Changes in anthropometry in full-term breastfed newborns and associated factors for the first month

OBJECTIVE

We aim to assess the changes and associated factors in newborn anthropometry in the first month for full-term, healthy, and exclusive-breastfed infants.

METHODS

Neonatal anthropometric measurements were taken on day 5, day 15, and day 30 after delivery. Generalized estimating equations (GEE) analyzed the changes.

RESULTS

From 169 mother-newborn pairs, GEE showed that weight gain during the first month was influenced by maternal body mass index (BMI), delivery type, birth weight, and jaundice after adjusting confounding factors (p < .05). The neonatal length was affected by the smoking status of parents, gestational maternal health problems, maternal height, birth weight, and jaundice (p < .05). Neonatal head circumference was influenced by the smoking status of parents, gestational maternal health problems, maternal BMI, delivery type, maternal height, and birth weight.

CONCLUSION

Adverse perinatal factors including mother's smoke exposure, maternal obesity and diabetes, cesarean birth, and neonatal hyperbilirubinemia influence anthropometry in the first months of life.

Trends and associated factors of bottle-feeding in Turkey: dramatic change over the last three decades under the limited implemented code

The study aimed to examine the trends and associated factors of bottle-feeding among children aged 0-35 months. Data covering 11,205 mother-child pairs, from six recent Turkey Demographic and Health Surveys (TDHSs) were analyzed by using complex sample crosstabs and logistic regression. Bottle-feeding was on an upward trend from 33.0% to 51.5% from 1993 to 2013 and fell slightly 47.9% in 2018. Increasing trends of bottle-feeding were found in children aged 6-35 months, the East region, lower wealth index, maternal education under 5 years, Kurdish mothers, and the low antenatal care attendance. Multivariate analysis using data from TDHS-2018 showed that young maternal age, low birth weight and being 6-23 months of age were associated with higher rates of bottle-feeding. The prolonged bottle-feeding became widespread, and the bottle-feeding was common even in 35-month-old children. Interventions by the Government and stakeholders to minimize low rates of bottle-feeding should focus on high-risk groups.

Comorbidity of behavioral problems and parental acceptance-rejection in children diagnosed with chest discomfort, palpitations, vasovagal syncope, and underlying heart disease: a multiple case-control study

BACKGROUND

Children who experience chest discomfort, palpitations, vasovagal syncope, and underlying heart disease often present a complex clinical picture. Not only are they dealing with potential cardiac issues, but they may also exhibit behavioral problems that can complicate the diagnostic and treatment process. Moreover, parental acceptance or rejection can significantly influence the child's well-being and medical outcomes in such cases. This study aims to explore the comorbidity of behavioral problems and parental acceptance-rejection in children diagnosed with these cardiac symptoms and underlying heart disease.

METHODS

In a case-control study, the Parental Acceptance - Rejection Questionnaire and Parental version of Strengths and Difficulties Questionnaire (SDQ) was filled by parents of 314 patients from pediatric cardiology clinic.

RESULTS

The control group scored substantially lower overall according to SDQ. The vasovagal syncope subgroup was found to have considerably lower scores on the subscale. The group with chest discomfort scored highly in hostility and aggression in the PARQ. In comparison to the other groups, the vasovagal syncope and chest pain group demonstrated higher scores in undifferentiated rejection and total score.

CONCLUSION

This study showed a correlation between children's behavioral and emotional problems and cardiac symptoms. This states that children's relationship with their parents has an impact on their symptoms. It will be necessary to conduct further studies to determine a causal association and devise preventative measures.

Rates of childhood vaccine refusal in Turkey during 2016-2017: Regional causes and solutions

OBJECTIVE

Vaccine hesitancy is a growing problem globally. This study aimed to detect the rates of vaccine refusal (VR) during childhood in each province and region of Turkey from 2016 to 2017 and to evaluate the experiences of Expanded Programme on Immunization (EPI) managers regarding childhood VR and opinions to solve and reduce vaccine hesitancy in Turkey.

METHODS

VR was defined as the refusal to vaccinate for at least one vaccine in children aged 0-23 months. In this descriptive study, information on notified VR cases and recommended solutions from every province in Turkey was accessed by the local EPI manager for the period 2016-2017. The VR rates were calculated.

RESULTS

From 80 provinces, 8977 VR cases were detected in 2016 (VR rate 3.5‰) and 14,779 cases in 2017 (VR rate 5.9‰; p<0.001). One quarter of Family Health Units reported at least one case of VR. The highest VR rate in children aged under 2 years was in East Marmara (8.4‰) in 2016, and the West Anatolia Region (10.9‰) and East Marmara region (10.9‰) in 2017. Concerns about the vaccine content, harmfulness, and fears about adverse effects were the most common reasons underlying VR. Educating healthcare workers about vaccines and interpersonal communication skills, increasing patient information with informative brochures, and preventing anti-vaccination publications in the media were the most frequent recommendations to solve VR.

