INTRODUCTION: Bloodstream infections are serious conditions that can cause significant morbidity and mortality. Early recognition of the bacteria and targeted early treatment play an important role in prognosis. The Verigene Gram-negative blood culture nucleic acid test (BC-GN; Nanosphere, USA) is a new method that can accurately identify both Gram-negative bacteria and resistance gene within 2 hours. In this study, we aimed to determine the accuracy of this assay for the rapid identification of certain Gram-negative microorganisms in children with bloodstream infections and to compare with conventional culture method.
METHODS: A total of 30 patients (<18 years-old) with bloodstream infections due to Gram negative bacteria were prospectively included who were followed up in the Department of Pediatrics of Ege University Faculty of Medicine between December 2015-June 2016. Microarray test results were compared with conventional blood culture results.
RESULTS: Klebsiella spp. (40%) were the most common, Acinetobacter spp. (20%) were the second most common Gram negative microorganisms. Accurate identification of microarray analysis was 100% (12/12) for Klebsiella spp, 100% (6/6) for Acinetobacter spp., 100% (5/ 5) for E. coli, 80% (4/5) for Enterobacter cloacae spp., 100% (1/1) for Pseudomonas aeruginosa and 100% (1/1) for Citrobacter amalonaticus, respectively. The test was able to correctly identify 96.5%. of Gram negative microorganisms that were located in the test panel. CTX-M was the most common gene responsible for the resistance.
DISCUSSION AND CONCLUSION: Verigene Gram negative (BC-GN) microarray test (Nanosphere) is a rapid method which can correctly identify the located Gram-negative microorganisms in the panel and results much faster than the conventional methods.

INTRODUCTION: Neonatal bilirubin-induced neurologic dysfunction can present with a wide spectrum of symptoms from mild neurologic impairment to severe acute bilirubin encephalopathy.In this study, we aimed to determine the risk factors of unconjugated hyperbilirubinemia among hospitalized infants with serum total bilirubin levels ≥25 mg/dl and evaluate the effects of high serum bilirubin levels due to hemolysis on the neurodevelopmental outcome at postnatal between 18 and 24 months.
METHODS: Thirty six-term infants were enrolled in the study. The patients were divided into two groups according to the condition of hemolytic and nonhemolytic hyperbilirubinemia. Neurodevelopmental assessment with The Bayley Scale of Infant Development-II at postnatal 18-24 months was performed to all infants.
RESULTS: 14 infants (38,9%) were in the nonhemolytic group, while 22 ( 61,1%) were in the hemolytic group and there was no statistically significant difference between the groups in terms of the measured mean Mental Developmental Index and Psychomotor Developmental Index scores. All 4 patients who underwent exchange transfusion had subgroup incompatibility and their Psychomotor Developmental Index scores were significantly low(p<0.05).
DISCUSSION AND CONCLUSION: In our study, we found that subgroup incompatibility was an important risk factor for hemolytic indirect hyperbilirubinemia and that the mean psychomotor neurodevelopmental score associated with high hyperbilirubinemia may be low in these patients. We believe that larger case series studies are needed to discuss the relationship between subgroup nonconformity and neurodevelopmental outcomes.

INTRODUCTION: Aim: The aim of this study was to investigate the effect of pinna position on body temperature measurements made with tympanic membrane thermometer in pediatric patients.
METHODS: Materials and Methods: The study was conducted with a quasi-experimental design with a pre-test and a post-test. For analysis of the data, frequencies, percentages, means and standard deviations were calculated, and the significance of the difference between paired values was tested in order to investigate the effects of auricle position on measurement values.
RESULTS: Results: The age of the patients included in the study ranged between 6 and 13 years, and the mean age was 10.25±1.83. The mean difference between measurements in two different positions was 0.350C. The measurements made in each position were represented in a Bland Altman plot. It was seen that the differences between the two positions were not distributed around zero, but instead showed a systematic distribution around 0.35. There was a significant relationship between the differences and the mean values. The difference between the mean durations was found to be 1.07 seconds. The discomfort levels of the patients during temperature measurement without pinna positioning and with pinna positioning ranged between 0-2 and 0-4 according to the facial expressions scale. During temperature measurement with pinna positioning and without pinna positioning felt no discomfort.
DISCUSSION AND CONCLUSION: In measurements carried out through tympanic membrane thermometers in pediatric patients, giving position to auricle by pulling it downward posteriorly yielded more reliable and correct outcomes.

