Neurological and Visual Outcomes in Infants and Toddlers Following Therapeutic Hypothermia for Neonatal Hypoxic-Ischemic Encephalopathy.

BACKGROUND: The majority of studies have investigated neurodevelopmental outcomes, whereas visual impairment is less explored in children with a history of neonatal (hypoxic-ischemic) encephalopathy. Our aim was to perform a detailed neurological and visual assessment and also to investigate the presence of cerebral visual impairment in infants and toddlers with neonatal encephalopathy. METHODS: Thirty participants with a history of neonatal encephalopathy, who had been hospitalized for therapeutic hypothermia, underwent a detailed neurological examination at age five to 36 months. Age-matched, 30 healthy children were also enrolled as a control group. All children in the study and control groups received neurological and a comprehensive ophthalmologic examination, including visual field and visual acuity. Presence of cerebral visual impairment was also evaluated clinically. RESULTS: Rates of cerebral palsy, severe motor impairment, cognitive impairment, epilepsy, and cerebral visual impairment were found to be 20%, 10%, 15.3%, 10%, and 20%, respectively. When compared with healthy controls, oculomotor functions, pupillary light response, refractive parameters, anterior/posterior segment examinations, ocular visual impairment rates, and last, visual acuities were found similar. However, we found a statistically significant increase in visual field defects in our study group. CONCLUSIONS: It could be better to perform a comprehensive ophthalmologic examination including visual field, visual acuity, and oculomotor functions by a pediatric ophthalmologist to accurately diagnose neurovisual deficits in infants following therapeutic hypothermia. Early identification and rehabilitation of the visual deficits might improve the neurodevelopment in these children.

Obesogenic Environment in Childhood: Implications of High Socioeconomic Level in a Developing Country.

OBJECTIVE: Today, obesity in childhood is considered as an important health problem, especially in developed countries. This study aims to determine the prevalence of obesity in children and to reveal the relationship between television watching habit, computer use and socioeconomic status in children. METHOD: A cross-sectional study was performed in 11 public schools selected with random sampling in Istanbul. A total of 1479 children (767 males (51.9%)) were included in the study. Their ages ranged from 10-15, and the mean age was 11.95±1.36 years for girls and 12.06±1.39 years for boys. Demographic characteristics and factors affecting obesity were inquired with the structured questionnaire form.The height, and body weights of the students were measured, and their body mass indexes were calculated. Those with a BMI above the 95th percentile were considered obese, and those between the 85th and 95th percentiles were considered as overweight. RESULTS: In the study group, the obesity rate was calculated as 5.3%, and the mild obesity rate as 14.9 percent. The total prevalence of overweight and obese children was 20.2%. The frequency of obesity in the high socioeconomic level group was significantly higher than low one (p<0.01). The average daily screen time was 3.74±1.58 hours. The obesity risk was found to increase three times when this period exceeded five hours. In the logistic regression analysis, while high socioeconomic level was found as the main determinant among the risk factors for obesity, the effects of daily screen time were found to be marginally significant (p<0.045). CONCLUSION: The lifestyle of the families with high socioeconomic status is the main determinant of obesity in adolescents. Nutrition with higher calorie foods, more frequent media use and a more sedentary life brought about is an obesogenic environment created by a high socioeconomic status. Environmental risk factors for obesity should be assessed.

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely.

BACKGROUND: Data about percutaneous endoscopic gastrostomy (PEG) insertions in small infants are limited, and most studies include older children. We aimed to evaluate the safety of PEG placement in infants weighing ≤5 kg together with their follow-up results. METHODS: A retrospective evaluation was made of records between January 2005 and December 2019. RESULTS: A total of 43 infants were ≤5 kg at the time of PEG insertion. The mean age was 5 ± 3 (19 days-16 months) months and the mean weight was 4.3 ± 0.6 (2.7-5.0) kg. The primary diagnoses were neurological disorders in 25, metabolic disorders in nine, cleft palates in four, muscular disorders in four, and a cardiac disorder in one. All procedures were completed successfully. A self-resolving pneumoperitoneum developed in one (2.3%). The tube was extruded in six (14%) patients postoperatively which required suture-approximation of the skin and subcuticular tissues. The tube was removed in four (9%) patients with achievement of oral feeds on the long-term. Eighteen (42%) died of primary diseases. The tubes were in situ for a median of 12.4 (17 days-73 months) months in these patients. A total of 20 (46.5%) patients are currently being followed up and their tubes are in situ for a median of 50.3 (4.7 month-9.8 years) months. CONCLUSIONS: Percutaneous endoscopic gastrostomy placement is safe in small infants with associated morbidities. Complications related to the procedure are within acceptable limits. The accidental extrusion of the tube was a special consideration in this patient group. The overall mortality was high because of underlying primary diseases.