Interaction of functional gastrointestinal disorders with postpartum conditions related to mother and baby.

BACKGROUND: Functional gastrointestinal disorders (FGID) may affect or may be affected by postpartum depression (PPD), mode of feeding and postpartum life quality. We aimed to evaluate the interaction between FGID and these parameters in infants. METHODS: The study group consisted of babies attending our outpatient clinics. There were three age groups: 4-6 weeks, 3-4 months and 6-7 months. Demographic data of the babies and mothers, and data of feeding were collected. For the diagnosis of FGID, Rome III criteria were used. Mothers were screened with the Edinburgh Depression Scale. Quality of life (QoL) scores were obtained by using the `Maternal Postpartum Quality of Life Questionnaire`. Factors affecting the presence of FGID, PPD and quality of life were analyzed. RESULTS: Two hundred thirteen infants were enrolled during the study period. FGID was present with similar rates in both genders and was lower (31.5%) in the 6-7 month-old group (p=0.001). Infantile colic was higher in girls (68.6% vs. 31.4%, p=0.016). In 4-6 week-old infants with infantile dyschesia, the delivery route was mostly cesarean (83.3% vs. 16.7%, p=0.006). Similarly, regurgitation was more frequent in 6-7 month-old infants born by cesarean (88.9% vs. 11.1%, p=0.035), and was more frequent in infants being exclusively breastfed (60.9%, p=0.037). QoL scores were lower in mothers with depression (20.9±3.4 vs. 23.9±3.6, p=0.003). Infantile colic was higher in mothers with depression, but not significantly (29.3% vs. 11.4%, p=0.057). CONCLUSIONS: Caesarian section delivery and breastfeeding were influential on infantile dyschesia and regurgitation subgroups. No other studied factor seemed to affect FGID.

Validity and reliability analysis of the Turkish version of pediatric nutritional risk score scale.

BACKGROUND/AIMS: We aimed to perform the validity and reliability analysis of the Turkish version of the Pediatric Nutritional Risk Score (PNRS). MATERIALS AND METHODS: The study group consisted of 149 patients aged between 1 month and 18 years who were admitted to the hospital for at least 48 h. The patients' age, gender, anthropometric measurements, length of stay, admission diagnosis, daily body weights, food consumption, and pain status were recorded. Backward and forward translations into Turkish were done. PNRS was performed by two different physicians. The consistency of the PNRS results was evaluated to determine the validity of PNRS. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated. RESULTS: Of all patients, 69 (46.3%) were female and 80 (53.7%) were male. The mean length of the stay was 7.3±4.0 days. The mean age of the patients was 51.9±63.6 months. The Kappa coefficient between the two physicians was 0.66. Weight loss was observed in 65.2% of the patients in the high-risk group and 25.4% in the low-risk group. The hospital malnutrition rate was 31.5%. A higher risk was identified in those with <50% food intake and more severe disease. The specificity, sensitivity, NPV, and PPV of PNRS were 82.1%, 77.8%, 92.0%, and 58.3%, respectively. CONCLUSION: A good consistency suggests that the Turkish validation was achieved successfully. The power of PNRS to discriminate the patients with moderate-low risk of developing malnutrition is higher than the patients with high risk. PNRS is considered a valid and reliable tool to establish the risk of malnutrition in the hospitalized patients.

Pediatricians' Attitude in Management of Acute Bronchiolitis: Did Guidelines Overcome Practices?

