Search

Background: This study aimed to determine postoperative cardiac and noncardiac complications and their association with the use of cardiopulmonary bypass (CPB), surgical outcomes (length of hospital and ICU stays), dependence on mechanical ventilation, and mortality. Methods: This retrospective cross-sectional study was conducted on pediatric patients aged 0 to 18 who underwent open or closed cardiac surgery over a 1-year period. The use of CPB support, CPB duration, cardiac surgery complexity according to the risk-adjusted classification for congenital heart surgery (RACHS-1), and demographics were examined as potential risk factors associated with an increased number of postoperative complications. The study was performed at the Children's Medical Center, a teaching hospital affiliated with Tehran University of Medical Sciences in Iran. Results: A total of 283 surgeries were included in our study. Seventy-six (26.9%) of the study population experienced at least 1 complication. Our analysis revealed that increased CPB durations were associated with higher odds of cardiac complications, with an odds ratio of 1.02 (P=0.002). Moreover, higher RACHS-1 levels were significantly associated with greater numbers of cardiac and noncardiac complications. Additionally, prolonged mechanical ventilation and open-heart surgery intensive care unit (OH-ICU) stays were significantly associated with cardiac and noncardiac complications. Our logistic regression analysis found no association between demographic and clinical risk factors, the number of complications, and mortality. Conclusion: Postoperative complications occurred in 27% of pediatric heart surgeries. Prolonged mechanical ventilation and OH-ICU stays were significantly associated with cardiac and noncardiac complications. However, no significant association was found between postoperative complications and mortality. [ABSTRACT FROM AUTHOR]

Introduction: Acute kidney injury (AKI) is a common complication after cardiac surgery, and its occurrence is associated with a worse prognosis and increased mortality. The term cardiac surgery associated AKI (CSA AKI) is used to describe the entity. CSA AKI is independently associated with an increase in short term morbidity, costs of treatment, and long term mortality. In this study, we evaluated the frequency of CSA AKI in an intensive care unit for children undergoing cardiac surgery to examine the prevalence of CSA AKI and the risk factors contributing to it. Methods: This retrospective descriptive cross sectional study evaluated 73 patients admitted to a single center for cardiac surgery in 2022. Inpatient files were reviewed for patients who underwent surgical procedures for congenital heart disease (CHD) during 2022. Results: AKI occurred in 35.6% of children undergoing cardiac surgery. The majority of cases were infants or had cyanotic heart disease (42.5% and 25.8%, respectively). Conclusions: Almost one third of postcardiac surgery patients develop AKI. Monitoring for AKI postoperatively is especially necessary in infants and patients with cyanotic CHD. [ABSTRACT FROM AUTHOR]

Background: Children with congenital heart diseases (CHDs) often require cardiac surgery, whose outcome depends on many preoperative, intraoperative, and postoperative factors. Objectives: We aimed to investigate the factors associated with in-hospital mortality among patients undergoing pediatric heart surgery for CHDs. Methods: This retrospective cross-sectional study included patients younger than l8 years who underwent cardiac surgery due to CHDs at the Children's Medical Center of Tehran University of Medical Sciences and were admitted to the open-heart surgery intensive care unit (OH-ICU) between March 2018 and March 2019. Patients with incomplete records were excluded. The collected data included age (months), weight (kg), type of congenital defect, duration of intensive care unit (ICU) stay, cardiopulmonary bypass (CPB) time, aortic cross-clamping (XCT) time, postoperative (day 1) platelet count and neutrophil-to-lymphocyte ratio (NLR), and mortality. Results: This study included 275 CHD patients who underwent cardiac surgery. The mean age and weight were 32.54 ± 37.4 months and 11.01 ± 8.43 kg, respectively. Those who died were younger (P = 0.05) and had lower weights (P = 0.001). An inverse relationship existed between thrombocytopenia and mortality. The NLR was higher in those who survived (mean 4.08 vs. 2.87), while the deceased patients had an extended duration of hospitalization, longer CPB time, and longer XCT time. Conclusions: Younger age, lower body weight, lower NLR ratio, lower platelet count, longer intraoperative CPB time, and XCT time were not associated with increased in-hospital mortality following cardiac surgery for CHDs. The Risk Adjustment for Congenital Heart Surgery (RACHS-1) score was not significantly related to mortality. Also, CPB and XCT times were significantly longer in cyanotic than in non-cyanotic patients. Cyanotic patients also had significantly lower platelets than non-cyanotic patients after the operation. Large, multicenter studies are needed to further investigate the predictors of mortality following surgery for CHDs. [ABSTRACT FROM AUTHOR]

