Pinar Uysal

Background: Late‐preterm birth is associated with increased respiratory morbidity, but tidal breathing at term‐equivalent age remains incompletely characterized. We hypothesized that healthy late‐preterm neonates would differ from term neonates, with the between‐group difference in t _PTEF /t _E designated as the primary outcome. Methods: In this prospective cross‐sectional study, 60 healthy late‐preterm and 60 term neonates underwent tidal breathing analysis (MasterScreen PAED) at term‐equivalent age (40 weeks’ postmenstrual age) during natural quiet sleep without sedation. Results: Late‐preterm neonates had lower t _PTEF /t _E (27.4 ± 7.0% vs. 31.2 ± 6.9%; Benjamini–Hochberg‐adjusted p = 0.028; Cohen's d = 0.544) and V _PTEF / V _E [28.6 (25.1–31.0)% vs. 32.1 (27.3–35.5)%; adjusted p = 0.028; Cliff's δ = 0.304] than term neonates. Respiratory rate was higher (53.2 ± 9.1 vs. 49.6 ± 9.5 breaths/min), but not significant after correction (adjusted p = 0.126). No other tidal breathing variables differed significantly after correction. In the primary multivariable model, each additional week of exact gestational age was associated with a 1.18‐percentage‐point increase in t _PTEF /t _E after adjustment for sex, body weight, and crown–heel length (B = 1.182; 95% CI, 0.540–1.823; β = 0.323; p < 0.001). When postnatal age replaced gestational age, the association was inverse (B = −0.167/day; 95% CI, −0.263 to −0.071; β = −0.306; p < 0.001). Conclusion: At term‐equivalent age, healthy late‐preterm neonates had modestly lower t _PTFEF /t _E and V _PTEF / V _E than term neonates. These findings may reflect subtle maturational differences in expiratory flow dynamics associated with late‐preterm birth.

Background: A limited number of studies have shown that fermented milk products (FMPs) regularly consumed by mothers during pregnancy may be beneficial for atopic dermatitis and food allergy in their children. In this study, we aimed to investigate the effect of regular maternal consumption of yogurt and cheese during pregnancy on the remission period of cow’s milk protein allergy (CMPA) in their children. Methods: In this retrospective cohort study, 59 consecutive children who presented to the pediatric allergy outpatient clinic between January 2020 and January 2023 and were evaluated for IgE-mediated CMPA were screened; 19 were excluded (incomplete data, non-IgE-mediated findings, or declined participation), leaving 40 children for analysis. The diagnosis of CMPA was made by skin prick test (SPT) and/or cow’s milk-specific IgE and oral food challenge (OFC). Demographic characteristics, laboratory data, duration of tolerance development and frequency of regular FMP consumption by mothers during pregnancy were recorded using a structured questionnaire. Results: Among cases, 42.5% were girls and 57.5% were boys. The median age of cases was 38.5 months (24-47.75). The median duration of breast milk intake was 20 months (14-24). Parental atopy was present in 45% of cases. The median age at symptom onset was 4.5 (2-6) months. Prediagnoses at presentation included atopic dermatitis in 57.5%, allergic proctocolitis in 5%, urticaria and angioedema in 32.5%, and anaphylaxis in 5%. The median cow’s milk SPT wheal diameter was 8 (5-13) mm, yogurt SPT wheal diameter was 5 (0-10) mm, and cow’s milk-specific IgE value was 0.66 (0.13-5.68) kU/L. Baked cow’s milk products were tolerated by 67.5% of subjects. Prevalence of daily FMP consumption during pregnancy was 55%, yogurt consumption was 62.5%, and cheese consumption was 70%. Although there was no significant difference between subgroups in age at onset of clinical symptoms, the age at first tolerance to cow’s milk, duration of tolerance development and yogurt SPT wheal diameter were significantly lower in children of mothers who consumed FMPs daily during pregnancy compared with those who did not (p<0.05); this lower yogurt wheal diameter may in part reflect a milder baseline sensitization profile in this subgroup. Age at symptom onset was correlated with serum total IgE and cow’s milk-specific IgE. Conclusion: The duration of remission of CMPA in offspring was found to be shorter if the mother used FMPs daily during pregnancy.

Allergic rhinitis (AR) is one of the most common chronic inflammatory diseases of childhood and adolescence, affecting a substantial proportion of children and imposing a considerable burden on qua...

Wheezing is a common respiratory symptom affecting a substantial proportion of preschool children, with a prevalence ranging from 10% to 30% in this age group. Wheezing during the preschool years i...