Background: Acute bronchiolitis is one of the most common diseases of early childhood. There are many recent changes in the treatment of acute bronchiolitis. The aim of this study is to evaluate treatment approaches to acute bronchiolitis among clinicians and to observe compliance with clinical guidelines. Materials and Methods: Our study was designed as a multicenter cross-sectional descriptive study. A cohort of pediatric residents, fellows, and attendants were surveyed with a questionnaire including general and occupational characteristics of pediatricians and treatment choices in acute bronchiolitis. Results: A total of 713 questionnaires were collected. Most commonly applied treatment among pediatricians was inhaled salbutamol, followed by intravenous hydration, hypertonic saline, and inhaled steroid. Most commonly preferred treatment in the management of mild bronchiolitis was oral hydration and inhaled salbutamol in severe bronchiolitis. Conclusion: Although recent guidelines for the treatment of acute bronchiolitis does not support the use of many different therapies, pediatricians still tend to use them, especially bronchodilators, corticosteroids, and antibiotics.

Does raising awareness in families reduce environmental tobacco smoke exposure in wheezy children?

INTRODUCTION: Environmental tobacco smoke (ETS) is thought to increase the severity and number of attacks in wheezy children. Objective assessments are needed to change the behavior of families to reduce the exposure of wheezy children to ETS. AIM: To determine whether informing families about their children's urinary cotinine levels curtailed the exposure of children to ETS. MATERIAL AND METHODS: A survey was used to determine the ETS exposure level, and the urinary cotinine level of each patient was tested. Children with positive urinary cotinine levels were included in the second part of the study. The families were randomly divided into two groups: an intervention group that was advised about urinary cotinine levels by telephone and a non-intervention group that was not so advised. The groups were followed-up 2 months later, and urinary cotinine levels were measured once again. RESULTS: The intervention group contained 65 children of average age of 24.4 ±8.9 months, of whom 46 (70.8%) were male. The non-intervention group contained 69 children of average age of 25.3 ±9.8 months (p > 0.05), of whom 52 (75.4%) were male. The urinary cotinine levels at the time of the second interview were lower in both groups. The number of cigarettes that fathers smoked at home decreased in the intervention group (p = 0.037). CONCLUSIONS: Presenting objective evidence on ETS exposure to families draws attention to their smoking habits. Measurement of cotinine levels is cheap, practical, and noninvasive. Combined with education, creating awareness by measuring cotinine levels may be beneficial.

Effect of socioeconomic status on allergic diseases and atopy in school children.

Sipahi S, Nacaroglu HT, Can D, Günay I, Ünsal-Karkiner CS, Kamali H, Özdemir A, Günay T. Effect of socioeconomic status on allergic diseases and atopy in school children. Turk J Pediatr 2017; 59: 670-677. Higher family socioeconomic status (SES) has been suggested as a risk factor for allergic diseases. We investigated the effect of SES on the prevalence of allergic diseases and atopy. The study included 13-14-year-old primary school students in Kemalpasa, Turkey. The International Study of Asthma and Allergies in Childhood phase 1 questionnaire was administered to all students to identify allergic diseases. Those identified as having allergic diseases underwent a skin prick test (SPT). Group I included students with allergic diseases and a positive SPT. Group II comprised students with allergic disease who were SPT negative. The control group was randomly selected from the students with no allergic diseases. Three weighted SES scores were calculated for each student (equally weighted, education-weighted, and social class-weighted). SES was classified as lower, middle, or upper according to the weighted SES scores. Allergic diseases were detected in 657 of the 1,373 children who participated in the study. A higher percentage of children with allergic diseases and atopy were in the lower SES group in all weighted SES analyses compared with controls (Group I: 59%, 83.1%, 67.5%; Group II: 62.9%, 80%, 63.5%; control group: 12.4%, 12.9%, 21.2%). Significantly more children with allergic and atopic diseases (Groups I and II) were in the lower SES group compared with the control group (p < 0.001). In contrast to the hygiene hypothesis, we found the incidence of atopic disease was higher in families with lower SES.

Risk of systemic allergic reactions to allergen immunotherapy in a pediatric allergy clinic in Turkey.

