Search

Background and aims The aim of our study was to investigate the effect of duration of exclusive breastfeeding (EBF) and duration of breastfeeding (BF) on the rate of infections during the first 2 years of life. Methods The study group consisted of healthy infants who admitted to the outpatient Healthy Child Clinics of Istanbul University, Cerrahpasa Medical Faculty for their routine control between February 2016 and May 2017. Files of the patients were reviewed retrospectively with regard to breastfeeding and infection history such as upper and lower respiratory tract infections(URTI, LRTI), acute gastroenteritis (AGE), urinary tract infection (UTI) and acute otitis media (AOM) during the first 2 years of life. Results A total of 200 infants (91/109:male/female) with a birth weight and length of 3286.2±446.9 gr, 50.4±2.4 cm, respectively and who were born at term were enrolled. The rate of vaginal and cesarian delivery was 72.5% and 27.5%, respectively. The mean duration of EBF and total duration of BF were 4.2±2.8 and 11.6 ±5.3 months, respectively. In those without any infection (42.5%), duration of EBF and total duration of BF were 5.9±0.4 and 13.4±4.6 months, respectively while in those with 1 infection (29.5%) it was 46±3.3 and 11.8±4.6 months and with ≥2 infections (28%), it was 1.3±1.9 and 8.7±5.9 months, respectively. This difference between each group was stastistically significant (p Conclusions Epidemiological data support the benefits of breast-feeding in preventing gastrointestinal and respiratory infections in both developing and developed countries. Our study also showed that increased duration of exclusive breastfeeding and increased duration of breastfeeding in general were associated with lower infection rate in infants in the first 2 years of life. WHO recommends exclusive breastfeeding up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. Therefore, lactating mothers should be encouraged to breastfeed their infants and it is our duty to raise awareness on breastfeeding for its encouragement.

Aim of this study was to evaluate the infant nutrition in the first 2 years of age, to determine the factors effecting nutrition, and reveal the relationship among nutrition with infant growth. Material method The study was carried out between September-December in 2018 by Cerrahpasa Faculty of Medicine, Department of Pediatrics in Istanbul.297 infants included who were not diagnosed with any disease born above 2500 gram. Face-to-face survey method was applied to parents using the indicators of infant and young child feeding (iycf) which was established by WHO in 2007 to evaluate breastfeeding and complementary feeding. Information about sociodemographic data was recorded in the same interview. Height and weight were taken by the trained outpatient clinic and according to the WHO growth curves, weight according to age Findings In the study, 52.5% were female while the rest were male. Infants age were between 15 days and 2 years. Initiating breastfeeding in the first hour was 25.6%. Exclusive breastfeeding rate was 62.1%. Breastfeeding up to 2 years of age rate was 60%. In the study, 5.1% infant was wasted, 3% was stunned and 2% was underweight. According to the IYCF minimum meal diversity rate was%62,3, minimum meal frequency 72.7%, minimum acceptable diet 62.3%. Starting solid food appropriate was%74. If father was educated or an officer, the rate of breastfeeding was increasing for the first 6 months. It was found that babies whose father was younger than 30 years of age were more likely to breastfed in the first hour. Cesarean significantly reduced breastfeeding during the first 6 months and increased the rate of using bottles. Babies with birth order more than 3 were fed less with bottles. Breastfeeding in the first 6 months who’s weighting less than 3000g ratio were lower than others. If the number of children in the family were more than 3 wasting was higher. Breastfeeding babies up to 2 years of age were higher in whom born in a state hospital rather than private hospital. If the babies are male, rate of breastfeeding in the first 6 months and starting solid food suitability were higher. If maternal age was 30 or above minimum acceptable diet rate was higher. Conclusion In our study nutrition rate according to WHO was majority this emphasizes the importance of educating the parents.

