Journal of Comprehensive Pediatrics
Volume:15 Issue: 1, Feb 2024

 Celiac disease (CD) treatment is based on life-long adherence to a gluten-free diet (GFD). Some patients with CD experience persistent symptoms despite adhering to a GFD. This condition is defined as a nonresponsive CD.

 The present study aimed to investigate the prevalence and cause of persistent symptoms in pediatric patients with CD adhering to a GFD in Sistan and Baluchestan province, southeastern Iran.

 This descriptive cross-sectional study was conducted on 112 patients with CD selected from all diagnosed CD patients receiving a GFD for 6 months and newly diagnosed cases studied within one year. Gastrointestinal (GI) and extraintestinal (EI) symptoms were recorded on a questionnaire at the onset and during treatment. Data were analyzed by SPSS16 software, independent t-test, univariate t-test, and analysis of variance (ANOVA).

 A total of 46.43% of our sample were boys, and 53.57% were girls (mean age = 82 ± 4.43 months). Abdominal pain and constipation symptoms were reported more frequently at the time of diagnosis and following one year of treatment. The most commonly observed EI symptoms at the time of diagnosis and during treatment were weight loss and growth failure, respectively. The percentage of treatment non-response in patients with a positive family history was significantly greater than in those with a negative family history.

 The results showed that GFD had a significant effect on the reduction of GI and non-GI symptoms, but the effect of this regime on insignificant symptoms, particularly at older ages, is negligible.

 Cognitive development during childhood has significant implications for an individual's cognitive functioning throughout life. Perinatal and postnatal factors may influence this function.

 In this study, we aimed to investigate the relationship between perinatal and postnatal factors and cognitive development in healthy toddlers aged 18 – 22 months.

 In this retrospective cross-sectional study, we examined 50 toddlers born between March 2015 and March 2016 at a teaching hospital in Zahedan, Iran. This study focused on perinatal and neonatal risk factors based on the results of the Bayley-3 test. Data were analyzed using Mann–Whitney U, Kruskal–Wallis, and Pearson correlation coefficient tests.

 Analysis revealed significant correlations between several perinatal factors and subsequent cognitive performance in toddlers. Greater maternal chronological age at the time of parturition, higher levels of mother's attained education, increased neonatal weight at delivery, augmented body weight in the toddler phase, as well as the documented occurrence of neonatal hyperbilirubinemia within the initial postpartum period, demonstrated meaningful associations with enhanced cognitive functioning as assessed during the toddler stage of development.

 Based on the results, it is advised that pregnancy commences at a maternal age that circumvents risks of very young childbearing. Offspring growth should be closely tracked, and neonatal jaundice promptly treated, as these perinatal factors impact cognitive performance. Giving priority to these factors improves a child's chances of healthy cognitive development, which is essential for success in life.

 The majority of children affected by coronavirus disease 2019 (COVID-19) are thought to be asymptomatic, with a lower mortality rate than adults.

 The aim of this study was to evaluate risk factors associated with mortality in children with COVID-19.

 In this study, all patients were under 19 years of age, and their COVID-19 was confirmed by RT-PCR analysis. Primary data were related to underlying diseases, clinical and laboratory information, mortality, or safe discharge. The recorded data were analyzed using SPSS software (version 18), taking into account the significance level of < 0.05.

 Of the 183 children enrolled in the study, the mortality rate was 13.67%. The major risk factors for death were clinical manifestations involving central nervous system (CNS) diseases (P = 0.006), platelet (PLT) count (P = 0.020), lactate dehydrogenase (LDH) (P < 0.001), alanine transaminase (ALT) (P = 0.033), erythrocyte sedimentation rate (ESR) (P < 0.001), and C-reactive protein (CRP) (P < 0.001) as laboratory measurements, and cardiovascular disease (CVD) was the underlying disease with an odds ratio of 10.94.

 The study concluded that the factors associated with death were laboratory measures, such as CRP, ESR, hemoglobin, and liver enzymes, and potential diseases, such as cardiovascular and central nervous system diseases.

 Toddlers are consuming more energy-dense, nutrient-poor foodstuffs in discordance with international dietary guidelines. Limited data are available on the dietary habits of children in Jordan.

 This study aimed primarily at assessing the local validity of the NutricheQ tool in reflecting the nutritional risk status of 12- to 36-month-old toddlers in Jordan.

