Routine Pediatric Vaccination During Pandemic: Attitudes of Parents.

OBJECTIVE: To examine the effects of a pandemic on children's routine vaccination between 0 months and 24 months and to determine the affecting factors on vaccination during the pandemic. MATERIALS AND METHODS: Our study was conducted between July 17, 2020, and August 1, 2020, among 513 mothers whose children were aged between 0 months and 24 months old. A total of 21 questions were asked to participants' sociodemographic characteristics and attitudes and behaviors towards pediatric vaccines during the pandemic. RESULTS: The rate of vaccination for children was 82.8% (n = 425), unvaccinated children was 3.9% (n = 1). 13.3% (n = 68) of vaccinated children had "delayed" vaccination. 76.2% (n = 391) of the participants stated "they were concerned about COVID-19 infection'' while visiting a healthcare center for vaccination. The 3 most common affecting factors for vaccination; 43.9% (n = 340 ) "pediatric vaccines are vital and must be administered," 23.6% (n = 183) they had vaccine appointment and have been informed "vaccination service would continue as usual," 22.7% (n = 176 ) have been informed that "required precautions have been taken". It was found that reasons for not to be vaccinated in the pandemic; 63.2% (n = 12) "fear of COVID-19," 15.8% (n = 3) "quarantined as the whole family" and 10.5% (n = 2) "vaccine hesitancy." CONCLUSION: Healthcare providers should inform parents that vaccination is vital, and vaccination must always be administered on time during a pandemic. During a pandemic, continuing appointments for vaccination services, calling to inform the parents that required precautions to minimize the spread of infection have already been taken, and alleviating parents' concerns would prevent vaccination rates from decreasing in this period.

Preseptal and Orbital Cellulitis: Analysis of Clinical, Laboratory and Imaging Findings of 123 Pediatric Cases From Turkey.

BACKGROUND: We aimed to compare the clinical and laboratory characteristics and imaging methods of patients diagnosed with preseptal cellulitis and orbital cellulitis in the pediatric age group. METHODS: The study was designed retrospectively, and the medical records of all patients who were hospitalized with the diagnosis of preseptal cellulitis and orbital cellulitis were reviewed. The findings of preseptal cellulitis and orbital cellulitis groups were compared. The risk factors for the development of orbital involvement were analyzed. RESULTS: A total of 123 patients were included, 90.2% with preseptal cellulitis and 9.8% with cellulitis. The male gender ratio was 60.2%, and the mean age was 72 ± 43 months. While all patients had eyelid swelling and redness, 20.3% had fever. Ocular involvement was 51.2% in the right eye and 4.9% in both eyes. The most common predisposing factor was rhinosinusitis (56.1%). Radiologic imaging (computed tomography/magnetic resonance imaging) was performed in 83.7% of the patients. Subperiostal abscess was detected in 7 cases (5.6%) in which three of the cases were managed surgically and four were treated with medically. The levels of C-reactive protein were significantly higher in patients with orbital involvement (P = 0.033), but there was no difference between the presence of fever, leukocyte and platelet values. CONCLUSIONS: Rhinosinusitis was the most common predisposing factor in the development of preseptal cellulitis and orbital cellulitis. Orbital involvement was present in 9.8% of the patients. It was determined that high C-reactive protein value could be used to predict orbital involvement.

Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo / Addressing early childhood development and developmental difficulties in Turkey: a training program for developmental pediatrics units

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23710 niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Introduction. Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. Population and methods. We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. Results. Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. Conclusions. In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed

Addressing early childhood development and developmental difficulties in Turkey: a training programfor developmental pediatrics units. / Abordaje del desarrollo en la primera infancia y sus dificultades en Turquía: programa de capacitación para las unidades de pediatría del desarrollo.

INTRODUCTION: Addressing early childhood development (ECD) and developmental difficulties (DDs) in low and middle-income countries (LMICs) requires applicable and sustainable programs. Seven years after its implementation in 2010, we evaluated the Developmental Pediatrics Unit (DPU) Training Program in pediatric referral centers in Turkey. POPULATION AND METHODS: We applied crosssectional design and quantitative/qualitative methods to assess services, training, research and advocacy of the DPUs. RESULTS: Five of six established DPUs sustained clinical services, training, research, and advocacy. A total of 23,710 children (9085 new cases in 2017) had been referred mainly for perinatal risks and chronic illness, all centers contributed with similar proportions of children. Staff motivation and endurance, hospital administrator support, and client satisfaction facilitated the program; whereas invisibility within the performance based healthcare system was a barrier. CONCLUSIONS: In Turkey and possibly other LMICs, the DPU Training Program is applicable and sustainable if health system barriers are addressed.

