To investigate the applicability of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease in pediatric patients in our country.This study included patients...To investigate the applicability of the European Society for Pediatric Gastroenterology, Hepatology, and Nutrition diagnostic criteria for celiac disease in pediatric patients in our country.This study included patients aged 1-18 years who have high tissue transglutaminase IgA antibody levels. The cut-off tissue transglutaminase IgA antibody value was expressed as times the upper limit of normality. Endomysial antibody IgA was analyzed with monkey liver tissue and the titer of the antibodies was measured. Based on the modified Marsh-Oberhuber classification, patients classified as stage III were considered to have celiac disease.Of the 416 patients, 290 (69.7%) patients were diagnosed with celiac disease. The sensitivity, specificity, positive predictive value, and negative predictive value of tissue transglutaminase IgA antibody≥10 upper limit of normality alone in the diagnosis of celiac disease were 86.5, 74.6, 88.7, and 70.7%, respectively. The tissue transglutaminase IgA antibody titer was revealed to be a significant predictor of discriminating celiac diseases from non-celiac diseases at a cut-off value of x10ULN (area under the curve=0.822, <0.05, and 95%, confidence interval: 0.772-0.873) with a sensitivity and specificity of 86.5% and 74.6%, respectively. The sensitivity and specificity of tissue transglutaminase IgA antibody≥10ULN and endomysial antibody IgA positivity were 79.1 and 64.3%, respectively.Although European Society for Pediatric Gastroenterology, Hepatology, and Nutrition posits that most of pediatric patients with celiac disease can be diagnosed without endoscopy, it seems highly difficult to apply these criteria in our country.
Pulse oximetry screening (POS) has been shown to be an effective, noninvasive screening method that can detect 50-70% of previously undiagnosed critical congenital heart diseases (CCHD). In this study, we sought to under...Pulse oximetry screening (POS) has been shown to be an effective, noninvasive screening method that can detect 50-70% of previously undiagnosed critical congenital heart diseases (CCHD). In this study, we sought to understand the role of POS in the detection of non-CCHD neonatal morbidities such as neonatal sepsis and polystemia. This cohort study was conducted in a central maternity hospital. Patients who failed POS were first evaluated by echocardiography, and then, other neonatal morbidities such as sepsis, polystemia and congenital pneumonia were evaluated. Overall, 29,840 infants had documented POS results in 34,806 live-born patients screened. A total of 301 (1%) infants had a positive test. A total of 23 (1.1%) patients had CCHD and significant congenital heart disease. Of those who failed pulse oximetry testing, noncardiac causes such as sepsis were observed in 101 (33.7%), congenital pneumonia in 16 (5.3%), polystemia in 32 (10.6%) and transient tachypnoea of the newborn in 52 (17.3%). POS can be a useful tool to aid clinical assessment in the diagnosis of significant non-cardiac morbidities such as sepsis, congenital pneumonia and polycythaemia in the newborn.
The number of premature births is rising globally, and medical needs are often complex. The transition from pediatric to adult healthcare is a critical phase that, without adequate support, may lead to difficulties. Espe...The number of premature births is rising globally, and medical needs are often complex. The transition from pediatric to adult healthcare is a critical phase that, without adequate support, may lead to difficulties. Especially extremely preterm infants face long-term health challenges requiring specialized care. This retrospective study examined how mothers perceive the transition process of their preterm and term-born children. We analyzed whether perinatal factors such as low gestational age (GA) influence transition experiences and adult healthcare. Additionally, healthcare utilization and comorbidities were compared between preterm and term-born adults. The Gutenberg Prematurity Study (GPS) retrospectively analyzed 310 preterm and 296 term-born adults (aged 18-52), categorized into GA groups (≥37, 33-36, 29-32,≤28 weeks). Multivariable logistic regression assessed associations between perinatal factors, transition ratings, and healthcare utilization. Mothers of children born at≤28 and 29-32 weeks GA rated the transition to adult healthcare more negatively than mothers of term-born children. In addition, care five years after transition was also rated significantly worse for the≤28 weeks group. Extremely preterm adults had more GP visits and more comorbidities, such as hypertension. Transition programs should be tailored to the needs of preterm individuals, especially those born extremely preterm, to improve long-term care and address comorbidities early.
