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© 2022 Elsevier B.V.Objective: Objective methods to monitor the sleep of preterm infants at the neonatal intensive care unit (NICU) are required to prevent potentially adverse neurodevelopmental outcomes. This study aimed to determine the concordance of actigraphy and amplitude-integrated electroencephalogram (aEEG) against gold standard direct observation (DO) in assessing sleep/wake states of typically developing preterm infants. Methods: This prospective observational study was conducted in a single center level III NICU. Sleep variables were measured using Philips Respironics Mini-Mitter® Actiwatch-2 for 24 h and compared with 8-h matched data of aEEG and DO. Sensitivity-specificity analysis, Cohen's kappa, prevalence-adjusted and bias-adjusted kappa (PABAK), and Bland Altman plots were generated. Results: Seventeen preterm infants were recruited. A total of 11252 epochs were studied. Sensitivity (86.4%), agreement rate (67.9%), and predictive value for wake (47.9%) for the actigraphy were highest at the automatic activity threshold whereas specificity (54.5%) and predictive value for sleep (75.5%) were highest at low threshold. The sensitivity of aEEG was 79.3% and the specificity was 54.3%. At all thresholds, the agreement was largely equivalent with low kappas (0.14–0.17) and PABAK coefficients (0.22–0.35) for actigraphy and DO. Moderate agreement was observed between aEEG and DO according to the PABAK coefficient (0.44). Mean differences in sleep parameters were not different between DO and aEEG as well as DO/aEEG and actigraphy at medium threshold (p > 0.05). Conclusions: Actigraphy at medium threshold can be used in depicting sleep in typically developing preterm infants at NICU. aEEG may be an alternative adjunctive method to actigraphy for the evaluation of sleep/wake states in the NICU setting. Clinical trial registration number: NCT04145362

Evaluation of emergency department (ED) presentation by Syrian refugee children might provide important information about their health care needs. For this purpose, we compared ED presentation of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Electronic medical records of Syrian refugee children ≤ 18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with resident children.The study population consisted of 7299 refugees and 690,127 resident children admitted to the ED. High-acuity cases were more frequent in Syrian refugees (2.2% vs 1% p 0.001). One-third of Syrian children were under 12 months of age (31% vs 17%, p 0.001). Syrian children were more commonly hospitalized (7.9% vs 3.1% p 0.001). The median age (and interquartile range - IQR) was lower in hospitalized refugee than in resident children [12 (0-83) months vs 41 (8-111) months, p 0.001]. Rate of intensive care unit hospitalization (13% vs 9.4%, p = 0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29% vs 12%, p 0.001). The median NICU stay was longer in refugees [6 (IQR 4-17) days vs 3 (IQR 1-9) days, p 0.001].Refugee children, as compared to resident children, are more likely to present to the ED with high acuity conditions and at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes.• Children are the most affected victims of armed conflicts in terms of health outcomes. • Refugees prefer to access healthcare through the emergency department.• Refugee children were more likely to present as urgent when compared to resident children. • Admission to neonatal and intensive care units was more frequent among refugee than resident children.

Introduction: Little is known about the COVID-19 disease characteristics and differences between different pediatric age groups. This study aimed to investigate the disease characteristics according to age groups. Methodology: We conducted a retrospective, single-center study of pediatric COVID-19 in a tertiary care hospital in Turkey. The patients were divided into three groups: 15 days-24 months old (Group 1), 25-144 months old (Group 2), and 145-210 months old (Group 3) according to age. Results: A total of 139 pediatric patients with COVID-19 were examined. Twenty-nine patients (20.9%) were in Group 1, 52 (37.4%) were in Group 2, 58 (41.7%) were in Group 3. Thirty-nine patients (28.1%) were hospitalized. The most common symptoms were cough (55.4%) and fever (51.8%). The median chest X-ray (CXR) score of hospitalized patients was 1 (min 0-max 7), and the median CXR score of outpatients was 1 (min 0-max 6). Fever was significantly more frequent in Group 1, and chest pain was more frequent in Group 3. Group 1 had significantly higher WBC, lymphocyte, thrombocyte counts, AST, LDH, D-dimer, and Troponin T levels but lower hemoglobin, total protein, and albumin levels. The treatment included antibiotics, oseltamivir, hydroxychloroquine, and supportive therapy. Only one patient (0.7%) received non-invasive mechanical ventilatory support. Conclusions: As we know the clinical course of COVID-19 in children is less severe than in adults. We also found significant differences in both clinical and laboratory findings between different pediatric age groups which supports the theory that disease pathogenesis is highly variable according to age.

