https://jpp.mums.ac.ir/ Journal of Pediatric Perspectives en daily 1 Wed, 01 Apr 2026 00:00:00 +0330 Wed, 01 Apr 2026 00:00:00 +0330 https://jpp.mums.ac.ir/article_27887.html Background: Hyperferritinemia is a prognostic marker in critical illness, but its role in postoperative outcomes of pediatric congenital heart defects remains poorly defined, especially in resource-limited settings. This study evaluated early serum ferritin as a predictor of outcomes after congenital heart surgery and its association with the Pediatric Index of Mortality 3 (PIM 3) score.Methods: A single-center prospective cohort study was conducted from April 2023 to October 2024 at a tertiary referral center in southeastern Brazil. Patients aged 29 days to 18 years, of both sexes, admitted to the pediatric intensive care unit (PICU) after congenital heart surgery were included and categorized according to the presence of cyanotic or acyanotic heart disease. Group comparisons were performed using Fisher’s exact test, chi-square test, Student’s t-test, ANOVA, or Kruskal–Wallis test, with statistical significance set at p < 0.05.Results: A total of 105 patients were included. Median ferritin was higher in patients with PICU stays < 7 days (183 ng/mL; p = 0.004) and was significantly associated with a PIM 3 score ≥ 5% (642 ng/mL; p < 0.006). Cyanotic patients had longer PICU stays (11.0 vs. 7.2 days; p = 0.02), longer use of vasoactive drugs (3.8 vs. 2.6 days; p = 0.01), and accounted for all deaths (p < 0.001). Hemoglobin and hematocrit were also significantly higher in cyanotic patients (14 vs. 13 g/dL and 40% vs. 37%; p < 0.001).Conclusions: Serum ferritin may serve as a marker of secondary outcomes and aid early risk stratification in congenital heart defect patients in the PICU. https://jpp.mums.ac.ir/article_27821.html Background: Mother’s milk is the ideal nutrition for preterm infants. However, due to the underdevelopment of swallowing reflexes and sucking in preterm infants, milk intake often decreases.Methods: In this clinical trial, 70 mothers of preterm infants (30–34 weeks of gestation) at Ghaem Hospital, Mashhad, were randomly assigned to either Jacobson’s progressive muscle relaxation (n=35) or foot reflexology intervention (n=35). Milk volume was quantitatively measured on days 1, 3, and 9, at one and two hours after each intervention session, using an electric breast pump and a graduated cup. Breastfeeding adequacy was assessed using a validated 14-item Persian questionnaire administered before the intervention and 21 days afterward during infant follow-up visits. The questionnaire’s content validity was confirmed by experts, and its reliability was demonstrated through test-retest (r=0.81) and Cronbach’s alpha (0.89). Group differences over time were evaluated using independent samples t-tests along with repeated measures analysis of variance (ANOVA).Results: The mean maternal age was 26.5 ± 0.99 years in the Jacobson’s relaxation group and 27.1 ± 0.94 years in the reflexology group (P = 0.488). No significant differences were observed between the groups regarding the type of delivery or neonatal gender (P > 0.05). Breastfeeding adequacy improved significantly within both groups after the intervention (P < 0.001), although the difference between groups was not statistically significant (P = 0.306). Milk volume increased significantly after the intervention on the first, third, and ninth days (P < 0.001).Conclusion: Both Jacobson's progressive muscle relaxation and foot reflexology were equally effective in increasing milk volume. These relaxation and foot reflexology as non-pharmacologic methods enhanced breastfeeding adequacy and milk production in mothers of preterm infants. https://jpp.mums.ac.ir/article_27850.html Background: Antiepileptic drugs (AEDs) constitute the cornerstone of epilepsy management in children. However, accumulating evidence suggests that certain AEDs may alter endocrine function, particularly the hypothalamic–pituitary–thyroid axis. Given the critical role of thyroid hormones in growth and neurodevelopment, clarifying the endocrine safety profile of these agents in pediatric populations is clinically essential.Objective: To evaluate the effects of carbamazepine, phenobarbital, clobazam, and levetiracetam on serum thyroid hormone levels (TSH, FT4, and T3) in children aged 2–16 years over a 6-month treatment period.Methods: In this prospective before-and-after interventional study, 80 children with epilepsy receiving monotherapy (20 per drug group) were enrolled. Baseline demographic and anthropometric