INTRODUCTION: Transition from tube to full oral feeding (FOF) represents an important milestone for very preterm infants, and can be affected by various factors. This study aimed to evaluate transition time to FOF in very preterm infants and to identify the factors affecting this skill.
METHODS: In this 4-year study, infants’ characteristics, feeding steps, and co-morbidities were retrospectively evaluated. Infants were categorized into two group based on FOF timing and comparisons were made. Logistic regression analysis was used to examine affecting factors.
RESULTS: Transition from tube to FOF occurred on a median of 20 days. There were 48 and 52 neonates in the ≤20 days and >20 days groups, respectively. Gender, delivery type, and antenatal history were similar between the groups. The majority were supported with formula. More infants were at >30 weeks of gestational age, and had a birth weight >1.47 kg in the ≤20 days group. A lesser proportion of those required invasive interventions, and had co-morbidities.
In this study, requirement of non-invasive ventilation ≤3 days, receiving kangaroo mother care and promotion of non-nutritive sucking within the first week, and achievement of full enteral feeding in ≤14 days were associated with a positive effect on translation to FOF in ≤20 days. However, a gestational age of ≤30 weeks and diagnosis of bronchopulmonary dysplasia had a negative effect.

DISCUSSION AND CONCLUSION: This was one of the few studies to investigate timing of transition to FOF in very preterm infants as well as its affecting factors. Further studies are required to provide guidance on interventions shortening FOF time and to provide kangaroo mother care, non-nutritive sucking and breastfeeding in very preterm population.

INTRODUCTION: To test the validity and reliability of the Turkish version of the Preterm Oral Feeding Readiness Assessment Scale (T-POFRAS) to add this scale to the literature.
METHODS: A methodological study was conducted with 90 preterms in Neonatal intensive care unit in a state hospital.
RESULTS: The best cut-off score values was 29 from the Receiver Operating Characteristics analysis. For the 1st observer, 100% sensitivity and 95.7% specificity were seen at a cut-off score of 29, whereas for the 2nd observer, 95.5% sensitivity and 97.8% specificity were seen. The inter-rater agreement was quite high when the two observers were divided into groups according to their cut-off scores (Kappa=0.933; p=0.0001). The inter-rater agreement was 96.7% (in 87 preterm).
DISCUSSION AND CONCLUSION: This study showed that the validity of the Turkish version of the Preterm Oral Feeding Readiness Assessment Scale was acceptable.

INTRODUCTION: Children with sickle cell disease (SCD) are at high risk for vitamin D deficiency (VDD). The prevalence of VDD in different countries is between 65-100% in these patients. The present study was undertaken to find the prevalence of VDD among sickle cell children and to assess the association of co-morbidities with VDD.
METHODS: Total 89 children who were attending sickle cell clinic /admitted in pediatric wards of Tertiary Care Centre were enrolled for the study. After history, clinical examination and anthropometry, samples were taken for serum 25-OH vitamin D and calcium level assessment. Outcome was morbidity in sickle cell children in terms frequency of pain episodes, number of febrile episodes, number of blood transfusions and total number of admissions.
RESULTS: Out of 89 cases, 58(65.17 %) cases were deficient for vitamin D (<20ng/dl), 22(24.72%) cases had insufficiency (20-30 ng/dl) and 9(10.11%) cases had normal vitamin D level (>30 ng/dl). The mean vitamin D level was 19.42ng/dl. Morbidity in SCD was more in VDD children compared to vitamin D sufficient children with significance in number of pain episodes and total number of hospital admissions but not in number of admissions for acute febrile illness or total number blood transfused.
DISCUSSION AND CONCLUSION: VDD was prevalent in 65.17% of children with SCD. Children between 4-12 years were more affected with male predominance. As this study involved children with SCD alone, a future study need to be carried out involving children without SCD to establish better possible link between vitamin-D and SCD morbidity.

