Iranian Journal of Child Neurology最新文献

Objectives: Migraine is a chronic and joint disease in children. The results of previous studies on the effectiveness of probiotics in preventing migraine attacks in children have been controversial. This study aims to investigate the effect of probiotics on migraine prophylaxis in children.

Materials & methods: In this clinical trial study, 41 children aged 5 to 15 with migraine enrolled the study in two control and intervention groups. Children in the intervention group (18 children) received propranolol at a dose of 1 mg per kilogram of body weight daily in two divided doses along with a 250 mg Yomogi capsule daily for three months, and children in the control group (23 children), received propranolol along with placebo for three months. The study compared the frequency and duration of headache days, PedMIDAS criteria, and parental satisfaction between the two groups before treatment, as well as one month and three months post-treatment.

Results: The number of headache days in both groups decreased over time, but in the intervention group, this decrease was more than the control group was statistically significant (P=0.045). The average PedMIDAS scale after treatment in the intervention group was 3.9 ± 3.8; in the control group, it was 8.4 ± 8.2, which was statistically significant (P=0.047). Parents' satisfaction with the treatment was statistically significantly higher in the intervention group (94.4%) than in the control group (54.5%) (P=0.011). No significant drug complications were seen in any of the two groups.

Conclusion: In children with migraine, adding probiotics to migraine treatment reduces the intensity and number of days of children's headaches and increases the Parents' satisfaction with the treatment.

Objectives: Acute necrotizing encephalopathy of childhood (ANEC) is a rare, potentially life-threatening condition. This study aimed to identify clinical profiles and outcomes of ANEC while assessing the accuracy of severity scoring in the Iranian population.

Materials & methods: The present study collected demographic, clinical, laboratory, and radiological data from children diagnosed with ANEC. Severity was measured using the ANE-Severity Score (ANE-SS), while outcomes were assessed with the Glasgow Outcome Score (GOS). This research analyzed the relationship between these scores and various parameters for statistical significance.

Results: Seven patients were included over three years, with an average age of 4.4±2.7 years (5 males). ANE-SS varied from moderate to high, with most patients experiencing moderate to severe disabilities, as indicated by the GOS. Significant correlations were found with initial serum magnesium levels, pupil light reactivity, and initial GCS score (P-value < 0.05).

Conclusion: Controlling initial magnesium levels may improve ANEC outcomes. Additionally, intact pupil light reactivity at admission was associated with a better prognosis.

Objectives: Based on case reports, researchers have observed the incidence and clinical manifestations of Guillain-Barré Syndrome (GBS) following COVID-19 infection. Current hypotheses suggest that the risk of GBS may increase with COVID-19, and worsening GBS could elevate the risk of infection and exposure to the virus. This study aimed to assess the cognitive epidemic and mortality of children under 15 years of age with GBS during the COVID-19 pandemic and to compare them to two years earlier without addressing the etiology.

Materials & methods: This cross-sectional study was conducted on all children admitted to Iranian hospitals with a diagnosis of GBS and whose clinical information was available in the national flaccid paralysis patient information registration system between April 2018 and April 2021.

Results: The total number of registered cases of GBS in the pre-COVID-19 period and during this period was 778 cases and 504 cases, respectively (total N=1282), indicating a decrease in registered GBS during COVID-19. The mean age of the patients in the pre-COVID-19 period was 9.00 ± 2.78 years, and during the COVID-19, it was 8.99 ± 2.03 years (P-value =0.998). No significant difference was found in gender distribution between the two periods (P-value =0.427). The total number of paralysis cases studied after 60 days was 14.3% before the COVID-19 period and 17.3% during the pandemic (P-value =0.216). The mortality rate in patients with GBS was 0.13% in the pre-COVID-19 period and 0.19% in the COVID-19 period (P-value =0.757).

Conclusion: Despite the decline in the frequency of diagnosis and referrals of patients with GBS during the COVID-19 period, no difference was found in the demographic characteristics and clinical outcomes of children with GBS in the pre-COVID-19 period and during this pandemic.

Objective: This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population.

Materials & methods: The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and in-person interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests).

Results: Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes.

Conclusion: In conclusion, the study demonstrated the efficacy of TR and in-person interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR's transformative role in enhancing the holistic well-being of children with SLDs.

