Ankara Bilkent City Hospital, Children’s Hospital
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From stomach to liver: The impact of Helicobacter pylori gastritis on pediatric hepatic steatosis
Objective: The purpose of our study was to examine the association between endoscopically diagnosed Helicobacter pylori (HP) gastritis and hepatosteatosis, and to investigate the correlation between the presence of HP and biochemical and anthropometric measurements in children. Materials and Methods: Patients who were followed up in the Pediatric Gastroenterology outpatient clinic of Kayseri City Training and Research Hospital and underwent esophagogastroduodenoscopy performed by the attending gastroenterologist were evaluated. Patients aged between 2 and 18 years, with a histopathological diagnosis of gastritis, both HP positive and negative, were enrolled in the study. Results: In patients with HP-positive gastritis, the incidence of hepatosteatosis was found to be statistically significantly higher compared to those with HP-negative gastritis (χ² = 22.704; p <0.001). A statistically significant weak positive correlation was found between the density of HP and the grade of hepatosteatosis (rho = 0.344; p <0.001). Conclusion: The HP-positive gastritis in children is associated with the development of hepatosteatosis, and the higher grade of hepatosteatosis in patients with HP-positive gastritis suggests that HP gastritis may impact the development of fatty liver.
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Response to the Letter entitled “Comment on Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors”
Hematological markers of systemic inflammation potentially associated with migraine in pediatric patients
Objective: The aim of this study was to evaluate potential neuroinflammatory processes in pediatric migraine using hematological inflammatory indices and to examine their associations with age and gender. Materials and Methods: This retrospective cross-sectional study included 90 children diagnosed with migraine and healthy control group, conducted between August 1, 2019, and August 1, 2025. Complete blood count parameters were analyzed for all participants. The neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), platelet-to-lymphocyte ratio (PLR), and other hematological inflammatory markers were calculated. Comparisons were made between the migraine and control groups. Additionally, the migraine group was subdivided according to age, gender, and treatment status, and subgroup analyses were performed. Results: Platelet-to-lymphocyte ratio values were significantly higher in the migraine group than in the control group. In gender-based comparisons, a statistically significant difference was observed only in red blood cell (RBC) counts, whereas no gender-related differences were detected in other inflammatory parameters. Within the migraine group, lymphocyte counts decreased in the older age subgroup, while platelet counts and NLR values showed a significant increase. Among patients receiving flunarizine treatment, no significant differences were observed in inflammatory markers, except for mean corpuscular volume (MCV). Conclusion: Platelet-to-lymphocyte ratio may serve as a marker of increased inflammatory burden in pediatric patients with migraine. The age-related increase in inflammatory indices may reflect neuroinflammatory processes involved in migraine pathophysiology. These findings highlight the importance of considering age in the clinical evaluation of pediatric migraine patients.
Beyond the threshold of viability: Mortality, morbidity, and critical prognostic cut-offs in infants born at 22–26 weeks of gestation
Objective: The aim of this study was to evaluate mortality, early morbidities, and critical prognostic thresholds in extremely preterm infants born at 22–26 weeks of gestation at the limit of periviability. Materials and Methods: This retrospective single-center study included live-born infants between 22+0 and 26+6 weeks of gestation who were admitted to a tertiary 194-bed neonatal intensive care unit between June 1, 2021, and March 31, 2023. Prenatal, natal, and postnatal characteristics were analyzed. The primary outcome was mortality. Receiver operating characteristic (ROC) analysis was performed to determine optimal gestational age and birth weight cut-off values for predicting mortality. Results: Among 11038 neonatal admissions during the study period, 263 (2.38%) were extremely preterm infants within the specified gestational age range. Overall mortality was 70.7%. Gestational age and birth weight were identified as the strongest independent predictors of survival. ROC analysis demonstrated significant cut-off values of 24.2 weeks for gestational age and 740 g for birth weight in predicting mortality. The most common early morbidities were patent ductus arteriosus (54.6%), culture-proven sepsis (38.7%), and osteopenia (28%). Survival improved markedly beyond 24 weeks of gestation, highlighting the critical prognostic importance of even small increments in maturity. Conclusion: Biological immaturity remains the principal determinant of outcome in infants born at the threshold of viability. However, identification of clinically relevant gestational age and birth weight thresholds may guide prenatal counseling, individualized resuscitation decisions, and intensive care strategies to improve survival in this vulnerable population. Ultimately, achieving “quality survival” – survival without major disability – requires long-term neurodevelopmental follow-up beyond hospital discharge.
Diagnostic accuracy of ultrasonography versus Tc-99m DMSA for detecting renal parenchymal damage in children with recurrent urinary fltract infections and vesicoureteral reflux: Patient-level and regression-based analyses
Objective: We aimed to assess the diagnostic performance of renal ultrasonography (USG) compared with technetium-99m dimercaptosuccinic acid renal cortical scintigraphy (DMSA scintigraphy) in detecting renal parenchymal damage in paediatric patients with vesicoureteral reflux (VUR) and/or recurrent urinary tract infection (rUTI). Materials and Methods: We retrospectively analysed 181 paediatric patients who underwent both renal USG and DMSA scintigraphy. Kidneys coded as absent were excluded. Diagnostic accuracy indices (sensitivity, specificity, PPV, NPV, accuracy, and AUC with 95% confidence intervals) were calculated at kidney and patient levels. Logistic regression was performed to evaluate the impact of age, gender, and renal uptake. Results: In comparison to DMSA scintigraphy as the reference standard, USG identified parenchymal damage with a sensitivity of 50.9% for the left kidney and 44.7% for the right kidney, while demonstrating exceptional specificity (>99%). At the patient level (n=162), USG achieved a sensitivity of 49.4%, specificity of 100%, accuracy of 76%, and AUC of 0.75. DMSA scintigraphy identified significantly more kidneys with parenchymal injury than USG in all age cohorts. Logistic regression further indicated that advancing age and diminished renal uptake on DMSA scintigraphy were independent predictors of parenchymal damage, while sex was not significant. Conclusion: Ultrasonography demonstrated excellent specificity but limited sensitivity compared with DMSA scintigraphy. These findings indicate that USG alone is inadequate for the early detection of renal parenchymal damage in children with VUR and/or rUTI. DMSA scintigraphy remains essential in this high-risk population.
