Iranian Journal of Pediatrics
Volume:35 Issue: 2, Apr 2025

Caffeine citrate is a commonly prescribed drug in preterm neonates. The direct effect of caffeine citrate on the activation of diaphragmatic motion has not been extensively researched.

This observational study aimed to assess the changes in electrical activity of the diaphragm in response to caffeine citrate administration and discontinuation in preterm neonates.

Preterm infants [< 34 weeks’ gestational age (GA)] admitted to a level-IV neonatal intensive care unit in South Korea supported by invasive or non-invasive neurally adjusted ventilatory assist with caffeine citrate administration were prospectively enrolled in this observational study. The electrical activities of the diaphragm (Edi), Edi peak and Edi min values, before and after administering the loading and initial maintenance doses of caffeine citrate, and before and up to 48 hours after discontinuation, were analyzed.

Thirteen infants with a GA and birthweight of 28.8 ± 2.1 weeks and 1231 ± 441 g, respectively, were included. Edi peak and Edi min tended to increase when the neural respiration rate was ≥ 30 breaths/min. Edi peak and Edi min showed a higher trend after caffeine citrate loading and maintenance dose administration, particularly in infants born at < 28 weeks of GA or with a birthweight of < 1250 g, compared with those born at ≥ 28 weeks of GA or with a birthweight ≥ 1250 g. Caffeine citrate discontinuation resulted in an increased number of episodes of apnea and desaturation.

Changes in Edi peak and Edi min showed different trends depending on perinatal factors. On caffeine citrate cessation, monitoring changes in clinical symptoms in near-term post-menstrual age may be prudent.

Brain tumors are the most common solid tumors in childhood. With the help of increased clinical awareness, improvements in imaging methods, and the identification of molecular characteristics, advances have been made in both diagnosis and treatment.

In our study, we aimed to discuss the childhood brain tumor cases followed in our clinic, along with their clinical and epidemiological features and treatment outcomes.

The study group comprised children younger than 18 years old who were followed in the Pediatric Hematology and Oncology Clinic of Istanbul Medical Faculty and diagnosed with a brain tumor over the past 5 years (2018 - 2023). Symptoms, age at diagnosis, treatment options (surgery, radiotherapy, chemotherapy), and side effects were reviewed retrospectively.

Thirty children were diagnosed with brain tumors. Of the patients, 14 (47%) were male and 16 (53%) were female. The mean age of the children was 8.8 ± 3.1 years, and the mean age at diagnosis was 65.6 ± 37.7 months. The most common symptom was vomiting (40%). The mean duration between the onset of symptoms and diagnosis was 3.8 months, with a median of 1 month. Of the patients, 60% were diagnosed with glial tumors and 40% with non-glial tumors. Gross total resection (GTR) was performed in 26% of patients, subtotal resection (STR) in 37%, and 37% of patients did not undergo surgery. Seventy-seven percent of the patients received chemotherapy, and 57% received radiotherapy. Of the patients, 57% were considered responsive to treatment (complete/partial), 30% had stable disease, and 13% had progressive disease. The overall brain tumor mortality rate in our clinic was 13%. While 73% of our 26 patients had no or mild neurological deficits, 27% had moderate to severe disabilities (gait impairment, hearing impairment, visual impairment).

Although the sample size was limited, it may be speculated that the surgery rate was low and long-term side effects were notable. Insufficient surgical resection can affect the treatment response and increase the risk of neurological sequelae and functional impairment. Molecular profiling should be expanded, and a palliative care team should be involved as early as possible to address long-term side effects and improve the quality of life for patients.

Nucleated red blood cells (nRBCs) are infrequently observed in the peripheral blood of healthy infants, adults, and elderly individuals. Studies have indicated that the presence of these cells in the peripheral blood of premature infants suggests intrauterine hypoxia.

This study aims to determine the association between nRBCs in the peripheral blood of premature infants and outcomes, specifically mortality, using accelerated failure time (AFT) models.

This registry-based, single-center cohort study was conducted on premature infants between March 5,2019, and September 10,2020, at a university hospital in Ilam, southwest Iran. A total of 450 premature infants were included in the study. Accelerated failure time models were applied to the dataset, and their performance was evaluated using visual Cox-Snell residuals and Akaike’s information criterion (AIC).