Objectives: To evaluate the need for lumbar puncture (LP) in children aged 6 to 60 months experiencing their first febrile seizure, regardless of seizure type, and to determine if LP is particularly beneficial for those under 12 months old.

Materials & methods: In this retrospective study, data from 253 children who presented with first febrile seizure were analyzed. All patients in this study underwent LP and were divided into two groups based on their cerebrospinal fluid (CSF) results: non-pleocytosis and pleocytosis. Patients were evaluated for age, sex, familial history of seizure, and type and duration of seizures. They were also evaluated based on laboratory results, including blood tests, CSF analysis, and electroencephalography.

Results: Sixty-seven (25.9%) of the 253 patients were under 12 months of age, and only two of the 67 patients (2.8%) had pleocytosis. Patients younger than 12 months did not have a higher rate of complex febrile seizure or pleocytosis than those over 13 months of age. None of the patients had bacterial meningitis. Regarding viral meningitis, seven patients (5.3%; age mean SD, 12.3±1.8 months) were diagnosed with enteroviral meningitis, though only one of them had pleocytosis. When compared to the non-pleocytosis group, the pleocytosis group showed no differences in clinical characteristics (age, sex, familial history of seizure, type, and duration of seizure), laboratory results, or the use of antiepileptic drugs.

Conclusion: The present study suggests that LP should be carefully considered in children with first febrile seizure, including children under 12 months of age.

Objectives: Premature infants (born before 37 weeks of gestational age) frequently experience feeding difficulties due to underdeveloped oral motor skills and poor chewing, swallowing, and breathing coordination. In order to improve oral feeding efficiency in these infants, Oral-Motor Stimulation (OMS) has been used in various studies. This systematic review study will aim to assess the effectiveness of OMS for oral feeding in preterm infants.

Materials & methods: The authors will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. They will conduct a search in electronic databases, including PubMed, Scopus, Web of Science, Cochrane Central Register of Controlled Trials in The Cochrane Library (CENTRAL), Medline via PubMed, and Cumulative Index to Nursing and Allied Health Literature (CINAHL) for nursing and related healthcare texts without language restrictions from the first month of 1991 to the fifth month of 2024 to achieve the study objectives. All Randomized Controlled Clinical Trials (RCT) examining the effect of OMS on oral feeding in preterm infants will be included in this study.

Results: The primary outcome of this systematic review will be oral feeding, and the secondary outcomes will include duration of hospitalization, weight gain, and feeding efficiency. Two independent reviewers will select and extract data for the study. The Cochrane Risk of Bias Tool (RoB2) will be used to evaluate potential biases in the study. Publication bias will be evaluated using funnel plots, Begg's, and Egger's tests. The degree of heterogeneity among the studies will be assessed using the I2 statistic and the χ2 test. Analyses of subgroups will also be carried out. All meta-analyses will be conducted using Stata V.14.

Conclusion: This systematic review protocol for preterm infants will aim to promote evidence-based decision-making and support the development of clinical practice guidelines in preterm feeding.

Objectives: Migraine is one of the common diseases of children, which can disrupt their quality of life. Some studies have shown the effect of melatonin in reducing migraine headaches. This study aims to investigate the effect of melatonin administration in reducing headaches in children with migraine without sleep disorders.

Materials & methods: In this clinical trial study, fifty-five children aged five to 15 years with migraines who had no sleep disorder were enrolled. The control group (twenty-seven patients) was treated with propranolol tablets, and the intervention group (thirty patients) was treated with propranolol tablets plus melatonin tablets for three months. Patients were visited before, one month, and three months after the start of treatment, and their data was collected and recorded.

Results: The number of headache attacks decreased significantly in the intervention group compared to the control group three months after the treatment (P=0.006). The number of patients with a good response to treatment in the intervention group was significantly more than the control group (p=0.023). Parents' satisfaction with the treatment in the intervention group was significantly higher than the control group (P=0.026). There was no significant difference in the intensity of disability caused by headaches after treatment in the two groups. No significant drug side effects were seen in any of the two groups.

Conclusion: Adding melatonin to the treatment of children with migraine without sleep disorders significantly reduces the frequency of headache attacks and increases satisfaction with the treatment.

