Journal of Pediatric Perspectives
Year:2022 | Volume:10 | Issue:5 (101)|Papers Count:18

Background: Pain neuroscience education (PNE) improves the functional outcomes of adults with chronic pain, and may also benefit children with chronic pain. We assessed pediatric primary headache patients’,baseline understanding of PNE through interviews and standardized questionnaires, and piloted an educational intervention using a 3D brain model. Methods: Seventeen patients, aged 12-18 with primary headaches, completed the interview, pre-intervention Concept of Pain Inventory (COPI), and an educational session. Twelve of these participants completed the post-intervention COPI. The patients completed the validated COPI at a regular clinic visit, and completed interviews focused on their concepts of and relation to their pain symptoms, used to tailor education to individual understanding. PNE included a presentation of a 3D-printed brain model (printed from a brain MRI) and a ten-minute discussion. The session concluded with a post-intervention COPI to gauge the intervention’, s impact on the subjects’,views of primary headache. Results: Comparison of pre-and post-intervention COPI scores revealed an average 9. 5 point score increase (p=0. 002). Overall low pre-intervention scores suggested a low baseline alignment with the concepts of PNE, additionally supported by the interview answers. The participants were generally interested in learning more about PNE, and were teachable as indicated by the significant COPI score increase. Conclusions: Pediatric primary headache patients are typically not well-versed in central concepts of PNE, but interactive sessions can increase understanding. 3D brain models can be an effective vehicle for delivering PNE. These findings support further research on the efficacy of PNE in the setting of pediatric headache.

Background: Child obesity is one of the main health problems all across the world, which leads to mental and physical health problems. There is no specific tool based on the constructs of social-cognitive theory (SCT) to assess the factors associated with child obesity. The aim of this study was to investigate the validity and confirmatory factor analysis of a SCT-based questionnaire for assessing obesity preventing behaviors among 4-6-year-old children. Method: This cross-sectional study was conducted to validate a SCT-based instrument for measuring factors affecting obesity prevention behaviors among children aged 4-6 years. 240 preschool children aged 4 to 6 years in Behbahan city, southwest Iran participated in the study. After performing the forward-backward translation method, the face, content, and construct validity of the SCT-based questionnaire were confirmed. The content validity index (CVI) and the content validity ratio (CVR) were used to assess the difficulty, relevancy, and ambiguity of the items, and Confirmatory factor analysis (CFA) was performed to measure the construct validity. Structural Equation Modeling (SEM) was also performed to evaluate the fitness of the model. Reliability of the questionnaire was also measured through Cronbach’, s alpha coefficient and Intraclass Correlation Coefficient (ICC). The obesity prevention behaviors used in the model included physical activity, consumption of fruit and vegetable, consumption of sugar-free drinks, and screen. Results: Results of this study confirmed the acceptable content and face validity of the SCT-based questionnaire. The results of confirmatory factor analysis also confirmed the factor loading of more than 0. 3 for all variables,therefore the SCT-based questionnaire had an acceptable validity and reliability. Conclusions: Since the SCT-based questionnaire had an acceptable validity and reliability, it can be used to assess the obesity prevention behaviors in 4-6-year-old children, and also to design relevant educational interventions.

Background: Allergic diseases represent one of the most common types of diseases globally and affect a large sector of population especially children. The main purpose of this study is to evaluate the relation between serum periostin and different allergic diseases and to compare them with children of non-allergic diseases as a control group. Methods: 80 children were included in the study,40 had allergic diseases and 40 children had no allergic diseases as controls. All participants completed the history and clinical examination, complete blood count, total serum immunoglobulin IgE (UI/ml), and serum periostin level. Results: Among the patients with allergic diseases, bronchial asthma was the most common diagnosed disease 29/40 (72. 50%). Patients with allergic diseases had significantly higher mean (±, SD) serum periostin when compared to infants with no allergic diseases (271. 9±, 263. 27 ng/ml and 115. 33±, 191. 42 ng/ml, P-value 0. 0001). However, highly elevated serum periostin >150 ng/ml were found exclusively in patients with allergic diseases 22/40 (55. 00%) and only in 4/40 (10. 0%) of the controls (p-value<0. 0001). Furthermore, there were a statistically significant difference between the patients with different degrees of allergic diseases severity and serum periostin level as it was 1080±, 251. 73 ng/ml in severe allergic diseases compared to 244. 5±, 263. 57 ng/ml in mild allergic diseases (P-value 0. 01). Conclusion: The most common type of allergic diseases in our study was bronchial asthma. Higher serum periostin levels were observed in allergic patients in comparison to the controls,and they were found to have a significant relationship with disease severity.