In the adjusted model, the Weibull model results indicated that the presence of nRBCs [adjusted time ratio (TR) 1.05, 95% CI: 1.01 - 1.08, P = 0.04] was a significant factor accelerating progression to death in premature infants.

The presence of nRBCs is a risk factor for mortality in premature infants. Counting nRBCs on the first day of birth in premature infants could serve as a simple, accessible, cost-effective, and prognostic factor for mortality and morbidity related to retinopathy of prematurity (ROP), bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH).

Over the past three years, zinc deficiency among adolescents has varied based on region and access to healthcare. Globally, zinc deficiency affects approximately 2 billion people, leading to serious issues such as immune problems and growth delays, particularly in developing countries. In the U.S., around 10% of adolescents experienced zinc deficiency in 2021, with a higher prevalence among teenage girls. In Europe, deficiency rates are generally low but can be significant in Eastern Europe and Central Asia. In Asia, particularly in rural and low-income areas, deficiency rates range from 20 - 30%. In Turkey, the prevalence is high due to poor nutrition.

This study aimed to develop a machine learning-based decision support system to determine zinc deficiency in children and adolescents aged 10 - 18 years.

This machine learning-based study was conducted with 370 adolescents aged 10 - 18 years to assess their zinc deficiency. The dataset consists of 8 feature vectors and an output vector. The machine learning methods used in the analysis include logistic regression, naive bayes, decision tree (CART), K-nearest neighbors (K-NN), support vector machine (SVM), gradient boosting classifier, AdaBoost classifier, bagging classifier, random forest classifier, multilayer perceptron (MLP) classifier, and XGBoost (XGB) classifier. Evaluation metrics such as accuracy, precision, recall, and F1 score were used to assess the performance of these methods. Including specific values for these metrics, such as "SVM achieved 94.6% accuracy," would allow readers to quickly compare the effectiveness of the models. Different metrics serve various

Accuracy provides an overall view of performance, precision and recall highlight specific aspects, and the F1 score balances precision and recall.

The mean age of the patients in the dataset was 13.79 ± 1.18 years. Of the children, 64.32% (n = 238) were female and 35.68% (n = 132) were male. It was found that 62.7% (n = 232) of the children had low zinc levels, while 37.3% (n = 138) did not require zinc supplementation. Thirteen different machine learning methods were applied to a 70% training and 30% testing set. As a result, the SVM method provided the most successful outcome with 94.6% accuracy. Implementing the SVM-based system in pediatric clinics could improve efficiency and patient care by automatically detecting high-risk zinc deficiency patients based on lab results, providing early intervention alerts for faster treatment, and improving health outcomes. Highlighting these practical applications could increase the study’s appeal to healthcare professionals by demonstrating its real-world benefits. Providing detailed information on these applications would enhance the study’s clarity and practical value, making it more valuable for researchers and healthcare providers interested in AI tools for adolescent health.

This study concluded that machine learning methods can effectively determine zinc deficiency in children. The SVM method demonstrated superior classification performance compared to the other methods. An SVM-based decision support system could be integrated into pediatric outpatient clinics to enhance diagnostic accuracy and patient care.

With the increase in pediatric obesity, the prevalence of metabolic syndrome (MetS) is rising worldwide. Early identification of children with obesity who are prone to developing MetS is important.

This study aimed to evaluate the value of the Systemic Immune–Inflammation Index (SII) and the Systemic Inflammatory Response Index (SIRI) in predicting MetS in obese children and adolescents.

This prospective single-center cross-sectional study involved 99 children and adolescents with obesity. The patients were assigned to two groups, MetS+ (n = 42) and MetS- (n = 57), based on the presence of MetS. Complete blood count results from the first visit were evaluated.