Background: Acute Appendicitis (AA) is a common cause of emergency room visits among children. Non-specific symptoms of appendicitis may pose a major challenge. Due to the lack of access to imaging modalities in all facilities and its high cost, the evaluation of clinical symptoms and examination results is important in diagnosing acute appendicitis. Methods: This study is a retrospective cross-sectional study. Patients admitted to our emergency department and were suspected of having acute appendicitis by pediatric residents, and underwent an appendectomy during 2013-2018 were included. A checklist of the patients’ clinical signs and symptoms, and laboratory results and imaging findings completed from the records of these patients. Results: We reviewed the files of 300 patients with a clinical diagnosis of acute appendicitis and having an appendectomy. Leukocytosis was found in 248 (82.7%), neutrophilia in 240 (80%) and CRP level equal or above 12 mg/L was observed in 107 (35.7%) patients. Ultrasound was performed in 283 patients (94.33%); of which 228 (80.56%) were reported as acute appendicitis. Abdominal CT scan was performed in 19 patients (6.33%); of which acute appendicitis was reported in 17 patients (89.47%). Conclusion: The results of this research showed that RLQ tenderness, and nausea/vomiting are the most common signs and symptoms, and leukocytosis is the most common laboratory finding in children with acute appendicitis. It can be suggested that relying just on the clinical presentation of AA (RLQ tenderness, fever, nausea/vomiting, anorexia and leukocytosis), can lead to the correct diagnosis of 78% of the suspected patients. [ABSTRACT FROM AUTHOR]

Background: Neonatal thrombotic diseases can cause mortality or serious morbidity and disability. Case report: In this report, we present a case of neonatal inferior vena cava thromboembolism with several underlying factors. Hereditary thrombophilia and genetic mutation in plasminogen activator inhibitor-1 and MTHFR A1298C genes in conjunction with cleft palate resulted in poor lactation and hypernatremic dehydration. A peripherally inserted central catheter in the inferior vena cava was an additional underlying factor. Thrombosis mass was dislodged to the right atrium while asymptomatic and accidentally detected during routine echocardiography. Conclusion: Surgical thrombectomy was done successfully, and the mass was removed from the right atrium. [ABSTRACT FROM AUTHOR]

Parapharyngeal abscess is a life-threatening disease. Upper respiratory tract infection is the main cause in children. We present a 15-month-old boy admitted to the emergency ward with the chief complaint of difficulty in breathing caused by parapharyngealabscess. His condition deteriorated gradually, and he transferred to the operation theater quickly for abscess drainage and because of the difficulty in orotracheal intubation; a tracheostomy was performed. His respiratory condition deteriorated 2 days after PICU admission, and the medical team noticed an unexplainable respiratory distress. A chest x ray obtained and showed a right side pneumothorax and subcutaneous emphysema around theneck area. The case presented here, had not been diagnosed at the first examination; however, there were enough clinical clues (such as respiratory distress, drooling, torticollis, bulging of theneck, previous viral respiratory infection, possible pharyngeal trauma). The story of this case reminds us the importance of the precise physical exam and history taking which could be life-saving. [ABSTRACT FROM AUTHOR]

We present a 7 yr old boy afflicted with super-refractory seizure that responded poorly to antiepileptic drugs and sustained a long course of hospitalization and complications of high doses of medications as well as longstanding stay in hospital. The differential diagnoses were, fever-induced refractory epileptic encephalopathy (FIRES), and infectious and autoimmune encephalitis. However, work-ups had not revealed any evidence of any specific diagnosis, so we assumed that he was afflicted by viral infectious encephalitis as he had, fever, vomiting, and prodromal symptoms of infectious (most probably viral) disease prior to onset of the seizure attacks. [ABSTRACT FROM AUTHOR]

