Impact of Dysphoric Milk Ejection Reflex on Mental Health.

Objective: Postpartum mental health, significantly influences breastfeeding. Dysphoric milk ejection reflex (D-MER) is defined as negative emotional reaction to milk ejection, such as unpleasant feelings, anger-irritability or a strange feeling in the stomach. This study investigates the impacts of D-MER on mothers experiencing negative emotions during breastfeeding. Method: This cross-sectional, descriptive study was conducted between July 1 and September 30, 2023 among surveyed mothers with babies of ages 0-2 experiencing discomfort while breastfeeding. Mothers reached out through Instagram and Facebook and completed a semi-structured 45-question survey using a Google form. Results: Out of 141 mothers, 27.7% (n: 39) had D-MER findings. Common emotions included tension (48%), exhaustion (43%), intolerance (41%), hypersensitivity (35%), and restlessness (33%). Symptoms reported to begin within the first month of breastfeeding in 59% of D-MER cases. Nausea was reported in 30% of mothers. The most common conditions that increased the severity of D-MER symptoms were insomnia, stress and breast fullness. Sleeping or resting, being alone, doing something else, drinking cold water, listening to music and talking to mothers who had similar experiences helped the mothers relax. In cases with D-MER findings, about 17.9% considered stopping breastfeeding, with 7.7% stopping. The postpartum depression score was ≥13 in 59% of D-MER cases. Conclusion: D-MER, which can cause early cessation of breastfeeding, may also be associated with the mother's mental health problems. Raising awareness about D-MER and equipping health professionals on this subject are important in the continuity of breastfeeding.

Should Breastfeeding Be Interrupted after Radiological Imaging Examinations? Evidence and Clinical Applications.

Purpose: Breastfeeding provides optimal growth and development for infants. Lactating mothers may have challenges maintaining breastfeeding, and one of those challenges is being falsely advised to interrupt breastfeeding following radiologic studies. The aim of this study was to evaluate the knowledge, attitudes and experiences of healthcare professionals regarding breastfeeding after radiological imaging studies on lactating mothers. Method: In this cross-sectional study, an online survey consisting of 29 semi-structured questions was delivered to radiology technicians and physicians in radiology and pediatrics via social media. Mixed methods were used to analyze responses descriptively. Results: Of the 404 participants, 39% (n = 158) were radiology technicians, 31% (n = 125) were pediatricians, 11% (n = 46) were radiologists, 10% (n = 41) were pediatric residents and 8% (n = 34) were radiology residents. Of all healthcare professionals, 91% reported that breastfeeding does not need to be interrupted after ultrasound, 75% X-ray, 56% mammography, 62% non-contrast CT, 18% contrast-enhanced CT, 93% non-contrast MRI and 23% contrast-enhanced MRI. Interruption of breastfeeding was recommended more frequently after contrast-enhanced imaging studies (p < 0.01). After contrast-enhanced CT, 54% of participants recommended pumping and dumping for <24 h and 25% for 24-48 h; after contrast-enhanced MRI, these rates were found to be 57% and 20%, respectively. Of the healthcare professionals, 63% reported that their knowledge about management of breastfeeding after radiological studies was not sufficient. Conclusions: Situations requiring the interruption of breastfeeding after radiological studies are rare. However, recommendations in clinical practice vary in our country. Increasing the awareness and knowledge of healthcare professionals will prevent breastfeeding from being negatively affected.

Infant and Young Child Feeding in Emergencies: A Narrative Review.

In emergencies, infants and young children are at risk of morbidity and mortality, which is increased by malnutrition. Environmental factors, food insecurity, household needs, misconceptions regarding breastfeeding, uncontrolled distribution of breast-milk substitutes, and psychological trauma make it difficult to implement proper feeding practices during disasters. Breastfeeding reduces the risk of infectious diseases and mortality in emergencies and is the safest way of feeding. Therefore, breastfeeding should be supported and promoted under all circumstances. When breastfeeding is not possible, relactation, wet nursing, or donor human milk should be considered as alternatives. If these options are not feasible, infant formula should be used. Formula should be provided only for infants in need, based on individual assessment. Donations of breast-milk substitutes should not be accepted; when needed, the procurement and distribution should be conducted by a single center under strict control, adhering to the requirements of the Code and Codex Alimentarius. Education and support should be provided to the family for the safe use of formulas. For infants older than 6 months, appropriate complementary feeding should be started. Complementary foods should contain nutrients that support the growth and development of infants, and they should be stored, prepared, and served safely. In conclusion, nutrition of infants and young children should be given priority in disasters as part of all emergency interventions. Determining the infants needs and ensuring proper nutrition, overcoming environmental challenges, and supporting parents will reduce nutrition-related risks and protect the health and well-being of infants and young children in emergencies.