Our study aimed to assess Carotid artery Intima-Media Thickness (CIMT) in a group of children with overweight/obesity as a good predictor for atherosclerosis. We included 39 prepubertal children with Body Mass Indexes (BMI) above 85% for age and sex,23% overweight, and 77% obese. Twenty matched non-obese healthy children were enrolled to compare CIMT results. About 44% of the cases had abnormal blood pressure, ~39% had dyslipidemia, and ~74% had an unhealthy metabolic state. We observed higher CIMT in cases than controls, with no significant difference between overweight and obese status (at a confidence interval of 95% and P < 0. 05). CIMT was positively associated with the BMI of the whole study group, and with HC and triglyceride in the children with obesity. CIMT was significantly higher among children with overweight/obesity than in average weight children, regardless of their metabolic status or blood pressure stage.

Background: Use of opium and derivatives is one of the major health, psychosocial and socioeconomic problems and can lead to complications for societies. The present study aimed to assess clinical and socioeconomic factors associated with the poisonings by Opium and its Derivatives (O&D) in children and adolescents. Methods: This retrospective study was carried out to review the recorded clinical information of children and adolescents admitted to the pediatric emergency department of the Ali Ibn Abi Talib Hospital due to acute poisoning by O&D during a seven-year period since 2014. Demo-economic information was taken from the patient’, s guardians at the time of discharge. Collected data were analyzed by SPSS 20 considering 0. 05 as the significant level. Results: From among 227 poisoned children, 50. 7% were female and 75. 8%, 8. 8% and 15. 4% were in age groups of <8 year, 8-12 and 12-18 years, respectively. About 42. 7% of the children poisoned by industrial substances, compared to the traditional substances. Respectively, 87. 7%, 11% and 1. 3% of the children were poisoned accidentally, intentionally, and due to family challenges or schooling problems. Variables of the children’, s gender, age, and father’, s age were associated with self-poisoning. The samples’,heart rate, blood pressure and seizure were affected by the type of narcotic. Conclusion: Overall, the majority of poisoned children were girls and young. Those with very young and very old parents had more tendency to self-poison due to family challenges. Types of narcotic substances significantly correlated with irregular changes in the size of the pupil, heart rate, blood pressure and seizure.

Background: There is insufficient evidence supporting the superiority of the Nasal Intermittent Positive-Pressure Ventilation (NIPPV) over the Nasal Continuous Positive Airway Pressure (NCPAP) in initial respiratory support of preterm neonates suffering from the Respiratory Distress Syndrome (RDS). The present study intended to compare the effectiveness of these two approaches in preterm neonates with RDS who receive the Less Invasive Surfactant Administration (LISA). Methods: The present clinical trial included 95 preterm neonates at the Fatemieh Hospital, Hamadan, Iran, from October 2019 to September 2020, with RDS, admitted to the Neonatal Intensive Care Unit. Sampling was performed using the convenience method. The participants were randomly assigned into two groups that received the NIPPV (n=48) or NCPAP (n=47) as the respiratory support method. Moreover, the neonates received LISA if needed. The groups were compared in the outcomes, such as the need for intubation within 72 hours after birth. Results: The groups were similar in clinical characteristics at birth. According to our findings, the NIPPV group had a significantly lower rate of need for intubation and invasive mechanical ventilation within 72 hours after birth compared to the control group (8. 3% vs. 27. 7%, P=0. 014),however, the groups were not significantly different regarding the need for the second dose of surfactant (66% vs. 56. 2%, P=0. 332), the mean respiratory support duration (6. 89±, 3. 20 vs. 6. 70±, 3. 71 days, P=0. 295), the mean hospital stay (19. 52±, 12. 364 vs. 17. 40±, 9. 57 days, P=0. 591), development of bronchopulmonary dysplasia (4. 2% vs. 8. 5%, P=0. 435), and mortality (6. 25% vs. 12. 8%, P=0. 317). Conclusion: Compared to NCPAP, the NIPPV could significantly reduce the need for invasive mechanical ventilation within 72 hours after birth in neonates undergoing LISA.

