Background: Children with type 1 diabetes are at risk of developing microvascular and macrovascular complications, with diabetic nephropathy (DN) being a significant microvascular complication. Microalbuminuria is a crucial diagnostic marker for the early detection of DN and can predict the risk of vascular complications. Objectives: This study aimed to investigate the relationship between microalbuminuria and body mass index (BMI), changes in hemoglobin A1c (HbA1c), and the age of disease onset in children and adolescents with type 1 diabetes. Methods: This cross-sectional study was conducted in Mofid and Imam Hossein hospitals in Tehran, Iran, within 2021 - 2022. This study included 120 children and adolescents aged 5 - 20 years who had been diagnosed with type 1 diabetes for at least 3 years. All patients underwent evaluation for microalbuminuria, and its association with BMI, HbA1c levels, and the age of diabetes onset was assessed. Results: Among the 120 patients, 51% were female. Microalbuminuria was present in 15% of patients; however, 13.3% were overweight or obese. Furthermore, 91% of patients had HbA1c levels above 7%. The mean age of diabetes onset was 13 years, and the mean disease duration was 5.5 years. The study revealed a significant association between microalbuminuria and HbA1c levels, BMI, and the age of diabetes onset (P-values < 0.05). Conclusions: Microalbuminuria showed a positive correlation with increased BMI and poorer glycemic control. An early age of diabetes onset was identified as a risk factor for microalbuminuria in children and adolescents with diabetes.
{"title":"Microalbuminuria in Children with Type 1 Diabetes and Its Relationship with Body Mass Index, Hemoglobin A1c, and Age at Diabetes Onset","authors":"Asieh Mosallanejad, Zahra Pournasiri, Hedyeh Saneifard, Armin Shirvani, Maryam Forati","doi":"10.5812/ijp-139616","DOIUrl":"https://doi.org/10.5812/ijp-139616","url":null,"abstract":"Background: Children with type 1 diabetes are at risk of developing microvascular and macrovascular complications, with diabetic nephropathy (DN) being a significant microvascular complication. Microalbuminuria is a crucial diagnostic marker for the early detection of DN and can predict the risk of vascular complications. Objectives: This study aimed to investigate the relationship between microalbuminuria and body mass index (BMI), changes in hemoglobin A1c (HbA1c), and the age of disease onset in children and adolescents with type 1 diabetes. Methods: This cross-sectional study was conducted in Mofid and Imam Hossein hospitals in Tehran, Iran, within 2021 - 2022. This study included 120 children and adolescents aged 5 - 20 years who had been diagnosed with type 1 diabetes for at least 3 years. All patients underwent evaluation for microalbuminuria, and its association with BMI, HbA1c levels, and the age of diabetes onset was assessed. Results: Among the 120 patients, 51% were female. Microalbuminuria was present in 15% of patients; however, 13.3% were overweight or obese. Furthermore, 91% of patients had HbA1c levels above 7%. The mean age of diabetes onset was 13 years, and the mean disease duration was 5.5 years. The study revealed a significant association between microalbuminuria and HbA1c levels, BMI, and the age of diabetes onset (P-values < 0.05). Conclusions: Microalbuminuria showed a positive correlation with increased BMI and poorer glycemic control. An early age of diabetes onset was identified as a risk factor for microalbuminuria in children and adolescents with diabetes.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138967584","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abolfazl Gilani, Dhruti Amin, P. Yousefichaijan, Roham Sarmadian
{"title":"The Relationship Between Attention Deficit-Hyperactivity Disorder and Kidney Disease in Children and Adolescents: An Emerging Area of Research","authors":"Abolfazl Gilani, Dhruti Amin, P. Yousefichaijan, Roham Sarmadian","doi":"10.5812/ijp-137300","DOIUrl":"https://doi.org/10.5812/ijp-137300","url":null,"abstract":"<jats:p />","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138967794","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Irem Gokdemir, Didem Bezen, O. Dikker, Hasan Dursun, Hüseyin Dağ
Background: Adropin is a bioactive protein that maintains energy balance through the metabolism of glucose and lipids. Adropin is associated with blood pressure, endothelial function, and glucose metabolism, according to reported studies. High blood pressure is one of the complications of obesity. Objectives: Our study investigated the relationship between adropin levels and systolic and diastolic blood pressure in obese adolescents. Methods: The study was conducted with a total of 88 adolescents, 45 females and 43 males, aged 10 - 18 years. The mean age of the participants was 13.79 ± 1.98 years. Participants were divided into two groups: "obese" (n = 61) and "control" (n = 27). Adolescents with a body mass index (BMI) above the 95% percentile for age, gender, and race were defined as "obese." The control group comprised adolescents with a body mass index between the 5th and 85th percentiles. A sample was taken from the forearm pit of the subjects after fasting for at least 12 hours for the determination of glucose, insulin, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), C- reactive protein (CRP), total cholesterol, low-density lipoprotein- cholesterol (LDL-cholesterol), high-density lipoprotein- cholesterol (HDL- cholesterol), triglyceride, thyroid-stimulating hormone (TSH), free T4 (fT4), and 25-hydroxyvitamin D3. In both groups, systolic and diastolic blood pressures were assessed