Knowledge and experiences of families regarding amber necklaces.

BACKGROUND: Amber necklaces have been used frequently to reduce the complaints of babies during teething. In this study, the knowledge and experience of families regarding the use of amber necklaces investigated. METHODS: The structured questionnaire was applied face-to-face to parents with a 4-24 month old baby who applied to the paediatric outpatient clinic. RESULTS: One hundred one families participating in the study reported that they used the amber necklace most frequently for restlessness (n = 72, 71.3%). Eighty- three% of families reported that the amber necklace was beneficial. It determined that 2% of the babies had suffocation and 2% had problems dispersing the grains. CONCLUSION: Although the parents think that the use of amber necklaces is effective during the teething period, they are not aware of the risks. It is important for healthcare professionals to inform their families about teething and especially the risks of using amber necklaces.

Effect of Ramadan Fasting on Breast Milk.

Introduction: Breast milk is an excellent biofluid that ensures optimal growth, development, and strong immunity of the baby. Breast milk content may alter depending on duration and time of breastfeeding, the infant's age, and maternal health status. There are few studies in the literature investigating the effect of religious fasting on breast milk composition. Method: The study included 21 fasting and 27 nonfasting mothers who exclusively breastfed their babies in 2021 Ramadan month. The energy, carbohydrate, protein, and lipid levels of the collected breast milk samples and the macro- and micronutrient contents of the mothers' diets and the weight gain of the infants during the study were evaluated. Results: The mothers' ages, education levels, and weights at birth and at the time of sampling were similar. There was no significant difference between the energy, carbohydrate, protein, and lipid composition of breast milk in fasting and nonfasting mothers. Although daily energy, protein, carbohydrate, fiber, and vitamin intakes between two groups were similar, mean daily intake of lipid, sodium, chloride, iodine, and omega-3 fatty acids was determined significantly higher in study group. Also, there was no difference in the weight gain of babies during the month of Ramadan. Conclusion: Religious fasting of mothers does not affect the energy and macronutrient content of breast milk. In addition, fasting does not seem to affect the weight of mothers and babies.

The Finger Feeding Method and Relactation.

BACKGROUND: Breastfeeding is one of the most important factors ensuring the healthy growth and development of babies. Preterm babies, babies with metabolic, neurological, or developmental delays, babies separated from their mothers for any reason, and adopted babies need alternative feeding methods. This study was carried out to investigate the effect of the finger feeding (FF) method on relactation. METHOD: In this retrospective study, infants who were admitted to the Istanbul Medipol University breastfeeding counseling clinic between January 2020 and June 2021 and were recommended to be fed with finger feeding were evaluated. Gender, gestation, mode of delivery, birth weight, age, cause for admission, feeding type, breastfeeding starting time, finger feeding time, and breastfeeding duration of the cases were recorded from the counseling forms. RESULTS: Of 41 babies, 29.3% were girls and 70.7% were boys, and 82.9% were term. Seventeen (41.5%) were born with spontaneous vaginal delivery and 24 (58.5%) with a cesarean section. The most common reason for admission was found to be the inability to latch. While 30 (73.2%) of the babies fed with finger feeding were able to suck, nine babies continued to be fed with a bottle, one baby with a spoon, and one baby with a supplemental nursing system (SNS). The breastfeeding starting time was 23.1 ± 27.5 (1-100) days. CONCLUSION: The finger feeding method is an effective alternative feeding method for successful breastfeeding. There is a need for studies to be conducted with more babies, both preterm and term, in this regard.

Is There An Association Between Vitamin B12 Level and Vitamin D Status in Children?

