INTRODUCTION: As we know that perfusion index is increased in nerve blocked area in regional anesthesia and it is used for predicting successful intervention; we hypothesized that, in neonatal brachial plexus palsy (NBPP), perfusion index may alter in the affected arm
METHODS: Prospectively, 11 patients with defective Moro reflex and were diagnosed as NBPP were included. Demographic data were collected and perfusion indices were measured from affected and non-affected limbs in the 24th hour of postnatal life. Measurements were statistically compared. Increase rate of PI was also calculated and the increment of PI in patients with and without clavicle fracture was compared.
RESULTS: PI values were statistically higher in affected extremity compared to not-affected extremity. (mean±SD, 2.47±0.74, 1.83±0.66 respectively, p=0.0003). There was no difference in patients with or without clavicle fracture.
DISCUSSION AND CONCLUSION: In the future, maybe PI can be evaluated as a prognostic factor for neurologic dysfunction in NBPP and a predictor for early surgical intervention with larger studies.

INTRODUCTION: The aim of study was to determine the anxiety and related factors in parents about new coronavirus disease (COVID-19).
METHODS: The sample of the descriptive study consisted of 494 parents with children aged 0-18. The data were collected during April-May 2020 with tools that were prepared via Google Docs, an online study. The link to the questionnaires was shared via social media. The volunteers were agreed to participate in the survey.


RESULTS: In the study, 94.5% of the parents participating are mothers, 69.5% are between the ages of 31-40 and 59.6% have one child. 31.8% of the parents stated that they worked during the COVID-19 pandemic, 90.3% applied social isolation or quarantine. The most frequent feeling that 83.6% of the parents was concern/anxiety, 69.0% used kitchen activities such as cooking and baking cakes as coping mechanisms, 68.4% used games, and painting activities with children.

DISCUSSION AND CONCLUSION: In this study, it was determined that parents' anxiety levels were mild. It is recommended that social and health initiatives be created to prevent and alleviate the psychosocial effects of the pandemic, and to develop programs that will reduce parents' anxiety.

INTRODUCTION: Nutrition has a significant impact on dental health. The aim of this study is to investigate the relationship between dental caries and BMI-for-age.
METHODS: 451 children who were 5-14 years, included in this study. Children were examined according to dmft/DMFT indexs under daylight with mirror and sond. After weight and height measurements, for BMI-for-age calculation, age, weight and height status were entered the WHO AnthroPlus Software program for gaining Z score recommended for child. Children were grouped according to Z score as Group 1: normal; Group 2: overweight; Group 3: fat/obese; Group 4: underweight; Group 5: severely underweight. Data were analysed using SPSS software22, correlation, frequency and independent sample t-tests.
RESULTS: The mean age of the children was 9.1±2.5 years. The mean DMFT/dmft values were 6.97±3.79. 55% of children were of normal weight, 16.2% were overweight, 11.8% fat/obese, 12.2% underweight and 4.8% severely underweight. In terms of DMFT/dmft, when the groups were compared, a statistically significant difference was found between Group 3 and Groups 1, 4 and 5. (p<0.05)
DISCUSSION AND CONCLUSION: The risk of caries increased as the weight increased in the children participating in the study. Obesity can be considered as an important risk factor for dental health. Parents are informed about children's wrong eating habits have an impact on dental health.

INTRODUCTION: Inflammatory bowel disease (IBD- Crohn’s Disease-CD, Ulcerative Colitis-UC) is characterised by chronic inflammation with multisystemic effects. Myocardial dysfunction may occur during active disease due to increased inflammation. The aim of our study is to evaluate the effect of disease activity index at diagnosis on myocardial functions in children with IBD in remission.
METHODS: The study consisted of 34 IBD patients and 21 healty children. Patients were divided into two groups according to disease activity at the diagnosis as mild and severe disease activity. Conventional echocardiography and strain echocardiography was performed for all study patients.
RESULTS: In IBD patients with severe disease activity at diagnosis, global longitudinal strain of left ventricle (GLLV), longitudinal strain (AP3) and (AP4) were lower than patients with mild disease activity at the diagnosis (p=0.043, p=0.032, p=0.028, respectively). Disease activity at the diagnosis was inversely correlated to EF (%), strain values of GLLV, LVAP3, LVAP2 in UC patients. (p=0.047, p=0.016, p=0.029, p=0.011, respectively). Mitral E, DT was lower in IBD patients than control patients (p=0.05, p=0.04). Strain value of LVAP4 was lower in CD patients, than UC patients (p=0.046). Strain values of GLLV, LVAP3, LVAP4 was decreased in CD patients than control patients (p=0.046, p=0.046, p=0.048). Mitral E and desceleration time were found to be decreased in IBD patients than control patients (p=0.05, p=0.04 respectively).
DISCUSSION AND CONCLUSION: Our study revealed that the severity of disease activity at diagnosis has longterm effects on myocardial functions.