The white blood cell (WBC), platelet, and neutrophil counts were higher in the MetS+ group (P = 0.003, P = 0.022, and P < 0.001, respectively), while no significant difference was observed in lymphocyte (P = 0.865) and monocyte counts (P = 0.488) between the two groups. When inflammatory parameters were compared, SII (P < 0.001), platelet-to-lymphocyte ratio (PLR) (P = 0.024), neutrophil-to-lymphocyte ratio (NLR) (P = 0.002), and SIRI (P = 0.012) were significantly elevated in the MetS+ group compared to the MetS- group. Binary logistic regression analysis revealed that SII and homeostasis model assessment of insulin resistance (HOMA-IR) were statistically significant risk factors for the presence of MetS (P = 0.003, P = 0.012, respectively). Additionally, a significant positive correlation was found between SII and diastolic blood pressure (DBP) (P = 0.024), high-density lipoprotein cholesterol (HDL-C) (P = 0.019), and fasting plasma glucose (FPG) (P = 0.048), as well as between SIRI and HDL-C (P = 0.044) and FPG (P < 0.001). Receiver operating characteristic analysis of the SII and SIRI ability to predict MetS in adolescents and children with obesity showed that the SII was more discriminative than the SIRI, with a specificity of 0.82, sensitivity of 0.57, and an area under the curve of 0.708.

The SII and SIRI can be used for the early diagnosis of MetS in pediatric obesity patients.

Due to the impact of coronavirus disease 2019 (COVID-19), all schools in Japan were closed in March 2020, including those providing compulsory education. They remained closed for up to 3 months.

Researchers investigated the difference in children’s physical fitness results before and after the spring of 2020, during which time Japanese schools were closed and fitness opportunities were limited.

Researchers compared the athletic performances of Japanese elementary school children before and after the COVID-19 pandemic (2014 and 2022 - 2023, respectively). This was a retrospective epidemiological study of 438 students between the ages of 8 and 10 years old at Elementary School A in Osaka Prefecture. Researchers used an unpaired t -test to investigate whether significant differences occurred according to grade, sex, and activity.

Results showed that in physical fitness exams for third- and fourth-grade children, the athletic performances of children in 2022 and 2023 significantly declined in all examined activities other than the trunk forward flexion and the 50-m run, compared with children in the same grade in 2014. In the 20-m shuttle run, there was a significant difference at the P < 0.01 level for fourth-grade boys and girls and a significant difference at the P < 0.05 level for those in third grade. In 2023, improvements were seen in explosive exercises. Following the self-restraint period during the COVID-19 pandemic, the 2022 and 2023 physical fitness exam results were substantially inferior in several aspects, compared with the results from similar exams conducted in 2014. Notably, muscle endurance and general endurance had significantly decreased.

Because the muscle endurance and general endurance of elementary school students were heavily impacted, sufficient caution is required when resuming physical education activities in the future. It is therefore necessary to teach students how to exercise safely using a detailed exercise program.

Pneumonia is a common and frequently occurring disease in pediatric patients.

This study aimed to evaluate the effects of family-centered nursing on psychological well-being and quality of life (QOL) in children with severe pneumonia in the intensive care unit (ICU).

A total of 98 children admitted between April 2021 and January 2023 were selected and divided into an observation group (n = 49) and a control group (n = 49) using a random number table. The control group received routine nursing care, while the observation group received family-centered nursing in addition to routine care. All children were cared for from admission until transfer out of the ICU or discharge. Clinical manifestations, blood gas analysis indicators, QOL scores, psychological status scores, and family satisfaction with care were compared between the two groups before and after two weeks of care.

After two weeks of nursing, ICU stay length, time to return to normal temperature, and resolution time for lung moist rales were all shorter in the observation group compared to the control group. The observation group showed greater improvements in partial pressure of oxygen, partial pressure of carbon dioxide, and oxygen saturation compared to the control group. Additionally, scores for physical function, social function, emotional function, and family satisfaction in the observation group were higher than those in the control group.

Family-centered nursing effectively improves clinical manifestations, blood gas levels, psychological well-being, and QOL in children with severe pneumonia in the ICU, while also enhancing family satisfaction with care.

Chronic kidney disease (CKD) is a rare condition that causes significant health problems in children.

To evaluate changes in serum and urinary levels of soluble Fas (sFas), soluble Fas Ligand (sFasL), and soluble E-selectin (sE-selectin) over time in children with CKD and determine their potential as biomarkers for CKD progression.

This longitudinal study was conducted as part of the PROGRESS study. A total of 117 patients with CKD and 56 healthy children were included. The CKD cohort underwent a 24-month prospective follow-up. Soluble Fas, sFasL, and sE-selectin levels were measured using the Luminex method at baseline, the 12th month, and the 24th month of the study.

