Turkish Journal of Pediatric Disease
type: channel
publisher: Ankara Bilkent City Hospital, Children’s Hospital
language: en
publication name: Turkish Journal of Pediatric Disease
issn: 1307-4490
copyright: This is an open access article distributed under the Creative Commons Attribution License (CC BY), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.
items: Response to comments “ Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis”
items: Comment on ‘‘Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis’’
items: Clinical course and prognosis of acute post-streptococcal glomerulonephritis in children: A single-center experience
items: Robotic-assisted Kasai portoenterostomy in biliary atresia: A case report and technical considerations
items: Comparison of febrile neutropenia episodes and outcomes in Turkish versus refugee children with cancer: A single-center experience
items: Retrospective analysis of child patients diagnosed with scabies, which is frequently confused with atopic dermatitis, in the Şırnak region
items: Comment on “Clinical and laboratory characteristics of nephropathic cystinosis in a resource-limited region”: linear growth retardation as a clinically important signal
items: Comment on “Clinical and laboratory characteristics of nephropathic cystinosis in a resource-limited region”
items: Altered heart rate variability and ventricular repolarization in children with mitral valve prolapse
items: Pediatricians’ knowledge of pediatric Mycoplasma pneumoniae infection in the post–COVID-19 period: A single-center cross-sectional survey from Türkiye
items: Pediatric benign transient hyperphosphatasemia: Clinical course and inflammatory ratios
items: From stomach to liver: The impact of Helicobacter pylori gastritis on pediatric hepatic steatosis
items: Pediatric perioperative management: An integrated review of preoperative evaluation, fasting protocols, postoperative nausea and vomiting, and postoperative pain in light of current guidelines
items: Comment on “Levetiracetam in childhood epilepsy: Expanding the evidence base”
items: Response to the Letter entitled “Comment on Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors”
items: Parental broader autism phenotype and its association with adolescent social anxiety
items: Assessing the training needs of pediatric healthcare professionals in communication, risk management, and psychosocial resilience
items: Family relationships in the digital age: The impact of problematic screen use on parent–adolescent relationships
items: Psychosocial outcomes in healthy siblings of children with celiac disease: A controlled cross-sectional study
items: Hematological markers of systemic inflammation potentially associated with migraine in pediatric patients
items: The role of fetuin-A in adolescent obesity: Association with anthropometric and metabolic parameters
items: Beyond the threshold of viability: Mortality, morbidity, and critical prognostic cut-offs in infants born at 22–26 weeks of gestation
items: https://turkjpediatrdis.org/article/view/1315
items: Surgical management of ductal origin of the right pulmonary artery in an infant
items: Diagnostic discrimination of C-reactive protein and blood count-derived indices for concurrent urinary tract infection in pediatric urolithiasis
items: Improving time to antibiotic administration in febrile neutropenia: A quality improvement initiative in a pediatric oncology inpatient unit
items: Germinal Matrix-intraventricular hemorrhage in very preterm infants: Frequency, associated factors, and the role of postnatal clinical course
items: Bone health assessment in children with osteogenesis imperfecta from a pediatric endocrinology perspective
items: RAS/MAPK Pathway and RASopathies
items: Hepatosplenomegaly in children: A gateway to inherited metabolic disorders

Response to comments “ Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis”
type: item
description: We sincerely thank the authors for their thoughtful comments and for their interest in our article entitled “Prevalence and Clinical Predictors of Sleep Disturbances in Children with Seasonal Allergic Rhinitis.” We appreciate their constructive observations, which provide an opportunity to further clarify the interpretation of our findings. The authors raise an important methodological point regarding the potential conceptual overlap between the Allergic Rhinitis and its Impact on Asthma (ARIA) severity classification and the Sleep Disturbance Scale for Children (SDSC). We agree that impaired sleep is one of the components considered when classifying allergic rhinitis as moderate-to-severe according to the ARIA guidelines, and therefore some degree of overlap between disease severity and sleep outcomes is theoretically possible. Regarding the specific question of how many children fulfilled the moderate-to-severe ARIA classification solely because of sleep impairment, this information was unfortunately not available, as we evaluated only the overall ARIA severity classification and did not record the individual criteria contributing to disease severity separately. We agree that evaluating disease severity after excluding the sleep-related criterion would represent a valuable methodological approach and could further clarify this relationship in future studies. The authors also appropriately emphasize that pediatric sleep health is influenced by multiple biological, behavioral, familial, environmental, and developmental factors. We fully agree with this broader perspective. Variables such as screen exposure, physical activity, bedtime routines, and sleep hygiene were not systematically collected, as they were beyond the predefined scope of our study, which primarily focused on the relationship between allergic disease characteristics and sleep disturbances. We acknowledge that these factors may influence sleep quality independently or interact with allergic symptoms,…
subject: Letter to the Editor
  topic: section
creator: Funda Aytekin Güvenir
creator: Enes Kaan Kılıç
creator: Aslı Kuzu Kuşaklı
creator: Tülay Tuğçe Kutsal Gültekin
creator: Zeynep Şangül Emeksiz
creator: Emine Dibek Mısırlıoğlu
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-25
publication date: 2026-08-25
starting page: 1
ending page: 1
doi: 10.12956/TJPD.2026.1417

