Journal of Pediatrics Review
Volume:11 Issue: 4, Oct 2023

Allergic disorders are increasing prevalence from decades. Often of allergic diseases such as chronic urticaria in some aspects of quality of life of patients affected. Outdoor and indoor allergens can cause   aggravation of symptoms in allergic patients.H1-antihistamines have been available for decades and those are over-the-counter drugs. The first generation H1-antihistamines have anticholinergic and sedative effects. Basically, their use (H1 blockers) for the routine management of allergic diseases is not recommended.  Second generation H1-antihistamines (bilastine, cetirizine, desloratadine, ebastine, fexofenadine, levocetirizine, loratadine, and rupatadine) have minimally or non-sedating and free of anticholinergic effects. About 10–15% of pregnant women used antihistamine within pregnancy.

Children with congenital heart disease (CHD) are prone to weakening and underweight. 

We aimed to evaluate the effect of high-density formula on weight gain and gastrointestinal intolerance in CHD children following heart surgery.

All randomized clinical trials (RCTs) on weight gain following heart surgery in CHD children were systematically searched on Web of Science, PubMed, and Scopus databases by related keywords from 1990/01/01:2022/12/30. Papers in languages other than English were excluded. Among 11 trials that evaluated the effect of a high-density formula on weight, 6 studies were excluded due to their study samples (older than 2 years) and using macronutrients to enrich the formula.

Finally, 5 eligible trials with a total of 278 participants were included in this systematic review. The follow-up duration ranged from 5 to 30 days. Among 5 included studies, 4 indicated that feeding with high-density or concentrated formula can improve weight gain in children with CHD compared to the standard formula. Diarrhea was the most common gastrointestinal complication associated with the high-density formula, although its frequency was low.

Feeding with a high-density formula or concentrated standard formula could be an inexpensive and practical way to fulfill the nutritional requirements of CHD children following surgery, which can lead to more weight gain without any significant gastrointestinal side effects.

There is an association between treatment options and growth in patients with mucopolysaccharidoses (MPS). The appropriate management of MPS is an essential factor for the growth of the patients.

This study aims to review systematically the available data on the growth status and related treatment factors in patients with MPS type I and MPS type II.

A systematic literature search was performed in PubMed, Scopus, and the Web of Science using related keywords by March 2023. In this systematic review, the primary outcome was determining the growth status (mainly height z-score) of patients with MPSI and MPSII from reviewed studies and its association with different treatment options. The author’s name, year of publication, country, type of MPS, growth status, treatment options, and any associations between growth status, disease, and treatment variables in the article were extracted. 

From the initially retrieved 743 references, 100 were removed due to being duplicates, 31 articles were evaluated by reading the full text, and finally 20 were included in the systematic review. Based on the analyses, treatment options improved growth in the MPS patients. Certain variables regarding the treatment were key factors, such as the age of treatment initiation, combination therapy, and human growth hormone therapy. Some factors related to the characteristics of the patients, including genotype (type of mutation) and disease severity, are also key factors. Patients with MPSI and MPSII had normal growth and height during the first years of life, but after 2-5 years, their growth rate decreases progressively.

The findings of this review indicated that growth impairment is common in patients with MPSI and MPSII. Treatment improved the growth development in these patients but not as much as expected. Some patients’ characteristics, such as disease severity and type of mutations, affect treatment efficacy and height gain. From treatment-related factors, the most important factor is the age of treatment initiation. Regarding other factors such as donor type, human growth hormone administration, and combination therapies, current findings are inconclusive, and more studies are needed.

Due to the increasing rate of abuse, several psychosocial interventions have been proposed for the adverse effects of child abuse. However, the conflicting and inconsistent results in this field should be explored. Accordingly, this study aimed to review the effectiveness of psychosocial interventions on the behavioral and psychological problems of abused children in Iran.

A systematic search was conducted in Iranian and international databases, including SID, Magiran, PubMed, Scopus, Web of Science, and Google Scholar search engine. The related articles were searched using the proper keywords. The study samples included male/female patients less than 12 years old. The search process was conducted until June 2023. Two researchers independently screened the titles and abstracts of the search results and then assessed the full texts, selecting the relevant studies. This review emphasized children-focused interventions.

A total of 11 qualified studies (8 quasi-experimental, 2 randomized clinical trials, and 1 single subject) out of 239 gathered articles were included in the present systematic review. Samples included 473 patients (198 boys, 247 girls, and 28 unclassified). According to this review, research has confirmed the effectiveness of psychosocial interventions on behavioral and psychological problems of abused children. 

