Dilek Dilli

Aims: Artificial Intelligence (AI) is increasingly used in healthcare, but its routine use by pediatricians remains unclear. This study examined the clinical and academic tasks for which pediatricians use AI, their willingness to use secure institutional systems, and the patient information they would enter. These dimensions were examined together to distinguish general acceptance of AI from task-specific use and willingness to share different types of patient information.Methods: This cross-sectional web-based survey included 302 pediatricians in Turkiye in June-July 2026. A 25-item questionnaire assessed task-specific AI use, ethical and professional concerns, institutional preparedness, willingness to use secure systems, and patient data-sharing preferences. Content validity was evaluated by 10 experts using a modified Lawshe approach. Data were summarized descriptively; Kruskal-Wallis, Mann-Whitney U, and Spearman correlation analyses were performed. Demographic and professional analyses were exploratory.Results: Overall, 90.1% were willing to use a secure institutional AI system compliant with national data protection requirements, whereas fewer than 15% would enter directly identifying information such as patient names or file numbers. Clinical use was most common for medical information seeking (61.3%) and least common for preparing patient or family education materials (22.8%); 12.6% reported no clinical use. In academic work, literature searching and summarization was most frequent (68.9%), while project or grant applications were least frequent (7.6%); 11.6% reported no academic use. Older age was weakly associated with lower regular AI use (ρ=-0.192, p

Children with CHD who require surgical or catheter-based intervention in the neonatal period are increasingly surviving into childhood; however, their long-term health-related quality of life remains insufficiently characterised, particularly in the preschool period. We aimed to evaluate health-related quality of life in preschool-aged children treated for CHD during the neonatal period and to identify associated clinical and sociodemographic factors. This retrospective, cross-sectional case–control study included 50 children aged 4–7 years with a history of neonatal CHD intervention and 100 age-matched healthy controls. Health-related quality of life was assessed using the parent-reported Kiddy-KINDL questionnaire. Demographic, clinical, and socio-economic data were obtained from medical records and structured parental interviews. Group comparisons were performed using appropriate parametric or nonparametric tests, and factors associated with health-related quality of life were analysed using multiple linear regression. Total Kiddy-KINDL scores were significantly lower in children with CHD compared with controls (55.4 ± 8.8 vs. 62.3 ± 6.5, p < 0.001). All health-related quality of life subdomains, including physical well-being, emotional well-being, self-esteem, family relations, social functioning, and kindergarten adjustment, were significantly impaired in the CHD group (all p < 0.05). In multivariable analysis, maternal and paternal education levels and household income were independent predictors of health-related quality of life, whereas the surgical risk category was not significantly associated with health-related quality of life outcomes. Preschool children treated for CHD in the neonatal period demonstrate significantly reduced health-related quality of life compared with healthy peers, with socio-economic factors playing a more prominent role than clinical disease severity. These findings underscore the importance of incorporating family-centred and socioeconomically sensitive strategies into the long-term follow-up of children with CHD.

Objective: Viral pathogens are an important cause of lower respiratory tract infection (LRTI) leading to hospitalization in neonates and young infants. This study evaluated the etiologic distribution, clinical course, and management of multiplex RT-PCR–confirmed LRTI among neonatal intensive care unit (NICU) admissions. Materials and Methods: Between September 2022 and November 2023, neonates admitted to the NICU with LRTI and a positive respiratory viral panel (multiplex RT-PCR) were retrospectively analyzed (n=44). Disease severity at admission was assessed using the Downes score. Demographics, seasonality, respiratory support, treatments, and outcomes were recorded. Correlations between Downes score, oxygen requirement (FiO₂), and length of stay were examined. Results: Median age at admission was 17 days (range: 1–45). Admissions peaked in January (29.5%) and November (18.1%). The most common presenting findings were respiratory distress/tachypnea, cough, and feeding difficulties. Median Downes score was 2 (range: 1–8) and median FiO₂ requirement was 31% (range: 25–45%). Respiratory support was required in 32 infants: mechanical ventilation in 11.4% (n=5), non-invasive ventilation in 22.7% (n=10), and supplemental oxygen in 38.6% (n=17). The most common agents were SARS-CoV-2 (n=22; 50%) and respiratory syncytial virus (RSV) ( n=14; 31.8%). Downes score correlated positively with FiO₂ (r=0.39, p=0.008) and length of hospital stay (r=0.42, p=0.004). Oseltamivir was administered to three infants with influenza. Median length of stay was 6 days (range: 2–56) and no mortality occurred. Conclusion: In this multiplex RT-PCR era snapshot, SARS-CoV-2 and RSV predominated among NICU-admitted neonates and young infants with viral LRTI. Management was primarily supportive, and admission Downes score may help anticipate oxygen requirement and hospitalization duration.