Background The aim of our study was to investigate the rate of developmental dysplasia of the hip (DDH), and the association between the risk factors for DDH and the results of the hip ultrasound (US) findings among healthy infants Methods The study group consisted of healthy infants who admitted to the outpatient Healthy Child Clinics of Istanbul University, Cerrahpasa Medical Faculty for their routine control between December 2014 and May 2015. Files of the patients who were followed up at least 1 year of age were reviewed with regard to risk factors (sex, birth weight and lenght, type of delivery, order of birth, type of presentation, maternal age, history of oligohydramnios, multiple pregnancy, swaddling history, family history of DDH) and hip US findings. All infants had their hip US performed at 4 to 6 weeks of age in the Radiology Department of Istanbul University. Results A total of 300 infants (175/125:male/female) with a birth weight and length of 3137.03±557.23 gr and 49.69±2.68 cm, respectively were enrolled. Fifteen infants had a history of maternal oligohidramnios (5%), 70 (23.3%) were born vaginaly, 27 (9%) were born as twins and 2 (0.7%) had a breech presentation. Family history of DHH was present in 17 infants (5.7%) and 28 (9.3%) had a swaddling history. US finding of immature hip was detected in 52.9% of those with a family history of DHH and 13.6% of those with a swaddling history. There was a statistically significant association between family history of DHH and swaddling, and finding of immature hip on US (p=0.0001). In those with findings of immature hip, left hip was affected in 28 (56%) and right hip was affected in 13 (26%) infants. Involvement of left hip was significantly more frequent in case of an immature hip on US (p=0,04). Only one infant had a finding of DDH (Type 2b) on US. Conclusions The rate of DHH in this study was 0.3%. while the rate of immature hip was 16.7%. Positive family history and swaddling were found to have a strong association with immature hip on US with a significantly more frequent involvement of the left hip. We want to emphasize that family history of DHH should be sought during evaluation of an infant with regard to DHH. We realized that swaddling was still a common practice in Turkey for which the parents should be warned about its associated risk for DHH.

Aims: To determine the prevalence of nasopharyngeal carriage of Streptococcus pneumoniae in healthy children aged 0-6 years who were vaccinated with pneumococcal conjugate vaccine. Methods: This cross-sectional study was conducted on 150 healthy Turkish children between 1 month and 6 years of age. Serotyping was performed and risk factors of carriage were evaluated. Results: The overall carriage rate was 14%. Vaccine type serotypes were determined in 17 (12.6%) children who received full-dose PCV13 vaccine. The highest carriage rate was observed among children younger than 24 months (76.2%). In multivariate analysis, respiratory infection in recent months, age, attendance at a day-care center and antibiotic usage were not statistically significant risk factors for carriage. Overall, S. pneumoniae strains were considered as penicillin susceptible and antimicrobial resistance was limited. Conclusion: We observed a low rate of pneumococcal carriage in children after PCV13 implementation compared with that of children receiving PCV7. Although it was reduced, vaccine serotype colonization in PCV13-vaccinated children remains persistent.

Background and aims Vitamin D deficiency has been associated with growth failure and rickets during childhood period. Turkish Ministery of Health recommends 400 IU of vitamin D supplementation during the first year of life in order to prevent rickets and vitamin D deficiency. Vitamin D has been started to be supplemented free of charge to all infants under 1 year of age since 2005. The aim of our study was to determine the serum 25-(OH) vitamin D (25-OHD) levels, the prevalence of vitamin D deficiency and insufficiency and the factors that influence the vitamin D status among healthy children aged 3–36 months. Methods The study group consisted of healthy children who admitted to the outpatient Healthy Child Clinics of Istanbul University, Cerrahpasa Medical Faculty for their routine control and vaccination between 1.9.2013 and 31.11.2013. A questionaire regarding the duration of vitamin D prophylaxis, dose, duration of sun exposure, duration of breastfeeding, consumption of Vitamin d-rich foods, maternal vitamin D prophylaxis during pregnancy and lactation, the educational status and clothing style of the mother, was given to the parents of each child. The levels of 25-OHD, paratyhroid hormone (PTH), calcium (Ca), phosphorus (P) and alkaline phosphatase (ALP) were determined in every child. Results A total of 190 healthy children (102/88: male/female) with a mean age of 15.9±10.4 months were enrolled. The mean 25-OHD level was 38.1±16.2 ng/ml. 25-OHD level was 1 year of age were on prophylaxis. The percentage of children with 25-OHD levels in the sufficiency range was significantly higher in children receiving vitamin D than those not receiving it (p=0.04). 25-OHD levels were in the sufficiency range (≥30 ng/ml) in 64.9%, 81.4% and 100% of children who received vitamin D at a dose of 400 IU, 400–800 IU and>800 IU, respectively. The PTH and ALP levels were found to be higher in children with 25-OHD levels Conclusions Vitamin D deficiency and insufficieny remain a serious public health concern worldwide. Not only the deficiency but also the insufficiency of vitamin D can be associated with many health related issues given the proposed role of vitamin D in many systems as vitamin D receptor (VDR) is expressed in various organs and tissues of the human body other than bone cells such as the kidney, the colonic mucosa and immune cells. Our study showed that vitamin D prophylaxis and dose of vitamin D had an influence on vitamin D status of the child. However, further studies are needed to determine the optimal dose and duration of vitamin D prophylaxis among healthy children.