characteristics were comparable across groups. Serum TSH, FT4, and T3 levels, along with weight and height, were measured at treatment initiation and after 6 months. Within-group changes were analyzed using paired t tests, and between-group differences were assessed using one-way analysis of variance (ANOVA). Statistical significance was defined as P < 0.05.Results: After 6 months, significant alterations in FT4 and T3 levels were observed exclusively in the carbamazepine group (P < 0.05), with mean hormonal changes differing significantly from those in the other treatment groups. No significant thyroid hormone changes were detected in the phenobarbital, clobazam, or levetiracetam groups. Although weight and height increased significantly in all groups (P < 0.01), the magnitude of growth changes did not differ between treatments.Conclusion: Carbamazepine was associated with measurable alterations in thyroid hormone levels over 6-month, whereas phenobarbital, clobazam, and levetiracetam demonstrated relative short-term endocrine stability. Ongoing thyroid function monitoring may be warranted, particularly in children receiving conventional enzyme-inducing AEDs. https://jpp.mums.ac.ir/article_27853.html Background: Tuberculosis (TB) in children remains a major public health problem, particularly among vulnerable age groups such as children under five years old. Poor nutritional status is considered one of the important host factors that may increase susceptibility to TB infection. This study aimed to determine the relationship between nutritional status and the incidence of tuberculosis among children aged 1–5 years in Jember Regency, Indonesia.Materials and Methods: This analytical observational study employed a retrospective case-control design, adhering to STROBE guidelines. Data were obtained from 16 Primary Health Centers (Puskesmas) in Jember Regency in 2025. The sample (n=214) included 107 children aged 1–5 years diagnosed with TB and 107 age-and sex-matched controls. Anthropometric status was assessed using WHO Z-score standards for weight-for-height (WHZ), weight-for-age (WAZ), and height-for-age (HAZ). Potential confounders, including feeding history (breastfeeding vs. formula), pre-existing anemia (Hb <11 g/dL), and secondary comorbidities, were analyzed. Data were analyzed using Chi-Square and binary logistic regression to adjust for expression bias and isolate the effect of nutritional status.Results: The results showed a significant relationship between nutritional status and tuberculosis incidence among children. Based on the BB/TB indicator, children with poor nutritional status had a 2.68 times higher risk of developing tuberculosis compared to children with normal nutritional status (χ² = 9.054; p = 0.003; OR = 2.684; 95% CI: 1.934–5.169). Significant associations were also found for BB/U (p = 0.001) and TB/U (p = 0.002).Conclusion: Nutritional status is significantly associated with the incidence of tuberculosis in children aged 1–5 years. Improving nutritional status should be integrated into tuberculosis prevention and control programs to reduce TB risk among young children. https://jpp.mums.ac.ir/article_27875.html Background: Urinary Tract Infection (UTI) is the most common serious bacterial infection in infancy and childhood. Identifying factors associated with its recurrence is crucial. This study aimed to determine the prevalence and correlation of abnormalities reported in urinary ultrasonography and other imaging studies in children hospitalized with UTI.Materials and Methods: This cross-sectional study was conducted on 116 children under 16 years of age diagnosed with UTI and admitted to Heshmatieh Hospital in Sabzevar in 2019. UTI was defined as the growth of ≥10⁵ colony-forming units (CFU)/mL of a single uropathogen on urine culture, accompanied by pyuria (≥5 white blood cells per high-power field) or clinical symptoms. Recurrent UTI was defined as ≥2 episodes of febrile UTI or ≥3 episodes of non-febrile UTI within 12 months. After obtaining informed consent, demographic data, clinical presentation, urinalysis, urine culture results, and findings from renal and urinary tract imaging (Ultrasound, VCUG, and DMSA scan) were recorded. Median and interquartile range (IQR) were reported for skewed continuous variables. Proportions are presented with 95% confidence intervals (CI). Data were analyzed using SPSS version 20, with Chi-square and Fisher's exact tests employed for comparisons. Odds ratios (OR) with 95% CI were calculated for significant associations.Results: The mean age was 40.45 ± 48.38 