using an aneroid manometer and a suitable cuff after subjects had rested for at least 10 minutes in the outpatient clinic. The following formula determined the homeostatic model of assessment for insulin resistance (HOMA-IR): fasting insulin (uIU/mL) × fasting glucose (mg/dL) /405. An enzyme-linked immunosorbent assay (ELISA) kit was used to measure adropin levels. Results: The insulin, HOMA-IR, AST, ALT, GGT, CRP, triglyceride, and LDL-cholesterol levels of adolescents in the obese group were statistically significantly higher than those in the control group (P < 0.05). HDL-cholesterol and 25-hydroxyvitamin D3 levels of adolescents in the obese group were statistically significantly lower than those of the control group (P < 0.05). There was no statistically significant difference between groups in glucose, urea, creatinine, total cholesterol, TSH, fT4, and adropin levels (P > 0.05). In the obese group, there was an inverse and statistically significant correlation between adropin level and diastolic blood pressure (P: 0.029; P < 0.05). Conclusions: We found an inverse relationship between adropin levels and DBP but no relationship between adropin levels and SBP in obese adolescents.
{"title":"Evaluation of the Relationship Between Adropin Levels and Blood Pressure in Obese Adolescents","authors":"Irem Gokdemir, Didem Bezen, O. Dikker, Hasan Dursun, Hüseyin Dağ","doi":"10.5812/ijp-139957","DOIUrl":"https://doi.org/10.5812/ijp-139957","url":null,"abstract":"Background: Adropin is a bioactive protein that maintains energy balance through the metabolism of glucose and lipids. Adropin is associated with blood pressure, endothelial function, and glucose metabolism, according to reported studies. High blood pressure is one of the complications of obesity. Objectives: Our study investigated the relationship between adropin levels and systolic and diastolic blood pressure in obese adolescents. Methods: The study was conducted with a total of 88 adolescents, 45 females and 43 males, aged 10 - 18 years. The mean age of the participants was 13.79 ± 1.98 years. Participants were divided into two groups: \"obese\" (n = 61) and \"control\" (n = 27). Adolescents with a body mass index (BMI) above the 95% percentile for age, gender, and race were defined as \"obese.\" The control group comprised adolescents with a body mass index between the 5th and 85th percentiles. A sample was taken from the forearm pit of the subjects after fasting for at least 12 hours for the determination of glucose, insulin, urea, creatinine, aspartate aminotransferase (AST), alanine aminotransferase (ALT), gamma-glutamyl transferase (GGT), C- reactive protein (CRP), total cholesterol, low-density lipoprotein- cholesterol (LDL-cholesterol), high-density lipoprotein- cholesterol (HDL- cholesterol), triglyceride, thyroid-stimulating hormone (TSH), free T4 (fT4), and 25-hydroxyvitamin D3. In both groups, systolic and diastolic blood pressures were assessed using an aneroid manometer and a suitable cuff after subjects had rested for at least 10 minutes in the outpatient clinic. The following formula determined the homeostatic model of assessment for insulin resistance (HOMA-IR): fasting insulin (uIU/mL) × fasting glucose (mg/dL) /405. An enzyme-linked immunosorbent assay (ELISA) kit was used to measure adropin levels. Results: The insulin, HOMA-IR, AST, ALT, GGT, CRP, triglyceride, and LDL-cholesterol levels of adolescents in the obese group were statistically significantly higher than those in the control group (P < 0.05). HDL-cholesterol and 25-hydroxyvitamin D3 levels of adolescents in the obese group were statistically significantly lower than those of the control group (P < 0.05). There was no statistically significant difference between groups in glucose, urea, creatinine, total cholesterol, TSH, fT4, and adropin levels (P > 0.05). In the obese group, there was an inverse and statistically significant correlation between adropin level and diastolic blood pressure (P: 0.029; P < 0.05). Conclusions: We found an inverse relationship between adropin levels and DBP but no relationship between adropin levels and SBP in obese adolescents.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138981003","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Sama Rahnemayan, Parinaz Habibi, Reza Ali Akbari Khoei, Alireza Lotfi, M. Ghojazadeh
Context: The use of functional magnetic resonance imaging (fMRI) in the evaluation of children's brains is becoming increasingly popular. However, due to the high number of publications, it's nearly impossible to read all the related articles and become aware of the crucial elements or the best approach to invest time and effort in this field. Objectives: Our goal was to gain a better overall understanding of fMRI publications and to use this information in policy and management contexts to make more efficient decisions. Methods: Data were downloaded from Scopus from the 1990s to the end of 2021 based on the theme of fMRI in pediatrics. The retrieved research articles were analyzed with the Bibliometrix package in R software. Results: From 8,544 documents written by 25,697 authors, the USA is by far the most productive country with a total of 3,609 publications. However, regarding the average article citations, Sweden is at the top of the list, with 77.79 average citations. Important themes include emotion, autism spectrum disorders, attention-deficit/hyperactivity disorders, and childhood maltreatment. Conclusions: The results of the present study on fMRI research in the field of pediatrics will be helpful for professionals to visually understand the pediatric modes and trends in fMRI.