Introducción. El abordaje del desarrollo en la primera infancia (DPI) y las dificultades del desarrollo (DD) en los países de ingresos bajos o medios (PIBM) requiere de programas aplicables y sostenibles. Se evaluó el programa de capacitación para las unidades de pediatría del desarrollo (UPD) en los centros de referencia tras siete años. Población y métodos. Diseño transversal con métodos cualicuantitativos para evaluar los servicios, la capacitación, la investigación y la promoción de las UPD. Resultados. Se mantuvieron los servicios clínicos, la capacitación, investigación y promoción. En total, 23 710niños fueron derivados. La motivación y resistencia del personal, el respaldo de los administradores y la satisfacción del paciente facilitaron el programa, aunque la invisibilidad dentro del sistema de salud fue un obstáculo. Conclusiones. En Turquía, y posiblemente otros PIBM, el programa de capacitación para las UPD es aplicable y sostenible si se abordan los obstáculos del sistema de salud.

Concentración de vitamina D en niños sanos de 12 a 24 meses que recibieron suplementación con vitamina D hasta el año en Turquía / Vitamin D levels of 12-24-month-old healthy children in Turkey who received vitamin D supplementation until the age of one year

Introducción. El objetivo fue evaluar la concentración de vitamina D en niños sanos de 12 a 24 meses suplementados con vitamina D (400 UI/día) durante el primer año.Métodos. Estudio descriptivo transversal entre junio de 2015 y mayo de 2016 en Estambul. Se incluyó a niños de 12 a 24 meses en seguimiento en la clínica del niño sano y con suplementación con vitamina D durante el primer año. Se midió calcio, fósforo, fosfatasa alcalina, hormona paratiroidea y 25-hidroxivitamina D [25(OH)D]. Se definió suficiencia (>20 ng/ml), insuficiencia (15-20 ng/ml) y deficiencia (<15 ng/ml) de vitamina D.Resultados. El estudio incluyó 197 niños. El 26,9 % (n = 53) siguió recibiendo suplementación después del año (dosis media: 491 ± 267 UI/día). La concentración media de 25(OH)D fue 38,0 ± 13,9 ng/ml. La ingesta regular de vitamina D en menores de un año (p = 0,008) y la continuación de suplementación después del año (p = 0,042) aumentaron la concentración de 25(OH)D en niños de 12 a 24 meses. Hubo deficiencia en 4,1 % e insuficiencia en 7,1 %. El nivel educativo materno (p = 0,009) y la leche maternizada (p = 0,012) fueron factores protectores contra deficiencia o insuficiencia.Conclusiones. La concentración de 25(OH)D era suficiente en el 88,8 % de los niños de 12 a 24 meses con suplementación con vitamina D (400 UI/día) durante el primer año. Los niños sanos de 12 a 24 meses con una suplementación correcta de vitamina D en el primer año podrían no requerir suplementación.

Introduction. The aim of this study was to evaluate vitamin D levels between 12-24 month-old healthy children supplemented with vitamin D (400 IU/day) during the first year.Methods. Descriptive-sectional study conducted between June 2015, and May 2016, in Istanbul (latitude 41ºN). Children aged 12-24 months followed up by the well-child clinic who had vitamin D supplementation in the first year were included in the study. The levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D [25(OH)D] were measured. Vitamin D status was defined as >20 ng/mL: sufficiency, 15-20 ng/mL: insufficiency and <15 ng/mL: deficiency.Results. The study was completed with 197 children. 26.9 % of children (n = 53) went on receiving supplementation after one year (mean dose 491 ± 267 IU/day). The mean 25(OH)D level was 38.0 ± 13.9 ng/mL. It was found that regular vitamin D intake under one year of age (p = 0.008) and continued support after one year of age (p = 0.042) increased level of 25(OH)D in children aged 12-24 months. Vitamin D deficiency was found in 4.1 % and vitamin D insufficiency in 7.1 %. Mother's education (p = 0.009) and use of formula (p = 0.012) were protective factors in relation to development of vitamin D deficiency or insufficiency.Conclusions. The level of 25(OH)D was sufficient in 88.8 % of children aged 12-24 months receiving 400 IU/day vitamin D supplementation in the first year. Vitamin D supplementation could not be required in healthy children aged 12-24 months who received properly vitamin D supplementation in the first year.