BackgroundThe direct and indirect effects of the COVID-19 pandemic on children and youth people are well documented. Little is known about children\"s experiences of the pandemic in their own words. We aimed to explore Turkish children\"s experiences and views about the pandemic, across private and public educational systems. MethodsSix focus group discussions were conducted online with 30 children aged between 7 to 18 years in 2021. Children were enrolled through snowball sampling technique according to developmental age groups. A thematic analysis was conducted. ResultsWe identified five themes: Compliance with public health measures about preventing the spread of COVID-19, changes in daily routines, emotional responses to the pandemic, distance education, and adaptive responses. Overall, children were well informed and receptive to the public health preventive measures with the exception of older children\"s tendency to disregard physical distancing with friends. They reported frustration with those who did not comply with measures and believed that the authorities should strictly enforce public health requirements. Emotional responses comprised fear of family members and themselves being infected, anxiety produced by the uncertainty of the virus, and the loss of social support. There was a perceived disparity between students from public and private schools regarding academic self-competence. Positive aspects of the pandemic included positive interactions with family members and the acquisition of new hobbies. Although most children acknowledged the support of their parents to deal with challenges, children of health workers were particularly isolated in terms of emotional support. ConclusionOur findings offer additional insights and validate previous research on the negative and positive effects of COVID-19 from the child\"s perspective across private and public educational systems. This study contributes to global advocacy efforts aimed at understanding the impact of the pandemic on children.

Sleep health is one of the major contributors to mental and physical health and as such should be an essential component of informed community and policy conversations around health. Non-physiological sleep problems are commonly referred to as Behavioral Sleep Problems (BSP) and include difficulties initiating sleep alone, bedtime resistance, difficulties re-initiating sleep after normally occurring overnight waking (requiring parental assistance to re-settle) and/or early morning wakening. BSP affects up to 40% of children under two years of age. Despite the high prevalence and impact of sleep disturbance, training and education curricula for pediatric medical and allied health professions include little information or awareness building about sleep, particularly in strategies to ameliorate sleep for children and their families. An evident need to train health professionals working with children in evidence-based pediatric behavioral sleep care is emerging. A recent partnership between Turkey and Australia has tackled this problem. By developing a scientific collaborative network between the two countries and using existing evidence-based methods, clinical information was shared between health professional workforces in these two countries as effective ways of translating knowledge in pediatric sleep interventions. Systematic training of primary and tertiary medical and allied health professionals must be considered as standard practice in tertiary education settings.

Objective The exact role of children in the household transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is not clear. In this study, we investigated the role of children with coronavirus disease 2019 (COVID-19) in household transmission by identifying the index patient and contact tracing the household members. Methods A total of 103 children with COVID-19 who attended Marmara University Pendik Training and Research Hospital, Istanbul, between 25th March and 27th May 2020 were included in the study. A family cluster was defined as a group of ≥two confirmed cases of SARS-CoV-2 in the same family, and a household contact (HHC) was defined as any person who had stayed in the same residence. Results In total, 78 family clusters and 307 HHCs belonging to these clusters were screened. In only four clusters was the index case determined to be in the pediatric age group (5.1%). Fathers, mothers, grandparents, and adult siblings were identified as the index cases in 37 (47.4%), 18 (23.0%), 8 (10.2%), and 6 (7.7%) clusters, respectively. Of the 307 HHCs, 88 were in the pediatric age group, and 39 were SARS-CoV-2 RT-PCR positive. Conclusion Our data showed that SARS-CoV-2 is uncommon in children without any history of contact to a RT-PCR test positive patient. The role of children as the index patient in family clusters is 5.1%, and the actual index case is usually an adult individual who has had an outside contact.

© 2022 European Sleep Research Society.Studies describing paediatric sleep patterns are needed by taking culture into consideration. The aim of this study was to identify parent-reported sleep–wake patterns in young children and explore possible factors influencing sleep problems. The mothers of 2,434 young children enrolled from well-child outpatient clinics in Turkey completed an online survey including sociodemographic variables, Brief Infant Sleep Questionnaire, Edinburgh Postnatal Depression Scale and Generalised Anxiety Disorder scales. Overall, young children in Turkey go to bed late (10:00 p.m.), awaken twice per night for 30 min, and obtain 11.5 h of total sleep, showing no sex-specific differences. Distinct night-time sleep patterns emerged after 18 months of age. Importantly, although currently breastfed healthy children were 3.8-times less likely to sleep through the night, total sleep duration and exclusive breastfeeding duration were higher in children who were not sleeping through the night. Overall, bedsharing was identified in 11.5%, and only room sharing was reported in 52.9%. Parental perception of a child's sleep as problematic was 35.8%. Mothers with higher educational attainment were more likely to perceive their children's sleep as a problem. Maternal depressive and anxious symptoms and a history of excessive infant crying were the determinants predicting the likelihood of both parent-perceived sleep problems and poor sleepers. The present analysis of sleep structure in infancy and toddlerhood provides reference data for well-child visits. These findings highlight the importance of considering maternal anxiety, depression and behaviour management techniques to cope with fussy infants in addressing childhood behavioural sleep problems.

Multisystem inflammatory syndrome in children (MIS-C) evolves in some pediatric patients following acute infection with SARS-CoV-2 by hitherto unknown mechanisms. Whereas acute-COVID-19 severity and outcomes were previously correlated with Notch4 expression on Tregs, here, we show that Tregs in MIS-C were destabilized through a Notch1-dependent mechanism. Genetic analysis revealed that patients with MIS-C had enrichment of rare deleterious variants affecting inflammation and autoimmunity pathways, including dominant-negative mutations in the Notch1 regulators NUMB and NUMBL leading to Notch1 upregulation. Notch1 signaling in Tregs induced CD22, leading to their destabilization in a mTORC1-dependent manner and to the promotion of systemic inflammation. These results identify a Notch1/CD22 signaling axis that disrupts Treg function in MIS-C and point to distinct immune checkpoints controlled by individual Treg Notch receptors that shape the inflammatory outcome in SARS-CoV-2 infection.

