INTRODUCTION: Fetal malnutrition is a condition characterized clinically by the inability of subcutaneous adipose tissue and muscle mass to reach the normal amount or by significant intrauterine loss. The major hormones regulating fetal growth, fetal energy metabolism and adipogenesis are insulin, leptin, ghrelin and adiponectin. Cholesterol and triglycerides are very important in fetal growth in the last period of pregnancy. In this study, it was aimed to compare the glucose, insulin, leptin, ghrelin, adiponectin, cholesterol and triglyceride levels in the cord blood of newborn babies with and without fetal malnutrition.
METHODS: Term babies born in our hospital were included in the study. Babies with a Clinical Assessment of Nutritional Status (CANSCORE) of 24 and below were considered as cases with fetal malnutrition, and those over 24 were considered as cases without fetal malnutrition. Glucose, insulin, leptin, ghrelin, adiponectin, total cholesterol, LDL cholesterol, HDL cholesterol, VLDL cholesterol and triglyceride levels were studied from blood samples taken from the umbilical cord after delivery.
RESULTS: A total of 80 term newborn babies, 40 babies with fetal malnutrition and 40 babies without fetal malnutrition, were included in the study. Birth weight, glucose and insulin values were found to be significantly lower in the group with fetal malnutrition (p<0.001; p<0.001; p=0.047; respectively), and adiponectin levels were found to be significantly higher (p<0.001).
DISCUSSION AND CONCLUSION: In our study, adiponectin levels in cord blood were found to be high in infants with fetal malnutrition. Considering the anti-inflammatory role of adiponectin, high adiponectin levels in infants with fetal malnutrition may directly or indirectly reflect a protective mechanism.

INTRODUCTION: In hematopoietic stem cell transplantation (HSCT), the phase of engraftment which can be described as an “immunogenic storm”, is also vulnerable to infections and it has been always very hard to discriminate the cause of fever in this special period of HSCT. In this study, we aim to determine if PCT could be used to define the cause of fever in the engraftment phase of HSCT.
METHODS: This study involves 81 patients who consecutively underwent allogeneic HSCT between October 2017 – June 2020 in our pediatric hematopoietic stem cell transplantation unit. The patients were divided into two groups due to the origin of the fever during engraftment as infectious fever group (n=42) and the non-infectious fever group (n=39).
RESULTS: The median duration of fever for all groups was 4 days (1-11 days) and it was significantly lower in the non-infectious fever group compared to the infectious fever group (3 vs 4 respectively p= 0,001). The median PCT levels was 0,6 ng/mL (0,04 - 83) for all groups and it was significantly higher in the infectious fever group compared to non-infectious (1.4 vs 0,3 p<0,001). According to ROC analysis, the cut-off PCT level of 0,515 ng/ml or more had an AUC of 0.817 and may predict the infectious fever with a sensitivity of 81% and a specificity of 76,9%.
DISCUSSION AND CONCLUSION: We observed that PCT may be used to discriminate infectious fever from non-infectious fever at the engraftment phase of HSCT and PCT could be a useful marker for antibiotic treatment strategy.

INTRODUCTION: Aim: This study was conducted as a descriptivly to determine the relationship between disease managements and perception of nursing support of parents whose children are monitored in Pediatric Intensive Care Unit (PICU).
METHODS: Material and Methods: It was carried out between August-December 2018 in the PICU. The sample of the study comprised 108 parents whose children is monitored with chronic disease diagnosis. The study data were collected with data collection form, The Family Management of Childhood Chronic Conditions (FaMM) and Nurse Parent Support Tool (NPST).
RESULTS: Results: Parents’ gender, knowledge about disease and FaMM three sub-dimension score averages is insignificant as statistical (p>0.05). And the difference between parents’ educational background, income status, the factor of getting support from social environment and sub-dimension score averages is significant (p<0.05). While the difference between interview parents’ gender and income status and NPST score average is insignificant (p>0.05); the deference between interview parents’ educational background, knowledge about disease, the status of getting support from social environment and NPST score average is significant (p<0.05).
DISCUSSION AND CONCLUSION: Conclusions: It was concluded that according as the perceived nurse support of the parents of the child with chronic disease increases, the disease management also increases.

