Turkish archives of pediatrics最新文献

Objective: This study aimed to evaluate the impact of the revised 2022 American Academy of Pediatrics (AAP) guideline for hyperbilirubinemia on hospitalization rates and short-term outcomes. Materials and Methods: This retrospective observational study compared 2 periods, before (period 1: January 1-August 31, 2022) and after (period 2: September 1-December 31, 2022) implementation of the AAP 2022 guideline in a tertiary neonatal unit. Neonates born at ≥35 weeks' gestational age who met phototherapy criteria were included. In period 2, infants who would have been hospitalized under the previous 2004 guideline but not under the new one were followed to assess the need for hospitalization and the occurrence of neurotoxicity. Results: The rate of hospitalization due to hyperbilirubinemia decreased from 23% (n = 95/409) in period 1 to 14% (n = 25/173) in period 2 (P = .017). When the new guideline was retrospectively applied, it was found that 58% (n = 55) of previously hospitalized patients in period 1 would not have required admission under the new criteria. In period 2, 37 neonates met the previous criteria, but only 25 were hospitalized under the new guideline; 2 of the 25 required rehospitalization. The remaining 12 newborns were followed as outpatients without developing neurotoxicity. Overall, 51% (n = 67) of newborns who met previous criteria did not meet the new hospitalization thresholds. Conclusion: The implementation of the AAP 2022 guideline was associated with a reduced risk of hospitalization without an increased risk of bilirubin-related neurotoxicity. Structured followup and individualized risk assessment remain essential for safe outpatient management.

Objective: Cardiomyopathies (CMP) are an important cause of end-stage heart failure in childhood. The study aims to evaluate the clinical features, treatments, and outcomes of the patients diagnosed with CMP followed in the pediatric intensive care unit (PICU). Materials and Methods: This retrospective study was conducted using the data of the patients followed in the PICU between January 1, 2008, and December 31, 2019. Demographic information of the patients, CMP types, informations of echocardiography and angiography, findings upon admission to the PICU, medical treatments applied, respiratory and circulatory support, cardiac transplantation status, and results were examined. Results: A total of 76 patients hospitalized with the diagnosis of CMP were included in the study. Among them, 39 (51%) patients were female. The majority (68.4%) were diagnosed with dilated CMP. The remaining patients were diagnosed with noncompaction left ventricular (LV) dilated CMP (14.5%), restrictive CMP (10.5%), hypertrophic CMP (5.3%), and noncompaction LV restrictive CMP (1.3%). Diuretics, inotropes, and invasive mechanical ventilation were used in 90.8%, 93.4%, and 75% of patients, respectively. While 43.4% (n = 33) of the patients needed extracorporeal membrane oxygenation (ECMO) support during their PICU hospitalization, 15.8% (n = 12) received LV assist device (LVAD) and 2.6% (n = 2) biventricular assist device (BiVAD) support. Heart transplantation was performed in 10 patients (13.2%). Finally, 40 (52.6%) of the patients died. Conclusion: Pediatric patients with CMP with severe heart failure require inotropes, mechanical ventilation, ECMO, LVAD, BiVAD, and heart transplantation, which are crucial for lifesaving measures, along with intensive care follow-up.

Objective: The aim of this study is to identify discrepancies in pediatric echocardiography reports across centers and emphasize the significance of establishing a standardized reporting approach. Materials and Methods: In this study, pediatric echocardiography reports from various institutions (university hospitals [UHs], training and research hospitals [TRHs], and private healthcare facilities) (33 reports from 29 centers) were evaluated for adherence to key criteria outlined in consensus guidelines by the European Association of Cardiovascular Imaging of the European Society of Cardiology and the Association for European Paediatric and Congenital Cardiology. Each echocardiography report was systematically categorized into distinct sections, including patient information, medical records, echocardiographic findings, and conclusions. Results: Systemic and pulmonary venous return was reported in 58.3% of cases from UHs, 77.7% from TRHs, and 66.7% from private healthcare institutions (PHIs). Pulmonary artery and aortic arch were documented in 83.3% of reports from PHIs, 88.8% from TRHs, and 25% from UHs. Coronary artery dimensions and course were reported in 58.3% of reports from UHs, 77.7% from TRHs, and 16.7% from PHIs. Physician interpretations and diagnoses were present in all reports. However, information regarding environmental factors, such as whether the patient was awake or agitated during the examination, was reported in 66.6% of cases from TRHs but was entirely absent in reports from other institutions. Conclusion: This study demonstrates important variability in pediatric echocardiography reports. Adopting international guidelines may facilitate standardized reporting, ensure consideration of underassessed parameters, and promote a unified terminology across institutions.