Diagnostic discrimination of C-reactive protein and blood count-derived indices for concurrent urinary tract infection in pediatric urolithiasis
Objective: The aim of this study was to evaluate the diagnostic discrimination of CRP and CBC-derived inflammatory indices for identifying concurrent culture-confirmed UTI in children with urolithiasis during early clinical assessment. Materials and Methods: This single-center retrospective observational study included 77 children with imaging-confirmed urolithiasis and 45 healthy controls. Concurrent UTI was defined by compatible symptoms together with urine culture growth of ≥10⁵ colony-forming units/mL. Neutrophil-to-lymphocyte ratio (NLR), monocyte-to-lymphocyte ratio (MLR), monocyte-to-platelet ratio (MPR), mean platelet volume (MPV), white blood cell count, and CRP were compared across study groups. Receiver operating characteristic analyses were used to assess diagnostic discrimination for culture-confirmed UTI. Results: Among 77 children with urolithiasis, 46 (59.7%) had concurrent culture-confirmed UTI. Compared with both healthy controls and stone/UTI-negative patients, those with concurrent UTI had significantly higher NLR, MLR, MPR, white blood cell count, and CRP levels, whereas MPV showed poor discriminatory performance. CRP demonstrated the highest diagnostic discrimination for concurrent UTI (AUC 0.996), with a cutoff of ≥5 mg/L yielding 98.0% sensitivity and 100% specificity. Among the complete blood count–derived indices, NLR performed best (AUC 0.838), followed by MLR (AUC 0.827) and MPR (AUC 0.779). Secondary exploratory analyses suggested declining inflammatory markers after infection control and stone clearance in the surgical cohort, whereas a very small subgroup with culture-negative postoperative fever showed descriptive marker re-elevation in exploratory analyses. Conclusion: In pediatric urolithiasis, CRP demonstrated the strongest diagnostic discrimination for concurrent culture-confirmed UTI, whereas NLR was the most informative supportive complete blood count–derived index. Secondary exploratory observations should be interpreted cautiously and require confirmation in larger cohorts. Overall, the present findings remain preliminary and require prospective validation before any routine clinical application.
Germinal Matrix-intraventricular hemorrhage in very preterm infants: Frequency, associated factors, and the role of postnatal clinical course
Objective: Germinal matrix-intraventricular hemorrhage (GMH-IVH) remains one of the most important complications associated with prematurity and is a major cause of neonatal morbidity and mortality. This study aimed to determine the frequency of GMH-IVH and to evaluate prenatal, natal, and postnatal factors associated with its development in preterm infants. Materials and Methods: This retrospective study included preterm infants with a gestational age between 24 and 32 weeks and a birth weight ≤1500 g who were followed in the neonatal intensive care unit of a tertiary referral center. Cranial ultrasonography, performed within the first 72 hours of life and repeated at the end of the first week, was used to diagnose and grade GMH-IVH according to the Volpe classification. Demographic characteristics, maternal factors, delivery characteristics, and early postnatal clinical and laboratory parameters were analyzed. Infants were grouped according to the presence of GMH-IVH and the severity of hemorrhage. Results: A total of 312 preterm infants were included in the study. GMH-IVH was detected in 49.7% of the infants. Among these, 83 (53.5%) had mild hemorrhage (Grade 1–2) and 72 (46.5%) had severe hemorrhage (Grade 3–4). Lower gestational age, lower birth weight, absence of antenatal steroid use, lower Apgar scores, requirement for invasive mechanical ventilation, presence of patent ductus arteriosus, and abnormalities in coagulation parameters were significantly associated with GMH-IVH. Conclusion: GMH-IVH in preterm infants is a multifactorial condition associated with several prenatal and postnatal factors. However, the retrospective design precludes establishing causality. Our findings highlight the strong association with postnatal clinical instability, particularly invasive mechanical ventilation and PDA treatment, suggesting that these are critical markers of illness severity. Identification of modifiable factors and optimization of perinatal and neonatal care may contribute to reducing the incidence and severity of GMH-IVH in this vulnerable population.
The RAS/Mitogen-Activated Protein Kinase (MAPK) pathway is a core developmental signaling cascade that regulates proliferation, differentiation, survival, and tissue growth across multiple organ systems. Germline dysregulation of this pathway results in RASopathies. Although the causal variants affect different components of the pathway, they converge on abnormal downstream signaling. This explains why these disorders share a recognizable clinical core despite clear syndrome-specific differences. The most prevalent and well-known entity is Noonan syndrome, while other major subtypes include cardiofaciocutaneous syndrome, Costello syndrome, and Noonan syndrome with multiple lentigines. RASopathies are characterized by distinctive craniofacial features and multisystem involvement. Congenital heart disease is a significant cause of morbidity. Neurodevelopmental difficulties are common across the spectrum and may be particularly pronounced in Cardiofaciocutaneous and Costello syndromes. Short stature, pectus anomalies, scoliosis, and other musculoskeletal findings are also recurrent features. Another important concern is the malignancy risk, which varies significantly by genotype. Although these disorders share a common pathway, genotype-phenotype correlations are increasingly relevant in daily practice. Molecular findings now directly inform risk assessment and long-term follow-up. In parallel, early experience with pathway-directed therapies is beginning to influence the management of selected complications. MEK inhibitors have shown promising results in selected manifestations, particularly hypertrophic cardiomyopathy and refractory lymphatic complications. In this review, we discuss the biological organization of the RAS/MAPK pathway and relate it to the clinical spectrum of RASopathies. We focus on shared and distinguishing phenotypic features, clinically relevant genotype-phenotype correlations, and the emerging role of targeted therapies.