OBJECTIVES: Even though allergen immunotherapy is an effective treatment method that has been used on rhinitis, asthma and venom anaphylaxis for over 100 years, systemic reactions (SRs) limit the use of this treatment method. We classified SRs associated with subcutaneous immunotherapy (SCIT) according to the World Allergy Organization Subcutaneous Immunotherapy Systemic Reaction Grading System. Risk factors for the SRs were assessed. METHODS: In this study 67,758 injections to 1350 children with allergic rhinitis and/or asthma were analyzed throughout January 1999-December 2014. RESULTS: A total of 51 systemic reactions were observed in 39 patients (0.075% per injection, %3 per patient). Mean age of SRs observed patients was 13±2.6 years (range 9.5-16 years) and 64.1% were male, 35.9% were female. 51.3% of SRs were grade 1, 38.5% grade 2, 7.7% grade 3 and 2.6% grade 4. SRs were early onset in 41% of the patients and delayed onset in 59%. 76.9% of SRs were seen during maintenance therapy and 56.4% during peak pollen season. In 28.2% of cases previous local reactions and in 30.8% previous grade 1 reactions were determined. There was no fatal outcome from any of the SRs. CONCLUSION: SCIT related SRs are generally of mild severity. Although only 10% of the SRs were grade 3 or 4, there is a still a small risk of severe reactions. 76.9% of SRs were observed during maintenance therapy. Delayed-onset SRs rate in our study is 59%. So both clinicians and parents should be alert about the delayed reactions after SCIT.

Is There Any Parameter Helpful for Predicting a Suitable Candidate for Mite Immunotherapy?

Few biomarkers that can predict the clinical response to allergen immunotherapy (AIT) have been identified. The aim of the present study was to investigate parameters that could be used "in predicting the clinical response to AIT" in children with asthma caused by house dust mites. We evaluated 107 children with mild persistent asthma who were sensitised only to mite aeroallergens. The study group included 47 patients who underwent a 4-to-5-year course of subcutaneous immunotherapy with standardised mite allergenic extract. Sixty patients who had not undergone AIT but were allergic to house mites were included in the control group. The clinical features and laboratory parameters of patients who did and did not sustain remission were compared. Remission was achieved in 74.5% of the 47 patients in the study group and in 20% of those in the control group. In the study group, one parameter predictive of a clinical response to AIT was identified by multivariate logistic analysis. This parameter was the serum total IgE level (tIgE) at the time of diagnosis (OR 131.64 and CI 0.858-20193; p = 0.032). Serum tIgE levels ≤ 339 kU/L at diagnosis were associated with an effective clinical response to AIT, with a sensitivity of 64.5% and specificity of 88.9%. We conclude that measurement of the serum tIgE level can be used as a predictive test prior to AIT in patients sensitized to mite aeroallergens.

Local and systemic reactions to subcutaneous allergen immunotherapy: Ten years' experience in a pediatric clinic.

BACKGROUND: Local and especially systemic reactions are important problems in subcutaneous immunotherapy (SCIT). Local and systemic reactions develop in 0.7% to 4% and 0.2% of all injections, respectively. OBJECTIVE: To evaluate the frequency of and risk factors for reactions developing in pediatric patients undergoing SCIT. METHODS: Local and systemic reactions developing after 14,308 injections between 2003 and 2013 were retrospectively evaluated in the current study using the Subcutaneous Immunotherapy Systemic Reaction Grading System, as recommended by the World Allergy Organization. The type of allergic disease, allergens producing a sensitivity, allergen immunotherapy content, adjuvant content, and the effects of treatment phase on the frequency of adverse effects were investigated. RESULTS: Of 319 patients, local reactions occurred in 11.9%, wide local reactions occurred in 5%, and systemic reactions occurred in 4.7%. A local reaction was observed in 0.38% of all injections, whereas a systemic reaction was observed in 0.1% of all injections. Local reactions were most frequent in the build-up phase, and systemic reactions were most frequent in the maintenance phase (P = .01). Side reactions were more common in patients undergoing SCIT with multiple allergens (P = .002) and house dust mite (P = .001). No statistically significant difference was found between adjuvant content and adverse effect frequency (P = .32). CONCLUSIONS: The frequencies of local and wide local reactions during SCIT were lower than expected. Although systemic reactions were frequently seen, no fatal reaction was observed in the current study. House dust mite SCIT and multiple allergen use increased the risk of reaction.