Vitamin D levels of 12-24-month-old healthy children in Turkey who received vitamin D supplementation until the age of one year. / Concentración de vitamina D en niños sanos de 12 a 24 meses que recibieron suplementación con vitamina D hasta el año en Turquía.

INTRODUCTION: The aim of this study was to evaluate vitamin D levels between 12-24 monthold healthy children supplemented with vitamin D (400 IU/day) during the first year. METHODS: Descriptive-sectional study conducted between June 2015, and May 2016, in Istanbul (latitude 41ºN). Children aged 12-24 months followed up by the well-child clinic who had vitamin D supplementation in the first year were included in the study. The levels of calcium, phosphorus, alkaline phosphatase, parathyroid hormone and 25-hydroxyvitamin D [25(OH)D] were measured. Vitamin D status was defined as >20 ng/mL: sufficiency, 15-20 ng/mL: insufficiency and <15 ng/mL: deficiency. RESULTS: The study was completed with 197 children. 26.9 % of children (n = 53) went on receiving supplementation after one year (mean dose 491 ± 267 IU/day). The mean 25(OH)D level was 38.0 ± 13.9 ng/mL. It was found that regular vitamin D intake under one year of age (p = 0.008) and continued support after one year of age (p = 0.042) increased level of 25(OH)D in children aged 12-24 months. Vitamin D deficiency was found in 4.1 % and vitamin D insufficiency in 7.1 %. Mother's education (p = 0.009) and use of formula (p = 0.012) were protective factors in relation to development of vitamin D deficiency or insufficiency. CONCLUSIONS: The level of 25(OH)D was sufficient in 88.8 % of children aged 12-24 months receiving 400 IU/day vitamin D supplementation in the first year. Vitamin D supplementation could not be required in healthy children aged 12- 24 months who received properly vitamin D supplementation in the first year.

Introducción. El objetivo fue evaluar la concentración de vitamina D en niños sanos de 12 a 24 meses suplementados con vitamina D (400 UI/día) durante el primer año. Métodos. Estudio descriptivo transversal entre junio de 2015 y mayo de 2016 en Estambul. Se incluyó a niños de 12 a 24 meses en seguimiento en la clínica del niño sano y con suplementación con vitamina D durante el primer año. Se midió calcio, fósforo, fosfatasa alcalina, hormona paratiroidea y 25-hidroxivitamina D [25(OH)D]. Se definió suficiencia (>20 ng/ml), insuficiencia (15-20 ng/ ml) y deficiencia (<15 ng/ml) de vitamina D. Resultados. El estudio incluyó 197 niños. El 26,9 % (n = 53) siguió recibiendo suplementación después del año (dosis media: 491 ± 267 UI/ día). La concentración media de 25(OH)D fue 38,0 ± 13,9 ng/ml. La ingesta regular de vitamina D en menores de un año (p = 0,008) y la continuación de suplementación después del año (p = 0,042) aumentaron la concentración de 25(OH)D en niños de 12 a 24 meses. Hubo deficiencia en 4,1 % e insuficiencia en 7,1 %. El nivel educativo materno (p = 0,009) y la leche maternizada (p = 0,012) fueron factores protectores contra deficiencia o insuficiencia. Conclusiones. La concentración de 25(OH)D era suficiente en el 88,8 % de los niños de 12 a 24 meses con suplementación con vitamina D (400 UI/día) durante el primer año. Los niños sanos de 12 a 24 meses con una suplementación correcta de vitamina D en el primer año podrían no requerir suplementación.

Recommending immunizations to adolescents in Turkey: a study of the knowledge, attitude, and practices of physicians.

