INTRODUCTION: Robotic-assisted surgery has demonstrated safety and feasibility in numerous pediatric cases. Nevertheless, there is a scarcity of literature regarding advanced pediatric thoracic robotic surgery (APTRS). The objective of this study was to present our experience with APTRS in 31 patients.
METHODS: From October 2020 to December 2023, a total of 31 APTRS procedures were conducted at our institution. A retrospective analysis was carried out, encompassing demographics, indications for surgery, console time, complication rates, length of hospital stay, and postoperative complications.
RESULTS: 31 patients (M/F: 13/18) underwent robotic-assisted surgery, with procedures including thoracic mass excision in 17 cases, esophageal surgery in 8 cases, and various other pathologies in 5 patients. The average age at the time of surgery was 8.4±5.2 years (10 months-17 years), and the average weight was 29.6±18.4 kg (10-65 kg). The mean console time was 165.6±124.8 minutes, with no instances of conversion. The median length of hospital stay was 3.5 days (1-30 days). Postoperative complications occurred in eight patients (25.8%).
DISCUSSION AND CONCLUSION: Our experience in pediatric robotic thoracic surgery reinforces its suitability even for complex cases. Robotic thoracic surgery appears to offer benefits, particularly in posterior mediastinal mass excision and esophagectomy for corrosive esophageal strictures, when compared to thoracoscopy.

INTRODUCTION: According to delivery room guidelines, optimal position is not specified for stabilisation of baby. This study aimed to defined positions effects on postnatal adaptation parameters and cerebral oxygenation in non-resuscitated neonates.
METHODS: A total of 60 neonates delivered by cesarean section stabilised randomly in the supine, right-side, left-side, or prone positions were enrolled. Apgar scores, the heart rate (HR), arterial oxygen saturation via pulse oximetry (SpO2), and perfusion index (PI) at the 2nd, 5th and 10th minutes were recorded. Cerebral regional oxygen saturation of patients was monitored by using near-infrared spectroscopy.
RESULTS: In the prone position, the 1stminute Apgar score was significantly lower than other groups, but no difference was observed at the 5thminute Apgar scores [1stminApgarprone,p=0.05]. Though there was no statistically significant difference, the prone position had the lowest heart rate in the 2nd minute, while the supine posture had the greatest heart rate in the 5th and 10thminutes. While the groups' SpO2 values were similar, the left-side group's perfusion rates increased at the 5th and 10thminute marks [5th and 10thminPIleft-side,p=0.67,p=0.21,respectively]. Regional cerebral oxygen saturation (rScO2) and cerebral fractional oxygen extraction (cFOE) did not differ significantly between groups when at 5th and 10thminute time intervals. Although right and left rScO2 were found to be high in the first 5 minutes in the prone position, this elevation did not lead to a statistically significant difference, and right and left rScO2 values were found to be similar in all groups at the 10th minute.
DISCUSSION AND CONCLUSION: Adaptation parameters were not affected by position, except for lower 1stminute Apgar in the prone group and higher perfusion indices in the left lateral position. Cerebral perfusion was similar in all groups. The left-side position, which affords a higher PI, may be a good alternative. Studies with larger case series may provide further information.

INTRODUCTION: Overweight and obesity characterized by excess fat accumulation and pose substantial health risks That represent significant public health challenges in the 21st century. Overweight and obese children will be overweight and obese adults of future. Individuals who are obese during childhood are more likely to develop non-communicable chronic diseases at an earlier age. Therefore, this study aims to investigate obesity rate and associated risk factors for obesity of primary school students in one of Izmir’s district.
METHODS: The study focused on primary school students aged five to nine years in the Bayraklı district of İzmir province. A total of 535 children were included in the study. We excluded 128 child that have chronic disease or taking medicine or refusing to get into the study. Dependent variable was obesity and independent variables were sociodemographic and natal features, physical activities, eating habits, screen time, family structure and parental weight. We conducted a questionnaire to parents and measured childrens weight and height thus calculated body mass index. Chi-square analysis, T-test and Mann Whitney U test were used for statistical calculations. Probablity rate was used for obesity and overweight associated factors.
RESULTS: Mean age is 8±1,1 years for 407 children. Overweight rate is%12 and obesity rate is%12. We detected that gender is not associated with obesity or overweight(p=0.486). Birth weight(p<0,05), untidy meal times(p=0,007), eating snacks(p=0,027), high monthly income(p=0,026), maternal(p=0,03) and paternal(p<0.05) obesity or overweight and being an only child(p=0,031) was found associated with overweight and obesity.
DISCUSSION AND CONCLUSION: This study found high rates of overweight and obesity among 5 to 9-year-olds in Bayraklı, similar to developed countries. Factors such as high family income, being an only child, and parental obesity correlate with this trend. The results emphasize the need for educating parents and caregivers about healthy nutrition practices.

INTRODUCTION: The objective of the present research is to compare the nutritional status, weight gain, length of hospital stay, and development of some complications in very low birth-weight (VLBW) infants who received and did not receive olive oil supplementation enterally.
METHODS: This study was a single-blind, randomized controlled trial with 96 VLBW infants (intervention: 48, control: 48) in Neonatal Intensive Care Unit. In this study, infants who met inclusion criteria for the study were divided into two groups by using random numbers table. The same feeding protocol (breast milk and/or formula milk) was applied to the infants in both groups. From the seventh day of life (after starting to take 25-30 ml/kg/day orally), 0.5 cc/30 ml of olive oil was added to the milk at each feeding of the infants in the intervention group.
RESULTS: In comparison with the control group, the infants in the intervention group had a higher daily weight gain rate in the first month and a higher weight on the tenth day, a shorter transition time to full enteral feeding, a higher amount of calories on the day of transition to full enteral feeding, and a shorter length of hospital stay (p<0.05). Furthermore, the need for rectal enema and the prevalence of sepsis, gastrointestinal system intolerance, and bronchopulmonary dysplasia were significantly lower in the intervention group in comparison with the control group (p<0.05).
DISCUSSION AND CONCLUSION: These findings suggest that olive oil supplementation enterally administered to preterm infants can be recommended since it positively affects the development of infants.
Trial registration The study was registered in ClinicalTrials.gov with the following ID: NCT05815849. The study was retrospectively registered by 14 April 2023.