Hepatosplenomegaly in children: A gateway to inherited metabolic disorders
Objective: Hepatomegaly and/or splenomegaly (HSM) are common clinical findings with a broad differential diagnosis, including infectious, hematologic, malignant, and inherited metabolic diseases. Although inborn errors of metabolism (IEM) are rare, they constitute critical and often treatable causes of HSM. This study aimed to evaluate pediatric patients presenting with hepatomegaly and/or splenomegaly for underlying metabolic disorders and to identify diagnostic indicators that may facilitate early recognition and appropriate management of IEM. Materials and Methods: This retrospective study evaluated 223 children presenting with hepatomegaly, splenomegaly, or hepatosplenomegaly between June 2023 and October 2025 at a pediatric metabolic clinic. Only those with genetically confirmed diagnoses of IEM were included in the final cohort. Clinical features and laboratory findings were evaluated. Results: Twenty-seven patients (15.4%) received a confirmed IEM diagnosis. The most frequent disorders were glycogen storage diseases (n=13, 7.4%), followed by Gaucher disease (n=6, 3.4%), acid sphingomyelinase deficiency (n=3, 1.7%), and single cases of Niemann-Pick type C, Mucopolysaccharidosis type II, GM1 gangliosidosis, hereditary fructose intolerance, and galactosemia. Consanguinity was present in 84.6%, and characteristic systemic findings such as hypoglycemia, hyperlipidemia, cytopenias, cholestasis, neurological involvement, or coarse facies served as critical diagnostic clues. Conclusion: Inborn errors of metabolism should be considered in children presenting with hepatomegaly and/or splenomegaly, particularly in the presence of accompanying systemic findings, especially in regions with high consanguinity rates. Recognition of diagnostic clues may facilitate earlier referral, reduce diagnostic delays, and enable timely initiation of disease specific treatments, including enzyme replacement therapy or dietary modification.
Maternal iron status in mothers of infants with ventricular septal defect: A retrospective case–control study
Objective: Maternal nutrition is increasingly recognized as a modifiable determinant of fetal cardiovascular development. Experimental and epidemiological studies suggest that iron deficiency may contribute to congenital heart disease, but data focusing on ventricular septal defect (VSD) remain limited. This study aimed to evaluate the association between maternal iron status and isolated perimembranous VSD in offspring. Materials and Methods: This single-center retrospective case–control study included mothers of 41 infants younger than one year with isolated perimembranous VSD and 38 control mothers whose infants had no structural heart disease after echocardiographic evaluation. Maternal laboratory parameters were retrieved from electronic medical records, and the earliest available results were used for analysis. Evaluated parameters included hemoglobin, ferritin, vitamin B12, folate, and 25-hydroxyvitamin D. Group comparisons were performed using the Mann–Whitney U test or chi-square test, as appropriate. Binary logistic regression was used to assess independent associations with VSD, and receiver operating characteristic analysis was performed for ferritin. Results: Maternal ferritin levels were significantly lower in the VSD group than in controls (median 25.8 [IQR 15.5–52.0] vs 57.9 [IQR 21.3–79.3] ng/mL, p=0.012), whereas maternal hemoglobin, vitamin B12, folate, and vitamin D levels did not differ significantly. In multivariable logistic regression adjusted for maternal age, hemoglobin, vitamin B12, and folate, ferritin remained independently associated with VSD (OR 0.83 per 10-ng/mL increase, 95% CI 0.72–0.96, p=0.012). Ferritin showed moderate discriminative ability for VSD (AUC 0.665, 95% CI 0.537–0.781). Conclusion: Lower maternal ferritin levels were associated with isolated perimembranous VSD in offspring, independent of hemoglobin levels. These findings suggest that reduced maternal iron stores may be relevant to fetal septal development and warrant confirmation in prospective studies with measurements obtained during early pregnancy.
Comment on “Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors”
Foreign body reaction following social media-driven skincare trend: A case report in an adolescent
Social media has become a major channel for the rapid spread of unverified health information. Hyaluronic acid (HA), widely used as a dermal filler under controlled conditions, is also promoted in skincare content online. Improper or unsupervised administration may result in foreign-body reactions and infectious complications, posing a risk especially to adolescents influenced by such trends. A 16-year-old female presented with acute facial swelling and erythema after self-injecting a commercially available topical serum containing 1% hyaluronic acid into the nasal dorsum using a 21G syringe, imitating a social media video. Examination revealed multiple nasal injection sites with marked edema extending to the eyelids and infraorbital region, while systemic findings and laboratory tests were normal. She was treated with intravenous corticosteroid and antihistamine, followed by oral methylprednisolone, cetirizine, and amoxicillin–clavulanate. During the two-week follow-up, inflammatory findings had regressed without sequelae. This case emphasizes the dermatological risks of unscientific cosmetic practices promoted on social media. Adolescents represent a particularly vulnerable group, underscoring the need for clinician awareness and preventive education regarding unsafe procedures outside medical supervision.
