Background: Early detection, diagnosis, and treatment of children with CHD has been the focus of research attention. Hainan is the southernmost underdeveloped province in China, where the technology of screening, diagnosis, and treatment for children with CHD has not been fully developed. Objectives: This study aimed to introduce and promote an appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD. Methods: Two indicators, namely cardiac auscultation plus pulse oximetry (POX), were used by screening staff to screen live newborns within six to 72 hours after birth at all screening institutions in Hainan province from January 1, 2019, to December 31, 2021. Diagnosis procedure for the screened-positive newborns was performed in 31 certified medical institutions, and evaluation procedure for the newborns confirmed with CHD was performed in six certified medical institutions. Data about screening, diagnosis, evaluation, and treatment were obtained, uploaded, and managed online through a neonatal CHD screening information management net. Results: A total of 321447 live births were included in the CHD screening project, and an overall screening rate of 97.59% (321447/329387) was determined. According to our results, 8032 cases were screened-positive. A total of 1099 cases of CHD were confirmed, suggesting a CHD prevalence of 3.419 per 1000 live births. Atrial septal defect (ASD) was the most common CHD lesion, with a prevalence of 1.313 per 1000 live births. The sensitivity of cardiac auscultation, POX, and two indicators’ combination (i.e., cardiac auscultation plus POX) for CHD detection were 69.15%, 33.49%, and 91.90%, respectively; and the specificity of them were 98.36%, 99.43%, and 97.81%, respectively. The ratio of both positive in two indicators among the children with major (serious and critical) CHD at the initial screening was significantly higher than that of single positive in any indicator (χ2 = 59.455, P < 0.001). All children with CHD were evaluated, out of who 154 children with major CHD were treated promptly. Only 15 cases of children with major CHD died, and the standardized mortality of children aged 0 - 1 years with CHD was 4.67/100,000. Conclusions: It was concluded that the combination of two indicators (i.e., cardiac auscultation plus POX) for CHD screening was reliable as well as non-invasive, simple, and easy to operate so that it was conducive for promotion. It was also found that introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD were extremely significant since they may have contributed to the timely diagnosing and treating children with CHD, especially those with major CHD.
{"title":"Appropriate Technology for Screening, Diagnosis, and Evaluation of Neonatal Congenital Heart Disease in the Southernmost Region of China","authors":"Qian-Qian Chen, Du-Fei Zhang, Ya-Zhou Wang, Xiang-Yun Zhang","doi":"10.5812/ijp-132589","DOIUrl":"https://doi.org/10.5812/ijp-132589","url":null,"abstract":"Background: Early detection, diagnosis, and treatment of children with CHD has been the focus of research attention. Hainan is the southernmost underdeveloped province in China, where the technology of screening, diagnosis, and treatment for children with CHD has not been fully developed. Objectives: This study aimed to introduce and promote an appropriate technology system for screening, diagnosis, and evaluation of neonatal CHD. Methods: Two indicators, namely cardiac auscultation plus pulse oximetry (POX), were used by screening staff to screen live newborns within six to 72 hours after birth at all screening institutions in Hainan province from January 1, 2019, to December 31, 2021. Diagnosis procedure for the screened-positive newborns was performed in 31 certified medical institutions, and evaluation procedure for the newborns confirmed with CHD was performed in six certified medical institutions. Data about screening, diagnosis, evaluation, and treatment were obtained, uploaded, and managed online through a neonatal CHD screening information management net. Results: A total of 321447 live births were included in the CHD screening project, and an overall screening rate of 97.59% (321447/329387) was determined. According to our results, 8032 cases were screened-positive. A total of 1099 cases of CHD were confirmed, suggesting a CHD prevalence of 3.419 per 1000 live births. Atrial septal defect (ASD) was the most common CHD lesion, with a prevalence of 1.313 per 1000 live births. The sensitivity of cardiac auscultation, POX, and two indicators’ combination (i.e., cardiac auscultation plus POX) for CHD detection were 69.15%, 33.49%, and 91.90%, respectively; and the specificity of them were 98.36%, 99.43%, and 97.81%, respectively. The ratio of both positive in two indicators among the children with major (serious and critical) CHD at the initial screening was significantly higher than that of single positive in any indicator (χ2 = 59.455, P < 0.001). All children with CHD were evaluated, out of who 154 children with major CHD were treated promptly. Only 15 cases of children with major CHD died, and the standardized mortality of children aged 0 - 1 years with CHD was 4.67/100,000. Conclusions: It was concluded that the combination of two indicators (i.e., cardiac auscultation plus POX) for CHD screening was reliable as well as non-invasive, simple, and easy to operate so that it was conducive for promotion. It was also found that introducing and promoting an appropriate technology for screening, diagnosis, and evaluation of neonatal CHD were extremely significant since they may have contributed to the timely diagnosing and treating children with CHD, especially those with major CHD.