INTRODUCTION: Nigeria has the highest number of children with sickle cell disease (SCD) with a consistent prevalence of 2 to 3% despite increased awareness and widespread premarital screening. In our practice, we observed that complaints of haemoglobin phenotype misdiagnosis are common among parents with children living with SCD. The present study was thus carried out to identify the prevalence, determinants, as well as the perceived impacts of haemoglobin phenotype misdiagnosis in Lagos, Nigeria.

METHODS: The study included parents of children with sickle cell disease aged below 18 years. Interviewer administered Questionnaires were used to obtain relevant biodata, sociodemographic data and assessment of perceived impact from both caregivers and their children, between May and July 2019
RESULTS: Fifty-nine (32.4%) out of the 182 parents recruited have had previous haemoglobin phenotype misdiagnosis. Misdiagnosis was significantly more in individuals in upper social class and those that had the test in private laboratories. Clinical, psychosocial and economic impacts of having affected child with SCD were reported
DISCUSSION AND CONCLUSION: The frequency of wrong haemoglobin phenotype diagnosis is alarmingly rampant amongst parents of children with SCD. This is potentially devastating to these families and the society, hence the government needs to step up, audit and enforce regulatory oversight of laboratories as well as institute a nationwide newborn screening programme to replace the existing widespread use of haemoglobin electrophoresis for diagnosis of SCD.

INTRODUCTION: Health care-associated infections are important situations that may lead to increased morbidity and mortality, prolonged hospital stay and increased costs. The incidence of health care-associated infections has been reported to be higher in developing countries but data regarding the epidemiology in pediatric patients is limited. The aim of this study was to determine the rate and distribution of health care-associated infections and the antimicrobial susceptibility patterns in pediatric intensive care unit
METHODS: Demographic and clinical details, microbiological findings, antibiotic susceptibility results and the outcomes of the all hospitalized pediatric intensive care unit patients were collected for one year(September 2017-2018).
RESULTS: The health care-associated infections rate was 5.6 per 100 admissions and the incidence density was 7.2 per 1000 patient-days. Bloodstream infections (50%) was the most common type and Klebsiella species (40.9%) was the most common cause of health care-associated infections All of the Klebsiella spp. were resistant strains with producing ESBLs (77.7% ) and the remaining were resistant to carbapenem. Acinetobacter species and colistin resistance was not detected in any isolates.
DISCUSSION AND CONCLUSION: This study demonstrated a low prevalence of health care-associated infections but a high rate of antibiotic resistance in Klebsiella species in pediatric intensive care unit. In addition to improved surveillance, consultation on infectious diseases in empirical treatment and the ongoing management will allow the development of interventions to reduce health care-associated infections and also provides appropriate targeted treatment.

INTRODUCTION: In this retrospective study, our objective was to evaluate the children with arterial or venous thromboembolism, who were treated with tissue plasminogen activator (tPA) in our hospital.
METHODS: The medical records of 56 tPA treatments administered to 53 patients with thrombosis in the pediatric intensive care unit and pediatric clinic at X University Balcali Hospital between September 2013 and August 2018, were investigated retrospectively.
RESULTS: Thirty-three of the patients were males (58.9%). The median age was 13.5 months (1-203 months). Fifty-two of the patients received low-dose tPA treatment (91.2%) and the mean treatment duration was 63.8±43.3 hours (3-192 hours). Thrombolytic treatment was administered to 38 patients (67.8%) with the catheter-related arterial thrombus, to 8 patients (14.3%) with the intracardiac thrombus, to 4 patients (7.2%) with the pulmonary arterial thrombus, to 6 patients (10.7%) with the deep venous thrombus. No complication was observed in 47 treatments (83.9%). However, 7 patients had minor (12.5%) and 2 patients had major bleeding (3.6%). Recanalization could not be achieved in 8 cases (14.3%) and 4 patients underwent embolectomy. The use of anticoagulant treatment with tPA did not change the complication rate and the success rate of the recanalization.
DISCUSSION AND CONCLUSION: We detected that low-dose tPA treatment was effective in the treatment of life- or limb- or organ-threatening arterial and venous thromboembolism in children. However, randomized studies with larger sample sizes and control groups are required.