INTRODUCTION: Diabetic ketoacidosis (DKA) is a critical, potentially life-threatening complication of diabetes mellitus in children, characterized by hyperglycemia, acidosis, and ketonemia/ketonuria. Despite known risk factors and mortality rates, few studies have focused on the pediatric population, especially in specific regions under standard treatment protocols. This study investigates the demographic, clinical, and laboratory characteristics of children with DKA, identifies triggering factors and factors affecting DKA severity and complications, and evaluates the outcomes of a standardized treatment protocol in a Turkish Pediatric Intensive Care Unit (PICU).
METHODS: In this single-center retrospective study at G. Hospital's PICU, we included 115 children diagnosed with DKA between 2015 and 2022, following the DKA Treatment Protocol of the Turkish Society of Pediatric Emergency and Intensive Care Medicine and the International Society for Pediatric and Adolescent Diabetes (ISPAD) guidelines. We analyzed patients’ demographic, clinical, and laboratory characteristics, treatment outcomes, and complications using SPSS 25.0.
RESULTS: The sample primarily consisted of female patients and those newly diagnosed with diabetes mellitus (DM), with a median age of 110 months. The mortality rate was low at 0.87%, with one death due to sepsis-induced multiple organ failure. DKA severity (lower GCS, younger age, electrolyte imbalance, acidosis, complications) correlated with longer PICU stay and recovery in children. The findings also highlighted the standardized treatment protocol's effectiveness in managing DKA and reducing complications.
DISCUSSION AND CONCLUSION: The study underscores the importance of early diagnosis, standardized treatment protocols, and comprehensive care in pediatric DKA management. It emphasizes the need for ongoing education and awareness among healthcare providers and caregivers to prevent DKA and its severe outcomes. Further multicenter studies are necessary to extend these findings to the broader pediatric population and refine DKA management strategies.

INTRODUCTION: Cystic fibrosis (CF) is an autosomal recessive disorder. Although it is considered as an epithelial disease due to impaired chloride transport, its pathogenesis remains unclear. CF is classified as a syndrome with congenital defects of phagocyte in recent human inborn errors of immunity phenotypic classification. Neutrophils are the most effective cells in the eradication of bacterial infections such as Pseudomonas aeruginosa. The aim of the present study was to investigate the phagocyte functions in pseudomonas colonized cystic fibrosis patients.
METHODS: A total number of 26 Pseudomonas colonized cystic fibrosis patients and 21 healthy controls (sex and age matched) were included in the study. Absolute neutrophil counts (ANC), immunoglobulin values (Ig), Migratest to evaluate chemotaxis in neutrophils and monocytes, CD11A/CD18/CD15 S (β2 integrin) adhesion molecules, and Phagoburst test for intracellular bacterial killing were analyzed by flow cytometer.
RESULTS: Absolute neutrophil counts (ANC), CD15S expression on neutrophils and IgG, IgA and IgM levels were higher in CF patients than the control group (p<0.01, 0,018). The neutrophils oxidative burst activity and chemotactic ability of CF patients did not differ from that of the controls. Patients with Allergic Bronchopulmonary Aspergillosis (ABPA) and with a mutation of 2183AA>G had significantly lower chemotaxis index than the others (respectively p: 0.01, p: 0.01).
DISCUSSION AND CONCLUSION: Our results from a small group of patients does not support impaired functions such as migration and phagocytosis of neutrophils in patients with CF. Further studies involving more CF patients are needed to make a definitive interpretation.

INTRODUCTION: Malignant chest wall tumors are rare in children. We aim to study management of Ewing family of tumors in chest wall of children.
METHODS: Patients files diagnosed with primitive neuroectodermal tumor and Ewing sarcoma of chest wall in the last 2 decades was retrospectively reviewed.
RESULTS: Total of 15 children with the median age of 10 (8-14) years were included. Symptoms were palpable mass (n=6), chest pain (n=4), B symptoms (n=2), cough (n=2) and abdominal pain. History revealed delayed diagnosis in 1/3 of patients due to misinterpretation of symptoms. All children except one had tru-cut biopsy and upfront chemotherapy. Median greatest diameter of mass at diagnosis was 100 (67-148) mm and 51 (39-100) mm at the preoperative imaging after chemotherapy. Pleural effusion (n=8), costal destruction (n=9), extension to neural foramina (n=3), pulmonary or diaphragmatic nodule (n=5) and distant bone metastasis (n=4) was present at diagnosis. More than one surgery was performed in 9 (60%) children to remove primary tumor and metastases. Costal excision (n=11), diaphragmatic resection (n=6) and chest wall reconstruction with graft material were done in (n=8) patients. All cases had radiotherapy postoperatively. Mortality occurred in 9 (60%) patients due to local recurrences or metastases. Only 3 children reached 5-year survival and cured. Other 3 patients completed first line oncologic treatments and under surveillance without treatment.
DISCUSSION AND CONCLUSION: Ewing family of tumors in chest wall are aggressive tumors with poor prognosis despite multimodality treatment. Surgeons dealing with these patients should be familiar with complex chest wall reconstruction techniques.