INTRODUCTION: Vitamin B12 is naturally obtained from animal-derived foods and is important for the development and wellbeing of babies. Vitamin B12 deficiency is a general health concern in developing countries. This study aimed to investigate the effects of different feeding practices on vitamin B12 levels and hemogram parameters in infants aged 6–9 months
METHODS: A total of 120 infants (61 boys, 59 girls) aged 6–9 months were retrospectively evaluated. The babies were assigned to three groups according to feeding practices: 1) only breast milk, 2) breast milk and formula, and 3) only formula in addition to complementary foods. Laboratory data (vitamin B12, hemoglobin, hematocrit, mean corpuscular volume, white blood cell count, and absolute neutrophil count) of the patients were retrospectively compared.
RESULTS: The mean and median age of the patients was 6.6±1.1 months. The vitamin B12 levels in babies that only received formula were statistically significantly higher than those in babies receiving only breast milk or receiving both breast milk and formula (p<0.05). Furthermore, the vitamin B12 levels were significantly lower in babies receiving only breast milk than in those receiving both formula and breast milk (p<0.001).
DISCUSSION AND CONCLUSION: This study showed that vitamin B12 levels were lowest in babies that only received breast milk compared to those in babies receiving formula. The babies that were receiving formula only had the highest levels of vitamin B12. This study determined that breast milk alone was not sufficient to maintain normal levels of vitamin B12 in 6–9-month-old babies in the region. Therefore, both mothers and babies should be provided with the necessary support in terms of vitamin B12 levels, and prophylaxis should be discussed from the viewpoint of preventive healthcare services.

INTRODUCTION: The aim of this study was to evaluate freeT4 and TSH concentrations among children and adolescents with obesity, and to assess possible correlations between glucose and parameters of lipid metabolism.
METHODS: A retrospective analysis of 100 obese patients, aged between 8-18 years, was performed in the pediatric endocrinology outpatient clinic. The anthropometric measurements, free T4 and TSH concentrations, glucose levels and lipid profile of children and adolescents with obesity were determined.
RESULTS: Mean age of patients was 11.43 ± 2.64 years. Fasting blood glucose and cholesterol levels had a significant positive correlation with TSH levels, and multiple regression analysis revealed that 1 unit of increase in blood glucose and cholesterol increased TSH levels by 0.047 units and 0.012 units, respectively.
DISCUSSION AND CONCLUSION: There is still a lack of data regarding the relationship between thyroid function and other metabolic risk factors in children with obesity. Our findings add to the literature in terms of demonstrating that obesity may have a central effect on thyroid function, before any effects on insulin levels and anthropometric features become apparent. It is important to better understand the relationship between thyroid function and obesity in order to develop strategies to prevent or treat childhood obesity.

INTRODUCTION: Mastocytosis is a rare disease characterized with clonal mast cell proliferation in one or more organs. It can lead to different clinical manifestations and has no definitive treatment. In this study, we aimed to evaluate the clinical and laboratory characteristics of our patients diagnosed with mastocytosis in our clinic.
METHODS: Thirteen patients that were followed with the dignosis of mastocytosis at Pediatric Hematology Clinic, in Ege University Faculty of Medicine between November 1999 and April 2016 were retrospectively analyzed.
RESULTS: Seven of patients were female(%53,8) and six were male(%42,6). The mean age at diagnosis was 20 (3-68) months. At the time of diagnosis, complete blood count and peripheral smear were found to be compatible with the anemia of iron deficiency in three patients. Other parameters were normal. Mean tryptase level was detected as 5,9 (3,6-16,6) ng/ml, and only one tryptase level was found as slightly increased. The median level of total IgE was 91,1 (4,47-362) IU/ml. Mast cell proliferation was not detected in bone marrow aspiration and biopsy material of any patients. All of the cases were evaluated as cutaneous type mastocytosis.
DISCUSSION AND CONCLUSION: The possibility of mastocytosis in systemic form in childhood is very rare and bone marrow examination may be necessary in selected cases.

INTRODUCTION: The study was carried out in order to determine the patient safety related implementations of nurses working in neonatal intensive care.
METHODS: This descriptive study was carried out in Neonatal Intensive Care Units (NICU) in six hospitals in Konya city center between April and May 2012. 96 nurses working in the intensive care unit participated in the survey. Newborn Patient Safety Survey Form was used in the study. The analysis of the data was done by number, percentage, Kruskall-Wallis, Man-Whitney U and Independent t tests.
RESULTS: It was seen that nurses scored most in interventions regarding falling down among the fields of patient safety implementations (92,42±6,36). A meaningful difference was found between NICU nurses' state of education and patient safety intervention regarding medication score average (p<0,05); nurses' working years and patient safety intervention regarding identity implementations score average (p<0,05).
DISCUSSION AND CONCLUSION: It was determined that nurses implemented interventions regarding falling down most among patient safety implementations. It was seen that patient safety implementations of nurses were related to state of education, working year, the number of patients cared daily, and receiving patient safety training.