INTRODUCTION: Aim: Bronchial asthma and allergic rhinitis are mediated by similar allergic inflammatory mechanisms. Platelets play a role in allergic reactions that are inflammatory processes. The mean platelet volume (MPV) is a marker of platelet activation.This study aimed to investigate MPV value differences between children with allergic rhinitis during the symptomatic or asymptomatic period to determine whether MPV is a useful indicator of inflammation in allergic rhinitis.

METHODS: The records of the patients with allergic rhinitis were analyzed retrospectively. Patients over two years old who had complete blood count both asymptomatic and during the symptomatic period were included in the study. Clinical characteristics (age, age at diagnosis, symptoms, comorbid allergic diseases) and laboratory data (thrombocyte count, MPV, white blood cell count, eosinophil count, and percentage, IgE level, and skin prick test results) were recorded from the patient file and hospital registry system.

RESULTS: MPV values during the symptomatic period were statistically significantly higher than the asymptomatic period (p<0,001) in all patients. When patients grouped according to having asthma, MPV was found to be higher in the symptomatic period compared to the asymptomatic period in the group with asthma, but there was no difference between the two periods in the group without asthma (p=0.017, p=0.102 respectively).Also MPV levels were significantly higher in the asthma group during the symptomatic and the asymptomatic period (p=0.04, p=0.013, respectively).
DISCUSSION AND CONCLUSION: This study suggest that MPV could not be used as an inflammation indicator in the symptomatic period with only patients with allergic rhinitis. Asthma influences MPV values. It would be good to conduct more detailed and prospective studies to show MPV inflammation in AR.

INTRODUCTION: To evaluate the association of etiology, cEEG findings and neuroimaging findings with short-term outcome for patients admitted to PICU for acute encephalopathy.
METHODS: A total of 24 children admitted to PICU for acute encephalopathy were taken into study. Etiology, treatment, duration of stay in PICU, demographic information and past medical history were recorded. cEEG was initiated as quickly as possible following admission to PICU and continued for at least 24 hours. The short-term prognosis was evaluated by Pediatric Cerebral Performance Category score (PCPC) at PICU discharge.
RESULTS: The most common cause was traumatic brain injury (TBI) consisting 25% (n=6) of all cases. Other common causes were asphyxia (hanging, foreign body aspiration, drowning) (n=4, 16,67%) and intoxication (n=3, 12.5%). 22 patients undergone cranial imaging. The most common findings in CT were hemorrhage (n=6, 30%) and ischemia/edema (n=6, 30%). Fourteen patients had unfavorable PCPC outcome scores. There was a tendency for poorer outcome in patients with hemorrhage/ fracture or ischemia/ edema in imaging and patients either who needed pre-hospital CPR or had non-convulsive seizures without statistical significance.
DISCUSSION AND CONCLUSION: cEEG in critically ill children is useful for detecting both epileptic and non-epileptic events. The use of cEEG in PICU would be helpful for better management of cases.

INTRODUCTION: The aim was to investigate maternal concerns of children with cerebral palsy (CP) who was referred for a chewing evaluation, and the relationship between chewing performance level and the concerns of their mothers.
METHODS: A total of 55 children with CP, and their mothers were included. Age, gender, height, weight, and type of CP were noted. The Karaduman Chewing Performance Scale (KCPS) was used to define chewing performance level.Children with KCPS level 0 were categorized as ‘children without chewing dysfunction’, and children with KCPS level I to IV were ‘children with chewing dysfunction’. The Turkish version of the Feeding/Swallowing Impact Survey (T-FS-IS) was used to evaluate the maternal concerns related to child’s feeding and swallowing problems.

RESULTS: The mean age of children was 4.45±2.56 (min=2, max=11) years, of which 58.2% were male. There was a moderate to strong correlation between the KCPS and daily activities, worry, feeding difficulties and total score from the T-FS-IS (p < 0.001, r = 0.71, r = 0.64, r = 0.72, r = 0.74, respectively). Mothers of children with chewing dysfunction reported more problems in total score and all subscales of the T-FS-IS than mothers of children without chewing dysfunction (p<0.01).
DISCUSSION AND CONCLUSION: This study suggests that chewing performance level of children was associated with maternal concerns, and mothers of children with CP who had chewing dysfunction have higher concerns related to feeding-swallowing difficulties. This knowledge regarding maternal perception points out that clinicians should consider concerns of mothers during management of chewing dysfunction.

