[Prevalence of maternal measles, rubella, mumps and varicella antibodies in the first six months of life]. / Ilk alti ayda maternal kizamik, kizamikçik, kabakulak ve suçiçegi antikorlarinin durumu.

The protection of infants against infections during the first few months of life is provided mainly by maternal antibodies. The presence of maternal antibodies can decrease vaccine efficacy. The waning time of maternal antibodies shows variations therefore seroepidemiological studies are important for the development of vaccination schedules. Some recent studies showed that the maternal measles antibodies may disappear around 3 months of age especially in infants born from mothers who were vaccinated. There are few cross-sectional studies from Turkey evaluating the maternal antibody levels of infants against measles in recent years. The aim of this prospective, multicentre study is to evaluate the seropositivity of measles, rubella, mumps, and varicella in mothers and their infants at 1 and 6 months after birth. The study was carried out at the Social Pediatrics Units of two university hospitals, a private hospital and a state hospital. The exclusion criteria were known impaired immune system or immune deficiency disorder in mother or child, preterm delivery (< 37 gestational week), administration of immunoglobulins or any blood products before admission or during the follow-up period, and history of vaccination or exposure to one of these diseases during the study period. The final analysis encompassed 209 mother-infant pairs. Blood samples were collected 1 month after birth from mothers and 1 and 6 months after birth from their babies. Antibody levels were determined by ELISA (Enzyme-Linked ImmunoSorbent Assay) method. Information on the socio-economic and demographic characteristics of the families were collected by a face-to-face questionnaire. Seropositivity was found as 95.7%, 92.8%, 92.8% and 96.7% for measles, mumps, rubella and varicella (MMRV) respectively. Majority of infants lost maternal antibodies at 6 months of age. Of all 6 month-old infants 25% were seropositive for measles,14.6% for mumps, 23.2% for rubella and 17.1% for varicella. The proportion of seropositive infants born from seropositive mothers was higher than those born from seronegative mothers for all four diseases. This difference was statistically significant only at 1 month of age (p= 0.001). Our study showed that maternal antibodies against MMRV decreased rapidly by 6 months of age therefore necessary measures should be taken to close this gap between the loss of maternal protection and the vaccination of infants for MMRV. As the epidemiology of the diseases changes in time, it is important to carry out such studies with large series in different countries and settings. Important results were determined in our study within this respect.

Baby-led complementary feeding: Randomized controlled study.

BACKGROUND: Baby-led weaning (BLW) is an approach to introducing solid foods to infants that gives control of the feeding process to the infant. Anecdotal evidence suggests that BLW is becoming popular with parents, but scientific research is limited to a few publications. This study assessed growth, hematological parameters and iron intake in 6-12-month-old infants fed by traditional or baby-led complementary feeding. METHODS: We recruited 280 healthy 5-6-month-old infants allocated to a control (traditional spoon feeding; TSF) group or an intervention (BLW) group in a randomized controlled trial. Infant growth, hematologic parameters and iron intake were evaluated at age 12 months. RESULTS: Infants in the TSF were significantly heavier than those in the BLW group. Mean weight in the BLW group was 10.4 ± 0.9 kg compared with 11.1 ± 0.5 kg in the TSF group. There was no statistically significant difference in the iron intake from complementary foods between the BLW (7.97 ± 1.37 mg/day) and TSF (7.90 ± 1.68 mg/day) participants who completed the diet records. Hematologic parameters were similar at 12 months. The incidence of choking reported in the weekly interviews was not different between the groups. CONCLUSIONS: To the best of our knowledge, this is the first randomized -controlled study to have examined the impact of weaning method on iron intake, hematological parameters and growth in breast-fed infants. BLW can be an alternative complementary feeding type without increasing the risk of iron deficiency, choking or growth impairment.

