Ganime Ayar

Children with life-limiting illnesses face physical, cognitive, and emotional challenges that restrict their activities of daily living. Although these needs require a holistic approach, rehabilitation services, particularly occupational therapy, are often limited in pediatric palliative care. This study aimed to evaluate the unmet rehabilitation needs of children receiving pediatric palliative care in Turkey based on the Person-Environment-Occupation model. A sequential explanatory mixed-methods design was used. Quantitative data on self-care, mobility, and caregiver burden were collected through standardized assessments. Qualitative data were gathered from semi-structured interviews with parents and analyzed using Directed Content Analysis. Quantitative findings revealed considerable impairments in mobility, self-care, and cognition, resulting in high caregiver burden. Qualitative findings contextualized these limitations, revealing themes of loss of independence, emotional distress, environmental barriers, and lack of professional and social support. Limited access to occupational therapy may impact quality of life. The findings suggest that occupational therapy may support children's participation in activities of daily living and ease caregiver burden in pediatric palliative care. Interventions focusing on physical, cognitive, and emotional challenges, as well as environmental adaptation, appear promising. Further research is needed to examine the long-term effects of occupational therapy in different care settings.

The foreign body aspiration into the respiratory system is an emergency situation with a high mortality rate, when diagnosis and treatment are delayed which can cause complications and repeated hospitalizations. Although it is especially common in children under the age of five, it can be seen at any age in chronically ill children with neurological problems. However, it is rarely seen in pediatric patients with tracheostomy and dependent on a home mechanical ventilator due to their nutritional style and severe neurological retardation. In this study, foreign body aspiration that developed in a pediatric patient with tracheostomy who was followed up with a home mechanical ventilator and fed from gastrostomy was presented.

Background Bisphenol A (BPA) is found in many medical materials used in the paediatric intensive care unit (PICU). Our aim was to evaluate how the urinary free-BPA(fBPA) and total-BPA(tBPA) levels were associated with the use of medical devices in the PICU in a prospective study. Methods The procedures applied to the patient were recorded during the follow-up period. Three urine samples were taken on the first day of hospitalization; the seventh day, and after 30 days or when the patients were discharged. Urinary tBPA and fBPA levels were determined using high-pressure liquid chromatography. Generalized estimating equations with repetitive measures were used to determine the associations between PICU procedures and BPA levels. Results A total of 115 urine samples of 40 children were studied. Mean urinary levels were 189.2 μg/g-creatinine for tBPA and 27.8 μg/g-creatinine for fBPA, and the fBPA/tBPA ratio was 27.9%. Endotracheal intubation, catheter, and haemodialysis procedures caused higher urinary fBPA levels. External drains, inhaler treatment, and the use of four or more medical devices were associated with considerably higher values of fBPA%. The increase in tBPA was positively correlated with fBPA. Conclusions fBPA levels and the fBPA/tBPA ratio varied according to the procedure and level of BPA exposure in children.

Aim: Positive parenting skills, especially mother–child interactions, are associated with positive effects in countless areas of child development. We aimed to evaluate mother–child interactions in children with developmental delay compared to those with age-appropriate development. Material and Methods: Children aged 1-5 years admitted to the outpatient clinic for child health supervision were evaluated for the study. A 10-minute video recording was obtained while the participant mother–child couple played together in a room. Children were divided into 3 developmental groups using the Denver Developmental Screening Test II (DDST-II); as age-appropriate, questionable, and delayed. Mother–child interaction was assessed using the “Parenting Interactions with Children: Checklist of Observations Linked to Outcomes” (PICCOLO) tool. Results: A total of 142 children, whose developmental status was evaluated according to DDST-II and were grouped as age-appropriate (59), questionable (39), and delayed (44), were included in the study. The mean age of the children was 29.0 ± 11.9 months. The median PICCOLO score was 43 (interquartile range (IQR)=36-47) in the age-appropriate developmental group, 44 (IQR=35-51) in the questionable group, and 36 (IQR=32-45) in the delayed group. When adjusted for child’s age, gender, presence of a sibling, maternal age, mother’s education level, mother’s occupation, and household size, multiple logistic regression revealed higher rates for optimum responsiveness and encouragement domains, and total scores in age-appropriate and questionable groups, than in the delayed development group (P < .05). Conclusion: Supporting all areas, especially the responsive and encouragement domains in mother–child interactions, may improve child development. Cite this article as: Ayar G, Yalçın SS, Bayoğlu B. Do the children of mothers with optimum PICCOLO scores have better Denver II test results?. Turk Arch Pediatr. 2021; 56(5): 423-428.