INTRODUCTION: Dental anxiety is a common problem in pediatric dentistry and to reduce it with improved communication is important. This study aimed to evaluate whether the anxious children give similar answers in the dental office even though they have different cultural backgrounds and to assess the international usability of the cognitive behavioral therapy tool of the Turkish version of ‘Your Teeth are in Control’ intervention includes ‘Message to Dentist’.
METHODS: 262 children aged 5-15 years attending a faculty clinic and a private dental office were included. Children were asked to complete the form to report how worried they felt and the levels of pain they experienced before and after the dental treatment on a scale 1-10 (1 the best and 10 the worst outcome). Statistical analysis was performed with IBM SPSS V23.
RESULTS: Most of the participants were worried about the needle, dentist, pain, respectively (38.2%, 34%, 28.2%). Most of the children raised their hand as a stop signal (94.7%). There was a statistically significant negative and weak correlation between age and anticipated pain, actual pain and anxiety scores (p: 0.016, 0.003, 0.001 respectively).
DISCUSSION AND CONCLUSION: The ‘Message to Dentist’form and cognitive behavioral therapy resource can be used in pediatric dentistry to reduce the dental anxiety in the Turkish version. It was useful to understand the source of dental anxiety in children can facilitate treatment by helping pediatric dentists understand how these patients feel about dental treatment procedures and, in their efforts, to improve patient care.

INTRODUCTION: The study was conducted to compare the effect of breastfeeding and kangaroo mother care in newborns on the level of pain and physiological changes due to injection of Hepatitis B vaccine.
METHODS: The study was designed as a comparative experimental study. The sample of the study consisted of a total of 70 infants including 35 in the Kangaroo group (KMC) and 35 in the Breastfeeding group (BF) who were followed up in the postnatal ward at XXX Education and Research Hospital between August 2016-February 2017 and met the sample criteria. Pain levels, duration of crying, heart rates (HR) and oxygen saturation (SpO2) of newborn infants were compared before and after Hepatitis B vaccine injection.
RESULTS: It was determined that there was no statistically significant difference between the infants in breastfeeding and kangaroo mother care groups in terms of pain scores (Z=0.949; p=0.343), SpO2 level (Z=1.032; p=0.302), number of HR (Z=0.206; p=0.837) and duration of crying (Z=0.135; p=0.892). Following the vaccination, heart rate and pain scores of the infants in the breastfeeding group increased less and they had a shorter duration of crying.
DISCUSSION AND CONCLUSION: According to these results, it will be effective to breastfeed infants in reducing the pain induced by invasive interventions as breastfeeding is easily applicable, takes a little time, encourages breast milk and strengthens the mother-infant attachment.

INTRODUCTION: Allergic rhinitis(AR) and asthma are the most prevalent allergic diseases, and environmental allergens are important factors in the pathogenesis and the exacerbation of these diseases.Although there are many studies investigating aeroallergen sensitivities in different regions of our country, this study aims to identify the aeroallergen sensitization in Tekirdağ province in the part of Turkey in Europe, namely Thrace, where aeroallergen sensitivities need to be known.
METHODS: 460 children with asthma and AR who were followed and had at least one aeroallergen sensitivity in skin prick test (SPT) were retrospectively evaluated. All patients were undergone SPT using the standard extracts, including house dust mites, molds, animal dander, pollens, and latex.
RESULTS: Results
The mean age of the patients was 10.2±3.4(5-18) years, 57.6% of them were male. Diagnoses of the patients were AR in 57.8%, asthma in 22.6% and both in 19.6%. 42.6%(n=196) of the patients were sensitized to more than one allergen.The most common aeroallergens in SPT were 63% house dust mites, 26.5% grass-rye mix, 26.1% grass mix, 19.8% molds, 11.3% cat epithelium, 8.5% cockroach, 7% weed mix, 7% olive tree, 5.7% dog, 4.3% cupressus, 3.5% tree pollen mix, 1.5% poplar, 1.3% mugwort, and 0.4% latex. Although the cockroach, pet, olive tree sensitivity and multiple allergen sensitivity were more frequent among the male children(p<0.05), there was no association between the gender and the sensitivity to other allergens. There was no difference between the aeroallergen distributions of the patients according to diagnoses(p>0.05). The house mites were the most common allergens throughout all seasons.
DISCUSSION AND CONCLUSION: The results of this study will be important in guiding the elimination measures of the triggering allergens that are important for the treatment and the course of the disease of the patients with asthma and allergic rhinitis in this region.

