The Turkish journal of pediatrics最新文献

{"title":"Factors for poor outcomes of neonatal bacterial meningitis: a retrospective multicenter study.","authors":"Lan Shao, Dongdong You, Yunpeng Shao, Huanhuan Xu, Feng Li","doi":"10.24953/turkjpediatr.2026.6678","DOIUrl":"10.24953/turkjpediatr.2026.6678","url":null,"abstract":"<p><strong>Background: </strong>Neonatal bacterial meningitis remains a severe infectious disease associated with substantial mortality and long-term neurological sequelae. This study aimed to identify factors associated with poor outcomes and to determine independent prognostic predictors in neonates with bacterial meningitis.</p><p><strong>Methods: </strong>This retrospective multicenter cohort study included neonates diagnosed with bacterial meningitis. Clinical characteristics, laboratory findings, microbiological data, treatment responses, and outcomes were analyzed. Univariate and multivariable logistic regression analyses were performed to identify factors associated with poor outcomes.</p><p><strong>Results: </strong>A total of 85 neonates were included in the final analysis. 31 neonates (36.5%) experienced poor outcomes, including death or long-term neurological sequelae. In multivariable analysis, the presence of neurological signs at admission (odds ratio [OR]: 7.315; 95% confidence interval [CI]: 1.875-28.535) and the development of acute neurological complications during hospitalization (OR: 7.541; 95% CI: 2.045-27.807) were the only factors independently associated with poor outcomes. Several variables, including elevated cerebrospinal fluid protein levels, early administration of blood-brain barrier (BBB)-permeable antibiotics prior to lumbar puncture, and adequate response to initial antimicrobial therapy, were significantly associated with outcomes in univariate analyses but did not retain statistical significance after multivariable adjustment.</p><p><strong>Conclusions: </strong>Neurological involvement at presentation and acute neurological complications are key independent predictors of poor outcomes in neonatal bacterial meningitis. Other clinical and laboratory variables may reflect disease severity or early clinical course and may assist in early risk stratification.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 2","pages":"210-220"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148008458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Leber hereditary optic neuropathy (LHON) in a 6-year-old boy with a transient spinal cord lesion.","authors":"Anıl Gök, Gökçe Cırdı, Adnan Deniz, Ayfer Sakarya Güneş, Leman Tekin Orgun, Bülent Kara","doi":"10.24953/turkjpediatr.2026.6882","DOIUrl":"10.24953/turkjpediatr.2026.6882","url":null,"abstract":"<p><strong>Background: </strong>Leber hereditary optic neuropathy (LHON) is a maternally inherited mitochondrial disorder that predominantly manifests as bilateral, painless vision loss in young males. While traditionally associated with the optic nerves, a subset of patients exhibits additional neurological symptoms, referred to as LHON-plus syndrome. Involvement of the spinal cord is uncommon, particularly among the pediatric population, and may result in diagnostic challenges, potentially leading to confusion regarding acquired demyelinating diseases.</p><p><strong>Case presentation: </strong>We report a 6-year-old boy with near-complete vision loss in the right eye and blurred vision in the left eye. Demyelinating diseases were suspected in the case of acute bilateral optic neuropathy. Cranial and orbital magnetic resonance imaging (MRI) showed no demyelinating lesions, whereas spinal MRI revealed a T2-hyperintense lesion at the C3-C6 levels. Due to unresponsiveness to conventional treatment for demyelinating diseases, genetic testing confirmed the homoplasmic m.11778G>A variant in NADH dehydrogenase subunit 4 (MT-ND4), establishing an LHON diagnosis. Spinal cord involvement supported the LHON-plus syndrome classification. Idebenone therapy was initiated, and follow-up was scheduled. During the 1.5-year follow-up, right eye visual loss persisted, while the left eye showed gradual vision decline. A second spinal MRI performed at 6 months showed complete resolution of the previous lesion without new lesions.</p><p><strong>Conclusion: </strong>Since optic neuropathy and spinal cord involvement typically indicate demyelinating diseases, these should be prioritized in initial evaluation due to their frequency and need for early immunomodulatory treatment. However, spinal cord involvement can occur in mitochondrial diseases, as demonstrated in this case. The presence of a transient and asymptomatic spinal cord lesion in this patient expands the recognized spectrum of central nervous system involvement in LHON. Therefore, LHON-plus syndrome should be considered when spinal cord involvement accompanies optic neuropathy after excluding other demyelinating diseases.