Comment on ‘‘Prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis’’
type: item
description: In the latest issue of the Turkish Journal of Pediatric Disease, Aytekin Güvenir et al. (1) evaluated the prevalence and clinical predictors of sleep disturbances in children with seasonal allergic rhinitis (SAR). The authors reported that 44.3% of children with SAR had clinically significant sleep disturbances and that the total and subscale scores of the Sleep Disturbance Scale for Children (SDSC) were higher in children with SAR than in healthy controls. In the multivariate analysis, a higher nasal visual analogue scale (VAS) score remained independently associated with sleep disturbances. The study offers useful insight into sleep disturbances among children with SAR. The evaluation of different SDSC subscales also provides valuable information by demonstrating that sleep-related difficulties in these children may extend beyond sleep-related breathing disorders. Apart from the study limitations acknowledged by the authors, we would like to highlight several points that may be relevant when interpreting the findings. The relationship between the ARIA severity classification and sleep outcomes may merit consideration. Since impaired sleep quality is itself one of the criteria used to classify rhinitis as moderate-to-severe, some children may have been assigned to the more severe category partly or solely on the basis of impaired sleep quality. Although the grouping variable in Table III is labelled as “sleep disorders,” the identical number of affected children reported according to the SDSC threshold and in Table III (n=51) suggests that the groups were defined on the basis of SDSC-defined sleep disturbance. This definitional overlap may have contributed to the observed association between rhinitis severity and SDSC-defined sleep disturbance. We would therefore be interested to know how many children met the moderate-to-severe classification because of impaired sleep quality alone or together with other ARIA criteria. It would also be informative to know whether …
subject: Letter to the Editor
  topic: section
creator: Ayşe Mete Yeşil
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-25
publication date: 2026-08-25
starting page: 1
ending page: 2
doi: 10.12956/TJPD.2026.1408

Clinical course and prognosis of acute post-streptococcal glomerulonephritis in children: A single-center experience
type: item
description: Objective: This study aimed to evaluate the impact of clinical and laboratory findings at presentation on renal function and their predictive value for long-term complications in children diagnosed with acute post-streptococcal glomerulonephritis (APSGN). Materials and Methods: Retrospective data of 37 APSGN patients aged 2–18 years, who were followed at the Konya City Hospital Pediatric Nephrology Clinic between January 2023 and January 2026, were analyzed. Clinical symptoms, laboratory parameters, ultrasonography findings, and treatment details were recorded. Results: Macroscopic hematuria was present in 73% of the patients and edema in 27%; approximately 70% of cases presented during the autumn and winter seasons. Patients who developed acute kidney injury (AKI) had significantly higher levels of C-reactive protein (CRP), anti-streptolysin O (ASO) and uric acid (p=0.004, p=0.025 and p=0.035, respectively). Increased renal parenchymal echogenicity on urinary system ultrasonography was observed in all patients with AKI (p=0.012). Hemoglobin levels were significantly lower in patients with nephrotic-range proteinuria (p=0.015). A total of 70.3% of the patients required hospitalization with a mean length of stay of 7.5±3.0 days. During follow-up renal function returned to normal in all patients and proteinuria regressed to normal levels in the majority of patients. Conclusion: Elevated inflammatory markers (CRP, ASO), high uric acid levels and increased renal parenchymal echogenicity are valuable early indicators of AKI in APSGN. Careful assessment of these non-invasive parameters at presentation is crucial for the early identification of high-risk patients and for guiding the management of potential complications.
subject: Research Article
  topic: section
creator: İsa Yılmaz
creator: Mustafa Soran
creator: Emre Leventoğlu
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-28
publication date: 2026-08-28
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1366

Robotic-assisted Kasai portoenterostomy in biliary atresia: A case report and technical considerations
type: item
description: Biliary atresia is a rare and fatal cholestatic disorder characterized by progressive obliteration of the extrahepatic and intrahepatic bile ducts, typically presenting during the neonatal period. Ethology remains uncertain, although immune-mediated injury, viral triggers, and developmental anomalies have been implicated. Kasai portoenterostomy is the primary treatment for biliary atresia, with optimal outcomes achieved when performed within the first 60 days of life. Despite early intervention, many patients experience progressive cirrhosis and portal hypertension. Liver transplantation remains the definitive therapeutic option. The timing of liver transplantation in early infancy remains controversial. A primary concern is increased mortality associated with the inability to administer live childhood vaccines to infants transplanted before six months of age, thereby elevating the risk of subsequent life-threatening infections. A 6-kg infant was diagnosed with biliary atresia and underwent surgery 84 days of age. Robotic-assisted Kasai portoenterostomy was performed to maintain bile flow until transplantation and to minimize adhesion formation, both of which are beneficial for subsequent transplantation. This report presents the technical aspects of the procedure.
subject: Case Report
  topic: section
creator: Sevim Ecem ÜNLÜ BALLI
creator: Gökhan Berktuğ Bahadır
creator: Oğuz Mehmet ÇEVİK
creator: Fatma Bilgecan SİMSEK
creator: Bilge GÖRDÜ
creator: Mehmet Bahadır ÇALIŞKAN
creator: Suzi DEMİRBAĞ
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: 1
ending page: 4
doi: 10.12956/TJPD.2026.1348

Comparison of febrile neutropenia episodes and outcomes in Turkish versus refugee children with cancer: A single-center experience
type: item
description: Febrile neutropenia (FN) is a frequent and potentially life-threatening complication of chemotherapy in pediatric oncology. Refugee and immigrant children are often considered to be at higher risk for adverse infectious outcomes due to socioeconomic disadvantage, substandard living conditions, and language barriers. This study aimed to compare FN episodes and short-term clinical outcomes between refugee/immigrant and Turkish pediatric oncology patients managed within a universal healthcare system. Materials and Methods: This retrospective, single-center study analyzed 50 FN episodes, with one episode included per patient, occurring between May and July 2022 at a tertiary pediatric oncology center. Patients were stratified by residency status as Turkish citizens (n=31) or refugee/immigrant children (n=19), primarily Syrian refugees under temporary protection. Comparative analyses included demographic characteristics, clinical presentation, microbiological findings, treatment characteristics, length of hospital stay (LOS), and socioeconomic parameters. Group comparisons were performed using Chi-square and Mann–Whitney U tests. Results: Refugee families demonstrated significantly greater socioeconomic disadvantage, with 94.7% having household incomes at or below the minimum wage compared with 38.7% of Turkish families (p<0.001). Blood culture positivity was higher among refugee patients (26.3% vs. 3.2%, p=0.024). Despite these differences, no significant between-group differences were observed in length of hospital stay (10.42 days for Turkish vs. 12.05 days for refugee patients, p=0.335), treatment intensity, or antifungal therapy requirements. Short-term FN-related clinical outcomes during hospitalization were comparable between groups. Conclusion: Despite marked socioeconomic and housing disadvantages and higher rates of documented bacteremia, refugee and immigrant children experienced short-term FN outcomes comparable to those of Turkish patients when managed in a …
subject: Research Article
  topic: section
creator: Fatma Burçin Kurtipek
creator: Selma Çakmakçı
creator: Seval Özen
creator: Aysun Yahşi
creator: Arzu Yazal Erdem
creator: Derya Özyörük
creator: İnci İlhan Ergürhan
creator: Aslınur Özkaya Parlakay
creator: Neriman Sarı
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-31
publication date: 2026-08-31
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1345