INTRODUCTION: Escherichia coli is the most common microorganism recovered in urinary tract infections (UTI) in all age groups. Lately, different pathogens, like Morganella morganii, are beginning to be isolated. The aim of this study was to investigate children with UTI caused by Morganella morganii.
METHODS: Children with UTI caused by Morganella morganii, in our pediatric outpatient clinic, were retrospectively evaluated.
RESULTS: The mean age of 11 children was 4.2±1.9 years (min: 19 months,max: 7.5 years). Four (36.4%) patients were female. The most frequent symptoms were irritability and dysuria (n=5, 45.5%). Urinalysis was positive for leukocytes in 9(81.8%), hematuria in 5(45.5%), and nitrite in 6 (54.5%) patients. None of the patients had electrolyte abnormalities or renal failure. Colony count was most prevalently 100,000CFU/mL (n=7,63.6%). The pathogen was most sensitive to imipenem/meropenem and piperacillin-tazobactam (n=11,%100,for both). Two(18.1%) patients were hospitalized. Empirical antibiotic treatments were switched to amikacin (15mg/kg/day) for outpatient patients and piperacillin-tazobactam (300mg/kg/day) for hospitalized patients for 10 days. Repeat urine cultures on the third day of treatment were negative.
DISCUSSION AND CONCLUSION: Morganella morganii, which is usually encountered as any kind of nosocomial or opportunistic infections, is presented as a cause of community-acquired UTI in this study. Antibiotic susceptibility profiles are crucial in directing treatment like other infections.

Hyperinsulinemic hypoglycemia is a rare disease affecting infants and children. The frequency of HNF4A mutation is the third commonest type following ABCC8 and KCNJ11 mutations. HNF4A inactivating mutations may cause hyperinsulinemic hypoglycemia generally in neonatal period by impairing insulin production and secretion in pancreatic β cells. Herein, we present a case of 8 months-girl with hyperinsulinemic hypoglycemia who had normal birth weight. In this case, hypoglycemia became prominent after acute gastroenteritis and long term glucose infusion was administrated to overcome hypoglycemia. On follow up, diazoxide treatment up to 12 mg/kg/day was required to achieve normal glucose levels. In the molecular genetic analysis, a heterozygous mutation was found in HNF4A gene (c.266G> A, p.R89Q), which is previously described in a case with MODY (maturity-onset diabetes of the young) type 1. During two weeks hospitalization, while glucose infusion rate was tapering, oral feeding was increased. Diazoxide treatment continued after discharged and was gradually stopped when she was at the age of 14 months, afterward, no hypoglycemia was observed. HNF4A gene mutation should be kept in mind even if there is no macrosomia or family history of diabetes in patients presenting with hypoglycemia and requiring diazoxide therapy.

INTRODUCTION: The toxic effects of scorpion stings may be mortal have been known for many years. The progression of poisonings due to scorpion stings is more severe in childhood. These poisonings can cause complications from local skin findings such as pain, redness, and pruritus to fatal complications such as heart failure and pulmonary edema.
We aimed to investigate the effectiveness of the second dose antivenom in this study.

METHODS: 100 patients between 0-17 years who were followed up due to scorpion stings or poisonings in Mustafa Kemal University, Faculty of Medicine, Department of Pediatrics between October 2016 and March 2018 were analyzed for age, gender, season, site of scorpion stings, clinical findings, treatment and follow-up steps, effects of second dose antivenom on clinical progression retrospectively.
RESULTS: Of the total 100 patients, 45 were female (45%) and 55 were male (55%).The average age of the patients was 3.5 years (3,6 years for girls and 3,5 years for boys).The most frequent applications were summer (71%). Bite locations in order of frequency; foots, hands, legs, arms, head-neck, genital area.
DISCUSSION AND CONCLUSION: We have observed that early antivenom therapy reduces the risk of developing systemic symptoms, and even recurrent dose antivenom corrects systemic findings. We think that antivenom should be applied especially in pediatric patients and all patients should be observed for at least 24 hours.

