Knowledge, Attitudes and Practices of Pediatricians About COVID-19 Vaccination to Children.

Objectives: Achieving high vaccination rates is very important in the prevention of the coronavirus disease 2019 (COVID-19) as in other infectious diseases. This study aimed to evaluate pediatricians' knowledge, attitudes and behaviours about COVID-19 vaccination of children. Methods: Our single-center, descriptive, cross-sectional, prospective study was conducted between September 20, 2022 and November 30, 2022. The sample consisted of 350 physicians who agreed to fill out the questionnaire voluntarily. Participants were asked 21 questions about their sociodemographic data, knowledge about COVID-19 vaccination of children, attitudes and behaviours via Google Forms. Results: A total of 350 pediatricians, 72.6% of whom were women, participated in our study. 51.4% of the participants were working in a Training and Research Hospital, and 99.1% had received COVID-19 vaccination themselves. While 65.7% (n=230) of pediatricians recommended COVID-19 vaccination for all children, 27.7% (n=97) recommended it only for children in the risk group, and 6.6% (n=23) did not recommend COVID-19 vaccination for children. The most common reasons why pediatricians did not recommend the vaccine to all children were; 56.7% lack of sufficient clinical research on vaccination in children, 50% concerns about the long-term effects of the vaccine, 27.5% vaccine-related side effects. The most risk groups for which participants recommended vaccination were asthma (chronic lung disease) 84.6%, diabetes mellitus 72%, and immunodeficiency 69.7%. 68.9% of pediatricians knew that COVID-19 vaccine was used for children aged 12 years and older in Türkiye, and 60.9% thought that COVID-19 vaccine was safe for children. Those who thought that COVID-19 vaccine was safe for children were more likely to recommend the vaccine to children (p<0.001). When the answers given to the knowledge questions were analyzed, it was found that the knowledge level of those who did not recommend vaccination to children was lower than the others (p<0.001). Conclusion: In the present study, pediatricians mostly recommend COVID-19 vaccine to children. The vaccine safety and the level of knowledge about COVID-19 vaccine are effective factors in recommending the vaccine. Therefore, we conclude that trainings to be organized for pediatricians about COVID-19 vaccine will increase the rate of recommending COVID-19 vaccine to children.

Pediatricians` attitudes, practices, and perceived barriers to school readiness.

BACKGROUND: School readiness (SR) has been adopted by the American Academy of Pediatrics (AAP) as a component of health supervision, but the medical community`s role is unknown. We evaluated the pediatricians` attitudes, practices, and perceived barriers to SR. METHODS: This multicenter, cross-sectional descriptive study was performed among 787 general pediatricians, pediatric residents, subspecialists, and subspecialty fellows. A 41-item survey was administered. RESULTS: Forty-nine point two percent of the pediatricians defined SR as a multidimensional issue, as outlined by the AAP, whereas 50.8% defined it as the child`s set of skills or passing the SR tests. Three-quarters of pediatricians believed that SR assessment tests are necessary before starting school, and children who do not appear ready should wait a year. To promote SR, the rates of usually fostering at least four of the five `Rs` (reading, rhyming, routines, rewarding, relationships) and integrating developmental surveillance into daily practice were 37.8% and 23.8%, respectively. Only 2.2% of pediatricians usually inquired about eight adverse childhood experiences (ACEs), and 68.9% did not usually ask about any. Usually fostering at least four of the five `Rs` was associated with usually integrating developmental surveillance (p < 0.001), usually inquiring about each ACE (p < 0.001), and being perceived as responsible for promoting SR (p < 0.01). Training on SR during pediatric residency was 2.7%. Time constraints and insufficient knowledge were the most common barriers. CONCLUSIONS: Pediatricians were not familiar with the concept of SR and had some misconceptions. There is a need for additional training regarding pediatricians` roles in promoting SR along with addressing multiple, modifiable barriers within the health system. < strong > Supplementary: < a href="https://www.turkishjournalpediatrics.org/uploads/2573-supplementary.pdf" target=`_blank` > Supplementary Appendix < /a > < /strong >.

Serum spexin levels are not associated with size at birth but are associated with metabolic syndrome components in prepubertal children born at term.