months (median: 18.0 months, IQR: 6.0–60.0), with 75% (95% CI: 66.2–82.4%) being female. The most common presenting symptom was fever (56%, 95% CI: 46.9–64.8%). E. coli (46.6% of all patients, 95% CI: 37.5–55.9%; representing 87.1% of positive cultures) was the most frequently isolated pathogen. Radiological investigations revealed urinary stones in 7.8% (95% CI: 3.8–14.0%), hydronephrosis in 16.4% (95% CI: 10.4–23.9%), and vesicoureteral reflux (VUR) in 57.1% of those imaged (95% CI: 28.9–82.3%) (with 37.5% Grade III and 62.5% Grade IV). Other structural anomalies were found in 23.3% (95% CI: 16.1–31.9%). A significant correlation was observed between the presence of hydronephrosis (OR = 5.63, 95% CI: 1.97–16.05, p=0.001), VUR (OR undefined due to zero events in non-recurrent group, p=0.024), and other structural abnormalities (OR = 5.43, 95% CI: 2.17–13.58, p<0.001) with a history of recurrent UTI.Conclusion: A significant proportion of children with UTIs, particularly those with recurrent infections, have underlying structural and functional urinary tract abnormalities. Comprehensive renal and urinary tract imaging in these high-risk children is essential for timely identification and management to prevent recurrent infections and potential long-term complications. https://jpp.mums.ac.ir/article_27822.html Maple Syrup Urine Disease (MSUD) is an autosomal recessive inborn error of branched-chain amino acid metabolism caused by a deficiency of the branched-chain α-keto acid dehydrogenase (BCKDH) complex. Although globally rare, MSUD prevalence is significantly elevated in populations with high consanguinity rates, including Iran. This narrative mini-review synthesizes current knowledge of the Iranian MSUD landscape, incorporating recent epidemiological data from expanded newborn screening programs, the unique mutational spectrum characterized by frequent novel mutations in the BCKDHA, BCKDHB, and DBT genes, and the newly published 2025 Comprehensive Iranian Guidelines for diagnosis and management. We further discuss conventional management strategies, the role of liver transplantation, and emerging therapeutic frontiers, including BCKDHA-BCKDHB digenic gene therapy and mRNA-based approaches. Recent preclinical studies demonstrate that gene therapy can restore metabolic homeostasis in animal models, offering hope for curative interventions. However, long-term risks-including immunogenicity, genotoxicity, and durability-remain to be addressed. This review provides a roadmap for clinicians and researchers managing MSUD in consanguineous populations and highlights priorities for future research in Iran. https://jpp.mums.ac.ir/article_27935.html Background: Aggressive behaviors including self-directed aggression and aggression toward others affect approximately of children with autism spectrum disorder, severely disrupting family adaptation. Maternal empowerment, defined as enhancing mothers' knowledge, competence, and control, is crucial for managing these behavioral challenges. This study aimed to examine the effect of an intervention based on the Family-Centered Empowerment Model on reducing aggressive behaviors in autistic children aged 6 to 12 years. Methods: This randomized clinical trial was conducted from October 2, 2021, to December 16, 2021. A total of 60 mothers of children with ASD were recruited during this period. In Part I, 30 mothers received eight structured educational sessions based on the FCEM, while 30 mothers received standard care. In Part II, the groups were reversed. Aggressive behaviors and empowerment were measured at baseline, post-intervention, and follow-up. Results: Statistical analysis revealed that the groups were homogenous at baseline across all demographic and clinical variables. Post-intervention, the Family-Centered Empowerment Model significantly reduced all domains of child aggression compared to the control group (P< 0.01). Specifically, within the intervention group, scores for aggression towards oneself significantly decreased from 40.13±10.18 at baseline to 33.10±10.89 post-intervention (P< 0.001). Similarly, significant reductions were observed for aggression towards others )from 40.83 ±10.42 to 30.00±10.45, P< 0.01) and aggression towards the environment (from43.20 ±10.26 to 29.17 ±10.42, P< 0.01). Conversely, the control group showed no statistically significant changes in any of the aggression domains (P> 0.05).Conclusion: These findings highlight the clinical value of integrating family-centered educational programs into routine autism care to empower parents and effectively