Aim: The aim of our study was to investigate the relation between lead and mercury exposure and some chronic neurodevelopmental diseases in children Material and Method: In the Departments of Pediatric Neurology and Pediatric Psychiatry clinics children diagnosed with motor mental retardation epilepsy attention deficit hyperactivity disorder and autism were included in the study as the study group 39 boys and 20 girls Age and sex matched healthy children were used as controls Blood lead and mercury levels were measured using the atomic absorption spectrophotometry method The possible effect of environmental factors that could cause exposure to heavy metals such as vaccination fish consumption and the number of dental fillings the mother had were also considered Results: The average age was 7 66 years and 7 68 years in the study and the control groups respectively The average lead level in the blood was 1 91 micro;g dl in the study group 2 19 micro;g dl in the control grocup The average mercury level in the blood was 0 84 micro;g L in the study group and 0 99 micro;g L in the control group No significant difference was found between the study and control groups in terms of blood mercury and lead levels When the relation of vaccination the frequency of fish consumption and the number of dental fillings in the mother with blood lead and mercury levels was evaluated no significant difference was found between the study and control groups Conclusions: Our study shows that the heavy metal levels of children with chronic neurodevelopmental diseases are not different from those of healthy children Yet this conclusion does not lower the significance of enviromental heavy metal hazard on human health Turk Arch Ped 2013; 48: 221 225

WOS: 000411471800018, PubMed ID: 28872486, We compared the efficacy of ferrous sulfate (divalent) and ferric polymaltose (trivalent) compounds for the prophylaxis of iron-deficiency anemia (IDA). Study infants included exclusively breast milk-fed term infants. Subjects were divided randomly into 2 groups at 4 months of age and group 1 (n=56) received divalent and group 2 (n=56) received trivalent iron (Fe) preparation at a dose of 2 mg/kg/d for 5 months. At 9 months of age, after a 5-month prophylaxis, a significant increase was observed in hemoglobin (Hb), hematocrit, serum Fe levels, and transferrin saturation in both groups. However, group 1 had significantly higher Hb, hematocrit, mean corpuscular volume, Fe, and transferrin saturation than group 2 (11.7 +/- 0.6 g/dL, 34.6% +/- 1.7%, 76.2 +/- 2.9 fL, 55.5 +/- 1.8 mcg, 20.8 +/- 3.9 g/L, respectively in group 1 vs. 11.3 +/- 0.5 g/dL, 33.5% +/- 1.5%, 74.7 +/- 3.2 fL, 42.5 +/- 1.8 mcg, 14.1 +/- 7.5 g/L, respectively in group 2). No significant difference was found in ferritin values between the groups. Fe deficiency was found in 17 (30.3%) of the subjects in group 1, and 23 (41%) of subjects in group 2 whereas 5 (8.9%) subjects had IDA in group 1 and 12 (12%) in group 2 which were insignificant between groups. No significant difference was found with regard to side effects between 2 Fe preparations. Although divalent Fe therapy led to a higher Hb and serum Fe level, both ferrous and ferric Fe preparations were effective for prophylactic use in the prevention of Fe deficiency and IDA with comparable side effects.