Side Effects of Leukotriene Receptor Antagonists in Asthmatic Children.

BACKGROUND: Leukotriene receptor antagonists (LTRAs) are drugs which have been widely used more than ten years. As the use of LTRAs increases, our knowledge with respect to their side effects increases as well. OBJECTIVES: The objective of our study was to evaluat the observed side effects of LTRAs used in patients with astma. PATIENTS AND METHODS: 1024 patients treated only with LTRAs owing to asthma or early wheezing were included in the study for a five-year period. The observed side effects of LTRAs in these patients were retrospectively investigated. The side effects were divided into two parts as psychiatric and non-psychiatric. RESULTS: Among the 1024 cases included in the study, 67.5% of the patients out of 41 with side effects were male, 32.5% were female and the average age was 6.5 years. The rate of patients with asthma was 63.41% and 36.58% of the patients had early wheezing. It was determined that sex, age and diagnosis (early wheezing or asthma) of the patients were ineffective in the emergence of side effects. The average period for the emergence of side effects was the first month. It was observed that hyperactivity was the most frequently observed psychiatric side effect and that abdominal pain was the non-psychiatric side effect. CONCLUSIONS: The side effects of LTRAs were common in children. Therefore, patients must be informed at the beginning of the treatment and they must be evaluated at certain intervals.

Eosinophilic cellulitis (Wells' syndrome) caused by a temporary henna tattoo.

Eosinophilic cellulitis (Wells' syndrome) is an uncommon condition of unknown etiology. Wells' syndrome is usually seen in adulthood but very rare in childhood. Although pathogenesis of the disease is not very clear, it is a hypersensitivity reaction developing against a variety of exogenous and endogenous antigenic stimuli. Paraphenylenediamine is a strong allergen frequently used as a temporary henna tattoo, which makes the color darker. Here, a 9-year-old male patient with Wells' syndrome is presented, which developed following a temporary henna tattoo and shown by the patch test sensitivity to paraphenylenediamine.

Risk factors for candidemia in pediatric intensive care unit patients.

OBJECTIVE: To determine the risk factors for developing candida infections in pediatric intensive care unit (PICU). METHODS: The present study was conducted as a case-control study and included the population of patients who were admitted to PICU during the period of March 2010-March 2011. RESULTS: During the study period, a total of 57 patients in PICU had candidemia, 4 cases were excluded due to their PICU stay less than 48 h and one due to the insufficient data. The most commonly isolated Candida species was C. albicans, followed by C. parapsilosis. The median duration of hospitalization in PICU was higher (22.0 d) in candidemia patients compared to control group (13.5 d) (p = 0.037). The patients with candidemia had higher rates of presence of mechanical ventilation, presence of central venous catheter, and being under total parenteral nutrition; compared to the control group. CONCLUSIONS: The longer PICU durations, mechanical ventilation, central venous catheter, total parenteral nutrition were the associated factors. Although trials for predicitive models or scoring systems for development of candidemia have been performed; more future studies were required for practical usage in clinics settings in order to prevent candidemia.

Prevalence of asthma among children in an industrial town.

Studies of the prevalence of asthma should be supported by objective markers. We aimed to measure the prevalence of childhood asthma in a particular area and age group using a questionnaire, and to compare the results with the rates of asthma diagnosed by objective measures. All students aged 13-14 (n=1511) in Kemalpasa, Izmir, were included in the study. Children whose responses on the ISAAC Phase-I Questionnaire revealed current wheezing were invited to the district health center. The prevalence of clinically proven asthma (current wheezing supported by objective markers) was investigated. The questionnaire was answered by 1373 (90.87%) students. Current wheezing was indicated in 428 children (31.0%), significantly more in girls than in boys (p<0.05). However, the prevalence of clinically proven asthma decreased by 42.5% when using objective markers. This study provided important epidemiologic information about the prevalence of asthma as indicated by questionnaires as opposed to that indicated by objective measures, especially in countries where the language lacks a word for "wheezing."