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136131728","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: A considerable percentage of school-age children and adolescents have signs and symptoms of mental health problems. Gender differences can also be important in mental health status. In Iran, talented students are selected through an entrance exam to enter special schools called SAMPAD. Mental health problems in talented school students can also be affected by gender. Objectives: This study was conducted to determine the prevalence of mental health problems of Iranian students studying in SAMPAD junior high schools, aiming to identify gender differences in emotional and behavioral problems. Methods: The study population of this cross-sectional study consisted of male and female students aged 12 - 15 years, in the seventh, eighth, and ninth grades studying in SAMPAD schools of Semnan province, Iran, within the academic year of 2019 - 2020. Sampling was performed by the stratified-cluster random method. The tool used to assess students’ mental health was the standardized Persian version of the Strengths and Difficulties Questionnaire related to adolescence, which is used to screen mental health problems in 11-17-year-old adolescents. Results: A total of 112 (52 boys and 60 girls, mean age: 14.0 ± 0.8 years) and their parents participated in the study. The prevalence of mental health problems was estimated at 19.6% (95% CI: 12.3 - 27.0%) and 14.3% (95% CI: 7.8 - 20.8%) according to the student questionnaire and the parents’ questionnaire, respectively. Based on the questionnaire completed by the students, the lack of prosocial behaviors was higher in female students (25% compared to 7.7%, P = 0.017). Based on the questionnaire completed by the parents, it was still significantly higher in female students than in male students (31.7% compared to 7.7%, P = 0.001). The frequency of conduct problems was higher in boys than in girls, according to the parents’ questionnaire (26.9% compared to 10%, P = 0.026). Conclusions: Girls regarding strengthening prosocial behaviors and boys regarding conduct problems require attention and effective action in SAMPAD junior high schools. Screening programs and holding periodic consultations to timely diagnose the problems mentioned above are recommended to the school officials and parents of students.
{"title":"Gender Differences in Emotional and Behavioral Problems of Adolescents: A Cross-sectional Study on Talented School Students in Iran (2019)","authors":"Majid Mirmohammadkhani, Mohadeseh Paknazar, Nemat Sodoteh Asl, Fatemeh Paknazar","doi":"10.5812/ijp-126543","DOIUrl":"https://doi.org/10.5812/ijp-126543","url":null,"abstract":"Background: A considerable percentage of school-age children and adolescents have signs and symptoms of mental health problems. Gender differences can also be important in mental health status. In Iran, talented students are selected through an entrance exam to enter special schools called SAMPAD. Mental health problems in talented school students can also be affected by gender. Objectives: This study was conducted to determine the prevalence of mental health problems of Iranian students studying in SAMPAD junior high schools, aiming to identify gender differences in emotional and behavioral problems. Methods: The study population of this cross-sectional study consisted of male and female students aged 12 - 15 years, in the seventh, eighth, and ninth grades studying in SAMPAD schools of Semnan province, Iran, within the academic year of 2019 - 2020. Sampling was performed by the stratified-cluster random method. The tool used to assess students’ mental health was the standardized Persian version of the Strengths and Difficulties Questionnaire related to adolescence, which is used to screen mental health problems in 11-17-year-old adolescents. Results: A total of 112 (52 boys and 60 girls, mean age: 14.0 ± 0.8 years) and their parents participated in the study. The prevalence of mental health problems was estimated at 19.6% (95% CI: 12.3 - 27.0%) and 14.3% (95% CI: 7.8 - 20.8%) according to the student questionnaire and the parents’ questionnaire, respectively. Based on the questionnaire completed by the students, the lack of prosocial behaviors was higher in female students (25% compared to 7.7%, P = 0.017). Based on the questionnaire completed by the parents, it was still significantly higher in female students than in male students (31.7% compared to 7.7%, P = 0.001). The frequency of conduct problems was higher in boys than in girls, according to the parents’ questionnaire (26.9% compared to 10%, P = 0.026). Conclusions: Girls regarding strengthening prosocial behaviors and boys regarding conduct problems require attention and effective action in SAMPAD junior high schools. Screening programs and holding periodic consultations to timely diagnose the problems mentioned above are recommended to the school officials and parents of students.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"33 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-10","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136131705","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: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; > 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P < 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P < 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.