Background: Invasive Haemophilus influenzae type b (Hib) infection has a high morbidity among young children, but the burden of disease and rate of Hib are different in different regions. The aim of the present study was to investigate the levels of Hib antibodies and the oropharyngeal Hib prevalence in young children. Methods: One hundred-fifty nine healthy children aged 19–36 months of age were included in this cross-sectional study. Anti-polyribosylribitol phosphate (anti-PRP) antibody concentrations were measured using commercially available enzyme-linked immunosorbent assay (ELISA), and serotyping of isolated Hib strains was conducted by slide agglutination with specific antisera. Results: Of the study participants, 57 (35.8%) were fully vaccinated (group 1A); 17 (10.7%) were incompletely vaccinated (group 1B), and 85 (53.5%) were non-vaccinated (group 2). Geometric mean titer (GMT) of anti-PRP antibody was 3.8 μg/mL, 2.2 μg/mL and 0.49 μg/mL in group 1A, group 1B and group 2, respectively. While all children in group 1 (n = 74) had seroprotective antibody concentrations (≥0.15 μg /mL), of the children in group 2 (n = 85) 31.8% did not have seroprotective anti-PRP levels (P

Undernutrition is a frequent manifestation and an important health problem. The aim of this study was to analyse the variables of nutritional status among primary school children and to determine the risk factors associated with it. The study group was composed of 1576 students between 6 and 16 years of age. The prevalence of stunting, underweight, wasting were calculated according to WHO recommended cut-off points to define undernutrition. Chi-square tests, logistic regression analysis were used to investigate the relationship between the prevalence of undernutrition and the sociodemographic factors. The overall prevalence of stunting, underweight and wasting were found as 5.7, 4.6 and 1.0%, respectively. There were significant relationships between underweight and age, sex, number of family members, monthly family income. But, a significant correlation was found only between stunting and age. No correlation was found between wasting and sociodemographic factors. Undernutrition is still a common problem among primary school children in Istanbul. Identification of risk factors is essential for prevention of undernutrition.

The neonatal immune system is immature and may be affected by Bacillus Calmette-Guerin (BCG) vaccine. We investigated the influence of BCG given at two different ages on the peripheral blood (PB) T-cell subpopulations. Forty full term healthy newborns were randomly chosen. Twenty of them were vaccinated with BCG at birth (group I) and the remaining at the age of 2 months (group II). The cell analysis were carried out before (pre-BCGI and pre-BCGII), and 2 months after (post-BCGI and post-BCGII) the vaccination. The analysis of the gamma/delta and alpha/beta T-cell receptor (TCR) antigens was done by two-colour flowcytometer. The purified protein derivative (PPD) response was investigated 2 months after vaccination. The results showed that although T-cell (TCR+ cell) counts showed no difference in PB before and after vaccination in both study groups, the total lymphocyte and non-T cell (TCR- cell) populations increased significantly whereas alphabetaT-cell population significantly decreased after vaccination. On the contrary, gammadeltaT-cell counts in PB increased significantly 2 months after vaccination in group I but not in group II. Total lymphocyte and non-T cell counts in vaccinated infants at 2 months of age (post-BCGI) were significantly higher than in unvaccinated infants of the same age whereas alphabetaT-cell count in vaccinated infants was significantly low. However, total T-cell and gammadeltaT-cell counts showed no difference. PPD positivity was similar in both study groups (61% in group I, 66% in group II). Neither alphabetaT- nor gammadeltaT-cell counts were different in PPD positive and PPD negative infants. Our study shows that BCG causes marked quantitative changes in the PB T-cell subpopulations in young infants.