Retrospective analysis of child patients diagnosed with scabies, which is frequently confused with atopic dermatitis, in the Şırnak region
type: item
description: Objective: This study examined patients referred to the pediatric and pediatric allergy departments of Şırnak State Hospital with preliminary diagnoses of scabies and atopic dermatitis, who were diagnosed with scabies and underwent treatment, as well as the applied treatment and treatment responses. The aim of this study was to contribute to the literature. Materials and Methods: Data from 77 pediatric patients aged 0–18 years who were referred to the Pediatric Allergy and Immunology and Pediatric Health and Diseases outpatient clinics of Şırnak State Hospital with a preliminary diagnosis of scabies or atopic dermatitis between May 2025 and November 2025 were retrospectively reviewed. Demographic characteristics, household size, bed sharing, nocturnal itching, family history of similar complaints, treatment adherence, treatment use by all individuals in the household, hygiene practices, and clinical treatment response were evaluated. Results: The study included a total of 77 child patients, 29 of whom were girls (37.7%) and 48 were boys (62.3%). The youngest patient was 1 year old and the oldest was 17 years old. A total of 35.1 of the cases were treated with a diagnosis of atopic dermatitis at the initial presentation. Itching that woke the patient from sleep at night was observed in 77.9%, and a family history of similar complaints was observed in 67.5%. Bed sharing was observed in 28.6%, and dormitory living in 9.1%. The rate of patients who achieved clinical benefit from Scabies treatment was 59.7%. While no treatment success was achieved in patients who shared a bed, clinical improvement was observed in 83.6% of those who did not share a bed (p<0.001). Failure to use the treatment together among all individuals in the household and failure to comply with hygiene measures were significantly associated with treatment failure (p<0.001). In the logistic regression analysis, household size and a diagnosis of AD at the initial presentation were significantly associat…
subject: Research Article
  topic: section
creator: Mehmet Özkaya
creator: Ceylan Bulat
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-07
publication date: 2026-08-07
starting page: 1
ending page: 6
doi: 10.12956/TJPD.2026.1321

Comment on “Clinical and laboratory characteristics of nephropathic cystinosis in a resource-limited region”: linear growth retardation as a clinically important signal
type: item
description: I read with great interest the article by Köksoy and Görükmez (1). Longitudinal data on nephropathic cystinosis from regions of high consanguinity, with constrained access to leukocyte cystine monitoring and uninterrupted cysteamine supply, are scarce, and the authors provide a valuable real-world account of presentation, tubular phenotype, genetics, and renal trajectory. The cohort is especially informative because the recurrent CTNS variant c.681G>A was observed in homozygous form in most genotyped patients. A particular strength of this cohort is the early age at diagnosis, at a median of around 11 months, which the authors note compares favorably with other series from developing settings and likely reflects heightened regional awareness of consanguinity-related disease (1). This makes the outcomes all the more thought-provoking: despite early diagnosis, estimated glomerular filtration rate (eGFR) declined significantly (116.66 to 77.40 mL/min/1.73 m², p=0.007) and height SDS fell further over follow-up, from −2.8 to −3.9 (p=0.034), while weight SDS did not change significantly and body bass index (BMI) SDS remained around −2.0 (1). This gap between early diagnosis and subsequent growth and renal outcome suggests that what determines outcome is not only how early cystinosis is recognized, but what is done after diagnosis to protect growth and bone. Growth retardation was in fact the leading presenting complaint in this cohort, and I would like to use this growth signal to draw attention to three areas that the study, by its scope, could not detail but that are central to that question. Before doing so, one nuance on the data should be addressed. The authors appropriately frame the height decline as multifactorial, citing chronic hypokalemia, persistent acidosis, phosphate loss with defective bone mineralization, reduced caloric intake, and hormonal factors (1). I read the magnitude cautiously given the small sample and heterogeneous follow-up, but the direction …
subject: Letter to the Editor
  topic: section
creator: Yesim Özdemir Atikel
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-24
publication date: 2026-07-24
starting page: 309
ending page: 310
doi: 10.12956/TJPD.2026.1387