INTRODUCTION: Gaucher disease (GD) is the most prevelant hereditary lysosomal storage disorder, affecting multiple organ systems. It is characterized by a deficiency of the enzyme glucocerebrosidase leading to accumulation of glucosylceramide in lysosomes. Majority of patients present with hepatosplenomegaly, anemia, thrombocytopenia, bleeding tendencies, skeletal pathologies, growth retardation and in severe cases pulmonary disease. The bone manifestations include bone infarcts, avascular bone necrosis, lytic lesions, osteopenia or osteoporosis. This article gives an overview on bone manifestations of 20 GD patients and review the current literature.
METHODS: Data of 20 patients with GD that were being followed-up in XXXX University Hospital Pediatric Metabolism Unit were retrospectively evaluated. Demographic information including age, gender, clinical findings, ERT status and duration were recorded. Laboratory analyzes including serum calcium, phosphorus, vitamin D, the presence of skeletal findings, and bone mineral density (BMD) Z scores were collected from the patient files. BMD statuses of patients were compared with the pre-treatment values.
RESULTS: Their main symptoms of referral were abdominal distention, cytopenia, bleeding tendency and skeletal findings. All patients had skeletal symptoms. Nineteen patients showed vitamin D deficiency. The medullary involvement of femur and vertebrae was present in 14 (70%), erlenmayer flask deformity in 3 (15%), avascular necrosis in one (5%) patient. Also, one patient (5%) had lytic bone lesions. Ten patients showed osteoporosis (50%), and 8 showed osteopenia (40%) at the time of diagnosis, before the inititation of ERT. The rate of osteoporosis was detected 40%, and osteopenia to 35% withing the study group after the inititation of ERT.
DISCUSSION AND CONCLUSION: Physicians, including pediatricians, may be unfamiliar with bone pathophysiology and the complexity of the skeletal manifestations of GD. There is a need to enhance awareness and to improve diagnosis and treatment of skeletal pathology in patients with GD.

INTRODUCTION: This study aimed to assess the clinical features, management, and long-term outcomes of pediatric patients with CMPA (cow’s milk protein allergy).
METHODS: This is a retrospective study consisting of 246 children with CMPA. Data of the patients were collected from the medical files.
RESULTS: 95.8% of patients experienced the first reactions associated with cow’s milk (CM) allergy during infancy. Hen’s egg (56%) was the most frequent triggering food coexisting with CMPA, and this was followed by tree nuts (6%), wheat (5%) and lentil (3%). During five years of the follow-up period, tolerance occurred in 78.9% of the patients. The optimal cutoff value for CM sIgE to predict the tolerance status for CMPA was 7.39 kU/L with a sensitivity of 87.3% and a specificity of 58.3%, (95% CI, 0,655-0,859, p<0.001). IgE-mediated hypersensitivity reactions (OR 4.369 [95% CI, 2.298-8.308, p<0.001), family history of atopy (OR 2.943 [95% CI, 1.324-6.541, p: 0.008), CM sIgE>7.39 (OR 9.683 [95% CI, 3.947-23.757, p<0.001), casein sIgE >0.56 (OR 6.909 [95% CI, 2.719-17.557, p<0.001), were the predictors for the persistence.
DISCUSSION AND CONCLUSION: This study showed that the majority of the CMPA in children gave rise to clinical manifestations in the infancy period, most of them less than six months of age. The prognosis of the disease was favorable with a spontaneous tolerance developed by the age of three in most patients. IgE-mediated hypersensitivity reactions, a family history of atopy and higher specific IgE values were predictive factors for the long-lasting disease.