Anemia is a frequent manifestation and an important health problem. The aim of this study was to found the prevalence of anemia among primary schoolchildren and determine the risk factors associated with anemia. The study group was composed of 1531 students between 6 and 16 years old from 14 primary schools located in seven different regions of Istanbul. Data were collected via a questionnaire filled out by parents. For all students, a complete blood cell count detected by an automated cell counter and anemia prevalence was determined according to Dallman criteria. The overall prevalence of anemia was found to be 27.6 per cent. There was no significant relationship between the prevalence of anemia and the students' age, gender, parents' educational level and employment, and monthly family income by logistic regression analysis. Only the number of family members and malnutrition were risk factors for anemia. Today, anemia is a common problem among primary schoolchildren in Istanbul. Identification of the risk factors is essential for the prevention of anemia.

The aim of this study was to demonstrate the prevalence of iodine deficiency among schoolchildren and the risk factors influencing it. One thousand five hundred and seventy-three schoolchildren were chosen from 14 schools in seven different regions in Istanbul. After all data relating to sociodemographic factors and the use of iodized salt were recorded, iodine contents of urine samples were determined by the Sandell Kolthoff reaction. Chi-squared and multiple regression analysis were used for the investigation of the correlation between iodine deficiency and risk factors. The prevalence of goitre (or = 2 grade) was 1.9 per cent. The median urine iodine level was in the normal range (10.5 microg/dl). In 46.2 per cent of the students the urine iodine levels were below 10 microg/dl and 13.9 per cent of the students had urine iodine levels below 5 microg/dl. The prevalence of iodine deficiency was significantly higher in younger (or = 10 years) children, in children with less educated mothers and fathers, and with poorer and more crowded families (p0.01, p0.01 and p0.01, p0.001, respectively). The rate of iodine deficiency was significantly higher in females than in males and also higher in children who lived on the European side of Istanbul than on the Anatolian side of Istanbul (p0.0001, p0.0001, respectively). The rate of use of iodized salt was 44.4 per cent and the iodine deficiency rate was not affected by the use of iodized salt (p0.05). Although the median urine iodine level was in the normal range, in 46.2 per cent of the students urine iodine levels were low (10 microg/dl). As there seems to be no effect from the use of iodized salt in iodine deficiency, the use of a more stable potassium iodate for the fortification of salt may be required.

The aim of this study is to determine the anaerobic fecal flora of 40 newborn, full-term healthy Turkish babies during 1 month and to find the difference of the flora depending on the manner of birth. Fecal samples of 15 newborn girls and 25 newborn boys whose mothers had no risk factors like infections and early membrane ruptures were studied. The newborn babies had a weight between 2550 and 4080 g and a gestational age between 38 and 41 weeks. All babies were breast fed and 20 of them were delivered vaginally, 20 by cesarean. Stool samples were taken during 0–2 days, 3–7 days and the 4th week of birth. The isolation of anaerobic bacteria was made from 0.1 dilution of 1 g stool and their identification was confirmed by API 20 A panels. The number of each microorganism isolated from the stool of newborns taken during 0–2 days, 3–7 days and the 4th week of birth was separately evaluated for the group of babies delivered vaginally and for the group of babies delivered by cesarean. The isolation rate of anaerobic bacteria which grew in a high concentration (3+ or 4+) and which showed a significant difference with a P value

In congenital or aqcuired immune deficiencies, infectious diseases which can be prevented by vaccination have a severe course because of supression of the immune system by the disease itself or the treatment methods used. Therefore, vaccination is important in immune deficiency. Although the protective antibody levels achieved in healthy individuals can not be provided in patients with immune deficiency, there is no drawback in administering inactive vaccines in accordance with the vaccination program. On the other hand, live viral and bacterial vaccines should not be administered during periods of immunosupression in conditions where the immune system is strongly supressed by diseases or drugs, since they would cause to systemic infection. Physicians should have sufficient knowledge about contraindications of vaccination in individuals with immune deficiency and in people who live in the same house with these individuals.