{"title":"From Past to the Future of fMRI in Pediatrics: A Bibliometric Analysis","authors":"Sama Rahnemayan, Parinaz Habibi, Reza Ali Akbari Khoei, Alireza Lotfi, M. Ghojazadeh","doi":"10.5812/ijp-141260","DOIUrl":"https://doi.org/10.5812/ijp-141260","url":null,"abstract":"Context: The use of functional magnetic resonance imaging (fMRI) in the evaluation of children's brains is becoming increasingly popular. However, due to the high number of publications, it's nearly impossible to read all the related articles and become aware of the crucial elements or the best approach to invest time and effort in this field. Objectives: Our goal was to gain a better overall understanding of fMRI publications and to use this information in policy and management contexts to make more efficient decisions. Methods: Data were downloaded from Scopus from the 1990s to the end of 2021 based on the theme of fMRI in pediatrics. The retrieved research articles were analyzed with the Bibliometrix package in R software. Results: From 8,544 documents written by 25,697 authors, the USA is by far the most productive country with a total of 3,609 publications. However, regarding the average article citations, Sweden is at the top of the list, with 77.79 average citations. Important themes include emotion, autism spectrum disorders, attention-deficit/hyperactivity disorders, and childhood maltreatment. Conclusions: The results of the present study on fMRI research in the field of pediatrics will be helpful for professionals to visually understand the pediatric modes and trends in fMRI.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138979087","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: Fiberoptic bronchoscopy is currently the most commonly used invasive examination method in clinical practice. Objectives: This study aimed to assess the impact of esketamine administration during fiberoptic bronchoscopy on the occurrence of negative postoperative behavioral changes (NPOBCs) in children. Methods: Ninety children undergoing fiberoptic bronchoscopy were enrolled and randomly assigned to 3 groups: the control group (group C, n = 30), treatment group 1 (group D1, n = 30), and treatment group 2 (group D2, n = 30). Group C received intratracheal surface anesthesia and sevoflurane inhalation, along with an intravenous injection of 5 mL of normal saline. Group D1 received intratracheal surface anesthesia and sevoflurane inhalation in addition to an intravenous injection of 0.5 mg/kg of esketamine diluted to 5 mL. Group D2 received intratracheal surface anesthesia and sevoflurane inhalation, with an intravenous injection of 0.75 mg/kg of esketamine diluted to 5 mL. Results: The incidence of NPOBCs was lower in groups D1 and D2 compared to group C at 1, 7, 14, and 30 days after the examination (P < 0.05). The pediatric anesthesia emergence delirium (PAED) scores were lower in groups D1 and D2 than in group C, with group D2 scoring lower than group D1 (P < 0.05). Groups D1 and D2 had a longer time to awaken than group C (P < 0.05), with group D2 having a longer time than group D1. The face, legs, activity, cry, and consolability (FLACC) scores in groups D1 and D2 were significantly lower than in group C, and group D2 had a lower score than group D1 (P < 0.05). The incidence of adverse reactions was lower in groups D1 and D2 compared to group C, and the rate was even lower in group D2 than in group D1 (P < 0.05). Conclusions: Administration of esketamine at a dose of 0.75 mg/kg may yield better clinical outcomes.