INTRODUCTION: The proper quantity and quality of breast-milk availability markedly influenced by the number of breastfeeding (BF) sessions per day. Thus, evidence-based information can assist efforts to improve the frequency of successful BF by making consistent professional support. We aimed to provide information on factors predicting maternal breastfeeding-frequency (BFF).
METHODS: A community-based cross-sectional study was conducted by including 861 selected lactating mothers through a cluster sampling. A face-to-face interview was administered using an Online-Data-collection-kit (ODK) platform. The collected data was directly downloaded from the Google Cloud and imported to Stata 14 for further analysis. Negative Binomial Regression was fitted to model the frequency of BF and its predictors.
RESULTS: Around 77% of mothers breastfed their infants at least 9 times per day, of which 15% of the mother's breastfed more than 12 times per day. The incidence of frequent BF increased among mothers who had postnatal follow-up (Adjusted Incidence Rate Ratio (AIRR): 1.07; 95% CI: 1.01- 1.13), who strongly perceived about the adequacy of their breast milk production (AIRR: 1.22; 95% CI: 1.04-1.44) and who had preterm births (AIRR: 1.06; 95% CI: 1.02-1.13). Furthermore, a one-centimetre increase in Mid Upper Arm Circumference (MUAC) of the mothers was associated with an increased frequency of BF (AIRR: 1.02; 95% CI: 1.02-1.03).
DISCUSSION AND CONCLUSION: The ratio of lactating mothers who breastfeed their infants was found to be lower than the Ethiopia Infant and Young Child Feeding Practice (IYCF) guideline. The incidence-rate-ratio of frequent breastfeeding was directly associated with antenatal MUAC, postnatal follow-up, preterm birth, and maternal perception about breasts’ milk production. Though BFF is one of the components of appropriate BF, the issue has been getting little attention in Ethiopia. Thus, frontline health professional and concerned bodies shall give attention to the enhancement of the frequency of BF by giving attention to the identified predictors.

INTRODUCTION: Twin studies allow the investigation of genetic and environmental influences on human brain development. The generalizability of those findings depends on the developmental similarity between twins and singletons.
METHODS: This study aimed to evaluate the structural and functional differences in a cohort of preterm-born twins and singletons, including 18 twins and 47 singletons at term age. Brain volumes from 3D T1-weighted images, quantitative metrics and structural connectivity from diffusion tensor imaging (DTI), and low-frequency brain activity and functional connectivity from resting-state functional MRI (rs-fMRI) were obtained from these neonates.
RESULTS: We found no significant volumetric differences after multiple comparison correction. The diffusivity values in the cingulum cingular part, cingulate gyrus, lateral fronto-orbital gyrus, gyrus rectus, as well as medial fronto-orbital gyrus were significantly higher in the twin group than the singleton group. Structural connectivity analysis showed higher transitivity in the twin group compared to the singletons, indicating increased local connectivity. For rs-fMRI, the twin group showed greater fractional amplitude of low-frequency fluctuation (fALFF) values in the salience network and several fronto-temporal regions compared with the singleton group. It is worth noting that we found differences both in structural and functional measurements (MD and fALFF) in prefrontal and cingulate cortex.
DISCUSSION AND CONCLUSION: The structural and functional differences collectively indicated that twins may have delayed brain development compared with gestational age-matched singletons at term-equivalent age.

INTRODUCTION: Neurofibromatosis type 1 (NF1) disease is an inherited skin disorder with variable severity and heterogeneous systemic involvement. Pathogenic variations of the NF1 gene are responsible for the NF1 phenotype. We aim to expand the variant spectrum of the NF1 gene.
METHODS: In this study, clinical and molecular manifestations of 92 molecularly confirmed NF1 patients from 86 unrelated families were presented. Next generation sequencing method (Using Ion Torrent PGM™ Platform) was performed for analyzing the whole coding exons of NF1 gene.
RESULTS: 76 different NF1 variations were identified that 27 of them were novel. 42.5% of the patients were familial and 57.5% were sporadic. Except for the 20-years-old patient with c.1637dupT variant who presented pilocytic astrocytoma without cutaneous findings, all the other patients demonstrated the several typical clinical criteria of NF1.
DISCUSSION AND CONCLUSION: Although NF1 diagnostic criteria are the most widely used and proficient clinical diagnostic tool, NF1 gene analysis can be applied as a definitive diagnostic tool in cases with atypical presentations and in early childhood.