INTRODUCTION: Standardization of an optimal treatment protocol for vesicoureteral reflux (VUR) correlated with duplex kidney systems remains controversial. In this study, we reviewed our experience in endoscopic subureteric injection to correct reflux in duplex systems with documented indications, in an aim to confirm its position as an alternative means of open surgery.
METHODS: The hospital records of complete renal duplex system patients who had experienced endoscopic subureteric injection for VUR between 2009 and 2018 were reviewed. The indications for the amelioration of VUR included breakthrough urinary tract infection (UTI) along with the presence of renal scarring.
RESULTS: A total of 24 patients (18 girls, 6 boys) with refluxing renal duplex systems were included in the study. The mean age at first injection was 46.4±28.8 months (5-160) and the mean duration of follow-up was 47.25±27.7 months. The success rate with the initial injection was 83.3% (20/24). The mean volume of material injected was 0.68±0.49 ml per duplex system.
DISCUSSION AND CONCLUSION: Management of reflux in duplex systems is still controversial with insufficient data. Our results suggest that endoscopic management should be considered as an alternative to open ureteral reimplantation in refluxing renal collecting systems. Major open surgery and accompanying discomfort can be avoided by an endoscopic injection which can be performed as an outpatient procedure in most of the reflux patients with duplex system who have an indication for surgical management.

INTRODUCTION: The purpose of this study was to determine the level of knowledge and awareness of pediatricians regarding nasoalveolar molding (NAM) and presurgical orthopedic treatment of newborns with cleft lip and/or palate (CL/P).
METHODS: We conducted a 10-item questionnaire and sent emails to 600 pediatricians in XXX. The participants were queried about title, years in practice, workplace, and knowledge of CL/P and NAM.
RESULTS: One-hundred twelve pediatricians responded to the questionnaire. There was a statistically significant number of pediatricians who had examined newborns with CL/P and knew about NAM therapy (p<0.001). There was a statistically significant difference in knowledge regarding preoperative treatment of newborns with CL/P between experienced and inexperienced pediatricians (p<0.05). All pediatricians reported referring newborns with CL/P to at least one specialist (orthodontist, dentist, or plastic surgeon). There was a linear regression between the number of cases seen and years of experience.
DISCUSSION AND CONCLUSION: Our results indicate that pediatricians do not have enough knowledge of NAM and its purpose. It is important to increase awareness and knowledge regarding treatment alternatives for patients with CL/P, including NAM and presurgical orthopedic treatment.