CONCLUSIONS

In Turkey, VR cases continue to increase. Correct and adequate information, effective communication, and trust between healthcare workers and parents can help reduce VR.

Zero-dose children in Turkey: regional comparison of pooled data for the period 1990 to 2018

BACKGROUND

Immunization plays a vital role in child health and survival. Zero-dose children are coming increasingly into focus as part of the global Immunization Agenda 2030. Although the percentage of zero-dose children has decreased in Turkey over time, regional/socioeconomic inequalities persist. This study aims to analyze the trend in zero-dose children and the factors associated with this problem in Turkey in light of regional inequalities.

METHODS

Six data sets (1993, 1998, 2003, 2008, 2013, and 2018) were pooled from the last six Turkey Demographic and Health Surveys (TDHSs). The vaccination module for children aged 12-35 months and variables related to household characteristics, socio-economic, cultural characteristics of parents, bio-demographic/health-related factors were taken from the DHS data. Binary logistic regression analyses were carried out by taking into account the complex sample design of surveys for Turkey in general, the East region, and other regions.

RESULTS

Significant progress has been made in reducing the number of zero-dose children in Turkey over the last three decades, as it has dropped from 3.2 to 0.9%. The results of multivariate analyses revealed that survey year, household wealth, the mother's level of education, payment of bride price, mother's native language, place of delivery, and the number of antenatal care visits are associated with zero-dose children. Factors associated with zero-dose children also differ between the East region, and other regions.

CONCLUSION

Public health programs targeting uneducated parents, poor households, lack of social security, Kurdish-speaking mothers, older mothers and those without antenatal care should be implemented to promote childhood immunization.

Associations between toxic elements and blood pressure parameters in adolescents

BACKGROUND

Both exposure to toxic elements and hypertension (HT) are a global health problem. We planned to examine the associations between some toxic elements in urine, and blood pressure (BP) and its diurnal changes in adolescents.

METHODS

In this cross-sectional study, 48 adolescents who were newly diagnosed with HT and 38 adolescents with age-appropriate BP and normal physical examination were included. Anthropometric measurements, urinary toxic elements, carotid intima media thickness (cIMT), and office and 24-hour ambulatory BP measurements (ABPM) of participants were taken. Urinary elements levels were studied with ICP-MS. Elements were grouped in tertiles according to urinary levels. Logistic regression analyses were performed to show the interactions.

RESULTS

Urinary cadmium, mercury, lead, and arsenic were found to be at detectable level in 90.7%, 69.8%, 91.9% and 100% of the participants, respectively. Univariate analyses showed that elevated daytime systolic and/or diastolic BP was associated with urinary cadmium and mercury. No association between urinary toxic elements and nighttime BP was found. When height and body mass index z-scores adjusted for, age, gender, and all four urinary creatinine-corrected toxic elements analyzed, multiple logistic regression revealed that there was an association between mercury (high vs. low; AOR:3.85) and office HT, and mercury (high vs. low; AOR:6.18) and cadmium (middle vs. low; AOR: 13.38) were associated with "elevated 24-hour systolic BP and/or diastolic BP", and "elevated 24-hour mean arterial BP" in ABPM.

CONCLUSION

There are complex relationships between toxic elements and BP parameters in adolescents, and more studies are needed to define the evolution of these relations.

Association of urine phthalate metabolites, bisphenol A levels and serum electrolytes with 24-h blood pressure profile in adolescents

Background

Among the possible causes of hypertension in adolescence, electrolyte imbalances and environmental pollutants are drawing increasing attention. We aimed to examine the relationship between bisphenol A (BPA), phthalate metabolites, and serum electrolytes and blood pressure.

Methods

Eighty-six participants aged 12–15 years were included in the study. Body mass index (BMI), office blood pressure and 24-h ambulatory blood pressure measurements (ABPM), and carotid intima-media thickness were determined. Blood samples were taken for hemogram, renal function tests, and serum electrolytes. Free- and total-BPA and phthalate metabolites were analyzed from urine samples.