Predicting extubation readiness in the neonatal intensive care unit (NICU) remains difficult. Prolonged mechanical ventilation may contribute to ventilator-induced diaphragmatic dysfunction, whereas premature extubation increases morbidity. We evaluated whether diaphragm ultrasound (DUS) parameters, alone or integrated with lung ultrasound aeration scoring, predict extubation outcomes in ventilated neonates. In this prospective, single-center pilot diagnostic accuracy study, 72 mechanically ventilated neonates underwent a standardized spontaneous breathing trial (SBT) on a Hamilton-C1 Neo ventilator while intubated. Index tests included diaphragmatic excursion (DE), inspiratory and expiratory diaphragm thickness (DTi, DTe), and inspiratory velocity, alongside lung aeration assessment using the LUS aeration score (LUS, 0–18; 6 regions) and the extended LUS aeration score (eLUS, 0–30; 10 regions). The reference standard was extubation outcome, with extubation failure defined as reintubation within 48 h. Discrimination was assessed using receiver operating characteristic (ROC) analyses (AUC with 95% confidence intervals), with DeLong tests for pairwise AUC comparisons. Extubation succeeded in 53/72 (73.6%) and failed in 19/72 (26.4%). Success was associated with higher DE (7.82 ± 2.48 vs 4.08 ± 1.10 mm; p < 0.001) and DTi (2.19 ± 0.48 vs 1.16 ± 0.39 mm; p < 0.001), and with lower LUS (3.79 ± 1.79 vs 6.01 ± 1.20; p < 0.001) and eLUS (4.09 ± 2.10 vs 8.11 ± 2.64; p < 0.001). ROC analyses showed excellent discrimination for DE (AUC 0.978; 95% CI 0.912–0.998) and DTi (AUC 0.928; 95% CI 0.841–0.975), and good discrimination for inspiratory velocity (AUC 0.843; 95% CI 0.738–0.918). DE outperformed inspiratory velocity (ΔAUC 0.135; p = 0.001), while DE and DTi were similar (ΔAUC 0.0506; p = 0.179). For predicting failure, eLUS (AUC 0.876; 95% CI 0.778–0.942) and LUS (AUC 0.838; 95% CI 0.732–0.914) did not differ (ΔAUC 0.0387; p = 0.178). After adjustment for gestational age, higher LUS/eLUS and lower DTi remained independently associated with failure. Conclusion: In this pilot study, DUS, particularly DE, provided excellent discrimination for extubation outcome, while LUS/eLUS added complementary information on residual lung disease burden. Multicenter validation is needed before routine clinical adoption. What is Known: • Prolonged mechanical ventilation may contribute to ventilator-induced diaphragmatic dysfunction; diaphragmatic performance is therefore relevant to weaning success. • Lung ultrasound aeration scoring can quantify residual lung disease burden and has been investigated as a predictor of post-extubation respiratory deterioration. What is New: • In this single-center pilot diagnostic accuracy study, diaphragmatic excursion measured during a standardized SBT showed excellent discrimination for extubation success within 48 h. • Lung aeration scores provided complementary prediction for extubation failure, with similar performance between eLUS and LUS.