Background/aim Established reference values are critical for the interpretation of immunologic assessments. In particular, the proportion and absolute counts of T- and B- cell subpopulations are subject to change with age and ethnicity. We aimed to establish age- specific reference values for lymphocyte subsets using updated immunophenotyping panels. Materials and methods We studied a total of 297 healthy Turkish subjects aged 0 to 50 years, stratified into major age brackets in a cluster factor of 10 per age-group. The predetermined age intervals contained randomly allocated participants enrolled over a period of 6 months, who were homogenously distributed by sex. We analyzed a complete blood count test and simultaneously with detailed immunophenotyping enumerated the percent and absolute cell counts of lymphocyte subsets. Results The percentage and absolute counts of lymphocyte subsets show a marked surge across the age-span. T helper, T cytotoxic, and the natural killer cell numbers were increasing from birth until 6 months, followed by a gradual decrease thereafter. B cell numbers were rising until 2 years, followed by a gradual decrease for the upcoming years, accompanied by a steady expansion of unclass-switched- and class-switched- B cells. Conclusion We provide updated extensive reference intervals for lymphocyte subpopulations in Turkish people.

For infants and their families, sleep consolidation is important in maturing neural and circadian rhythms, and in family dynamics. The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant's sympathetic nervous system. The current study evaluated the effect of the Possums program on infant sleep and breastfeeding in infants (6-12 months) from a well-child outpatient clinic in Turkey, with the program intervention group (n = 91) compared with usual care (n = 92). In total, 157 mother-infant dyads completed the study. Infant sleep and breastfeeding rates were assessed at baseline and after 3 months. Nocturnal wakefulness, daytime sleep duration, naps, and night wakening decreased in both groups. Nocturnal sleep duration and the longest stretch of time the child was asleep during the night increased significantly in both groups without any change in total sleep duration. Night wakening was significantly lower and nocturnal sleep duration was significantly higher in the intervention group. However, mixed effects model analyses indicated no significant differences between the groups on any of the sleep outcomes after adjusting for confounders. Despite this, breastfeeding rates were significantly higher in the intervention group compared with those in the usual care group at follow-up.Conclusion: The Possum infant sleep program provided equivalent positive results on sleep parameters compared to usual care while advocating a more cued response. The critical difference was evident in sustained breastfeeding. What is Known: • Responsive sleep programs produce sleep consolidation, by responding to the infant's cues without ignoring, and then gradually reducing parental interaction. • Breastfeeding to sleep may be considered an undesirable sleep association in some infant sleep interventions. What is New: • The Possums Infant Sleep Program provided equivalent positive results to usual care while advocating a more cued response. • The critical difference was in sustaining breastfeeding, and the program was associated with better breastfeeding rates.

Background: The prevalence of allergic disorders is on the rise, affecting about 10% of the population. In this retrospective cohort, we investigated prevalence of allergic disorders, associated risk factors, and the outcome of food allergies. Material and methods: We analyzed data from birth cohorts of two university hospitals' well-child outpatient clinics. Factors related to onset and type of allergic diseases were assessed from demographic, socioeconomic, and clinical data. Results: Analyses were performed on 949 (431F/518M) infants at a mean current age of 28 +/- 6 months. Any allergic disease was established among 177 cases (22%); atopic dermatitis in 123 (12.8%), respiratory allergies in 55 (5.7%), and food allergy in 41 (4.3%). The risk for allergic disorders was found to be significantly increased for male gender (OR: 2.31, 95% CI; 1.54-3.46), and positive parental atopy (OR: 1.94, 95% CI; 1.31-2.86). The risk of food allergies was significantly higher in the male gender (OR: 2.47, 95% CI; 1.21-5.02), who consumed egg-white between 6 and 12 months (OR: 2.34, 95% CI; 1.22-4.48), and who were formula-fed before 6 months (OR: 2.16, 95% CI; 1.14-4.10). We found no significant association between the rate of food allergy outgrowth or food induced-anaphylaxis with regards to the timing of introducing egg-white into the diet. Conclusions: Although the introduction of egg-white into infant diet at 6-12 months of life appeared as an independent risk for any food allergy, none of the patients developed anaphylaxis. Age at symptom onset and outgrowing food allergy were similar compared to those introduced egg-white after 12 months. We recommend promoting exclusive breast-feeding during the first 6 months of life, and avoidance of prolonged restrictive diets for children with food allergy. (C) 2021 Codon Publications. Published by Codon Publications.

Multisystem inflammatory syndrome in children (MIS-C) evolves in some pediatric patients following acute infection with SARS-CoV-2 by hitherto unknown mechanisms. Whereas acute-COVID-19 severity and outcome were previously correlated with Notch4 expression on regulatory T (Treg) cells, here we show that the Treg cells in MIS-C are destabilized in association with increased Notch1 expression. Genetic analysis revealed that MIS-C patients were enriched in rare deleterious variant impacting inflammation and autoimmunity pathways, including dominant negative mutations in the Notch1 regulators NUMB and NUMBL. Notch1 signaling in Treg cells induced CD22, leading to their destabilization in an mTORC1 dependent manner and to the promotion of systemic inflammation. These results establish a Notch1-CD22 signaling axis that disrupts Treg cell function in MIS-C and point to distinct immune checkpoints controlled by individual Treg cell Notch receptors that shape the inflammatory outcome in SARS-CoV-2 infection.