背景:外周置管中心导管(PICC)是一种替代中心静脉插管的方法。本研究旨在确定与儿童PICC置入首次成功率相关的因素。方法:本回顾性研究纳入了在浙江省儿童医院(2020年1月- 2020年12月)接受PICC安置的儿童患者。穿刺成功的定义是血液顺利回流并插入导丝。收集临床资料，并通过逻辑回归分析确定与首次尝试成功相关的因素。结果:最终纳入儿童640例，其中男性360例，占56.2%。首次穿刺成功380例(59.4%)。多因素logistic回归分析显示:镇静后不配合(OR = 2.745, 95%CI: 1.028 ~ 7.331, P = 0.044)、镇静后配合(OR = 0.318, 95%CI: 0.128 ~ 0.791, P = 0.014)、目标静脉深度(0.5 ~ 1 vs.≤0.5:OR = 1.715, 95%CI: 1.081 ~ 2.720, P = 0.022;1.1 ~ 1.5 vs.≤0.5:OR = 3.036, 95%CI: 1.166 ~ 7.903, P = 0.023;比;1.5 vs.≤0.5:OR = 10.453, 95%CI: 2.366 ~ 46.139, P = 0.002)，靶静脉直径(2.0 ~ 2.9 vs.≤2:OR = 0.313, 95%CI: 0.180 ~ 0.545, P <0.001;≥3 vs.≤2:OR = 0.122, 95%CI: 0.055 - 0.272, P <0.001)和3F导管规格(vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031)与首次穿刺失败独立相关。结论:配合程度、靶静脉直径和深度、导管规格与首次尝试成功率独立相关。
{"title":"Factors Associated with Successful First-attempt Puncture in Pediatric Patients Undergoing Ultrasound-guided Peripherally Inserted Central Catheter","authors":"Midan Zhang, Xiaofei Chen, Hongqin Zhou, Meifang Xu","doi":"10.5812/ijp-130372","DOIUrl":"https://doi.org/10.5812/ijp-130372","url":null,"abstract":"Background: Peripherally inserted central catheter (PICC) is an alternative to central venous cannulation. This study aimed to identify factors associated with first-attempt success rate in children undergoing PICC insertion. Methods: This retrospective study included pediatric patients who underwent PICC placement at the Children’s Hospital of Zhejiang (1/2020-12/2020). The successful puncture was defined as smooth blood return and insertion of the guide wire. Clinical data were collected, and factors associated with first-attempt success were identified by logistic regression analyses. Results: The final analysis included 640 children (360 males, 56.2%). Successful puncture at the first attempt was achieved in 380 (59.4%) patients. Multivariate logistic regression revealed that being uncooperative after sedation (OR = 2.745, 95%CI: 1.028 - 7.331, P = 0.044), being cooperative after sedation (OR = 0.318, 95%CI: 0.128–0.791, P = 0.014), target vein depth (0.5 - 1 vs. ≤ 0.5: OR = 1.715, 95%CI: 1.081–2.720, P = 0.022; 1.1-1.5 vs. ≤ 0.5: OR = 3.036, 95%CI: 1.166 - 7.903, P = 0.023; > 1.5 vs. ≤ 0.5: OR = 10.453, 95%CI: 2.366 - 46.139, P = 0.002), target vein diameter (2.0 - 2.9 vs. ≤ 2: OR = 0.313, 95%CI: 0.180 - 0.545, P < 0.001; ≥ 3 vs. ≤ 2: OR = 0.122, 95%CI: 0.055 - 0.272, P < 0.001), and 3F catheter specification (vs. 1.9F: OR = 2.057, 95%CI: 1.069 - 3.958, P = 0.031) were independently associated with puncture failure at the first attempt. Conclusions: The degree of cooperation, target vein diameter and depth, and catheter specification were independently associated with the first-attempt success rate.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"519 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136176221","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 analyze contralateral patent processus vaginalis (CPPV) in the laparoscopic high ligation of the vaginal process, treat eligible children surgically, and evaluate the clinical long-term outcomes. Methods: A total of 300 children with unilateral inguinal hernia or unilateral hydrocele treated in our hospital were selected for laparoscopic high ligation of the vaginal process, during which CPPV was analyzed. The 300 children were randomly divided into two groups of 150. In the study group (n = 58), 11 children met the requirements of high ligation and were treated with simultaneous surgery. The 53 children in the control group received simultaneous treatment. The prevalence of CPPV was compared between children with unilateral indirect inguinal hernia and unilateral hydrocele, left and right patent processus vaginalis (PPV), and different ages. After surgery, both groups were followed up for one year. The recurrence rate of contralateral indirect inguinal hernia or hydrocele was compared. Significant differences were assessed between the two groups receiving different treatments. Results: The prevalence of CPPV was 23% in children with unilateral indirect inguinal hernia and 49% in children with unilateral hydrocele. The prevalence of CPPV in children with unilateral hydrocele was significantly higher than that in children with inguinal hernia (P = 0.00). The prevalence of CPPV was 42% in children with left PPV and 33% in children with right PPV, without a statistically significant difference (P = 0.19). The prevalence of CPPV was 63% in children aged 1 - 2 years, which was significantly higher than that in other age groups (χ2 = 7.46, P = 0.01). The prevalence of CPPV was 14% in children aged > 6 years, which was significantly lower than that in other age groups (χ2 = 4.43, P = 0.04). A postoperative one-year follow-up showed that the recurrence rate was 9% in the study group and 1% in the control group, without a statistically significant difference (P = 0.25). Conclusions: The prevalence of CPPV decreases with age. Hydrocele combined with CPPV is more common. For younger children with hydrocele, it is very important to explore the contralateral side during surgery. Moreover, the transformation of CPPV to indirect inguinal hernia or hydrocele occurs rarely, and only eligible children can receive simultaneous treatment during surgery.