Twenty years after the first robotic pediatric surgery, robotic surgery still plays a limited role in pediatric surgery. A better understanding of the current application of robotic pediatric surgery, could be valuable f...Twenty years after the first robotic pediatric surgery, robotic surgery still plays a limited role in pediatric surgery. A better understanding of the current application of robotic pediatric surgery, could be valuable for the further development and implementation of minimally invasive and robotic pediatric surgery. The aim of this study was to analyze the nationwide distribution of robotic surgery in children and its acceptance among pediatric surgeons. The national database of administrative claims data from the Institute for the Remuneration System in Hospitals (InEK) and the quality reports in Germany were analyzed to determine the number of pediatric patients who underwent surgery using a robotic system and the number of pediatric surgical departments having access to this system. Additionally, an electronic questionnaire was developed for a nationwide cross-sectional survey within the DGKCH. From 2019 to 2024, the number of robot-assisted surgeries in children increased from 105 cases in 2019 to 376 cases in 2024. The majority of procedures are urological surgeries. The online survey was completed by 39 pediatric surgeons between December 2022 and March 2023. The survey identified and mapped differences in the use of robotic systems, the patient population treated, and the assessment of outcomes, complication rates, and patient satisfaction. This study is the first to document the varying views on pediatric robotic surgery in Germany.
This study examined serum uric acid levels in children with migraine compared to healthy controls, and explored links with gender and attack frequency.A retrospective analysis was conducted on pediatric migraine patients...This study examined serum uric acid levels in children with migraine compared to healthy controls, and explored links with gender and attack frequency.A retrospective analysis was conducted on pediatric migraine patients and controls seen between August 2019 and January 2025. Uric acid, Hb, Hct, iron, and TIBC levels were recorded.No significant difference in uric acid levels was found between groups or by attack frequency. However, male patients had higher uric acid levels than females (p=0.046). Other blood parameters were similar.Uric acid is not a reliable standalone marker for pediatric migraine, though gender differences suggest potential hormonal influences. Further research is needed.
BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is one of the most common viral hemorrhagic fevers. After entering the body, the virus replicates in regional lymph nodes and tissues, then spreads via lymph and monocyt...BACKGROUND: Crimean-Congo hemorrhagic fever (CCHF) is one of the most common viral hemorrhagic fevers. After entering the body, the virus replicates in regional lymph nodes and tissues, then spreads via lymph and monocytes, causing systemic inflammatory response syndrome, septic shock, and disseminated intravascular coagulation (DIC). METHODS: Sociodemographic, clinical, and hematological data of children (0-18 years) diagnosed with CCHF at the Pediatric Infectious Diseases Clinic of Erzurum Training and Research Hospital between September 2018 and June 2020 were analyzed. RESULTS: Of 19 patients, 14 were male and 5 female, with a mean age of 14.2±3.2 years. Common presenting symptoms included fever, fatigue, and myalgia. Initial lab results showed a white blood cell count of 3012±1559/mm³, platelet count of 102.105 ± 50.350/mm³, and PT of 17.3±3.5 seconds. Two patients with persistent fever (>5 days) developed CCHF-associated hemophagocytic syndrome and received intravenous immunoglobulin in addition to ribavirin. Eleven patients with severe thrombocytopenia and/or bleeding received apheresis platelet concentrates; six received fresh frozen plasma. CONCLUSION: CCHF should be considered in patients-regardless of tick exposure-presenting with sudden fever, fatigue, leukopenia, thrombocytopenia, abnormal coagulation, and elevated liver enzymes.
The purpose of this study is to compare serum magnesium levels between migraine patients and the control group and to examine the relationship between attack frequency and duration and average serum magnesium level.Patie...The purpose of this study is to compare serum magnesium levels between migraine patients and the control group and to examine the relationship between attack frequency and duration and average serum magnesium level.Patients diagnosed with migraine were included in the study retrospectively. Patients diagnosed with migraine were included as the study group and healthy children presenting to the pediatric neurology clinic in the same period as the control group. The demographic, clinical and laboratory characteristics were recorded.Sixty-one pediatric migraine patients and 50 healthy controls were included in the study. The mean age of the migraine patients was 13.39±3.47 years. Mean magnesium levels were 2.02±0.12 (1.7-2.3) mg/dl in the patient group and 2.05±0.13 (1.8-2.5) mg/dl in the control group, and the difference was not statistically significant (p=0.17). No significant association was determined between attack frequencies and durations and magnesium (p=0.89 and p=0.061, respectively).The role of magnesium among the triggering factors in the etiopathogenesis and in the treatment of migraine is well-established. However, very few previous studies have reported magnesium levels in pediatric migraine patients, and the present research determined no significant difference in serum levels between patients with migraine and a control group.