Objective: Excessive gestational weight gain (GWG) and postpartum weight retention are risk factors for female obesity. The aim of the study was to assess postpartum weight change patterns among 64 Turkish, exclusively breastfed to 6 months and continued to 1 year and beyond, mothers during 1-year follow-up. Materials and Methods: Postpartum women's sociodemographic characteristics and breastfeeding patterns were obtained and anthropometric measurements were determined at five time points (1st, 3rd, 6th, 9th, and 12th months). Results: Mean GWG was 12.2 ± 5.8 kg and mean postpartum weight retention was 4.2 ± 4.9, 4.6 ± 4.8, 3.7 ± 5.4, 2.8 ± 5.0, and 3.3 ± 5.5 kg at 1st, 3rd, 6th, 9th, and 12th months, respectively. According to the results of repeated measure analysis of variance (ANOVA), there was significant time effect in body weight (F = 6.509; p = 0.001), body mass index (BMI) (F = 6.743; p = 0.001), and weight retention (F = 6.509; p = 0.001) measured over 1 year. Bonferroni multiple post hoc tests results showed similar significant changes between 1st–9th months (p

Background: This study examines the frequency of problematic internet use and sleep problems in adolescents aged 14–18 years during the COVID-19 pandemic and identifies the impact of factors such as sociodemographic characteristics, internet habits, changes in daily life, and perceived social support on these problems. Methods: This multicentre study was a questionnaire-based online survey study. The questionnaire included the Young Internet Addiction Scale, the Pittsburgh Sleep Quality Index, and the Multidimensional Scale of Perceived Social Support, as well as questions about demographic information, internet habits, and changes in daily life during pandemic. Several multivariate Backward logistic regression models were run to determine the variables that predicted problematic internet use and poor sleep quality. Results: It was determined that the frequency of problematic internet use was 15.5%, and the frequency of poor sleep quality was 47.8%. Poor sleep quality was found 2.5 times higher in problematic internet users. The perceived social support was found insufficient in adolescents with problematic internet use and poor sleep quality. Various factors such as the excessive use of internet and social media, low school success, lack of physical activity, lack of rules for internet use at home, and worsening of relationships with parents were found to be predictive factors for these problems. Conclusions: Problematic internet use during the pandemic is associated with worsening sleep quality in adolescents. It is important to create special interventions for problematic internet use and sleep problems that develop in adolescents as a result of restrictions during the pandemic. © 2022 Association for Child and Adolescent Mental Health.

Objectives: Evaluation of emergency department (ED) utilization by Syrian refugee children will provide important information about their health care needs and utilization as a prerequisite for improving preventive health services and outcomes. We aimed to compare ED utilization of refugee and resident children in a tertiary university hospital in Istanbul, Turkey.Methods: Electronic medical records of Syrian refugee children ≤18 years old presenting to the ED between January 2013 and July 2019 were retrospectively reviewed and compared with the resident children.Results: The study population consisted of 7299 refugee and 690127 resident children admitted to the ED. Emergent cases were more frequent in Syrian refugees (2.2% vs 1.0% p ppp=0.001) and neonatal hospitalization was higher in Syrians compared to resident children (29.3% vs 12.0%, pConclusion: Refugee children as compared to native children are more likely to present to the ED with high acuity conditions, at a younger age resulting in higher rates of inpatient admissions. Strategies to increase access to preventive health care services for young refugee children should be explored to decrease ED and hospital services and improve health outcomes.

Aim: The aim of this study was to determine the influences of herbal galactagogue teas consumption on the composition of human milk energy and macro nutrients. Methods: It was a cross-sectional study conducted between 12 March and 30 June 2018, involving mothers having 0-4 month old infants consuming (n=43) and non-consuming (n=56) herbal tea containing galactagogue. Energy and macronutrients of human milks collected from mothers by hand expression were measured using a human milk analyzer, and retrospective 1-day food consumption records were obtained. Significance level was accepted as p 0.05). Type of herbal galactagogue tea did not affect the content of human milk (p>0.05). Conclusion: The consumption of herbal galactagogue teas did not change HM energy and macronutrient composition. It has been proposed that the safety, efficacy and possible side effects of these teas should be assessed in larger sample groups and randomized controlled trials., Amaç: Bu çalışmanın amacı galaktagog içeren bitki çayı tüketiminin anne sütü enerji ve makro besin ögesi bileşimine etkisini belirlemektir. Yöntemler: Çalışma 12 Mart – 30 Haziran 2018 tarihleri arasında, 0-4 aylık bebeği olan, galaktagog içeren bitki çayı tüketen (n=43) ve tüketmeyen (n=56) anneler ile yürütülmüştür. El ile sağılan sütlerin enerji ve makro besin içeriği anne sütü analizi cihazı kullanılarak ölçülmüş; annelerden geriye dönük 1 günlük besin tüketim kaydı alınmıştır. Anlamlılık düzeyi p0,05). Galaktagog içeren bitki çayı türünün anne sütü içeriğini etkilemediği saptanmıştır (p>0,05). Sonuç: Galaktagog içeren bitki çaylarının anne sütü içeriğini deiştirmediği belirlenmiştir. Bu çayların güvenlik, etkinlik ve olası yan etkilerinin daha büyük örneklem gruplarında ve randomize kontrollü çalışmalarda değerlendirilmesi gerektiği düşünülmüştür.

