The Journal of Pediatric Academy

Validity of Erythrocyte Indices in Differentiation between Iron Deficiency Anemia and β-Thalassemia Trait in Children

2024-01-02T09:21:08+03:00

Iron deficiency anemia (IDA) and β-thalassemia trait (BTT) are the most common causes of hypochromic microcytic anemia (HMA). Various erythrocyte indices that may help in the initial discrimination between IDA and BTT have been reported, but data evaluating their reliability in children are scarce. We aimed to evaluate the validity of 12 erythrocyte indices in the differentiation between IDA and BTT in children. These indices were red blood cell (RBC) count, Mentzer Index, England and Fraser Index, Srivastava Index, Shine and Lal Index, RBC distribution width (RDW), Ricerca Index, Green and King Index, RDW Index, Sirdah Index, Ehsani Index, and Serdar Index. Among 1,444 children with HMA, 136 (9.4%) were stratified into the IDA group and 137 (9.5%) into the BTT group. Of the 12 indices, the Green and King Index showed the highest reliability, as it had the highest Youden’s index (75.1%). Its sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate were 92.7%, 82.4%, 84.1%, 91.8% and 87.5%, respectively. The second most reliable index was the RDW Index, having a Youden’s index, sensitivity, specificity, positive predictive value, negative predictive value and correct diagnosis rate of 64%, 94.2%, 69.9%, 75.9%, 92.2% and 82%, respectively. Receiver operating characteristic analysis showed that the revised cut-off values for the Green and King Index and RDW Index had higher sensitivity and specificity levels than the cut-off values commonly used in the literature. The findings of this study suggest the superiority of the Green and King Index and the RDW Index as screening tools in the initial differentiation between IDA and BTT among children with HMA.

Hemogram Parameters Cannot Distinguish Pediatric COVID-19 from Other Respiratory Infections

2024-01-02T09:21:28+03:00

To fight against the pandemic, which has become the most significant public health problem of modern times, the isolation of patients and early detection of the coronavirus disease-2019 (COVID-19) disease are crucial. This study aimed to show the diagnostic predictor of hemogram parameters and the rates obtained from these parameters in differentiating COVID-19 from other respiratory tract diseases. Data of patients aged between 1 month and 18 years who were admitted to the 3^rd and 2^nd level pediatric emergency with the pre-diagnosis of “COVID-19-like disease” between 12 January 2022 and July 12, 2022, which is one month after the Omicron (Nu) variant was accepted as an established variant in Türkiye, were retrospectively reviewed. A total of 724 children with pre-diagnosis of COVID-19-like disease whose complete blood count and severe acute respiratory syndrome-coronavirus-2 (SARS‑CoV‑2) polymerase chain reaction (PCR) test from oropharynx/nasopharyngeal swab samples were included in the study. Two hundred children were positive for SARS-CoV-2 PCR (27.6%). Total leukocytes, neutrophils, lymphocytes, monocytes, eosinophils, platelets, platelet distribution width, platelet crit counts, and neutrophil/lymphocyte ratio were lower, and hemoglobin values were higher in the COVID-19 group than in the other group. These differences were statistically significant (p<0.05). When these parameters were evaluated by receiver operating characteristic analysis, the area under the curve values of the other parameters, except the eosinophil count, were statistically significant. However, when the obtained possibility ratios were examined, significant cut-off values could not be obtained regarding diagnostic predictiveness. It was found that using complete blood count parameters in the diagnostic process is not helpful in differentiating SARS-CoV-2 from other respiratory tract diseases. It is essential to conduct studies with larger sample sizes to understand whether complete blood count parameters can predict the diagnosis of COVID-19.

Evaluation of Etiologic Agents of Lower Respiratory Tract Infections in Children Hospitalized Just Before Normalization of COVID-19