Results

Of the participants, 34 were evaluated as normal blood pressure profile, 33 as white-coat hypertension (WCHT), and 19 as ABPM-hypertension. Adolescents in ABPM- hypertension groups had higher BMI-standard deviation score (SDS), leucocyte, platelet count; but lower serum chloride, compared to the normal blood pressure profile group. The percentage of adolescents with detectable urinary mono-benzyl phthalate (MBzP) was higher in ABPM-hypertension (42.1%) and WCHT groups (33.3%), compared to the normal blood pressure profile group (5.9%, p = 0.004). Associations between MBzP and ABPM- hypertension and WCHT were remained after confounding factor adjustment. Adolescents with detectable MBzP levels had also higher “albumin-corrected calcium” and lower serum phosphate and “albumin-corrected calcium x phosphate product” compared to others. Adolescents with detectable urinary MBzP levels had higher blood pressure profiles in some 24-h (mean arterial pressure-SDS, systolic blood pressure-SDS), daytime (systolic blood pressure-SDS), and night-time (mean arterial pressure-SDS, systolic blood pressure-SDS, and diastolic blood pressure-SDS) measurements, compared to others. WCHT was found to be associated negatively with monomethyl phthalate and the sum of dibutyl phthalate metabolites and ABPM-HT with MCPP. There was no significant association between blood pressure profiles and free- and total-BPA status.

Conclusion

MBzP was associated with adverse blood pressure profiles in adolescence. Additive follow-up studies are necessary for cause-effect relations.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12882-022-02774-y.

Effects of the COVID-19 pandemic on perinatal outcomes: a retrospective cohort study from Turkey

Background

Lockdowns, pregnant women’s fear from hospitalization in addition to uncertainties about appropriate birthing practices at the beginning of the pandemic may have affected the health outcomes of mother-infant couples. We aimed to explore whether pregnancy outcomes including the rates of cesarean delivery (CS), preterm, and low birth weight (LBW) births have changed during the pandemic period compared with the pre-pandemic period.

Methods

We applied a population-based retrospective cohort, before-after approach in 2020 vs. similar calendar months in 2019 for five periods [Jan-Feb (pre-pandemic); March–May (1st wave and lockdown); June–August; September–October; November–December (2nd wave and lockdown)]. The data was modelled through multiple logistic regressions using key outcomes; CS, preterm, and LBW births as the dependent variables, and adjustments were made for independent variables in SPSS software. We evaluated the modification of years by periods by adding interaction term (yearXperiod) to the model.

Results

The rate of CS in hospital births increased from 57.7% in 2019 to 60.2% in 2020. CS rates were significantly increased during the 3rd and 4th periods. The overall preterm rate was 11%. When singleton pregnancies were considered, adjusted multivariable analyses showed a decrease in preterm proportions during all time periods with respect to the pre-pandemic period. The percentage of LBW was 7.7% during the pandemic period and was found to be significantly reduced compared to the pre-pandemic period. There was a significant reduction in LBW rates in all periods except the second lockdown period.

Conclusions

Our findings suggested significant reductions in preterm and LBW births possibly due to the indirect effects of the pandemic. Moreover, strategies need to be considered to address the increased CS rates and shifting of maternity service utilization to private facilities.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-04349-5.

Presence of melamine in human milk and the evaluation of the effects on mother–infant pairs in a cohort study

Melamine contamination is a recent public health problem emerging globally. Present study aimed to detect the rate of melamine presence in human milk in a cohort study and to evaluate any possible differences in maternal–infant pair characteristics such as breastfeeding status, crying and sleep problems of infants, maternal postpartum depression, maternal–infant bonding, infant and maternal anthropometry, and maternal complete blood count caused by the melamine exposure. Mothers of infants born in Şanlıurfa were invited to participate in ‘Urfa Child Cohort Survey’. Overall, two breast milk samples were taken between 5 days and 15 days postpartum and between 4 weeks and 10 weeks. Randox Food’s InfiniPlex array was used to analyse the presence of melamine. Melamine was detected in 32.2% and 24.4% of the first and the second milk samples; 16.7% of mothers had two positive samples. z Scores for birth weight and z scores for height for age were detected to be significantly lower in cases with two positive samples compared to cases with negative samples. Mean maternal white blood cells counts were found to be lower in cases with repeated melamine contact. Melamine might have a detrimental effect on birth weight, infant height and maternal blood count. Further studies should be done to detect environmental contamination in different regions and countries.

Determinants of Exclusive Breast Feeding in sub-Saharan Africa: A Multilevel Approach

BACKGROUND

The study aimed to provide an overall picture of the general pattern of exclusive breast feeding (EBF) in sub-Saharan Africa (SSA) by examining maternal sociodemographic, antenatal and postnatal factors associated with EBF in the region, as well as explore countries variations in EBF rates.

METHODS

We utilised cross-sectional data from the Demographic Health Surveys in 27 SSA countries. Our study sample included 25 084 infants under 6 months of age. The key outcome variable was EBF in the last 24 h. Due to the hierarchical structure of the data, a multilevel logistic regression model was used to explore factors associated with EBF.