INTRODUCTION: Exogenous surfactant may be needed not only for respiratory distress syndrome treatment; but also in the management of other pulmonary diseases of infants. In this study we aimed to investigate the impact of single versus multiple doses of surfactant therapy in pulmonary problems of preterm infants.
METHODS: In this study, preterm infants who needed surfactant treatment were retrospectively evaluated. Surfactant therapy for respiratory distress syndrome were given as 200mg/kg poractant or 100mg/kg beractant and repeated with 100mg/kg doses when needed later. Poractant or beractant (100mg/kg) were given in the treatment of other pulmonary diseases.
RESULTS: Totally 64 preterm patients were recruited in the study. Patients in the Group 1 (43.8%) received single dose of surfactant; whereas Group 2 patients (56.2%) had more than one dose. Mean gestational age and birth weight of infants in Group 2 were significantly lower than Group 1 (p<0.05). Intrauterine growth restriction was more common in Group 2 (p=0.041). Multiple doses of surfactant were needed for severe respiratory distress syndrome, atelectasis, pulmonary hemorrhage and pneumonia. Duration of mechanical ventilation and hospitalization were longer in Group 2 (p<0.05). Mortality rates were higher in Group 2 (p=0.011).
DISCUSSION AND CONCLUSION: Preterm infants with earlier gestational age and lower birth weight; particularly with intrauterine growth restriction may need multiple doses of surfactant due to more severe respiratory problems regardless of antenatal steroid or maternal chorioamnionitis status. Duration of mechanical ventilation, hospitalization and also neonatal mortality remained higher due to disease severity in preterms who needed multiple doses of surfactant.

INTRODUCTION: Illicit substance use is a worldwide important public health problem with increasing substance use rate and decreasing starting age. In this study our aim was to determine the complaints of the patients in pediatric emergency department admission in order to increase awareness about substance use.
METHODS: The data of this cross-sectional study was gathered from the patients admitted to the pediatric emergency department with complaints of substance abuse and patients without an history of substance abuse, but with a positive urine drug test. A screening urine test was used for the qualitative determination of drug substances. If positive, a quantitative liquid chromatography integrated mass/mass spectrometry test was order for confirmation.
RESULTS: A total of 17 patients were presented in the emergency department. Most frequent symptoms were unstable cognitive conditions and tachycardia. Laboratory analyses showed high creatine kinase-MB. Synthetic cannabinoids were the most frequently detected substance in urine screening and confirmation tests. Twenty-nine percent of patients were hospitalized and no mortality was observed.
DISCUSSION AND CONCLUSION: The use of illegal substances is increased in teenagers. Emergency department doctors must be informed and trained regarding substance abuse since patients are frequently presented in the emergency department with cognitive malfunctions. Also, it should be remembered that patients may present with symptoms concerning various organ systems.

INTRODUCTION: The purpose of this study was to determine the anxiety levels and needs of the fathers whose children were hospitalized in the Pediatric Surgery Intensive Care Unit.
METHODS: This cross-sectional study was conducted with the fathers of children hospitalized in the Pediatric Surgery Intensive Care Unit in 2016/2017by using the Critical Care Family Needs Inventory, and State and Trait Anxiety Scale Setting: Turkey, a university hospital.
RESULTS: The study included 113 fathers. The fathers’ mean age was 36.6 ± 6.31. There was a weak positive correlation between the scores the fathers obtained from the State Anxiety Scale and the Critical Care Family Needs Inventory. There was a difference between the fathers’ intensive care needs in terms of their education levels. While "feeling that hospital personnel are attentive to the patient" was important for 92% of the fathers, "being sure that as much care as possible is given” for was important 88.5% and "being informed about the patient at least once a day" was important for 85.8%.
DISCUSSION AND CONCLUSION: The anxieties and needs of the fathers of the patients staying in the Pediatric Surgery Intensive Care Unit were high, particularly in those with low educational level. Health professionals should be aware of fathers’ feelings, needs and stressors so that they can provide interventions specific to fathers