Investigation of the relationship between motor performance and sensory processing skills and quality of life in preschool children with type 1 diabetes
Objective: The aim of this study was to examine the relationship between motor performance and sensory processing skills and quality of life in preschool children with type 1 diabetes (T1DM). Materials and Methods: The study included children with T1DM aged between 60 and 78 months. Sociodemographic information of the children was recorded. Motor performance were assessed using the “Bruininks-Oseretsky Motor Competency Test 2 (BOT 2),” sensory processing skills using the “Sensory Processing Scale (SPM) House Form,” and quality of life using the “Children’s Quality of Life Scale (CQL). Results: A total of 20 children with T1DM were included in the study. In the relationship between BOT 2 and CQL, the following BOT 2 parameters were found to be associated with CQL; fine motor sensitivity [physical functioning (r=-0.510, p=0.020), school functioning (r=-0.580, p=0.010), and total CQL score (r=-0.550, p=0.010)], fine motor integration [emotional functioning (r=-0.450, p=0.040), psychosocial health (r=-0.570, p=0.010), and total CQL score (r=-0.520, p=0.010)], hand dexterity [school functioning (r=-0.480, p=0.020)], and bidirectional coordination [physical functioning (r=-0.450, p=0.040)]. A moderately positive correlation was found between physical functionality and the SPM parameters body awareness (r=0.049, p=0.020), planning and ideation (r=0.047, p=0.030), and total SPM score (r=0.450, p=0.040). A moderately positive correlation was found between planning and ideation and the total CQL score (r= 0.440, p= 0.040). Conclusion: In preschool children with T1DM, impairments in motor skills and sensory processing abilities are associated with quality of life. It is recommended to assess motor performance and sensory processing skills in early childhood.
Platelet indices as predictors of late-onset sepsis and mortality in thrombocytopenic neonates: A retrospective cohort study
Objective: Late-onset neonatal sepsis (LOS) is frequently complicated with thrombocytopenia. The aim of this study was determine the prevalence of LOS, and whether platelet indices affect LOS and mortality in neonates with thrombocytopenia in the neonatal intensive care unit (NICU) population. Materials and Methods: This retrospective observational cohort study included neonates admitted to a level 4 NICU between 2018 and 2022 who developed thrombocytopenia (platelet count <150×10⁹/L). Platelet indices were recorded during thrombocytopenic episodes preceding or coinciding with late-onset sepsis (LOS). Multivariable logistic regression and Cox proportional hazards models were used. Results: A total of 223 (13.3%) thrombocytopenic neonates were included in the study. According to multivariable logistic regression analysis, multiparity (OR: 3.32 95% CI 1.40-7.89, p=0.006), caesarean section (OR: 5.81, 95% CI 1.99-16.89, p<0.001), invasive ventilation (OR: 8.43 95% CI 3.60-19.75, p<0.001, high MPV levels (OR: 1.62 95% CI 1.24-2.12, p<0.001) and duration of thrombocytopenia (OR: 1.13 95% CI 1.06-1.20, p=0.001), duration of hospitalization (OR: 1.03 95% CI 1.01-1.05, p=0.004) were independently associated with the development of LOS. Multivariable Cox hazard modelling demonstrated that invasive ventilation (HR: 9.459, 95% CI 3.38-26.45, p<0.001), platelet transfusion (HR: 2.833 95% CI 1.54-5.20, p=0.001), lymphopenia (HR: 0.766, 95% CI 0.64-0.92, p=0.003), grade 2≥ of NEC (HR: 7.274, 95% CI 1.68-31.52, p=0.008), any type of haemorrhage (HR: 2.728, 95% CI 1.69-9.10, p=0.001), platelet nadir (HR: 0.972, 95% CI 0.96-0.98, p<0.001), MPV (HR: 0.805, 95% CI 0.66-0.98, p=0.032), and lymphopenia (HR: 0.745, 95% CI 0.63-0.89, p=0.001) independently predicted overall mortality. Conclusion: Key findings indicate that larger platelet sizes, prolonged thrombocytopenia, and extended hospitalization are linked to late neonatal sepsis. Furthermore, lower platelet levels characterized by smaller platelet sizes and the necessity for platelet transfusions may also contribute to these adverse outcomes.
Experience with peripherally inserted central catheters in very low birth weight neonates: Indications, complications, and clinical outcomes
Objective: Vascular access is a critical factor in the monitoring and treatment of neonates requiring intensive care. In this context, peripherally inserted central catheters (PICCs) are one of the primary methods for safely and for extended periods in neonates, compared to traditional central vascular access routes. This study aimed to evaluate the indications and complications of PICC placement and to raise awareness of the development and implementation of protocols to prevent complications. Materials and Methods: In this study, after obtaining approval from the Ethics Committee, the indications, compositions, and clinical outcomes of patients born at Mersin City and Education Hospital between 01.01.2024-01.10.2025, weighing ≤1500 g and those who had peripheral central catheters left in place, were evaluated retrospectively. Results: A total of 89 patients were included in the study. Forty-nine cases were male (44.9 %). Forty-nine of the cases were 28 weeks of gestation or less. Thirty-three cases were inserted due to prematurity, forty-two due to feeding difficulties, and three due to pre/post-operative complications. The median PICC placement day was 5 d (4-12.5), and the median weight was 1020 g (780-1310). Nineteen cases developed complications related to PICCs. Among the complications, phlebitis was the most common (47.4%). Four patients required catheter removal due to infection. Nine patients (10.1%) died. Eighty patients (89.9%) were discharged after recovery. Conclusion: Peripherally inserted central catheters play a crucial role in neonatal intensive care by providing reliable, long-term venous access in neonates. When used with appropriate indications, strict aseptic technique, and standardized care protocols, they provide a healthy and safe vascular pathway for newborns with low complication and infection rates. A specialized team approach, guided by protocols, can enhance the quality of care in the neonatal intensive care unit.