RESULTS

The overall prevalence of EBF in SSA was 36.0%, the prevalence was highest in Rwanda and lowest in Gabon. In the multilevel regression model, factors that were associated with increased likelihood of EBF included secondary and above maternal education, mothers within the ages of 25-34 years, rural residence, richer household wealth quantile, 4+ antenatal care visit, delivering in a health facility, singleton births, female infants, early initiation of breast feeding (EIBF), and younger infants. However, countries with higher gross national income per capita had lower EBF rates.

CONCLUSIONS

To achieve a substantial increase in EBF rates in SSA, breast-feeding interventions and policies should target all women but with more emphasis to mothers with younger age, low educational status, urban residence, poor status, multiple births, and male infants. In addition, there is a need to promote antenatal care utilisation, hospital deliveries, and EIBF.

Association between anthropometric measurements and dental caries in Turkish school children

AIM

To evaluate the association between anthropometric measurements and dental caries in school children.

METHODS

The study was conducted on 245 primary school children (50.2% boys, 49.8% girls,), aged 5 to 9 years. The prevalence and severity of dental caries was measured using the decayed, missing or filled surfaces (dmfs, DMFS) and teeth (dmft, DMFT) indices.

RESULTS

Mean dmft indices in children for boys and girls were 5.5 +/- 3.92 and 5.0 +/- 3.64, respectively. The prevalence of children with dental caries (dmft > or = 1) was 84.9%. The prevalence of children with body mass index (BMI) <-1SD and > or = +1SD was 15.9% and 22.9%, respectively. Dental caries were found in 89.7% of children with low body weight (including underweight and at risk for underweight) and in 66.1% of overweight-obese children (p<0.05). Similarly, high indices were detected significantly more often in children with low body weight (p<0.05). Height, weight, BMI and percent of fat mass were found to be negatively correlated with dmft indices (r:-0.141, p: 0.028; r:-0.171, p: 0.007; r:-0.139, p: 0.030; r:-0.158, p: 0.013, respectively).

CONCLUSION

Children with low body weight have a higher risk of developing dental caries than overweight-obese children. For these reasons, the evaluation of nutritional status in children should be implemented in control programs for dental caries both on the community and individual levels.

Effects of supplementary iodine on the performance and egg traits of laying hens

1. This experiment was carried out to determine the effects of dietary iodine supplementation on the performance and egg traits of laying hens. A total of 600 SHSY type brown layers aged 21 weeks of age were chosen at random from a large flock. They were randomly distributed into 30 pens at 20 hens per pen. Each treatment comprised 6 replicates of 20 layers in groups of 5 birds. The diets were supplemented with 0, 3, 6, 12 and 24 mg/kg iodine as calcium iodate. The experimental period lasted 30 weeks. 2. There were no significant differences among the groups in body weight, food consumption, egg production, food consumption per kg eggs, eggshell index, eggshell breaking strength, shell thickness or egg yolk index. 3. Supplementation of the diet with 12 mg/kg iodine increased food consumption per dozen eggs compared to the groups fed on diets supplemented with 0 and 6 mg/kg iodine. 4. Egg weight was less in groups fed on diets supplemented with 12 and 24 mg/kg iodine than in the group receiving no iodine supplementation. 5. Iodine supplementation to provide 12 and 24 mg/kg reduced egg albumen index and egg Haugh units. 6. There were no significant differences among the groups in egg cholesterol and egg yolk cholesterol contents. 7. The iodine concentrations in egg yolk, egg albumen and whole egg increased with increased iodine supplementation. 8. As a result, the 3 and 6 mg/kg iodine supplementation of diet could be used to enrich the eggs with iodine without any adverse effect on performance and egg traits.

The factors that have a role in variability for temperature

Our objective was to determine the factors that affect (i) the rectal-axillary temperature measurement difference (RATD) for digital and mercury-in-glass thermometers and (ii) the difference between mercury-in-glass and digital thermometer readings taken by the rectal and axillary routes. Children (between the ages of 2 and 48 months) who were admitted to Hacettepe University Children Hospital and Corum Children's Hospital in 2 months period were included in this study. Two measurements were taken from each patient within 2 days at two different occasions including day/night and sleep/awake by the same physician. A total of 135 patients were enrolled. RATD was 0.61 + 0.54 degrees C in the mercury-in-glass thermometer, and 0.81 +/- 0.57 degrees C in the digital thermometer. The mean differences between digital and mercury-in-glass thermometers were 0.16 degrees C for rectal routes and -0.02 degrees C for axillary routes. Children at older age with hypoalbuminemia and children exposed to higher ambient temperatures had lower values of RATD than others. Temperature recordings from different sites might change with ambient temperature and individual characteristics of children.