In this study, we aimed to examine and compare the perinatal outcomes between refugee and resident mother–infant dyads. Data of refugee women who had given birth in a university hospital (n = 924) ...

Aim A recent improvement was made on the law regulating maternity leave in 2011 in Turkey. The leave without pay period was increased, the right to stop working on night shifts was granted, and work hours were improved. It is a known fact that returning to work is a barrier against exclusive and total breastfeeding duration. Legal regulations have crucial importance on the ability of working mothers to breastfeed their infants. The aim of this study was to calculate the effect of the improved law on breastfeeding rates among female physicians. Moreover, the difference in the duration of exclusive breastfeeding and total breastfeeding were evaluated in relation to the new law. Material and methods Three of the major hospitals in Istanbul were included in the study. A pilot study was planned and our questionnaire was tried. The actual study included 40 female physicians from each hospital. Mothers who went through antenatal or postnatal complications were excluded from the study. Infants who required intensive care after birth or were never breastfed were similarly excluded. A total of 109 female physician resident mothers' questionnaires were included in the study. Results The effects of the improvement in the law were statistically significant on the duration of maternity leave and improved working hours after returning to work (OR: 2.74 and OR: 2.52). Exclusive breastfeeding rates and total breastfeeding for more than 12 months significantly increased after the new law (OR: 4.47 and OR: 2.56). Conclusions This study showed that legal improvements did reflect on positive outcomes. There is more to be done, especially with condition of the work places and distributing rights equally to women practicing in surgical disciplines as well. If the physicians can breastfeed after they become mothers, their experience may affect their breastfeeding advocacy and the guidance they will provide for their patients.

BACKGROUND Interpretation of the results of steroid hormone measurements is challenging at early infancy. The liquid chromatography-tandem mass spectrometry (LC-MS/MS) method provides a powerful tool for diagnosing steroidogenesis disorders. We aimed to develop normative data for a 14-steroid panel and four adrenal enzyme activity indices, determined by LC-MS/MS from 3 days to 6 months of age. METHODS Age- and sex-specific plasma steroid concentrations were calculated in 324 healthy full-term neonates and infants (151 females). Percentile curves were devised. Steroid ratios were evaluated as biomarkers of adrenal enzyme activities. The steroid profiles of four patients with adrenal enzyme deficiencies were included to test the diagnostic efficiency. RESULTS Nine steroids showed age, but none showed sex specificity. The concentrations of progestins and androgens were higher at 7-14 days than at 3-7 days. After the first month, adrenal androgen concentrations decreased significantly. Adrenal enzyme activities changed towards increasing cortisol over the first 6 months. There were several-fold differences in diagnostic steroids and related adrenal enzyme activity indices between the patients and the healthy group. CONCLUSIONS The majority of adrenal steroids show age-related variations in the neonatal period and early infancy. Our data will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis. IMPACT LC-MS/MS method is capable of quantitating numerous analytes simultaneously, which provides an integrated picture of adrenal steroidogenesis in a small amount of sample. The development of LC-MS/MS-based normative data of steroid hormones in healthy infants is crucial to differentiate physiologic alterations from steroidogenic defects during the first 3-6 months of infancy. Previous studies had limitations due to the small numbers of samples available by sex and by age groups. Our detailed normative data and percentile curves will enable accurate interpretation of steroid measurements for etiologic diagnosis of disorders of steroidogenesis without the need for further invasive testing.

BackgroundIn the context of containment measures against the COVID-19 pandemic, the aims were to examine the impact of lockdown and school closures on childs’ and adolescents’ health and well-being and social inequalities in health.MethodsLiterature review by searching five databases until November 2020. We included quantitative peer-reviewed studies reporting health and well-being outcomes in children (0–18 years) related to closure measures' impact due to COVID-19. A pair of authors assessed the risk of bias of included studies. A descriptive and narrative synthesis was carried out.FindingsTwenty-two studies, including high-income, middle-income and low-income countries, fulfilled our search criteria and were judged not to have an increased risk of bias. Studies from Australia, Spain and China showed an increase in depressive symptoms and decrease in life satisfaction. A decrease in physical activity and increase in unhealthy food consumption were shown in studies from two countries. There was a decrease in the number of visits to the emergency department in four countries, an increase in child mortality in Cameroon and a decrease by over 50% of immunisations administered in Pakistan. A significant drop of 39% in child protection medical examination referrals during 2020 compared with the previous years was found in the UK, a decrease in allegations of child abuse and neglect by almost one-third due to school closures in Florida, and an increase in the number of children with physical child abuse trauma was found in one centre in the USA.InterpretationFrom available reports, pandemic school closure and lockdown have adverse effects on child health and well-being in the short and probably long term. We urge governments to take the negative public health consequences into account before adopting restrictive measures in childhood.