BACKGROUND: Babies born small for gestational age (SGA) are at risk of obesity and metabolic syndrome (MetS). Spexin (SPX) is a novel peptide implicated in food intake and obesity. Spexin levels are lower in obese subjects. This study investigated the potential association of SPX and some obesity related peptides such as leptin and active ghrelin with size at birth and MetS components in prepubertal children born term and either SGA or appropriate for GA (AGA). Secondary aim was to identify whether any of the investigated peptides were associated with MetS components. METHODS: We conducted a cross-sectional study of 37 consecutive (median age: 5.6 y) SGA- and 50 (median age: 5.9 y) AGA-born children. Clinical evaluations were performed using standard methods. Several biochemical variables (SPX, total leptin, and active ghrelin levels) were analyzed. Age-dependent cut-off values were used to define MetS components, including excess adiposity, hypertension, insulin resistance, and dyslipidemia. The associations between the assessed clinical and laboratory variables and MetS components were investigated. RESULTS: Children born SGA had higher frequencies of MetS components than AGA-born peers (p < 0.01). None of the investigated peptides were different between children born SGA and AGA after correcting for body mass index (p > 0.05 for all). Serum SPX levels were lower in children with at least one metS component than those without MetS components (p = 0.018). CONCLUSIONS: Size at birth had no association with serum SPX. Serum SPX levels are decreased in prepubertal children with MetS components.

Acute rheumatic fever: 10-year single-center experience: clinical and laboratory findings, with subclinical carditis and treatment complications.

BACKGROUND: Acute rheumatic fever in childhood continues to cause serious morbidity despite all developments. The objective of this study was to evaluate the clinical and laboratory characteristics of patients with acute rheumatic fever and to determine the frequency of subclinical carditis and the side effects of the drugs used in the treatment. METHODS: The data of patients hospitalised between 2008 and 2018 with the diagnosis of acute rheumatic fever were included in the study. The relationship of gender and age with the frequency of major symptoms and the distribution of the drugs used in the treatment and their side effects were evaluated. RESULTS: Medical records of 102 patients with complete data were reviewed. 56.9% of the patients were male and the mean age was 10.7 ± 1.9 years. The most common distribution of complaints found were arthritis (51%), arthralgia (25.5%) and fever (16.7%). 10.8% of all patients (n = 11) were diagnosed subclinical carditis via echocardiographic evaluation. The frequency of carditis was higher in female patients with a borderline statistical significance (p = 0.05). However, there was no statistically significant difference between gender and arthritis (p = 0.22) and carditis (p > 0.05). Anti-congestive therapy was required in 22% and inotropic treatment was needed in 6.1% cases. Toxic hepatitis developed in four cases during the acetylsalicylic acid treatment. CONCLUSIONS: In a 10-year period, detection of subclinical carditis in 10.8% cases supported that echocardiography should be performed as a standard method for the diagnosis of acute rheumatic fever. Patients should be followed closely in terms of hepatic toxicity due to acetylsalicylic acid used in the treatment.

COVID-19 Management in Newborn Babies in the Light of Recent Data: Breastfeeding, Rooming-in and Clinical Symptoms.

COVID-19 infection proceeds to spread rapidly, it has affected approximately 22 million people and resulted in 770.000 deaths worldwide so far (18 August 2020). The effect of COVID-19 infection on newborn babies still remains unclear. There is limited data regarding the effect of the virus in fetal life and among neonates after birth. Due to insufficient data, an ideal management method or treatment and follow-up guideline for disease in newborn babies cannot be established. In the recent three studies with the highest number of cases, it is reported that mothers who had COVID-19 infection in the last trimester, can breastfeed their babies if they comply with the appropriate hygiene and transmission prevention rules. It is also reported that pregnant women who got infected during pregnancy, have higher rates of maternal mortality, preterm birth frequency and cesarean delivery. Moreover it is asserted that vertical transmisson of the virus is possible and the babies who have community-acquired COVID-19 infection after birth often have symptoms of fever, hypoxemia, cough, tachypnea, less frequently feeding difficulty, retraction, ral, nasal congestion and exanthema. Topics as; its transmission via vaginal secretions during vaginal delivery, presence of the virus in breast milk and whether it has a teratogenic effect in intrauterine period, have not been fully explained. In this study, it is aimed to review the studies on newborn babies with COVID-19 infection and to compile the epidemic data, clinical findings, diagnosis and current information recommended for treatment. Although there is a limited number of published data on babies of mothers who had COVID-19 infection in the last period of pregnancy and babies who had infection in the neonatal period, the effects of the virus on the fetus in the early period of pregnancy and the long-term problems of newborn babies remain unknown.