The effect of oral L-carnitine supplementation on the lipid profiles of hyperlipidaemic children

AIM

To investigate the carnitine status and the effect of carnitine supplementation on serum lipid profiles in children with hyperlipoproteinaemia, a clinical open trial was conducted at Hacettepe University Ihsan Dogramaci Children's Hospital, Section of Nutrition and Metabolism.

METHODS

Patients were given carnitine at a dose of 100 mg/kg/d for 12 wk. Blood samples for the determination of lipid profile and carnitine levels and urine samples for carnitine levels were obtained on admission, at week 4 and week 12 of the study period.

RESULTS

A total of 41 children were enrolled in the study: 20 patients had type II heterozygotes, eight patients had type II homozygotes, three patients had type III, six patients had type V and four patients had secondary hyperlipidaemias. Serum and urine carnitine levels were within normal limits on admission. No significant correlations were found between serum carnitine levels and serum lipid profiles. Serum HDL and apolipoprotein A-I decreased significantly during the 12 wk of intervention in type II heterozygotes. In type II homozygotes, total cholesterol and LDL levels at weeks 4 and 12 increased significantly compared to initial levels. No significant change was noted for lipid parameters in hyperlipoproteinaemia type V.

CONCLUSION

The results of this trial demonstrated that carnitine supplementation was of no benefit for children with hyperlipidaemias, especially in primary hyperlipoproteinaemia type II heterozygotes, homozygotes and type V.

Factors that affect television viewing time in preschool and primary schoolchildren

BACKGROUND

Excessive viewing of television (TV) has been linked to aggressive behavior, violence and childhood obesity.

METHODS

A cross-sectional study was conducted among preschool children and primary schoolchildren in Ankara during March and April 1999 to detect the factors that affect TV viewing time and to evaluate their parents' knowledge, attitudes and practices with regard to TV. The parents were asked to fill out a questionnaire about TV habits of their family, the number and location of TVs in the household and the effect of TV on children. Of 400 questionnaires, 350 answered the questions appropriately for this study. Children were divided into two groups, preschool children and primary schoolchildren. Television viewing time was given daily, as a mean of weekday.

RESULTS

The mean age for becoming a TV viewer was 2.7 +/- 1.6 years. Of all, 62% of children spent >/= 2h/day watching TV and 8.3% of children spent > 4 h. The TV viewing time of child was significantly and positively correlated with that of siblings, mother and father for both groups. Age and sleeping time of the child, age and the education level of mother, presence of TV in the child's room and the starting age watching TV did not affect the viewing time. One-half of parents reported that the TV programs watched included violence, and one-third thought TV depicts child abuse, especially emotional abuse.

CONCLUSIONS

It was found that the TV watching habits of parents had an influence on those of their children. Therefore, pediatricians should take 'TV histories' of children and their parents and educate parents how to become good TV viewers.

Short-term developmental outcome of iron prophylaxis in infants

BACKGROUND

Previous studies on the cognitive effects of iron treatment have focused on anemic or non-anemic iron-deficient infants. The effect of iron supplementation on cognitive development among iron-sufficient infants has not been studied. The aim of the present study was to examine the effect of iron supplementation on performance in the Bayley Scales of Infant Development (BSID) and anthropometric measurement in 6-month-old iron-sufficient healthy infants.

METHODS

Healthy, iron-sufficient infants who were 6 months of age and were attending the Well Baby Clinic were considered for enrollment. Infants were randomly assigned to take ferrous sulfate supplementation (1 mg/kg per day) or no supplementation and were followed for 3 months. Anthropometric measurement, hematologic status and BSID were evaluated on admission and after 3 months.

RESULTS

Seven infants in the intervention group and nine in the control group completed the study. No significant differences were observed in anthropometric measurements and complete blood counts between the two groups after the 3 month study period. The mean transferrin saturation (TS) level decreased significantly in the control group during the study period (from 15.3+/-2.6 to 7.8+/-5.1%; P = 0.0117), but no such reduction was seen in the intervention group. At the end of the study, the TS of the control group was found to be significantly lower than that of the intervention group (7.8+/-5.1 vs. 19.9+/-7.9%, respectively; P = 0.0033). The BSID scores of infants in both groups were within the normal range on admission and at the end of the study period.

CONCLUSIONS

Short-term iron supplementation did not change developmental test scores despite the hematologic response in iron-sufficient healthy infants. The high prevelance of iron-deficiency anemia and its relationship with adverse developmental outcome suggests that prevention of iron-deficiency anemia with prophylaxis needs to be emphasized, rather than treatment.