{"title":"Effect of Esketamine Applied in Fiberoptic Bronchoscopy on Negative Postoperative Behavioral Changes of Children","authors":"Yu Zhang, Junli Yao, Chen Yang, Li Li","doi":"10.5812/ijp-136679","DOIUrl":"https://doi.org/10.5812/ijp-136679","url":null,"abstract":"Background: Fiberoptic bronchoscopy is currently the most commonly used invasive examination method in clinical practice. Objectives: This study aimed to assess the impact of esketamine administration during fiberoptic bronchoscopy on the occurrence of negative postoperative behavioral changes (NPOBCs) in children. Methods: Ninety children undergoing fiberoptic bronchoscopy were enrolled and randomly assigned to 3 groups: the control group (group C, n = 30), treatment group 1 (group D1, n = 30), and treatment group 2 (group D2, n = 30). Group C received intratracheal surface anesthesia and sevoflurane inhalation, along with an intravenous injection of 5 mL of normal saline. Group D1 received intratracheal surface anesthesia and sevoflurane inhalation in addition to an intravenous injection of 0.5 mg/kg of esketamine diluted to 5 mL. Group D2 received intratracheal surface anesthesia and sevoflurane inhalation, with an intravenous injection of 0.75 mg/kg of esketamine diluted to 5 mL. Results: The incidence of NPOBCs was lower in groups D1 and D2 compared to group C at 1, 7, 14, and 30 days after the examination (P < 0.05). The pediatric anesthesia emergence delirium (PAED) scores were lower in groups D1 and D2 than in group C, with group D2 scoring lower than group D1 (P < 0.05). Groups D1 and D2 had a longer time to awaken than group C (P < 0.05), with group D2 having a longer time than group D1. The face, legs, activity, cry, and consolability (FLACC) scores in groups D1 and D2 were significantly lower than in group C, and group D2 had a lower score than group D1 (P < 0.05). The incidence of adverse reactions was lower in groups D1 and D2 compared to group C, and the rate was even lower in group D2 than in group D1 (P < 0.05). Conclusions: Administration of esketamine at a dose of 0.75 mg/kg may yield better clinical outcomes.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138980511","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Maryam Veisizadeh, Seyed Abolfazl Afjehi, M. Zarkesh, Mohammad Kazemian, Ahmad Shafaeizadeh, Leila Khedmat
Background: Monitoring regional cerebral oxygen saturation (rScO2) and hemodynamic stability (eg, mean arterial blood pressure [MABP]) in high-risk premature infants is crucial to enhance daily clinical practices in neonatal intensive care units (NICUs). Objectives: This study aimed to investigate potential differences between oxygen saturation measurements obtained via near-infrared spectroscopy (NIRS) and pulse oximetry (PO). Methods: This pilot study enrolled 20 very low-birth-weight (VLBW) premature neonates through a non-random, available sampling approach. We gathered maternal and fetal demographic data along with clinical characteristics of the neonates. The study focused on assessing tissue and cerebral oxygenation using PO and NIRS. We specifically monitored changes in mean rScO2 and MABP at various time points: before, during, and 5 and 10 min after the administration of surfactant injection (SI) via the endotracheal tube. Results: The mean gestational age, neonatal birth weight, and Apgar scores at 1 and 5 min after birth were 28.44 ± 2.57 weeks, 1063 ± 246 g, 6.05 ± 2.57, and 7.94 ± 1.79, respectively. No significant differences were observed between mean rScO2 values measured by NIRS and PO before (P = 0.631), during (P = 0.722), and 5 min after (P = 0.783) SI. However, a significant difference between PO and NIRS-based rScO2 values was found 10 min after SI (96.95% vs 75.0%; P = 0.04). Additionally, there was no significant correlation between mean rScO2 and MABP recorded before, during, and after SI. Conclusions: There were no differences in oxygen saturation measurements (recorded by PO) and rScO2 values (recorded by NIRS) before, during, and immediately after SI. Therefore, using PO in NICUs to assess cerebral oxygenation, autoregulation, and hypoxia appears both reasonable and cost-effective. Further multicenter studies are needed to validate the practical advantages and cost-effectiveness of NIRS as an emerging monitoring system.