Early childhood development forms the cornerstone for a healthy, fulfilling, and productive life. Research in health psychology and longevity highlights that social relationships are the most significant determinant of lifelong health and development. Among these, early attachment between children and caregivers, bolstered by positive experiences and nurturing environments, is pivotal for optimal growth, development, and well-being. This highlights the need for holistic approaches in healthcare, particularly during the critical first 1000 days of life. To address these needs, comprehensive evaluations must include assessments of childcaregiver interactions alongside biological, psychological, social, and environmental factors. Recognizing this, the American Academy of Pediatrics has embraced the Early Relational Health (ERH) framework, focusing on fostering healthy relationships during this crucial period. The framework encompasses all caregivers, including parents, extended family, and peers. The ERH framework emphasizes a broad assessment of factors affecting health-biological, psychological, interactional, economic, and environmental-within the child and caregivers' living contexts. The primary objective is not to teach parenting skills but to cultivate safe, stable, nurturing relationships supporting lifelong well-being. The ERH underscores the critical importance of assessing relational health as a "fifth vital sign," alongside traditional measures such as respiratory rate, heart rate, temperature, and blood pressure, in the first 1000 days. Integrating this framework into health systems can enhance the well-being of children and caregivers, ensuring a robust foundation for lifelong development.

Kohlschütter-Tönz syndrome (KTS) (OMIM#226750) is a rare autosomal recessive disorder characterized by epileptic encephalopathy, developmental delay, and amelogenesis imperfecta. Early diagnosis and management are crucial, but the complexity of symptoms, particularly dental and neurological impairments, poses significant challenges. The aim of this report is to describe the clinical findings of 2 siblings and their dental management, whose dental examination led to genetic referral and subsequent diagnosis of KTS. Dental examinations revealed enamel defects consistent with amelogenesis imperfecta, including yellow-brown discoloration, soft enamel, and diastemas in both siblings. The younger sibling, a 9-year-old boy, exhibited early-onset seizures, intellectual disability, spasticity, and a history of kidney stones. The older sibling, a 13-year-old boy, presented with more severe neurodevelopmental delay, early-onset seizures, and drug-resistant epilepsy. Genetic testing confirmed homozygous deletions in the ROGDI gene, leading to the diagnosis of KTS in both siblings. The younger sibling received successful restorative treatment under general anesthesia, while the older sibling's oral care was managed conservatively due to contraindications for general anesthesia. These cases underscore the importance of pediatric dentists in the early identification of rare genetic disorders such as KTS, especially when dental anomalies like amelogenesis imperfecta are present. Timely referral for genetic evaluation can facilitate accurate diagnosis and appropriate care planning. Moreover, sharing clinical experiences and treatment outcomes contributes to a better understanding of this rare syndrome and helps guide future diagnostic and therapeutic strategies.

Objective: The purpose of this research is to (1) determine the frequency of viral acute diarrheal disease in 2 months to 5 years of aged children admitted to the hospital; (2) describe the clinical and laboratory characteristics among children diagnosed with viral acute diarrheal disease; and (3) evaluate patterns of antibiotic utilization in treating pediatric acute diarrheal disease. Materials and Methods: A cross-sectional study involved 232 pediatric inpatients at the Department of Gastroenterology, Can Tho Children's Hospital from March 2023 to February 2024. This study utilized real-time polymerase chain reaction (PCR) to identify etiological pathogens responsible for infection. Results: Real-time PCR detected viruses in 140/232 (60.3%) of acute diarrhea cases, with 85/232 (36.6%) being only virus infections. Age, sex, and nutritional status showed no significant differences between the viral infection only and other case groups (P > .05). Vomiting predominated in viral infections only (P < .05), while mucoid-bloody stools and elevated C-reactive protein marked other cases (P < .05). Antibiotics were used in 52.9% of viral and 60.3% of total cases. The study found no differences in hospitalization time, fever length, or duration of diarrhea between the antibiotic use and non-antibiotic use groups (P > .05). Conclusion: Viruses were the predominant cause of acute diarrhea in children, yet antibiotics were frequently used without clinical benefit. Among children with confirmed viral infections, antibiotic use showed no advantage in reducing hospitalization duration, fever length, or diarrhea resolution. These findings support the need to limit unnecessary antibiotic use in pediatric diarrhea management.