Comment on “Clinical and laboratory characteristics of nephropathic cystinosis in a resource-limited region”
type: item
description: In the latest issue of the Turkish Journal of Pediatric Disease, Köksoy et al. (1) found that growth faltering and progression to renal failure were notable challenges for Turkish patients with cystinosis. We herein address a worthy notice. The CTNS gene mutations encoding a protein named cystinosine, which is a lysosomal cystine transporter, are the primary cause of cystinosis and there are approximately over 140 distinct CTNS mutations. The clinical phenotypes of cystinosis are controlled by the functional effects of the various CTNS mutations (2). Accordingly, sequencing the CTNS gene coding exons has been developed in numerous populations for the early cystinosis identification and characterization of the disease spectrum employing molecular diagnostic tests (3-4). Studies on the genetic landscape of cystinosis in Türkiye are scarce in the literature and they primarily involved small size series in localized settings (5-7). The available study that targeted CTNS mutations at national level based on a Turkish pediatric cystinosis registry was released by Topaloglu et al in 2017 (8). The 57-kb deletion, which is most common among Caucasian cystinosis patients, was not identified in any of the patients. However, seven novel mutations were detected. The most common CTNS mutations were c.681G.A (p.Glu227Glu), c.1015G.A (p.Gly339Arg), and c.18_21 del (p.Thr7Phefs*7) identified in 31%, 22%, and 14% of the patients respectively. Compared to other mutations, the above-mentioned three mutations were importantly correlated with the disease’s earlier onset age and patients with severe CTNS mutations tended to develop worse renal outcomes (8). Notably, the identified genetic CTNS variants in Köksoy et al’s study (1), namely c.681G>A (p.Glu227Glu), c.18_21delGACT (p.Thr7Phefs*7), and c.1015G>A (p.Gly339Arg), contribute to those previously addressed by Topaloglu et al (8). Updating national data on the CTNS mutational spectrum among cystinosis patients and genetic counseling w…
subject: Letter to the Editor
  topic: section
creator: Mahmood Dhahir Al-Mendalawi
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-24
publication date: 2026-07-24
starting page: 311
ending page: 312
doi: 10.12956/TJPD.2026.1384

Altered heart rate variability and ventricular repolarization in children with mitral valve prolapse
type: item
description: Objective: The aim of this study was to evaluate heart rate variability (HRV) parameters and ventricular repolarization abnormalities in children with mitral valve prolapse (MVP) compared with healthy controls. Materials and Methods: This retrospective single-center study included 78 children with MVP and 92 healthy controls with similar age and gender distributions. Demographic characteristics, 24-hour Holter-derived HRV parameters, and electrocardiographic measurements were analyzed. HRV indices included SDNN, SDANN, SDANNi, rMSSD, pNN50, total power, VLF, LF, HF, LF/HF ratio, and triangular index. Multiple comparisons were adjusted using the Benjamini–Hochberg false discovery rate (FDR) method. Multivariable linear regression analyses adjusted for age and sex were performed for selected representative variables. Results: Children with MVP demonstrated significantly lower SDANNi, rMSSD, total power, LF, HF, and triangular index values compared with controls after FDR correction. Maximum QTc values were significantly higher in the MVP group. In multivariable regression analysis, MVP remained independently associated with lower HF and rMSSD values and higher maximum QTc values after adjustment for age and gender. No significant differences were observed for LF/HF ratio, SDNN, SDANN, or pNN50 after FDR correction. Conclusion: Children with MVP exhibit reduced parasympathetic modulation together with prolonged ventricular repolarization independently of age and gender. These findings suggest that pediatric MVP may be associated with autonomic and electrophysiological alterations.
subject: Research Article
  topic: section
creator: Utku Pamuk
creator: İbrahim İlker Çetin
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-09-01
publication date: 2026-09-01
starting page: 1
ending page: 4
doi: 10.12956/TJPD.2026.1365

Pediatricians’ knowledge of pediatric Mycoplasma pneumoniae infection in the post–COVID-19 period: A single-center cross-sectional survey from Türkiye
type: item
description: Objective: Mycoplasma pneumoniae (MP) remains an important cause of respiratory tract infections and community-acquired pneumonia in children and has regained prominence in the post–COVID-19 period. We aimed to evaluate pediatricians’ knowledge of pediatric MP infection across key clinical domains and to compare knowledge according to professional experience. Materials and Methods: This single-center, cross-sectional, questionnaire-based study was conducted in November–December 2025. A literature-based, face-to-face survey with 29 multiple-choice items (single best answer) assessed knowledge in four domains: risk factors (5 items), clinical manifestations/complications (8 items), diagnostic tests (6 items), and treatment (10 items). Participants were stratified by experience (0–5 years vs. ≥6 years). Item-level correct response rates were compared using chi-square/Fisher’s exact tests, and domain scores were compared using the Mann–Whitney U test. Results: A total of 126 physicians participated (0–5 years: n=93; ≥6 years: n=33). Domain-level knowledge scores were comparable between groups across risk factors, clinical manifestations/complications, diagnostic tests, and treatment. However, several item-level differences were observed; these item-level comparisons were exploratory. Physicians with ≥6 years of experience more frequently answered correctly questions related to the incubation period, cutaneous manifestations, limitations of serologic testing, and identification of an antibiotic ineffective against M.pneumoniae infection. In contrast, physicians with 0–5 years of experience more frequently answered correctly items concerning post-infection immunity, the most commonly affected age group, M.pneumoniae-associated CNS disease, hospitalization-related knowledge, and management of MP-associated hemolytic anemia. Conclusion: Overall knowledge of pediatric M.pneumoniae infection was comparable across experience strata at the domain level; however, item-level find…
subject: Research Article
  topic: section
creator: Büşra Demirci
creator: Aslınur Özkaya-Parlakay
creator: Dilan Günaydın
creator: Gülşah Efeoğlu-Gülsoy
creator: Sevinç Püren Yücel
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-09-01
publication date: 2026-09-01
starting page: 1
ending page: 5
doi: 10.12956/TJPD.2026.1362

