Iranian Journal of Child Neurology

Diabetes mellitus during pregnancy is a common complication of gestation, but its effects on the offspring’s development are poorly understood. Recently, some studies reported that gestational diabetes mellitus (GDM) impairs cerebellar development, and some genetic alterations have been described as consequences. Cerebellum, one of the hindbrain derived structures in the posterior cranial fossa, plays a crucial role in cognition and behavioral functions. In recent years, some surveys stated that gestational diabetes hasadverse effects on the fetus’s cerebellum. Disruption of cerebellar cortex morphogenesis, reduce the volume of the cerebellum, reduce the thickness of cerebellar cortex layers, and its neuronal cells and effects on the expression of synaptophysin, insulin, and insulin-like growth factor -1 receptors are some of the maternal diabetes effects on developing cerebellum. On other hand, GDM, as a neurotoxic agent, impaired cerebellar development and could be a cause for the behavioral, functional, and structural anomalies observed in pups of diabetic mothers. Based on the literature review, most studies have pointed out that administering insulin in patients with GDM decreased the cellular and molecular alterations that induced by GDM in the developing cerebellum. Undoubtedly, screening strategies for all pregnant women are necessary.

Objectives
Jaundice occurs in 60% of full-term and 80% of pre-term newborns. This study compared the effect of phototherapy with and without phenobarbital on icteric newborns.
Materials & Methods
This study is a randomized clinical trial conducted from July until March 2018 at Imam Reza Hospital, Mashhad University of Medical Science, Iran. Full-term and near-term neonates with more than 2000 grams who were hospitalized in the mentioned period for jaundice were entered into the study. The newborns were divided into two groups using block randomization. Data were analyzed by SPSS version 19.
Results
The average gestational age was 36.4 weeks (SD 2.39) in the intervention group and 36.9 weeks (SD 2.16) in the control group, with no significant difference between them. The mean hospital stay for the intervention group was 72 hours (SD 1.66), compared to 55 hours (SD 1.88) for the control group. At discharge, the serum bilirubin level in the intervention group was 11.53 mg/dL (SD 0.77), while it was 10.80 mg/dL (SD 1.09) in the control group, a statistically significant difference.
Conclusion
According to this study, phototherapy with phenobarbital is not more effective than phototherapy alone in neonatal hyperbilirubinemia.

Objectives
Therapeutic plasma exchange (TPE) is a plasmapheresis procedure whose Safety data for pediatric neuro-immunological disorders (PNID) is confined. The present research documents TPE’s safety and feasibility data in these conditions.
Materials & Methods
The current study involved six distinct groups of patients with PNID undergoing TPE: neuromyelitis optic spectrum disorder (NMOSD), autoimmune encephalitis (AIE), acute disseminated encephalomyelitis (ADEM), multiple sclerosis (MS), Guillain-Barre syndrome (GBS), and optic neuritis (ON). This study documented complications related to each TPE process. In addition, TPE’s efficacy was studied in these patients.
Results
The present study recorded adverse effects in 18 patients with PNID that received 121 TPE cycles: five cycles (4.13%) in MS, three(2.48%) in AIE subgroup, one (0.82%) in ADEM, and two (1.65%) in GBS. No severe complications were observed among the patients.
Conclusion
Patients with PNID tolerated therapeutic plasma exchange, which was a safe process.

Objectives:

Shigellosis is one of the common causes of bacterial diarrhea in children. Seizures are common in shigellosis. It is essential to identify the risk factors of seizure in this disease.
Materials & Methods
This study was conducted on 224 children with shigellosis. The patients were divided into: With (case groups = 63 cases) and without seizures (control group = 161 cases). Groups were compared regarding different variables such as age, gender, clinical symptoms, and laboratory findings. Data analysis was done using statistical tests and SPSS software. Logistic regression analysis was used to determine the risk factors of seizures.
Results
Out of 224 cases of children with shigellosis, 107 (47.8%) were male and 117 (52.2%) female. Significant differences were observed between the two groups in terms of age, history of febrile convulsions, frequency of bloody diarrhea, frequency of fever, duration of diarrhea before hospitalization, abdominal pain, increase in BUN, hyponatremia, hypocalcemia, and red blood cell count in stool (P<0.05). Logistic regression analysis showed that a history of febrile seizure, fever, and hyponatremia are the risk factors for seizures in shigellosis