2023-12-25T13:06:33+03:00

Lower respiratory tract infections (LRTIs) are one of the most common causes of hospitalization among children in the early childhood period. Knowing the pathogens that cause pneumonia, its management will be more exact and effective. In this study, we aimed to investigate the frequency of pathogens causing LRTIs in children at the end of the COVID-19 pandemic by performing a real-time multiplex polymerase chain reaction (RT-MPCR) test within our hospital. We included two hundred forty-seven children, aged between 1 month and 18 years, diagnosed with LRTIs, and hospitalized between May 2021 and April 2022. Demographic characteristics and clinical and laboratory findings were retrospectively collected from patients’ hospital records. Of the 247 children diagnosed with LRTIs, 153 (61.9%) were female. At least one pathogen was identified in the nasopharyngeal swap specimens of 218 (88.3%) patients, and 74.9% (n=185) of them were viruses. The most common identified pathogens were respiratory syncytial virus (24.7%), human bocavirus (21.1%), and severe acute respiratory syndrome coronavirus 2 (15.4%). 7.7% of identified pathogens were bacteria. Haemophilus influenzae was the most commonly detected bacteria. Despite a lengthy period of isolating the community causative agents of pneumonia, their frequency remains unchanged from before the isolation time. RT-MPCR is beneficial for the early detection of pathogens and in the prevention of unnecessary antibiotic usage.

Maternal Obesity and ADHD: An Original Review of Evidence and Potential Mechanisms

2023-11-20T09:17:07+03:00

This review explores the potential link between maternal obesity [body mass index (BMI) >30 during pregnancy] and the development of attention-deficit/hyperactivity disorder (ADHD) in offspring. This study assesses the strength of this association by examining epidemiological studies and investigating possible biological mechanisms, including inflammation, oxidative stress, hormonal changes, prenatal programing, and epigenetic modifications. In addition, the review considers moderating variables and discusses the public health implications, with the objective of providing valuable insights into addressing this complex relationship for future clinical approaches and public health policies. This original review conducted a comprehensive literature search in August 2023 using various databases and keywords related to maternal obesity and ADHD. English articles published from 2005 to 2023, including case-control studies, cross-sectional studies, cohort studies, and reviews were considered. Multiple authors independently conducted searches, screened titles/abstracts, and extracted data to ensure rigorous methodology. Initially, 414 articles were retrieved from various databases and managed using Zotero. After eliminating 96 duplicates, 318 articles remained for screening on Rayyan. Of these, 47 papers met the eligibility criteria and underwent full-text review for inclusion in the study. Multiple studies suggest a positive correlation between maternal obesity and ADHD symptoms in children. Additionally, maternal obesity is associated with other neurodevelopmental disorders and behaviors in offspring, including heightened motor and anxiety behaviors. The complex relationship between maternal obesity and ADHD necessitates further investigation. Although existing research indicates associations, causality remains unconfirmed. Genome-wide association studies reveal shared genetic pathways, supported by rodent models. Human studies must address confounding factors. Promising interventions exist but require validation. Comprehensive research encompassing genetic, environmental, and metabolic factors is crucial for understanding the full impact of maternal obesity on neurodevelopmental outcomes.

A Narrative Review: Transforming Pediatric Oncology Care Through Virtual Reality - Pain Management and Enhanced Patient Experience

2024-02-20T12:47:42+03:00

Virtual reality (VR) technology has received considerable interest in the healthcare field, particularly in pediatric oncology. The purpose of this study was to examine the existing and future applications of VR in reducing the discomfort associated with pediatric oncology procedures such as bone marrow biopsy, bone marrow aspirate, and lumbar puncture. A comprehensive search was conducted across numerous databases from 2005 to 2023, embracing several study designs to provide a strong evidence foundation. Using diversion and relaxation strategies, VR can help pediatric cancer patients cope with the emotional issues they confront during operations. VR has shown significant potential for lowering pain and anxiety during several pediatric medical procedures. Patient feedback focused on VR’s empowering and anxiety-reducing benefits, while healthcare staff reported increased patient participation and procedural efficiency. VR implementation challenges include the cost of specialized technology, the need for specific virtual settings, and the need for training healthcare workers. VR shows promise in improving the pediatric cancer experience, but more study and cooperation are required to realize its full potential.

Unexpected Tumor Rupture in a Case of Treatment-naïve Neuroblastoma - A Mortality Experience from a Tertiary Medical Institution

2023-12-24T14:32:07+03:00

Neuroblastoma (NBL) is one of the most common extracranial neoplasms in children. Mortality is often attributed to treatment-related adverse events, sepsis secondary to immunocompromised status, and multi-organ failure resulting from advanced illness. Cases of NBL initially presenting with life-threatening events are rare. Here, we present a fatal NBL case that initially manifested profound anemia and coagulopathy, which later progressed to hemorrhagic shock due to tumor rupture.