背景:监测高危早产儿区域脑氧饱和度(rScO2)和血流动力学稳定性(如平均动脉血压[MABP])对于加强新生儿重症监护病房(NICUs)的日常临床实践至关重要。目的:本研究旨在探讨近红外光谱(NIRS)和脉搏血氧仪(PO)测量的氧饱和度之间的潜在差异。方法:本研究采用非随机、有效的抽样方法，招募了20例极低出生体重早产儿。我们收集了产妇和胎儿的人口统计数据以及新生儿的临床特征。研究的重点是利用PO和NIRS评估组织和脑氧合。我们专门监测了不同时间点的平均rScO2和MABP的变化:在气管内注射表面活性剂(SI)之前、期间、5分钟和10分钟后。结果:出生后1 min、5 min平均胎龄28.44±2.57周，新生儿体重1063±246 g, Apgar评分6.05±2.57,7.94±1.79。NIRS测量的rScO2平均值与PO在SI前(P = 0.631)、SI中(P = 0.722)和SI后5 min (P = 0.783)无显著差异。然而，在SI后10分钟，PO和nir的rScO2值存在显著差异(96.95% vs 75.0%;P = 0.04)。此外，在SI之前，期间和之后记录的平均rScO2和MABP之间没有显着相关性。结论:在SI之前，SI期间和SI之后，氧饱和度测量(通过PO记录)和rScO2值(通过NIRS记录)没有差异。因此，在nicu中使用PO来评估脑氧合、自动调节和缺氧是合理和划算的。需要进一步的多中心研究来验证近红外光谱作为一种新兴监测系统的实际优势和成本效益。
{"title":"The Relation Between Oxygen Saturation Measured by Pulse Oximetry vs Near-infrared Spectroscopy Following Surfactant Therapy in Very Low-birth-weight Neonates","authors":"Maryam Veisizadeh, Seyed Abolfazl Afjehi, M. Zarkesh, Mohammad Kazemian, Ahmad Shafaeizadeh, Leila Khedmat","doi":"10.5812/ijp-140078","DOIUrl":"https://doi.org/10.5812/ijp-140078","url":null,"abstract":"Background: Monitoring regional cerebral oxygen saturation (rScO2) and hemodynamic stability (eg, mean arterial blood pressure [MABP]) in high-risk premature infants is crucial to enhance daily clinical practices in neonatal intensive care units (NICUs). Objectives: This study aimed to investigate potential differences between oxygen saturation measurements obtained via near-infrared spectroscopy (NIRS) and pulse oximetry (PO). Methods: This pilot study enrolled 20 very low-birth-weight (VLBW) premature neonates through a non-random, available sampling approach. We gathered maternal and fetal demographic data along with clinical characteristics of the neonates. The study focused on assessing tissue and cerebral oxygenation using PO and NIRS. We specifically monitored changes in mean rScO2 and MABP at various time points: before, during, and 5 and 10 min after the administration of surfactant injection (SI) via the endotracheal tube. Results: The mean gestational age, neonatal birth weight, and Apgar scores at 1 and 5 min after birth were 28.44 ± 2.57 weeks, 1063 ± 246 g, 6.05 ± 2.57, and 7.94 ± 1.79, respectively. No significant differences were observed between mean rScO2 values measured by NIRS and PO before (P = 0.631), during (P = 0.722), and 5 min after (P = 0.783) SI. However, a significant difference between PO and NIRS-based rScO2 values was found 10 min after SI (96.95% vs 75.0%; P = 0.04). Additionally, there was no significant correlation between mean rScO2 and MABP recorded before, during, and after SI. Conclusions: There were no differences in oxygen saturation measurements (recorded by PO) and rScO2 values (recorded by NIRS) before, during, and immediately after SI. Therefore, using PO in NICUs to assess cerebral oxygenation, autoregulation, and hypoxia appears both reasonable and cost-effective. Further multicenter studies are needed to validate the practical advantages and cost-effectiveness of NIRS as an emerging monitoring system.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138590740","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Hanieh Abbassinia, S. Dashti, Roya Gholami, Leila Ghalekhondabi, Nasrin Borumandnia
Background: Each year, an estimated 15 million pre-term births occur worldwide, with the incidence of pre-term labor on the rise globally. Complications arising from pre-term labor are a leading cause of mortality among children under the age of 5. Despite this, there has been limited research on the trend of pre-term labor in Iran. Objectives: This study aimed to assess the trend of pre-term labor and identify influencing factors on pre-term labor in Arak city, Iran, from 2005 to 2019. Methods: We analyzed a total of 89 307 live birth cases in Arak city from 2005 to 2019. The trend of pre-term labor over this study period was evaluated using statistical analysis software packages, specifically SPSS version 25. Linear trend analyses, as well as univariate and multivariate logistic regression analyses, were performed for statistical analysis. Results: The mean percentage of pre-term labor incidence during the first, second, and third 5-year periods was 8.9%, 10.3%, and 12.1%, respectively. Multivariate logistic regression analysis showed an increasing trend in pre-term labor incidence, even after adjusting for confounding factors (P < 0.001). Conclusions: The observed increasing trend in pre-term labor incidence indicates the necessity for a comprehensive preventive strategy. This strategy should focus on identifying high-risk pregnancies and implementing effective interventions. The increasing incidence of pre-term labor in Arak city highlights the necessity for preventive measures to reduce the burden of this condition.