In 2018, we shortened the fasting time in our clinic for clear fluid to 1 h. Since 2021 'drinking until call to the operating theatre' applies. This quality assurance study investigates whether this regulation has furthe...In 2018, we shortened the fasting time in our clinic for clear fluid to 1 h. Since 2021 'drinking until call to the operating theatre' applies. This quality assurance study investigates whether this regulation has further shortened the fasting times and which factors influence its implementation.In this prospective observational study, a two-part anonymous questionnaire from the attending anaesthetist and the parents was completed.A total of 204 children were included in the study. The fasting time for clear fluid (median [IQR] (min-max)) was 2 [1-4.6] (0.33-22) hours and was shorter than 3 [2-7.8] (0.5-17) hours in the pre-transition period. More than 50% of the children had access to clear fluid directly at the bedside or freely available on the ward. The children's drinking behaviour showed that 54% of the children drank on their own and only 4% of the children complained of thirst. When comparing the wards there were differences with regard to the fasting time for clear fluid. There were no differences in the fasting times depending on the operating theatre position. The length of time between the informed consent consultation and anaesthesia or language barriers had a negative influence on adherence to the fasting rules.Two years after the introduction of the 'sip til send' rule there was a significant reduction in fasting times. Fasting times did not differ between operating theatre position.
Renal artery involvement (RAI) can cause renovascular hypertension and/or organ dysfunction in Takayasu arteritis (TA). The literature includes few data regarding renal involvement in pediatric-onset TA patients. We aime...Renal artery involvement (RAI) can cause renovascular hypertension and/or organ dysfunction in Takayasu arteritis (TA). The literature includes few data regarding renal involvement in pediatric-onset TA patients. We aimed to describe the renal characteristics, management, and outcomes in TA patients with RAI.We retrospectively reviewed the clinical, laboratory, and radiological findings, treatments, and outcomes in TA patients with RAI, diagnosed between 2008 and 2022.Nine of 20 pediatric-onset TA patients had RAI; their median age was 14.7 (13.1-15.5) years. Five patients had bilateral RAI. Six patients presented with hypertension, 2 of which as hypertensive emergency. Five patients had proteinuria (median urine protein/ creatinine ratio: 1.75 mg/mg), one patient had microscopic hematuria. Kidney size asymmetry was detected in 5 patients. The median duration of follow-up was 35 months (22-45). All patients received steroids, and TNF-α and/or IL-6 inhibitors. One patient underwent percutaneous transluminal angioplasty (PTA), 2 patients underwent thoraco-abdominal aortic and aortorenal bypass. At last visit there was no progression in renovascular findings in 75% of the patients, and all patients had an eGFR>60 ml/min/1.73m.Hypertension, proteinuria, and kidney size asymmetry can accompany a substantial number of pediatric-onset TA patients with RAI. Prompt initiation of treatment, including PTA or surgery, result in good mid-term renal outcomes.
Functional dyspepsia (FD) is common in children and refers to discomfort in the epigastric/duodenal region, which cannot be explained by structural or biochemical abnormalities. Since the pathophysiology is still not ful...Functional dyspepsia (FD) is common in children and refers to discomfort in the epigastric/duodenal region, which cannot be explained by structural or biochemical abnormalities. Since the pathophysiology is still not fully understood, no guidelines in terms of treatment do exist.The aim of this study was to compare the therapeutical effect of plant extracts (STW-5) and acupressure in children with functional dyspepsia.This is a randomized, double-blind placebo-controlled trial. Before and after the allocated intervention of four weeks, participants had to fill in a cross-cultural validated questionnaire consisting of 52 questions to assess quality of life, as well as the extent of their discomfort (using a standardized visual analog scale (VAS)).33 patients were included in the study: 12 male and 21 female with an average age of 12.09 years (range: 7-17 years). Symptoms improved after four weeks of intervention in most treatment-groups: By 68% in children, who received STW-5, by 40% in the wristband (WB)- group and by 35% in the wrist-band-Placebo-group (WBPL). Patients receiving STW-5- Placebo showed even an increase of symptoms.This double-blind, placebo-controlled pilot study showed, that STW-5 and/or anti-nausea wristbands are a cheap and effective option to treat children and teenagers suffering from functional dyspepsia.
