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BACKGROUND The diagnosis of cows milk protein allergy (CMPA) is not always easy. Cow's Milk-related Symptom Score (CoMiSS) has been developed to raise the awareness of CMPA among the primary health-care providers. In this study, we aimed to evaluate the validity of CoMiSS as a diagnostic approach of CMPA in infants in our country. METHODS Infants with a CoMiSS of more than 12 points were included. An elimination diet was implemented in these infants for 4 weeks, and CoMiSS was reapplied. Infants with a reduction of ≥3 points in CoMiSS were considered responsive to the elimination diet, and an open oral challenge test was performed. Infants with symptom recurrence were diagnosed with CMPA. RESULTS The study included 168 infants. When they were included in the study, the first CoMiSS score was 13.6 ± 1.9. After the elimination diet, the number of responsive infants was 154 (91.7%). Of the infants, 91 (54.2%) were diagnosed with CMPA with positive challenge. The majority of the patients diagnosed with CMPA presented with gastrointestinal and/or dermatological symptoms (80.3%). Positive family history of allergy was more prevalent in CMPA(+) infants (P

Background: Environmental tobacco smoke (ETS) exposure and sleep associated problems can lead to serious health problems in children. We aimed to evaluate association between ETS and sleep disturbance in children. Methods: We enrolled 209 children without chronic health problems or acute infections aged 4 to 12 years between June 2019 and March 2020 to this cross-sectional study. Parents’ smoking habits and ETS exposure of children were questioned and Children’s Sleep Habits Questionnaire (CSHQ) was administered to screen for the most common sleep problems in children. “Sleep disturbance” was defined as a score ≥41 in CSHQ. Plasma cotinine levels were measured in all subjects enrolled and levels ≥ 3 ng/mL were defined as ETS exposure. Results: Total 115 children (55 %) were in the “sleep disturbance” group according to CSHQ, and 66 (57.3%) of them were exposed to ETS according to parental report. The children with parent reported ETS exposure had increased risk of sleep disturbance (adjusted OR: 1.3). All 209 children had plasma cotinine levels ≥3 ng/ml, with a mean (SD) 50.55 (13.78) ng/ml, revealing that all of them were exposed to ETS although only 105 of them were parent reported. Multivariable analysis of risk factors for sleep disturbance revealed that parent reported ETS exposure was associated with increased risks of sleep disturbance (p=0.023, adjusted OR: 1.9 and 95%CI: 1.09-3.3) Conclusions: Parent reported ETS exposure is associated with sleep disturbance in their children however parental reports about smoking habits may not be compatible with plasma cotinine levels of the children.

Subaponeurotic (subgaleal) fluid collection (DSFC) is a rare clinical entity of unknown etiology. We aimed to present our series of infants who were diagnosed with DSCF at Ankara University Children's Hospital. We retrospectively reviewed clinical findings, imaging studies, laboratory tests, management, and clinical courses of infants diagnosed with DSCF between June 2014 and June 2018. Five infants (4 males, 1 female), aged 5-14 weeks, were identified during the study period. All deliveries were non-progressive (3 normal deliveries, 2 cesarean sections) while instrumentation (vacuum extraction or forceps) was used in 2. History of recent trauma, concern for child abuse, and family or personal history of coagulopathy were negative for all patients. Conservative management with the spontaneous resolution was observed in 2 to 12 weeks in all infants. Although rare, DSFC should always be kept in mind in the differential diagnosis of scalp swelling in young infants. The diagnosis is primarily clinical, and current treatment is conservative.

Congenital vallecular cyst (VC) is a rare but potentially fatal pathology in neonates and infants. It usually manifests with symptoms such as stridor, apnea and cyanosis that develop shortly after birth. Stridor is the most common encountered symptom. VC is frequently accompanied by laryngomalacia (LM) and LM is the most common cause of stridor in infants. Diagnosis can be made by flexible laryngoscopy or bronchoscopy. Surgery is the mainstay for VC treatment. Here we present an infant who had respiratory distress, biphasic stridor and cyanosis worsened during feeding and crying, and diagnosed VC. The respiratory symptoms of the patient recovered rapidly after surgical resection.