{"title":"Analysis of Contralateral Patent Processus Vaginalis in Laparoscopic High Ligation of the Vaginal Process and Clinical Long-term Effect of Individualized Treatment","authors":"Bin Yang, Na Guo, Xiao-dan Wang, Su-mei Wang","doi":"10.5812/ijp-123152","DOIUrl":"https://doi.org/10.5812/ijp-123152","url":null,"abstract":"Background: We aimed to analyze contralateral patent processus vaginalis (CPPV) in the laparoscopic high ligation of the vaginal process, treat eligible children surgically, and evaluate the clinical long-term outcomes. Methods: A total of 300 children with unilateral inguinal hernia or unilateral hydrocele treated in our hospital were selected for laparoscopic high ligation of the vaginal process, during which CPPV was analyzed. The 300 children were randomly divided into two groups of 150. In the study group (n = 58), 11 children met the requirements of high ligation and were treated with simultaneous surgery. The 53 children in the control group received simultaneous treatment. The prevalence of CPPV was compared between children with unilateral indirect inguinal hernia and unilateral hydrocele, left and right patent processus vaginalis (PPV), and different ages. After surgery, both groups were followed up for one year. The recurrence rate of contralateral indirect inguinal hernia or hydrocele was compared. Significant differences were assessed between the two groups receiving different treatments. Results: The prevalence of CPPV was 23% in children with unilateral indirect inguinal hernia and 49% in children with unilateral hydrocele. The prevalence of CPPV in children with unilateral hydrocele was significantly higher than that in children with inguinal hernia (P = 0.00). The prevalence of CPPV was 42% in children with left PPV and 33% in children with right PPV, without a statistically significant difference (P = 0.19). The prevalence of CPPV was 63% in children aged 1 - 2 years, which was significantly higher than that in other age groups (χ2 = 7.46, P = 0.01). The prevalence of CPPV was 14% in children aged > 6 years, which was significantly lower than that in other age groups (χ2 = 4.43, P = 0.04). A postoperative one-year follow-up showed that the recurrence rate was 9% in the study group and 1% in the control group, without a statistically significant difference (P = 0.25). Conclusions: The prevalence of CPPV decreases with age. Hydrocele combined with CPPV is more common. For younger children with hydrocele, it is very important to explore the contralateral side during surgery. Moreover, the transformation of CPPV to indirect inguinal hernia or hydrocele occurs rarely, and only eligible children can receive simultaneous treatment during surgery.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"70 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136176493","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 outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created unexpected impacts worldwide. Objectives: This study aimed to examine the association of SARS-CoV-2 viral load in pregnant women with maternal disease severity and neonatal outcomes. Methods: In this retrospective cohort study, 55 pregnant women infected with SARS-CoV-2 and their newborn infants were included. The association between maternal viral load (tested by cycle threshold) and maternal disease severity/neonatal outcomes was examined. Results: Infants had a median gestational age of 38 (29 - 41) weeks and birth weight of 3200 (630 - 4570) grams. The median Ct value of pregnant women was 30 (20 - 37). No significant difference was detected among mild, moderate or severely ill pregnant women in terms of median Ct values (30, 28.5, and 30, respectively; P > 0.05). The median Ct value of pregnant women who gave preterm delivery was similar to those who had term delivery [30 (21 - 36) vs. 30 (25 - 35); P > 0.05]. The median Ct values were similar among pregnant women who died or survived [32.5 (30 - 34) vs. 30 (21 - 36); P > 0.05]. Preterm delivery rates and overall mortality were not associated with SARS-CoV-2 RT-qPCR Ct values, (r = 0.04, P > 0.05). No correlation was found between maternal SARS-CoV-2 viral load and maternal disease severity/neonatal outcomes. Conclusions: To the best of our knowledge, this study was the first one examining the association between maternal SARS-CoV-2 viral load and maternal/neonatal outcomes. It was suggested that viral load may not have been used for predicting the severity of maternal disease and maternal/neonatal outcomes.