Pediatric benign transient hyperphosphatasemia: Clinical course and inflammatory ratios
type: item
description: Objective: Benign transient hyperphosphatasemia (BTH) is a self-limited condition characterized by marked isolated serum alkaline phosphatase (ALP) elevation in children without evidence of bone or hepatobiliary disease. This study aimed to describe the clinical course of pediatric BTH and to test the hypothesis that Neutrophil-to-lymphocyte ratio (NLR) and platelet-to-lymphocyte ratio (PLR) differ between children with BTH and healthy controls. Materials and Methods: In this single-center retrospective study, we screened all pediatric ALP measurements (0–18 years) recorded between 2018 and 2025. Children were included if ALP was at least 2 times the age-specific upper reference limit, liver-related biochemical parameters were normal, there was no clinical evidence of bone or hepatobiliary disease, and ALP normalized during follow-up. NLR and PLR were compared with those of age and gender similar healthy controls without known chronic disease, medication use, or evidence of recent or ongoing infection or inflammatory conditions. Results: Thirty-nine children met the inclusion criteria, with a mean age of 51.9±59.7 months (range, 3–166 months). Of these, 69.2% were younger than 3 years and 59.0% were female. Mean ALP at presentation was 1006.2±1061.9 U/L (range 504–6576). ALP normalized spontaneously within 8.5±3.9 week (range 3–17). Compared with controls, the BTH group had significantly lower NLR (0.85 vs 2.66; p<0.001) and PLR (83.76 vs 122.51; p=0.047). Conclusion: BTH should be considered in clinically well children with isolated ALP elevation after exclusion of serious bone and hepatobiliary disorders. Lower NLR and PLR may provide supportive exploratory information, but require confirmation in larger prospective studies before clinical application.
subject: Research Article
  topic: section
creator: Tolga Kasap
creator: Samet Can Tekin
creator: Hakan Sarbay
creator: Korhan Yavuz
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-31
publication date: 2026-08-31
starting page: 1
ending page: 5
doi: 10.12956/TJPD.2026.1358

From stomach to liver: The impact of Helicobacter pylori gastritis on pediatric hepatic steatosis
type: item
description: 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.
subject: Research Article
  topic: section
subject: Children
  topic: keywords
subject: gastritis
  topic: keywords
subject: Helicobacter pylori
  topic: keywords
subject: hepatosteatosis
  topic: keywords
creator: Buket Daldaban Sarıca
creator: Emine Zülal Emsal
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: 202
ending page: 207
doi: 10.12956/TJPD.2025.1263

Pediatric perioperative management: An integrated review of preoperative evaluation, fasting protocols, postoperative nausea and vomiting, and postoperative pain in light of current guidelines
type: item
description: The aim of this review is to present an integrated overview of pediatric perioperative anesthesia care by focusing on its fundamental components—preoperative evaluation, fasting management, prevention of postoperative nausea and vomiting (PONV), and postoperative pain control—based on current guidelines and evidence. The aim is to emphasize the need for individualized, risk-based approaches in pediatric patients. This study is designed as a narrative review based on current international guidelines and relevant literature on pediatric perioperative anesthesia. Key domains including preoperative assessment, fasting protocols, PONV prophylaxis, and postoperative pain management were evaluated within a comprehensive and integrated clinical framework. Emphasis was placed on risk stratification strategies, avoidance of unnecessary routine investigations, and the implementation of multimodal and age-appropriate approaches. Current evidence indicates that pediatric perioperative care differs significantly from adult practice due to limited physiological reserves, developmental variability, and age-related pharmacokinetic and pharmacodynamic differences. Risk-adapted strategies improve patient safety and outcomes. Specifically, shortened and evidence-based fasting protocols reduce metabolic stress; opioid-sparing multimodal analgesia minimizes adverse effects; risk-based antiemetic prophylaxis decreases the incidence of PONV; and age-appropriate pain assessment tools enhance postoperative pain management. Avoiding unnecessary routine tests further contributes to efficient and patient-centered care. Pediatric perioperative anesthesia care should be based on an integrated, individualized, and risk-oriented approach. The effective combination of optimized preoperative evaluation, evidence-based fasting strategies, tailored PONV prevention, and multimodal pain management improves safety and clinical outcomes. Current evidence strongly supports a shift from routine, standardized…
subject: Review
  topic: section
creator: Vildan Ergen
creator: Eyüp Horasanlı
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-24
publication date: 2026-07-24
starting page: 302
ending page: 308
doi: 10.12956/TJPD.2026.1356

Comment on “Levetiracetam in childhood epilepsy: Expanding the evidence base”
type: item
description: We read with genuine interest the article by Toksöz and Teber recently published in the Turkish Journal of Pediatric Disease, which presents long-term efficacy and safety data on levetiracetam (LEV) monotherapy in 101 children managed at a tertiary pediatric neurology centre (1). The reported seizure-response rate of 72.3%, with complete seizure freedom in 38.0% of patients, positions this study squarely within the broader real-world evidence base and confirms LEV’s standing as a first-line antiseizure medication (ASM) in childhood epilepsy. Particularly clinically useful is the identification of age over four years and low pre-treatment seizure frequency as independent predictors of a favourable response—two stratification criteria that translate directly into day-to-day prescribing decisions. Yet, precisely because this paper contributes to a growing corpus of retrospective evidence on LEV, it also highlights several dimensions that deserve more rigorous prospective investigation. To begin with, situating the results of Toksöz and Teber within the comparative effectiveness literature raises questions that a single-arm retrospective design cannot resolve. A systematic review and meta-analysis of four randomised controlled trials including 381 children demonstrated that LEV monotherapy was associated with a significantly lower frequency of at least one seizure and a 76% reduction in dermatological adverse events relative to carbamazepine (CBZ), while seizure-freedom rates did not differ significantly between the two agents (2). This context matters: an overall response rate of 72.3% is meaningful, but without a comparator arm—whether historical or concurrent—it remains difficult to determine whether this figure reflects a drug effect, a patient-selection effect, or an institutional effect. A large Turkish tertiary centre cohort of 281 children treated with LEV monotherapy across a decade found seizure reduction rates that, while broadly consistent with the current p…
subject: Letter to the Editor
  topic: section
creator: Samir Iddir
creator: Lounis Brahim
creator: Zakia batoul Benlahreche
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-05
publication date: 2026-08-05
starting page: 1
ending page: 3
doi: 10.12956/TJPD.2026.1354