INTRODUCTION: Williams–Beuren syndrome, which is characterized by dysmorphic facial features, cardiovascular findings, intellectual disability, endocrine abnormalities and a typical cognitive profile, is caused by a microdeletion in the 7q11.23 region. In this study, we aimed to evaluate the dysmorphic and clinical manifestations of patients with Williams-Beuren syndrome.
METHODS: We, retrospectively, collected data from 27 Turkish patients who had clinically and genetically confirmed Williams-Beuren syndrome. The multisystemic manifestations, demographic data and dysmorphic facial features were recorded.
RESULTS: All patients had the characteristic facial phenotype. The most frequent dysmorphic facial features were periorbital fullness, short nose, broad nasal tip and wide mouth. Aortic stenosis (59.2%) and pulmonary stenosis (37%) were the most common cardiac findings. Short stature (25.9%), idiopathic central precocious puberty (7.4%), hypothyroidism (congenital, non-congenital or subclinical) (40.7%) and hypercalcaemia (3.7%) were the major endocrine manifestations in the patients. Genitourinary abnormalities were detected in 6 patients. All patients had some degree of intellectual disability; most of the patients (62.9%) had mild intellectual disability. Besides, behavioral problems were frequently detected and the most common abnormality was overfriendliness (77.7%). Renal abnormalities (double collecting system, bladder diverticulae and renal calculi) were also detected.
DISCUSSION AND CONCLUSION: Dysmorphic facial features, which have a crucial role in the diagnosis of Williams-Beuren syndrome, should be assessed in suspected patients with supravalvular aortic stenosis and concomitant intellectual disability, to make an early diagnosis. It should be kept in mind that endocrine abnormalities, musculoskeletal, neurologic and psychiatric manifestations are also common in patients with Williams-Beuren syndrome, necessitating multidisciplinary approach.

INTRODUCTION: Glycemic variability can be affected in diabetes camps due to sports, social activity and nutrition. Close glucose monitoring is necessary to reduce glycemic variability; especially hypoglycemia.
Aim: Assessment of glycemic variability and time in range by using flash glucose monitoring system (FGMS) in children and adolescents with type 1 diabetes.
METHODS: Method: Children and adolescents between 10-18 years of age who participated in the 2018 diabetes camp were included.
RESULTS: Results: Mean age and duration of diabetes mellitus was 13.3 ± 0.5 and 4.9 ± 0.7 years respectively. Twelve (43 %) of the participants were boy and 16 (57 %) were girl. Ten (35.7 %) of the participants used continuous subcutaneous insulin infusion (CSII) pump therapy while 18 (64.3 %) used multiple dose insulin (MDI) therapy.
When participants were evaluated according to TIR (time in range), during the camp while the duration of TIR increased, level 1 and level 2 hyperglycemia decreased. Participants using CSII had spent more time in level 2 hypoglycemia before camp, but during and after the camp similar values reached for both groups. Before camp participants with good metabolic control had longer duration of hypoglycemia than participants with poor metabolic control. During and after the camp level 1 and level 2 hypoglycemia periods were similar between the groups.
DISCUSSION AND CONCLUSION: Conclusion: In diabetes camp, healthy diet, regular exercise, and close glycemic control improve glycemic variability. By using FGMS, normoglycemia periods can be increased without increasing hypoglycemic attacks. As a result, using FGMS had positive effect on diabetes management and controlling hypoglycemia periods during diabetes camp.

