity of clinical symptoms was assessed.

After therapeutic regimens, the intervention group was found to have a significantly higher decrease in the severity grades of some symptoms including heartburn, gastroesophageal reflux, and abdominal pain in the epigastric area as compared to the control group (P<0.05). The assessment of the frequency of clinical symptoms in the intervention and control groups also indicated a greater reduction in epigastric pain in the group treated with Helicobacter pylori eradication as compared to the control group (P<0.05).

Prescribing a sequential Helicobacter pylori eradication regimen can lead to reducing the severity of clinical symptoms in children suffering from chronic gastritis.

Thalassemia is a common inherited anemia; and population-level screening followed by molecular evaluation is the most effective way to prevent it. Given the significance of beta-thalassemia minor and its prevalence in communities, this study aimed to identify the prevalence of beta-thalassemia minor among participants in the pre-marital screening program in Birjand City, located in South Khorasan province, Iran.

The study included individuals who underwent pre-marital testing between 2014 -2019 and were categorized as high-risk for beta-thalassemia based on their blood indices and medical diagnosis. Data on their blood indices and follow-up results were collected from Birjand City's health center using a pre-designed form. The data were analyzed using statistical tests to assess significance.

Out of 35,801 couples who underwent premarital testing, 195 (390 individuals) were identified as the high-risk group for beta-thalassemia. Among these high-risk couples, 67.2% responded to iron therapy. Thalassemia prevalence was 9.7% among high-risk couples, 31.6% among individuals at actual risk, and 76% among those who underwent Prenatal Diagnosis (PND). The mean values of MCV, MCH, and Mentzer indices were significantly higher in the group that responded to iron therapy compared to the group eligible for PND.

It was demonstrated that the prevalence of beta-thalassemia carriers among marriage applicants attending the health center in Birjand City is currently low. However, the implementation and continuity of beta-thalassemia screening programs for couples in this region can effectively prevent the birth of infants with thalassemia major and prevent unexpected medical treatment expenses.

Childhood is a sensitive and important period in life, and is a key period in the formation of people's nutritional habits throughout life. Proper nutrition in teenage students can affect the quality and quantity of their growth. The purpose of this study was to investigate the effects of a health literacy training program on nutritional behaviors among children in Iran.

In this study, carried out using an interventional method, 30 children were selected by available sampling and divided into two groups by randomized block method. The intervention group received 8 sessions of nutritional health literacy training and the control group did not receive any training. Data were collected using Children's Eating Behavior Questionnaire (CEBQ). Data analysis was performed using SPSS 25 software and analysis of covariance (ANCOVA).

The implementation of the health literacy training program significantly improved the nutritional behaviors of sixth-grade male students (P=0.001, F=6.57). This improvement was associated with reducing the average scores of the negative dimensions of nutritional behaviors (response to food, complaining, emotional overeating, emotional undereating, and the desire for drinks) and increasing the average scores of the positive dimensions (enjoying food, responding to satiety and eating slowly) (p<0.05).

According to the findings, the health literacy program can be used to improve the dimensions of children's nutritional behaviors along with other treatment options. Therefore, it is recommended to implement similar educational programs for students of other grades and for female students.

Most research on children and adolescents with COVID-19, had limited sample sizes and little clinical, laboratory, and radiological findings. The purpose of this research was to examine the features of children and adolescents with COVID-19 infection.

This analytical retrospective study was conducted on children (1 to 12 years old) and adolescents (13 to 19 years old) with COVID-19 in Shahid Beheshti Hospital, Kashan, Iran. The data were then collected, entered into SPSS and analyzed.

In the adolescent group, the frequency of dyspnea (47.1 % vs. 11.9%), cough (67.1 % vs. 39.2%), lethargy (42.9 % vs. 25.9%), headache (35.7 % vs. 10.5%), myalgia (38.6 % vs. 14%), and chest pain (12.9 % vs. 0.7%) were significantly higher than those in children (p<0.05). Furthermore, in terms of laboratory findings, the normal range of neutrophils (13.8% vs. 1.4%), Cr (95% vs. 75.7%), and CRP (77.9% vs. 58%) were higher in children. Moreover, we found that the CT severity score among adolescent patients was significantly higher than that in children (4.84 ± 5.21 vs. 1.76 ± 3.25, p=0.006). Also, the frequency of consolidation (61.3 % vs. 19%), and ground-glass opacity (58.1 % vs. 28.6%) among adolescents were significantly higher compared to child cases (p<0.05) while only the frequency of mosaic pattern of pulmonary parenchymal attenuation was significantly higher among children (p=0.035).

This research found milder clinical, biochemical, and radiological symptoms in children with COVID-19 than adolescents. However, radiological examinations showed greater rates of pulmonary parenchymal mosaic attenuation, which might help early diagnosis of COVID-19.

Congenital Diaphragmatic Hernia (CDH) is a rare developmental abnormality of the diaphragm with an incidence of approximately 2.5 cases per 10,000 births. Despite advances in treatment, mortality and long-term morbidity among survivors remain high.

A newborn was delivered by planned caesarean section due to prenatal diagnosis of CDH, diagnosed at 18 weeks and 5 days (Correction 3.1) during routine ultrasound. The Observed-to-Expected (O/E) Lung area-to-Head circumference Ratio (LHR) was 52%. After birth, the newborn was in respiratory distress and required mechanical invasive ventilation. Surgical repair was planned after stabilisation for the second day of life. A subcostal laparotomy was performed, and an anteromedial hernia with mostly small intestine, the left colon flexure and the spleen as content was found. The abdominal contents were reduced, and the hernia was repaired with a suture. Due to the development of a severe pulmonary hypertension, extubation was only possible on the fifth postoperative day, but reintubation was needed. The patient remained in the intensive care unit for a total of 25 days and could be discharged 46 days after birth in a good condition.

When treating patients with CDH, the most feared complication is pulmonary hypertension, which can be life-threatening and refractory to treatment. Surgical repair should be postponed until the newborn is medically stable.

CDH presents a diagnostic and therapeutic challenge. When diagnosed prenatally, patients should be referred to a tertiary centre for a multidisciplinary approach.

Caustic ingestion in the pediatric population usually occurs accidentally in children under five years due to insufficient care or negligent household depositing of caustic substances. Neglectful behavior of parents while preparing formula for a neonate can lead to this rare condition in newborns.

We are reporting the case of a four-day-old newborn that was accidentally given house cleaning liquid mixed with formula by his mother, who mistook it for water to dilute the milk. This led to the development of extensive oral and esophageal lesions. 

This report highlights the importance of providing education for parents on how to prevent such accidents and avoid neglectful behaviors while caring for their children.