SUMMARY OBJECTIVE: The aim of this study was to describe early outcomes after neonatal modified Blalock-Taussig shunt and identify perioperative predictors of mortality in a tertiary congenital cardiac center. METHODS: In this retrospective cohort, 129 neonates with critical congenital heart disease who underwent modified Blalock-Taussig shunt were analyzed. Demographic, clinical, and perioperative variables were collected, and multivariate logistic regression was used to identify independent predictors of neonatal mortality. RESULTS: Overall neonatal mortality was 21.7%. Shunt failure occurred in 18.9% (24/127) of neonates transferred to the neonatal intensive care unit and was strongly associated with mortality (66.7 vs. 11.6%; p=0.001). Independent risk factors for neonatal mortality included lower gestational age (OR 0.82, 95%CI 0.72–0.94; p=0.004), preoperative inotropic support (OR 3.46; p=0.006), preoperative mechanical ventilation (OR 4.28; p=0.001), shunt failure (OR 5.12; p=0.001), and postoperative metabolic acidosis (OR 6.78; p=0.001). CONCLUSION: Neonates undergoing modified Blalock-Taussig shunt remain at high risk for postoperative complications and death. Preoperative hemodynamic instability, shunt failure, and postoperative metabolic acidosis are strong predictors of poor outcome. These findings support vigilant perioperative monitoring and individualized management strategies in neonatal modified Blalock-Taussig shunt candidates.

Oxidative stress is defined as an imbalance between oxidant and antioxidant substances in favor of oxidants. Despite the well-known adverse effects of oxidative stress on the mother, fetus, and newborn, the impact of birth type on oxidative stress experienced by both mother and child remains unclear. Our study aimed to investigate the effects of birth type on the oxidant and antioxidant systems through umbilical cord blood analysis. Between 37 and 41 weeks of gestation, cord blood was collected from 92 newborn babies. Participants were divided into two groups according to their mode of birth: Group Cesarean Section (n = 45) and Group Normal Vaginal Delivery (n = 47). The material used in the study was umbilical cord blood samples collected immediately after birth. Total Antioxidant Status, Total Oxidant Status, thiol, catalase, arylesterase, paraoxonase and stimulated paraoxonase, measurements were determined. Neonatal cord blood thiol levels were significantly lower in both the Cesarean section group (195.60 ± 4.27) compared to the Normal Vaginal Delivery group (212.06 ± 6.01,p = 0.025), and in newborns of mothers with a history of urinary tract infection (189.9 ± 2.8) versus those without (206.26 ± 4.3,p = 0.041). No significant differences were observed in Total Antioxidant Status, Total Oxidant Status, catalase, stimulated paraoxonase, paraoxonase or arylesterase levels across the studied groups. The cesarean birth and maternal urinary tract infection history are associated with significantly reduced neonatal cord blood thiol levels while other oxidative stress markers remain unchanged highlighting thiol's potential role as a sensitive biomarker for birth-related oxidative imbalance and supporting its use in early postnatal risk assessment.

Background and Objective: This study aims to investigate the clinical significance and risk factors of retinal hemorrhages (RH) and white-centered retinal hemorrhages (Roth spots, RS) in neonates with hypoxic-ischemic encephalopathy (HIE), as well as their long-term ophthalmologic outcomes. Materials and Methods: Neonates diagnosed with HIE were classified into three stages according to the Sarnat classification. A comprehensive ophthalmologic assessment was performed within the first three days of life and at two years of age. Retinal hemorrhages were staged based on the Egge classification, and the presence of RS was also documented. The clinical characteristics and risk factors associated with RH and RS were systematically recorded. Results: Retinal hemorrhages were identified in 178 eyes (42.3%), and RS were observed in 180 eyes (42.8%). The prevalence of both RH and RS was significantly higher in neonates with Stage 2 and Stage 3 HIE (p < 0.001). The resolution time for both RH and RS was significantly prolonged in neonates with Stage 3 HIE compared to those with lower grades (p < 0.001). Furthermore, the frequency of grade 3 RH increased with advancing HIE stages (p < 0.001). Logistic regression analysis revealed that Stage 2 HIE (OR: 5.41, 95% CI: 1.19–24.54, p = 0.03) and Stage 3 HIE (OR: 27.17, 95% CI: 5.38–137.25, p < 0.001) were significantly associated with RS. Similarly, Stage 2 HIE (OR: 4.54, 95% CI: 1.00–20.68, p = 0.05) and Stage 3 HIE (OR: 40.88, 95% CI: 7.75–215.68, p < 0.001) were significantly associated with RH. At the age of two, strabismus was identified in 34 (18.4%) patients, while refractive errors were detected in 68 (37.4%) patients. Conclusions: The prevalence of RH and RS increases in correlation with the severity of HIE. While these hemorrhages generally resolve spontaneously, the risk of refractive errors and strabismus remains elevated.