{"title":"Increasing Trend and Influencing Factors of Pre-term Labor in Iran from 2005 to 2019","authors":"Hanieh Abbassinia, S. Dashti, Roya Gholami, Leila Ghalekhondabi, Nasrin Borumandnia","doi":"10.5812/ijp-139823","DOIUrl":"https://doi.org/10.5812/ijp-139823","url":null,"abstract":"Background: Each year, an estimated 15 million pre-term births occur worldwide, with the incidence of pre-term labor on the rise globally. Complications arising from pre-term labor are a leading cause of mortality among children under the age of 5. Despite this, there has been limited research on the trend of pre-term labor in Iran. Objectives: This study aimed to assess the trend of pre-term labor and identify influencing factors on pre-term labor in Arak city, Iran, from 2005 to 2019. Methods: We analyzed a total of 89 307 live birth cases in Arak city from 2005 to 2019. The trend of pre-term labor over this study period was evaluated using statistical analysis software packages, specifically SPSS version 25. Linear trend analyses, as well as univariate and multivariate logistic regression analyses, were performed for statistical analysis. Results: The mean percentage of pre-term labor incidence during the first, second, and third 5-year periods was 8.9%, 10.3%, and 12.1%, respectively. Multivariate logistic regression analysis showed an increasing trend in pre-term labor incidence, even after adjusting for confounding factors (P < 0.001). Conclusions: The observed increasing trend in pre-term labor incidence indicates the necessity for a comprehensive preventive strategy. This strategy should focus on identifying high-risk pregnancies and implementing effective interventions. The increasing incidence of pre-term labor in Arak city highlights the necessity for preventive measures to reduce the burden of this condition.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138595044","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: The coexistence of a metabolic or genetic disease can complicate the course of an atrial septal defect device closure. Methods: The database of our hospital was searched for patients who had undergone atrial septal defect (ASD) device closure and had concurrent metabolic and genetic diseases. Out of 188 such patients, 11 were identified. Results: This cohort study included 11 patients with type 1 diabetes mellitus, insulin resistance, mitochondrial diseases, rickets, Seckel syndrome, Alagille syndrome, cystic fibrosis, Down syndrome, and Crigler-Najjar syndrome type II. The patients were followed for a median of 4 years. Two patients experienced thromboembolic events. One procedure failed as the device was embolized. Large devices with a waist circumference greater than 1.5 times the body weight were used in 3 patients. One patient died 19 days after the procedure due to multi-organ failure, which was not related to device closure. Conclusions: In patients with metabolic or genetic diseases, this procedure may be complicated by factors such as small patient size, hypercoagulation, organ failure (cardiac, renal, or hepatic), vascular abnormalities, and issues with anesthesia or transesophageal echocardiography. It is recommended that careful attention be given to the specific challenges associated with each disease. The utilization of large devices can be considered safe, particularly in patients beyond 4 years of age.
{"title":"Atrial Septal Defect Device Closure in Patients with Metabolic or Genetic Diseases","authors":"Keyhan Sayadpour Zanjani, Morteza Heidari, Nima Nazari, Hosein Alimadadi, Reihaneh Mohsenipour","doi":"10.5812/ijp-137508","DOIUrl":"https://doi.org/10.5812/ijp-137508","url":null,"abstract":"Background: The coexistence of a metabolic or genetic disease can complicate the course of an atrial septal defect device closure. Methods: The database of our hospital was searched for patients who had undergone atrial septal defect (ASD) device closure and had concurrent metabolic and genetic diseases. Out of 188 such patients, 11 were identified. Results: This cohort study included 11 patients with type 1 diabetes mellitus, insulin resistance, mitochondrial diseases, rickets, Seckel syndrome, Alagille syndrome, cystic fibrosis, Down syndrome, and Crigler-Najjar syndrome type II. The patients were followed for a median of 4 years. Two patients experienced thromboembolic events. One procedure failed as the device was embolized. Large devices with a waist circumference greater than 1.5 times the body weight were used in 3 patients. One patient died 19 days after the procedure due to multi-organ failure, which was not related to device closure. Conclusions: In patients with metabolic or genetic diseases, this procedure may be complicated by factors such as small patient size, hypercoagulation, organ failure (cardiac, renal, or hepatic), vascular abnormalities, and issues with anesthesia or transesophageal echocardiography. It is recommended that careful attention be given to the specific challenges associated with each disease. The utilization of large devices can be considered safe, particularly in patients beyond 4 years of age.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138600814","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