Clinical accuracy of tympanic thermometer and noncontact infrared skin thermometer in pediatric practice: an alternative for axillary digital thermometer.

INTRODUCTION: The aim of this study was to compare the body temperature measurements of infrared tympanic and forehead noncontact thermometers with the axillary digital thermometer. METHODS: Randomly selected 50 pediatric patients who were hospitalized in Dr Behcet Uz Children's Training and Research Hospital, Pediatric Infectious Disease Unit, between March 2012 and September 2012 were included in the study. Body temperature measurements were performed using an axillary thermometer (Microlife MT 3001), a tympanic thermometer (Microlife Ear Thermometer IR 100), and a noncontact thermometer (ThermoFlash LX-26). RESULTS: Fifty patients participated in this study. We performed 1639 temperature readings for every method. The average difference between the mean (SD) of both axillary and tympanic temperatures was -0.20°C (0.61°C) (95% confidence interval, -1.41°C to 1.00°C). The average difference between the mean (SD) of both axillary and forehead temperatures was -0.38 (0.55°C) (95% confidence interval, -1.47°C to 0.70°C). The Bland-Altman plot showed that most of the data points were tightly clustered around the zero line of the difference between the 2 temperature readings. With the use of the axillary method as the criterion standard, positive likelihood ratios were 17.9 and 16.5 and negative likelihood ratios were 0.2 and 0.4 for tympanic and forehead measurements, respectively. DISCUSSION: The results demonstrated that the infrared tympanic thermometer could be a good option in the measurement of fever in the pediatric population. The noncontact infrared thermometer is very useful for the screening of fever in the pediatric population, but it must be used with caution because it has a high value of bias.

Sphingomonas paucimobilis infections in children: 24 case reports.

Sphingomonas paucimobilis is a causative agent of infection in immunocompromised patients, and healthcare-associated infection. Although the infections associated with S.paucimobilis occurs rarely, it has been encountered with increasing frequency in clinical settings. In the current study we reported clinical features of the children with S.paucimobilis infection, and the antimicrobial susceptibilities of the isolated strains among the patients. This study was conducted in Dr. Behçet Uz Children's Hospital, Turkey, during the period of January 2005 and December 2012. The medical records of pediatric patients with positive cultures for S.paucimobilis were reviewed. Sphingomonas paucimobilis isolates were recovered from 24 pediatric patients. The median age was 4 years (ranging from 3 days infant to 15 years) and 58,3% were male. Eight (33,3%) of the patients were under 1 months of age. Among the patients; 13 (54,2%) infections were community related however 11(45.8%) infections were nosocomial infection. The median duration of hospital stay was 7 days (ranging from 4 to 22 days). The most effective antibiotics were fluoroquinolones, carbapenems, and trimethoprim/sulfamethoxazole. This is the first largest study in children to evaluate the clinical features of S. paucimobilis infections. Sphingomonas paucimobilis may cause infections in both previously healthy and immunocompromised children. Although variable antimicrobial regimens were achieved to the patients, there was no attributable fatality due to S.paucimobilis infections due to the low virulence of the bacteria.

Resuscitation skills of pediatric residents and effects of Neonatal Resuscitation Program training.