INTRODUCTION: We aimed to investigate the frequency of diabetic ketoacidosis (DKA) and the associated factors at the diagnosis of type 1 diabetes (T1D) in children in a tertiary health center in Turkey, and to review previous studies conducted in Turkey.
METHODS: Data of 180 children with T1D (98 boys) aged 1 to 18 years were analyzed retrospectively. All children were consecutively diagnosed as having T1D at our pediatric endocrinology clinic between April 2016 and December 2019. To conduct a literature review, we screened PubMed, Google Scholar, Web of Science, and article reference lists as well as proceedings of the national conferences organized by the Turkish Pediatric Endocrinology and Diabetes Society for the period until January 1st, 2020.
RESULTS: DKA was detected in 81 (45.0%) children with T1D at diagnosis in this cohort. An association between DKA and high glycated hemoglobin (HbA1c) levels at the time of diagnosis was determined (p=0.038). Furthermore, a relationship was also detected between severe DKA (pH <7.1 or serum bicarbonate <5 mmol/L) and children residing in rural areas, as well as mothers with education less than high school (p=0.003 and p=0.022, respectively). This study, together with a literature review of 49 other studies, identified that 4037 (45.6%) of 8837 children with newly diagnosed with T1D presented with DKA at diagnosis between 1981 and 2019.
DISCUSSION AND CONCLUSION: In this cohort, presentation with DKA was associated with high levels of HbA1c, and presentation with severe DKA was associated with rural life as well as low education levels of mothers at the diagnosis of T1D in children. Almost half of all children with T1D presented with DKA in Turkey. There should be more efforts to increase awareness

INTRODUCTION: Childhood absence epilepsy is a common idiopathic epilepsy in childhood. This epilepsy, which has been shown to impair cognition, needs to be treated promptly and correctly. Therefore, determining the prognostic factors before treatment can provide a prediction about the duration of treatment, drug selection, and drug dosage.
METHODS: Electroencephalography (EEG) and clinical findings of patients diagnosed with childhood absence epilepsy who were monitored for at least 12 months in the pediatric neurology clinics of two university hospitals were reviewed retrospectively between 2006 and 2010. The patients were divided into two groups as responsive and unresponsive, according to seizures, EEG findings, and recurrent seizures after treatment. The epidemiological and clinical features of the two groups were compared.
RESULTS: Sixty-three patients who were diagnosed with childhood absence epilepsy according to the Panayiotopoulos criteria participated in the study. 39 (62%) of the patients were responsive to treatment (Group 1), the remaining 24 patients (38%) (group 2) were unresponsive to treatment. Fifteen patients were treatment-resistant, and nine patients relapsed after drug discontinuation in group 2. The mean age of the patients was 7.87±1.68. The mean follow-up period was 29.1±13.6 (13-72 months) months. The mean age was lower in the responding group of patients
The time between the onset of seizures and treatment was significantly longer in group 2. The number of patients with OIRDA in the responding group was higher. A significant difference was found in the number of spike-slow wave complex and amplitude of discharges between the two groups.

DISCUSSION AND CONCLUSION: In our study, the young age was an advantage for the treatment response. Early initiation of treatment, OIRDA was a good prognostic factor, while high amplitude and numerous discharges were among the poor prognostic factors.

INTRODUCTION: Dietary factors are considered one of the possible environmental risk factors for attention-deficit hyperactivity disorder (ADHD). The aim of the study was to demonstrate the relationship between ADHD and celiac disease (CD) and non-celiac gluten sensitivity (NCGS) in children.
METHODS: In this prospective study, the children with ADHD, aged 6-18 years, were asked for the presence of gastrointestinal symptoms and their relationship with gluten intake with a previously prepared questionnaire form. Also, they were screened for CD (anti-tissue transglutaminase immunoglobulin (Ig) A and total IgA) and NCGS (anti-gliadin IgA/ IgG antibodies).
RESULTS: Of the 117 children (76% male), the mean age was 9.2 ± 2.4 years. Ninety-six patients (82%) had no gastrointestinal complaints. There was no relationship between gluten intake and complaints in the patients who had constipation (12.8%), recurrent abdominal pain (2.5%), dyspeptic symptoms (1.7%), and irritable bowel syndrome (0.8%). None of the patients had anti-tissue transglutaminase IgA or IgG positivity. Only 1 (0.8%) patient had anti-gliadin IgA, 6 (5.1%) patients had anti-gliadin IgG positivity. There wasn’t any relation between the presence of symptoms and anti-gliadin IgG positivity (p= 0.08).
DISCUSSION AND CONCLUSION: There was no increase in the frequency of CD and NCGS in the children with ADHD