Background: Separation of the mother from her preterm hospitalized infant and the restrictions imposed by the Covid-19 pandemic can influence psychological dimensions such as the mothers’,attachment to the preterm infants. Methods: This cross-sectional correlational study was conducted during the Covid-19 pandemic and before the nationwide vaccination in a 4-month period from December 2020 to March 2021 on 190 mothers whose preterm infants were admitted to the neonatal intensive care unit (NICU) of the selected hospitals in Isfahan, Iran. All mothers with the inclusion criteria had the chance of participating in the study. After obtaining their consent, they completed Brockington's Postpartum Bonding Questionnaire, Corona Disease Anxiety Scale (CDAS), the multidimensional scale of perceived social support (mspss), and a researcher-made form concerning the Maternal-Neonatal Demographic Characteristics. Results: The Covid-19 anxiety (12. 21±, 10. 31), perceived social support (66. 55±, 12. 81) and maternal attachment (43. 81±, 6. 82) were estimated to be at the levels of mild, high, and medium respectively. As shown by the results of the Pearson correlation coefficient, a significant relationship was observed between the Covid-19 anxiety and maternal attachment (P <0. 001). No significant relationship was observed between the perceived social support and maternal attachment at the significance level of 0. 05 (p <0. 05). Moreover, based on the results of the final multiple regression model, the Covid-19 anxiety, income level of the mother and her job were significant predictors of maternal attachment (P <0. 001). Conclusion: Based on the results of the study, increased anxiety of the Covid-19 could reduce the level of maternal-neonatal attachment. The factors of Covid-19 anxiety, income level and job of mothers were significant predictors of maternal attachment.

Background: Research evidence has approved the effectiveness of surfactant prescription for respiratory distress syndrome (RDS). However, previous studies have not reported the priority of curosurf and Beraksurf. The present study aimed to compare the effectiveness of Iranian surfactant (beraksurf) and Italian surfactant (curosurf) in the treatment of pulmonary distress. Methods: This clinical trial was performed on 80 premature infants with respiratory distress in NICU of Taleghani Hospital in Ilam, all of whom were treated with surfactant. Results: There was no significant difference regarding the duration of needs for ventilation and/or oxygen, duration of hospitalization, pulmonary hemorrhage, bronchopulmonary dysplasia, intraventricular hemorrhage, patent ductus arteriosus (PDA) and pneumothorax between the groups (p>0. 05). Conclusion: Beraksurf seems to be as effective as curosurf in premature neonates with RDS, but is less expensive than it.

Background: Immunodeficiency, Centromeric region instability, and Facial anomalies syndrome (ICF) is a rare autosomal recessive disorder with Centromeric instability as a hallmark. Method: In this case report, we describe an Iranian 6-year-old male who was diagnosed with ICF syndrome. He had a history of recurrent infections, hydrocephalus report in pregnancy, failure to thrive, facial anomalies, global developmental delay, and umbilical hernia. Results: The investigation showed esophageal dilatation in barium swallow, ascending aortic dilatation in echocardiography and cutis laxa in skin biopsy. In laboratory data, impaired antibody function was observed. Finally, to find the probable causative genetic variant, a whole exome sequencing was performed. The data analysis using bioinformatics tools revealed c. 1592G>A mutation in the exon 15 of DNMT3B. With respect to the diagnosis of ICF syndrome, our patient was treated with intravenous immunoglobulin (IVIG). Conclusion: It is necessary to perform periodic neurologic and ophthalmologic examinations. Echocardiography must be done annually. In addition, the possibility of HSCT should be evaluated.