Objectives: Hypoxic-ischemic encephalopathy (HIE) is still a relevant cause of neonatal mortality and morbidity. HIE severity can predict long-term outcomes. Sarnat staging is one of the most common methods used to evaluate HIE severity. However, an ongoing urge exists to find other accurate and affordable ways to accompany this clinical staging for HIE. This study aimed to evaluate the relationship between cerebral arteries' resistive indices and other hypoxic-ischemic encephalopathy indicators using Sarnat scoring of newborns subjected to perinatal asphyxia.

Materials & methods: In this retrospective study, 76 neonates with gestational age ≥34 weeks affected with HIE were investigated. The patients were categorized into three groups according to Sarnat staging: I, II, and III. Initially, perinatal data were analyzed to assess the correlation between HIE severity and various factors such as gestational age, type of delivery, Apgar scores, necessity for resuscitation, and requirement for respiratory assistance. Notably, these relationships were significant.

Results: Examining various symptoms in different HIE stages showed that the incidence of coagulopathy was significantly higher in severe HIE neonates than in mild neonates. Eventually, proposedly, cranial arterial Doppler indices, i.e., the anterior cerebral artery's resistive index (RI), significantly differed between HIE stage groups.

Conclusion: This study represented a combination of available and affordable data to achieve early HIE staging, including perinatal data, clinical symptoms, and a bedside Doppler ultrasonography of cerebral perfusion. Higher cranial artery RI was associated with severe HIE and could be considered for therapeutic hypothermia, which may reduce HIE mortality and morbidity.

Objectives: This study evaluated the efficacy of Polyethylene glycol 4000 for fecal disimpaction in children with cerebral palsy.

Materials & methods: A randomized control trial study was conducted on children with cerebral palsy between February - March 2017 in the pediatric neurology outpatient clinic Dr. Soetomo Hospital. Children aged 2-16 years with fecal impaction randomly assigned into polyethylene glycol 4000 (PEG 4000) and saline enema group. Polyethylene glycol 4000 was given at a dosage of 0.7 g/kg and enema using normal saline 15ml/kg twelve hourly. Constipation was diagnosed using ROME IV criteria, and abdominal palpation identified fecal impaction. Efficacy was evaluated by clinical observation and adverse symptom monitoring. Data were analyzed by statistical software using an independent t-test (p<0,05).

Results: Thirty-two children were randomized into the study. Muscle relaxant was discovered in 17/32 patients. Sex, age, and body weight were not statistically different between groups. The resolution of fecal impaction was significantly different between PEG 4000 and saline enema (21.69 hours and 39 hours respectively; p=0.001). Application of muscle relaxant and severity of the disease did not involve treatment efficacy. There was no adverse symptom reported during treatment.

Conclusion: Polyethylene glycol 4000 results in fecal disimpaction faster than enema in constipated children with cerebral palsy.

Objectives: This study aimed to determine the prevalence of central auditory processing disorder (CAPD) in elementary school students in Kerman, Iran, during 2018-2019.

Materials & methods: This cross-sectional study was conducted on 1369 elementary school students in Kerman. These students were selected by cluster sampling from different areas of Kerman and then screened using the Buffalo Model Questionnaire (BMQ). Based on the data obtained from the questionnaire, normal children were excluded from the study. Then, children with suspected central auditory processing disorder (CAPD) underwent ear exams and were excluded from the study in case of abnormal results in the tympanic membrane examination (rapture-effusion). The remaining subjects underwent peripheral audiometry evaluation, and children with abnormal audiometry were excluded from the study. Finally, the remaining children with suspicious screening results, a normal examination, and normal audiometry underwent a specific test to detect Central auditory processing disorder. Data analysis was carried out using SPSS software.

Results: One thousand three hundred sixty-nine primary school students with a mean age of 9.15 ±2.63 years enrolled in this study. 52%% of students were male. 8.03% of them had CAPD. A statistically significant relationship was found between the prevalence of CAPD and gender (P<0.001), place of residence (P<0.001), history of middle ear inflammation (P<0.001) and history of head injury.

Conclusion: The quality of life of these students with CAPD can be improved via timely recognition of CAPD and the provision of appropriate preventive and therapeutic facilities.