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 2","pages":"330-336"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148008470","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Should we prioritize proton beam therapy before making a decision on orthotopic liver transplantation for unresectable hepatoblastoma?","authors":"Yi-Wen Hsiao, Yi-Lun Wang, Chen-Kan Tseng, Tsung-Yen Chang, Shih-Hsiang Chen, Tang-Her Jaing","doi":"10.24953/turkjpediatr.2026.6426","DOIUrl":"10.24953/turkjpediatr.2026.6426","url":null,"abstract":"<p><strong>Background: </strong>In unresectable hepatoblastoma (HB), particularly \"pre-treatment extent of tumor\" (PRETEXT) IV tumors or those with positive annotation factors, standard management consists of intensive chemotherapy followed by surgical resection or orthotopic liver transplantation (OLT). Radiotherapy has traditionally been avoided because of the liver's radiosensitivity and the risk of radiation-induced liver disease. Proton beam therapy (PBT), owing to its dosimetric advantage and ability to spare uninvolved liver parenchyma, may represent a potential local control strategy in selected pediatric patients for whom curative surgery or OLT is not feasible.</p><p><strong>Case presentation: </strong>We describe five pediatric patients with advanced hepatoblastoma treated with proton beam therapy at our institution between February 2022 and January 2024. The cohort included three girls and two boys, with a median age of 3.0 years (interquartile range [IQR], 1.6-4.0) and a median alpha-fetoprotein level of 435,453 ng/mL (IQR: 7,668-1,276,681) at diagnosis. All patients were initially considered inoperable because of extensive hepatic involvement, inadequate future liver remnant, or multifocal disease, and OLT was not feasible owing to donor limitations or medical comorbidities. All received neoadjuvant chemotherapy using SIOPEL-based regimens, achieving partial tumor response. Tumors ranged from 5 to 12 cm and involved central hepatic segments, the portal region, or both lobes. PBT was delivered at a total dose of 50 GyE in 10-25 fractions as definitive or consolidative therapy, followed by surgical resection in three patients. Two patients additionally received targeted therapy and immunotherapy. At last follow-up, four patients were alive with no evidence of disease, while one patient died from tumor progression.</p><p><strong>Conclusions: </strong>These cases suggest that proton beam therapy may serve as a feasible liver-sparing local treatment option for selected pediatric patients with unresectable or residual hepatoblastoma when surgery or OLT is not possible. While limited by availability and cost, PBT may facilitate multimodal therapy and preserve future treatment options.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 2","pages":"324-329"},"PeriodicalIF":0.0,"publicationDate":"2026-03-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148008553","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Author Correction to: \"Assessment of hormone measurement methods in girls with premature adrenarche, polycystic ovary syndrome, and non-classical congenital adrenal hyperplasia.\" [Turk J Pediatr 2025; 67: 692-699.].","authors":"Mert Uçar, Aysun Ata, Burcu Barutçuoğlu, Güneş Ak, Sara Habif, Zühal Parıldar, Damla Gökşen, Şükran Darcan, Samim Özen","doi":"10.24953/turkjpediatr.2026.8020","DOIUrl":"10.24953/turkjpediatr.2026.8020","url":null,"abstract":"","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"172"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505844","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Beyond contamination rates: a broader lens on diagnosing neonatal sepsis.","authors":"Mishquat Shabbir, Fatima Zahid, Noman Alam, Manahil Bahrawar","doi":"10.24953/turkjpediatr.2026.6987","DOIUrl":"10.24953/turkjpediatr.2026.6987","url":null,"abstract":"","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"164-165"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505866","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clinical and economic burden of preseptal cellulitis in children: a 6-year review.","authors":"Çağla Özbakır, Deniz Ergün, Pelin Kaçar, Berna Kahraman Çetin, Hıncal Özbakır, Arife Özer, Gizem Güner Özenen, Aybüke Akaslan Kara, Dilek Orbatu, Nuri Bayram, İlker Devrim","doi":"10.24953/turkjpediatr.2026.6660","DOIUrl":"10.24953/turkjpediatr.2026.6660","url":null,"abstract":"<p><strong>Background: </strong>Children diagnosed with preseptal cellulitis frequently require hospitalization, leading to both clinical management challenges and substantial healthcare-related costs. The condition often necessitates intravenous antibiotic therapy, radiological imaging, laboratory tests, consultations, and inpatient care, which collectively contribute to the overall economic burden. However, data on the clinical characteristics and cost distribution among pediatric patients remain limited. This study aimed to evaluate both the clinical and economic burden of preseptal cellulitis in hospitalized children and to identify the clinical factors influencing healthcare costs.