Introduction: The aim of this study was to determine the knowledge, attitudes, and practices of family physicians and pediatricians in regard to adolescent immunization.Methods: The study was conducted from March to May 2017. A total of 665 physicians participated. Participants were asked 31 questions about their personal sociodemographic characteristics and their knowledge, attitudes, and practices around adolescent immunization.Results: The study sample consisted of 348 family physicians (52.3% of the sample) and 317 pediatricians (47.7%). The results showed that 5.4% of family physicians and 10.4% of pediatricians thought that they had enough knowledge about adolescent immunization (p < .01). Overall, 15.8% of family physicians and 12.7% of pediatricians provided adolescents with information about vaccines 'always/most of the time'. A variety of reasons for not providing information about adolescent vaccines was provided, including 'inability to allocate time' (50.2% of family physicians, 69.3% of pediatricians); 'forgetfulness' (34.8% of family physicians, 28.5% of pediatricians); 'lack of knowledge about vaccines' (34.1% of family physicians, 27.4% of pediatricians); and 'no need to immunize adolescents' (15.7% of family physicians, 6.5% of pediatricians) (p < .01). HPV immunization was recommended only to girls by 30.5% of family physicians and 38.8% of pediatricians (p < .01). The percentages of family physicians and pediatricians not recommending that adolescents be immunized with the Tdap vaccine were 53.4% and 42.6%, respectively (p = .016). Meningococcal immunization was not recommended by 20.7% of family physicians and 11.4% of pediatricians (p < .01), and influenza immunization was not recommended by 10.3% of family physicians and 8.2% of pediatricians (p < .01).Conclusion: Family physicians and pediatricians in Turkey have low rates of recommendation of immunization to adolescents. Reasons for not recommending immunization include an inability to allocate time, forgetfulness, and lack of knowledge about vaccines. We conclude that educational programs should be used to improve knowledge of adolescent immunization among family physicians and pediatricians.

Does Food Allergy Require Any Change in Measles-Mumps-Rubella Vaccination?

OBJECTIVES: To determine the allergic reactions that develop after Measles and Measles-Mumps-Rubella (MMR) vaccination, and whether any delay in the timing of vaccination occurs in children with food allergy. METHODS: Children with food allergy who were admitted to the Sisli Hamidiye Etfal Training and Research Hospital Healthy Child Clinic between 1st January 2015 and 30th June 2018 for Measles or MMR vaccination were studied retrospectively. Their age, delayed days of vaccination, the types of allergic food, the results of the specific IgE and skin tests, and any reaction after the vaccination were recorded. RESULTS: During the study period, 159 patients were vaccinated and 170 doses of Measles or MMR vaccine were administered. Children allergic to egg were 50.3%, allergic to egg and milk were 25.8%, and 13.2% had multiple food allergy including egg. The rate of post-vaccination reactions in the patients with food allergy was 1.76%. Minor reaction was observed in three patients and no anaphylaxis was seen in any patient. Delayed days of vaccination in the patients referred by another center were greater than followed-up by present clinic (p < 0.001). CONCLUSIONS: Any serious allergic reaction was not observed in this study. Food allergy does not necessitate modification of routine vaccination. Anaphylaxis may develop in any vaccinated child regardless of whether he/she has food allergy or not. Therefore, vaccines should be administered in a healthcare facility that can treat anaphylaxis.

How should we give vitamin D supplementation? evaluation of the pediatricians' knowledge in Turkey.

BACKGROUND: We aimed to determine the knowledge and attitudes of Turkish pediatricians concerning vitamin D supplement. METHODS: The study was planned cross-sectional to be carried out between April-May 2015 in Turkey. A questionnaire form that determined the participants' opinions and practices concerning vitamin D supplement was completed via face-to-face interview. RESULTS: A total of 107 pediatricians (49.3%) and 110 pediatric residents (50.7%) participated in the study. Of the physicians, 85.2% recommended vitamin D supplement for all infants and children regardless of diet, 13.4% recommended for the infants which are solely breastfed. Vitamin D supplement is recommended at a dose of 400 IU/day by 88.8% of pediatricians and by 90% of pediatric residents. Of the pediatricians and pediatric residents, 72% and 68.2%, respectively commence vitamin D supplement when the newborn is 15 days old. The rates of recommending vitamin D supplement until the age of one and two years were higher among pediatricians (48.6% and 41.1%, respectively) than pediatric residents (40.9% and 32.7%, respectively). The rate of starting vitamin D supplement for fontanelle closure was significantly higher among pediatric residents (15.5%) than pediatricians (3.7%) (p = 0.002). It was determined that the rate of prescribing vitamin D supplement until fontanelle closure was higher among pediatric residents (18.2%) than pediatricians (0.9%). CONCLUSIONS: The present study suggest that the knowledge of pediatricians about recommendation of vitamin D needs to be enhanced by education programs in addition to free vitamin D supplement provided by the Ministry of Health.