INTRODUCTION: Inappropriate auditory stimulants lead to neonatal stress and changes in physiological parameters. Nowadays, particular emphasis is placed on the developmental aspects of the care of preterm infants. The lullaby is a suitable auditory stimulus for preterm infants, which as a subtype of developmental care decreases stress responses. This study investigates the effects of lullabies in mothers’ voices on preterm infants’ physiological parameters.
METHODS: This single group study is a randomized clinical trial. Forty study-qualified hospitalized infants were included in the study, at the lullaby stage and at the non-lullaby stage. Their physiological parameters including respiratory rate, heart rate and oxygen saturation level were recorded. Mothers’ lullabies were played for those at the lullaby stage. No intervention was performed in the non-lullaby stage and only infants’ variables were recorded. Infants were assessed for four successive days, two days for every stage. Data collection was recorded every 2min. Data was statistically analysed after gathering and entering into the SPSS.22 by means of Friedman’s and paired sample t-test.
RESULTS: : In this study of 40 case studies, 45% were female and 55% were male, with an average gestational age of new-borns at 32.43 weeks and mean birth weight at 2189.36gr. In the intervention group, during the time that the lullaby was played, mean rates of heart beat was significantly decreased (P=0.03) and SaO2 was increased (P=0.039), which were significantly different from their basic recorded levels at the beginning and those of the control group, but there was no significant difference between two groups in mean of respiratory rates (P=0.070).
DISCUSSION AND CONCLUSION: Since a mother’s lullaby has significant effects on physiological parameters, we hope that nurses will tell mothers to use the lullaby as a supportive developmental care for infants to assist improving the physiological state of preterm new-borns.

INTRODUCTION: Developmental dysplasia of the hip is an orthopedic problem which is a spectrum of disorders from the instability of hip joint to total dislocation. Developmental dysplasia of the hip is frequently seen and has a good prognosis when diagnosed and treated early. The aim of our study is to examine the risk factors leading to developmental dysplasia of the hip and to assess the value of hip ultrasonography.
METHODS: In our research, 9102 hip ultrasonography information of 4551 infants analyzed retrospectively. 151 infants who diagnosed with developmental dysplasia of the hip and 170 healthy infants as the control group; are compared in terms of birth order, being a firstborn, type of delivery, gestational age, birth weight, oligohydramnios, multiple pregnancy, breech presentation, swaddling, family history and existence of foot anomaly.
RESULTS: Prematurity, oligohydramnios and positive family history are founded significant risk factors for developmental dysplasia of the hip.
DISCUSSION AND CONCLUSION: It is possible to prevent the complications and necessity of surgical treatment with early diagnosis. Therefore, we propose screening for developmental dysplasia of the hip to all infants.

INTRODUCTION: The aim of this cross-sectional study was to investigate the perceptions of professional values and job satisfaction levels of pediatric nurses and the influencing factors.
METHODS: This study was conducted with 134 nurses working in the pediatric clinics of three hospitals in Turkey. Nurses’ Professional Values Scale and Minnesota Job Satisfaction Questionnaire were used to collect the data.
RESULTS: It was found that the pediatric nurses had high professional values and job satisfaction scores were moderate. It was further noted that pediatric nurses who were single, received the education in a nursing high school, had a professional experience of 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working at day shift steadily had higher scores of professional values. It was found that job satisfaction of the pediatric nurses, who were married, received the education in a nursing high school, had a professional experience 11-15 years in pediatric clinics, were working as clinical responsible nurse, and were working at day shift steadily, was significantly higher than the others. The results also indicated a positive and high correlation between pediatric nurse’ perception of professional values and job satisfaction levels.
DISCUSSION AND CONCLUSION: It was concluded that promoting professional values among nurses would eventually result in increasing levels of job satisfaction. This study is believed to provide substantial data in this particular field in Turkey, which is considered to guide nurse managers to design well-established and unbiased programs for pediatric nurses.

INTRODUCTION: Aim: The mortality rate indicator for children is one of the important indicators of population health and socioeconomic development of countries. In addition, to reduce mortality in children is essential to determine the causes of death. This study aims to determine the mortality causes in children 1–59 months in Northeastern Iran.
METHODS: Materials and Methods: This population-based cross-sectional study was conducted based on the data from the Children Mortality Surveillance System, from March 2011 to March 2017. The mortality rate was evaluated according to demographic variables (sex, place of residence and mother's education). Causes of death were coded according to the International Classification of Diseases (ICD 10). Chi-square and Mann-Whitney tests were applied to investigate the relationships.
RESULTS: Results: The mortality rate in children 1-59 months was (8.2, CI 95%: 7.6-8.8) per 1000 live births from 2011 to 2017. Totally 53.2% of mortalities occurred in boys (P = 0.07). The frequency of death in the age group of 1-11 months was 1.7 times more than the age group of 12-59 months. The highest mortality rates occurred in the rural areas and among children with illiterate mothers. During the study period, on average, the mortality rate decreased by 0.7 per 1000 live births every year. The most common causes of death were unintentional accidents (33.8%) and congenital or chromosomal abnormalities (22.1%).
DISCUSSION AND CONCLUSION: Conclusion: Improving maternal education is among the key strategies for reducing children mortality. Therefore, it is necessary to raise the level of education and awareness regarding childhood mortality, especially in rural areas.