{"title":"SARS-CoV-2 Viral Load in Pregnant Women and Association with Maternal Disease Severity and Neonatal Outcomes","authors":"Beril Yasa, Nuran Karabulut, Sait Ilker Uslu, Seyma Memur, Dilek Yavuzcan Ozturk, Onur Bagci, Halime Sema Can Buker, Ibrahim Polat, Merih Cetinkaya","doi":"10.5812/ijp-132681","DOIUrl":"https://doi.org/10.5812/ijp-132681","url":null,"abstract":"Background: The outbreak of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) created unexpected impacts worldwide. Objectives: This study aimed to examine the association of SARS-CoV-2 viral load in pregnant women with maternal disease severity and neonatal outcomes. Methods: In this retrospective cohort study, 55 pregnant women infected with SARS-CoV-2 and their newborn infants were included. The association between maternal viral load (tested by cycle threshold) and maternal disease severity/neonatal outcomes was examined. Results: Infants had a median gestational age of 38 (29 - 41) weeks and birth weight of 3200 (630 - 4570) grams. The median Ct value of pregnant women was 30 (20 - 37). No significant difference was detected among mild, moderate or severely ill pregnant women in terms of median Ct values (30, 28.5, and 30, respectively; P > 0.05). The median Ct value of pregnant women who gave preterm delivery was similar to those who had term delivery [30 (21 - 36) vs. 30 (25 - 35); P > 0.05]. The median Ct values were similar among pregnant women who died or survived [32.5 (30 - 34) vs. 30 (21 - 36); P > 0.05]. Preterm delivery rates and overall mortality were not associated with SARS-CoV-2 RT-qPCR Ct values, (r = 0.04, P > 0.05). No correlation was found between maternal SARS-CoV-2 viral load and maternal disease severity/neonatal outcomes. Conclusions: To the best of our knowledge, this study was the first one examining the association between maternal SARS-CoV-2 viral load and maternal/neonatal outcomes. It was suggested that viral load may not have been used for predicting the severity of maternal disease and maternal/neonatal outcomes.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"66 4 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-02-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136180579","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}
Context: Access of adolescents to key reproductive health services (KRHS) has been emphasized; however, how to provide it has not been addressed. This study aimed to propose a bioethics framework to justify at-risk child/adolescent access to KRHS without parental consent. Evidence Acquisition: First, articles and documents were searched using the age of consent laws, reproductive health, and ethical/legal standards phrases with AND/OR separators in PubMed and Web of Science using the Google Scholar search engine in English. After a concise review of the age of consent in child/adolescent-related laws, at-risk child/adolescent access to KRHS without parental consent was justified using major ethical and legal principles and standards. Results: Given the different purposes and nature of harm preventive services, in the first part, the authors argue that considering the age of consent for at-risk adolescents’ access to KRHS is a limiting and inefficient factor, and KRHS could be provided for the at-risk adolescent with his/her own assent. In the second part, the authors argue that in decision-making for at-risk adolescents’ access to KRHS, the best interest standard is applicable on the ground of harm standard. Regarding the sociocultural context of the community, after assessing the seriousness of the harm and the threshold of intervention, practical steps are taken toward reducing or removing harm and choosing the option that best promotes adolescents’ interests. Conclusions: Regarding the existence of restrictive laws, the suggested framework can be applied in different communities as a bioethics policy guide for legislation and appropriate actions of adolescents’ healthcare professionals.
背景:强调青少年获得主要生殖健康服务的机会;然而，如何提供它还没有解决。本研究旨在提出一个生物伦理框架，以证明有风险的儿童/青少年在未经父母同意的情况下获得KRHS的合理性。证据获取:首先，使用Google Scholar英文搜索引擎在PubMed和Web of Science中使用带有and /OR分隔符的年龄同意法、生殖健康和伦理/法律标准短语搜索文章和文件。在对儿童/青少年相关法律中的同意年龄进行简要审查后，使用主要的道德和法律原则和标准，有风险的儿童/青少年在未经父母同意的情况下获得KRHS是合理的。结果:鉴于危害预防服务的目的和性质不同，第一部分作者认为考虑同意年龄对高危青少年获得KRHS是一个限制和低效的因素，可以在其本人同意的情况下为高危青少年提供KRHS。在第二部分中，作者认为在危险青少年获得儿童健康服务的决策中，基于危害标准，应适用最佳利益标准。考虑到社区的社会文化背景，在评估伤害的严重性和干预的门槛之后，采取实际步骤减少或消除伤害，并选择最能促进青少年利益的选择。结论:在存在限制性法律的情况下，建议的框架可以作为青少年卫生保健专业人员立法和适当行动的生物伦理政策指南，适用于不同社区。
{"title":"A Bioethics Framework for At-risk Child/Adolescent Access to Key Reproductive Health Services Without Parental Consent","authors":"F. Akrami, A. Zali, M. Abbasi","doi":"10.5812/ijp-120591","DOIUrl":"https://doi.org/10.5812/ijp-120591","url":null,"abstract":"Context: Access of adolescents to key reproductive health services (KRHS) has been emphasized; however, how to provide it has not been addressed. This study aimed to propose a bioethics framework to justify at-risk child/adolescent access to KRHS without parental consent. Evidence Acquisition: First, articles and documents were searched using the age of consent laws, reproductive health, and ethical/legal standards phrases with AND/OR separators in PubMed and Web of Science using the Google Scholar search engine in English. After a concise