Response to the Letter entitled “Comment on Hypertension in children with congenital adrenal hyperplasia: Prevalence and associated factors”
type: item
subject: Letter to the Editor
  topic: section
creator: Mihriban İnözü
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: 220
ending page: 220
doi: 10.12956/TJPD.2026.1353

Parental broader autism phenotype and its association with adolescent social anxiety
type: item
description: Objective: Social anxiety disorder (SAD) and autism spectrum disorder (ASD) share overlapping social-cognitive features. The broader autism phenotype (BAP), reflecting subclinical autistic traits in parents, may be relevant in understanding adolescent social anxiety within a family context. This study aimed to examine the association between parental BAP traits and social anxiety severity in adolescents. Materials and Methods: In this study, 109 adolescents with SAD (aged 11–17 years, 79.8% female) and their parents (109 mothers and 109 fathers) were included. Adolescents completed the Social Anxiety Disorder Severity Scale–Child Version, while parents completed the Autism Spectrum Quotient (AQ) and the Social Responsiveness Scale (SRS), used as a secondary exploratory measure of social functioning. Non-parametric analyses and binary logistic regression were performed. Results: Greater SAD severity was associated with lower paternal AQ scores (ρ=–0.29, p=0.002). In addition, adolescents in the higher-severity SAD group had significantly higher SRS scores compared to those in the lower-severity group (p=0.003). Conclusion: Parental BAP traits, particularly paternal autistic traits, may be associated with social anxiety severity in adolescents. However, due to the cross-sectional design, reliance on questionnaire-based measures, and potential shared-informant bias, these findings should be interpreted cautiously and considered hypothesis-generating rather than confirmatory.
subject: Research Article
  topic: section
creator: Şermin Bilgen Ulgar
creator: Mehtap Eroğlu
creator: Neşe Yakşi
creator: Tuğba Menteşe Babayiğit
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-07
publication date: 2026-08-07
starting page: 1
ending page: 8
doi: 10.12956/TJPD.2026.1351

Assessing the training needs of pediatric healthcare professionals in communication, risk management, and psychosocial resilience
type: item
description: Objective: The quality of pediatric healthcare is closely tied to the communicative and psychosocial capacities of healthcare professionals. This study aimed to quantitatively determine the training needs of staff working in a tertiary pediatric hospital focusing on communication, management of violence-related risks, and psychosocial resilience. Materials and Methods: A cross-sectional descriptive design was employed using the Hennessy-Hicks Training Needs Analysis approach. Data were collected via an online questionnaire from 133 healthcare professionals. The training need for each specific skill was calculated using discrepancy scores, which represent the difference between the perceived importance of the skill for professional duties and the participant’s self-assessed current competence. Results: Positive discrepancy scores were observed across all 16 items, although the magnitude of these differences was modest in absolute terms. At the domain level, relatively higher training needs were identified in the management of violence-related risks (M=0.44) and the psychosocial resilience/organizational dimension (M=0.42). Communication skills presented a relatively lower but still positive need (M=0.24). The training topics ranked highest included recognizing and coping with burnout, achieving competency in “White Code” (a national emergency response protocol for workplace violence) procedures, and exhibiting safe behaviors during threats. Conclusion: Training needs in pediatric hospital settings extend beyond individual knowledge gaps to represent structural requirements driven by professional roles and high-stress environments. In-service training policies should prioritize risk management and psychosocial resilience as core components, embedding communication skills as a foundational layer rather than an isolated module. Training designs must be sensitive to specific professional roles, unit intensities, and shift schedules.
subject: Research Article
  topic: section
creator: Hikmet Cansın İşçi
creator: Cüneyt Karagöl
creator: Tarık Tuncay
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-20
publication date: 2026-07-20
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1334

Family relationships in the digital age: The impact of problematic screen use on parent–adolescent relationships
type: item
description: Objective: Problematic screen use (PSU) in adolescence has been linked to impaired well-being, but its associations with parent–adolescent relationship quality remain insufficiently characterized. This study examined whether PSU levels were associated with positive relationship, negative relationship, and openness dimensions in mother– and father–adolescent relationships. Materials and Methods: This cross-sectional study included 196 adolescents aged 11–18 years who presented to a pediatric outpatient clinic. Data were collected using a Sociodemographic Information Form, the Child–Adolescent Digital Addiction Scale, and the Parent–Adolescent Relationship Quality Scale. Group differences were evaluated using appropriate non-parametric statistical methods. Results: The mean age of the participants was 14.29±2.21 years, and 59.7% were female. Positive relationship with mother scores differed significantly across PSU groups (p=0.029), with post hoc analysis indicating a difference primarily between healthy users and adolescents in the digital addiction group. Negative relationship with mother scores also differed significantly (p<0.001), with healthy users scoring lower than those in the excessive use and digital addiction groups. Paternal openness (p=0.007), positive relationship with father (p = 0.038), and negative relationship with father (p=0.012) also varied significantly across groups, whereas maternal openness showed a borderline association (p=0.055). Conclusion: Higher PSU was associated with poorer parent–adolescent relationship quality, particularly in the domains of conflict and positive relational functioning. These findings suggest that assessment of adolescent PSU should incorporate family relational processes, especially trust-based communication and parent–adolescent conflict.
subject: Research Article
  topic: section
creator: Bilal Yılmaz
creator: Elif Küçük
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-31
publication date: 2026-07-31
starting page: 1
ending page: 5
doi: 10.12956/TJPD.2026.1347

