Timucin Imdadoglu

Background: Pectus excavatum (PE) is the most common congenital anterior chest wall deformity, yet most prevalence data derive from older children and adolescents. Systematic measurement-based neonatal data are scarce, and the early course of PE detected during this period remains largely unknown. This study evaluated the prevalence and early course of measurement-defined PE in a prospectively screened neonatal cohort. Methods: In this prospective single-center cohort, consecutive late-preterm and term neonates underwent ruler-based measurement of sternal depression. Neonates with an initial depth of ≥0.3 cm underwent independent confirmatory measurements by two trained study clinicians. Measurement-defined PE required a confirmatory patient-level depth of ≥0.3 cm and was classified as mild, moderate, or severe. Infants meeting this criterion were reassessed at 5–7 months using the same standardized protocol. Results: Among 2579 neonates, 143 met the screening threshold and underwent confirmatory assessment; 122 met the study-defined criterion for PE (measurement-defined neonatal prevalence, 4.73%). Follow-up was completed in 118 infants (96.7%). At 5–7 months, study-defined resolution occurred in 39 infants (33.1%), severity decreased in 22 (18.6%), remained stable in 44 (37.3%), and increased in 13 (11.0%). Median sternal depression depth decreased from 0.50 cm (IQR 0.40–0.70) to 0.40 cm (IQR 0.20–0.65; p < 0.001). Study-defined resolution was less frequent with a positive family history (15.8% vs. 49.2%; p < 0.001); positive family history and greater baseline severity were independently associated with lower odds of study-defined resolution at 5–7 months in exploratory analysis. Conclusions: Measurement-defined neonatal sternal depression showed heterogeneous early changes. Greater baseline severity and positive family history were associated with lower odds of study-defined resolution at 5–7 months. These findings may inform counseling about the early course but do not establish a benefit from universal neonatal screening or predict later clinically significant PE.

Background/Objectives: Serum vitamin B12 testing is frequently ordered in pediatric outpatient practice, either routinely or incidentally as part of broad laboratory panels or in response to symptoms and nutritional concerns; however, how the yield of low serum vitamin B12 results varies across age groups and testing indications remains poorly defined. The primary focus was age-related variation in low serum vitamin B12 results, with recorded testing indications examined as a secondary question and symptom-specific analyses considered exploratory. Methods: This single-center retrospective study analyzed testing episodes from children aged 0–18 years attending general pediatric outpatient clinics in 2025. Outcomes were <200 pg/mL (primary) and <300 pg/mL (secondary). Two blinded physicians classified testing indications. Cluster-robust regression evaluated age, sex, and indication; 18 symptom indicators were evaluated in age- and sex-adjusted models with Benjamini–Hochberg correction. Results: Of 34,744 episodes, 34,721 were valid; 5.8% were <200 pg/mL and 27.5% were <300 pg/mL. Low-result yield (<200 pg/mL) showed a bimodal age pattern: 7.9% at ages 0–2 years, 2.3% at 3–5 years, and 10.6% at 15–18 years. The number of tests per low result ranged from 9.4 at ages 15–18 years to 42.8 at ages 3–5 years. Routine or incidental testing comprised 63.9% of episodes; crude yield by indication ranged from 4.9% to 7.3%. Compared with 6–11 years, adjusted odds were higher at 0–2 years (aOR 2.81, 95% CI 2.44–3.24) and 15–18 years (aOR 3.92, 95% CI 3.42–4.51). No indication independently predicted the primary outcome; no symptom remained significant for that outcome after false discovery rate correction. Conclusions: The yield of low serum vitamin B12 results was strongly age-dependent and bimodal, with higher-yield periods during the first two years of life and adolescence. Broad retrospectively recorded testing indications were not independently associated with results < 200 pg/mL after adjustment for age and sex. These findings support age-informed assessment alongside clinician-directed testing.

Introduction: Biopsy-related hemorrhage in neonates is rare but may rapidly become life-threatening when refractory to conventional hemostatic interventions. This case is unique in reporting the first successful use of topical Ankaferd Blood Stopper® (ABS) as a salvage hemostatic agent in a neonate with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas, an exceptionally rare malignancy, following life-threatening, refractory post-biopsy hemorrhage. Patient concerns and clinical findings: A term female neonate presented with a rapidly enlarging left facial mass with proptosis and restricted eye movements. Intraoral incisional biopsy was performed to obtain histopathological diagnosis. Within 72–74 h post-biopsy, active hemorrhage persisted despite multiple conventional hemostatic measures, including local compression, topical epinephrine, intravenous tranexamic acid, vitamin K, and fresh frozen plasma (FFP). The neonate developed hemorrhagic shock with hemodynamic instability (heart rate >170 bpm, blood pressure 45/25 mmHg, oxygen saturation <88%) and required packed red blood cell (PRBC) transfusion. Baseline coagulation parameters were within normal neonatal reference ranges; comprehensive coagulopathy screening excluded an underlying bleeding disorder. Diagnosis, intervention, and outcomes: Histopathological examination was most consistent with infantile undifferentiated round-cell sarcoma within the differential spectrum of BCOR-altered sarcomas. Topical ABS was applied as a salvage intervention at 72–74 h post-biopsy. Hemostasis was achieved within minutes and was reproducible across three applications, with a total administered volume of no more than 6 mL and no local or systemic adverse effects. The neonate subsequently underwent urgent surgical debulking/resection and adjuvant therapy. At six-month follow-up, the patient remains alive without evidence of disease recurrence. Conclusion: Topical ABS may represent an effective and potentially lifesaving option for managing severe, refractory hemorrhage in neonates when conventional therapies fail. Its coagulation-independent mechanism may be particularly advantageous in this vulnerable population. This case highlights the importance of considering ABS in life-threatening neonatal hemorrhagic emergencies and underscores the need for prospective studies to establish standardized neonatal protocols.