Background: Maternal diabetes disrupts fetal lung development. This study aimed to compare cord blood adipokines and neonatal respiratory function tests (RFTs) in healthy neonates of diabetic mothers versus controls. Methods: This prospective cohort study involved term, healthy newborns born to diabetic mothers (NDM group, n = 37) and sex‐ and age‐matched healthy controls (NHC group, n = 40). RFTs were performed at 48 h of life using tidal breath analysis (TBA). The assessed parameters included time to peak tidal expiratory flow (TPTEF), the ratio of TPTEF to total expiratory time (TPTEF/TE), the ratio of volume to peak expiratory flow to total expiratory volume (VPTEF/VE), reflecting early airway mechanics. Low respiratory function was defined as TPTEF/TE below 35%. Cord blood adipokines including leptin, ghrelin, and adiponectin levels were measured by ELISA. Results: The NDM group exhibited lower TPTEF, TPTEF/TE, and VPTEF/VE ratio TBA parameters ( p < .001 for all). Cord blood leptin levels were higher in the NDM group, while ghrelin and adiponectin levels were lower ( p = .002, p < .001 and p < .001 respectively). Ghrelin levels were positively correlated with TPTEF ( ρ = 0.231, p = .043), TPTEF/TE ( ρ = 0.264, p = .020), and VPTEF/VE ( ρ = 0.236, p = .038). Decision tree analysis identified ghrelin as the primary discriminator of low RFTs, with an accuracy of 74%. Conclusion: Clinically healthy term infants born to diabetic mothers exhibit measurable impairments in RFTs at birth, accompanied by altered cord blood adipokine profiles, suggesting a potential role for adipokines as early biomarkers of respiratory vulnerability. image

Objective: Although coronavirus disease 2019 (COVID‐19) usually exhibits a mild clinical course in children, concerns remain regarding persistent airway dysfunction after recovery. This study aimed to evaluate pulmonary function tests (PFTs) in children following mild COVID‐19 infection and to compare the findings with those of healthy controls. Methods: In this prospective cross‐sectional study, children aged 6–18 years with polymerase chain reaction–confirmed COVID‐19 infection were identified retrospectively from February 2022 and evaluated prospectively between June and December 2022. Fifty‐eight post‐COVID‐19 patients and 56 age‐ and sex‐matched healthy controls were included, and their demographic and clinical characteristics were recorded. PFTs were assessed using impulse oscillometry (IOS) followed by spirometry. Results: There were no significant differences in demographic and anthropometric measurements between the post‐COVID‐19 group and the healthy controls. In terms of IOS measurements, zR5 and R5‐20 (reflecting airway resistance) were higher and zX5 and zX20 (reflecting airway reactance) were lower in the post‐COVID‐19 group ( p = .006, p = .002, p < .001, and p = .001, respectively). No significant differences were observed in spirometric parameters, including zFEV1, zFVC, zFEV1/FVC, and zFEF25–75. Notably, three patients exhibited persistent cough and dyspnea after COVID‐19, had FEV1 values <90% predicted, positive bronchodilator reversibility, and inhalant allergen sensitization despite having no prior history of asthma or allergic rhinitis. Conclusion: Children recovering from mild COVID‐19 infection may exhibit persistent airway dysfunction detectable by IOS despite normal spirometric findings. IOS appears to be a sensitive tool for identifying subclinical airway involvement in children following COVID‐19.

Atopic dermatitis (AD) is frequently associated with respiratory comorbidities, yet data on pulmonary function in infancy remain scarce. This study aimed to evaluate pulmonary function in infants with AD using tidal breath analysis (TBA) and to compare these findings with those of wheezy infants and healthy controls (HC). A total of 115 infants under 3 years of age were categorized into three groups: infants with AD without any respiratory disease or symptoms (n = 50), infants with wheezing (n = 35), and HCs (n = 30), and their data were retrospectively analyzed. Pulmonary function was assessed using TBA. Peak tidal expiratory flow time (TPTEF), time to expiratory time (TE), ratio of peak tidal expiratory flow time to expiratory time (TPTEF/TE), volume required for PTEF (VPTEF), expiratory volume (VE), and respiratory rate (RR) were measured by TBA. The key parameter was the TPTEF/TE. The severity of AD was based on the Scoring Atopic Dermatitis (SCORAD) index. Wheezing phenotypes were classified as episodic viral wheeze (EVW) or multiple-trigger wheeze (MTW). Significant differences were observed among the three groups in terms of TPTEF (p = 0.022), TPTEF/TE (p < 0.001), VPTEF/VE (p < 0.001), and RR (p = 0.044). Subgroup analysis revealed that TPTEF/TE was significantly lower in both wheezing infants (p = 0.003) and those with AD (p < 0.001) compared to HC, with no significant difference between the wheezing and AD groups (p = 0.668). Additionally, TBA parameters did not significantly differ between the EVW and MTW phenotypes (p > 0.05). Despite the absence of respiratory symptoms, TBA revealed bronchial obstruction in infants with AD, comparable to wheezy infants. Pulmonary function also showed no significant differences between wheezing phenotypes.