Tracheostomy in pediatric intensive care: A comprehensive overview of indications, clinical outcomes, and the role of palliative care
Objective: Tracheostomy is frequently required in pediatric intensive care units (PICUs), particularly for children with complex neurological or respiratory conditions. This study aimed to evaluate the indications, outcomes, and the role of pediatric palliative care (PPC) services in the post-tracheostomy management of pediatric patients. Materials and Methods: This retrospective, single-center study included 42 pediatric patients (0–18 years) who underwent their first tracheostomy in the PICU between January 2020 and November 2024. Demographics, clinical indications, complication rates, palliative care utilization, and discharge outcomes were analyzed descriptively. Results: The median age was 2 (0–11.25) years, with 66.7% male patients. Prolonged intubation was the most common indication (66.7%), followed by subglottic stenosis and neuromuscular causes. Tracheostomy-related complications occurred in 40.4% of patients. Remarkably, 95.2% were transferred to the PPC unit, where they stayed for a median of 21 days. Discharge to home was achieved in 88.1% of patients, and overall mortality was 11.9%, with no deaths directly attributable to tracheostomy. Among discharged patients, 60.5% required home mechanical ventilation. Conclusion: This study highlights the critical role of PPC services in facilitating safe discharge and optimizing outcomes for children undergoing tracheostomy. The high home discharge rate and low mortality underscore the benefits of a structured, multidisciplinary care model. Integration
Factors affecting mortality in patients during postoperative follow-up after cardiac surgery in a pediatric intensive care unit
Objective: Congenital heart diseases (CHD) frequently necessitate cardiovascular surgery (CVS) in pediatric patients. This study aimed to evaluate postoperative complications following CVS and to investigate their association with mortality. Materials and Methods: In this retrospective study, the medical records of 124 patients who underwent CVS and were subsequently monitored in the pediatric intensive care unit were reviewed. Results: Among the 124 patients who underwent cardiovascular surgery, 52.4% (n=65) were male. The median age was 7 months (range, 2–71). Ventricular septal defect closure (n=49) and complete atrioventricular septal defect repair (n=15) were the most frequently performed procedures. Twenty-seven patients had chromosomal anomalies, most commonly Down syndrome. No postoperative complications were observed in 95 patients. The most common complications were atelectasis, arrhythmia, and subcutaneous emphysema. Extracorporeal therapy was administered to 12 patients. Overall mortality was 8.8% (n=11). Preoperative pulmonary hypertension (PHT) was the most common cause of death. Among the deceased patients, additional factors associated with mortality include infection and lower albumin levels, while nitric oxide therapy and intraoperative cardiopulmonary bypass use were also more common, possibly reflecting greater clinical severity. Conclusion: As the use of cardiovascular surgery for CHD continues to increase in pediatric patients, optimizing intraoperative management and promptly identifying postoperative complications are crucial for improving survival outcomes.
Clinical characteristics of juvenile systemic lupus erythematosus: Prepubertal and pubertal onset
Objective: Systemic lupus erythematosus (SLE) is a chronic autoimmune disease that affects multiple organ systems and is characterized by periods of flare-ups and remission. In approximately 15-20% of SLE patients, clinical symptoms onset during childhood or adolescence and are defined as juvenile SLE (jSLE). Age at disease onset has been suggested to influence the clinical phenotype, severity of inflammatory activity, and overall disease course in jSLE. The aim of this study was to compare clinical features and disease course between prepubertal (<10 years) and pubertal (≥10 years) jSLE patients. Materials and Methods: This retrospective, single-center, cross-sectional study was conducted on patients diagnosed with jSLE who were followed up at the pediatric rheumatology clinic between January 2015 and September 2025. Patients included in the study had been diagnosed with jSLE according to the 2012 Systemic Lupus International Collaborating Clinics classification criteria. Results: A total of 54 patients with juvenile-onset SLE were included, of whom 88.9% were female. Patients were grouped according to age at diagnosis: prepubertal-onset jSLE (<10 years) included 9 patients (16.7%), and pubertal-onset jSLE (≥10 years) included 45 patients (83.3%). Fever and elevated C-reactive protein levels were significantly more common in jSLE with pre-pubertal onset, whereas mucocutaneous involvement was more prevalent in jSLE with pubertal onset. Renal, hematological, and neurological involvement, autoantibody profiles, and disease activity and damage index at diagnosis were similar across groups. At the last visit, disease activity was significantly lower in jSLE with pre-pubertal onset. No differences in treatment were observed between age groups. Conclusion: In this cohort, prepubertal-onset jSLE tended to present with more prominent inflammatory features, whereas pubertal-onset jSLE more often showed mucocutaneous involvement. Despite these observed phenotypic differences, cumulative organ damage appeared similar between groups.
The role of essential fatty acid deficiencies in cognitive function among patients with organic acidemias
Objective: Organic acidemias (OAs) are metabolic disorders characterized by enzyme deficiencies that impair amino acid catabolism, leading to metabolic imbalances. Essential fatty acids (EFAs), particularly Omega-3 and Omega-6, are vital for cellular and neurological functions but are often affected by protein-restricted diets used in OA management. The aim of this study was to evaluate the plasma EFA levels in OA patients and explores their clinical relevance. Materials and Methods: A prospective, case-control design was adopted, including 26 OA patients (methylmalonic acidemia, propionic acidemia, isovaleric acidemia, maple syrup urine disease) and 22 healthy age- and gender-matched controls. Plasma EFA levels were quantified via gas chromatography-mass spectrometry. Cognitive and psychiatric evaluations were performed using standardized tests, including DSM-V-TR criteria, Wechsler Intelligence Scale for Children, and other psychometric tools. Statistical analyses assessed the relationships between EFA levels and clinical findings. Results: Organic acidemias patients exhibited significantly lower levels of docosahexaenoic acid (DHA), eicosapentaenoic acid (EPA) + DHA, and Omega-3 compared to controls, with higher Omega-6/Omega-3 ratios. Despite these findings, no significant correlations emerged between EFA levels and cognitive or psychiatric outcomes. Conclusion: EFA deficiencies are prevalent among OA patients on protein-restricted diets, underscoring the potential need for targeted nutritional interventions. However, the absence of a direct association with clinical findings suggests multifactorial influences on disease outcomes. Future research should explore the longitudinal effects of EFA supplementation and its role in mitigating neurodevelopmental impairments in OA.
Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors
Objective: Congenital adrenal hyperplasia (CAH) is a group of inherited disorders of adrenal steroidogenesis that may predispose affected patients to hypertension through both disease- and treatment-related mechanisms. Although hypertension represents an important comorbidity in CAH, its prevalence and contributing factors in the pediatric population, particularly across different CAH subtypes, remain incompletely defined. The aim of this study was to evaluate the prevalence and determinants of hypertension in patients with CAH. Material and Methods: This retrospective, single-center study included 143 children and adolescents aged 1–21 years with a confirmed diagnosis of CAH who were followed at a tertiary pediatric center. Blood pressure measurements obtained during routine outpatient visits were evaluated according to age-, gender-, and height-specific pediatric reference values. Patients were classified by CAH subtype, and demographic, clinical, and treatment-related characteristics were compared between patients with and without hypertension. Correlations between blood pressure levels and clinical parameters were analyzed. Results: A total of 143 patients with CAH (female-to-male ratio, 1.38) were included, with a median follow-up duration of 111.33 months (IQR; 144.70). Hypertension was diagnosed in 15 patients (10.5%). The prevalence of hypertension differed significantly according to CAH subtype (p<0.001), with the highest rate observed in patients with 11β-hydroxylase deficiency (88.8%), followed by those with 21-hydroxylase deficiency (8.4%). No cases of hypertension were observed in other CAH subtypes. Patients with hypertension received significantly higher hydrocortisone doses compared with normotensive patients (p=0.012), while fludrocortisone dose did not differ between groups. Blood pressure levels showed strong correlations with age at last visit and moderate correlations with follow-up duration and body mass index. Hypertensive cardiomyopathy was detected in 40% of hypertensive patients and was more frequent in those with 11β-hydroxylase deficiency. Conclusion: Hypertension is a relevant clinical finding in children with CAH and is closely associated with disease subtype, particularly 11β-hydroxylase deficiency. Long-term follow-up, regular blood pressure monitoring and careful evaluation of glucocorticoid exposure may be important for cardiovascular risk assessment in this population.
Ferritin/erythrocyte sedimentation rate ratio in macrophage activation syndrome in patients with systemic juvenile idiopathic arthritis: A single center experience
Objective: Systemic juvenile idiopathic arthritis (JIA) is a subgroup of JIA that can involve multiple systems other than the joints. Macrophage activation syndrome (MAS) is a life-threatening condition that can be observed in patients with systemic JIA. The aim of this study was to evaluate the performance of the ferritin/erythrocyte sedimentation rate (ESR) ratio, a diagnostic parameter for MAS, in our cohort. Materials and Methods: Children with systemic JIA who were followed in our hospital’s pediatric rheumatology department and diagnosed with MAS were retrospectively recorded for the presence or absence of MAS. The performance of the ferritin/ESR ratio between these patient groups was analyzed. Results: The study included 45 patients with systemic JIA without MAS and 11 patients with systemic JIA with MAS. No differences were observed between the two groups in terms of age, gender, and follow-up duration (p =0.121, p = 0.547, and p = 0.495, respectively). The JADAS-27 score, which includes rash, hepatomegaly, splenomegaly, and disease activity score, was significantly higher in the systemic JIA group with MAS (all p<0.050). The ferritin/ESR ratio was significantly higher in systemic JIA patients who developed MAS [247.71 (36.23-886.66) vs. 31.47 (0.39-555.55); p<0.001]. A ferritin/ESR ratio of >38.84 had 100% sensitivity and 73.3% specificity for the development of MAS in patients with systemic JIA. Conclusion: A ferritin/ESR ratio of (>)38.84 had high sensitivity and specificity for predicting the development of MAS in patients with systemic JIA in our cohort.
A comprehensive clinical and microbiological profile of culture-positive urinary episodes in children with acute lymphoblastic leukemiaurinary leukemia
Objective: This study aimed to assess the frequency, causative microorganisms, antimicrobial resistance patterns, and unusual clinical and laboratory findings of culture-positive urinary episodes throughout the entire chemotherapy course in pediatric patients with Acute Lymphoblastic Leukemia (ALL). Material and Methods: We reviewed the medical records of 93 pediatric ALL patients who completed BFM-based chemotherapy protocols between 2019 and 2025. A total of 1265 urine cultures were analyzed. Culture positivity was defined as ≥105 colony-forming units per milliliter (CFU/mL) of a single or two different pathogens. For retrospective analysis, contamination was defined by a negative control culture within 48–72 hours or clinical resolution without antibiotic treatment. Data on urinalysis, neutropenia status, and antibiotic resistance were collected. Results: Forty-eight patients (51.6%) experienced a median of two culture-positive episodes. Incidence was highest during intensive treatment phases (induction, reinduction). Escherichia coli was the most common agent (39.8%), followed closely by Klebsiella pneumoniae (36.7%). Overall ESBL positivity was 26.6%. A concerning 30.6% of K. pneumoniae isolates showed carbapenem resistance. Standard urinalysis was found to be unreliable, with 71.4% of positive cultures lacking typical findings; leukocyturia was only present when the absolute neutrophil count was relatively preserved. Three cases of urosepsis (3%) were identified, all involving highly resistant organisms. Conclusion: Pediatric ALL patients, particularly during intense chemotherapy, face a high burden of culture-positive urinary episodes and a notable shift towards multidrug-resistant non-E. coli pathogens like K. pneumoniae. The unreliability of standard urinalysis in this immunocompromised population necessitates the routine collection of urine cultures during febrile neutropenia workups, irrespective of symptoms, to ensure timely, targeted therapy guided by local resistance data. The observed extreme resistance profile appears to be a transient reflection of the intensive chemotherapy environment.