INTRODUCTION: Hyponatremia is a common electrolyte abnormality in hospitalized patients. Administration of isotonic maintenance fluids are recommended to prevent hyponatremia. The present study was conducted to evaluate the frequency and severity of hyponatremia in children with acute lymphoblastic leukemia (ALL).
METHODS: The frequency, severity and possible causes of hyponatremia in children with ALL throughout their entire intensive treatment were retrospectively evaluated. All children in this study received isotonic fluids as maintenance iv treatment during hospitalization period.
RESULTS: In a five year period 618 hyponatremia episodes were seen in 92 children with ALL (median age 59 months), treated with ALLIC 2002 protocol were entered into the study. The median hyponatremia episode per patient was 6. All patients had at least one hyponatremia episode which of them were classified as mild in 83.2 %, moderate in 13.2 %, severe in 2.9% and very severe in 0.6%. The median duration of hyponatremia episodes was 5 (range netween 1-43) days. Total duration of all hyponatremia episodes of each patient was changed between 6 to 138 days with a median of 30 days.
In 241 episodes of 68 children there was inadequate salt intake secondary to oral feeding intolerace, nausea, vomitting and oral aftous stomatitis.
In four patients seizure was seen during hyponatremia period and thought to be secondary to hyponatremic encephalopathy. No patient developed central pontine myelinosis.
DISCUSSION AND CONCLUSION: Hyponatremia is very frequent in ALL patients. Despite use of isotonic iv fluids it seems can not be completely prevented.

INTRODUCTION: Chronic spontaneous urticaria (CSU) is characterized by urticaria recurring almost every day and lasting more than six weeks, with either known or unknown etiology. It may lead to various psychiatric disorders. Our aim is to determine the relationship of CSU with depression and anxiety in children.
METHODS: Children younger than 18 years of age who were followed by the Pediatric Immunology and Allergy Clinic of Diyarbakır Children’s Hospital with diagnosis of CSU were included in the study. A control group matched in terms of age and sex was formed. Both patient and control groups were evaluated by pediatric psychiatrics with regards to anxiety and depression. Prior to psychiatrics evaluation, Beck’s anxiety and depression scales were applied to the children aged 12 years or above. Patient and control groups were compared for anxiety and depression disease and symptom scores.
RESULTS: The study included 63 patients, 32 of whom were aged 12 years or above (12+ patients), and 82 controls, 32 of whom were aged 12 years or above (12+ controls). In the patient group, both anxiety and depression disorders were significantly more frequent. Similarly, anxiety and depression symptom scores were significantly higher in the 12+ patient group. This increase was found to show positive correlation with age and disease duration (p<0.05). There were no significant differences between patients with and without autoimmunity regarding anxiety and depression disorder (p>0.05).
DISCUSSION AND CONCLUSION: In children, chronic spontaneous urticaria leads to anxiety and depression. This condition increases with age and disease duration.

INTRODUCTION: Pneumothorax is detected in approximately 1-2% of all term newborns and this rate can reach 15-20% in neonatal intensive care units; tube thoracostomy is the traditional treatment in symptomatic newborns. The management of neonatal pneumothorax, and etiologies, and risk factors related to mortality were evaluated in this study.
METHODS: A total of 6647 newborns who were treated in the neonatal intensive care unit during the last ten years were evaluated retrospectively. Newborns with pneumothorax were included in the study. Demographic characteristics, treatment modalities, and outcomes were evaluated.
RESULTS: Pneumothorax was diagnosed in 124 (1.9%) newborns. The mean gestational age was 33.3±5.1 weeks and the mean birth weight was 2163.7±899.4 grams; 101 (81 %) were preterm and 40 (32%) were with very low birth weight newborns. Seventy-four (58%) newborns were diagnosed as having respiratory distress syndrome, the diagnosis was transient tachypnea of the newborn in 43 (35 %), meconium aspiration syndrome in 3 (2.5%) and pneumonia in 4 (3%). One hundred nineteen newborns were treated with tube thoracostomy. Spontaneous resolution was observed in five newborns with close follow-up. A total of 139 (bilateral pneumothorax in 20 newborns) tube thoracostomies were performed at the bedside with no major complication. The overall mortality rate was found as 21 %. Gestational ages were 33 weeks or less in 25 of the 26 deaths.
DISCUSSION AND CONCLUSION: Very low birth weight and prematurity in neonatal pneumothorax are associated with mechanical ventilation necessity and mortality. Tube thoracostomy with small-bore chest drains is safe and effective in the management.

