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Background: Breast milk is a complex and unique substance, distinct from the lactation secretions of other species. Besides providing essential nutrients, it offers crucial protection during the newborn's adaptation process to the extraterrestrial environment. The components of breast milk not only directly combat pathogens but also stimulate the development of the newborn's immune sys-tem, strengthening its defense capabilities and reducing the risk of allergic conditions. Objective: The aim of the study was to assess the knowledge of mothers who have breastfed or are currently breastfeeding regarding breastfeeding and its benefits. Specifically, we aimed to explore the impact of the mothers' educational level at the time of breastfeeding on their understanding of the benefits for the infant, especially in terms of reducing obesity, fostering the emotional bond between mother and infant, promoting strong immune system development, ensuring good digestion, and soothing the in-fant. We also analyzed the relationship between the mother's background and the timing of introduc-ing solid foods. Material and methods: This study represents a cross-sectional survey conducted between January and February 2024, using a Google Forms questionnaire to assess mothers' knowledge. The questionnaire was distributed on social media platforms, with informed consent and under anonymity protection. It was completed by 1000 individuals. The collected data were analyzed using SPSS (Statistical Package for the Social Scienc-es). Data distribution was tested using the Chi-square test, with p < 0.05 considered statistically signifi-cant. Results : The study identified a statistically significant association between the level of education and the reduc-tion of obesity risk as a benefit of breastfeeding (p < 0.0001). Another statistically significant association was found between the mother's background and the timing of introducing solid foods (p < 0.001). However, no statistical significance was found between the level of education completed and the emotional bond created between mother and infant during breastfeeding (p > 0.058). Another non-significant association was detected between the completed level of education and breastfeeding as a factor in developing strong infant immunity (p > 0.507), ensuring good digestion (p > 0.283), and soothing the infant (p > 0.52). Conclusions: This study revealed that the mothers with university and postgraduate studies, are more informed about the benefits of breastfeeding, especially related to reducing infant obesity, compared to the mothers that have high school and post-high school studies. Similarly, the mothers from rural background have introduced solid foods earlier than the ones from urban background. [ABSTRACT FROM AUTHOR]

Background: With the advent of the internet and digitalization, a new challenge has emerged: the increasing amount of screen time in the early stages of life. This can be a significant problem that can have numerous adverse effects on children's normal development. Objective: This study aims to investigate the amount of screen time and digital exposure in children and to observe the relationship between screen time and behavioural changes. Material and methods: The study involved 308 children from different age groups. The data was collected through an online survey using Google Forms, which the parents had to complete for their children. The survey consisted of 30 questions aimed at identifying data related to demographics, exposure to screens and effects of the exposure. The data was then analysed using Microsoft Office Excel 2021 and SPSS applying the Pearson-R. Results: Most of the children, 251 out of 308 (81.5%), were from urban areas, while 57 (18.5%) were from rural areas. Mothers tend to be better educated than fathers. Specifically, 226 mothers (73.3%) had completed higher education (college, master's degree, or doctorate), whereas only 176 fathers (57%) had done so. Only 35.4% (109) of parents used parental control software on their children's devices. Additionally, 64.3% (198) tended to copy the behaviour seen in the digital environment. Most parents (73.7%) want to reduce the amount of screen time their children consume. Statistically significant correlations were found between native environment (urban or rural) and the amount of daily screen-time (r=0,172; p=0,002). Conclusions: Children from rural areas were more prone to a increased screen exposure. The issue of excessive screen time for children is a concern that many parents are well aware of. [ABSTRACT FROM AUTHOR]

Objective: To evaluate the anthropometric and biochemical status of children with nutritional deficiency. Methods: We have conducted a prospective study on 226 children admitted in Pediatric Clinic I, divided into two groups: one group of 49 children with nutritional deficiency (body-mass-index < -2SD) and one control group (177 children). We have followed demographic data, anthropometric indices evaluated as standard deviations (weight, height, middle upper-arm circumference, tricipital skinfold), biochemical proteic status (Insulin-like Growth Factor 1 IGF-1, albumin, total proteins). We also followed parameters of general nutritional biochemistry. Results: The mean age for underweight children was 5.8 years, lower than in the control group. The weight of the nutritional-deficient group was significantly lower than in the control group, unlike the height (p <0.001). We have also found significant differences in body-mass-index, middle upper-arm circumference and tricipital skinfold, all of them with low SDs in children with nutritional deficiency. Regarding the biochemical markers, we have found significantly higher values of transaminases (p <0.001) and lower IGF-1 (p = 0.02) and total proteins (p = 0.013) in nutritional-deficient group. Most IGF-1 values were in normal range in both groups, but with a higher percent of low values in nutritional deficient children (37.5% vs 14.2%, p = 0.0046). There were no significant differences in height, albumin, cholesterol, triglyceride and glucose levels between the two groups. Conclusions: The anthropometric measurements are the most precise methods in evaluating the nutritional status. Among the studied biochemical markers, IGF-1, total proteins and transaminases are correlated with nutritional deficiencies. [ABSTRACT FROM AUTHOR]