</p><p><strong>Methods: </strong>This retrospective study included children aged 1 month to 18 years who were hospitalized with a diagnosis of preseptal cellulitis between January 2019 and December 2024. Patients were grouped according to age and presence of predisposing factors. Length of stay, total hospital costs, and cost components were analyzed based on clinical characteristics.</p><p><strong>Results: </strong>A total of 166 patients were included (mean age: 70.1 ± 46.9 months; 62% male). The most common findings were periorbital swelling (96.4%) and erythema (75.3%). Median length of stay was 5 days, with no significant differences by age, sex, or predisposing factors (p>0.05). However, a strong positive correlation was found between length of stay and total cost (rho=0.775, p<0.001). The total hospital expenditure was 25,412.95 USD, with antibiotics accounting for the largest share (48.3%). Sinusitis and odontogenic infections were significantly associated with higher costs (p=0.007 and p=0.030). In multivariable analysis, length of stay, age, and odontogenic infection emerged as independent determinants of total cost, with costs increasing by approximately 15% per additional hospital day, 0.2% per month of age, and 25% in the presence of odontogenic infection.</p><p><strong>Conclusion: </strong>Developing standardized treatment protocols and promoting rational antibiotic use are critical for optimizing healthcare resource utilization and preventing antibiotic resistance.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"79-86"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505864","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to \"Perspectives on 'Assessment of hormone measurement methods in girls with premature adrenarche, polycystic ovary syndrome, and non-classical congenital adrenal hyperplasia'\".","authors":"Mert Uçar, Aysun Ata, Burcu Barutçuoğlu, Güneş Ak, Sara Habif, Zühal Parıldar, Damla Gökşen, Şükran Darcan, Samim Özen","doi":"10.24953/turkjpediatr.2026.7475","DOIUrl":"10.24953/turkjpediatr.2026.7475","url":null,"abstract":"","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"170-171"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505896","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The impact of hematocrit, punch location, and cellular interference on neonatal screening for biotinidase deficiency.","authors":"Ceyhan Ceran Serdar","doi":"10.24953/turkjpediatr.2026.6966","DOIUrl":"10.24953/turkjpediatr.2026.6966","url":null,"abstract":"<p><strong>Background: </strong>Biotinidase deficiency is a core condition in newborn screening programs worldwide. While fluorometric enzyme activity assays from dried blood spots (DBS) are the standard first-tier test, their accuracy can be susceptible to pre-analytical variation. To date, the specific impact of hematocrit (HCT), punch location, and cellular interference on fluorometric biotinidase measurements have not been systematically examined.</p><p><strong>Methods: </strong>We prepared blood pools to isolate specific variables: a reference pool at 50% HCT (HCT50), a low-HCT pool at 34% (HCT34), and a leukocyte-depleted pool (HCT50(-W)). Secondary pools were created with biotinidase activities of 0, 50, 100, and 200 U. DBS samples were prepared from all pools. Biotinidase activity was measured fluorometrically from central and peripheral punches (n=12 per condition). Statistical analysis included t-tests and Cohen's d effect sizes, with a >10% deviation set as the threshold for clinical significance.</p><p><strong>Results: </strong>Our results demonstrated a significant systematic bias: Peripheral punches yielded higher biotinidase activity than central punches across all sample types (13.36%–16.61% difference, p<0.05). Lower hematocrit (HCT34) led to a significant overestimation of activity, yielding >20% higher values at the critical biotinidase activity-50 U level. Crucially, leukocyte depletion resulted in a statistically significant decrease in measured activity (~10.6%, p<0.05), indicating that approximately 10% of the quantified activity in DBS is leukocyte-derived and constitutes a previously unaccounted source of analytical bias.</p><p><strong>Conclusion: </strong>This study is the first to definitively quantify the effects of key pre-analytical variables on fluorometric biotinidase testing. Punch location, hematocrit, and cellular content are not merely sources of noise but are significant confounders that can lead to both false-positive and false-negative results. We strongly recommend that DBS calibrators and patient samples be punched from the center of the spot and that second-tier testing interpretations consider individual infant hematological parameters to enhance the clinical sensitivity of newborn screening for biotinidase deficiency.