Vitamin A supplementation in acute diarrhea

BACKGROUND

Vitamin A supplementation reduces the severity of subsequent diarrheal episodes. This study was conducted to examine the effect of single oral high-dose vitamin A supplementation on the duration of acute diarrhea in 6- to 12-month-old infants who are not malnourished.

METHOD

In this double-blind, randomized, placebo-controlled study, infants who were admitted to Hacettepe University Ihsan Dogramaci Children's Hospital Diarrheal Diseases Training and Treatment Unit with acute diarrhea were randomly assigned either to a group receiving a single oral dose of 100,000 IU vitamin A or placebo. There were 60 infants in each group. All infants were followed up until the diarrheal episode ended. Serum vitamin A levels were determined both at admission and 2 weeks later.

RESULTS

No effect of vitamin A supplementation could be demonstrated on either the total duration of diarrhea (7.4 +/- 3.2 days in the treatment group vs. 7.8 +/- 3.1 days in the placebo group) or on its duration after intervention (3.8 +/- 2.3 days in the treatment group vs. 3.9 +/- 1.9 days in the placebo group; P > 0.05 for both comparisons). Serum vitamin A levels were not significantly different at admission (23.5 +/- 9.7 microg/dL in the treatment group vs. 24.1 +/- 9.7 microg/dL in the placebo group; P > 0.05) nor at the end of a follow-up period of 2 weeks (treatment: 33.3 +/- 13.7 microg/dL, placebo: 35.2 +/- 11.2 microg/dL; P > 0.05). However, the increase in serum vitamin A levels at the end of the 2-week follow-up interval for infants in both the treatment and placebo groups were found to be significant compared with levels at admission (P < 0.01). The mean weight gain in both groups were similar by the end of the first month (6.9 +/- 5.0% in the treatment group vs. 6.3 +/- 4.2% in the placebo group; P > 0.05).

CONCLUSION

No effect of oral vitamin A supplementation on serum vitamin A levels, duration of diarrhea, or weight gain during an acute diarrheal episode could be demonstrated in our study group of infants between 6 and 12 months of age who had no malnutrition.

Multimedia and children in Turkey

Multimedia will be regarded as essential tools for children to create their new world. The effects of television on young children's life have been well studied. Television differs, however, from other media, including the movies, in its pervasive impact on children. Children spend more time watching television than any other activity except sleeping. Overall 31% of children spent at least 4 hours a day watching television during weekday and 71.7% during weekend in Turkey. Television's influence on children is a function of the length of time they spend watching and the cumulative effect of what they see. Television may be a cause as well as a solution for many serious childhood problems. Excessive viewing of television has also been linked to aggressive behavior, violence, childhood obesity. On the other hand, television may act as a socializing agent and as a learning tool if the recommendations of American Academy of Pediatrics is learned by pediatricians, parents and broadcasters. The use of home personal computers in urban residence increased from 3.2% in 1993 to 6.5% by January 1998 in Turkey. Around 20% of computer households reported owing a modem. Internet has been using only for 5 years in Turkey. Nearly 40% of computer households also used CD-ROM equipment. The percentage of schools that have a computer laboratory is only 2.64%. On the other hand, multimedia allows students to move away from a uniform education for everyone to assert individual identity, liberalize education and management. It seems likely that, within the next few years, most of the countries with substantial internet infrastructure will use the internet as the major medium for disseminating information, including information on children. To prepare students for such a world demands that educational systems make the best possible use of all knowledge and technologies currently available.

Clinical trial to evaluate immunogenicity and safety of inactivated hepatitis A vaccination starting at 2-month-old children

Active immunization with hepatitis A vaccine has been shown to provide long-term protection against hepatitis A virus (HAV) infection. However, few data are available regarding use of the hepatitis A vaccine in children under two years of age. The present study was conducted to test the safety and immunogenicity of inactivated hepatitis A vaccine administered to infants, and to evaluate the correlation between mother and infant anti-HAV antibodies. A total of sixty healthy children, two months of age, were enrolled in this study and immunized with 360 EU of inactivated hepatitis A vaccine (Havrix) according to the two, four and six months of age schedule. Blood sampling was performed prior to the first vaccination and one month after the third vaccination at seven months. Venipuncture was also done on mother on admission. The reactogenicity was expressed as the percentage of reported local and systemic reactions. The most common side effects were erythema on the injection site and fever. Infants with passively transferred maternal anti-HAV antibodies had a reduced anti-HAV GMT after vaccination. On admission, only one infant and his mother were seronegative and seroconversion was only detected in this infant. One month after the third dose seven infants (12.3%) were found to be seronegative. The infant without passively acquired maternal anti-HAV had the protective levels with a GMT of 3176 mIU/ml one month following the third dose. There was a significant positive correlation between the titers of mother and infant anti-HAV antibodies (n = 0.96, p < 0.001) on admission. Hepatitis A vaccine showed no immunogenicity in infants with presence of maternal antibodies. Hepatitis A vaccine is safe but it should be used after the disappearance of maternal antibodies.