Anemia is a widespread public health problem associated with an increased risk of morbidity and mortality. This study was undertaken to determine the cut-off value of hemoglobin for infant anemia.A cross-sectional retrospective study was carried out at well-baby clinics of a tertiary care hospital. A total of 1484 healthy infants aged between 4 to 24 months were included in the study. The relationship of hemoglobin (Hb) levels with mother age, birth weight, weight gain rate, feeding, and gender was evaluated.The Hb levels were assessed in four age groups (4 months, 6 months, 9-12 months, and 15-24 months) and the cut-off values of Hb were determined. Hb cut-off values (5th percentile for age) were detected as 97 g/L and 93 g/L at 4 months and 6 months, respectively. In older infants, the 5th percentile was 90.5 g/L and 93.4 g/L at 9-12 months and 15-24 months, respectively. The two values were lower than the World Health Organization criteria for anemia, which could partly due to the lack of information on iron status in our population. However, this difference highlights the need for further studies on normal Hb levels in healthy infants in developing countries. Hb levels of females were higher in all age groups; however, a statistically significant difference was found in gender in only 6 month-old infants. No statistically significant difference was found among Hb levels, mother's age, birth weight, weight gain rate, and nutritional status.Hb cut-off values in infants should be re-evaluated and be compatible with growth and development of children in that community.

Background Juvenile idiopathic arthritis (JIA) and familial Mediterranean fever (FMF) are the most common chronic inflammatory rheumatic disorder in children and is a significant cause of both short- and long-term disabilities. The fact that vitamin D inactivates Th1 and Th17, both of which are thought to have a role in JIA pathophysiology, supports the claim that there may be a relationship between vitamin D deficiency and JIA. However, data are limited regarding the association between disease activity and serum 25(OH)D levels in children with JIA. In the few studies serum 25(OH)D levels were found to correlate inversely with disease activity in patients with FMF. Objectives The aims of this study were to determine the frequency of vitamin D deficiency and/or insufficiency of children with JIA and FMF and to assess the relationship between vitamin D and disease activity for JIA and FMF. Methods 64 patients with JIA, 36 patient with FMF and 100 healthy children were included in this prospective cross-sectional study. The children with JIA were diagnosed according to classification criteria of the International League of Associations for Rheumatology (ILAR), and children with FMF according to the criteria set by Livneh. Serum 25-hydroxyvitamin D levels [25(OH)D] of children with JIA and FMF during activation and remission periods were measured using chemiluminescence immunoassay (CLIA). The serum levels of Results Mean serum 25(OH)D levels of patients with JIA during activation and remission periods of disease were 18,9±11 ng/ml and 18,6±9,2 ng/ml respectively. Mean serum 25(OH) D levels of patients with FMF during attack and attack-free periods were 16±8,5 ng/ml and 13,1±6,4 ng/ml respectively. Mean serum 25(OH)D levels of healthy children were 26,7±10,5 ng/ml. Serum Vitamin D levels of patients with JIA and FMF both during active and remission periods of diseases were lower than control group (p Conclusions Serum 25(OH)D levels of children with JIA and FMF were significantly lower than healthy children. Frequency of vitamin D deficiency and insufficiency were quitely high among patients with JIA and FMF. There was no relationship between disease activity and serum vitamin D levels. References Gowdie PJ, Tse SM. Juvenile idiopathic arthritis. Pediatr Clin North Am 2012;59(2): 301-2. Hewison M. Vitamin D and the immune system: new perspective on an old theme. Endocrinol Metab Clin North Am 2010;39(2):365-79. Disclosure of Interest None declared

This study was conducted to evaluate the influence of demographic characteristics, hospital practices, maternal psychosocial factors, and knowledge about infant feeding and breast milk on duration of breastfeeding. The mothers of 91 healthy, term infants delivered at a university hospital between June 1998 and December 1998, and first seen in the well-child unit within 10 days of delivery, participated in the study. Forty-nine (54%) infants were exclusively breastfed at 4 months of age. Cox regression analysis showed a negative association between formula supplementation during the hospital stay and duration of exclusive breastfeeding. The median age for starting non–breast milk liquids was 1 month for those who received formula in the hospital and 3 months for those who did not ( P= .001). The hospital practices were more predictive of the duration of exclusive breastfeeding in this study group than mothers'knowledge of infant feeding or psychosocial factors. Thus, hospital practices should be reevaluated.