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"107-119"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505931","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The relationship between early feeding skills and general movements of preterm infants in the neonatal intensive care unit.","authors":"Seda Ayaz Taş, Seda Yakıt Yeşilyurt, Tansu Birinci Olgun, Sezen Tezcan, Sinan Taş, Mustafa Dilek","doi":"10.24953/turkjpediatr.2026.6500","DOIUrl":"10.24953/turkjpediatr.2026.6500","url":null,"abstract":"<p><strong>Background: </strong>Early feeding skills and general movements (GMs) are negatively affected by hypotonia due to prematurity. Interventions for feeding skills can be guided by understanding the relationship between feeding skills and GMs. In the light of this, the study focused on understanding the relationship between early feeding skills and preterm infants' GMs in the neonatal intensive care unit (NICU).</p><p><strong>Methods: </strong>Participants in this cross-sectional study were forty infants with a postmenstrual age of 34-37 weeks who were hospitalized in the NICU at Abant İzzet Baysal University Training and Research Hospital. The data consisted of demographic characteristics (birth weight, gestational age, date of birth, age, and sex), feeding skills, assessed with the Early Feeding Skills Assessment Tool, and GMs, assessed with the General Movement Assessment.</p><p><strong>Results: </strong>A strong correlation was found between the Oral-Motor Function subscale of the Early Feeding Skills Assessment Tool and the Upper Limbs subscale of the General Movements Motor Optimality Score (rho=0.74, p=0.001). Among the demographic characteristics, only maternal age was associated with feeding skills. A weak correlation was determined between the Physiologic Stability subscale of the Early Feeding Skills Assessment Tool and maternal age (rho=0.34 p=0.03).</p><p><strong>Conclusions: </strong>This study reveals the relationship between feeding skills and general movement of preterm infants at NICU. GMs of upper extremity were found to positively affect feeding skills. This process may be accelerated by interventions to improve the GMs of upper extremity during the transition to oral feeding.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"54-67"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505919","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of a structured influenza seminar on pediatric residents' knowledge and attitudes: a pre-post single-group study.","authors":"Pınar Garipçin Sarı, Yıldız Ekemen Keleş, Esra Bal Yüksel, Eda Karadağ Öncel, Ahu Kara Aksay, Dilek Yılmaz","doi":"10.24953/turkjpediatr.2026.6530","DOIUrl":"10.24953/turkjpediatr.2026.6530","url":null,"abstract":"<p><strong>Background: </strong>Influenza remains a primary global health concern associated with significant morbidity and mortality, especially among high-risk pediatric populations. Pediatric residents are involved in the diagnosis, treatment, and prevention of influenza during their training; however, gaps in influenza-related knowledge have been reported. The aim of this study was to evaluate the impact of a structured educational seminar on improving pediatric residents' knowledge of influenza symptoms, complications, treatment, and vaccination practices.</p><p><strong>Methods: </strong>This prospective, single-center, pre-post study included pediatric residents at a tertiary hospital. Participants completed the same structured 25-item questionnaire immediately before and one month after a 60-minute educational seminar on influenza. The questionnaire assessed knowledge of clinical symptoms, transmission routes, antiviral treatment, chemoprophylaxis, and vaccination. Item-level correct response rates and the total knowledge score (range 0-25) were compared between pre- and post-seminar assessments.</p><p><strong>Results: </strong>Sixty-two residents participated. After the seminar, correct response rates increased for several clinical features, including sudden onset of illness (p = 0.006), rapid progressive disease (p = 0.003), diarrhea (p < 0.001), abdominal pain (p < 0.001), febrile seizure (p = 0.003), and complex febrile seizure (p < 0.001). Knowledge regarding transmission routes and oseltamivir-related adverse effects improved significantly (p < 0.05), while chemoprophylaxis-related items showed mixed changes in correct response rates. The total knowledge score increased from 14 (interquartile range [IQR]: 12-16.25) to 18 (IQR: 15-21) after the seminar (p < 0.001).</p><p><strong>Conclusion: </strong>A single, structured educational seminar was associated with improvements in several domains of influenza-related knowledge among pediatric residents. The observed declines in selected chemoprophylaxis items indicate that some topics may require repeated or reinforced educational approaches.</p>","PeriodicalId":101314,"journal":{"name":"The Turkish journal of pediatrics","volume":"68 1","pages":"130-137"},"PeriodicalIF":0.0,"publicationDate":"2026-02-27","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147505906","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}