T. Yuniati, V. Permatagalih, F. Suryaningrat, Kurnia Wahyudi, F. Kadi, Aris Primadi, A. Sukadi
Background: Respiratory distress is the most often encountered problem in preterm infants and the most frequently encountered reason for neonatal intensive care unit (NICU) admission. It can develop into respiratory failure and cause high morbidity and mortality. Noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), was the first line for neonates with respiratory distress. The progression of respiratory distress to respiratory failure in neonates with NCPAP (NCPAP failure) increases the need for mechanical ventilation on the first day of life. With limited resources, clinical observation is critical to predict prognosis and golden time for referral. Downes scores are the accurate and easiest measurement that is used to determine the severity and monitoring of respiratory distress in neonates. However, in Indonesia, there has still been no study that showed an effect of the increment of Downes score in 24 hours and the risk of NCPAP failure. Objectives: This study aimed to measure the association of Downes score at birth, ages 2, 6, 12, and 24 hours, and the risk of NCPAP failure in the first 72 hours using survival analysis. Methods: This prospective observational cohort study included all neonates with 28 - 36 weeks gestation born at Hasan Sadikin General Hospital, Bandung, Indonesia, within March to May 2019, with respiratory distress and NCPAP as respiratory support. Clinical monitoring was conducted using Downes score at birth, 2, 6, 12, and 24 hours of age. The time of NCPAP failure in the first 72 hours was also obtained. Survival analysis with Kaplan-Meier and Cox regression was used to determine the association. Results: This study analyzed 121 neonates at 72 hours with an overall survival rate of 70.2% and a mean survival time of 61.1 hours. Neonates born 28 < 32 weeks and birth weight 1000 - 1499 g had the lowest survival (54.5% and 56.9%). Downes score ≥ 4 at birth and 2 and 6 hours had lower survival than Downes score < 4 (67.7%, 60.5%, and 52.7%). The risk of NCPAP failure in 72 hours was increased with a higher Downes score at 2 hours (hazard ratio [HR] = 1.86 [95% confidence interval [CI]: 1.3 - 2.6, P < 0.001), 6 hours (HR = 1.67 [95% CI: 1.2 - 2.2], P < 0.001). Downes score ≥ 4 at 2 hours (3.26 times, P = 0.030) and 6 hours (2.44 times, P = 0.014) had a high risk of NCPAP failure in 72 hours. Conclusions: The increase in Downes score was associated with a high risk of NCPAP failure at 72 hours of age in preterm neonates with respiratory distress. Two to six hours of monitoring of the Downes score should be considered a critical time for referral.
{"title":"Downes Score as a Predictor of Nasal Continuous Positive Airway Pressure Failure in Neonates of 28 - 36 Weeks Gestation with Respiratory Distress: A Survival Analysis","authors":"T. Yuniati, V. Permatagalih, F. Suryaningrat, Kurnia Wahyudi, F. Kadi, Aris Primadi, A. Sukadi","doi":"10.5812/ijp-134539","DOIUrl":"https://doi.org/10.5812/ijp-134539","url":null,"abstract":"Background: Respiratory distress is the most often encountered problem in preterm infants and the most frequently encountered reason for neonatal intensive care unit (NICU) admission. It can develop into respiratory failure and cause high morbidity and mortality. Noninvasive respiratory support, such as nasal continuous positive airway pressure (NCPAP), was the first line for neonates with respiratory distress. The progression of respiratory distress to respiratory failure in neonates with NCPAP (NCPAP failure) increases the need for mechanical ventilation on the first day of life. With limited resources, clinical observation is critical to predict prognosis and golden time for referral. Downes scores are the accurate and easiest measurement that is used to determine the severity and monitoring of respiratory distress in neonates. However, in Indonesia, there has still been no study that showed an effect of the increment of Downes score in 24 hours and the risk of NCPAP failure. Objectives: This study aimed to measure the association of Downes score at birth, ages 2, 6, 12, and 24 hours, and the risk of NCPAP failure in the first 72 hours using survival analysis. Methods: This prospective observational cohort study included all neonates with 28 - 36 weeks gestation born at Hasan Sadikin General Hospital, Bandung, Indonesia, within March to May 2019, with respiratory distress and NCPAP as respiratory support. Clinical monitoring was conducted using Downes score at birth, 2, 6, 12, and 24 hours of age. The time of NCPAP failure in the first 72 hours was also obtained. Survival analysis with Kaplan-Meier and Cox regression was used to determine the association. Results: This study analyzed 121 neonates at 72 hours with an overall survival rate of 70.2% and a mean survival time of 61.1 hours. Neonates born 28 < 32 weeks and birth weight 1000 - 1499 g had the lowest survival (54.5% and 56.9%). Downes score ≥ 4 at birth and 2 and 6 hours had lower survival than Downes score < 4 (67.7%, 60.5%, and 52.7%). The risk of NCPAP failure in 72 hours was increased with a higher Downes score at 2 hours (hazard ratio [HR] = 1.86 [95% confidence interval [CI]: 1.3 - 2.6, P < 0.001), 6 hours (HR = 1.67 [95% CI: 1.2 - 2.2], P < 0.001). Downes score ≥ 4 at 2 hours (3.26 times, P = 0.030) and 6 hours (2.44 times, P = 0.014) had a high risk of NCPAP failure in 72 hours. Conclusions: The increase in Downes score was associated with a high risk of NCPAP failure at 72 hours of age in preterm neonates with respiratory distress. Two to six hours of monitoring of the Downes score should be considered a critical time for referral.