The results of this review propose that psychosocial interventions are practical and can be used for children suffering from abuse. Considering their efficacy, such psychosocial interventions are recommended in clinical and educational contexts. Clinical and research implications are presented in the discussion section.

Tonsillectomy is a common procedure for alleviating tonsil-related symptoms in children. However, postoperative pain management has remained challenging. Inadequate pain control can result in discomfort, prolonged recovery, and increased complications. This review evaluates pain management methods in tonsillectomy surgery, encompassing preoperative, intraoperative, and postoperative approaches.

To gather data, a systematic search of electronic databases (PubMed, Embase, Cochrane Library) was conducted using relevant keywords to tonsillectomy, such as pain, opioid, recovery, and so on. The inclusion criteria comprised studies published in English between January 2000 and September 2022 involving pediatric and adult tonsillectomy patients. Eligible study types included randomized controlled trials, cohort studies, systematic reviews, and meta-analyses. Studies were initially screened based on titles and abstracts, followed by a full-text review.

Postoperative pain intensity and prevalence after tonsillectomy can vary significantly. Administering analgesics should be started before pain perception. Also, the period from the beginning of surgery to the patient’s awakening is critical for optimal pain control. Delayed analgesic administration upon patient awakening may have limited efficacy. Multimodal analgesia, combining different medications with complementary mechanisms of action, is highly effective. Non-opioid analgesics such as acetaminophen and nonsteroidal anti-inflammatory drugs are commonly used alongside opioids to achieve synergistic pain relief. Regional anesthesia techniques, like peripheral nerve blocks, provide targeted pain relief and reduce systemic opioid requirements. Patient education and expectation management are vital for effective pain management. Informing patients and caregivers about the potential severity and duration of postoperative pain, as well as available pain management strategies, reduces anxiety and improves compliance. Psychological factors, including anxiety and fear, influence pain perception and tolerance, necessitating their consideration. Techniques such as cognitive-behavioral therapy, relaxation techniques, and distraction methods improve pain control and reduce anxiety. Implementing protocols of enhanced recovery after surgery (ERAS) holds promise in optimizing pain management. These protocols involve a multidisciplinary approach, including preoperative optimization, standardized pain management regimens, and early mobilization. Healthcare providers can enhance postoperative recovery and pain control in tonsillectomy patients by adopting ERAS principles.

Effective pain management in tonsillectomy surgery necessitates a multimodal approach with preoperative analgesics, intraoperative techniques like regional anesthesia, and postoperative pain control using a combination of non-opioid and opioid medications. Patient education, addressing psychological factors, and implementing ERAS protocols are critical for optimizing pain management and improving patient outcomes in tonsillectomy surgery.

Given the lack of general standards for pain treatment after orthopedic operations, orthopedists and anesthesiologists need evidence to choose analgesic options for children. Therefore, this paper seeks to evaluate the effectiveness of morphine administration in reducing pain after orthopedic surgery in children in different contexts.

To find study trials on the effect of morphine on pain relief in children with orthopedic surgery, we systematically reviewed PubMed, ISI Web of Science, Embase, Google Scholar, Cochrane, and Scopus databases until March 2020. The following keywords were searched: “Morphine,” “ opioid,” “children,” “pediatric,” “preschool,” “child,” “orthopedic,” “orthopedics,” and “orthopedic procedures” to find relevant papers. The quality of articles was evaluated using the Jadad scale.

Nine studies were included in the meta-analysis. Analgesia with sublingual buprenorphine had an effect similar to the intramuscular morphine. The effect lasted significantly longer in the buprenorphine group than in the morphine group (P=0.03). About 67% of the children experienced pain relief after the first injection and 94% after the second injection (after 15 minutes) of morphine. In the propacetamol group, 77% of the children had pain relief. It is recommended to administer propacetamol initially. If the propacetamol is not effective, a subsequent injection of morphine is suggested after the first injection of propacetamol. About 84.6% of parents in the ketamine group and 66.6% of parents in the morphine group were very satisfied with the analgesic intervention. However, no significant difference was observed between the two groups (P=0.296). According to two studies, the pain score was significantly lower in the morphine group than in the meperidine group (P<0.005). The morphine administered in combination with ketorolac induced greater analgesia compared to the group receiving morphine alone (P=0.002). According to three studies, morphine was not superior to ibuprofen in relieving children’s postoperative pain (P>0.005).

Morphine was more effective than meperidine. However, morphine did not surpass ibuprofen, buprenorphine, and ketamine in treating children with orthopedic pain.