Efecto del tabaquismo materno sobre el estado oxidativo en los niños / The effect of smoking by the mother on a child's oxidant and antioxidant status

El hábito de fumar es una de las más importantes causas evitables de muerte. Globalmente, más de mil millones de personas son fumadoras, dejando vulnerable al resto de la población no fumadora expuesta al humo de segunda mano (HSM). La exposición a los componentes del cigarrillo durante el embarazo y la vida posnatal temprana es, quizá, la exposición ambiental ubicua más peligrosa y evitable. Asimismo, se demostró que el humo del cigarrillo tiene consecuencias negativas sobre la salud de los niños, en especial, durante el primer año de vida. El daño oxidativo es un cambio en el equilibrio entre los procesos prooxidantes y el sistema de defensa antioxidante a favor de los prooxidantes. Esta aparece en condiciones de producción aumentada de radicales libres, en la insuficiencia de los sistemas antioxidantes o en ambos. Se ha sugerido que el aumento del daño oxidativo desempeña un papel importante en la patogenia de varias enfermedades relacionadas con el tabaquismo. El humo del cigarrillo contiene grandes cantidades de radicales libres que muchos de ellos son oxidantes y prooxidantes. El tipo de nutrición en niños expuestos al HSM es muy importante para protegerlos del daño oxidativo. El propósito de esta revisión es efectuar una revisión de los estudios que han tratado la relación entre el daño oxidativo y el tipo de nutrición en la infancia y el daño oxidativo causado por la exposición al HSM durante los períodos prenatal, posnatal y en la infancia.

Tobacco smoking is one of the most important preventable causes of death. Globally, more than 1 billion people smoke, leaving much of the world's non-smoking population vulnerable to second-hand smoke (SHS) exposure. Exposure to tobacco constituents during pregnancy and early postnatal life is perhaps the most ubiquitous avoidable hazardous environmental exposure. Additionally, tobacco smoke has been shown to have negative consequences on infant health, especially during the first year of life. Oxidative stress is a change in balance between pro-oxidant processes and antioxidant defense system in favor of pro-oxidants. It appears in conditions of increased production of free radicals, insufficiency of antioxidant systems or both. It has been suggested that increased oxidative stress plays a major role in the pathogenesis of several smoking-related diseases. Tobacco smoke contains large quantities of free radicals, many of which are oxidants and pro-oxidants. The type of nutrition in infants who are exposed to SHS is very important to protect them from oxidative stress. The purpose of this paper is to review the studies dealing with the relation between oxidative stress and the type of nutrition in infancy and oxidative stress caused by SHS exposure during prenatal, neonatal, postnatal and childhood periods.

Oral sucrose administration to reduce pain response during immunization in 16-19-month infants: a randomized, placebo-controlled trial.

UNLABELLED: Although the analgesic effect of sucrose on newborns is well established, little is known about whether these solutions are effective in reducing procedural pain in infants beyond the newborn period. The purpose of this study was to determine the effect of sucrose solution given orally on infant crying times and measure the distress in a 16-19-month age group. A total of 537 healthy, 16-19-month-old infants attending for their immunizations with intramuscular diphtheria, tetanus, and acellular pertussis (DTaP)/Haemophilus influenza type b/IPV (along with oral polio vaccination (OPV)), intramuscular pneumococcus and intramuscular hepatitis A were randomized to receive 2 mL of a 75 % sucrose solution, a 25 % sucrose solution or sterile water 2 min before injections. Infants receiving a 75 % sucrose solution had significantly reduced total crying times and Children's Hospital of Eastern Ontario Pain Scale scores (CHEOPS) compared with infants in the control and 25 % sucrose solution groups (p < 0.001). CONCLUSION: Sucrose solution reduces infant distress and is safe and clinically useful even for 16-19-month-old infants.

Effect of cup feeding and bottle feeding on breastfeeding in late preterm infants: a randomized controlled study.

BACKGROUND: Cup feeding has been used as an alternative feeding method for preterm infants. OBJECTIVE: The purpose of this study was to determine the effect of bottle and cup feeding on exclusive breastfeeding rates at hospital discharge and 3 and 6 months post-discharge in late preterm infants. METHODS: Included in the study were preterm infants of 32 to 35 weeks' gestation fed only by intermittent gastric tube at the time of recruitment; 522 infants were randomly assigned to 2 groups: the cup-fed group (n = 254) and bottle-fed group (n = 268). Main outcomes were prevalence of exclusive breastfeeding at discharge and 3 and 6 months after discharge, and length of hospital stay. RESULTS: Infants randomized to cup versus bottle feeding were more likely to be exclusively breastfed at discharge home (relative risk [RR], 1.58; 95% confidence interval [CI], 1.36-1.83), 3 months after discharge (RR, 1.64; 95% CI, 1.42-1.89), and 6 months after discharge (RR, 1.36; 95% CI, 1.14-1.63). There was no significant difference between groups for length of hospital stay. The mean hospital stay was 25.96 ± 2.20 days in the bottle-fed group and 25.68 ± 2.22 days in the cup-fed group. There was no significant difference between groups for time spent feeding, feeding problems, or weight gain in hospital. CONCLUSION: Cup feeding significantly increased the likelihood of late preterm infants being exclusively breastfed at discharge and 3 and 6 months after discharge, and cup feeding did not increase the length of hospital stay. Overall, we recommend cup feeding as a transitional method prior to breastfeeding for late preterm infants during hospitalization.