 This national, multicentre, observational validation study analyzed the data of healthy 12- to 36-month-old toddlers who were identified and prospectively enrolled during a routine clinic visit. After providing written informed consent, the parents or legal guardians of toddlers were asked to (a) complete a food intake diary form (FIDF) over three days (two weekdays and one weekend day); and (b) to answer the NutricheQ questionnaire completed by the physician during a single outpatient visit, as part of the case report form (CRF).

 Out of 213 Jordanian toddlers, 31 (14.6%) were at low nutritional risk; 145 (68.1%) (95% confidential interval (CI): 61.5 - 74.0) were at moderate nutritional risk, and 37 (17.4%) (95% CI: 12.8 - 23.1) were at an increased nutritional risk. The average nutritional intake of the toddlers did not meet the daily intake of the main nutrients recommended across all food categories, with a default daily intake of vitamin A, vitamin D, fiber, and iodine and an excess daily intake of protein and iron. NutricheQ-predicted risk categories significantly correlated with meat intake and the number of weekly servings of fruits and cooked vegetables.

 NutricheQ is a valid tool to predict nutritional risk among toddlers in Jordan.

 There are important cognitive issues in patients with epilepsy, which can be referred to as impairment in executive functions such as attention.

 This research aims to compare the effectiveness of computer-based cognitive rehabilitation programs and task-oriented cognitive rehabilitation programs on attention in children with epilepsy in Tehran.

 The present research was a semi-experimental study with a pre-test and post-test design with a control group. The statistical population of the study included all children with epilepsy who were referred to the neurology clinic of Mofid Children's Hospital in 2021. Using the purposeful sampling method, 45 eligible children were included in the study and were randomly divided into 2 experimental groups and 1 control group (15 people in each group). The Integrated Visual and Auditory Continuous Performance Test (IVA2) of Sohlberg and Mateer (2001) was used for data collection. The experimental groups underwent the intervention of the computerized cognitive rehabilitation program of the Cambridge Neuropsychological Test (1980) (12 sessions of 45 minutes) and the task-oriented cognitive rehabilitation program (12 sessions of 45 minutes). The control group did not receive any intervention. SPSS 20 software was used for data analysis. Univariate covariance analysis (ANCOVA) was performed using a significance level of 0.05.

 The results demonstrated that both computer-based cognitive rehabilitation programs and task-based cognitive rehabilitation were effective in increasing the attention of epileptic children in Tehran (P < 0.001). There was no significant difference between the effectiveness of computer-based cognitive rehabilitation programs and task-based cognitive rehabilitation in increasing the attention of epileptic children (P = 0.67).

 It can be concluded that computer-based and task-oriented cognitive rehabilitation programs can be used to increase attention and executive functions in children with epilepsy.

 Many clinicians have used the Apgar scoring system to evaluate newborn babies at the first minutes of birth. Expanded and combined Apgar have been introduced due to the interventions done for babies in the first minutes of life. This study evaluates the predicting values of combined Apgar scores in short-term neonatal outcomes.

 A diagnostic test was conducted on alive preterm and term babies without major anomalies between October 2021 and August 2022. Infants with congenital heart disease, congenital metabolic disorders, and those transferred to another hospital were excluded. Demographic data, feeding volume, conventional, expanded, and combined Apgar scores were assessed at 5 minutes of birth and recorded. The area under the receiver operating characteristic (ROC) curve was used to determine the sensitivity and specificity of the combined Apgar score to predict short-term outcomes (need to admission, duration of hospitalization, and oral feeding progression).

 Of 599 babies (339 boys and 260 girls) with a mean gestational age of 35.3 ± 3.8 weeks (25 - 42 weeks), 280 (46.7%) babies were admitted. As the average Apgar score decreased, progression to full oral feeding was associated with longer delay. The area under the ROC curve for the Combined Apgar score was 80% and 55% in correlation with the need for admission and duration of hospitalization, respectively.

 This study showed that the 5th-minute combined Apgar score is a good predictor of the need for admission and oral feeding progression but does not seem suitable for predicting the duration of hospitalization.

 Despite advances in pediatric pain management, postoperative pain remains a significant concern. By recognizing the multifaceted nature of pain and its susceptibility to various factors, there is a growing need to identify risk factors for postoperative pain and effective pain coping strategies.