Radiological evaluation of Chiari 1 malformation: Diagnostic findings and postsurgical imaging
Objective: Chiari 1 malformation is a congenital anomaly characterized by downward displacement of the cerebellar tonsils through the foramen magnum. Surgical decision-making in Chiari 1 largely depends on clinical symptoms and imaging findings, particularly the presence of headache and syringohydromyelia. This study aimed to evaluate the radiological characteristics and postoperative imaging changes in pediatric patients with Chiari 1 and Chiari 1.5 malformations. Material and Methods: This retrospective study included 101 pediatric patients (age range; 1–18 years) diagnosed with Chiari 1 or Chiari 1.5 based on brain and cervical spine MRI findings between November 2022 and April 2025. Clinical and radiological data, including tonsillar descent, syringomyelia, craniovertebral junction anomalies, and basal angle measurements were analyzed. Twenty-one patients underwent posterior fossa decompression and postoperative MRIs were evaluated at 3 and 6 months. Statistical analyses were performed using chi-square, Mann–Whitney U, Wilcoxon signed-rank, and McNemar tests, with p <0.050 considered significant. Results: Among the 101 patients, 52 (51%) were female, and 49 (49%) were male (mean age; 11.1±4.9 years). Headache was significantly more frequent in operated patients (66.7% vs. 32.5%, p=0.014). Syringomyelia was also more common in the surgical group (33.3% vs. 3.8%, p <0.001), and tonsillar descent was greater (14.3±5.3 mm vs. 9.5±3.6 mm, p<0.001). No significant differences were found between the groups regarding age, sex, basal angle, or foramen magnum diameter. Postoperative follow-up revealed regression of syrinx dimensions and clinical improvement in all operated patients. Conclusion: Headache, syrinx formation, and greater tonsillar descent are key radiological and clinical predictors of surgical intervention in pediatric Chiari 1. While craniovertebral junction anomalies and hydrocephalus may coexist, they appear less predictive of surgical necessity. Posterior fossa decompression remains a safe and effective treatment in symptomatic pediatric patients, leading to both clinical and radiological improvement.
Anxiety disorder of hypertensive children and burnout levels of their families
Objective: Our study focused on assessing the anxiety levels of children and adolescents being monitored for hypertension (HTN), as well as the burnout levels experienced by their caregivers. Material and Methods: The study included 67 patients, aged 12 and older, who were monitored for HTN as the study group, and 60 children and adolescents, matched for gender and age, without chronic illnesses, were selected from the pediatric outpatient clinic for routine check-ups to serve as the control group. The State Anxiety Inventory (STAI-1), Trait Anxiety Inventory (STAI-2), and Beck Anxiety Inventory (BAI) were applied to the children, while the Maslach Burnout Inventory (MBI) was applied to their parents. Results: We found the mean STAI-1 scores of the study group lower than the control group (43.6±6.4 vs. 51.6±15.4; p <0.001). However, no difference was detected between these groups in terms of the STAI-2 scores (p= 0.140). The median BAI scores were higher in study group than control group (10.0 vs.6.5; p=0.010) but no significant difference have been found in terms of severity of anxiety (p=0.170). There was no difference in caregivers between the emotional exhaustion (MBI-EE) and personal accomplishment (MBI-PA) subscale scores of the MBI of the caregivers (p=0.280, p=0.340 respectively). Conclusion: Our study revealed low anxiety levels among HTN patients and low burnout scores in their families. However, we believe that continuous psychiatric support for both patients and their families may be essential for managing chronic conditions, indicating the need for further research in this area regard.
Recurrent isolated torsion of fallopian tube in premenarcheal 12-year-old girl
Isolated torsion of the fallopian tube is an uncommon event. It is a difficult condition to evaluate clinically and surgery is often necessary to establish the diagnosis. In this case report, a 12 year old female isolated fallopian tube torsion (ITT) -a rare condition in the pediatric age group requiring laparoscopic surgery due to recurrance- is presented with acute pelvic pain, nausea, and vomiting. A diagnostic laparoscopy was performed which confirmed the diagnosis of isolated tubal torsion. Based on this experience as well as other similar reported cases, isolated torsion of the fallopian tube should beconsidered in the differential diagnosis of acute lower abdominal/pelvic pain in the female patient. Prompt surgical intervention may allow for preservation of the tube.
Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis
Objective: Seasonal allergic rhinitis (SAR) is one of the most common allergic diseases in childhood and is characterized by nasal congestion, rhinorrhea, sneezing, and itching. Beyond these classical nasal symptoms, SAR may also be associated with sleep disturbances. The present study aimed to determine the prevalence of sleep disturbances in children with SAR and to evaluate potential clinical predictors, including symptom severity, symptom timing, and comorbid allergic diseases. Material and Methods: Children aged 6–16 years with seasonal allergic rhinitis (SAR) who were followed at the Pediatric Allergy and Immunology Department of Ankara City Hospital were enrolled in the study. An age- and demographically matched control group was also recruited. Sleep disturbances were assessed using the Sleep Disturbance Scale for Children (SDSC). SAR severity was classified according to the Allergic Rhinitis and Its Impact on Asthma (ARIA) guidelines, and symptom intensity was further evaluated using a visual analog scale (VAS). Logistic regression analysis was performed to identify independent predictors of SDSC-defined sleep disturbances. Results: A total of 115 children with SAR (mean age: 11.6±3.2 years; 61.7% male) and 115 healthy controls were included. According to SDSC, 43.3% of children with SAR had clinically significant sleep disturbances. Compared with controls, children with SAR had significantly higher SDSC total scores (63.4±15.5 vs. 53.9±12.2; p < 0.001) and higher scores across all subscales. In multivariate logistic regression, an elevated nasal VAS score remained an independent predictor of sleep disturbances (OR: 1.86; 95% CI: 1.06-2.41; p=0.020). Conclusion: Sleep disturbances were more prevalent in children with SAR than in healthy controls, and greater nasal symptom severity was independently associated with impaired sleep quality. Incorporating routine sleep quality assessment into the clinical evaluation of children with SAR may improve disease management and contribute to better overall quality of life.