INTRODUCTION: Congenital hypothyroidism (CH) is one of the most common endocrinological problems in the neonatal period. CH, which occurs in 1: 3,000-4,000 births, is a preventable cause of mental retardation. In the literature, the most common cause of CH is dysgenesis of the thyroid gland, followed by thyroid dyshormonogenesis. We aimed to determine the prevalence of permanent (P-CH) / transient (T-CH) CH in cases followed up with a diagnosis of CH and identify a prediction method for persistency.
METHODS: We retrospectively analyzed medical records of 105 children with CH.
RESULTS: From the 105 children (58 males, 47 females) enrolled in this study, 38 (36.2 %) were referred from National Newborn Screening Program. Cases with normal thyroid appearance were evaluated as thyroid dyshormonogenesis (n: 94; 89.5 %), and other cases were evaluated as thyroid dysgenesis (n: 11; 10.5 %). Treatment was discontinued during the 3rd-year follow-up period in 44 (41.9 %) of the cases with normal thyroid gland morphology. L-thyroxine (L-T4) therapy was discontinued at a median age of 1.9±1.08 years.
At the time of diagnoses, fT4 level was significantly higher in T-CH group than P-CH including thyroid dysgenesis (p=0.037). TSH levels at the time of diagnosis were higher in the P-CH group, but this difference was not statistically significant (p = 0.165).
At the sixth month, first and second years of follow-up, L-T4 doses were significantly higher in P-CH than T-CH group (p<0.001, p<0.001, p<0.001 respectively). TSH levels were also higher in P-CH than T-CH group (p=0.123, p=0.038, p=0.049 respectively). Consistent with these results, measured fT4 levels were found to be lower in the P-CH group compared to the T-CH group (p=0.431, p=0.361, p=0.028 respectively).

DISCUSSION AND CONCLUSION: L-T4 doses at 6, 12 and 24 months may predict transient hypothyroidism in patients with normal thyroid gland morphology before 36 months.

INTRODUCTION: Secretory IgA in one of the important components of the immune system and has prominent role in preventing infections that are transmitted through the gastrointestinal tract and respiratory mucosa. The primary objective of this study was to evaluate the effect of massage on salivary secretory IgA (sIgA) level in preterm infants and the secondary objective was to assess the effect of massage on neonatal weight gain.
METHODS: This study was performed on 150 preterm infants weighing between 1500 g and 2000 g which have been hospitalized in 3 main medical centers of Khorramabad city, Iran from March 2018 to March 2019. The 3 major selected centers were; Asalian, Shahid Madani and Shahid Rahimi Hospitals. All infants were randomly allocated to intervention (n=75) and control (n=75) groups. Due to our criteria, 18 patients were excluded from the study. In total, 132 infants were included in this study. The initial samples of sIgA were obtained from saliva of neonates in both groups on the second day after birth and when the acute symptoms of RDS had resolved. The second samples were collected on the 14th day of birth. During this period, neonates of intervention group were massaged properly using Field technique for 15 minutes, three times a day by a trained NICU nurse for 12 consecutive days. It should be noted that due to the effect of breast milk on the neonates sIgA level, we selected all subjects from those who were deprived of breast milk for some reason and were fed with Formula
RESULTS: According to our findings, a significant difference was observed between the mean weight of the infants between the second and 14th days after birth in both intervention and control groups (P<0.001). However, in comparison, there was no significant difference between the mean weight changes of the infants in both groups (P=0.845). Moreover, there was a significant difference was found between the mean sIgA level changes between the second and 14th days after birth in both groups (P<0.001), but these changes were more significant in the intervention group compared to the control group (P<0.001).
DISCUSSION AND CONCLUSION: The results showed that the massage therapy in neonates can increase the level of sIgA as an important part of the infant's immune system. Although it had no positive effect on the weight gain process. It is recommended that the massage therapy can be used as a safe auxiliary therapeutic procedure for preterm infants and mothers can learn and perform this technique as a simple way to boost the immune system of their infants.

INTRODUCTION: The purpose of our study was to evaluate the diagnostic performance of fetal MRI-based texture analysis (TA) to differentiate the two most common lung malformations, congenital pulmonary airway malformation (CPAM) and pulmonary sequestration (PS).
METHODS: This retrospective single-center study included 24 patients with CPAM and 8 patients with PS who had a fetal MRI examination between January 2015 and December 2020. T2-weighted coronal images were used for TA. One reader designated the malformation borders and drew a region of interest for TA. The differences of the texture features’ values between the groups were assessed and receiver operating characteristic curves were calculated for each statistically significant feature. A p value < 0.05 was considered statistically significant.
RESULTS: Forty-eight texture features were calculated for each malformation. Twenty features on T2-weighted images were significantly different between the CPAMSs and PSs. Among these, short-run high gray-level emphasis (SRHGE) and long-run emphasis (LRE), which are gray-level run-length matrix features (GLRLM) parameters, had the largest area under the curves: 0.956 (sensitivity 87%, specificity 95%) and 0.943 (sensitivity 87%, specificity 85%), respectively.
DISCUSSION AND CONCLUSION: Our results suggest that fetal MRI-based TA may be used to distinguish CPAMs from PSs in fetuses with uncertain pulmonary findings prior to birth.