BACKGROUND: The Neonatal Resuscitation Program (NRP) is an effective tool in decreasing mortality and morbidity due to birth asphyxia. The aim of the study was to assess the skill and knowledge level of pediatric residents in a teaching hospital and the effects of NRP training. METHODS: Subjects consisted of pediatric residents of Dr Behcet Uz Hospital, Izmir, Turkey. They were assessed on practice exam scenarios and NRP provider course flow charts. Teams with two members were formed randomly. Each resident was evaluated on a 100 point scale covering all resuscitation steps and interventions. Exam scores were analyzed for two major parameters: resident participation in NRP training (never, within the last 6 months, and ≥6 months previously) and being a senior (>18 months residency). RESULTS: A total of 49 residents enrolled in the study (94.2% of the target group). Twenty-one residents had NRP training (42.9%). Junior residents comprised 46.9% of the study group. The mean skill score was 72.1, and it was significantly higher for senior residents and residents who attended the NRP course (P < 0.05). Although there was no difference between the members within a team, residents who had not attended the NRP course performed better when paired with a resident with NRP certification. CONCLUSIONS: NRP training significantly increases the resuscitation knowledge and skill of pediatric residents, although this can be achieved by being a senior. Residents should undergo training as soon as possible to achieve a higher level of quality in resuscitating babies.

Factors affecting Brucella spp. blood cultures positivity in children.

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms.

The epidemiology and economic impact of varicella-related hospitalizations in Turkey from 2008 to 2010: a nationwide survey during the pre-vaccine era (VARICOMP study).

Varicella can cause complications that are potentially serious and require hospitalization. Our current understanding of the causes and incidence of varicella-related hospitalization in Turkey is limited and sufficiently accurate epidemiological and economical information is lacking. The aim of this study was to estimate the annual incidence of varicella-related hospitalizations, describe the complications, and estimate the annual mortality and cost of varicella in children. VARICOMP is a multi-center study that was performed to provide epidemiological and economic data on hospitalization for varicella in children between 0 and 15 years of age from October 2008 to September 2010 in Turkey. According to medical records from 27 health care centers in 14 cities (representing 49.3% of the childhood population in Turkey), 824 children (73% previously healthy) were hospitalized for varicella over the 2-year period. Most cases occurred in the spring and early summer months. Most cases were in children under 5 years of age, and 29.5% were in children under 1 year of age. The estimated incidence of varicella-related hospitalization was 5.29-6.89 per 100,000 in all children between 0-15 years of age in Turkey, 21.7 to 28 per 100,000 children under 1 year of age, 9.8-13.8 per 100,000 children under 5 years of age, 3.96-6.52 per 100,000 children between 5 and 10 years of age and 0.42 to 0.71 per 100,000 children between 10 and 15 years of age. Among the 824 children, 212 (25.7%) were hospitalized because of primary varicella infection. The most common complications in children were secondary bacterial infection (23%), neurological (19.1%), and respiratory (17.5%) complications. Secondary bacterial infections (p < 0.001) and neurological complications (p < 0.001) were significantly more common in previously healthy children, whereas hematological complications (p < 0.001) were more commonly observed in children with underlying conditions. The median length of the hospital stay was 6 days, and it was longer in children with underlying conditions (<0.001). The median cost of hospitalization per patient was $338 and was significantly higher in children with underlying conditions (p < 0.001). The estimated direct annual cost (not including the loss of parental work time and school absence) of varicella-related hospitalization in children under the age of 15 years in Turkey was $856,190 to $1,407,006. According to our estimates, 882 to 1,450 children are hospitalized for varicella each year, reflecting a population-wide occurrence of 466-768 varicella cases per 100,000 children. In conclusion, this study confirms that varicella-related hospitalizations are not uncommon in children, and two thirds of these children are otherwise healthy. The annual cost of hospitalization for varicella reflects only a small part of the overall cost of this disease, as only a very few cases require hospital admission. The incidence of this disease was higher in children <1 year of age, and there are no prevention strategies for these children other than population-wide vaccination. Universal vaccination is therefore the only realistic option for the prevention of severe complications and deaths. The surveillance of varicella-associated complications is essential for monitoring of the impact of varicella immunization.