Midterm Neuromotor Development Results of Preterm Babies less than 34 Weeks Gestational Age.

OBJECTIVES: This study aimed to evaluate the neuromotor development of premature babies and to determine the risk factors affecting neuromotor development in the middle time (3 years). METHODS: All babies with ≤34 weeks gestational age and born between 2011-2014 and hospitalized in our neonatal clinic were included in this study. Prenatal, perinatal and postnatal features of the babies were recorded. Consent was obtained from the families who had an outpatient follow-up and agreed to participate in this study. Neurological examination and Denver II Developmental Screening Test (DDST-II) were applied to babies and their results were recorded. Factors affecting neurodevelopment were evaluated. RESULTS: Complete data for 96 of the study infant were obtained. Fifty (52.1%) of the cases were female. The mean birth weight was 1542±518 grams. The mean corrected age was 20.9±10.7 months at the time of the examination. It was found cerebral palsy in 11 babies (11.5%) with the neurological examination and developmental retardation in 15 babies (15.6%) with DDST-II. Low birth weight, a gestational period of 25-26 weeks, Apgar score at 5th minute <7 were found to be the main risk factors for cerebral palsy and abnormal DDST-II result (p<0.05). In babies with abnormal neurological examination, the frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage were found to be high (p<0.05), and in babies with abnormal DDST-II results the frequency of respiratory distress syndrome, bronchopulmonary dysplasia and sepsis were found to be high (p<0.05). CONCLUSION: In our study, abnormal neurological examination rate was found 11.5% in preterm infants with gestational age ≤34 weeks, and the rate of abnormal DDST-II was found 15.6%. The main factors affecting neuromotor development were gestational week, birth weight and 5th minute Apgar score. The frequency of bronchopulmonary dysplasia, sepsis and intraventricular hemorrhage in babies with abnormal neurological examination, and the frequency of respiratory distress, bronchopulmonary dysplasia and sepsis were found to be high in babies with abnormal DDST-II.

Neuromotor Development Evaluation of Preterm Babies Less than 34 Weeks of Gestation with Bayley III at 18-24 Months.

OBJECTIVES: To assess and evaluate the risk factors affecting the neuromotor development of preterm babies at corrected age 18 to 24 months. METHODS: Preterm babies ≤ 34 weeks of gestational age (GA) who were born in our hospital between 2011 and 2014 were prospectively included in the study. Prenatal, perinatal, and postnatal features of the babies were recorded. Bayley Scales of Infants and Toddler Development, Third Edition (Bayley-III), was applied at corrected age 18 to 24 months. RESULTS: All data of 96 babies were obtained during the study, mean birth weight was 1542 ± 518 g, and mean corrected age was 20.9 ± 4.7 months. Cerebral palsy was found in 11 babies (11.5%). According to Bayley III scores, 13.5% cognitive delay, 19.8% language delay, and 33.3% motor delay rations were detected. A positive correlation was found between GA and motor composite scores (p = 0.011). The mean motor composite score was lower in babies with the Apgar score less than 7 at 1st and 5th minutes (p = 0.007 and p = 0.003) and applied resuscitation in the delivery room (p = 0.033). The mean language composite score was found to be higher in babies with antenatal steroid administration (p = 0.003). A negative correlation was found between the motor composite score and the oxygen treatment time and mechanical ventilation support time (p = 0.001 and p = 0.007). CONCLUSION: In preterm babies less than 34 weeks, the birth weight, GA, Apgar score, oxygen treatment time, mechanical ventilation support time, and resuscitation in a delivery room were determined to affect the Bayley III motor score. Language development was found better in babies with antenatal steroid administration.

Evaluation of retinal neurovascular structures by optical coherence tomography and optical coherence tomography angiography in children and adolescents with type 1 diabetes mellitus without clinical sign of diabetic retinopathy.

