Turkish archives of pediatrics最新文献

Objective: Although a limited number of studies have assessed the impact of the Coronavirus disease 2019 (COVID-19) pandemic on adults with eosinophilic esophagitis (EoE), there are no data on children. This study aimed to assess the impact of the COVID-19 pandemic on children with EoE, including long-term follow-up, treatment adherence, COVID-19 infection, and vaccination status. Materials and Methods: Treatment adherence, symptoms, and endoscopic-pathological findings were compared at the beginning and the end of the first and second years of the pandemic. The COVID-19 infection and vaccination status were also assessed. Results: The study included 66 children (median age 13.2 years) with EoE. Both treatment adherence and endoscopic follow-up decreased significantly during the pandemic compared to the beginning (P < .001 and P < .001, respectively). No strictures were observed. Twentytwo patients underwent endoscopy both before and during the pandemic, showing increased total eosinophilic esophagitis endoscopic reference score (EREFS) and peak eosinophil counts (P = .045 and P = .08, respectively). Among children aged 12 and older, 66% were vaccinated against COVID-19. Infection with COVID-19 was detected in 24 children (36.3%), with asymptomatic or mild symptoms in 95.8% of cases. Conclusion: No strictures developed during the first 2 years of the pandemic in children with EoE. However, increased tissue eosinophilia and EREFS scores suggest a possible risk of fibrostenosis if treatment adherence remains low. Eosinophilic esophagitis does not seem to pose an increased risk for COVID-19 infection in children.

Resilience is a dynamic adaptation process defined as an individual's ability to overcome and recover from stress or unhappiness. A person's resilience is determined by the balance between risk factors and protective factors. Risk factors increase the likelihood of negative outcomes, whereas protective factors modify responses to the negative event, thereby avoiding potential negative outcomes. Studies on the neurobiology of resilience are heterogeneous and have associations in the structure, activity, and connectivity of prefrontal and subcortical areas. Chronic diseases, which have increased in frequency in children and adolescents over the years, are an important risk factor for resilience. Resilience in chronic diseases is closely related to both the course of physical illness and mental outcomes. In chronic diseases, family resilience is of great importance in addition to individual-level characteristics such as self-efficacy, selfconfidence, and coping strategies. The whole family in the child's life, which cannot exist alone, is affected by the disease and the process and affects each other. Family resilience mainly includes shared family belief systems, forms of family organization, and family members' open communication and problem-solving skills. Through the resilience they develop, families cope with the stress of chronic illness, thereby improving their children's ability to cope with stress. As a dynamic concept, resilience can change and be developed over time. Increasing resilience through community, family, and individual interventions at different levels can have a positive impact on medical and psychosocial outcomes.

Objective: This study aims to evaluate the long-term neurological outcomes of neonates diagnosed with mild hypoxic-ischemic encephalopathy (HIE) and compare them with moderate/ severe cases, hypothesizing that a significant proportion of mild HIE cases may experience adverse neurodevelopmental sequelae. Materials and Methods: This was a cross-sectional observational study evaluating the neurodevelopmental outcomes of neonates with mild versus moderate/severe HIE. Maternal, perinatal, and neonatal characteristics along with treatments were documented. Neurological outcomes were assessed via brain MRI, the Ankara Developmental Screening Inventory (ADSI), and developmental milestones. Results: The study included 42 infants, 20 (47.6%) were classified as having mild HIE and 22 (52.4%) as moderate/severe HIE. Baseline characteristics were similar except that moderate/ severe cases had lower 1-minute Apgar scores (median 4 vs. 6; P = .02) and more frequent need for advanced resuscitation (68% vs. 25%; P = .006). All moderate/severe infants received TH vs. none in the mild group. Invasive mechanical ventilation and adjuvant neuroprotective agents were also more frequently used in the moderate/severe group. Magnetic resonance imaging abnormalities consistent with HIE were present in 2/12 mild cases (16.7%) vs. 8/19 (42.1) in moderate/severe cases. There were no significant differences in HIE injury pattern between the 2 groups (P = .197). On ADSI screening, 8/12 (66.7%) mild HIE survivors showed gross motor delay compared with 5/7 (71.4%) moderate/severe survivors. Conclusion: Even infants with mild HIE are at risk of adverse neurological outcomes. The development of more sensitive diagnostic tools could improve treatment strategies and early interventions, ultimately impacting prognosis. With proper recognition, tailored follow-up, and appropriate therapeutic approaches, potential neurodevelopmental impairments in mild HIE cases could be mitigated.