BackgroundThe aim of this study was to determine the influences of herbal tea consumption containing galactagogues on the composition of human milk energy and macro nutrients. MethodsIt was a cross-sectional study conducted between March and May 2018, involving mothers having 0-4 month old infants consuming (n=43) and non-consuming (n=56) herbal tea containing galactagogue. Energy and macronutrients of human milks collected from mothers by hand expression were measured using a human milk analyzer, and retrospective 1-day food consumption records were obtained. Significance level was accepted as p 0.05). No statistically significant difference was found between the type of herbal tea containing galactagogue and the content of human milk (p>0.05). ConclusionIt was determined that the herbal tea containing galactagogue did not affect the content of breast milk energy and macronutrients. Also; it was proposed that the safety, efficacy and possible side effects of these teas should be assessed in larger sample groups and randomized controlled trials.

For infants and their families, sleep consolidation is important in maturing neural and circadian rhythms, and in family dynamics. The Possums Infant Sleep Program is a cued care approach to infant sleep, responding to infant cues in a flexible manner, dialing down the infant's sympathetic nervous system. The current study evaluated the effect of the Possums program on infant sleep and breastfeeding in infants (6-12 months) from a well-child outpatient clinic in Turkey, with the program intervention group (n = 91) compared with usual care (n = 92). In total, 157 mother-infant dyads completed the study. Infant sleep and breastfeeding rates were assessed at baseline and after 3 months. Nocturnal wakefulness, daytime sleep duration, naps, and night wakening decreased in both groups. Nocturnal sleep duration and the longest stretch of time the child was asleep during the night increased significantly in both groups without any change in total sleep duration. Night wakening was significantly lower and nocturnal sleep duration was significantly higher in the intervention group. However, mixed effects model analyses indicated no significant differences between the groups on any of the sleep outcomes after adjusting for confounders. Despite this, breastfeeding rates were significantly higher in the intervention group compared with those in the usual care group at follow-up.Conclusion: The Possum infant sleep program provided equivalent positive results on sleep parameters compared to usual care while advocating a more cued response. The critical difference was evident in sustained breastfeeding. What is Known: • Responsive sleep programs produce sleep consolidation, by responding to the infant's cues without ignoring, and then gradually reducing parental interaction. • Breastfeeding to sleep may be considered an undesirable sleep association in some infant sleep interventions. What is New: • The Possums Infant Sleep Program provided equivalent positive results to usual care while advocating a more cued response. • The critical difference was in sustaining breastfeeding, and the program was associated with better breastfeeding rates.

Objective This study is the first concerted effort to ascertain factor structure of EPDS using evidence based analytical techniques. It is the most widely used scale for assessing postpartum depression in Turkey, and yet no investigations have been conducted to assess it factor structure. This study was conducted from April 2012 to April 2018 at the Marmara University Hospital operating under the name of Marmara University Pendik Training and Research Hospital in Istanbul Turkey. Results A total of 1700 women were included in this study, who responded to the EPDS, in addition to demographic characteristics and well-being of their offspring. A total of 1615 mothers provided adequate data for inclusion in analysis. Standardized Chronbach’s alpha for EPDS was 0.81 with corrected item-total correlations ranging from 0.35 to 0.62. Parallel analysis, MAP Velicer Test and Hull’s method dictated retaining of one factor structure. All the items revealed adequate communalities (> 0.20) except item 2 (enjoyment) and item 10 (self-harm). Their communalities were 0.16 and 0.19, however, these items were not dropped. All of the items yielded moderate to strong factor loadings. Minimum factor loading was for item 2 (0.40) and highest for item 8 (0.71).

Additional file 1: Turkish Translation of Edinburgh Postnatal Depression Scale.

Aim In the presence of food allergies, especially egg allergies, primary physicians in Turkey avoid vaccine administration and refer children to a hospital setting. We aimed to evaluate children who had allergies or suspected allergies and were referred to our Well Child Clinic in a university hospital for vaccination. Material and methods Charts of all children referred to our clinic due to concerns for allergies in the last two years, were reviewed. Demographic data, laboratory evaluation and reactions after immunization were recorded. Results A total of 122 children with or without a confirmed diagnosis of allergies were referred by primary physicians. In the history, 50 children (43.5%) had reactions with egg, 42 (36.5%) had reactions with multiple foods, nine (7.8%) had reactions with milk and seven (6.1%) had reactions with a previous vaccination. The most common reaction was rash (n=89, 86.4%). Nine children reported anaphylaxis. Skin testing or serum allergen specific IgE measurement revealed that 66 (54.1%) children had sensitization to egg white and 25 (20.5%) had sensitization to egg yolk. Most children (n=87, 71.9%) were referred for all the 12th-month vaccines, and 21 children were referred only for the measles-mumps-rubella vaccine (n=21, 17.4%). The median delay time in the administration of the measles-mumps-rubella vaccine was 20.0 (interquartile range: 8.7-41.2) days. No reaction was observed except for one child reporting a slight rash several hours after vaccination. Conclusion Egg allergy was the most common barrier of vaccine administration in children referred from family physicians. Given the absence of any reactions, we support the administration of the measles-mumps-rubella vaccine in primary care settings to prevent delays in national vaccine schedule.

