Etiology and therapeutic management of neonatal jaundice in Iran:a systematic review and meta-analysis

Background Jaundice is a life-threatening disorder in the neonates.In the present study,we aimed to assess systematically available evidence on causes and management of jaundice in Iranian newborn patients.Methods We searched the databases of PubMed,Web of Sciences,Scopus and Google Scholar for English articles published since inception until May 2019.A search was also done for Persian articles in Magiran and Scientific Information Database.Studies were evaluated based on predefined criteria by two reviewers.Data analysis was performed by STATA software.Results A total of 33 articles were finally included.The overall pooled prevalence of causes of jaundice among Iranian neonates was as follows:ABO blood groups incompatibility,16.9%[95%confidence interval(CI)10.9-22.8];Rh blood group incompatibility,4%(95%CI 2.5-5.5);ABO and Rh blood groups incompatibility,3.6%(95%CI 0-7.7);glucose6-phosphate dehydrogenase(G6PD)deficiency,6.3%(95%CI 5.1-7.5);infection,6.6%(95%CI 5.2-8.1);hypothyroidism,4.2%(95%CI 0.1-8.3);infant of diabetic mother:2.3%(95%CI 0.1-4.5);unknown,50.7%(95%CI 33.4-68);cephalohematoma,0.6%(95%CI 0.3-0.9).Regarding treatment of icterus,seven and eight articles were found on phototherapy and exchange transfusion,respectively.In five studies,all patients underwent phototherapy,but rate of exchange transfusion use was between 6.6%and 50.9%.Conclusions According to the results,unknown factors were the most common causes of icterus in Iranian neonates,followed by ABO blood groups incompatibility,infections and G6PD deficiency.By the way,phototherapy and exchange transfusion were found as therapeutic choices of neonatal jaundice.

Gastrointestinal viral shedding in children with SARS‑CoV‑2:a systematic review and meta‑analysis

Background Coronavirus disease 2019(COVID-19)has diferent manifestations in pediatric cases.It is assumed that they might present more gastrointestinal symptoms with a diferent viral shedding pattern in gastrointestinal samples.In this systematic review and meta-analysis,we aimed to evaluate the viral shedding pattern in gastrointestinal specimens of children with COVID-19.Methods We searched all published studies in English language in PubMed,Web of Science,and Scopus,up to date as of October 2021.Our search included the term"severe acute respiratory syndrome coronavirus 2,COVID-19,SARS-CoV-2,novel coronavirus,or coronavirus;and shed,excrete,secret,or carriage;and stool or rectal;and children or pediatrics".We included studies evaluating SARS-CoV-2 shedding in gastrointestinal specimens,including rectal swabs and stool samples of children with COVID-19 infection.We excluded duplicated data,case reports,and studies without original data.Results Twelve studies met the eligibility criteria for the qualitative synthesis,10 of which were included in the meta-analysis.The pooled prevalence of gastrointestinal severe acute respiratory syndrome coronavirus 2(SARS-CoV-2)RNA in children with COVID-19 was 86%(95%confdence interval 73%–96%,I 2=62.28%).After respiratory specimen had become negative,72%(43/60)had persistent shedding in gastrointestinal specimens.The gastrointestinal RNA had a positive test result for more than 70 days after symptoms onset.Conclusions Gastrointestinal shedding of SARS-CoV-2 might occur in a substantial portion of children and might persist long after negative respiratory testing.Further research is recommended to fnd the role of SARS-CoV-2 gastrointestinal shedding in transmission in children.