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138603853","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Background: We aimed to establish and validate diagnostic models for distinguishing bacterial/viral infections among sepsis neonates and also a model for prognostic evaluation. Methods: Training data sets (cohorts) of neonatal sepsis patients were derived retrospectively from 2017 to 2019, and the verifying sets were followed up from 2019 to 2021. The backward elimination method of logistic regression was used in identifying the optimum feature combination by adding all potential factors to the regression equation. Results: The current study established 3 models. For distinguishing bacterial sepsis patients and bacterial culture-negative patients, we found Y=1.930+0.105X1+0.891X2-1.389X3-0.774X4 (Y symbolizes the status of bacterial infectious sepsis, X1 is age increase, X2 is intra-amniotic infection (mother), X3 is vomiting sign, and X4 is cough sign). Similarly, for distinguishing bacterial infectious sepsis patients and bacterial/viral double-positive patients, we found Y=2.918+1.568X1+1.882X2-0.113X3-2.214X4-2.255X5-2.312X6 (Y means the bacterial/viral double-positive status, X1 is IL-6 increase, X2 means CRP increase, X3 means age increase, X4 means high fever sign, X5 is cyanotic sign, and X6 is HGB increase). For predicting hospital days as one of the prognoses, we found Y=-1.993+0.073X1+1.963X2+0.466X3-0.791X4-0.633X5 (Y means worse prognosis, which is hospital days longer than 7 days, X1 means age increase, X2 means intra-amniotic infection (mother), X3 is IL-6 increase, X4 is convulsion with unconsciousness, and X5 is cough sign). Then, the ROC curves of the models from the verifying cohort indicated that all of the 3 models had good performance among sepsis children. Conclusions: Two diagnostic models and one prognostic model were established for clinical reference from the current first-step analysis with excellent model performance, which could be suggested as new useful diagnostic tools and a therapeutic strategy guiding marker for neonatal sepsis in the future.
{"title":"Establishment and Validation of Models Based on Clinical Parameters/Symptoms for Diagnostic and Prognostic Assessment of Neonatal Sepsis","authors":"Ying Zhang, Cheng Zhang, Jianbo Shu, Fang Zhang","doi":"10.5812/ijp-138660","DOIUrl":"https://doi.org/10.5812/ijp-138660","url":null,"abstract":"Background: We aimed to establish and validate diagnostic models for distinguishing bacterial/viral infections among sepsis neonates and also a model for prognostic evaluation. Methods: Training data sets (cohorts) of neonatal sepsis patients were derived retrospectively from 2017 to 2019, and the verifying sets were followed up from 2019 to 2021. The backward elimination method of logistic regression was used in identifying the optimum feature combination by adding all potential factors to the regression equation. Results: The current study established 3 models. For distinguishing bacterial sepsis patients and bacterial culture-negative patients, we found Y=1.930+0.105X1+0.891X2-1.389X3-0.774X4 (Y symbolizes the status of bacterial infectious sepsis, X1 is age increase, X2 is intra-amniotic infection (mother), X3 is vomiting sign, and X4 is cough sign). Similarly, for distinguishing bacterial infectious sepsis patients and bacterial/viral double-positive patients, we found Y=2.918+1.568X1+1.882X2-0.113X3-2.214X4-2.255X5-2.312X6 (Y means the bacterial/viral double-positive status, X1 is IL-6 increase, X2 means CRP increase, X3 means age increase, X4 means high fever sign, X5 is cyanotic sign, and X6 is HGB increase). For predicting hospital days as one of the prognoses, we found Y=-1.993+0.073X1+1.963X2+0.466X3-0.791X4-0.633X5 (Y means worse prognosis, which is hospital days longer than 7 days, X1 means age increase, X2 means intra-amniotic infection (mother), X3 is IL-6 increase, X4 is convulsion with unconsciousness, and X5 is cough sign). Then, the ROC curves of the models from the verifying cohort indicated that all of the 3 models had good performance among sepsis children. Conclusions: Two diagnostic models and one prognostic model were established for clinical reference from the current first-step analysis with excellent model performance, which could be suggested as new useful diagnostic tools and a therapeutic strategy guiding marker for neonatal sepsis in the future.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":null,"pages":null},"PeriodicalIF":0.5,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138602117","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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