INTRODUCTION: Thiopurine S-methyltransferase (TPMT) is an essential enzyme in thiopurine drugs' metabolism, and its activity may be change due to different polymorphisms in the TPMT gene. TPMT gene has different genetic polymorphisms in different ethnic groups. This study aimed to determine the frequency of TPMT polymorphisms in children with acute leukemia/ non-Hodgkin lymphoma (AL/ NHL ) and healthy children and to evaluate their association with severe toxicities in the study population.

METHODS: Sixty-seven pediatric AL/NHL patients and 84 healthy children evaluated. Genotyping for the TPMT*2, TPMT*3A, TPMT*3B, TPMT*3C, TPMT*4, TPMT*5, TPMT*6, and TPMT*7 alleles performed by real-time PCR technique. The number of grade ≥3 hematologic and hepatic toxicities recorded from the patient charts.

RESULTS: In AL/NHL patients, we found that the patients had generally wild-type TPMT*1 allele in 80.6%, whereas TPMT*2 (238G>C) in 1.5%, TPMT*3A (c.460G>A and c.719A>G) in 0%, TPMT*3B polymorphisms (460G>A) in 17.9 %. We found wild-type TPMT*1 allele in 98.8% and TPMT*3B polymorphisms (460G>A) in 1.2% in healthy volunteers. Grade grade ≥3 myelosuppression developed in 22/54 patients with wild type allele while in 5/12 patients with TPMT*3B allele. Six (8.9%) patients had grade ≥3 AST elevations while 17 (25%) patients had grade ≥3 ALT elevations (1-5 times), and 42 patients had (62.6%) grade ≥3 total bilirubin elevations.
DISCUSSION AND CONCLUSION: TPMT*3B polymorphism was the most common allele detected in our study group. This allele frequency is very high according to other studies from our country and overrepresented in comparison to healthy volunteers. We did not find any relationship between severe hematologic/hepatic toxicities and TPMT gene polymorphisms.

INTRODUCTION: Aim: This randomized controlled study aims to analyze the effects virtual reality (VR) and carton distraction techniques pain due to dressing change and fair levels in children that underwent abdominal surgery.
METHODS: The study was conducted on 96 children between 7 and 10 years of age, who visited pediatric surgery department of Bağcılar Research and Training Hospital between 1 November 2018 and 30 November 2019. Personal Information Form on Children and Parents, Wong-Baker Faces Pain Rating Scale and Children’s Fear Scale were used for data collection. Due to dressing change, no intervention was made to the children in the first group whereas children in the second and third groups watched video with VR headset and cartoon from tablet, respectively. Pain severity and fear levels were self-assessed. Descriptive statistics, correlation analysis, Wilcoxon signed-rank, Kruskal-Wallis, Mann-Whitney U, Pearson’s chi-square and Fisher-Freeman-Halton exact tests were used for data analysis. Statistical significance was set at p<0.05.
RESULTS: Mean age of children was 8.58±1.13 and 56.3% (n=54) were male. Pain and fear scores due to dressing change were lower for the VR and carton distraction groups. Statistically significant difference between the control and the distraction groups stemmed from the VR distraction group (p<0.05).
DISCUSSION AND CONCLUSION: This study found that allowing children to watch video with VR headset due to dressing change is an effective way to distract attention and decrease pain and fear levels.