Vitamin B12 (vit B12) or cobalamin is a water-soluble vitamin that acts as a coenzyme and is effective in the formation of a healthy nervous system and erythrocytes. In its deficiency, except fatigue and weakness, may cause serious signs and symptoms such as macrocytic anemia, cognitive-developmental delay, irreversible neurological damage. In this study, hemoglobin, leukocyte, thrombocyte, iron, iron-binding, ferritin, and vit B12 levels were evaluated retrospectively during the routine controls of 689 children 5 to 18 years old without any complaints. In addition, the relationship between serum 25-Hydroxyvitamin D (vit D) levels and vit B12 levels, which were evaluated in 487 of the cases, was investigated. Vit B12 deficiency was diagnosed in a total of 160 (23.2%) cases, 99 (24.4%) girls and 61 (21.4%) boys. Vit B12 level was significantly lower in children over 12 years old. Vitamin D deficiency was found to be 49.3% in 487 cases and was significantly higher in the group under 12 years and girls. The frequency of anemia was 7.2% in this group. There was a significant relationship between vit D deficiency and vit B12 deficiency. In conclusion, vit B12 deficiency is common in school-age children, especially in the adolescent age group. It should be known that vit D deficiency may also be present in vit B12 deficiency cases. More comprehensive studies are needed to reveal the relationship between B12 and vit D deficiency.

Comparison of immunogenicity and reactogenicity of inactivated SARS-CoV-2 vaccine (CoronaVac) in previously SARS-CoV-2 infected and uninfected health care workers.

The effects of inactivated SARS-CoV-2 vaccine (CoronaVac) on previously naturally infected individuals are unknown. This study compared immunogenicity and reactogenicity of CoronaVac in once naturally infected health-care workers (HCWs) and uninfected HCWs. All HCWs were immunized with two doses of CoronaVac (600 U/0.5 ml) intramuscularly at a 28-day interval. Adverse reactions were obtained by web-based questionnaires or telephone calls seven days after each vaccine dose. Detection of antibody levels against the receptor-binding domain (RBD) of SARS-CoV-2 spike protein was done four weeks after the second dose of the vaccine. We enrolled 103 previously naturally infected and 627 uninfected HCWs. The mean time for vaccination after the first nasopharyngeal SARS-CoV-2 positivity was 64 days (range: 15-136 days) in previously naturally infected HCWs. Among the previously naturally infected HCWs, 41 (40%) were asymptomatic, 52 (50%) had mild upper respiratory tract infections, 10 (105) had pneumonia, and only 6 (5%) were hospitalized. Any reported adverse reactions, either from the first dose or the second dose of vaccine administration, did not differ between previously infected and uninfected HCWs. Anti-RBD antibody titers were obtained in 50 (51%) of 103 previously infected HCWs and 142 (23%) of 627 uninfected HCWs. Anti-RBD antibody titers were significantly higher in HCWs with a previous natural infection (median 1220 AU/ml, range: 202-10328 AU/mL) than in uninfected HCWs (median: 913 AU/ml, range: 2.8-15547 AU/mL, p = .032). CoronaVac administration was safe and may elicit higher antibody responses in previously naturally infected individuals.

Pediatricians' COVID-19 experiences and views on the willingness to receive COVID-19 vaccines: a cross-sectional survey in Turkey.

Developing an effective and safe vaccine against Covid-19 will facilitate return to normal. Due to hesitation toward the vaccine, it is crucial to explore the acceptability of the COVID-19 vaccine to the public and healthcare workers. In this cross-sectional survey, we invited 2251 pediatricians and 506 (22%) of them responded survey and 424 (84%) gave either nasopharyngeal swap or antibody assay for COVID-19 and 71 (14%) of them got diagnosis of COVID-19. If the effective and safe COVID-19 vaccine was launched on market, 420 (83%) of pediatrician accepted to get vaccine shot, 422 (83%) of them recommended vaccination to their family members, 380 (75%) of them accepted to vaccine their children and 445 (85%) of them offered vaccination to their pediatric patients. Among the participated pediatricians 304 (60%) of them thought COVID-19 vaccine should be mandatory. We found that there are high COVID-19 vaccine willingness rates for pediatricians for themselves, their own children, family members and their pediatric patients. We also found that being a pediatric subspecialist, believing in achieving an effective vaccine, willingness to participate in the phase 1-2 clinical vaccine trial, willingness to get an influenza shot this season, believing a vaccine and vaccine passport should be mandatory were significant factors in accepting the vaccine. It is important to share all information about COVID-19 vaccines, especially effectiveness and safety, with the public in a clear communication and transparency. The opposite will contribute to vaccine hesitancy and anti-vaccine movement.

Comparison of Clinical and Laboratory Features and Treatment Options of 237 Symptomatic and Asymptomatic Children Infected with SARS-CoV-2 in the Early Phase of the COVID-19 Pandemic in Turkey.