Background: Prenatal smoke exposure impairs fetal lung development, but the interplay between cotinine, oxidative stress, and early respiratory dysfunction remains unclear. This study aimed to quantify the effects of prenatal smoke exposure on neonatal respiratory function and develop a validated predictive model to identify this dysfunction. Methods: This prospective cohort study included term newborns with prenatal tobacco smoke exposure ( n = 50) and healthy controls ( n = 41). Cord blood cotinine, oxidative stress markers, and tidal breathing parameters assessed at 48 h post‐delivery were compared. A decision tree model was developed and rigorously validated for performance, calibration, and temporal stability to predict decreased expiratory flow. Results: Smoke‐exposed newborns exhibited significantly impaired expiratory flow ( p < .001), elevated cord cotinine ( p < .001), and increased systemic oxidative stress ( p < .05). The decision tree model selected a cord blood cotinine level >26.1 ng/mL as the primary predictor, conferring a 94% probability of dysfunction. For those with lower cotinine, a total oxidant status >9.75 μmol/L was a secondary predictor (87.5% probability). The final model achieved 72.5% accuracy and demonstrated good calibration. Conclusion: Prenatal smoke exposure induces quantifiable neonatal respiratory dysfunction mediated by oxidative stress. Cord blood cotinine and total oxidant status are robust biomarkers for risk stratification. Our validated decision tree offers a practical framework for identifying respiratory dysfunction in newborns. image

Skin prick tests are a common method for diagnosing allergies in pediatric allergy clinics. Unfortunately, these tests can be distressing for children, causing pain and fear that can make them challenging to conduct. Virtual reality (VR) can be used to distract children during medical procedures. This study examines the effect of VR on skin prick test-related pain and fear in children. This parallel-group, single-blind, prospective, randomized controlled trial enrolled 233 children evaluated at the Pediatric Allergy Clinic and scheduled to undergo skin prick testing between March and June 2024. Among these children, 75 children aged 4–10 years who met the inclusion criteria were divided into two groups as VR group (n = 25) and control group (n = 25) by block randomization using gender and age group variables. The VR group wore VR goggles during the skin prick test, while the control group underwent the standard procedure. Pain and fear levels were assessed using the Wong-Baker FACES® Pain Scale and the Child Fear Scale. Children in the VR group exhibited a significant reduction in pain and fear levels associated with the skin prick test experience compared to the control group, as evaluated by children, parents, and researchers (p < 0.05). No side effects related to VR were reported. Conclusion: Virtual reality can be an effective tool in pediatric allergy clinics to reduce pain and fear during skin prick testing. By enhancing the child’s comfort, VR may also improve adherence to allergy follow-up and treatment, ultimately contributing to better clinical outcomes. What is Known: • Children often experience significant pain and fear during invasive procedures such as skin prick tests, and distraction methods have been shown to reduce pain and anxiety. What is New: • This study is the first randomized controlled trial to demonstrate that virtual reality (VR) significantly reduces pain and fear during skin prick tests in children. • This study supports the integration of new technologies such as VR as a standard practice for managing pain and fear during skin prick tests in pediatric allergy clinics. Trial registration: The clinical trial registration number is NCT06421779. Study start date: March 22, 2024. Study completion date: July 22, 2024. (https://clinicaltrials.gov/study/NCT06421779). Graphical Abstract

Introduction: Limited data are available regarding the effectiveness of different omalizumab-dosing strategies in childhood chronic spontaneous urticaria (CSU). This study aimed to investigate the efficacy of omalizumab initiated at different doses in children and adolescents with CSU based on real-life data. Methods: This study was conducted at five academic medical centers in Turkey. Patient data were obtained from their file data. Omalizumab treatment was initiated at a dose of 150 mg every 4 weeks in 37 (60.7%) patients (group 1) and 300 mg in 24 (39.3%) patients (group 2). Results: The mean age of patients was 14.4 ± 2.6 years (6.3–18 years), and female-to-male ratio was 2.2 (42/19). There was no difference between the mean initial UAS7 scores of groups 1 and 2 (34 ± 8.8 and 34.6 ± 9.1, respectively) (p = 0.854). Groups 1 and 2 achieved an urticaria-free or well-controlled status at rates of 75.7% (n = 28) and 87.5% (n = 21), respectively, during the treatment period (p = 0.334). Group 2 achieved urticaria-free or well-controlled status in a shorter time than group 1 (median: 1 month [1–3 months] and median: 2 months [1–4 months], respectively) (p = 0.036). The rate of patients who achieved urticaria-free status during the study period was 59.5% (n = 22) and 87.5% (n = 21) in groups 1 and 2, respectively (p = 0.023). Seven patients in group 1 (31.8%) and 2 patients in group 2 (9.5%) experienced recurrence (p = 0.132). At the last evaluation, more patients in group 2 (83.3%, n = 20) were urticaria-free than in group 1 (48.6%, n = 18) (p = 0.008). A patient had an exacerbation of urticaria associated with omalizumab within the first 24 h of the first dose, but this complication was not repeated. Other than dizziness in 1 patient, no different side effects were seen in our cohort of patients. Conclusion: Omalizumab is an effective and reliable treatment option for childhood CSU. Urticaria-free or well-controlled status can be achieved in a shorter time by initiating treatment with a 300 mg/4 week regimen. Although this dose may need to be increased in most cases, control can be achieved with a dose of 150 mg/4 weeks in a considerable number of patients.