Clinical characteristics of transient glucose intolerance during acute diarrhoea

Transient glucose intolerance (TGI) is an important cause of WHO G-ORS (Glucose-Oral Rehydration Solution) treatment failure and hospitalization in dehydrated children during acute diarrhoea. This retrospective case-control study was designed to determine some risk and predictive factors for developing TGI among moderately dehydrated patients with acute diarrhoea while under G-ORS therapy. Among moderately dehydrated patients, files of 22 patients with TGI and 66 other dehydrated patients without intolerance were reviewed. Patients with TGI were younger (9.7+/-10.5 mo and 11.6+/-7.8 mo, respectively, p < 0.05), the median age being 6 mo in the TGI group and 10 mo in non-TGI group. There was no difference between groups for sex, admission season, history of fever or vomiting, frequency of vomiting, presence of blood, mucous or leukocyte in stool, presence of associated disease and duration of diarrhoea on admission. The admission haemoglobin, white blood cell, blood pH, sodium and potassium levels were similar in both groups. The mean serum chloride level (116.8+/-6.9, 109.6+/-7.9 mEq/l, respectively, p<0.05) was higher in the TGI group and the bicarbonate level was lower (12.9+/-3.8, 15.3+/-6.0, respectively, p < 0.05). Stool frequency was also higher in patients with TGI (11.2+/-5.3/24 h, 5.9+/-4.4/24 h, respectively, p < 0.05). No difference was found between the nutritional status of children in both groups. More children were breastfed in the group without TGI (34/56, 61%, 6/18, 33% respectively, p=0.079, OR=0.32, 95% CI [0.09-1.11]). It was concluded that patients with TGI are younger and have high stool frequency. Although statistical significance could not be shown, breastfeeding seems to protect children from TGI, as it protects from diarrhoea.

The impact of the sexual maturation stage on body mass index in adolescent girls

Body mass index (BMI) is used in the clinical assessment of adiposity in children and adolescents. Population-based, race-specific and age-specific curves of BMI for children and adolescents exist, but there are noknown sexual maturation-based BMI curves. The aim of this study was to investigate the effects of pubertal development (assessed according to the Tanner breast stage) on BMI in adolescent girls in a cross-sectional study. The study group comprised 167 healthy girls, between the ages of nine and 16 years, attending school near a hospital in Gerede, Bolu. A significant positive correlation was found between the Tanner stage of breast development and BMI (r = 0.79, p < 0.001). Age also had a significant influence on BMI (r = 0.69, p < 0.001). After controlling the effects of age, BMI was highly correlated with weight (r = 0.82, p < 0.001) and the Tanner breast stage (r = 0.49, p < 0.001), but not with height. The correlation between BMI and the sexual stage was also found to increase with increasing age. But when breast development was taken as a control parameter, BMI was not statistically associated with age or height. As a result, there was a significant variation in BMI with the Tanner breast stage in addition to the well known change with increasing age in adolescent girls. Developmental differences occurring in the same age may require that BMI be evaluated only within the same sexual stages in adolescence. This study indicates that the curves of BMI need to take into account the sexual maturation stage of adolescents.

Rehydration of moderately dehydrated children with transient glucose intolerance using rice oral rehydration solution

Following the successful rehydration of two moderately dehydrated patients with transient glucose intolerance (TGI) using rice-oral rehydration solution (R-ORS), R-ORS has been used in Hacettepe University Ihsan Dogramaci Children's Hospital Diarrhea Training and Treatment Unit (DTTU) to rehydrate moderately dehydrated children with TGI. The files of children with moderate dehydration and glucose intolerance admitted to the unit were reviewed retrospectively within two periods according to the availability of R-ORS. The clinical and laboratory findings were analysed where available. Before R-ORS became available (September 1993) 6 patients were admitted, all of whom deteriorated with glucose (G)-ORS treatment in 7.0 +/- 3.8 h and were hospitalized for i.v. fluid treatment. During the second period 22 moderately dehydrated children with TGI were admitted. The clinical and laboratory characteristics on admission of the children in the two periods were not statistically different (p > 0.05). Among the 22 patients admitted during the second period 10 were administered G-ORS in the unit and 12 had already received G-ORS at home. Clinical and laboratory deterioration was observed in these 10 patients while receiving G-ORS in the unit within 6.3 +/- 3.7 h and rehydration was continued with R-ORS. Clinical and laboratory improvement were demonstrated in 8 patients within 18.2 +/- 6.5 h. Overall, 17 patients were rehydrated successfully with R-ORS, with a mean time of 18.0 +/- 7.2 h. Five patients were hospitalized. The overall success rate of R-ORS was 77.3%. R-ORS may be considered as an alternative mode of therapy to i.v. treatment in the rehydration of moderately dehydrated children with TGI.