Purpose. To evaluate the serum levels of infl ammatory markers in children with alterations in nutritional status and the correlation of these markers with clinical diagnoses of infection. Methods. We conducted a prospective study on 120 children admitted to the Pediatric Clinic I Tg. Mures. We have followed the nutritional status and the presence or absence of infectious signs, the children being evaluated anthropometrically and by laboratory analysis (suggestive infection markers). Results. Underweight was found in 28.3% of children, and 24.2% were overweight. Clinically, at least one infectious syndrome has been identified in 31.7% of children, ESR being increased in these children compared to the healthy ones (p=0.034); no differences were observed in the other serological markers. We have found IL-6 and IL-8 values below the detection limit especially in underweight children with diagnosis of infection; significantly higher values of IL-6 and IL-8 were found in overweight children with a diagnosis of associated infection. Conclusions. Interleukins have significantly lower values in underweight children, even in the context of a possible infection. In order to confirm or infirm an infectious syndrome, the clinical judgment is not enough and the corroboration with complex laboratory data is necessary. [ABSTRACT FROM AUTHOR]

Introducere. Obezitatea prezintă multiple complicaţii, consecinţa inflamaţiei cronice şi insulinorezistenţei, modificări induse de produşii secretaţi de adipocite. Scop. Determinarea nivelurilor serice a adipokinelor inflamatorii la copiii obezi şi evaluarea relaţiei cu indicii antropometrici şi parametrii biochimici. Material şi metodă. Studiu prospectiv incluzând 110 copii obezi, între 1 octombrie 2010-1 martie 2013. S-au determinat leptina, adiponectina, interleukinele (IL6-8), căutând corelaţiile acestora cu parametrii antropometrici şi de metabolism. Rezultate. Leptina a fost 16,79 ±1,39 ng/ml la obezi, mai mare decât la lotul martor (2,78 ± 0,43 ng/ml), iar adiponectina 14871,07 ± 713,17 ng/ml la martor şi 9.883,49 ± 562,54 ng/ml la obezi, cu diferenţe semnificative statistic (p < 0,0001 ambele). IL6 şi IL8 au fost, de asemenea, mai mari la lotul de obezi. Au fost corelaţii semnificative între adipokine şi indicii antropometrici. Dislipidemia s-a semnalat la 20% din obezi, 8,18% cu LDL-colesterol crescut, 26,36% hipertrigliceridemie şi 9,09% HDL-colesterol scăzut. Concluzii. Adipokinele inflamatorii sunt crescute la copiii obezi, corelate cu dislipidemia, iar adiponectina scade, sugerând că adipozitatea marcată poate avea şi la copil rol în patogeneza complicaţiilor. [ABSTRACT FROM AUTHOR]

Scop. Evaluarea nivelurilor serice ale unor markeri inflamatori la copiii cu alterări ale statusului nutriţional şi corelarea acestor markeri cu patologii infecţioase. Material şi metodă. Am efectuat un studiu prospectiv pe 120 de copii internaţi in Clinica Pediatrie I Tg. Mureş, la care am urmărit statusul nutriţional şi prezenţa sau absenţa unor semne infecţioase, copiii fiind evaluaţi antropometric şi paraclinic prin markeri sugestivi pentru infecţii. Rezultate. 28% dintre copii au avut deficit ponderal, iar 24% exces ponderal. Clinic s-a identificat cel puţin un sindrom infecţios la 31,7% dintre copii, VSH fiind mărit la aceşti copii comparativ cei clinic sănătoşi (p = 0,034); nu s-au observat diferenţe în acest sens în cazul celorlalţi markeri serologici. S-au observat valori ale IL-6 şi IL-8 scăzute sub limita de detecţie, în special la copiii subponderali cu diagnostic de sindrom infecţios, şi valori crescute ale IL-6 si IL-8 la copiii supraponderali cu diagnostic de sindrom infecţios asociat. Concluzii. Interleukinele au valori semnificativ scăzute la copiii subponderali, chiar în contextul unei eventuale infecţii. Pentru a confirma sau infirma prezenţa unui sindrom infecţios nu este suficientă aprecierea clinică, ci este necesară coroborarea cu date complexe de laborator. [ABSTRACT FROM AUTHOR]