Objective This study aimed to call attention to hypercalcemia, a rare finding in children which carries the potential of leading to serious complications without proper intervention. Methods Diagnosis, treatment, and clinical course of children with sustained hypercalcemia admitted between the years 2006-2016 were reviewed. Group 1 [parathyroid hormone (PTH)-dependent] consisted of patients with high/unsuppressed PTH levels and group 2 (PTH-independent) included cases with normal/suppressed PTH levels. Results Twenty patients (11 male, 9 female) with a median age of 6.25 (0.03-17.88) years were evaluated. Symptoms were mostly related with the gastrointestinal system, while six patients (30%) were asymptomatic. Physical examination findings were diverse, non-specific, and normal in four patients (20%). Median time of diagnosis was 45 (2-720) days. Patients were divided into group 1 (n=7) and group 2 (n=13). Most frequent etiologies were primary hyperparathyroidism (n=5), idiopathic infantile hypercalcemia (IIH) (n=5), and malignancy (n=4). A moderate positive correlation was noted between serum calcium and creatinine levels (r=0.53, p=0.02). Nephrocalcinosis was the most common complication (n=9) (45%). Treatment was not implemented in 2 patients with mild hypercalcemia, while other patients received medical treatment ± surgery. Treatment-resistant patients were cases of malignancies and neonatal severe hyperparathyroidism. Long-term follow-up displayed resistant hypercalciuria in three infants diagnosed as IIH. Conclusion Many patients with childhood hypercalcemia are asymptomatic or exhibit a non-specific and heterogeneous clinical presentation, resulting in delayed diagnosis. Mild cases may not be recognized, while symptoms may be missed in the presence of accompanying illnesses. Nevertheless, serious complications may only be avoided with prompt diagnosis and intervention.

Giriş: Kistik fibrozis (KF), yaşamkalitesini ve süresini olumsuz yönde etkileyen kalıtsal bir hastalıktır. Ülkemizdeyenidoğan taraması topuk kanında bakılan immün reaktif tripsinojen (IRT) düzeyiyüksek bulunan bebeklerde ter testi (TT) yapılarak uygulanmaktadır. Buçalışmada ulusal yenidoğan taraması nedeniyle merkezimize yönlendirilenbebeklerin TT yapılma ve değerlendirilme sürecinde elde ettiğimiz verilerisunmayı amaçladık.Gereç ve yöntemler: Bu retrospektif çalışmada Ocak 2015 -Ocak 2019 arasında merkezimize KF yenidoğan tarama testi pozitifliği nedeniyleyönlendirilen bebeklerin klinik verileri, TT ve kistik fibrozis transmembran regülatör (KFTR)geni mutasyon analizi sonuçları araştırıldı. Terde klor testi (TKT), Objective: Cystic fibrosis (CF) is an inherited disorder which has negative impact on life span and quality. Newbornscreening (NBS) is carried out by sweat chloride test (SCT) in babies with high immunoreactive trypsinogen (IRT) values.We aimed to present our data consisting of application and evaluation of sweat chloride test in babies referred to ourcenter with two elevated IRT levels following national NBS.Material and Methods: This retrospective study evaluated clinical data, sweat chloride test and CF transmembraneregulator (CFTR) gene mutation analysis results of referred infants due to positive CF NBS between January 2015–January 2019. Sweat chloride test results were interpreted as normal (