INTRODUCTION: Cystic fibrosis (CF) is characterized by local and chronic inflammation accompanied by increased neutrophil and macrophage counts, high elastase levels, and inflammatory cytokines due to impaired haemostasis. Changes in immunoglobulin levels (Ig) may occur due to recurrent chronic infections and may be associated with the deterioration of respiratory functions. In this study, we aimed to evaluate the interaction of high Ig levels with respiratory functions and chronic infections in CF.
METHODS: The diagnosis of the patients CF was made in accordance with the “National Cystic Fibrosis Diagnosis and Treatment Guidelines”. The sociodemographic characteristics, immunoglobulin values, and the pulmonary function tests were evaluated according to children age group.
RESULTS: A total of 107 patients were included in the study. The patients’ median age was 65 (6–200) months. It was found that patients with high IgG (p = 0.01) and IgA (p < 0.001) values had more moderate-to-severe respiratory function than those with normal values. Also, there was no statistically significant difference when the patients were compared for P. aeruginosa colonization using IgG levels (p = 0.51), Ig A levels (p = 0.16) and Ig M levels (p =0.34).
DISCUSSION AND CONCLUSION: Elevated IgG and IgA levels in patients with CF may be an indirect indicator of deterioration in pulmonary function tests. There was no significant difference in IgG, IgA, and Ig M levels for P. aeruginosa colonization. We recommend that the results of our study be supported by cohort studies.

INTRODUCTION: This descriptive study was conducted to determine the relationship between internet addiction, cyberbullying, cyber victimization and parental attitudes towards them.
METHODS: The sample constituted 550 students attending the ninth grade and volunteering to participate in the study. Consents of the ethical committee, institute and parents were obtained for the study. Data were collected using the Student Individual Information Form, Young’s Internet Addiction Test-Short Form, Cyberbullying Scale, Cyber Victimization Scale and Perceived Parental Attitudes Scale.
RESULTS: It is determined that 47.1% of the students had computer or tablet and 99.5% of them had Smartphone; 44.9% of the students used computer once a week, 44.9% used computer and 57.4% used Smartphone for watching video or film and following social media. There was a positive relationship between the Young’s Internet Addiction Test and the Cyberbullying scale while there was a negative relationship between Internet addiction and cyber victimization (p<0.05).
DISCUSSION AND CONCLUSION: According to these results, educational programs for adolescents and their parents should be developed related to Internet use in adolescents and the risks of addiction, cyberbullying.

INTRODUCTION: We aimed to evaluate life quality in functional and organic dyspepsia and its change during follow-up.
METHODS: Children between 4-17 years of age with dyspeptic complaints were enrolled in the study. Organic and functional dyspepsia were differentiated based on clinical findings and the findings of upper gastrointestinal endoscopy, if performed. KINDL questionnaire was conducted when patients referred to the hospital and at 1st and 3rd month visits, prospectively. Both groups were compared with regard to demographic data, symptoms and quality of life scores. Factors that affect the results of KINDL and the change in KINDL scores during follow-up were evaluated.
RESULTS: The study group consisted of 71 functional dyspepsia and 65 organic dyspepsia patients. Mean quality of life scores in physical wellness and school subscales were higher among functional dyspepsia. Total score of functional dyspepsia group was higher. There was no relation between gender, number of symptoms and KINDL scores. At the first month visit, total scores and mean scores of self-esteems, family, school and friends subscales were higher in functional dyspepsia group. At the third month visit, mean self-esteem score was higher in functional dyspepsia group. Total scores increased significantly during follow up in both organic dyspepsia and functional dyspepsia groups. This increase was higher in organic dyspepsia group.
DISCUSSION AND CONCLUSION: Quality of life in both functional dyspepsia and organic dyspepsia patients is affected; recommendations and treatments increase quality of life of both groups. Quality of life scale might be used to monitor the response to treatment.