review of the age of consent in child/adolescent-related laws, at-risk child/adolescent access to KRHS without parental consent was justified using major ethical and legal principles and standards. Results: Given the different purposes and nature of harm preventive services, in the first part, the authors argue that considering the age of consent for at-risk adolescents’ access to KRHS is a limiting and inefficient factor, and KRHS could be provided for the at-risk adolescent with his/her own assent. In the second part, the authors argue that in decision-making for at-risk adolescents’ access to KRHS, the best interest standard is applicable on the ground of harm standard. Regarding the sociocultural context of the community, after assessing the seriousness of the harm and the threshold of intervention, practical steps are taken toward reducing or removing harm and choosing the option that best promotes adolescents’ interests. Conclusions: Regarding the existence of restrictive laws, the suggested framework can be applied in different communities as a bioethics policy guide for legislation and appropriate actions of adolescents’ healthcare professionals.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"80 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-11-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"83833098","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}
M. Fallahi, Golnaz Babaee, Sina Kazemian, S. Tajalli, Shamsollah Noripour, M. Rouzrokh, M. Hajipour, M. Kazemian
Background: Esophageal atresia and tracheoesophageal fistula (EA/TEF) is a known correctable anomaly of the esophagus, and its prognosis depends on multiple factors. Studies investigating the EA/TEF post-operative outcomes among the Iranian population are limited to small sample sizes, and the current prevalence of coexisting anomalies and predictors of poor prognosis in the Iranian population is still unclear. Objectives: This study aimed to investigate the predictors of in-hospital mortality in neonates with EA/TEF at our center within a 12-year period. Methods: In this retrospective cohort study, we investigated neonates with EA/TEF admitted/referred to a tertiary referral center in Tehran, Iran, from March 2008 to April 2020. Neonates with chromosomal anomalies or age > 10 days at operation date were excluded. Baseline characteristics, associated anomalies, type of EA, and transmission distance were compared in the study population. We followed the neonates for incurring in-hospital mortality. Results: We included 233 neonates in the final analysis. The mean age at operation was 3.1 ± 1.7 days, and 111 (47.6%) cases were female. The most common EA type was type C (proximal esophageal atresia with distal fistula), with a prevalence of 94.4%. In this cohort, 23 (9.9%) cases had vertebral anomalies, anal atresia, cardiovascular malformations, trachea-esophageal fistula, renal and limb anomalies (VACTERL) association, and 29 (12.4%) cases died during the in-hospital course. Moreover, neonates with lower birth weight, gestational birth weight < 37 weeks, other coexisting anomalies, cardiovascular defects, and non-VACTERL anomalies were at higher risk of in-hospital mortality. In contrast, EA types and transmission distance did not increase the mortality risk. Furthermore, we measured a cut-off value of < 2575.0 g for birth weight to predict in-hospital mortality with 65.5% sensitivity and 61.3% specificity. Conclusions: Lower birth weight, prematurity (< 37 weeks), and coexisting anomalies, especially cardiovascular defects, were associated with an increased risk of in-hospital mortality in neonates after EA/TEF repair surgery.
{"title":"Predictors of Early Mortality in Esophageal Atresia: A 12-year Cohort Study in Tehran, Iran","authors":"M. Fallahi, Golnaz Babaee, Sina Kazemian, S. Tajalli, Shamsollah Noripour, M. Rouzrokh, M. Hajipour, M. Kazemian","doi":"10.5812/ijp-129266","DOIUrl":"https://doi.org/10.5812/ijp-129266","url":null,"abstract":"Background: Esophageal atresia and tracheoesophageal fistula (EA/TEF) is a known correctable anomaly of the esophagus, and its prognosis depends on multiple factors. Studies investigating the EA/TEF post-operative outcomes among the Iranian population are limited to small sample sizes, and the current prevalence of coexisting anomalies and predictors of poor prognosis in the Iranian population is still unclear. Objectives: This study aimed to investigate the predictors of in-hospital mortality in neonates with EA/TEF at our center within a 12-year period. Methods: In this retrospective cohort study, we investigated neonates with EA/TEF admitted/referred to a tertiary referral center in Tehran, Iran, from March 2008 to April 2020. Neonates with chromosomal anomalies or age > 10 days at operation date were excluded. Baseline characteristics, associated anomalies, type of EA, and transmission distance were compared in the study population. We followed the neonates for incurring in-hospital mortality. Results: We included 233 neonates in the final analysis. The mean age at operation was 3.1 ± 1.7 days, and 111 (47.6%) cases were female. The most common EA type was type C (proximal esophageal atresia with distal fistula), with a prevalence of 94.4%. In this cohort, 23 (9.9%) cases had vertebral anomalies, anal