At baseline, patients with CKD had significantly higher serum median levels of sFas, sFasL, and sE-selectin compared to the control group (8337 pg/mL vs. 3951 pg/mL, 68 pg/mL vs. 33 pg/mL, and 26460 pg/mL vs. 19801 pg/mL, respectively; P < 0.0001 for all). Additionally, the CKD group showed significantly higher urinary ratios of sFas/Cr, sFasL/Cr, and sE-selectin/Cr compared to the control group (P < 0.0001 for all). In the CKD group, median serum sFasL levels (68 pg/mL vs. 51 pg/mL) and urinary sFasL/Cr ratios (19 pg/mg vs. 14 pg/mg) significantly decreased at the 24th month compared to baseline (P < 0.0001 for both). Similarly, serum sE-selectin median levels and urinary sE-selectin/Cr ratios showed significant decreases over time (P = 0.003 and P < 0.0001, respectively). Baseline urinary sFas/Cr, sFasL/Cr, and sE-selectin/Cr ratios were highest in CKD stages 4 - 5 compared to stages 2, 3a, and 3b (P < 0.0001, P < 0.0001, and P = 0.007, respectively), while no significant differences were observed in baseline serum levels of sFas, sFasL, and sE-selectin across CKD stages (P > 0.05). Baseline serum sFasL median levels were lower (P = 0.038), while baseline serum sFas median levels were higher (P = 0.045) in patients with rapid CKD progression compared to those without rapid progression. Urinary sFas/Cr, sFasL/Cr, and sE-selectin/Cr ratios positively correlated with all urinary HSP/Cr ratios (P < 0.0001 for all).

Our study highlights that CKD progression is a complex process involving sFas, sFasL, and sE-selectin; however, these biomarkers do not serve as predictors of CKD progression.

Zinc (Zn) is one of the trace elements in the body that, despite its low level, plays important roles in molecular and cellular activities. A few investigations have assessed the correlations between cord blood Zn levels and neonatal anthropometric measures; however, the results are conflicting.

The purpose of the present study was to investigate the relationships between the Zn level in the umbilical cord blood and the birth weight, height, and head circumference of term newborns.

A cross-sectional study was conducted on full-term newborns in Tehran, Iran, in 2021. Neonates’ Zn levels in umbilical cord blood were evaluated. Data related to perinatal and neonatal variables such as the number of pregnancies (gravida), birth height, weight, and head circumference were recorded, and their relationships with umbilical cord Zn levels were assessed. P-values < 0.05 were considered statistically significant.

One hundred mothers with a mean age of 30.792 ± 5.908 years and a parity of 2.693 ± 1.181 were included. Of all the newborns, 68% were boys, and 2% had low birth weight. The mean level of cord blood Zn was 107.703 ± 27.843 µg/dL. Evaluating the correlations between cord blood Zn levels and maternal and neonatal qualitative variables, data analysis showed no relationships between Zn levels and neonatal sex (P = 0.70), low birth weight (P = 0.87), and maternal underlying disease (P = 0.49). Data analysis regarding correlations between quantitative variables also showed no significant correlations between cord blood Zn levels and birth weight (P = 0.466), height (P = 0.466), and head circumference (P = 0.925).

Although adequate Zn levels were observed in all neonates, these levels did not significantly influence neonatal anthropometric measures or immediate health indicators. Further studies with larger sample sizes are recommended to provide more comparative data, particularly in relation to long-term growth outcomes.

Neonatal respiratory distress syndrome (RDS), also known as hyaline membrane disease (HMD), occurs due to a deficiency of pulmonary surfactant (PS), leading to rapid onset, fast progression, and poor prognosis of the disease.

To analyze the perinatal high-risk factors for RDS in late preterm infants.

This was a case-control study. One hundred and thirty-eight late preterm infants admitted to our hospital from January 2022 to December 2023 were selected and divided into the observation group (n = 36) and the control group (n = 102) based on the occurrence of RDS. The general conditions and risk factors of the two groups were analyzed using univariate analysis and multivariate logistic regression analysis.