INTRODUCTION: Aim: To determine the effects of face mask use on ocular structures in children during the Coronavirus disease-2019 (COVID-19) pandemic
METHODS: Forty-two children’s ocular data in pandemic period were compared with the same children's ocular data in pre-pandemic period.
RESULTS: The mean age was 14.6±2.1 (9-18) years initially. Tear film break-up time values of children with a mask in pandemic period were significantly shorter than those of children without a mask in pre-pandemic period (9.35±1.40 vs 12.10±1.05 second, p=0.033). There was no staining in any case in pre-pandemic period, while minimal punctate epithelial corneal staining pattern was determined in 4 (9.5%) children in pandemic period. Schirmer 1 test value detected in pandemic period was similar to the value detected in pre-pandemic period (11.14±2.07 vs 12.03±1.01 mm, p=0.127). Additionally, there were no significant changes in visual acuities, central corneal thicknesses, anterior chamber depths, lens thicknesses, and axial lengths between the pre-pandemic and pandemic periods (p>0.05).
DISCUSSION AND CONCLUSION: To our knowledge, this is the first study to date to evaluate the effects of face mask use on ocular structures only in children. The use of face masks may cause the increased tear evaporation and the dry eye in pediatric cases. Educating the children about the correct use of face masks can be important. Thus, possible ocular surface changes that may occur related to the mask can be prevented, and the children may be more willing to use masks. Increased mask compliance may also indirectly help protect the children from the virus.

Ehlers Danlos syndrome musculocontractural type (mcEDS) is a rare hereditary connective tissue disorder caused by biallelic pathogenic variants in CHST14 or DSE genes resulting in defective dermatan sulfate biosynthesis. It is characterized by congenital malformations and contractures, distinctive facial features and multisystemic fragility-related complications. To date, less than 100 patients with mcEDS have been reported. Vascular complications remain the major morbidity and may lead to mortality in the affected individuals. In this clinical report, we report on a currently 12-year-old boy with a novel homozygous CHST14 variant who presented with typical mcEDS symptoms and subsequently developed a life-threatening subcutaneous skull hematoma following a minor trauma, which required intensive care unit admission and surgical drainage along with several blood transfusions. This case expands the clinical and genetic spectrum of CHST14-related mcEDS which is essential for providing accurate prognosis, management and genetic counseling.

Thrombocytopenia-absent radius (TAR) syndrome is a rare congenital syndrome in which thrombocytopenia and absence of radius can be accompanied by various organ anomalies. Bilateral phocomelia is the most severe form of the clinic. Thumbs are always present. The deletion of the RNA-binding motif protein 8A (RBM8A) gene on chromosome 1q21.1 in Array comparative genomic hybridization (CGH) confirms the diagnosis of TAR syndrome. Thrombocytopenia, which can cause complications, tends to resolve in the first year of life. Although there are delays in motor development, mental retardation is not one of the common clinical findings of the syndrome. In the differential diagnosis of severe radial defects, TAR syndrome, Holt-Oram syndrome, Roberts syndrome, Fanconi anemia, VACTERL association are included. The presence of key findings of each syndrome is important in the differential diagnosis. Here, we aimed to evaluate the approach to the differential diagnosis of severe radial anomalies in a patient with TAR syndrome and neuromotor retardation.

Introduction
Adrenocortical carcinoma (ACC) are categorized as functional (hormone-secreting), which is most commonly found in children and adolescents, or non-functional (silent), which is usually found in adults with symptoms of abdominal discomfort or back pain caused by the large mass of the tumor
Material Method
Here, we describe a rare case of a 4year-old girl with pure androgen secreting adrenal oncocytic carsinoma who presented with premature pubarche, clitoromegaly and advanced bone maturation.
Results
we diagnosed adrenal carsinoma in patient who presented with signs of peripheral puberty precoccus
Discussion
To the best of our knowledge, only one functional oncocytic adrenocortical carcinoma has been reported in the literature in pediatric age population. So this case we have reported is the second case in the literature.
Conculision
In conclusion, virilization is an important manifestation of adrenocortical tumors in both sexes. We report the first case of virilizing functional oncocytic adrenocortical carsinoma in a girl with accelerated skeletal maturation, clitoromegaly and premature pubarche. A high index of suspicion and an increased awareness of pediatricians play an important role in the early diagnosis and treatment of this disease.