Objective: Rickets is a metabolic bone disease characterized by inadequate mineralization of growing bone due to a deficiency of calcium, phosphorus, and vitamin D or defects in their metabolism. This study aimed to evaluate the clinical, laboratory, and molecular characteristics and long-term follow-up of the patients diagnosed with genetic rickets. Materials and Methods: This study is designed as a retrospective case series with genetic rickets. The clinical, laboratory, and molecular characteristics of 16 patients, monitored at the Department of Pediatric Endocrinology in Dr. Behçet Uz Children's Hospital between 2010 and 2024, were analyzed retrospectively. A questionnaire was used to evaluate all clinical, biochemical data related to the diagnosis, treatment, and long-term follow-up. The characteristics of the patients who reached their final height were analyzed. Results: Sixteen patients were included in the study. Six patients had vitamin D-dependent rickets type 1, 2 had vitamin D-dependent rickets type 2, and 8 had hypophosphatemic rickets (HPR). The most common presentation was leg deformities, followed by delayed walking, growth retardation, and alopecia. The mean age at presentation was 3.5 ± 3.1 years. Physical examination findings included short stature, joint widening, genu varum, and genu valgum. The diagnosis of 14 of the cases was confirmed by demonstration of the variants. The mean followup period for the patients was 6.6 ± 4.75 years. The mean final height of the 4 patients, who reached their final height, was 142.07 ± 11.19 cm. Nephrocalcinosis was observed in 2 patients during follow-up. Conclusion: This study provides valuable insights into the clinical and laboratory characteristics, as well as long-term follow-up outcomes of children with genetic rickets.

Acute respiratory distress syndrome (ARDS) was first described in adults. However, the risk factors for the development of ARDS, etiological causes, and the pathophysiology of the disease, as well as morbidity and mortality, are not the same in children and adults. Since adult definitions were used for many years and the definition of pediatric ARDS was not clear within these definitions, this situation caused the prevalence of pediatric ARDS to be underestimated. For the reasons stated above, the pediatric ARDS (PARDS) definition, which is made considering only children and is used today, was made by "The Pediatric Acute Lung Injury Consensus Conference (PALICC) Group" in 2015, and new updates were published in the PALICC-2 guideline in 2023. The aim of this review is to summarize the diagnostic and treatment approaches of PARDS according to the PALICC-2 guideline recommendations.

Objective: Child mortality remains a global public health concern and a key indicator of societal development. Despite advances in healthcare, many children-especially in low- and middle-income countries-continue to die from preventable causes. Pediatric intensive care units (PICUs), which provide critical care and continuous monitoring, offer a unique opportunity to systematically analyze preventable child deaths and identify areas for intervention. This study aims to identify preventable causes of death in a tertiary PICU and highlight systemic and clinical factors contributing to these outcomes. It seeks to raise awareness and guide quality improvement efforts to reduce avoidable pediatric mortality. Materials and Methods: This descriptive study included patients admitted to the PICU of Mersin City Training and Research Hospital between April 2022 and August 2024. Included patients were previously healthy, aged 1 month to 18 years, and died due to preventable causes. Demographic, clinical, and cause-specific data were analyzed using SPSS. Results: Of 3038 PICU admissions, 207 children died, and 47 (23%) of these deaths were determined to be preventable. The leading cause was traffic accidents (n=15, 32%), followed by home accidents (n = 10,21%), vaccine-preventable diseases (n= 7, 15%), suicides (n = 5, 11%), and drownings (n=5, 11%). Conclusion: Nearly 1 in 4 deaths in the PICU were preventable. These results emphasize the importance of implementing targeted preventive strategies, such as public education, environmental safety improvements, and early health interventions, to reduce avoidable pediatric mortality.

Objective: This study aimed to evaluate the effectiveness of various trauma scoring systems in predicting mortality in pediatric patients with multiple trauma and to determine their cut-off values. Materials and Methods: A methodological study was conducted on pediatric patients under 18 years of age admitted to the pediatric intensive care unit for multiple trauma. Demographic data, clinical parameters, and trauma scores, including the Revised Trauma Score (RTS), Pediatric Trauma Score (PTS), Glasgow Coma Scale (GCS), Abbreviated Injury Scale (AIS), Injury Severity Score (ISS), Pediatric Risk of Mortality Score III (PRISM-3), and Pediatric Logistic Organ Dysfunction (PELOD-2), were collected and analyzed. Results: Among the 107 patients, there were 15 deaths (14%). Significant differences were observed between survivors and non-survivors in all trauma scores. Non-survivors had higher AIS, ISS, PRISM-3, and PELOD-2 scores, while survivors had higher PTS, RTS, and GCS scores (P < .001). In the multivariate binary logistic regression analysis, both ISS (odds ratio [OR] 1.060 [95% CI: 1.029-1.092], P < .001) and RTS (OR 0.059 [95% CI: 0.007-0.517], P =.011) were independently associated with mortality. Injury Severity Score demonstrated the highest area under the curve (AUC) value of 0.98 in the receiver operating characteristic (ROC) analysis. Conclusion: Both ISS and RTS were identified as independent predictors of mortality in pediatric trauma patients. Injury Severity Score was the strongest predictor, while RTS also provided significant prognostic value. Integration of these scores into early assessment may enhance risk stratification and support clinical decision-making in pediatric trauma care.