Background/Objectives: Viral gastroenteritis can have a potentially fatal outcome at young ages and the recognition of severe cases could be aided by clinically derived severity scores. Methods: This observational study intended to conduct a comparative assessment of the utility of the Vesikari and modified Vesikari score in the evaluation of viral gastroenteritis severity and for the possible prediction of the dehydration degree. A total number of 113 children diagnosed with gastroenteritis were retrospectively enrolled and divided based on viral etiology into group 1 (34 children with unknown viral etiology), group 2 (60 children with rotavirus) and group 3 (19 children with adenovirus). Results: The highest mean Vesikari and modified Vesikari scores were found in group 2 (p < 0.01; p = 0.01). A significant increase in liver enzymes was also identified in patients infected with rotavirus. The highest mean diarrhea, vomiting duration and body temperature were found in group 3 (p < 0.01; p < 0.01; p = 0.02), as well as the highest mean inflammatory markers, such as C-reactive protein (CRP; p = 0.01) and the erythrocyte sedimentation rate (p < 0.01). Significant linear associations were found between pH, bicarbonate level, base excess and the Vesikari scores, whereas urea, CRP and aspartate aminotransferase levels were associated with both severity scores. ROC curve analysis revealed a significant correlation between the Vesikari scores and dehydration degree (p < 0.01), with numeric cut-off values of 11.5 being proposed for the differentiation between mild and moderate gastroenteritis and 13.5 for the distinction between moderate and severe gastroenteritis. Conclusions: Both severity scores are useful in clinical settings, but more studies enrolling populations with various enteral infections could provide more insight into their etiology-based performance and reflection of paraclinical changes. [ABSTRACT FROM AUTHOR]

Introduction: pGALS (Pediatric Gait, Arms, Legs and Spine) is a method of examining the gait, upper and lower limbs and spine in order to evaluate the joints. pREMS (regional examination of the musculoskeletal system) refers to the regional examination of the musculoskeletal system in children. Rheumatological disorders are sometimes difficult to identify, thus prolonging the diagnostic time. Scope: The presentation of the pGALS and pREMS examination and the study of the literature in order to assess the need to introduce the pGALS and pREMS examination methods as part of the clinical examination of the child in the current practice of family physician and pediatrician for an earlier diagnostic of rheumatological disorders. Material and method: We synthesized literature data on this topic, both for rheumatological and other aetiology. Results: We identified 14 international papers with reference to pGALS in the international database search. The pGALS application time was between 2.9 and 4.5 minutes. Up to 97% of patients did not experience discomfort during pGALS examination. The analyzed materials recommended the use of pGALS as a method of identifying rheumatologic disorders. Conclusions: pGALS and pREMS have been shown to be effective in diagnosing patients with rheumatologic conditions. Applying these methods is easily accepted by children and parents. We consider it useful to introduce pGALS and pREMS as a screening in the clinical assessment of the pediatric patient. [ABSTRACT FROM AUTHOR]

Background: Pneumonia is an acute respiratory infection of pulmonary parenchyma that can be caused by microbial pathogens such as bacteria, viruses, or fungi. The pulmonary alveoli are full of fluids and pus, and this results in clinical symptoms such as difficulty breathing, cough, and altered status. Objective: Analyze age-related differences in the clinical presentation of pneumonia. Notice the influence of age on the hospital admission status. Identify age-specific risk factors predisposing infants and young children to pneumonia, including prematurity, comorbidities, and environmental background. Material and methods: This study is retrospective and observational, including all patients diagnosed with pneumonia who were admitted at the Pediatrics 1 Clinic of the County Emergency Hospital Targu Mures between 2018 and 2020, aged between 1 month and 3 years. The research included collecting data from the medical record, background, and personal data such as gender, current age, and gestational age. Results: In this study, 131 patients with a mean age of 12.66 months were enrolled. Of these, 60 patients (45.80%), were young children while 71 patients (54.20%) were infants. Among the young children group, 33 (25.19%) were born prematurely, while in the infants group only 23 (17.56%). The hospital admission status was influenced by age (p=0.0119) resulting in more young children (31.30%) with an altered status than infants (25.19%), this category representing 74 patients out of the entire cohort (56.49%). Regarding the clinical symptoms, there was a difference between the productive cough (p=0.0043) and dry cough (p<0.0001), the first one being more common for young children while the second one being more common for infants. Conclusions: This study highlights significant age-related differences in clinical presentation, hospital admission status, and prematurity rates among infants and young children. [ABSTRACT FROM AUTHOR]