Neonatal arrhythmias (NAs) refer to abnormal heart rate and rhythm in the neonatal period. Various inherent cardiovascular, systemic, or metabolic abnormalities can precipitate NAs. We sought to evaluate the incidence, types, and implications of NAs.

A retrospective observational study was performed on newborns diagnosed with NAs during hospitalization in 4 neonatal intensive care units (NICUs) in North Maharashtra, India, from May 2018 to June 2021. 

During the study period, 42 neonates with arrhythmias were identified. The incidence of arrhythmias was 0.67% in the 4 NICUs. Their mean gestational age was 36 weeks (Range: 29–42 weeks). Eighteen of the infants (42.85%) were diagnosed with fetal arrhythmia (FA) during the third trimester of pregnancy. The distribution of NA types was as follows: 12(28.57%) supraventricular tachycardia (SVT), 12(28.67%) premature atrial contractions (PACs), 7(16.67%) premature ventricular contractions (PVCs), 3(7.14%) multiple arrhythmias such as SVT+PAC and AV block+PVC, and 6(14.28%) with AV block. The Wolff-Parkinson-White syndrome (WPW) was present in 2 patients. An association of NAs with congenital heart defects was identified in 18 cases. 

Non-benign cardiac arrhythmias are significant causes of infant morbidity and even mortality if undiagnosed and untreated. The pediatrician must know the etiology, development, and natural history of arrhythmias in the fetal and neonatal periods.

Few studies have investigated catatonia or adequately elucidated its epidemiology or pathophysiology. Catatonia is a debilitating neuropsychiatric syndrome. 

In this case report, we present a 15-year-old boy who was brought to the emergency room with weakness, gait disturbance, and urinary incontinence.

The findings of this investigation indicate that in cases where medicinal intervention has proven ineffective, electroconvulsive therapy (ECT) seems to be a commendable substitute form of treatment.

Refractive errors are among the most common causes of vision loss in patients attending healthcare facilities in the first and second decades of life. Astigmatism stands out as one of the common and treatable causes of vision loss in pediatrics. 

In this cross-sectional study, the samples were chosen by random cluster sampling among children aged between 7 and 13 years from elementary schools in 2014-2015 academic year. For all students, refractive errors were assessed by Autorefractor Keratometer and retinoscopy. Internal astigmatism was defined as the difference between refractory and corneal astigmatism. SPSS software, version 16 was used for data analysis.

A total of 1009 children participated in the study. Among them, 468(46.4%) were male, and 541(53.6%) were female. Their mean age was 9.2±1.7 years. About 14.5% of them had refractory astigmatism. Corneal astigmatism was the most common type, with 12.5% of students suffering from it. The prevalence of corneal astigmatism was not significantly different between males and females (P=0.19). Also, there was no significant relationship between increasing age and prevalence of astigmatism in this age group (P=0.06).

There was no significant difference in the rate of refractory astigmatism, lenticular and corneal astigmatism, between males and females. Because correcting refractory errors in students has a positive effect on learning ability and physical and mental development, screening and follow-up are recommended in this age group.

Acute kidney injury stands out as one of the common complications in the pediatric intensive care unit. 

This study was designed to evaluate acute kidney injury’s frequency, etiologies, and its course in critically ill children.

This cross-sectional study was conducted in a tertiary training pediatric intensive care unit. The definition of acute kidney injury is based on the pRIFLE (pediatric risk, injury, failure, loss, end stage renal disease). Analysis of possible variables contributing to acute kidney injury was made using data up to 48 hours before the onset of renal failure.

In 255 patients analyzed, the median age was 18 (IQR, 6-60) months. The common causes of admission were infectious diseases (50.2%) and neurologic disorders (25.9%).Acute kidney injury occurred in 63 patients (24.7%). Prerenal acute kidney injury occurred in 43 patients (68.3%), renal in 11(17.5%), postrenal in 2(3.2%), and 7(11.1%) were unspecified. Patients with the risk, injury, failure, and loss stages of the pRIFLE definition were 40(63.5%), 14(22.2%), 6(9.5%), and 3(4.8%), respectively. The length of hospital stay was significantly higher in acute kidney injury patients (P=0.041). After controlling for other risk factors, acute kidney injury was higher in patients with lower age, higher PRISM (pediatric risk of mortality) III scores, multiple organ dysfunction, leukocytosis, hypernatremia, and acidosis (P<0.05).

Acute kidney injury is a significant concern in pediatric intensive care units, which contributes to prolonged hospital stay. The lower age, higher mortality scores, multiple organ dysfunction, leukocytosis, hypernatremia, and acidosis are risk factors for the next 48 hours of acute kidney injury.