Background: The study aims to investigate the social, emotional, and behavioral challenges in children with a specific learning disability (SLD) and to identify the factors that accompany these problems by screening with the Strengths and Difficulties Questionnaire (SDQ).Methods: The descriptive study was conducted on 278 children with SLD. Strengths and difficulties in children were evaluated by the SDQ applied to their mothers. The percentage of cases above the cut‐off limits of the SDQ was calculated. Chi‐square test and multiple logistic regression analysis were used for analysis.Results: The mean (SD) total SDQ score was 15.8 (6.5). The percentage of scores of abnormal total difficulties in SLD was 47.8%. Multivariate analysis revealed that cases exposed to antenatal smoking had higher odds ratio of abnormal emotional symptoms and abnormal total difficulties; cases with poor familial income and the presence of a history of antenatal smoking exposure showed considerably higher odds ratio of conduct problems; cases with younger age at the diagnosis of SLD, dyscalculia, extreme duration of preschool screen time (≥4 h), and history of hospitalization had significantly higher odds ratio for hyperactivity–inattention problems; and cases having shorter breastfeeding duration had higher odds ratio of peer problems compared to counterparts.Conclusion: Children with SLD have a high score on the SDQ. Practitioners could especially give guidance and support to families with financial problems and those having a child with an early age at diagnosis, exposure to antenatal smoking, short breastfeeding period, early age of the first screen use, and long screen exposure duration during the preschool period.

Aim and Objective: This study aimed to investigate the value of Thiol/Disulfide homeostasis in pediatric diabetic ketoacidosis patients suffering from type 1 diabetes mellitus. Materials and Methods: This study featured children who were diagnosed with diabetic ketoacidosis and who were consecutively admitted to pediatric intensive care within one year of their diagnosis. Thiol/disulfide homeostasis was evaluated in 45 pediatric patients suffering from DKA, as well as 45 healthy controls of parallel gender and age. Thiol/disulfide homeostasis parameters were measured using a novel automated measurement method and the correlation between demographic data and parameters was measured. Results: Pediatric patients were found to have low native thiols, total thiols and disulfide levels with type 1 diabetes after DKA (331.82±106.40, 362.71±113.31, 17.02±5.33 μmol/L, respectively) as compared to the control group (445.08±24.41, 481.21± 28.47, 18.06±5.12 μmol/L, respectively). Conclusion: Thiol/disulfide homeostasis was distorted in pediatric patients with DKA. Furthermore, it was found that they are not likely to return to normal, immediately after treatment.