 This study aimed to investigate the relationship between psychological variables and postoperative pain in children.

 A descriptive-correlational study was conducted with a sample of 171 children aged 6 - 13 years, conveniently selected from a children’s hospital in Tehran, Iran, based on specific inclusion criteria. The data were collected through a demographic questionnaire, the Child Pain Anxiety Symptoms Scale (CPASS), Spielberger’s State-Trait Anxiety Inventory (STAI), and the Coping Strategies Questionnaire (CSQ). Statistical analysis was performed using SPSS software (version 21).

 The majority of the 171 participants were male (65.5%), with an average age of 9.58 years. Abdominal surgery was the most common procedure (53.2%), with an average duration of 134.29 minutes. Regression analysis revealed a statistically significant association between psychological variables and postoperative pain. Specifically, for each point increase in children’s and parents’ mean anxiety scores, postoperative pain increased by 0.31% and 0.30%, respectively. Conversely, for each point increase in children’s mean coping score, postoperative pain decreased by 0.14%.

 Child and parental anxiety and coping strategies were linked to postoperative pain. Accordingly, higher levels of anxiety in children and their parents were associated with an increased likelihood of postoperative pain; nevertheless, better coping skills in children correlated with reduced postoperative pain. Therefore, implementing psychological interventions might prove effective in managing postoperative pain in children.

 Celiac disease (CD) triggers an autoimmune response in the body involving the immune system.

 This study was designed to evaluate and compare the quality of life (QOL) in children with CD and those without CD. Additionally, the study aimed to contrast the self-reported QOL of children with CD with the assessments made by their parents.

 In this cross-sectional, case-control study, the QOL of children with CD, aged 6-12 years, was compared with that of age- and gender-matched children without CD. Additionally, the study involved a comparison of the QOL assessments reported by both parents and children. The Quality-of-Life Questionnaire (Kid-KINDL) was used to appraise QOL from the perspectives of both children and their parents. Specifically, the parents completed the Pediatric Symptom Checklist (PSC).

 The present results indicated significant differences between children with and without CD in terms of QOL, psychological problems, attention, internalizing symptoms, and externalizing symptoms (as reported by the parents), as well as school performance, self-esteem, and emotional well-being (as reported by children) (P < 0.05). Furthermore, significant differences were observed in the QOL and self-esteem reports between children with CD and their parents (P < 0.05).

 This study offered valuable insights into the QOL, psychological disorders, and related factors in children with and without CD. Additionally, it underscored the tendency of parents with children suffering from CD to underestimate their children’s QOL.

 Recent studies in humans show that increased uric acid predicts hyperinsulinemia and obesity.

 Our study aimed to investigate whether hyperuricemia and insulin levels predict hypertension in obese children.

 This analytical cross-sectional study was conducted on the records of 161 obese children aged 5 to 15 years old based on the defined inclusion criteria. Children's blood pressure, height, weight, FBS (fasting blood sugar), HDL (high-density lipoprotein), LDL (low-density lipoprotein), TG (triglyceride), HbA1c (hemoglobin A1c), urine albumin, creatinine, insulin levels, and uric acid were measured. Data were analyzed by SPSS software. The significance level was considered P < 0.05.

 According to the data obtained from this study, the mean of SBP (systolic blood pressure) and DBP (diastolic blood pressure) in obese children with hyperuricemia was higher than in obese children without hyperuricemia. The average insulin in obese children and hypertension was higher than in obese children without hypertension, especially in males and the age group of 5 - 10 years. The levels of cholesterol and LDL in hypertensive males were higher than in those with hyperuricemia. HDL was higher in children without hyperuricemia than in children with hyperuricemia. The strongest predictors of uric acid were age (P < 0.001, B = 0.183), HbA1c (P = 0.014, B = 0.255), and cholesterol (P = 0.03, B = -0.007), respectively.

 Based on this study, there is a relationship between uric acid levels and parameters such as obesity and blood pressure, and the findings showed that increased uric acid predicts hyperinsulinemia and obesity. Therefore, this study indicates that physicians and healthcare workers should consider the level and state of uric acid.

 Hearing impairment (HI), as the most prevalent sensorineural impairment, can affect both children and their families' quality of life (QOL) by its remarkable consequences, like parental stress (PS). It is a type of stress that parents perceive following their parent-child interactions, alongside the children's mental, physical, or developmental disturbances.