Introduction: According to NASPGHAN, intestinal pseudo-obstruction is a severe condition characterized by episodes and signs of intestinal obstruction, including radiological signs of intestinal dilatation, in the absence of fixed lesions that obstructs the intestinal lumen. Purpose of this paper is to present a case of a rare and heterogeneous clinical syndrome with a relapsing and remitting pattern that appears idioaptic (as a consequence of visceral myopathy or neuropathy) or in non-intestinal disorders. Material and method: We present the case of a 12-year-old female child known for genetic syndrome, cachexia, sequelae encephalopathy, neuropsychomotor retard, cheilognatopalatoschizis resolved surgically, which in the last 2 years experienced abdominal meteorism episodes with severe constipation. She was admitted in our clinic with acute abdominal meteorism, abdominal pain, constipation. Results: Abdominal radiography detects generalized marked colon gas and abdominal CT evokes aeroenteria, the ascending colon with a minimal content of faecal matter with thin walls, 220/110 mm in diameter, with compressive effect on parenchymal organs. In spite of medical treatment and therapeutic maneuvers, the abdomen continues to distend, there is intense abdominal pain, absence of faecal matter, with ineffective defecation effort, so it intervenes surgically by practicing colostomy, with no evidence of an intraoperative mechanical obstacle, death occurring within 48 hours of the intervention. Conclusions: A child with neurological conditions, known for accentuated meteorism episodes and bowel movements disorders, presents severe form of intestinal motility disorder, manifested as a fatal pseudo-occlusive intestinal syndrome. [ABSTRACT FROM AUTHOR]

Background: An association of signs and symptoms is a syndrome (all changes that occur together in a disease). Purpose: We present the case of a patient whose clinical and paraclinical findings were suggestive, but the diagnosis was delayed. Material and Methods: The history of a Kawasaki-disease case in an infant. Results: NS(7months), presented in emergency for fever. From the Anamnesis he had been discharged the day before from another Pediatric Service. From History he underwent an episode of symptomatically treated respiratory- tract-infection, and was then vaccinated. The disease started ten days before, with fever, mouth and skin lesions;the general practitioner recommended anti-thermic and antimycotic; anorexia appeared, the patient being hospitalized;hydrocortisone, anti-thermic, electrolyte and eye-drops were administered;dermatological consultation labeled as Hand-foot-and-mouth disease; peeling of the fingers-skin occurred; he was discharged after 7 days. At hospitalization in our clinic: general influenced condition, hyperemic facies, warm skin, desquamation (flaps) of upper and lower limb skin, swollen edema of the hands and feet, red lips, mouth sores, angular cheilitis, sabour tongue, hiperemic pharynx (otherwise negative). Due to anamnestic, clinical and paraclinical data (leukocytosis, positive inflammatory-tests) the case was interpreted as Kawasaki-disease and treatment according to the guide was started. The outcome was favorable without complications or coronary lesions. Conclusions: For a correct diagnosis, the signs and symptoms should be analyzed and synthesized; thus, having a patient, with at least 5 days fever and four elements of: extremity changes, polymorphous exanthem, bilateral conjunctival injection, mouth/lips changes and cervical lymphadenopathy, the diagnosis of Kawasaki disease should be considered. [ABSTRACT FROM AUTHOR]

Nephrogenic diabetes insipidus (NDI) is characterized by impaired urinary concentrating ability, despite normal or elevated plasma concentrations of the antidiuretic hormone, arginine vasopressin (AVP). NDI can be inherited or acquired. NDI can result from genetic abnormalities, such as mutations in the vasopressin V2 receptor (AVPR2) or the aquaporin-2 (AQP2) water channel, or acquired causes, such as chronic lithium therapy. Congenital NDI is a rare condition. Mutations in AVPR2 are responsible for approximately 90% of patients with congenital NDI, and they have an X-linked pattern of inheritance. In approximately 10% of patients, congenital NDI has an autosomal recessive or dominant pattern of inheritance with mutations in the AQP2 gene. In 2% of cases, the genetic cause is unknown. The main symptoms at presentation include growth retardation, vomiting or feeding concerns, polyuria plus polydipsia, and dehydration. Without treatment, most patients fail to grow normally, and present with associated constipation, urological complication, megacystis, trabeculated bladder, hydroureter, hydronephrosis, and mental retardation. Treatment of NDI consist of sufficient water intake, low-sodium diet, diuretic thiazide, sometimes in combination with a cyclooxygenase (COX) inhibitor (indomethacin) or nonsteroidal anti-inflammatory drugs (NSAIDs), or hydrochlorothiazide in combination with amiloride. Some authors note a generally favorable long-term outcome and an apparent loss of efficacy of medical treatment during school age. [ABSTRACT FROM AUTHOR]