The effect of live measles vaccines on serum vitamin A levels in healthy children

OBJECTIVE

Serum retinol levels have been shown to be depressed during measles infection. This study aims to demonstrate whether there is any decrease in serum vitamin A level following immunization with live viral vaccine and its relation with vaccine seroconversion in children with measles. Since many children receive measles vaccine alone or in combination with measles-mumps-rubella vaccine, we studied serum vitamin A levels and antibody levels in healthy, well-nourished children before and after immunization with monovalent and combined live attenuated measles vaccine.

METHODS

The first group included 21 healthy children between the ages of 9-11 months who received live measles (Schwarz) vaccine. There were also 21 healthy children (range 14-20 months of age) who received measles-mumps-rubella Trimovax (Pasteur Merieux) vaccine. All children were tested for serum vitamin A levels before vaccination, on days 9-14 and 30-42 following both vaccinations. Measles specific antibody levels were also measured on admission and 30-42 days following vaccinations.

RESULTS

In both vaccination groups, mean serum vitamin A levels reduced significantly on days 9-14, but increased slightly on days 30-42 in the measles-mumps-rubella vaccinated group (P < 0.05). The baseline and follow-up levels of mean serum vitamin A did not differ between seroconverted and nonseroconverted cases within the measles vaccinated group.

CONCLUSION

Serum vitamin A levels are reduced following vaccination with monovalent and combined live attenuated measles vaccines.

Clinical value of glycated hemoglobin and fructosamine in the long-term glycemic control of children with acute lymphoblastic leukemia

Hyperglycemia in children with acute lymphoblastic leukemia (ALL) has been well documented in the literature. The purpose of the present study was to evaluate the clinical value of glycated hemoglobin (GHb) and fructosamine (Frc) in the long-term glycemic control of ALL patients. An attempt was made to identify the risk factors for hyperglycemia in ALL patients. The study group comprised 26 newly diagnosed ALL patients admitted to hospital during 1995-96. Patients with a history of blood transfusion or infection within the past 3 months were excluded from the study. White blood cell (WBC) counts, fasting blood glucose (FBG), GHb and Frc levels were analyzed in venous blood on screening day 0, before induction of chemotherapy. Frc analysis was repeated on the 21st day and GHb level on the 60th day of chemotherapy. FBG tests were performed before each dose of L-asparaginase, on days 21 and 60. None of the patients was obese. Although six children (23%) had hyperglycemia during the induction therapy, four of them had a GHb level higher than normal on admission. Only one patient who developed hyperglycemia had a family history of diabetes mellitus. Patients with a high initial WBC count (> 20 x 10(9)/L) had a significantly higher baseline GHb than patients with a WBC count below this level. GHb values returned to normal after achievement of complete remission. It is suggested that the leukemic process could impair glucose metabolism and baseline GHb may be used to monitor possible small changes in glucose homeostasis of ALL patients, prior to chemotherapy.

Experience with oral rehydration therapy in moderately dehydrated children due to diarrhea

Additional reports on oral rehydration therapy (ORT) in the management of moderately dehydrated patients may convince practitioners to convert from high-cost intravenous treatment to low-cost and efficient ORT in moderately dehydrated patients. Therefore, the failure rate and its association with admission serum sodium, potassium and bicarbonate levels of 162 moderately dehydrated children with diarrhea treated with ORT were analyzed retrospectively. The overall failure rate was found to be 17.6 percent. This rate did not differ significantly among normonatremic, hyponatremic and hypernatremic patients (16%, 25% and 28%, respectively; p > 0.05), nor did the rate differ among normokalemic, hypokalemic and hyperkalemic patients (16%, 33% and 25%, respectively; p > 0.05). Only moderately and severely acidotic patients had higher failure rates than non-acidotic and mildly acidotic cases (21%, 38%, 4% and 14% respectively; p < 0.05). Severely acidotic patients were also rehydrated over a longer time (10.4 +/- 6.6 hours) than were nonacidotic patients (6.7 +/- 2.3 hours, p < 0.001). Thus the degree of acidosis, which is closely related to the clinical severity of dehydration, was found to be much more predictive of ORT failure and the duration of rehydration than were other electrolyte disturbances. Besides correcting dehydration, ORT was safe and effective in treating various electrolyte disturbances.