Univariate analysis of perinatal high-risk factors in late preterm infants indicated significant differences in male sex, elective cesarean section, amniotic fluid aspiration, premature rupture of membranes (PROM), intrauterine hypoxia, pregnancy complications, and other factors between the two groups (P < 0.05). Meanwhile, a multivariate logistic regression analysis was performed for the factors with statistically significant differences. This analysis found that all univariate factors with statistically significant differences, except for intrauterine hypoxia, were high-risk factors for RDS in late preterm infants (P < 0.05).

The indications for cesarean section should be strictly controlled, health education during pregnancy should be strengthened, maternal newborns with pregnancy complications should be monitored as early as possible, and effective intervention measures should be taken to reduce the risk of RDS.

Traumatic injuries are among the leading causes of visits to the pediatric emergency department (PED).

This study aims to evaluate the pediatric approach to musculoskeletal trauma in children to determine whether the routine use of X-rays can be reduced by encouraging the use of ultrasound.

This retrospective observational study included children aged 0 - 18 years admitted to the PED of the Policlinico A. Gemelli with a diagnosis of musculoskeletal trauma from January 2017 to December 2021. Patients were divided into two groups based on the presence of fractures identified through radiological examinations: "Fracture Yes" and "Fracture No." Data on X-rays performed were categorized according to the site of trauma.

A total of 5,972 children were enrolled. The most notable findings concern the regions of trauma. Among 1,273 patients who underwent X-rays of the hand region, 617 (48%) showed fractures, and 656 (51%) did not. Of the 744 X-rays performed for the foot region, 235 (31%) revealed fractures, while 509 (68%) were negative for fractures. In the upper limbs region, 1,334 X-rays were performed, with 1,079 (80%) identifying fractures and 255 (20%) showing no fractures. For the lower limbs region, 479 X-rays were conducted, 204 (42%) of which revealed fractures, while 275 (58%) were negative for fractures. All these results demonstrated statistically significant differences (P < 0.05).

Despite the limitations of the study's retrospective design and its single-center setting, the findings highlight a high prevalence of X-rays in the hand and upper limb regions, often with positive results. In contrast, radiography of the lower limbs and feet frequently yielded negative findings, suggesting potential overuse. Future research should investigate the clinical utility of musculoskeletal ultrasound as an alternative imaging modality to minimize unnecessary radiation exposure in pediatric patients.

HALP and modified-HALP (m-HALP) scores are novel indices combining albumin, hemoglobin, platelets, and lymphocytes, reflecting systemic inflammation and the physiological well-being of an individual. These scores provide information about a patient's prognosis.

In this study, we examined the prognostic effectiveness of HALP and m-HALP scores in patients with acute bronchiolitis for the first time.

This retrospective cross-sectional study, which was conducted at the Department of Pediatrics, Balikesir Ataturk City Hospital, Turkey, between January 2021 and January 2023, focused on children over 2 years of age diagnosed with acute bronchiolitis. Children who did not provide all necessary laboratory tests, were transferred to another center, or had comorbidities were excluded. HALP and m-HALP scores were calculated based on data obtained from patients’ blood samples, including albumin, hemoglobin, platelet, and lymphocyte counts. The primary outcome was defined by the necessity for admission to the intensive care unit (ICU). Secondary outcome measures included the need for intubation and the patients' clinical course.

A total of 344 pediatric patients were included in the study. The mean age of the patients was 13.17 ± 9.28 months (range: 1 - 24 months). Of the participants, 40.9% were male, and 43.31% required hospitalization in the ICU. Statistically significant differences were observed in albumin, lymphocyte count, NLR, PLR, HALP, and m-HALP values when comparing patients based on service and ICU hospitalization. HALP and m-HALP scores were effective parameters for differentiating the need for ICU admission, the need for intubation, and the severity of bronchiolitis in pediatric patients. Receiver operating characteristic (ROC) curve analysis was performed to assess the diagnostic performance of HALP and m-HALP in predicting the need for ICU hospitalization. The optimal cut-off values were 50.54 and 7645023, respectively, and the area under the curve (AUC) values were 0.605 (95% CI: 0.544 - 0.667) and 0.631 (95% CI: 0.571 - 0.690), respectively. The sensitivity and specificity of the HALP score were 0.54 and 0.67, respectively, while the sensitivity and specificity of the m-HALP score were 0.57 and 0.69, respectively.