 Considering the significant catastrophic consequences of HI in both children and their families' QOL, the current cross-sectional and descriptive-correlational study was conducted to investigate the relationship between PS and QOL among Iranian parents of hearing-impaired children with cochlear implantation (CI) history.

 A total of 80 parents of HI children with CI history participated in the current cross-sectional and descriptive-correlational study based on the inclusion criteria and simple random sampling. Therefore, their PS and QOL were evaluated using the "Questionnaire of Clinical and Demographic Information", the "Parenting Stress Index, Fourth Edition Short Form (PSI-4-SF)," and the "36-Item Short Form Survey (SF-36)." Eventually, SPSS version 26 was utilized to analyze the obtained data.

 Most of the 80 participants were female (85.0%), housewives (58.8%), and had bachelor's degrees (35.0%). Moreover, PS and QOL in parents of HI children with CI history were relatively low (�- = 67.42, P < 0.05) and relatively satisfactory (�- = 70.12, P < 0.05) respectively. Eventually, there was a significant (P = 0.001) and inverse correlation (r = -0.811) between PS and QOL in parents of HI children with CI history.

 The level of PS in the parents of HI children with CI history had a strong and inverse correlation with their QOL. Also, at the time of the study, the stress level of the parents was relatively low, and their QOL was reported to be relatively satisfactory. Thus, examining the factors affecting PS and QOL will be effective in achieving permanent, stable outcomes.

 Acute otitis media (AOM) is a common issue among children, often requiring antibiotic treatment. It is crucial to explore methods for the rational use of antibiotics. This study aimed to assess the effectiveness of the watchful waiting approach in treating children aged 6 months to 18 years with mild to moderate AOM.

 This prospective quasi-experimental study was conducted on 100 children with mild to moderate AOM. All patients, except those in severe or critical conditions, were placed on the watchful waiting strategy. A follow-up was conducted after 48 - 72 hours. If symptoms had improved, the watchful waiting approach continued. If medication was necessary for various reasons, these reasons were documented. Subsequently, children who completed the watchful waiting strategy were compared to those who received antibiotics. The collected data were analyzed using chi-square and t-tests in SPSS Statistics for Windows (version 16.0).

 In this study, 59 patients (59%) were treated with the watchful waiting approach; nevertheless, 41 patients (41%) received antibiotics. The presence or absence of postnasal discharge showed a significant difference between the two groups (P = 0.001). No significant differences were observed between the two groups regarding fever (P = 0.066), enlarged tonsils (P = 0.740), snoring (P = 0.252), and bilateral involvement of the tympanic membrane (P = 0.313).

 Based on the results, the watchful waiting strategy is a cost-effective method for children aged over 6 months with mild to moderate symptoms, provided that parents cooperate fully. Clinicians should be cautious and consider alternative treatments if postnasal discharge is present, as it might indicate a higher likelihood of treatment failure with the watchful waiting approach.

 The use of herbal drugs for treating neonatal jaundice is a common practice in many societies despite the potential complications. However, little is known about the individuals or groups who typically recommend the use of these drugs for affected neonates.

 This study aims to investigate the main recommendations of herbal drugs for treating neonatal jaundice.

 The format of the present cross-sectional study was designed and implemented based on interviews with parents of infants who have infantile jaundice who used herbal drugs for their neonates during 2019 and 2022 and were admitted to the Children’s Medical Center of Tehran, Iran. Along with baseline data, the socioeconomic situation of families was also evaluated.

 Regarding the role of people in recommending the use of herbal drugs, in 52.1% of cases, the main recommenders to use this substance to treat infant jaundice were the patient's relatives, while the role of parents in recommending the consumption of this compound was 25.5%. Also, 6.4% of the neighbors of the patients’ family were the main recommenders to use herbal drugs for the affected neonates. Interestingly, 4.3% of doctors and 11.7% of pharmacists had the leading role in recommending the use of herbal drugs to treat infant jaundice. Parents who recommended using herbal drugs for their neonates were more likely to be smokers and less affluent.

 Relatives, parents, grandparents, and even neighbors play a significant role in recommending the use of herbal drugs in the treatment and control of neonatal jaundice. The role of doctors and pharmacists in recommending the use of this compound in the treatment of jaundice, especially considering the potential side effects, should not be underestimated.