atresia, cardiovascular malformations, trachea-esophageal fistula, renal and limb anomalies (VACTERL) association, and 29 (12.4%) cases died during the in-hospital course. Moreover, neonates with lower birth weight, gestational birth weight < 37 weeks, other coexisting anomalies, cardiovascular defects, and non-VACTERL anomalies were at higher risk of in-hospital mortality. In contrast, EA types and transmission distance did not increase the mortality risk. Furthermore, we measured a cut-off value of < 2575.0 g for birth weight to predict in-hospital mortality with 65.5% sensitivity and 61.3% specificity. Conclusions: Lower birth weight, prematurity (< 37 weeks), and coexisting anomalies, especially cardiovascular defects, were associated with an increased risk of in-hospital mortality in neonates after EA/TEF repair surgery.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"13 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-11-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89605752","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}
A. Setoodeh, A. Rabbani, F. Sayarifard, Z. Haghshenas, A. Sayarifard, P. Rostami, F. Abbasi, Mohadeseh Bayat, S. Amini, R. Tavakolizadeh
Background: The purpose of this study was to compare the effectiveness of once-daily versus twice-daily insulin detemir injection in children with type 1 diabetes mellitus (T1DM). Methods: In this randomized 4-month clinical trial, 60 children aged 33 - 156 months with T1DM were randomly assigned into two groups, once-daily (group 1) and twice-daily (group 2) detemir insulin injection with pre-meal insulin Aspart. The first month of the study was devoted to educating the patients and insulin dose titration. Hemoglobin A1C (HbA1C) measured at the end of the first month and again after the fourth month was considered as the outcome. Hypoglycemia as one of the major complications was defined as blood glucose lower than 70 mg/dL with clinical symptoms or blood glucose lower than 50 mg/dL in the absence of clinical symptoms. Results: Mean HbA1C in the fourth month was 8.5% ± 1% in group 1 and 8.5% ± 1.1% in group 2 (P = 0.98). Mean changes in the fourth month compared to baseline were -0.09% (95% CI: -0.47 - 0.3) in group 1, and -0.42% (95% CI: -0.94 - 0.09) in group 2 (P = 0.273). The treatment modification rate was 39% and 15% in groups 1 and 2 (P = 0.02). However, there were no statistically significant differences between the two groups in terms of insulin dose, hypoglycemia, and other complications. Conclusions: Twice-daily injections did not change HbA1c in comparison with once-daily injections. However, the lower treatment modification rate in the twice-daily group in the age group of our study was considerable.
{"title":"Comparison of Once-daily versus Twice-daily Injection of Insulin Detemir in Children with Type 1 Diabetes Mellitus","authors":"A. Setoodeh, A. Rabbani, F. Sayarifard, Z. Haghshenas, A. Sayarifard, P. Rostami, F. Abbasi, Mohadeseh Bayat, S. Amini, R. Tavakolizadeh","doi":"10.5812/ijp-116461","DOIUrl":"https://doi.org/10.5812/ijp-116461","url":null,"abstract":"Background: The purpose of this study was to compare the effectiveness of once-daily versus twice-daily insulin detemir injection in children with type 1 diabetes mellitus (T1DM). Methods: In this randomized 4-month clinical trial, 60 children aged 33 - 156 months with T1DM were randomly assigned into two groups, once-daily (group 1) and twice-daily (group 2) detemir insulin injection with pre-meal insulin Aspart. The first month of the study was devoted to educating the patients and insulin dose titration. Hemoglobin A1C (HbA1C) measured at the end of the first month and again after the fourth month was considered as the outcome. Hypoglycemia as one of the major complications was defined as blood glucose lower than 70 mg/dL with clinical symptoms or blood glucose lower than 50 mg/dL in the absence of clinical symptoms. Results: Mean HbA1C in the fourth month was 8.5% ± 1% in group 1 and 8.5% ± 1.1% in group 2 (P = 0.98). Mean changes in the fourth month compared to baseline were -0.09% (95% CI: -0.47 - 0.3) in group 1, and -0.42% (95% CI: -0.94 - 0.09) in group 2 (P = 0.273). The treatment modification rate was 39% and 15% in groups 1 and 2 (P = 0.02). However, there were no statistically significant differences between the two groups in terms of insulin dose, hypoglycemia, and other complications. Conclusions: Twice-daily injections did not change HbA1c in comparison with once-daily injections. However, the lower treatment modification rate in the twice-daily group in the age group of our study was considerable.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"26 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-11-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84122930","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}
Hojjat Mortezaeian, M. Farshidgohar, A. Vesal, B. Alizadeh, Yasaman Khalili, M. Meraji, N. Haas
Background: Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited. Objectives: We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far. Methods: This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure. Results: A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block. Conclusions: Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.