The researchers identified cases of multisystem inflammatory syndrome in children, which was linked to COVID-19 starting in 2020. Multisystem inflammatory syndrome in children is associated with significant cardiovascula...The researchers identified cases of multisystem inflammatory syndrome in children, which was linked to COVID-19 starting in 2020. Multisystem inflammatory syndrome in children is associated with significant cardiovascular morbidity in the acute phase. A small number of articles in the literature have recorded the long-term myocardial effects of multisystem inflammatory syndrome in children treated in pediatric intensive care units. Our study aimed to investigate the late cardiac outcomes of multisystem inflammatory syndrome in children using cardiac magnetic resonance imaging.A median of 16 months had passed after the onset of the disease in multisystem inflammatory syndrome in children. Ejection fraction (%), cardiac output (L/min), stroke volume (mL), end-diastolic volume index (mL/m), cardiac index (L/min/m), and stroke volume index (mL/m) were all significantly lower in multisystem inflammatory syndrome in children. During at least a 1-year follow-up, minor cardiac damage was discovered in 26% of individuals who underwent cardiac magnetic resonance imaging. In addition, none of the 23 infants showed symptoms of late gadolinium enhancement or pericardial effusion. While all patients underwent cardiac magnetic resonance imaging, the transthoracic echocardiogram evaluation revealed normal heart function.Our study found no evidence of late gadolinium enhancement, which indicates cardiac fibrosis in cardiac magnetic resonance imaging performed after a prolonged hospitalization in multisystem inflammatory syndrome in children who were admitted to the intensive care unit. This absence of late gadolinium enhancement is a reassuring finding, suggesting that the long-term cardiac outcomes of multisystem inflammatory syndrome in children may not be as severe as initially feared. However, the long-term cardiac magnetic resonance imaging results revealed mild left ventricular dysfunction in these patients that could not be detected via a transthoracic echocardiogram.
The prevalence of childhood hypertension is steadily increasing, and there is growing evidence that dysbiosis of the gut microbiota plays a role in this process. This study compares the gut microbiota of children with pr...The prevalence of childhood hypertension is steadily increasing, and there is growing evidence that dysbiosis of the gut microbiota plays a role in this process. This study compares the gut microbiota of children with primary hypertension to that of normotensive controls.This case-control study included 20 children with primary hypertension and 20 normotensive children matched for age, gender, and BMI. Exclusion criteria were the presence of chronic diseases other than hypertension, recent antibiotic use, and active infection. Stool samples were analyzed using 16S rRNA sequencing. Statistical analyses included Student's t-test, Mann-Whitney U test, and FDR correction.Microbial richness was significantly reduced at all taxonomic levels in hypertensive patients. However, there were no significant differences in alpha and beta diversity indices between the groups. Levels of and were lower in patients, while the ratio was increased (p<0.05).Changes in gut microbiota composition were observed in children with hypertension compared to the control group. These findings may enable the development of microbiota-based diagnostics and personalized treatments, and open the way for preventive approaches by identifying individuals at risk for chronic diseases.
Psychological safety (PS) is essential for effective teamwork in pediatrics. However, the factors influencing PS and the challenges it poses have hardly been researched. The aim of the study is to assess the perception o...Psychological safety (PS) is essential for effective teamwork in pediatrics. However, the factors influencing PS and the challenges it poses have hardly been researched. The aim of the study is to assess the perception of PS in the interprofessional team of a pediatric oncology unit. Factors such as error culture, communication, and workload are to be analyzed.In 2024, employees (nursing and medical staff) on a tertiary pediatric oncology ward were surveyed in a digital, anonymous, pretested questionnaire. The questionnaire comprised 31 items that were evaluated using a six-point Likert scale.Response rate was 62%. The results show positive trends in communication, but challenges in workload and induction of new employees. Deficits in feedback and error culture became apparent.The findings of our study highlight the need for further research on the factors influencing PS in pediatrics. Future studies should investigate the relationships between PS, communication, and workload to better understand the complexities of team dynamics in pediatrics.Our study shows that PS is of crucial importance in pediatric oncology and can be assessed using an easy-to-use digital tool. Future research should focus on developing and evaluating interventions to enhance PS and its effects on team dynamics and patient care, with a focus on improving teamwork and job satisfaction in pediatric oncology settings, and exploring the potential benefits of PS on patient outcomes.