We present a case of caustic ingestion by a 1.5-year-old boy. The caustic agent was drain opener which is a strong alkaline substance. Children in Iran and many other countries are still exposed to not "child proof" (child resistant packaging) toxic substance containers. Ingestion of caustic agents may lead to necrosis, perforation, and strictures. Substances that are ingested more frequently are liquid alkali material which causes severe, deep liquefaction necrosis. Common signs and symptoms of caustic agents are vomiting, drooling, refusal to drink, oral burns, stridor, hematemesis, dyspnea, dysphagia and abdominal pain. Even if no oropharyngeal lesion is seen, a significant esophageal injury which can lead to perforation and stricture cannot be ruled out. If abdominal pain or rigidity, substernal, chest or back pain exists, visceral perforation should be considered. The first thing to be checked is airway assessment. A lot of patients should be admitted to intensive care unit, and endoscopic evaluation, surgical intervention, long-term hospitalization, and worsening quality of life or among the complications. Preventive measures especially at the country level and approving proper legislation for obligating the related industries to produce child proof containers for house hold toxic products are the urgent measures to be followed by all of us. [ABSTRACT FROM AUTHOR]

We presents an infant with several indurated plaques and nodules scattered on her body. She was brought to the hospital because of fever, runny nose and cough from one month ago. During the examination and investigation the plaques and nodules grabbed the attention of the clinicians and the skin biopsy and other lab works revealed the diagnosis of congenital leukemia. [ABSTRACT FROM AUTHOR]

In this case we present a previously healthy child with sudden behavioral change and acute confusional state (ACS). ACS is a neurologic emergency. The clinical manifestations of ACS are; confused affect, limited verbal response, disturbance in performing orders, some automatism, stable vital signs and absence of tonic-clonic movements and it has a wide range of differential diagnosis which should be assessed by detailed medical history, medical examination and laboratory tests. The only abnormal test found in this patient, was cerebrospinal fluid abnormality, consistent with viral encephalitis. [ABSTRACT FROM AUTHOR]

Pleuritic pain is not an unusual problem in children. Other concomitant symptoms should be considered for diagnostic approach in a child with pleuritic chest pain. In this report we discuss chest pain in a 6-year-old child with regard to other signs and symptoms. Finally, we found a rare life-threatening complication of juvenile systemic lupus erythematosus (JSLE) in our patient. [ABSTRACT FROM AUTHOR]

We reports a six-year-old child with autistic disorder and methadone intoxication. Developmental disorders may mislead the caretakers and doctors to interpret the clinical manifestation and behavioral changes of these patients. Methadone indigestion can be fatal in children even in a tiny amount and cardiac monitoring should be performed at least for the first 24 hours. The pervasive prescription of methadone for detoxification programs and its extensive availability at homes of the addicted parents should point parents, doctors and media to pay more attention to provide safe-home environment for children. [ABSTRACT FROM AUTHOR]

Recurrent bacterial meningitis is not a common disease and makes physicians seek underlying predisposing factors which can result from anatomic anomalies or immunodeficiency. In this paper we present a boy with recurrent bacterial meningitis with the history of trauma and sensorineural hearing loss. Mondini dysplasia was demonstrated with computed homographic scans (CT-Scan) of temporal bones. [ABSTRACT FROM AUTHOR]

Child maltreatment happens in all countries and cultures. Children as the vulnerable part of the societies are subject to rage, abuse and maltreatment and need special multidisciplinary attention to get proper protection and care. Appropriate legislation, community education, advocacy in media and attention of care givers and children health providers may alter the trend of child abuse in communities. In order to raise awareness about child abuse for healthcare professionals, in this report we introduce a disastrous case of 4 years old boy who was attacked by his father which presented to Children's Medical Center in Tehran. The living environment of the victim was a dysfunctional family and an addict father as the risk factors of dangerous circumstances for a child. [ABSTRACT FROM AUTHOR]