INTRODUCTION: Enuresis(EN) is a common problem in childhood. Family Physicians have an important role in revealing the children with EN. The aim of this study to assess the knowledge and attitude of Family Medicine (FM) Residents about the diagnosis and treatment of enuresis in children.
METHODS: Family Medicine residents were invited to complete a questionnaire concerning enuresis in children. Those who had completed their pediatrics rotation were defined as Group 1, and those who had not completed or were currently in the process of performing the pediatrics rotation as Group 2, and the responses were compared among the groups.
RESULTS: Sixty (%88) of the FM residents accepted to complete the survey. Mean age of the participants was 28.7 (25-35) years, 38 (63%) had completed the pediatrics rotation (Group 1). The question about the age of nighttime bedwetting was answered correctly higher in Group 1 (19/38) (p=0.025). In the question for the symptoms of non-monosymptomatic enuresis; constipation option marked as a symptom only by 15 of participants (25%), 13 (87%) of whom had completed the pediatrics rotation (p=0.03). The correct response rate to the questions about other symptoms of non-monosymptomatic enuresis, causes of secondary enuresis, need for treatment, treatment options and follow up of a patient with enuresis; were similar between Group 1 and 2.
DISCUSSION AND CONCLUSION: As a result of this study, more correct answers which aimed to provide adequate information and experience about enuresis were obtained from those who had concluded their pediatrics rotation.

INTRODUCTION: Surgical methods are the most commonly used methods in the treatment of pilonidal sinus (PS) in the world but their recovery durations and return to work/school periods are long and the complication rates are high. Among minimally invasive methods, phenol therapy is frequently used in adults and successful results are reported. However, studies on phenol treatment in adolescents with PS are limited and the number of patients is small. Therefore, our study aims to determine whether 80% liquid phenol treatment can be used as first-line therapy in this age group.
METHODS: Primary and recurrent SPS patients aged between 14 and 19 years who were treated with 80% liquid phenol were included in this study. Patient data were obtained from their files retrospectively.
RESULTS: Of the patients, 69 (69.7%) were male and 30 (30.3%) were female. The mean age of the patients was 17.4 ± 1.3 (min-max 14-19). The total recurrence and complication rates after phenol administration were 10.7% and 16.1%, respectively. According to the Likert-type questionnaire, the mean satisfaction rate was 8.7 ± 1.7 (min-max 5-10).
DISCUSSION AND CONCLUSION: In our study, it has been shown that 80% liquid phenol treatment can be successfully applied in adolescents with PS with low recurrence and low major complication rates. In addition, we think that 80% liquid phenol treatment should be recommended as the first-line treatment option for both primary and postoperative recurrent adolescent patients with PS, as it ensures a quicker return to work / school and shows high satisfaction rates.

INTRODUCTION: The aim of this retrospective study is to determine the indicators of survival with native liver of patients operated for biliary atresia (BA).
METHODS: Review included 53 BA patients in 13-year period. There were two groups: (1) surviving with native liver (NLS) and (2) necessitating transplantation (LTx). Age at operation, bilirubin levels on 7th day, 1st and 3rd months postoperatively were recorded. Mann Whitney-U and Logistic Regression Analysis were used for statistical analysis for survival with NL and LTx.
RESULTS: Kasai Portoenterostomy (KPE) was performed in 38 patients, and 15 were directed to LTx due to cirrhotic liver at presentation. Twenty-three of 38 patients with KPE survived with native liver, and 15/38 patients required LTx during follow up. Mean age at portoenterostomy for NLS and LTx was 54.43∓24.64 and 68.33∓24.35 days respectively(p>0.05). 1st and 3rd month bilirubin levels were lower in NLS group (p<0.01). 1st month and 3rd month bilirubin levels after KP were significant predictors for survival with NLS. Cut-off value of 5.7mg/dl bilirubin level at 1st month predicted the necessity of transplantation after KPE with a sensitivity of 83.3% and specificity of 78.9%.
DISCUSSION AND CONCLUSION: Bilirubin levels of 1st and 3rd months are reliable predictors for success of portoenterostomy.