OBJECTIVES We aimed to call attention to respiratory system manifestations which occur in the course of many inherited metabolic diseases (IMD), and present as the leading cause of death. MATERIALS AND METHODS We retrospectively reviewed the diagnosis, treatment, and outcome of patients evaluated at our hospital between June 2012 and June 2018 with a diagnosis of IMD and accompanying respiratory manifestations. RESULTS A total of 50 children (29 [58%] male, 21 [42%] female) with IMD and respiratory manifestations were defined. Disorders of intracellular metabolism (n = 33, 66%) formed the majority, followed by intoxication type metabolic disorders (n = 9, 18%) and energy metabolism disorders (n = 8, 16%). The most frequent respiratory symptoms were snoring (20, 40%), tachypnea (16, 32%) and wheezing (14, 28%). Physical examination findings were signs of respiratory distress (n = 28, 56%), crackles (n = 24, 48%), thoracic deformity (n = 23, 46%), decreased breath sounds (n = 17, 34%), rhonchus (n = 17, 34%), wheezing (n = 17, 34%) and stridor (n = 10, 20%). Major respiratory manifestations were chronic airway aspiration (n = 23, 46%), upper airway obstruction (n = 23, 46%), and recurrent pneumonia (n = 18, 36%). Twenty-three 23 patients (46%) experienced endotracheal intubation, 9 patients (18%) required whole-house mechanical ventilation and tonsilloadenoidectomy was performed in 7 patients (14%). Overall survival rate was 70% (n = 35) in a median follow-up period of 2.36 (0.05-5.86) years. CONCLUSIONS Respiratory system manifestations of IMD strongly relate with increased morbidity and mortality. Therefore, prompt diagnosis and correct intervention of respiratory complications with a multidisciplinary team including pediatric metabolic diseases specialists, pulmonologists, otorhinolaryngologists, physiotherapists, and anesthesiologists are crucial to prevent progression and irreversible damage.

Chronic cough in children may be due to a diverse range of etiologies. We aimed to evaluate children with chronic cough following a standardized cough algorithm and assess obstructive sleep apnea (OSA) as a possible etiology. In addition, cough resolution rates of two different treatment protocols in children with non-specific cough were compared. A total of 237 children referred for chronic cough were assessed and classified according to etiologies. Children with non-specific cough were assigned either in the early-arm (group-1, n = 13) or delayed arm (group-2, n = 23). The presence of OSA was evaluated using a pediatric sleep questionnaire, and polysomnography was handled in indicated patients. Asthma (n = 82) and protracted bacterial bronchitis (PBB) (n = 73) were the most frequent etiologies. Cough resolution was higher in group-1 (100%) compared with group-2 (50%) (absolute risk reduction (rr) = 43.48% [95% CI 21.38-65.58%]). Polysomnography revealed mild (n = 6), moderate (n = 7), or severe (n = 5) OSA in 18 children, with adenoid/adenotonsillary hypertrophy as the leading cause.Conclusion: We recognized asthma and PBB as the most frequent causes of chronic cough in our cohort. Early treatment of patients with high parental anxiety might be beneficial. We also believe that further studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms. What is known? • Chronic cough in children may be due to a diverse range of etiologies, including serious respiratory disorders. Thus, its correct diagnosis and treatment are essential. • Although a well-defined reason of chronic cough in adults, obstructive sleep apnea (OSA) has not been been evaluated so far in children with chronic cough. What is new? • We examined OSA for the first time as a possible cause of chronic cough in children and detected OSA with polysomnography in cases who scored high pediatric sleep questionnaire (PSQ) scores. • We believe that studies including larger series might eventuate in incorporation of assessment of OSA to standardized algorithms for children with chronic cough.