Case Presentation: This report describes a 7 years old boy who has had chronic and recurrent respiratory distress and wheezing episodes since infancy. He had been treated for hyper-reactive airway disease and asthma, with partial response. The problem had been associated with cyanosis and did not improve with asthma treatment; therefore, we consider other underlying diseases, such as cardiovascular problems. In "double aortic arch" the ascending aorta bifurcates and ends to a right and left sided arch which surround the esophagus and trachea and then join together to compose the descending aorta. The right arch is often larger than the left one. The diagnostic work-ups revealed the "double aortic arch" which had not been diagnosed for years. Vascular ring is among the differential diagnoses of chronic cough. Other possible causes of chronic cough include: Gastroesophageal reflux disease, cystic fibrosis, inhaled foreign body, infection, tracheomalacia, immune deficiency, vocal cord dysfunction, bronchiectasia, chronic sinusitis with or without postnasal drip, allergic disease, and branchial cleft cysts. The clinical signs and symptoms of vascular ring in children vary from a completely asymptomatic patient to severe respiratory distress in a neonate. The most prevalent presentations in children are nonspecific and include; choking, vomiting, dysphagia, cough, stridor, wheezing and episodes of upper respiratory tract infection. The clinical presentation of double aortic arch most often occurs in infancy. External pressure on the airway by vascular ring causes respiratory and feeding problems. Feeding problems such as slow feeding, difficult swallowing, hyperextension of head during eating, may occur later in life, since these problems typically present when solid foods are introduced. Chronic wheezing is aggravated by eating, crying and neck flexion, while neck extension alleviates the noisy breathing. Severe problems such as apnea and cyanosis may also occur. Conclusion: Patients with vascular rings usually present with nonspecific and vague complaints and can mimic asthma or hyper-reactive airway disease. Physicians should consider vascular rings in the list of differential diagnosis of chronic cough, respiratory problems and refractory asthma to prevent the unnecessary interventions and procedures and delaying the diagnosis. [ABSTRACT FROM AUTHOR]

A letter to the editor is presented about a boy suffering from epilepsia partialis continua.

Blood infection due to different circumstances could immediately develop to an extreme body reaction that leads to a serious life-threatening condition, called Sepsis. Currently, therapeutic protocols through timely antibiotic resuscitation strategies play an important role to fight against the adverse conditions and improve survival. Therefore, timing, and more specifically early diagnosis of the illness, is crucially important for an effective treatment. Studies have indicated that vital signals such as heart rate variability (HRV) could provide potential prognostic biological markers that can help with early detection of sepsis before it is clinically diagnosed through its actual symptoms. Therefore, this study employs neonatal and pediatric electrocardiogram (ECG) to extract 52 hourly sets of linear and non-linear features from the HRV, starting from 24 hours prior to the clinical diagnosis of sepsis in patients with positive blood cultures (n=14). Similar sets of features were also obtained from a non-sepsis control group to create an evaluation benchmark (n=14).In particular, this study initially demonstrates how the variations within the 24 hours values of specific HRV feature-sets could effectively reveal prognostic information about the evolution of sepsis, prior to the actual clinical diagnosis. Moreover, this study demonstrates that differences in the values of a particular set of features at 22 hours before the actual clinical diagnosis/symptoms can be reliably used to train a convolutional neural network for automatic classification between the individuals in the sepsis and non-sepsis groups with 88.89±7.86% accuracy.

Sepsis as bacterial infection is the most common and costly causes of mortality in critically ill patients. The early diagnosis of sepsis is significantly important for effective treatment. In this study, over a period of two years, the electrocardiogram of nearly 500 pediatric and neonate patients with heart diseases were collected in 24 hours before diagnosis. The collected data of 22 patients were studied including 11 sepsis patients with positive blood cultures and 11 non-sepsis patients. After extracting the HRV (Heart Rate Variability) signal, 28 linear and nonlinear features according to previous research were extracted. By using the relative entropy method as a feature selection technique, the extracted features were evaluated for their ability to discriminate the data in sepsis and non-sepsis groups, and the best features were entered into the classification process. Using the four classification models of SVM, LDA, KNN and Decision Tree, the accuracy of 86.36% was obtained with Decision Tree for discrimination of sepsis patients from other patients.

We reports a six-year-old child with autistic disorder and methadone intoxication. Developmental disorders may mislead the caretakers and doctors to interpret the clinical manifestation and behavioral changes of these patients. Methadone indigestion can be fatal in children even in a tiny amount and cardiac monitoring should be performed at least for the first 24 hours. The pervasive prescription of methadone for detoxification programs and its extensive availability at homes of the addicted parents should point parents, doctors and media to pay more attention to provide safe-home environment for children.