Feeding problems in preterm infants: Associations with perinatal risks and development
Objective: This study aimed to examine behavioral feeding difficulties in preterm infants compared with term infants and to explore how perinatal risk factors, birth weight, and developmental outcomes are associated with feeding problems in preterm infants. Material and Methods: A total of 107 infants aged 18–24 months were included, comprising 60 preterm and 47 term infants. Feeding behavior was assessed using the Behavioral Pediatrics Feeding Assessment Scale (BPFAS), and developmental status was evaluated with the Bayley Scales of Infant and Toddler Development–Third Edition (Bayley-III). Preterm infants were further classified as small (SGA), appropriate (AGA), or large (LGA) for gestational age and perinatal risk levels were based on National Neonatology Association guidelines. Results: Sociodemographic characteristics were comparable between groups. No significant differences were observed between preterm and term infants across any BPFAS domains, although preterm infants tended to show slightly higher scores. Within the preterm group, Bayley-III composite and subscale scores were not correlated with BPFAS outcomes. However, SGA infants demonstrated significantly higher total frequency, total problem, and poor strategies scores than their AGA and LGA peers (p = 0.021, p=0.023, p=0.032, respectively). BPFAS scores did not differ significantly by perinatal risk classification, though higher values were consistently observed in the high-risk group. Conclusion: Feeding difficulties in preterm infants likely result from the interplay of biological, developmental, and environmental factors. Within this context, SGA infants may be particularly susceptible, with potential implications for later growth and metabolic health. Early identification and holistic, multidisciplinary follow-up that integrates nutritional, developmental, and family-centered care are essential to support healthy feeding patterns and prevent long-term complications.
Social pediatrics internship students’ perspectives on the Covid-19 pandemic’s effects on children
Objective: Social pediatrics evaluates children’s health within the context of society, environment, education, and family, employing a global, holistic, and multidisciplinary approach to child health. Our study aimed to explore the viewpoints and attitudes of fifth-year medical students who completed the Social Pediatrics Internship Education Program regarding the effects of the COVID-19 pandemic on children. Material and Methods: We asked medical students to write about the most common effects of the COVID-19 pandemic on children from their perspective using a Google Form. Subsequently, we employed both quantitative and qualitative methodologies to analyze the responses provided by the medical students. Results: Overall, 246 students voluntarily participated in the study and wrote a total of 1722 items. The medical students predominantly addressed the impact of the COVID-19 pandemic on various facets of children’s well-being, including development, physical activity, community/social dynamics, physical health, mental health, safety, healthcare access and provision, and infectious diseases. Conclusion: This study highlights the ability of medical students who undertook the Social Pediatrics programme to demonstrate empathy and adopt a social pediatrics perspective when examining the impact of COVID-19 on children.
Pediatric unintentional injuries in emergency care: A three-year retrospective study from a tertiary care center
Objective: Pediatric unintentional injuries are a major public health concern, as most are preventable. This study aimed to assess emergency department cases by etiology, demographics, seasonal distribution, and outcomes, to define the regional profile and guide prevention. Material and Methods: This retrospective study included 2524 children aged 0–18 years admitted with unintentional injuries between January 2021 and June 2024. Cases were classified as trauma, poisoning/aspiration, environmental injuries, or other causes. Results: Of the cases, 1454 (57.6%) were male, median age 47 months. Poisoning/aspiration was most common (n=1153; 45.6%), followed by trauma (n=840; 33.2%), environmental injuries (n=473; 18.7%), and others (n=62; 2.4%). Poisonings predominated in 0–5 years, while trauma was more frequent in adolescents. Leading poisoning causes were drugs (n=516; 20.4%) and corrosives (n=441; 17.5%). Carbon monoxide poisoning was notable among environmental injuries (n=267; 10.6%). Most patients were discharged (80.6%), while 14.5% were hospitalized, 3.7% required intensive care, and 5.5% underwent surgery. Mortality and sequelae were each 0.3%. Seasonal variation was evident: poisonings in spring–summer, trauma in summer–autumn, and carbon monoxide in winter. Conclusion: Poisonings were the leading cause in early childhood, while trauma predominated in adolescents. Preventive strategies, including parental education, household safety, and region-specific policies, are essential to reduce morbidity and mortality.
Bowel habit changes in children with PFAPA Syndrome: Before and after treatment evaluation with the Bristol Stool Scale
Objective: Periodic Fever, Aphthous Stomatitis, Pharyngitis, and Adenitis (PFAPA) syndrome is one of the most common autoinflammatory diseases of childhood. Although gastrointestinal system (GIS) complaints are reported, bowel habits have not been objectively evaluated in these patients. This study investigated changes in bowel habits before and after treatment in children with PFAPA using the Bristol Stool Scale and daily stool frequency. Materials and Methods: We included 101 children diagnosed with PFAPA according to the EUROFEVER/PRINTO criteria. Clinical, laboratory, daily stool frequency, and stool form were evaluated during febrile attacks before and after treatment. Stool form was evaluated using the Bristol Stool Scale and classified as hard (types 1–3), normal (type 4), and loose (types 5–7). Results: Following treatment, median daily stool frequency during attacks decreased (2 [0.25–10] vs. 1 [0.25–6]; p=0.008), while stool form assessed by the Bristol Stool Scale remained unchanged (4 [1–7] vs. 4 [1–7]; p=0.943). No significant difference was observed in stool consistency categories (p=0.174). In the probiotic group, patients with normal stool form increased from 53.6% (n=15) pre-treatment to 57.1% (n=16) post-treatment. Conclusion: To our knowledge, this study is the first to objectively evaluate bowel habits in children with PFAPA syndrome. Following treatment, stool frequency during episodes decreased significantly, while stool form remained unchanged. These results indicate that post-treatment alterations in bowel habits are primarily related to stool frequency. Future studies incorporating fecal biomarkers may provide further insights into gastrointestinal involvement and potential subclinical intestinal inflammation in PFAPA.