Background: The amount of sedation required for children in the pediatric intensive care unit (PICU) is a usually challenging issue. Fentanyl is a commonly used sedative in PICU, but respiratory depression limits its use. Dexmedetomidine (DEX) is an effective sedative and anesthetic agent with negligible respiratory depression and hemodynamic stability. This study was aimed to assess the effects of using DEX as a sedative in comparison to fentanyl. Methods: We conducted a randomized double-blind clinical trial on children aging 1 month to 18 years who were required central venous catheter at PICU. The patients were randomized into the DEX and fentanyl (loading dose 1 mcg/kg and 1 mcg/kg/h for continuous infusion) groups. The primary outcome was defined as the time to achieve Ramsay Sedation Scale (RSS) ≥, 3, along with the safety outcome. Results: A total of 55 patients were recruited for the analysis between July 7 and December 30, 2020. The two groups were comparable at baseline. There was no statistical difference in the number of patients (63% in DEX and 50% in fentanyl group p=0. 39) and the time of reaching RSS≥, 3 (10 min for DEX and 15 min for fentanyl group p=0. 098). Furthermore, the catheterization time between the two groups was not different when the agents were administered individually or with propofol (15 min for DEX and 17. 5 min for fentanyl, p=0. 225, and 22. 5 for DEX and 30 min for fentanyl group, p=0. 075 respectively),neither was the safety profile significantly different in the two groups. Conclusions: This study found that DEX as a primary sedative is non-inferior to fentanyl, and it could facilitate sedation alone or in combination with propofol.

Background: Exclusive breastfeeding is a very important principle in ensuring the health of infants. Its benefits for the infant, mother, family, and community are emphasized by all experts. The aim of this study was to investigate the attitudes of mothers toward exclusive breastfeeding and its related factors. Methods: This descriptive-analytical study was performed on 420 women referred to comprehensive health service centers in Tehran. The samples were selected through multistage sampling. The data were collected by a questionnaire consisting of two sections: behavioral beliefs and evaluation of behavioral outcomes and were analyzed by t-test and ANOVA using SPSS 16. Results: The mothers’,attitude, behavioral beliefs, and evaluation of behavioral outcomes were significantly correlated with their age, job, place of delivery, and hospitalization of their infants. The mothers’,attitudes and behavioral beliefs were also significantly correlated with their husband’, s education and the status of infants (P<0. 05), but their attitude, behavioral beliefs, and evaluation of behavioral outcomes were not significantly associated with the other variables (P > 0. 05). The findings showed that most of the mothers' beliefs about the outcomes of exclusive breastfeeding (increased emotional bond between the mother and the infant, growth and strength of infant's bones and teeth, and infant's immunity to diseases such as diarrhea) were significant (P< 0. 05). Conclusions: When designing interventions, efforts should be made to create and maintain a positive attitude toward exclusive breastfeeding through the promotion of behavioral beliefs and evaluation of behavioral outcomes.

Background: The main purpose of this study was to compare the effectiveness of brain gymnastics exercises and spark on gross motor skills of mentally retarded female students. Methods: The present study is semi-experimental and applied research. 45 mentally retarded girls aged 8-12 years (with the mean age of 10±, 1. 9 years) were included in the study and were divided into three groups of 15 subjects: brain gymnastics, spark and control. Bruininks-Oseretsky gross test was used as the pre-and posttest,it consists of four components: running speed and agility, static and dynamic balance, bilateral coordination, and strength. The brain gymnastics and Spark groups were practiced by the intervention groups for two months (3 sessions of 45 minutes in a week) under the supervision of the researcher and according to the special conditions of mentally retarded children. To compare the dependent variables, the analysis of variance (ANOVA) test was used. Results: It was revealed that brain gymnastics and spark exercises had a positive and significant effect on the mean scores of gross motor skills (running speed and agility, static balance, dynamic balance, bilateral coordination, and strength) of the trainable mentally retarded girls. Nonetheless, spark exercises were more effective than brain gymnastics. Conclusion: It seems that the greater effectiveness of the Spark movement program is due to the fact that it provides the participants with a better training opportunity, creating more appropriate time, facilities and equipment. Its content is mainly oriented towards the development of motor skills,it exposes children to a variety of training conditions, enjoys high levels of participatory learning and low levels of stress, and nicely motivates children for continuing the exercises.