Psychosocial outcomes in healthy siblings of children with celiac disease: A controlled cross-sectional study
type: item
description: Objective: The aim of this study was to compare health-related quality of life (QoL) and anxiety/depressive symptoms in healthy siblings of children with celiac disease (CD) with age- and gender-similar healthy siblings of children without chronic illness. Materials and Methods: This controlled cross-sectional study, conducted in a pediatric gastroenterology and child psychiatry setting at a tertiary-care hospital, enrolled healthy siblings aged 8–17 years into a CD-sibling group (n=70) and a control group (n=70). Sociodemographic data were collected using a standardized form, QoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) Generic Core Scales, and psychiatric symptoms were assessed using the Revised Child Anxiety and Depression Scale (RCADS). Between-group comparisons and Spearman rank correlations were used, and predictors of total anxiety and psychosocial QoL were examined using univariable and multivariable linear regression. Results: Sociodemographic and familial characteristics were largely comparable between groups. Compared with controls, the CD-sibling group had higher total anxiety scores (p=0.007), whereas depressive symptoms were similar between groups (p=0.758). Psychosocial and total QoL were lower in the CD-sibling group (both p<0.001), while physical QoL did not differ between groups (p=0.201). In multivariable models within the CD-sibling group, longer time since diagnosis and maternal psychiatric disorder independently predicted higher anxiety and poorer psychosocial QoL, whereas a greater number of siblings predicted lower anxiety and better psychosocial QoL. Conclusion: Healthy siblings of children with CD experience increased anxiety and reduced psychosocial/total QoL, underscoring the importance of family-centered monitoring that includes sibling well-being and maternal mental health.
subject: Research Article
  topic: section
creator: Halenur Teke
creator: Hilal Tuter Mavi
creator: Selcuk Teke
creator: Yasin Maruf Ergen
creator: Birce Izgi Akçay
creator: Mehmet Ayhan Congoloğlu
creator: Necati Balamtekin
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-24
publication date: 2026-07-24
starting page: 283
ending page: 289
doi: 10.12956/TJPD.2026.1316

Hematological markers of systemic inflammation potentially associated with migraine in pediatric patients
type: item
description: 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.
subject: Research Article
  topic: section
creator: Özlem Kemer Aycan
creator: Hilal Aydın
creator: Oğuzhan Korkut
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-06-17
publication date: 2026-06-17
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1314

The role of fetuin-A in adolescent obesity: Association with anthropometric and metabolic parameters
type: item
description: Objective: Childhood obesity is a growing global health problem linked to chronic inflammation and metabolic complications, including dyslipidemia, insulin resistance, type 2 diabetes mellitus, nonalcoholic fatty liver disease, and hypertension. Fetuin-A, a hepatokine involved in insulin signaling and inflammation, has been studied in adults, but its role in pediatric obesity is unclear. This study evaluated fetuin-A levels in obese adolescents and their association with anthropometric and metabolic parameters. Materials and Methods: This cross-sectional study included 40 obese adolescents (BMI > 95th percentile) and 30 healthy controls (BMI between the 15th and 85th percentiles) who had no additional systemic diseases and were not receiving any medication. Anthropometric measurements and fasting glucose, insulin, high-sensitivity C-reactive protein, and fetuin-A were assessed. The presence of dyslipidemia, hepatic steatosis, and hypertension was evaluated. Results: Hs-CRP levels were significantly higher in obese patients than in controls (p=0.015) However, fetuin-A levels did not differ significantly between the groups. Fetuin-A showed no correlation with insulin resistance, lipid parameters, hepatic steatosis, or hypertension. Conclusion: Obesity-related complications (insulin resistance, dyslipidemia, fatty liver, and hypertension) were observed in more than half of our group. Although hs-CRP levels of obese cases were high, fetuin-A concentrations were observed to be similar in all cases and in subgroup analyzes. It may be due to factors affecting fetuin-A levels or its posttranslational modification. Further large-scale longitudinal studies are required to elucidate its contribution to metabolic inflammation in children.
subject: Research Article
  topic: section
creator: Gülin Karacan Küçükali
creator: Semra Çetinkaya
creator: Erdal Kurnaz
creator: Elvan Bayramoğlu
creator: Şervan Özalkak
creator: Gülşah Demirci
creator: Hasan Serdar Öztürk
creator: Şenay Savaş Erdeve
creator: Zehra Aycan
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-24
publication date: 2026-07-24
starting page: 290
ending page: 294
doi: 10.12956/TJPD.2026.1322

Beyond the threshold of viability: Mortality, morbidity, and critical prognostic cut-offs in infants born at 22–26 weeks of gestation
type: item
description: 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.
subject: Research Article
  topic: section
creator: Merve Hanım Ertilav Mucuk
creator: Cüneyt Tayman
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-06-26
publication date: 2026-06-26
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1323

https://turkjpediatrdis.org/article/view/1315
type: item
title: 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
description: 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.
subject: Research Article
  topic: section
subject: Pyelonephritis
  topic: keywords
subject: Tc-99m DMSA
  topic: keywords
subject: urinary tract infections
  topic: keywords
subject: ultrasonography
  topic: keywords
subject: vesicoureteral reflux
  topic: keywords
creator: Mehmet Tarık Tatoğlu
creator: Ebru İbişoğlu
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-06-08
publication date: 2026-06-08
starting page: 1
ending page: 6
doi: 10.12956/TJPD.2026.1315

Surgical management of ductal origin of the right pulmonary artery in an infant
type: item
description: This clinical case report describes a 1.5-month-old infant with ductal origin of the right pulmonary artery. The surgical management included reconstruction of the right ventricular outflow tract and reimplantation of the right pulmonary artery using a 6‑mm ringed expanded polytetrafluoroethylene (ePTFE) graft.
subject: Case Report
  topic: section
creator: Oleg Egunov
creator: Elena Poluboyarinova
creator: Shakhreziddin Zainidinov
creator: Roman Kozhanov
creator: Frank Cetta
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-03
publication date: 2026-08-03
starting page: 1
ending page: 3
doi: 10.12956/TJPD.2026.1308