Background: Exclusive breastfeeding (EBF) provides health benefits, yet its continuation remains limited. Maternal endocrine disorders, including gestational hypothyroidism, may impair lactogenesis through hormonal dysregulation; however, evidence regarding the association between gestational hypothyroidism and breastfeeding outcomes remains limited. Objective: To investigate the association between maternal gestational hypothyroidism and breastfeeding outcomes in term infants, with a focus on EBF at the end of the first month and formula-free breast milk feeding at 6 months. Methods: This retrospective matched case–control study compared term infants of mothers with gestational hypothyroidism treated with levothyroxine ( n = 103) and matched controls ( n = 103). Feeding data were obtained from medical records and 6-month telephone follow-up, and factors associated with early formula supplementation were analyzed using multivariable logistic regression. Results: EBF rates were significantly lower in the case group at 1 month (58.3% versus 81.6%, p < 0.001). Formula supplementation within the first postnatal day was more frequent in the case group than in controls (46.6% versus 21.4%; χ ² = 14.63, p < 0.001). At 6 months, formula feeding—either alone or combined with breastfeeding and/or complementary foods—was significantly more frequent in the case group (45.6% versus 25.2%, p = 0.003). Among infants who ever received formula ( n = 84), formula was initiated during the first postnatal month more frequently in the case group (82.7% versus 59.4%, p = 0.018), with earlier mean age at formula initiation (1.4 ± 0.97 versus 2.3 ± 1.51 months, p = 0.003). Multivariable logistic regression showed that higher maternal gravidity was independently associated with early formula supplementation (odds ratio = 3.16; 95% confidence interval: 1.09–9.10; p = 0.033). Conclusions: Gestational hypothyroidism was associated with lower EBF rates at 1 month and increased early formula supplementation. These findings underscore the need for targeted lactation support and careful postpartum follow-up in mothers with gestational hypothyroidism.

The literature on neonates with SARS-CoV-2 is mainly concerned with perinatal cases, and scanty data are available about environmentally infected neonates. To fill knowledge gaps on the course and prognosis of neonatal cases, we analyzed 1-year data from the Turkish Neonatal Society in this prospective cohort study of neonates with postnatal transmission. Data from 44 neonatal intensive care units (NICUs), of neonates with positive RT-PCR results at days 5–28 of life, were extracted from the online registry system and analyzed. Of 176 cases, most were term infants with normal birth weight. Fever was the most common symptom (64.2%), followed by feeding intolerance (25.6%), and cough (21.6%). The median length of hospitalization was 9 days, with approximately one quarter of infants receiving some type of ventilatory support. Myocarditis (5.7%) was the most common complication during follow-up. Among the clinical findings, cough (odds ratio [OR]: 9.52, 95% confidence interval [CI]: 4.17–21.71), tachypnea (OR: 26.5, 95% CI: 9.59–73.19), and chest retractions (OR: 27.5, 95% CI: 5.96–126.96) were associated with more severe clinical disease. Also, there were significant differences in the C-reactive protein level, prothrombin time (PT), partial thromboplastin time, international normalized ratio, and days in the NICU (p = 0.002, p = 0.012, p = 0.034, p = 0.008, and p < 0.001, respectively) between patients with mild-moderate and severe-critical presentations. A PT above 14 s was a significant predictor of severe/critical cases, with a sensitivity of 64% and specificity of 73%. Conclusions: Our data showed that late-onset COVID-19 infection in neonates who need hospitalization can be severe, showing associations with high rates of ventilatory support and myocarditis. Cough, tachypnea, and retractions on admission suggest a severe disease course. Trial registration: ClinicalTrials.gov identifier: NCT04401540. What is Known: • Neonatal cases of COVID-19 infection are mainly reported as perinatal COVID-19 cases. • Neonates with perinatal transmission have a mild course and favorable prognosis. What is New: • Among symptomatic neonates with late-onset COVID-19 infection, fever was the most common symptom, and almost one quarter of hospitalized cases needed some type of respiratory support. Myocarditis was the most common complication. • The presence of cough, tachypnea, retractions, and a PT above 14 s were associated with an increased risk of severe COVID-19.