Conclusion
This study concluded that a history of febrile seizure, fever, and hyponatremia are risk factors for seizure in childhood shigellosis, thus rapid diagnosis and treatment of childhood shigellosis with risk factors is very important

Objectives
This study aimed at culturally adapting, validating, and standardizing the Ages and Stages Questionnaire, third edition (ASQ-3) by implementing a nation-wide cross-sectional methodological study in order to provide a valid and reliable tool for determining the developmental status of Iranian children.
Materials & Methods
This cross-sectional and methodological study was conducted on Iranian children between 1-66 months. The ASQ-3 tool was translated; following that, its face and content validity, as well as the crosscultural adaptation were assessed by 51 specialists and experts in the field of pediatrics and child development. In order to determine the reliability of the ASQ-3 (using Cronbach’s alpha), and cut-off points. All statistical analyses were performed using STATA software.
Results
This study was enrolled in 2 phases. The face and content validity, as well as the cultural relevance of the Persian version of ASQ- 3 was confirmed using panel of specialists views then researchers investigated 11,740 children aged 1-66 months in order to evaluate the reliability of the tool. The Cronbach’s alpha coefficients (reliability) determined for the ASQ-3 and the cut-off points for the ASQ-3 of different age groups and domains were determined by calculating one and two SDs below the mean; the latter represents the main cutoff point, and the interval between the two represents the monitoring zone according to the ASQ-3 technical manual.

Conclusion
The results of this study showed that the Iranian version of ASQ-3 is valid and reliable; moreover, the cut-off points designated for it can be implemented in the Iranian children community to assess their developmental status.

Objectives
Attention Deficit Hyperactivity Disorder (ADHD) and obesity are major pediatric public health problems. The present study aimed to examine the association between these two health parties in our pediatric populations.
Materials & Methods
This study is a single group retrospective cohort study about Body Mass Index (BMI) changes in 149 children and adolescents between 3-18 years old with a diagnosis of ADHD based on one child and adolescent psychiatrist interview according to the Diagnostic and Statistical Manual of Mental Disorders 4th edition criteria (DSMIV-TR). All participants were treated with methylphenidate. Besides, they were reassessed by the Kiddie Schedule for Affective Disorders and Schizophrenia-Present and Lifetime Persian version (K-SADS-PL-P). Furthermore, the height, weight, and BMI of
participants were calculated. The data were analyzed by descriptive statistics, repeated measures, and Wilks’ lambda analysis using IBM SPSS Statistics version 23.
Results
The mean age of patients was 8.2±2.6 years, and 71.8% were boys. The obtained results showed that those treated with methylphenidate for more extended periods had higher BMI increases (p <0.001). The change in BMI was not related to the age at the start of treatment (p = 0.125), but this index was significantly different based on the years under treatment (p = 0.002). Moreover, changes in BMI were not significant based on gender (p = 0.850), the type of ADHD specifiers (p= 0.686), and concomitant drugs (p = 0.783).

Objective
This study investigated the efficacy of telerehabilitation (TR) in school-based Occupational Therapy (OT) for children with Specific Learning Disorder (SLD), focusing on occupational competence and parental satisfaction, aiming to contribute empirical insights to the discourse on the educational well-being of this population.
Materials & Methods
The study adopted a Randomized Controlled Trial (RCT) design involving 31 children diagnosed with SLD, implementing TR and inperson interventions alongside a control group. Outcome measures included the School Self-Concept Inventory, Child Occupational Self-Assessment (COSA), and Canadian Occupational Performance Measurement (COMP), analyzed using descriptive and inferential statistics (ANOVA, post hoc tests).
Results
Both TR and in-person interventions exhibited significant enhancements in academic self-efficacy (F=23.96, p<0.001, Partial ȵ²=0.461), occupational competence (F=70.59, p<0.001, Partial ȵ²=0.716), and parent satisfaction (F=17.03, p<0.001, Partial ȵ²=0.378) compared to the control group. Notably, no significant differences emerged between the TR and in-person groups, emphasizing their comparable effectiveness in improving outcomes.
Conclusion
In conclusion, the study demonstrated the efficacy of TR and inperson interventions in school-based OT for children with SLD. The cohesive outcomes in academic self-efficacy, occupational competence, and parental satisfaction highlight TR as a versatile modality. This research, grounded in robust methodology, encourages further exploration of TR’s transformative role in enhancing the holistic well-being of children with SLDs