In early December, pneumonia cases of unknown origin and on January 7, 2020, these cases were declared to be caused by a novel beta-coronavirus according to viral genome sequencing on 11 February 2020.Coronaviruses are enveloped, single strand RNA viruses that have been known to have ability to mutate rapidly, alter tissue tropism and adjust different epidemiological situations. As of end of April, 122.392 with laboratory-confirmed COVID-19 have been detected in Turkey, of whom 3.258 have died. From beginning of the epidemic COVID 19, children seem to be less affected than adults. Therefore, there are limited data regarding clinical features of COVID 19 in children. The majority of children had a history of family cluster. The most common symptoms were fever and cough. Previous data suggest that nearly half of patients are afebrile at the onset of disease.Hospitalization and PICU admission rates were lower than adults. However, PICU admission can be necessitated in children with severe disease. Infants particularly under the age of 12 months, were more likely to develop severe disease. In children, milder and asymptomatic cases can be challenging and can play a role in transmitting. Clinicians should test children in particular, having a history of family cluster even they are asymptomatic or presenting with mild symptoms.

INTRODUCTION: The aim of this study was to investigate the relationship between physical activity level and body mass index of children with Down syndrome.
METHODS: The study included 26 children (15 men, 11 women) with Down syndrome. In the study, demographic information was recorded, the physical activity was measured with Eurofit battery; body fat content, muscle weight, protein content, body fluid ratio, basal metabolism rate by Bioelectric Impedance Analysis.
RESULTS: The mean age of the participants was10,96 ± 2,94 years and the mean BMI of the participants was 21,51 ± 6,719. There was moderate correlation between general fat weight and arm motion speed (r: -0,40); moderate correlation between sit and reach test and general fat weight (r: -0.45), trunk fat weight (r: -0.52), liquid ratio (r: 0.54); moderate correlation between basal metabolic rate and right hand grip strength (r: 0.73), right arm weight witout fat (r: 0.70), right arm muscle weight (r: 0.69), basal metabolic rate (r: 0.73); left hand grip muscle with left arm muscle weight (r: 0.74), left arm weight witout fat (r: 0.75), basal metabolism rate (r: 0.72), mineral amount (r: 0.83), amount of protein (r: 0.83); moderate correlation between thirty-second shuttle and fat percentage body (r: -0.44), liquid ratio (r: 0.45), body density (r: 0.46); moderate correlation between Twisted arm hanging strength and fat rate in arm (r: -0.47) with trunk fat rate (r: -0.40), fat weight (r: -0.39); moderate correlation between Twenty-meter resistance and trunk fat rate (r: -0.40).
DISCUSSION AND CONCLUSION: It was seen that the physical activity level decreased as the fat ratio increased in individuals with Down syndrome. Basal metabolic rate, fluid ratio and physical activity were found to be correlated.

INTRODUCTION: The ratio of monocytes to lymphocytes (ML) could reflect an immunity to Mycobacterium tuberculosis. The objective of this study was to evaluate the relationship between ratio of monocytes to lymphocytes, clinical status of patients with active tuberculosis (TB).
METHODS: This was a retrospective review of data collected from the clinical database of the Behcet Uz Children Research Hospital.138 patients were diagnosed with pulmonary and extrapulmonary TB from January 2006 to January 2015. White blood cell count, absolute monocyte and absolute lymphocyte counts, ML ratio, erhytrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were compared between extra-pulmonary and pulmonary TB. Pre-treatment and after treatment values of the paramters were also compared in both of the groups.
RESULTS: A total of 138 patients were diagnosed as pulmonary and extrapulmonary tuberculosis during the study period. No significant difference between pulmonary and extra pulmonary TB was present regarding white blood cell count, absolute monocyte and lymphocyte, ESR and CRP (p>0.05). In patients with pulmonary TB and extra-pulmonary TB, significant decrease in white blood cell count, absolute monocyte count, ESR and CRP values after treatment comparing to pretreatment (p<0.05). The ML ratio was not significantly different in extrapulmonary tuberculosis (p>0.05) while significantly difference was present between pre and post-treatment group in pulmonary tuberculosis (p=0,000).
DISCUSSION AND CONCLUSION: The hematological markers including ML rate were found to be more useful for monitoring the response of tuberculosis therapy, rather than differential diagnosis of pulmonary tuberculosis from extra-pulmonary tuberculosis.