Brief intervention to preteens and adolescents to create smoke-free homes and cotinine results: a randomized trial.

BACKGROUND: Little research has focused on brief and practical strategies for addressing environmental tobacco smoke exposure through interventions focused explicitly on creating a smoke-free home. METHODS: We used a two-group (intervention and control groups) repeated-measures randomized controlled trial design. Families were randomized to the intervention (n = 176) or control (n = 176) condition after the baseline interview, with outcome assessments for reported and urine cotinine measures at 2 (post-intervention), 6 (follow-up) and 12 (follow-up) months. RESULTS: Baseline urinary cotinine levels of both groups were not statistically significantly different (P > 0.05); however, post-intervention urinary cotinine levels were significantly different at 2, 6 and 12 months after start of the study (P < 0.001). CONCLUSION: As a physician-based brief intervention, our intervention was effective. Clinical providers might offer feedback and brief interventions to preteens and adolescents. Because of the ease of intervention on delivery, this intervention has the potential to have significant impact if widely disseminated.

Abusive head trauma: report of 3 cases.

Abusive head trauma (AHT) is perpetrated when an infant or young child is shaken violently by an abuser, resulting in injuries to various intracranial structures, historically called "shaken baby syndrome" (SBS). Three cases of AHT with different constellations of clinical symptoms are presented here. Case 1- Three-month-old female infant was admitted with recurrent seizures, drowsiness, and low grade fever. Ophthalmologic examination revealed retinal hemorrhages (RH) in the left eye. Computed tomography of cranium showed left frontal intra-parenchymal subdural hematoma (SDH). Case 2- Twelve-month-old male infant was admitted with a history of favoring left leg. Ophthalmologic examination revealed RH in the right eye. Cranial magnetic resonance imaging (MRI) revealed subacute SDH in the right frontoparietal region. Case 3- Three-month-old male infant was admitted with irritability and seizures. Ophthalmologic examination revealed bilateral disseminated RH. Cranial MRI scan showed bilateral frontoparietal subacute SDH. All cases were reported to Child Protective Services, who decided not to remove children from homes, but evaluated psychosocial risks and developed a safety plan, including home visits and family education. Physicians must be aware of possibility of AHT in infants presenting both subtle and overt neurologic symptoms. It is important to provide training on AHT to staff involved in the management of these cases.

A case report of successful relactation.

Exclusive breastfeeding is recommended from birth until the first six months and then with complementary feeding up to age two. In our country, only 41.6% of infants are exclusively breastfed during the first six months, and the average duration of breastfeeding is 16 months.The term 'relactation' is used for the resumption of breastfeeding in infants who were not breastfed before or who quit suckling due to an illness of the mother or infant, breast problems, rejection of suckling by the infant, insufficient milk production, the mother's change of mind about breastfeeding, or adoption.Relactation is a laborious process that requires motivation and trained personnel. In our case, the process of achieving successful relactation in an eight-week-old infant who had not been breastfed before is described. The infant's young age and mother's strong motivation led to the success in relactation in this case.

Effects of Active and Passive Smoking on Ear Infections.

Otitis media (OM) is one of the most frequent diseases in young children, causing to visit a physician, and also the most common indication for antibiotic prescription. The peak incidence and prevalence of OM is 6 to 18 months of age. In children, second-hand smoke (SHS) exposure is associated with upper and lower respiratory tract infections, such as acute otitis media (AOM), pneumonia, and bronchitis. Despite the overwhelming evidence of the role of SHS exposure on infant health, a very high proportion of children still continue to be exposed. This important relationship between all kinds of smoking and poor health may not be appreciated universally. With this article, we aim to review tobacco smoke exposure and OM connection. How this exposure may cause OM especially in young children? What can be done to prevent and to reduce the harmfull effects of tobacco smoking?

Rare laryngeal anomaly or spontaneously drained bilateral saccular cyst?