Otitis media with effusion (OME) is an important clinical entity because of its high prevalence, difficulties in diagnosis, complications and diversities in management. Herein, we aimed to evaluate current physician approaches on OME and determine clinical adherence to current guidelines.A total of 370 physicians [Group 1: pediatricians (n = 256, 69.2%), Group 2: otorhinolarynologists (n = 114, 30.8%)] completed a survey instrument addressing demographic data and clinical practice parameters on OME in children. We also compared clinical approaches of Group 1 and Group 2. In addition, multiple logistic regression analysis was performed to evaluate factors which may effect correct approaches.The mean period of clinical experience was 9.30 ± 8.35 [median 6 (1-40)] years. A total of 311 (84%) respondents reported satisfactory level of self-confidence as regards of clinical approaches to OME. Reduced mobility of the tympanic membrane and preference of pneumatic otoscopy was signified by 107 (28.9%) and 64 (17.3%) respondents, respectively. Fifty-six (15.1%) physicians identified "watchful waiting" for 3 months for children who are not at risk while 314 (84.9%) reported preference of medications, with antibiotics the most preferred prescription (n = 223, 63%). Comparison of Group 1 and Group 2 indicated similar results except better, yet insufficient, characterization of physical examination findings of OME by Group 2 (p 0.001, for each parameter). Group 2 preferred tympanometry more in uncertain cases (p 0.001) and handled chronic cases better (p 0.001). Multiple logistic regression analysis revealed lower signification of reduced mobility of the tympanic membrane for respondents who denoted depending on personal experience ([OR] = 3.077 [95% CI 1.042-9.09]) or following clinical guidelines ([OR] = 3.365 [95% CI 1.38-8.20]) rather than combining them both. Rate of antibiotic avoidance was lowest in physicians with a period of clinical experience5 years ([OR] = 2.14 [95% CI 1.32-3.48]).Despite notifying high self-confidence and adherence to current guidelines on OME, both pediatricians and otorhinolaryngologists lacked to exhibit proper approaches. Further research is warranted to evaluate the causes of poor adherence to current guidelines and bring suggestions for the maintenance of consistent and correct clinical approaches to OME.

Background: Chronic cough in children is a clinical condition requiring proper intervention. Objectives: This pragmatic real-life study aimed to evaluate children with chronic cough using a standardized clinical algorithm and call attention on obstructive sleep apnea (OSA) as a causative factor. Methods: Children referred for chronic cough between January 2016-January 2017 were assessed and classified according to etiologies. Presence of OSA was evaluated using a pediatric sleep questionnaire (PSQ) and polysomnography was handled in patients with scores ≥8. Results: A total of 251 patients with a median age of 5,88 years (0,28-17,89) were enrolled. The most frequent etiologies were asthma (n=80) (31,8%), protracted bacterial bronchitis (PBB) (n=79) (31,5%) and adenotonsillary hypertrophy (n=19) (7,6%) (Figure 1). We identified 14 patients with OSA (adenotonsillary hypertrophy (n=11), gastroesophageal reflux (n=1), obesity (n=1) and no identifiable cause (n=1)). All patients were cough free after treatment of OSA. Conclusions: As compatible with previous research, we recognized asthma and PBB as the most frequent causes of chronic cough. We believe that implementation of a standardized algorithm including investigation of OSA as an etiological factor of chronic cough in children may improve clinical outcomes. Figure-1: Etiologies of patients (n=251) *: Three patients were diagnosed as astma and gastroesophageal reflux

Aim To evaluate the efficacy of oral sucrose combined with non-nutritive sucking for reducing pain associated with retinopathy of prematurity screening. Methods This was a randomised controlled study of 64 infants undergoing eye examination for retinopathy of prematurity screening. Topical anaesthetic (Proparacaine; Alcaine® drop 0.5%: ALCON CANADA Inc., Mississauga, Canada) was applied 30 sec before the eye examination in all infants. The infants in intervention group (Group 1, n = 32) received 0.5 mL/kg of 24% sucrose with a pacifier. The control group (Group 2, n = 32) received 0.5 mL/kg of sterile water with a pacifier. Results The groups had similar gestational ages (28.5 ± 2.8 weeks), mean birthweight (1304 ± 466 g) or corrected gestational age (35.4 ± 3.7 weeks) at examination. The intervention group had a significantly lower mean Premature Infant Pain Profile score during examination of the first eye, following insertion of the speculum (Group 1:13.7 ± 2.1 vs. Group 2:16.4 ± 1.8, p = 0.001). Conclusion Although sucrose combined with non-nutritive sucking modestly reduces pain scores during eye examinations, there is need to further studies to explore significant pain relief for infants undergoing retinopathy of prematurity screening.