Aim and Objective: Ischemia modified albumin (IMA) is a biomarker that has been introduced recently for use in the evaluation of oxidative stress. The aim of this study was to measure the ischemia modified albumin serum levels in pediatric patients with diabetic ketoacidosis (DKA) during acidosis and after the patient recovered from acidosis and to compare these with the control group. Materials and Methods: Pediatric patients with Type I diabetes mellitus (T1DM) who were admitted to the pediatric intensive care unit with the diabetic ketoacidosis were assigned as the study group and healthy children who were admitted to the outpatient clinic and decided as healthy after clinic and laboratory evaluation were selected as the control group. IMA and adjusted IMA levels were evaluated in the blood samples from the control group and the study group when admitted first time to the intensive care unit during the acidosis period (DKA before treatment, DKA-BT), and after recovering from acidosis (DKA after treatment, DKA-AT). Results: A total of 24 pediatric patients with diabetic ketoacidosis and 30 healthy control children matching age and sex were included in the current study. The albumin levels in pediatric patients with T1DM during DKA-BT were higher than the albumin levels after acidosis (4.101±0.373, 3.854±0.369 g/dL, respectively) (p<0.05). However, there was no significant difference when these values were compared to the control group. Mean values of IMA and Adj-IMA were statistically higher in DKAAT compared to the control group (0.748±0.150 vs 0.591±0.099, p< 0.001; 0.708±0.125 vs 0.607±0.824, p< 0.001, respectively). IMA and adjusted IMA levels measured after recovered from acidosis were significantly higher compared to the level of IMA during DKA (0.748±0.150 vs 0.606±0.105 as absorbance unit, p<0.001; 0.708±0.125 vs 0.625±0.100, p<0.05, respectively). Conclusion: In children with T1DM, even though acidosis recovered following the treatment in diabetic ketoacidosis, which is an oxidative stress marker, the ischemia modified albumin levels and adjusted ischemia modified albumin levels were high.

The aim of this study is to evaluate a novel oxidative stress marker (thiol-disulphide homeostasis) in paediatric sepsis and to determine their effects on the prognosis of sepsis. Patients diagnosed with sepsis (n= 38) and healthy controls (n= 40) were incorporated in the study. Total thiol, native thiol, disulphide, disulphide/total thiol, disulphide/native thiol, and native thiol /total thiol levels were measured in the sepsis and control groups. Additionally, the parameters were compared between survivors and non-survivors in the sepsis group. The levels of hemoglobin, white blood cell, platelet, lactate, and C-reactive protein were measured in patients with sepsis at diagnosis. The paediatric risk of mortality and paediatric logistic organ dysfunction scores of the patients were used to estimate the disease severity. The plasma thiol levels of the patients with sepsis were significantly lower than the control group (p < 0.001). This study showed that thiol/disulphide homeostasis is abnormal in children with sepsis in Paediatric Intensive Care Unit.

Healthcare-acquired infections (HAIs) have become a major concern and a significant cause of morbidity and mortality in pediatric intensive care units (PICUs). The purpose of this study was to evaluate HAI rates as well as the rates of invasive device utilization at a PICU at a large tertiary care pediatric teaching hospital from a developing country over a 4-year period, and to compare findings with those of the National Health Safety Network United States, the International Nosocomial Infection Control Consortium, and Turkey's national HAI rates. An active prospective surveillance was performed at a tertiary care PICU from January 2014 to December 2017. It was especially analyzed for nosocomial infections, related to invasive devices: the central line catheter (CL), mechanical ventilator (MV), and the urinary catheter (UC). During the 4-year period, a total of 2,855 patient admissions and 30,499 patient-days were evaluated. The device-associated (DA)-HAI incidence density was 17.57 per 1,000 patient-days, and the incidence rate was 18.8 per 100 admissions. The most common site of the DA-HAIs was ventilator-associated pneumonia (VAP) with the highest rate (60.9%). The second was the central line-associated bloodstream infection (CLA-BSI) rate (24.8%). Catheter-associated urinary tract infections (CA-UTI) rank third (14.3%). The HAI location was VAP in 187 patients (11.31/1,000 MV-days), CLA-BSI in 76 patients (4.39/1,000 CL-days), and CA-UTI in 44 patients (3.35/1,000 UC-days). The most frequent pathogens, isolated from the overall DA-HAIs as being causative microorganisms were Acinetobacter baumannii (23%), followed by Pseudomonas aeruginosa (14%). Resistance of Acinetobacter baumannii to Carbapenem was 76.47%, and methicillin-resistance Staphylococcus aureus was 50% at the pediatric ICU. This study reported data on incidence rates as well as pathogens of HAIs from a developing country's PICU, which may later supply useful data about other pediatric hospitals.