Background In ductus-dependent left-sided heart lesions, systemic circulation depends on right-to-left flow via the ductus arteriosus. These lesions may occur as an isolated defect or complex disease. Objective In this study, we aimed to investigate the neonatal outcomes of duct-dependent systemic circulatory lesions, especially aortic coarctation (CoA) and interrupted aortic arch (IAA). Methods A total of 159 patients with duct-dependent systemic lesions were followed up in the Cardiac NICU of our institution from 2012 to 2022. We retrospectively reviewed the medical charts of all patients from the hospital database. They were analyzed for clinical and surgical outcomes. A p-value of <0.05 was considered statistically significant. Results Of 159 patients, CoA was detected in 120 (75.4%) and IAA in 39 (24.5%) patients. Cardiac catheterization was performed in 74 (61.6%) patients with CoA in the neonatal period; 49 (40.8%) underwent therapeutic and 25 (20.8%) diagnostic procedures. One hundred one patients with CoA (84.1%) underwent surgery at a median age of 14 days (9-23). Thirty-four of 39 patients with IAA (87.1%) underwent surgery; single-stage repair was performed on 13 patients (38.2%), while two-stage repair was applied to 21 (61.7%) patients. The overall neonatal mortality rate was 19.5% (n=31). In multivariate analysis, the higher STAT categories (OR:2.3, CI:95%, 1.1-5.1, p=0.03) and the presence of major postoperative complications (OR:9.8, CI:95%, 2.1-35.1, p=0.003) have increased the risk of neonatal mortality. Conclusion Newborns with congenital duct-dependent aortic anomalies necessitate meticulous perioperative care due to their heightened risk of morbidity and mortality.

Resumo Fundamento Em lesões cardíacas do lado esquerdo dependentes do canal, a circulação sistêmica depende do fluxo da direita para a esquerda através do canal arterial. Essas lesões podem ocorrer como um defeito isolado ou uma doença complexa. Objetivo Neste estudo, objetivamos investigar os resultados neonatais de lesões circulatórias sistêmicas dependentes do canal, especialmente coarctação da aorta (CoA) e arco aórtico interrompido (AAI). Métodos Um total de 159 pacientes com lesões sistêmicas dependentes de canal foram acompanhados na UTIN Cardíaca de nossa instituição de 2012 a 2022. Revisamos retrospectivamente os prontuários médicos de todos os pacientes do banco de dados do hospital. Eles foram analisados para desfechos clínicos e cirúrgicos. Um valor de p < 0,05 foi considerado estatisticamente significativo. Resultados De 159 pacientes, CoA foi detectada em 120 (75,4%) e AAI em 39 (24,5%) pacientes. Cateterismo cardíaco foi realizado em 74 (61,6%) pacientes com CoA no período neonatal; 49 (40,8%) foram submetidos a procedimentos terapêuticos e 25 (20,8%) diagnósticos. Cento e um pacientes com CoA (84,1%) foram submetidos à cirurgia com idade mediana de 14 dias (9-23). Trinta e quatro de 39 pacientes com AAI (87,1%) foram submetidos à cirurgia; reparo em estágio único foi realizado em 13 pacientes (38,2%), enquanto reparo em dois estágios foi aplicado a 21 (61,7%) pacientes. A taxa geral de mortalidade neonatal foi de 19,5% (n=31). Na análise multivariada, as categorias STAT mais altas (OR:2,3, IC:95%, 1,1-5,1, p=0,03) e a presença de complicações pós-operatórias graves (OR:9,8, IC:95%, 2,1-35,1, p=0,003) aumentaram o risco de mortalidade neonatal. Conclusão Recém-nascidos com anomalias aórticas congênitas dependentes do canal necessitam de cuidados perioperatórios meticulosos devido ao risco elevado de morbidade e mortalidade.