In the presence of food allergies, especially egg allergies, primary physicians in Turkey avoid vaccine administration and refer children to a hospital setting. We aimed to evaluate children who had allergies or suspected allergies and were referred to our Well Child Clinic in a university hospital for vaccination.Charts of all children referred to our clinic due to concerns for allergies in the last two years, were reviewed. Demographic data, laboratory evaluation and reactions after immunization were recorded.A total of 122 children with or without a confirmed diagnosis of allergies were referred by primary physicians. In the history, 50 children (43.5%) had reactions with egg, 42 (36.5%) had reactions with multiple foods, nine (7.8%) had reactions with milk and seven (6.1%) had reactions with a previous vaccination. The most common reaction was rash (n=89, 86.4%). Nine children reported anaphylaxis. Skin testing or serum allergen specific IgE measurement revealed that 66 (54.1%) children had sensitization to egg white and 25 (20.5%) had sensitization to egg yolk. Most children (n=87, 71.9%) were referred for all the 12Egg allergy was the most common barrier of vaccine administration in children referred from family physicians. Given the absence of any reactions, we support the administration of the measles-mumps-rubella vaccine in primary care settings to prevent delays in national vaccine schedule.Besin alerjisi olan çocuklarda, aile hekimleri aşılama uygulamaktan kaçınmakta ve çocukları hastanelere yönlendirmektedir. Bu çalışmada Çocuk Sağlığı İzlem Polikliniği’mize alerjisi olup, aşılama için yönlendirilen çocukları değerlendirmeyi hedefledik.Son iki yılda aşı yapılması için yönlendirilen alerjik çocukların dosyaları geriye dönük incelendi. Demografik ve laboratuvar verilerle, aşı sonrası reaksiyonlar değerlendirildi.Alerjisi olan ya da alerji şüphesiyle yönlendirilen 122 çocuk saptandı. Çocukların 50’sinde (%43,5) yumurta, 42’sinde (%36,5) çoklu besinler, dokuzunda (%7,8) süt, yedisinde (%6,1) daha önceki aşılamalar, öyküde etmen olarak bildirildi. En sık bildirilen reaksiyon cilt döküntüsüydü (n=89, %86,4). Sadece dokuz çocukta anafilaksi yakınması vardı. Cilt testi ve kanda alerjen spesifik IgE ölçümü ile hastaların 66’sında yumurta beyazı (%54,1) ve 25’inde (%20,5) yumurta sarısına duyarlanma saptandı. Çocukların çoğu (n=87, 71,9%) tüm 12. ay aşıları için, 21 (%17,4) çocuk sadece kızamık-kabakulak-kızamıkçık aşısı için yönlendirilmişti. Ortanca gecikme süresi kızamık-kabakulak-kızamıkçık aşısı için 20 gündü (8,7-41,2). Bir çocukta aşılamadan birkaç saat sonra ortaya çıkan döküntü dışında, diğer çocuklarda reaksiyon izlenmedi.Yumurta alerjisi, aile hekimlerinden yönlendirilen çocukların aşılamasında en yaygın engel olarak bulundu. Yumurta ile ciddi reaksiyon tanımlayan çocuklarda dahi aşılama sonrası reaksiyon izlenmemiştir. Ciddi reaksiyon olmadığı düşünüldüğünde, ulusal aşı takviminde gecikmelerin önlenmesi için, kızamık-kabakulak-kızamıkçık aşısının aile hekimlerince uygulanmasında sakınca gözlenmemiştir.

Amaç: Hepatit A enfeksiyonu epidemiyolojisi yaşam koşullarına göre farklılık gösteren bir sorundur. Bu nedenle hastalığın değişen epidemiyolojisini değerlendirmek koruyucu hekimlik uygulamaları açısından önemlidir. Çalışmanın amacı anne ve bebek çiftlerinde hepatit A antikoru seropozitifliğinin belirlenmesi ve bunu etkileyen faktörlerin değerlendirilmesidir. Gereç ve Yöntem: Çalışmada 209 anne-bebek çiftinin verileri değerlendirilmiştir. Kan örnekleri annelerden doğumdan 1 ay sonra ve bebeklerinden ise 1. ve 6. aylarda alınmıştır. Hepatit A IgG antikor düzeyleri ELİSA yöntemi ile belirlenmiştir. Ailelerin sosyo-ekonomik ve demografik özelliklerine yönelik bilgiler yüz yüze uygulanan bir anket yolu ile toplanmıştır. Bulgular: Annelerde 1. ayda hepatit A seropozitifliği %67, bebeklerde 1. ayda %66,1, 6. ayda %68,9 olarak saptanmıştır. Ebeveynlerin eğitim süresinin, ailenin aylık gelirinin, gravida ve paritenin hepatit A seropozitiflik düzeyine istatistiksel açıdan ileri düzeyde anlamlı etkisi olduğu saptanmıştr. Eğitim düzeyi, aylık gelir arttıkça seropozitiflik oranı düşmekte; gravida ve parite artıkça yükselmektedir. Sonuç: Süt çocuklarında hepatit A seropozitiflik düzeyinin sosyo-ekonomik faktörlerden etkilendiği düşünülmüştür., Objective: Epidemiology of hepatitis A infection differs according to living conditions. Therefore, evaluating the changing epidemiology of the disease is important for preventive medicine. The aim of the study was to determine the seropositivity of hepatitis A antibody in mothers and their babies and to evaluate the factors affecting it. Materials and Methods: The data of 209 mother-infant pairs were evaluated. Blood samples were collected from mothers one month after birth and at 1 and 6 months of age from their babies. Hepatitis A IgG antibody levels were determined by ELISA method. The socio-economic and demographic characteristics of the families were collected by a questionnaire. Results: The seropositivity of the hepatitis A antibody was 67% in mothers at one month after birth, 66.1% and 68.9% in their babies at 1 and 6 months of age respectively. Parental education, family monthly income, gravity and parity were found to have a statistically significant effect on hepatitis A seropositivity. As the level of education and monthly income increased, hepatitis A seropositivity decreased. On the other hand as parity and gravida increased, seropositivity increased as well. Conclusion: Hepatitis A seropositivity in infants is thought to be affected by socio-economic factors.