Background: Malnutrition undermines the beneficial outcomes of clinical interventions and also increases hospital costs. Therefore, this study aimed to estimate the prevalence of malnutrition through a multicenter observational study at the time of admission and discharge in Iranian hospitalized children and adolescents. Methods: The present cross-sectional study was performed on children and adolescents aged one month to 18 years from three Iranian public tertiary pediatric hospitals located in different cities of Iran. To determine the participants’,nutritional status, Z-score of the weight for height (for those with 1month to 5years of age) and Z-score of BMI (for ≥, 5 to 18-year-old patients) were calculated using the WHO growth standards. Data were analyzed using SPSS version 23. Results: Information about 1499 patients was collected. At the time of admission, 64% of the participants had a good nutritional status, 15. 5% were at high risk of wasting, 8. 4% were wasted, and 12. 1% were severely wasted. Among 295 malnourished patients, the nutritional status of 182 patients (63%) had been improved at the time of discharge. Also, 23% of all subjects with normal nutritional status at the admission time (85 participants), were at risk of malnutrition at discharge. The prevalence of moderate and severe malnutrition at the discharge time was about 20%. Conclusion: More than one-third of the hospitalized children had moderate or severe malnutrition or were at high risk. Although the prevalence of malnutrition decreased somewhat during hospitalization, some children were not malnourished at the time of admission and were malnourished at discharge.

Background: Pregnancy as a sensitive period of a woman's life can be affected by various psychological factors. Covid-19 pandemic is a new phenomenon,and there is limited information about its psychological consequences such as the Coronavirus disease anxiety in these women. So, the present study aimed to determine the level of Covid-19 anxiety in the third trimester of pregnancy and its related factors. Methods: In this descriptive-analytical study, 215 pregnant women with 28-33 weeks of gestational age were studied. The samples were selected from the health centers and hospitals in Isfahan, Iran, by cluster sampling. A questionnaire of Demographic, fertility and Coronavirus-related factors as well as the Corona Disease Anxiety Scale (including psychological and physical components) were completed by the mothers in person. The data was analyzed by SPSS-24 software using One-way analysis of variance, independent t-test, Kruskal-Wallis, Mann-Whitney, Pearson and Spearman correlation tests. Result: The results showed that the mean score of Corona disease anxiety in pregnant women was 11. 45±, 7. 56. Anxiety was reported to be low in 62. 8% of pregnant women, moderate in 32. 6% and high in 4. 6%. The mean score of the psychological component (8. 40±,4. 78) was higher than the score of the physical component (3. 06±,3. 59). Working women, women with client-related occupations, and those having a working husband had lower anxiety scores. Factors such as death of family members due to Coronavirus disease and higher gestational age were associated with a significant increase in Corona anxiety score. Conclusion: Considering that death of a family member due to Coronavirus disease and higher gestational age are associated with higher Coronavirus disease anxiety, the results of this study can be used to identify high-risk pregnant women and suggest early psychological interventions for preventing pregnancy anxiety complications.

Background: Child Abuse and Neglect (CAN) is a major health problem with serious consequences. Since health care professionals play an important role in identification, management, and reporting CAN cases, they should have precise knowledge on this subject. The aim of this study is to investigate the level of knowledge, attitude and practice of the pediatricians, pediatric residents, and nurses regarding CAN issues as well as their possible needs for any educational programs in this regard. Methods: 130 pediatric nurses and physicians working at two pediatric tertiary centers, in Tehran, Iran participated in this descriptive cross-sectional study. An anonymous validated and standardized self-report questionnaire was used as the study instrument. The questionnaire consisted of five sections on demographic information, knowledge, attitude, practice and needs assessment. Analytical statistical tests including t-test, Kruskal–, Wallis and Mann-Whitney tests were used to analyze the data. Results: The level of the participants’,knowledge was moderate (mean score: 16. 6±, 3. 17) and their attitude towards child abuse and neglect was at a good level (mean score: 45. 72 ±, 4. 25). The results of this study revealed that the overall performance of the participants in dealing with a suspicious case of child abuse and neglect was moderate. Almost all participants (95. 5%) indicated the need for educational programs on child abuse both for nurses and physicians. Conclusion: Results of our study revealed that the overall knowledge, attitude, and practice of the health care professionals in the field of pediatrics regarding child abuse and neglect are not satisfactory and training programs on this issue are mandatory for pediatricians, pediatric residents, and nurses due to their serious role in caring for children.