BACKGROUND: The aim of the study was to investigate whether retinal neurovascular structural impairment in children and adolescents with type 1 diabetes mellitus (T1D) without clinical signs of diabetic retinopathy (DR) could be detected early via optical coherence tomography (OCT) and OCT angiography (OCTA). METHODS: In the current prospective, cross-sectional, observational clinical study children and adolescents with T1D without DR were evaluated between December 2018 and May 2019. Retinal neurovascular structures in the macular and optic disc regions were examined in detail and quantitatively assessed using OCT and OCTA. Data from subjects with T1D were compared with data from healthy controls. Whether retinal neurovascular structural changes were significantly associated with puberty stage, diabetes duration, and HbA1c level was also investigated. RESULTS: The T1D group included 110 eyes and the control group included 84 eyes. In the T1D group the mean inside disc vessel density (VD) was significantly lower than that of the control group (p < 0.001), as was the mean superior temporal disc VD (p < 0.043). Puberty stage was significantly associated with retinal thickness, parafoveal superficial capillary plexus VD, and peripapillary retinal nerve fiber layer thickness (p < 0.05). Diabetes duration and HbA1c level was significantly correlated with retinal layer thickness, foveal avascular zone diameter, and superficial and deep capillary plexus VDs. CONCLUSION: In children and adolescents with T1D without clinical signs of DR, the VD of the disc region is affected earlier than the macular region. In these patients, early neurovascular impairment can be detected non-invasively via OCT and OCTA.

Maternal Characteristics and Obstetric and Neonatal Outcomes of Singleton Pregnancies Among Adolescents.

BACKGROUND Adolescent pregnancy remains a global public health issue with serious implications on maternal and child health, particularly in developing countries The aim of this study was to investigate maternal characteristics and obstetric and neonatal outcomes of singleton pregnancies among adolescents. MATERIAL AND METHODS A total of 241 adolescent women who gave birth to singletons between January 2015 and December 2015 at our hospital were included in this descriptive cross-sectional study. Data on maternal sociodemographic and obstetric characteristics as well as neonatal outcome were recorded. RESULTS Primary school education (66.0%), lack of regular antenatal care (69.7%), religious (36.7%) and consanguineous (37.0) marriage, Southeastern Anatolia hometown (34.9%) and Eastern Anatolia hometown (21.2%) were noted in most of the adolescent pregnancies, while 95% were desired pregnancies within marriage. Pregnancy complications were noted in 19.5% (preeclampsia in 5.8%) and cesarean delivery was performed in 44.8% of adolescent pregnancies. Preterm delivery rate was 27.0% (20.3% were in >34 weeks). Overall, 13.3% of neonates were admitted to neonatal intensive care unit (NICU) in the postpartum period (prematurity in 28.1%), while 25.3% were re-admitted to NICU admission in the post-discharge 1-month (hyperbilirubinemia in 55.7%). Adolescent pregnancies were associated considerably high rates of fetal distress at birth (28.7%), preterm delivery (26.9%), and re-admission to NICU after hospital discharge (25.3%). CONCLUSIONS In conclusion, our findings indicate that along with considerably high rates of poor antenatal care, maternal anemia and cesarean delivery, adolescent pregnancies were also associated with high rates for fetal distress at birth, preterm delivery, and NICU re-admission within post-discharge 1-month.

Prevalence of Metabolic Syndrome in Middle School Children and Evaluation of Components of Metabolic Syndrome.

OBJECTIVES: This study was designed to determine the prevalence of metabolic syndrome (MS) in Turkish children and to examine the relationship between MS components in this age group. METHODS: A total of 395 students in Istanbul aged 10 to 14 years in the 2004-2005 school year were enrolled in the study. Body weight, height, waist circumference, hip circumference, and systolic-diastolic blood pressure were measured. Of the total, 353 provided blood samples for analysis of fasting glucose level, basal insulin, total cholesterol, triglyceride, high-density lipoprotein (HDL), low-density lipoprotein (LDL), and very-low-density lipoprotein (VLDL) levels. Modified World Health Organization criteria were used for the diagnosis of MS. RESULTS: In this study, 44.5% of the children were female and 55.5% were male. The mean body mass index (BMI) was 20.57±3.48 kg/m², 10.4% (n=41) were overweight, and 12.7% (n=50) were obese. MS was diagnosed in 0.85% of the entire study group and in 6% of the obese children. There was a positive correlation between BMI and waist circumference (p<0.001), waist/hip ratio (p<0.001), systolic blood pressure (p<0.001), diastolic blood pressure (p<0.001), basal insulin level (p<0.001), homeostasis model assessment of insulin resistance (p<0.001), triglyceride value (p<0.001), total cholesterol level (p<0.05), LDL (p<0.001), and VLDL level (p<0.001), and a negative correlation with HDL level (p<0.001). CONCLUSION: The study results confirmed that MS is present in children and not limited to adults, and this is an important health problem. The prevalence of MS is more common in obese children. Therefore, early diagnosis of obese children and examination of cardiovascular risk factors and metabolic syndrome criteria is very important.