The protection of infants against infections during the first few months of life is provided mainly by maternal antibodies. The presence of maternal antibodies can decrease vaccine efficacy. The waning time of maternal antibodies shows variations therefore seroepidemiological studies are important for the development of vaccination schedules. Some recent studies showed that the maternal measles antibodies may disappear around 3 months of age especially in infants born from mothers who were vaccinated. There are few cross-sectional studies from Turkey evaluating the maternal antibody levels of infants against measles in recent years. The aim of this prospective, multicentre study is to evaluate the seropositivity of measles, rubella, mumps, and varicella in mothers and their infants at 1 and 6 months after birth. The study was carried out at the Social Pediatrics Units of two university hospitals, a private hospital and a state hospital. The exclusion criteria were known impaired immune system or immune deficiency disorder in mother or child, preterm delivery (37 gestational week), administration of immunoglobulins or any blood products before admission or during the follow-up period, and history of vaccination or exposure to one of these diseases during the study period. The final analysis encompassed 209 mother-infant pairs. Blood samples were collected 1 month after birth from mothers and 1 and 6 months after birth from their babies. Antibody levels were determined by ELISA (Enzyme-Linked ImmunoSorbent Assay) method. Information on the socio-economic and demographic characteristics of the families were collected by a face-to-face questionnaire. Seropositivity was found as 95.7%, 92.8%, 92.8% and 96.7% for measles, mumps, rubella and varicella (MMRV) respectively. Majority of infants lost maternal antibodies at 6 months of age. Of all 6 month-old infants 25% were seropositive for measles,14.6% for mumps, 23.2% for rubella and 17.1% for varicella. The proportion of seropositive infants born from seropositive mothers was higher than those born from seronegative mothers for all four diseases. This difference was statistically significant only at 1 month of age (p= 0.001). Our study showed that maternal antibodies against MMRV decreased rapidly by 6 months of age therefore necessary measures should be taken to close this gap between the loss of maternal protection and the vaccination of infants for MMRV. As the epidemiology of the diseases changes in time, it is important to carry out such studies with large series in different countries and settings. Important results were determined in our study within this respect.

OBJECTIVEAnterior fontanel size and closure time can be useful clinical signs for the early diagnosis of diseases. Knowing age-related normal variations is important to decide on further investigations. The authors of this study aimed to describe fontanel size variation according to age, determine fontanel closure time, and identify the optimal method for assessing fontanel size.METHODSFor this prospective cohort study, 321 healthy term babies who fulfilled the inclusion criteria were consecutively recruited. Percentile charts for the mean anterior fontanel size and oblique measurements from birth to 24 months of age were created.RESULTSThe mean fontanel closure time was 9.7 ± 5.0 months (girls 10.3 ± 4.7 months, boys 9.2 ± 5.1 months). No differences were observed between the traditional method and oblique measurements. Early fontanel closure was not associated with microcephaly.CONCLUSIONSOblique measurements can be used because they are as accurate as the traditional method. Children with fontanels measuring above the 95th percentile should be monitored closely and investigated further for potentially associated diseases.

Background Delivery of supplemental oxygen is the initial vital management of hypoxemic acute lower respiratory infection (HALRI). Oxygen delivery systems include low-flow and high-flow devices. In high-flow devices such as the Venturi mask, a constant mixture of oxygen is delivered. As a result, increased rate of breathing does not affect the concentration of oxygen delivered. In this study, we compared the efficacy of oxygen masks and Venturi masks in the management of hypoxemia in pediatric patients. Methods A total of 65 children, aged 3-36 months, diagnosed with HALRI, were enrolled. Patients were allocated into groups, via simple alternate randomization, to receive oxygen through an oxygen mask or through a Venturi mask. Respiratory rate, heart rate, retraction, blood gas parameters, oxygen saturation, length of hospitalization, and oxygenation were recorded before and after oxygen treatment. Results After 24 h of treatment, respiratory rate was significantly lower among patients in the Venturi mask group compared with the oxygen mask group. Duration of supplemental oxygen and length of hospitalization were significantly lower in the Venturi mask group compared with the oxygen mask group. Conclusion In both groups, there was marked improvement in all measured parameters following introduction of supplemental oxygen. Oxygen was delivered more efficiently, however, by high-flow systems. The Venturi mask may decrease the total duration of oxygen usage time as well as the length of hospitalization among young children with HALRI through rapid symptom resolution.