Diagnostic discrimination of C-reactive protein and blood count-derived indices for concurrent urinary tract infection in pediatric urolithiasis
type: item
description: 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 cautio…
subject: Research Article
  topic: section
creator: Derya Yayla
creator: Huseyin Tugrul Tiryaki
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-07-09
publication date: 2026-07-09
starting page: 1
ending page: 8
doi: 10.12956/TJPD.2026.1339

Improving time to antibiotic administration in febrile neutropenia: A quality improvement initiative in a pediatric oncology inpatient unit
type: item
description: Objective: Febrile neutropenia (FN) is a medical emergency requiring prompt initiation of empirical antibiotic therapy. We aimed to evaluate the impact of a structured, unit-based quality improvement intervention on time to antibiotic administration (TTA) in hospitalized pediatric oncology patients. Materials and Methods: This single-center quality improvement study was conducted in a pediatric oncology inpatient unit. The intervention consisted of a structured educational program targeting healthcare professionals, including physicians and nurses. FN episodes were analyzed across pre-intervention, intervention, and post-intervention phases, and TTA was compared between these periods. Results: A total of 73 FN episodes in 40 patients were included. Median TTA decreased from 38 minutes in the pre-intervention phase to 32 minutes during the intervention phase and to 18 minutes in the post-intervention phase (p<0.001). The proportion of patients receiving antibiotics within 60 minutes increased from 77% to 100% (p=0.010). Conclusion: A structured, unit-based quality improvement intervention significantly reduced TTA in hospitalized pediatric oncology patients. These findings highlight the importance of system-level strategies in improving time-sensitive clinical processes in high-risk patient populations.
subject: Research Article
  topic: section
creator: Yasin Yilmaz
creator: Gozde Gul
creator: Cansu Ceren Eryilmaz
creator: Ece Melis Adalet Peker
creator: Gulcan Erbas
creator: Osman Kuleli
creator: Sifa Sahin
creator: Pinar Taspinar
creator: Vildan Kocali
creator: Gulsah Tanyildiz
creator: Deniz Tugcu
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-06
publication date: 2026-08-06
starting page: 1
ending page: 5
doi: 10.12956/TJPD.2026.1343

Germinal Matrix-intraventricular hemorrhage in very preterm infants: Frequency, associated factors, and the role of postnatal clinical course
type: item
description: 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…
subject: Research Article
  topic: section
creator: Ilayda Zorlukus Altın
creator: Cüneyt Tayman
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-06-26
publication date: 2026-06-26
starting page: 1
ending page: 8
doi: 10.12956/TJPD.2026.1325

Bone health assessment in children with osteogenesis imperfecta from a pediatric endocrinology perspective
type: item
description: Objective: Osteogenesis imperfecta (OI) is an uncommon hereditary disorder of connective tissue that results in fragile bones due to abnormalities in collagen structure. This study aimed to evaluate bone health in children with OI who were hospitalized for fracture treatment. Materials and Methods: This retrospective observational study reviewed the records of children aged 3–18 years and diagnosed with OI and hospitalized in the pediatric orthopedics ward for fractures between May 1, 2023, and January 31, 2026. The patients’ demographic characteristics, biochemical parameters, bone mineral density (BMD) Z-scores, vertebral radiographs, vitamin D levels, sun exposure, and treatment status were evaluated. Results: A total of 37 patients participated in the study. The average age of the patients was 10.35±3.82 years, and 78.4% were male. Mean BMD Z-score was -1.44±1.61. Vertebral fractures were present in 27% of the patients. Significant differences were observed between groups stratified by vitamin D levels for age (p = 0.020), serum calcium (p = 0.003), phosphorus (p = 0.005), alkaline phosphatase (p = 0.027), parathyroid hormone (p = 0.018), and BMD Z-score (p = 0.023). Patients with vitamin D deficiency showed lower serum calcium levels and BMD Z-scores. Additionally, a statistically significant positive correlation was identified between BMD Z-score and serum calcium levels (r=0.343; p=0.038). Conclusion: Evaluation of skeletal health in children with OI should not rely solely on BMD measurements; vertebral fractures, biochemical markers, growth, and environmental factors should also be considered. Collaboration between pediatric orthopedics and pediatric endocrinology is vital for better long-term outcomes.
subject: Research Article
  topic: section
creator: Banu Turhan
creator: Niyazi Erdem Yaşar
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-08-05
publication date: 2026-08-05
starting page: 1
ending page: 7
doi: 10.12956/TJPD.2026.1336

RAS/MAPK Pathway and RASopathies
type: item
description: 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.
subject: Review
  topic: section
subject: Genotype-Phenotype Correlation
  topic: keywords
subject: Noonan syndrome
  topic: keywords
subject: MAP Kinase Signaling System
  topic: keywords
subject: RASopathies
  topic: keywords
creator: Aslı Genç
creator: Esra Kılıç
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: 211
ending page: 218
doi: 10.12956/TJPD.2025.1329

Hepatosplenomegaly in children: A gateway to inherited metabolic disorders
type: item
description: 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.
subject: Research Article
  topic: section
subject: Hepatomegaly
  topic: keywords
subject: inborn errors of metabolism
  topic: keywords
subject: splenomegaly
  topic: keywords
creator: Ezgi Burgaç
creator: Merve Yoldaş Çelik
creator: Burcu Köşeci
rights: Copyright © 2026 The Author(s) https://creativecommons.org/licenses/by/4.0
date: 2026-05-18
publication date: 2026-05-18
starting page: 197
ending page: 201
doi: 10.12956/TJPD.2025.1276