INTRODUCTION: The provision of appropriate respiratory support has a great role in outcome of patients presenting to the emergency department (ED) with respiratory distress (RD) associated with severe pneumonia. In recent years, heated humidified high-flow nasal cannula (HHHFNC) therapy has become one of the most popular non-invasive respiratory support modality in all pediatric settings. In this study, we aimed to assess whether the use of HHHFNC therapy is associated with reduced respiratory distress RD and improving hypoxaemia among children with severe bacterial pneumonia (SBP) presenting to the ED.
METHODS: We performed a prospective observational study of patients with SBP admitted to a tertiary children’s hospital pediatric ED and received HHHFNC therapy within 2 years study period. The primary outcome was accepted as treatment failure (It was defined as a clinical escalation in respiratory status) and increase in peripheral capillary oxygen saturation (SpO2). Secondary outcomes covered a decrease of respiratory rate (RR), heart rate (HR), and rates of weaning, intubation and intensive care unit (ICU) admission.
RESULTS: Fifty-six patients were included in the analyses. Treatment failure was 21.5% (12/56). Among this patients, 9 (16%) were intubated and 3 (5.5%) placed on bilevel positive airway pressure. The mean initial RR values were significantly higher in non-responders group than the responder group (p=0.027). Significant variation in the intubation rate or the ICU admission rate was not determined. At the 2nd hour, the falling down of RR (p<0.001), HR (p<0.001), and the increase of SpO2 (p<0.001) were significantly more evident when compared with the beginning.
DISCUSSION AND CONCLUSION: HHHFNC therapy reached treatment success in majority of the patients with SBP and provided an earlier effect. Patients with more severe RD responded less to HHHFNC. Further larger studies are needed to assess the impact of HHHFNC compared with other possible therapies.

INTRODUCTION: To evaluate retrospectively the epidemiologic data and outcomes of pediatric open globe injury (OGI).
METHODS: The medical records of all pediatric cases (<16 years old) diagnosed with OGI in İzmir Katip Çelebi University Atatürk Teaching and Research Hospital, Department of Ophthalmology between January 2009 and December 2018 were screened. Age, sex, history, cause of trauma, treatment received, visual acuity (VA) at presentation, and final VA were recorded.
RESULTS: A total of 48 patients were included into the study. The mean age at the time of injury was 10,72±4,74 years, ranging from 1 to 16 years. Game related accidents were the most common causes of all pediatric OGI patients with a frequency of 58,3% (n=28). Of the OGIs 56,3% (n=27) were in zone I, followed by zone II (39,5%; n=19), and zone III (4,2%; n=2). Patients with vitreous hemorrhage or retinal detachment at admission were found to have higher risk of poor prognosis. The principal predictor for the good visual outcome was found to be initial BCVA over 20/200.
DISCUSSION AND CONCLUSION: To predict the prognosis in a best way, every patient with OGI should be carefully evaluated both at the time of admission and during follow-up period.

INTRODUCTION: Children with cutaneous or systemic mastocytosis may experience severe manifestations of mast cell mediator release including anaphylaxis. The perceived risk for adverse vaccine reactions creates concern among parents and pediatricians regarding modification of the routine vaccine schedule for safety.
METHODS: Using the NIH Biomedical Translational Research Information System and Clinical Research Information System, we conducted a retrospective chart review of 94 children ≤ 18 years of age, evaluated at NIH with mastocytosis. Based on the recommended childhood immunization schedule, we estimated that these 94 patients received approximately 2136 vaccinations. Post vaccination reactions were determined as expected or unexpected according to the CDC parameters for vaccine-associated events.
RESULTS: Eighty-four patients (89.4%) had no reports of moderate-severe post-vaccination reactions. Eleven reactions after vaccination were reported in 10 of 94 patients (10.6%), of which four patients had unexpected reactions (4.3%). Unexpected reactions included facial swelling, flushing and exacerbation of skin lesions which are not reported as possible vaccine reactions by the CDC. One patient was treated for anaphylaxis 2 hours post-varicella vaccine administration. Five patients with a history of anaphylaxis and a mean tryptase level of 115 ng/ml did not report vaccine-induced reactions.
DISCUSSION AND CONCLUSION: Children with mastocytosis in this study did not experience a higher rate of adverse vaccine reactions compared to the general population. Anaphylaxis to other causes was not a risk factor for an untoward vaccine response. In patients that experience a severe post-vaccination reaction such as anaphylaxis, a modified schedule with single vaccine administration is a safer approach.