Objectives
Migraine is a chronic and joint disease in children. The results of previous studies on the effectiveness of probiotics in preventing migraine attacks in children have been controversial. This study aims to investigate the effect of probiotics on migraine prophylaxis in children.
Materials & Methods
In this clinical trial study, 41 children aged 5 to 15 with migraine enrolled the study in two control and intervention groups. Children in the intervention group (18 children) received propranolol at a dose of 1 mg per kilogram of body weight daily in two divided doses along with a 250 mg Yomogi capsule daily for three months, and children in the control group (23 children), received propranolol along with placebo for three months. The study compared the frequency and duration of headache days, PedMIDAS criteria, and parental satisfaction between the two groups before treatment, as well as one month and three months post-treatment.
Results
The number of headache days in both groups decreased over time, but in the intervention group, this decrease was more than the control group was statistically significant (P=0.045). The average PedMIDAS scale after treatment in the intervention group was 3.9 ± 3.8; in the control group, it was 8.4 ± 8.2, which was statistically significant (P=0.047). Parents’ satisfaction with the treatment was statistically significantly higher in the intervention group (94.4%) than in the control group (54.5%) (P=0.011). No significant drug complications were seen in any of the two groups.

Conclusion
In children with migraine, adding probiotics to migraine treatment reduces the intensity and number of days of children’s headaches and increases the Parents’ satisfaction with the treatment

Objectives
Pain and its control is a significant health problem worldwide. The present study aimed to determine the effects of white noise (bird sound) on the severity of muscle vaccination pain in children under two years old.
Materials & Methods
This study was a case-control study conducted in 2021. The samples included seventy children under two years old referred to the health centers in Ramsar City, Iran. The samples were selected using the convenient sampling method and divided into experimental and control groups. The data were collected using the demographic characteristics questionnaire, facial expression, and pain assessment in pediatric patients (FLACC). They were then analyzed by SPSS16 using an independent t-test and analysis of covariance (P<0.05).
Results
A significant difference was observed between the severity of muscle vaccination pain in children in the two groups (p=0.042); the pain intensity mean in the experimental group (6.45±2.01) was lower than the control group (8.94±1.28).

Conclusion
This method can be a harmless and inexpensive intervention to reduce pain intensity and behavioral pain responses in infants during painful procedures, especially vaccination.

Objectives
Gangliosidosis is one of the hereditary metabolic diseases caused by the accumulation of Gangliosid in the central nervous system, leading to severe and progressive neurological deficits. Regarding phenotype, GM1 and GM2-Gangliosidosis are divided into Infantile, Juvenile, and Adult.
Materials & Methods
In this study, thirty-seven patients with GM1 and GM2-Gangliosidosis were referred to the neurology department of Mofid Children’s Hospital in Tehran, Iran, whose disease was confirmed from September 2019 bto December 2021. This study assessed age, sex, and developmental status before the onset of the disease, clinical manifestations, brain imaging, and electroencephalography.

Results
97.20% of patients were the result of family marriage. Approximately 80% of juvenile patients were developmentally normal before the onset of the disease. Developmental delay was more common among infantile GM1-Gangliosidosis than infantile GM2-Gangliosidosis, but in total, more than 50% of GM1&GM2-Gangliosidosis patients had reached their developmental milestone before the onset of the disease. With the onset of disease symptoms, 100% of patients regressed in terms of movement, 97.20% of them mentally, and 75% of them had seizures during the disease. The most common clinical findings were cherry-red spot, Mongolian spot, macrocephaly, organomegaly, hyperacusis, and scoliosis. The most common brain imaging findings included bilateral thalamus involvement, brain atrophy, PVL, and delayed myelination. The most common finding in electroencephalography was background low voltage with abnormal sharp waves.
Conclusion
This study concluded that most of the patients are the result of family marriage, and most of the juvenile patients are developmentally normal before the onset of the disease. In addition, more than 50% of infantile patients reach their developmental milestones before the onset of the disease. The most common clinical findings of these patients are seizures, cherry-red spot, macrocephaly, hyperacusis, Mongolian spot, and bilateral involvement of the thalamus.

Brown-Vialetto-Van Laere syndrome (BVVLS) is a rare neurodegenerative disorder of childhood. According to the previous reports, it has various primary signs and symptoms. Because of the simple treatment with riboflavin supplementation, it is important to have suspicious to this disease and begin treatment even before genetic test confirm. We report a five-year-old girl with BVVLS that manifest with hearing problems, first. There was obvious improvement in her disease clinical signs with riboflavin supplementation treatment.