INTRODUCTION: Aim: To determine the effects of positioning on adaptation to spontaneous breathing in premature infants after weaning from mechanical ventilation.
METHODS: This randomized controlled experimental study was conducted with 60 (study group=30; control group=30) premature infants in the neonatal intensive care unit. The infants in the study group and the control group were in a prone position and a supine position, respectively, during the first 120 minutes when spontaneous breathing started after they were weaned from mechanical ventilation.
RESULTS: There were significant intragroup differences in mean heart rate between repeated measures at different time points. The differences were not found to be due to positioning. The mean SpO2 was higher in the study group than in the control group, although the difference was not significant. This finding suggested that positioning did not have an influence on SpO2. Two infants in the control group failed to maintain spontaneous breathing. Although the study group had a significantly higher respiratory rate than the control group, the difference was not significant. Therefore, positioning was not found to affect respiratory rate.
DISCUSSION AND CONCLUSION: There was no effect of positioning on adaptation to spontaneous breathing in premature infants after weaning from mechanical ventilation.

INTRODUCTION: The Amelogenesis Imperfecta (AI) term includes numerous inherited congenital enamel defects indicating clinical and genetic heterogeneity. The aim of the present study was to emphasize the importance of the potential prediction of AI via biochemical parameters.
METHODS: In total, 50 children were assessed in the study. The subjects included 13 syndromic AI, 22 isolated AI and 15 healthy children with a mean-age of 12.01±3.79 years old. The Bone Alkaline Phosphatase (BALP) and Growth Hormone (GH) blood levels of the children were evaluated. All data were statistically analysed by the SPSS 15,0 programme, oneway-Anova and Chi-square tests.
RESULTS: 72.7% of syndromic AI and 47.6% of isolated AI group children have higher than normal BALP levels; 33% of syndromic AI and 28% of isolated AI group children have lower than normal blood GH levels. Subjects with AI have statistically significant abnormal blood BALP and GH levels and the presence of an additional syndrome other than AI did not affect the results.
DISCUSSION AND CONCLUSION: Pediatricians may have a key role in early AI diagnosis via the evaluation of abnormal BALP and GH levels in blood tests and may help in providing comprehensive dental treatment in terms of prevention, prognosis and restoration of teeth in children with AI.

INTRODUCTION: This study aims to identify the frequency of the most seen health complaints and the relations with the socio-demographic characteristics of households in Turkey.
METHODS: Turkey Health Survey research was conducted as cross sectional study by The Turkish Statistical Institute (TURKSTAT). Within the scope of the research, the health status history of a total of 3,921 children aged 7-14 was examined to identify the following factors: Gender and age of the children, some sociodemographic characteristics of their households, having any health complaints in the last 6 months, treatment status at health-care facility for the children aged 7-14 years.
RESULTS: The findings showed that of the 3,921 children who participated in this research, 50.8% were male, 34.4% had at least one health complaint, and 88.0% of the children with health complaints were treated. The most seen health complaints in the children in the last 6 months were oral and dental-related health complaints (25.8%), eye-related health complaints (14.6%) and infectious diseases (9.8%). According to the results of the logistic regression, as the higher numbers of people living in the household, the presence of a person who define his health status as poor and the presence of an individual with chronic disease in the household are effecting the presence of the health complaints in children negatively.
DISCUSSION AND CONCLUSION: We have found that the health status of children can be effected in families with chronic disease or poor health, and suggest that researches on child health should be investigated deeply in such families.