Laryngeal malformations are usually present at birth. Common anomalies include laryngomalacia, vocal fold paralysis, and subglottic stenosis; less common are congenital saccular cysts, laryngeal webs and atresias, and laryngeal lymphangiomas. Symptoms may range from stridor and hoarseness to respiratory distress. In some cases, patients are asymptomatic. Here, we present a case with abnormal laryngeal ventricles.

The urinary cotinine levels of infants and the determinants.

The aim of this study was to determine the effect of the route of tobacco smoke exposure on urinary cotinine levels of infants. A cross-sectional analysis was done on 254 six-month-old infants. The infants were grouped according to the route of tobacco smoke exposure. The urinary cotinine/creatinine ratios were determined. Forty-nine percent (124/254) of mothers were smokers. Urinary cotinine levels in infants of smoking mothers were statistically significantly higher than levels in infants of non-smoking mothers. The highest mean cotinine/creatinine level was found in the breast-milk-exposed group. Linear regression analysis showed that maternal smoking increased urinary cotinine level by 541 times and breastfeeding increased it by 171 times, whereas early start of formula feeding decreased it by 63 times. Tobacco exposure by breastfeeding may be more harmful than other routes of exposure. Mothers should be encouraged to stop smoking during the breastfeeding period even if they avoid exposing their infants to passive tobacco smoke.

Effect of passive smoking on growth and infection rates of breast-fed and non-breast-fed infants.

BACKGROUND: The aim of the present study was to determine the effect of passive tobacco smoking on growth and infection rate of infants, and to evaluate whether breast-feeding might be protective against harmful effects of cigarette smoke. METHODS: A cross-sectional study on 254 6-7-month-old infants was carried out. A questionnaire was given to mothers; and infants' head circumference, bodyweight, height, and urinary cotinine levels were measured. RESULTS: Multivariate analysis of factors influencing lower respiratory tract infections showed that smoking mothers increased the rate by 9.1-fold; breast-feeding decreased it by 3.3-fold; formula feeding at birth increased it by a factor of 15.2; another smoker at home increased it by a factor of 40.1. Multivariate analysis of factors influencing upper respiratory tract infections showed that smoking mothers increased the rate by a factor of 23; early formula feeding increased it by a factor of 62; breast-feeding decreased it by a factor of 5; smoking fathers increased it by a factor of 15. Multivariate analysis of factors influencing otitis media found that smoking mothers and fathers increased it by a factor of 9.4 and 6.15, respectively, and breast-feeding decreased it by a factor of 5.4. CONCLUSION: Tobacco smoke exposure of infants has negative consequences on growth, otitis media, and upper and lower respiratory tract infections. Breast-feeding promoted the growth of infants who were passively exposed to tobacco smoke and protected them against infections. Smoking should not be permitted in households with infants. When this is impossible, breast-feeding should be promoted to protect the infants against the health hazards of passive smoking.

The effect of passive smoking and breast feeding on serum antioxidant vitamin (A, C, E) levels in infants.

AIM: Toxic substances in tobacco smoke are known to have negative effects on the antioxidant capacity of human body. In order to investigate the effect of passive smoking on serum antioxidant levels in infants, serum vitamin A, E, C levels and urinary cotinine/creatinine levels were measured in 254 infants at the age of 6 months. METHODS: The information about infants' nutrition and exposure to tobacco smoke was obtained from the mothers by the help of a questionnaire. The infants were grouped according to both smoking status of mother and urinary cotinine/creatinine levels. RESULTS: The mean serum vitamin A, C and E levels of infants of smoking mothers were significantly lower than those of non-smoking mothers (p < 0.05). Vitamin A, E and C levels were negatively correlated with urinary cotinine/creatinine levels (p < 0.05, r: -0.61, -0.42, -0.53, respectively). Multivariate analysis revealed independent factors determining the serum vitamin A, E and C levels of infants as maternal smoking and breast feeding (p < 0.05). CONCLUSION: Tobacco smoke exposure of infants significantly decreases their serum antioxidant vitamin A, C and E levels. However, breast feeding may help to prevent the decrement of antioxidant vitamin levels of passive smoking infants.

Hydraulic conductivity of compacted clay liners permeated with inorganic salt solutions.