Little is known about the therapeutic use of hydroxychloroquine in pediatric patients with coronavirus disease 2019 (COVID-19). Here, we retrospectively retrieved data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) PCR-positive pediatric patients from 20 hospitals in 8 Turkish cities. We obtained epidemiological, clinical, and laboratory features of the patients, as well as the drugs used for treating COVID-19. A total of 237 nasopharyngeal swab SARS-CoV-2 PCR-positive children were included in the study from March 26, 2020 to June 20, 2020. The mean age of asymptomatic children (118 ± 62 months) was higher than that of symptomatic children (89 ± 69 months). Symptomatic children had significantly lower mean lymphocyte counts and higher mean CRP, D-dimer, procalcitonin, and LDH levels than asymptomatic children in the univariate analysis. Among 156 children, 78 (50%), 15, 44, and 21 were treated with a hydroxychloroquine-containing regimen, hydroxychloroquine + azithromycin + oseltamivir, hydroxychloroquine + azithromycin, and hydroxychloroquine alone, respectively. Among 156 patients who received medical treatment, 90 (58%) underwent pre- and/or post-treatment electrocardiogram (ECG). However, none of them had ECG abnormalities or required hydroxychloroquine discontinuation due to adverse drug reactions.

Blood lactate level and meconium aspiration syndrome.

PURPOSE: Approximately 5% of infants born with a meconium-stained amniotic fluid (MSAF) develop meconium aspiration syndrome (MAS). Early recognition of infants at highest risk for the development of MAS and the prediction of disease severity are important for optimizing the clinical strategies for prevention and treatment. The aim of the present study was to identify the risk factors for MAS and to investigate the effect of blood lactate level on the development of MAS. METHODS: Between January 2011 and January 2012, data were recorded with regard to gender, mode of delivery, gestational week, birth weight, 5-min Apgar score, and need for resuscitation of the meconium-stained depressed infants who underwent tracheal aspiration. Moreover, the number of cases developing MAS, blood pH value, and lactate level in capillary blood gases obtained during the first hour after delivery, duration of oxygen supplementation, the number of cases receiving mechanical ventilation and surfactant therapy, duration of hospital stay, and outcomes of the infants were recorded. RESULTS: The number of live births during the study period was 17,202, and of them, 1,341 (7.8%) infants were born through MSAF. Of 195 infants who were meconium-stained depressed, 90 were girls and 105 were boys. Their mean gestational week was 39.37 ± 0.89 weeks and mean birth weight was 3,426 ± 634 g. Eighty-four of them were born through cesarean section (C/S), and 111 were born via normal spontaneous labor. For 40 infants, Apgar score at fifth minute was less than 6. In total, resuscitation was performed on 43 (22.9%) infants. Of the infants, 141 did not develop MAS and 54 developed MAS. While there were no significant differences between infants with and without MAS with regard to gender, delivery route, gestational week, and birth weight, a significant difference was observed regarding the Apgar score (p = 0.0001). The blood pH value in capillary blood gas analysis was less than 7.25 in 18 (28.5%) cases with MAS and four (3.2%) cases without MAS. There was no significant difference between infants with and without MAS with regard to blood pH levels (p = 0.031). The mean blood lactate level was 8.5± 3.4 mmol/L in the patients with MAS, and there was a significant difference between infants with and without MAS regarding blood lactate level (p = 0.0001). The mean duration of oxygen supplementation was 86.62 ± 66.52 and 44.36 ± 19.03 h in patients with MAS and without MAS, respectively. In total, 30 infants required mechanical ventilation (24 infants with MAS and 6 infants without MAS). In addition to mechanical ventilation, 16 infants with MAS were administered surfactant therapy. The mean duration of hospital stay of infants with MAS was significantly higher than infants without MAS (p = 0.0001). There was a correlation between blood lactate levels, blood pH value, and hospitalization duration (p < 0.05). All of the infants, except one patient, were discharged from the NICU. CONCLUSION: In addition to the blood pH value and 5-min Apgar score, increased blood lactate level may be a risk factor for the development of MAS in infants born with MSAF. This may aid in the early detection of MAS and, with appropriate measures taken sooner, reduce morbidity and mortality. Further studies are needed to elucidate the role of lactate level, which is an important indicator of hypoxia during the development of MAS.

A case of rhizomelic chondrodysplasia punctata in newborn.