Background: The epidemiology of pediatric poisoning differs from one country to another. Due to the scarcity of reviews on this issue in Iran, we performed a systematic review and meta-analysis of studies providing data on Iranian pediatric poisoning epidemiology. Methods: PubMed, Web of Sciences, Science direct, Embase, Scopus and the Persian databases Magiran, Scientific Information Database (SID), and Iranmedex were searched. Twenty-seven studies published between 2002 and 2019 were included, based on the inclusion and exclusion criteria. Results: 54. 7% of the participants in the reviewed studies were male, and 88. 1% of them were unintentional. Most of the children were in the age range of 3-5 years. Non-pharmaceutical agents were the most common causes of poisonings (n=7175, 59. 2%) and among them, illicit drugs (19. 3%) followed by hydrocarbons (16. 4%) constituted the most common non-pharmaceutical poisonings. Illicit drugs, especially opioids, showed an upward trend from 2002 to 2019. Among pharmaceuticals, central nervous system (CNS) drugs (50. 4%), especially benzodiazepines (BZDs) (25. 8%) and analgesics (14. 5%), were the most frequent agents implicated. CNS complaints (51. 8%), followed by gastrointestinal complaints (27. 6%), were the most common symptoms. Ingestion was the most common route of poisoning (22. 1%). Most of the poisoning cases occurred in summer (28. 2%). 21. 7% of the cases were hospitalized and the mortality rate was 0. 8%. A remarkable downward trend in both hospitalization and death rates occurred over time. Conclusion: Overall, non-pharmaceutical toxicity was found to be the most common cause of poisoning. However, considering the agents separately, pharmaceuticals, illicit drugs, and hydrocarbons were the most common causes of poisoning, respectively. In contrast to the decreasing trend in hydrocarbons, pesticides, and pharmaceutical poisonings, we found an increase in opioid poisoning during our study period.

Background: Our main goal in this study was to evaluate impulsivity and risky decision making in adolescents’,intermediate-expert chess players and compare them with non-players. We also looked at the relationship between impulsivity and risky decision making in the two groups. Method: The present study employed a comparative-correlational method which was performed in 2019 in Tehran. Based on the previous research, 55 chess players (14-17 years old) and 79 nonplayers (13-17 years old) participated in the study. Impulsivity was measured by the Go/no-go task,and risky decision making was assessed via the Iowa Gambling Task (IGT). Independent t-test and Pearson Correlation Coefficient were used for statistical analysis. Results: There were no significant differences between groups regarding age or education. In the go/no go tasks, there were significant differences between the groups in commission error, omission error and inhibition subscales. In the IGT, we observed significant differences between the groups in the net score, raw score and ratio of advantageous/disadvantageous choices in different subscales. In both groups, net scores, raw scores and ratio of advantageous/disadvantageous choices were negatively correlated with the commission error. Additionally, omission error was positively correlated with the inhibition subscale. We found that the relationship between impulsivity and risky decision making was stronger in non-chess players than chess players. Conclusion: The results of this study might put chess in the spotlight as an option to improve impulsivity and risky decision making in clinical settings.

Background: Testicular adrenal rest tumors (TARTs) are an important complication in patients with Congenital Adrenal Hyperplasia (CAH). Ultrasonography is the diagnostic modality of choice. In this study we examined the possibility of sonographic classification of TARTs in the Reporting and Data Systems (RADS) imaging format. Methods: 35 male patients with the diagnosis of congenital adrenal hyperplasia due to 21 hydroxylase deficiency were evaluated. Results: 19 patients had one or more sonographic findings of TARTs. No significant relation was found between 17 Hydroxyprogesterone (17 OH p), ACTH and androstenedione levels in patients with and without TARTs. Five sonographic patterns for testicular lesions were found. The five-stage classification of sonographic findings of TARTs is matched with histological classifications. Conclusion: This classification system will allow clinicians to perform more accurate approaches. In general, TARTS should be considered in male patients with CAH. Sonography is a good imaging modality for the diagnosis of TARTs. TART-RADS imaging of lesions will allow clinicians to develop more accurate and appropriate approaches.