INTRODUCTION: This study investigated the vaccination status of the children who received inpatient treatment due to measles disease and explored the beliefs and practices of their parents related to the refusal of childhood vaccines.
METHODS: This study is a descriptive research performed at a training and research hospital in eastern Turkey. The study data were collected through the parents of children with measles who were receiving inpatient treatment. In the study, the introductory information form and the State–Trait Anxiety Inventory were used.
RESULTS: The results revealed that 61.8% of the children with measles were not vaccinated against measles. Factors that played a role in the parents' vaccine refusal included family elders' unwillingness, negative media reports, side effects of vaccines, and negative attitudes of health care workers. Parents with poor socioeconomic status, low educational status, and extended family types were found to have significantly higher rates of vaccine refusal. The parents had an average state anxiety score of 60.15 ± 5.73 and an average trait anxiety score of 50.21 ± 3.33.
DISCUSSION AND CONCLUSION: Many factors were found to influence the causes of parents not having their children vaccinated. Community-based training is needed to address the parents’ misconceptions, concerns, and lack of knowledge about vaccination. Renewing the policies on vaccination, establishing standards, and imposing legal sanctions can be effective in reducing vaccine refusal rates.

INTRODUCTION: Home injury risk of children is high because of not being aware of the danger, being sensitive to environmental risks and being curious about finding and learning new things.
The main aims of this study were to determine the frequency of home injuries in children over 3 years of age; to examine the relationship between frequency of home injuries and characteristics of home and the safety measures.


METHODS: The study data were collected through a questionnaire about the sociodemographic characteristics and safety of the home and the “Scale for Identification by Mothers of the Safety Measures Taken to Prevent Home Injuries in Children between 0-6 Ages”.
RESULTS: In this study, it was determined that 26.4% of children had a home injury once in their life, and 7.3% of children had home injury during the last year. The most common home injury was falling and the most frequently injured area is the upper and/or lower extremity. It was determined that the injuries occurred most frequently in the lounge, in summer, on Tuesdays, and in the afternoon.
DISCUSSION AND CONCLUSION: Observation of children is very important in terms of preventing possible injuries. It should not be forgotten that home injuries are preventable. Parents should be educated about home injuries.

Corrosive esophageal injuries are mostly traumatic in childhood. In this case report, the child suffering from nutritional problems due to corrosive esophageal injury and her parents are discussed according to Watson's Theory of Human Caring Model. It is also intended to set an example for using a model in nursing care in the field of pediatric surgery. Since love and compassion are at the center of this model, it was applied comfortably in the department of pediatric surgery. Because in the department of pediatric surgery, love, compassion, and understanding are shown as well as supporting the child and fparents to be operated on. In the case, nursing care was applied over the three basic concepts of the model. The child, mother and father were supported and observed with the caritas processes that started in the preoperative period and continued after the surgery. As a result of the care given and the authentic relationship established according to this model, the satisfaction of the child and her parents increased.

INTRODUCTION: Lower respiratory tract infection (LRTI) is a serious illness especially in under 5 years of age. Hyponatremia is the most common electrolyte abnormality seen in hospitalized children. This study aimed at evaluating the correlation between hyponatremia in children admitted to the pediatric ward, in the setting of acute LRTI in different age groups and to determine the association of hyponatremia with different types of acute LRTI in children.

METHODS: This study included 231 clinically diagnosed children (1 month to 12 years) of acute LRTI. General examination and systemic examination was done. Laboratory investigations included serum electrolyte level (Na+) and radiological investigation included chest X-ray. There were Bronchopneumonia (BPN), lobar pneumonia, wheeze-associated lower respiratory tract infection (WALRI), bronchiolitis, and empyema were characterized in children. Statistical analysis was done using SPSS 16.0 version. P-value <0.05 was considered statistically significant.

RESULTS: Out of 231 cases, hyponatremia was present in 136 cases (58.9%). Mild, moderate, and severe hyponatremia were present in 83.8%, 13.2%, and 2.9% patients, respectively. Most of the patients with BPN had mild hyponatremia (89%). The prevalence of hyponatremia was significantly higher in age 6-10 years (OR=4.29, 95%CI=0.90-20.45, p<0.05), females (OR=0.56, 95%CI=0.32-0.96, p=0.03) and cases of empyema (OR=4.49, 95%CI=1.48-13.60, p=0.008).

DISCUSSION AND CONCLUSION: In conclusion, among children hospitalized with LRTI, an older age (6-10 years), being female, and the presence of empyema are significant risk factors for the development of hyponatremia. In such children, serum electrolytes should be regularly measured to prevent adverse clinical outcomes.