INTRODUCTION: The treatment of vesicoureteral reflux (VUR) in infants is controversial. Subureteric injection is considered by some to be a popular alternative to long-term antibiotic prophylaxis. In this study, we reviewed our experience in endoscopic sub-ureteric injection to correct high-grade reflux in infants with documented indications for antireflux surgery.
METHODS: The hospital records of patients with grade 4-5 VUR and breakthrough urinary tract infections who had undergone endoscopic subureteric injection in the first year of life between 2009 and 2016 were reviewed retrospectively. Radiologic success was defined as complete resolution of reflux in VCUG obtained at least three months after the injection, and clinical success was defined as the downgrading of reflux grade below three and absence of urinary infection.
RESULTS: A total of 23 patients (5 girls, 18 boys) with 34 high grade refluxing units were included in the study. The mean age at first injection was 6.3±1.8 months (1-11 months). Radiologic success rate with initial injection was 61.7%, and it was 85.2% after repeated injections. The overall clinical success rate at first injection was 70.6% and 97.1% after repeated injections. Mean injected material volume was 0.34±0.27 (0.1-1) ml per ureter.
DISCUSSION AND CONCLUSION: Management of high-grade infantile reflux is still controversial with insufficient data. Published studies comparing endoscopic treatment and antibiotic prophylaxis have inconclusive results due to a wide range of success rates. Although it needs to be supported by prospective studies, endoscopic treatment is a successful alternative in high grade vesicoureteral reflux infants with breakthrough infection.

Anomalous total coronary artery from the pulmonary artery (ATCAPA) is an extremely rare congenital coronary artery malformation. Only a few cases have been reported over the years, but with no comprehensive medical imaging data. We present imaging findings of this case about transthoracic echocardiography (TTE), transesophageal echocardiography (TEE), computed tomography angiography (CTA) and cardiac catheterization.

Transient lesions involving the splenium of corpus callosum is defined as reversible splenial lesion syndrome (RESLES). Benign convulsions with mild gastroenteritis is a rare condition which may be associated with RESLES. Since the prognosis is excellent, the awareness of this association is important to prevent unnecessary investigations and anti-epileptic drug therapy.

Background: The presence of rhabdomyolysis secondary to various etiologies has been reported, predominantly viral infections such as influenzas. It is well known that COVID-19 can include a large array of symptoms during infection, and there have been a few reported cases of COVID-19-associated rhabdomyolysis.
Methods: We report a 10-year-old boy who presented with fever, some dry cough, myalgias, and painful walking. COVID-19 PCR was positive. His initial creatinine kinase (CK) level was 8000 U/L. He was treated with isotonic intravenous fluids because of rhabdomyolysis.
Results: Myalgia and weakness are common symptoms of COVID-19, but clinicians should be aware that rhabdomyolysis may also occur, particularly when patients report focal muscle pain and weakness.
Conclusion: Pediatric clinicians should be aware of this complication related to the novel coronavirus 2019. Prompt recognition and appropriate treatment improve patients’ outcomes.

We reported a probable vertical transmission of SARS-CoV-2 infection in Presidente Prudente, São Paulo state, Brazil. The data support the hypothesis that in utero SARS-CoV-2 vertical transmission, while low, is possible and might help determine the appropriate obstetric management of both COVID-19 pregnant women and their newborns.