{"title":"Long-Term Follow-up of Transcatheter Ventricular Septal Defect Closure in Children, and Comparison of Single-Hole Versus Multi-holes Ventricular Septal Defects","authors":"Hojjat Mortezaeian, M. Farshidgohar, A. Vesal, B. Alizadeh, Yasaman Khalili, M. Meraji, N. Haas","doi":"10.5812/ijp-129278","DOIUrl":"https://doi.org/10.5812/ijp-129278","url":null,"abstract":"Background: Evaluation of complications after transcatheter ventricular septal defect (VSD) closure in long-term follow-up and large samples of children is limited. Objectives: We compared the residual shunt after transcatheter closure in VSDs with a single hole and multiple holes, a new task that has not been done so far. Methods: This retrospective study included all patients who underwent transcatheter device closure for VSD in a tertiary cardiovascular center from 2009 to 2020. Follow-up evaluation using transthoracic echocardiography (TTE) and electrocardiogram (ECG) was performed at 1, 6, 12 months, and annually after the procedure. Results: A total of 409 patients underwent transcatheter VSD closure. The mean age was 7 years (2 - 15 years), and the median follow-up duration was 48 months (1 - 10 years). The number of patients with a singular VSD was 259 (63.4%), and those with multiple exit holes were 150 (36.6%). The incidence of a residual shunt immediately after implantation was significantly higher in VSDs with multiple holes than those with a single hole (P = 0.008). During the follow-up, the residual shunts decreased in the group of VSDs with a single hole. Forty-five patients (11%) and 16 patients (4%) had a new-onset of mild and moderate tricuspid regurgitation (TR), respectively, and it decreased dramatically over time. Only 1 patient showed a new-onset mild aortic regurgitation (AR). The most crucial complication shown in 2 patients was a persistent complete heart block. Conclusions: Ventricular septal defects with multiple exit holes are a risk factor for a residual shunt. After transcatheter VSD closure, the residual shunt in patients with a multiple-hole VSD was significantly higher (P = 0.008). Although TR may increase during the procedure, it decreases dramatically over time. Interestingly, patients who had pre-procedure tricuspid or aortic regurgitation disappeared after 2 years of the procedure. The most important complication was a complete heart block in 2 patients.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"1 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-11-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85016601","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}
Ashkan Habib, Mohadeseh Molayemat, A. Habib, Zinatosadat Hejrati, Z. Kheirandish
Background: Zinc and vitamin D are essential factors required for growth. Recently, studies have shown a possible link between serum zinc and vitamin D levels. Objectives: This study was designed to evaluate this link and its possible affecting growth factors in children and adolescents in Iran. Methods: This cross-sectional study was performed on the data obtained from children aged 2 to 18 years old referring to a growth assessment clinic for routine growth follow-ups in the city of Shiraz from April to August 2019. A total of 454 children who were checked for 25-hydroxyvitamin D and zinc simultaneously were included. Results: Vitamin D was negatively correlated with body mass index (BMI) z-scores, while zinc was positively correlated with vitamin D and height z-scores. Subjects with vitamin D levels ≤ 8.6 ng/mL were 2.081 times more likely to have a zinc deficiency. Vitamin D insufficiency was significantly higher in overweight and obese children. Mean vitamin D and zinc levels were significantly lower, and vitamin D insufficiency was significantly higher in boys than girls. While mean zinc levels were significantly lower in short children, the prevalence of zinc deficiency was not statistically different between short and normal height statures. Conclusions: Very low vitamin D levels are likely to be accompanied by zinc deficiency, possibly caused by malnutrition and the modulatory effect of serum vitamin D on zinc absorption. Unlike zinc deficiency, vitamin D insufficiency is much more prevalent in Iranian children than in children from other countries. Vitamin D and zinc are associated with BMI and height z-scores, respectively.
{"title":"Vitamin D and Zinc are Interlinked but Affected by Different Growth Factors in Iranian Children and Adolescents: Vitamin D and Zinc in Iranian Children and Adolescents","authors":"Ashkan Habib, Mohadeseh Molayemat, A. Habib, Zinatosadat Hejrati, Z. Kheirandish","doi":"10.5812/ijp-127158","DOIUrl":"https://doi.org/10.5812/ijp-127158","url":null,"abstract":"Background: Zinc and vitamin D are essential factors required for growth. Recently, studies have shown a possible link between serum zinc and vitamin D levels. Objectives: This study was designed to evaluate this link and its possible affecting growth factors in children and adolescents in Iran. Methods: This cross-sectional study was performed on the data obtained from children aged 2 to 18 years old referring to a growth assessment clinic for routine growth follow-ups in the city of Shiraz from April to August 2019. A total of 454 children who were checked for 25-hydroxyvitamin D and zinc simultaneously were included. Results: Vitamin D was negatively correlated with body mass index (BMI) z-scores, while zinc was positively correlated with vitamin D and height z-scores. Subjects with vitamin D levels ≤ 8.6 ng/mL were 2.081 times more likely to have a zinc deficiency. Vitamin D insufficiency was significantly higher in overweight and obese children. Mean vitamin D and zinc levels were significantly lower, and vitamin D insufficiency was significantly higher in boys than girls. While mean zinc levels were significantly lower in short children, the prevalence of zinc deficiency was not statistically different between short and normal height statures. Conclusions: Very low vitamin D levels are likely to be accompanied by zinc deficiency, possibly caused by malnutrition and the modulatory effect of serum vitamin D on zinc absorption. Unlike zinc deficiency, vitamin D insufficiency is much more prevalent in Iranian children than in children from other countries. Vitamin D and zinc are associated with BMI and height z-scores, respectively.","PeriodicalId":14593,"journal":{"name":"Iranian Journal of Pediatrics","volume":"24 1","pages":""},"PeriodicalIF":0.5,"publicationDate":"2022-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"81828894","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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