HALP and m-HALP scores are effective parameters for predicting poor prognosis in patients with bronchiolitis and may be useful for clinicians in patient follow-up and prognosis prediction.

Brachial plexus neuropathy is a common and frequently occurring disease that may present with upper limb numbness and dysfunction, leading to a high disability rate.

To analyze the magnetic resonance imaging (MRI) features of brachial plexus neuropathy in children.

This study included 60 children who underwent MRI of the brachial plexus at our hospital from July 2019 to May 2024. The MRI scans included axial T 1 WI and T 2 WI sequences, axial and coronal T 2 -STIR sequences, and coronal 3D-FIESTA sequences. The imaging results were analyzed to identify features of brachial plexus neuropathy.

In this study, all 60 children underwent MRI of the brachial plexus. It was found that 34 (56.67%) cases were diagnosed as brachial plexus nerve injury via imaging, including 12 (20.00%) cases on the left side, 18 (30.00%) cases on the right side, and 4 (6.67%) cases on both sides. The imaging diagnoses were consistent with the clinical diagnoses in 32 cases and inconsistent in 2 cases. Meanwhile, 4 (6.67%) cases were diagnosed as other types of brachial plexus neuropathy, including 1 (1.67%) case of neurofibroma, 2 (3.33%) cases of neurosheathoma on the left side, and 1 (1.67%) case of right radicular sleeve cyst. The results were consistent with the clinical diagnoses in 3 cases and inconsistent in 1 case. Additionally, 7 (11.67%) cases were diagnosed as non-brachial plexus neuropathy, while 15 (25.00%) cases showed no obvious abnormality of the brachial plexus nerve. The sensitivity, specificity, and positive/negative predictive values were 100.00% (14/14), 78.95% (15/19), 91.11% (41/45), and 100.00% (15/15), respectively.The imaging features of brachial plexus nerve injury included thickening and thinning of nerve roots, high signals on T 2 fat-suppression sequences, small cystic low signals at the level of the intervertebral foramen, cystic dilatation of nerve roots, formation of spinal cysts, and irregularly shaped long T 1 and T 2 signals at the C 6 intervertebral foramen. The imaging features of neurofibroma included spike-shaped isometric T 1 and T 2 signals in the cervical soft tissues and high signals on T 2 fat-suppression sequences, with relatively homogeneous signals, a clear boundary, and an irregular morphology of the lesion wrapping around the brachial plexus nerve. Additionally, the imaging features of neurosheathoma included space-occupying lesions, predominantly oval-shaped isometric T 1 and slightly longer T 2 signals, located at the lateral upper edge of the thorax, the lower part of the posterior clavicle, and the left side of the brachial plexus.

The MRI can effectively show the location, range, and type of lesions, providing a valuable imaging reference for the early diagnosis and treatment of brachial plexus neuropathy in children.

Context: 

Mourning following the death of a loved one is a natural and necessary process, but some people lack the skills and abilities to deal with the grief process, which can lead to many psychological problems. Bereaved children are a vulnerable population at risk of social and psychological harm.

The present study aimed to investigate the effects of grief on children and effective interventions to increase adaptation to it. Evidence Acquisition: The present study was a review-type design based on the review of the literature on loss and bereavement in children, reactions, and effective interventions. The literature search was conducted in PubMed, Scopus, and Web of Science databases, as well as in the Google Scholar search engine up to December 2024. Relevant keywords and their combinations used for the literature search were as follows: Loss, bereavement, children.

Supportive interventions in children's traumatic bereavement include cognitive behavioral therapy, developing coping skills, relaxing activities (yoga), and creative counseling techniques (expressing feelings or experiences through poems, drawings, singing, dancing, writing and drawing trauma narratives, epitaphs which are short texts performed in honor of a deceased person, holding a memorial service, holding a holiday program that focuses on helping the child cope with the grief during important family holidays).

Childhood grief reactions are distinct from those in adults and are affected by developmental and contextual factors such as the age of the child and changes in caregiving environments. Empirically supported interventions can help young people to navigate the many grief-related challenges.