Due to their low permeability, geosynthetic clay liners (GCLs) and compacted clay liners (CCLs) are the main materials used in waste disposal landfills. The hydraulic conductivity of GCLs and CCLs is closely related to the chemistry of the permeant fluid. In this study, the effect on the hydraulic conductivity of clays of five different inorganic salt solutions as permeant fluid was experimentally investigated. For this purpose, NaCl, NH(4)Cl, KCl, CaCl(2), and FeCl( 3) inorganic salt solutions were used at concentrations of 0.01, 0.10, 0.25, 0.50, 0.75 and 1 M. Laboratory hydraulic conductivity tests were conducted on low plasticity (CL) and high plasticity (CH) compacted raw clays. The change in electrical conductivity and pH values of the clay samples with inorganic salt solutions were also determined. The experimental test results indicated that the effect of inorganic salt solutions on CL clay was different from that on CH clay. The hydraulic conductivity was found to increase for CH clay when the salt concentrations increased whereas when the salt concentrations were increased, the hydraulic conductivity decreased for the CL clay.

Accidental cyanoacrylate glue ingestion.

Cyanoacrylates have a variety of medical and commercial applications as adhesives. They are commonly found as glue in the household. They can be swallowed accidentally by children. However, no case was reported so far in the English medical literature. Their effect on the mouth, pharynx, larynx, esophagus and the rest of gastrointestinal system is unknown. Here we report our own child who accidentally ingested cyanoacrylate glue without unwanted sequelae due to prompt intervention.

The role of oxidants and antioxidants in otitis media with effusion in children.

OBJECTIVE: Determine the possible role of oxidants and antioxidants in the pathogenesis of otitis media with effusion in children. STUDY DESIGN AND SETTING: Randomized controlled trial, tertiary referral center. The study group was made up of children with otitis media with effusion who were to undergo bilateral ventilation tube insertion and adenoidectomy. The control group was comprised of otherwise healthy children. The blood levels of antioxidants (retinol, beta-carotene, alpha-tocopherol, laycopene, ascorbic acid, superoxide dismutase, glutathione peroxidase, GSH) and oxidation products (malondialdehyde) were determined before and 1 month after the operation in the study group and once only in the control group. These substances were also measured in the adenoid tissue and middle ear fluids. RESULTS: In the study group, the blood levels of antioxidants and oxidants before and after the operation were significantly different when compared with the control group (P < 0.05). In the study group, the blood antioxidant levels increased and oxidant levels decreased significantly after the operation (P < 0.05). The levels after the operation never reached those of the control group. CONCLUSIONS AND SIGNIFICANCE: Oxidants and antioxidants played a significant role in the pathogenesis of otitis media with effusion in children. These children are under significant oxidative stress. Insertion of a ventilation tube and adenoidectomy significantly decreased the oxidative stress in these patients, but could not normalize it completely. Additional studies are necessary in the clinical use of antioxidants in otitis media with effusion.

Factors influencing sleeping pattern of infants.

Many families apply to pediatricians with complaints of sleep problems of their infants. It is very important to inform families about the sleep pattern of infants and factors influencing it, and to answer their questions about infantile sleep. A questionnaire was given to 165 families to elucidate the factors influencing continuous sleep pattern of the baby. Our study demonstrated that 50% of four-month-old and 96% of nine-month-old infants acquired continuous sleep pattern. Our figures were compatible and even higher than those in the literature. None of the factors studied has an independent effect on infantile continuous sleep pattern in multifactorial analysis. Early weaning does not facilitate acquisition of continuous sleep pattern by the baby. This will help to support prolonged breast-feeding. It may be advisable not to keep children beside their mother during sleep for a long period of time. Care of the children by the maternal grandmother may facilitate their acquisition of continuous sleep pattern.

Factors influencing breastfeeding for working mothers.

In order to evaluate the relation between breastfeeding and working conditions a descriptive study was conducted on 301 working mothers. Seventy-seven percent of mothers breastfed their infants four months and longer, and the mean breastfeeding period was 6.2 +/- 3.4 months. Forty-one percent of mothers started weaning before four months of age. The multifactorial analysis of independent factors significantly influencing breastfeeding time were, in decreasing order of significance, breastfeeding conditions at work, maternal leave period, mother's smoking habit and the use of breastpump. For weaning period, these factors were the use of breastpump, breastfeeding leave at work and maternal leave period. In conclusion, in order to support breastfeeding at work, maternal leave period must be prolonged, and breastfeeding conditions at work must be improved.