mitigate behavioral challenges in children with ASD. https://jpp.mums.ac.ir/article_28045.html Background: Pediatric syndactyly is a common congenital hand anomaly that may impair both function and appearance. Various surgical techniques have been proposed; however, the optimal reconstructive approach remains controversial. This systematic review evaluated recent clinical evidence regarding surgical outcomes, complications, and contemporary reconstructive strategies in pediatric syndactyly. Methods: A systematic search of PubMed/MEDLINE, Scopus, Web of Science, Embase, and Cochrane Library was performed for clinical studies published between January 2010 to March 2026. Studies assessing functional, aesthetic, or postoperative outcomes following pediatric syndactyly surgery were included. Data extraction and quality assessment were conducted independently by two reviewers. Results: Ten eligible clinical studies were included. Conventional skin grafting remained the most commonly reported technique, although flap-based and graftless approaches have increasingly been utilized in recent years. Flap reconstruction and dermal substitute–assisted procedures were generally associated with lower rates of web creep, hypertrophic scarring, and donor-site morbidity compared with traditional grafting methods. Nevertheless, postoperative complications, particularly scar contracture and recurrent web creep, remained frequent in complex and syndromic cases. Considerable heterogeneity in surgical techniques and outcome assessment limited direct comparison among studies. Conclusions: Current evidence suggests that flap-based and graft-sparing techniques may provide improved functional and aesthetic outcomes with fewer complications compared with conventional grafting approaches. However, high-quality prospective multicenter studies with standardized outcome measures are still required to establish evidence-based surgical guidelines for pediatric syndactyly reconstruction https://jpp.mums.ac.ir/article_28054.html Abstract: A 4.5-year-old boy was admitted to the hospital with a history of three weeks of fever, cough, and weight loss. He was initially started on empiric treatment for community-acquired pneumonia. Suspicion of tuberculosis led to the addition of anti-tuberculosis therapy. However, his condition further deteriorated, warranting the persistence of investigations. Chronic granulomatous disease (CGD) and pulmonary aspergillosis were confirmed in the patient by various laboratory tests. He responded quite well to a combination antifungal therapy including liposomal amphotericin B and voriconazole. This case emphasizes that CGD should be considered in patients with recurrent infections caused by opportunistic pathogens. https://jpp.mums.ac.ir/article_28065.html Background: Stunting is a form of malnutrition that remains a health problem globally. Household food insecurity is associated with poor dietary diversity. This condition is correlated with children experiencing inadequate nutrition and is linked to higher stunting rates. This study aimed to analyze the association between household food insecurity and the stunting incidence among infants aged 6-23 months in Jember Regency. Materials and Methods: A cross-sectional study was conducted among 211 families who had infants aged 6-23 months using a total sampling method. The level of food insecurity was assessed using the Household Food Insecurity Access Scale (HFIAS), while the infants’ anthropometry was measured using a digital baby scale and length board. Results: Among 211 households, 92.4% of families were household food insecure, with 55.5% experiencing moderate food insecurity. The stunting incidence was classified into two mutually exclusive categories, where 63% of infants were considered moderately stunted and 34% were considered severely stunted. The Chi-Square test indicated that household food insecurity was significantly associated with the stunting incidence (χ2 = 9.853; p-value = 0.020). Compared to food-secure households, infants from severely food-insecure households had higher odds of being stunted (OR = 1.782; 95% CI = 0.575-5.525). However, because the confidence interval includes 1, the specific risk estimate for this subgroup lacks strict statistical precision despite the overall significant association. Conclusion: Household food insecurity is associated with stunting among infants aged 6-23 months. Therefore, this study recommends that families utilize local resources to reduce dependency on expensive food while meeting infants’ nutritional needs.