Rhizomelic chondrodysplasia punctate (RCDP) is a rare autosomal recessive peroxisomal disease. The main features of the disease are shortening of the proximal long bones, punctate calcifications located in the epiphyses of long bones and in soft tissues around joints and vertebral column, vertebral clefting, dysmorphic face, and severe growth retardation, whereas cervical spinal stenosis may also rarely be present. Imaging of the brain and spinal cord in patients with this disorder may aid prognosis and guide management decisions. We report the newborn diagnosed as CDP with cervical stenosis. Our aim is to discuss current knowledge on etiopathogenesis as well as radiological and clinical symptoms of diseases associated with CDP.

Effect of iron supplementation on development of iron deficiency anemia in breastfed infants.

This trial aimed to investigate the effect of iron supplementation on the development of iron deficiency anemia. The study encompassed 6-month-old infants who had been exclusively breastfed in the first 4 months of life. Infants in the supplemented group were given 1 mg kg(-1 )day(-1) ferrous sulfate for 6 months starting at 6 months of age. Blood samples were taken at age 12 months. A 3-day-diet was evaluated at 1 year of age. Data of 51 infants in the supplemented and 54 infants in the control group were analyzed. Mean hemoglobin values were similar in the two groups at the age of 12 months. Mean ferritin level of the supplemented group was significantly higher than that of the control. There was a significant positive correlation between dietary iron intake and hemoglobin levels. Nutrition might be more important than iron supplementation in preventing iron deficiency anemia during infancy.

Subarachnoid-pleural fistula in a child: the cause and treatment.

Hydrothorax of the cerebrospinal fluid after a subarachnoid-pleural fistula is a rare condition. Subarachnoid-pleural fistula may appear after a trauma at the thoracolumbar vertebral column or iatrogenically after thoracotomy. A two years and four months old boy who was operated because of ganglioneuroblastoma was admitted to hospital due to respiratory distress. The chest roentgenogram obtained two months after thoracotomy, showed a pleural effusion at the left side and a chest tube was inserted. The craniospinal magnetic resonance imagining revealed subarachnoid-pleural fistula and lumbar external cerebrospinal fluid drainage was performed. The chest tube was removed by application of tetracycline between pleural layers. After the patient was discharged, respiratory distress reoccurred after 3 weeks and a chest tube was reinserted due to fluid at the left hemithorax. An external lumbar drainage was reapplied. The location of the fistula was determined by craniospinal magnetic resonance imagining and myelography. The fistula was surgically restored by a posterior approach and laminectomy. The cerebrospinal fluid drainage and chest tube was removed three days and seven days after the operation respectively. The patient was discharged at the 13 days after the operation. During periodical outpatient follow up the patient has no symptoms and is neurologically intact. Subarachnoid-pleural fistulas, usually do not regress spontaneously or respond to conservative methods. Invasive approaches including surgery may be needed to treat patients with subarachnoid-pleural fistulae.

A rare case of sepsis in newborn: Streptococcus pneumoniae septicemia.

BACKGROUND: Streptococcus pneumoniae is a rare cause of sepsis in the newborn. CASE: The term baby was admitted on complaint of dyspnea, and antibiotherapy was begun after samples for hemocultures were obtained with the suspicion of sepsis according to the clinical and laboratory data. S. pneumoniae was demonstrated in the vaginal culture of the mother of the patient whose lumbar punction and chest roentgenogram were normal but hemoculture revealed the propagation of S. pneumoniae. The patient, treated with antibiotherapy for 14 days, was discharged without any complications. CONCLUSION: In preventing the probable complications, it is important to absolutely treat the maternal pneumococcal colonization that can cause severe infections in the newborn and also to treat the newborns even if they are asymptomatic.

Intravenous frusemide for transient tachypnoea of the newborn: a randomised controlled trial.

AIM: To investigate the effect of intravenous frusemide on the course of transient tachypnoea of the newborn (TTN). METHODS: Fifty term infant with TTN were randomised at the time of diagnosis to receive either intravenous frusemide 2 mg/kg or saline placebo. Outcomes assessed included duration of supplemental oxygen requirement, the period of tachypnoea, time to discharge from hospital and weight loss in the first 24 h of life and before discharge. RESULTS: The two groups were similar with respect to sex, birthweight, mode of delivery and age at presentation. The study group lost significantly more weight in the first 24 h after birth. There were no significant differences between the two groups in the duration of oxygen requirements, the period of tachypnoea and the time to hospital discharge. CONCLUSION: A single dose of intravenous frusemide (2 mg/kg) does not improve the clinical course of TTN. This finding suggests that either frusemide is not effective in promoting resorption of lung fluid or factors other than delayed resorption of this fluid contribute to the pathogenesis of TTN.