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Kawasaki disease (KD), also referred to as mucocutaneous lymph node syndrome and infantile polyarteritis nodosa, is characterized by inflammation of small and medium-sized blood vessels across the body. It can manifest in various clinical features among pediatric patients admitted to general pediatric departments with fever, particularly those aged less than 5 years. Despite its relatively benign nature, it is crucial to promptly identify potential complications. We describe the case of a 10-month-old female patient admitted to the general pediatric department due to a 5-day history of fever peaking at 40.5⁰C, diarrhea, and irritability. Physical examination revealed no conjunctivitis, cervical lymphadenopathy, or rash, but notable irritability and edematous induration on the dorsum of her hands and feet. Initial laboratory investigations showed elevated acute phase reactants, and radiological assessment indicated terminal ileitis. Considering the presentation consistent with incomplete KD, characterized by persistent fever, ill appearance, ileitis, hypoalbuminemia, and elevated acute phase reactants, we pursued further evaluation. Echocardiography revealed ecstatic and prominent coronary artery without dilation of the main coronary arteries. It is important to recognize that not all KD patients will exhibit all typical features, and presentations may vary. While inflammatory changes in multiple systems have been documented in KD, terminal ileitis has not been previously reported in pediatric patients. [ABSTRACT FROM AUTHOR]

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Aim: In addition to increased survival rates, systemic complications which can impair the quality of life have been seen in 25-30% of childhood and adolescent cancer cases. The respiratory system is one of the severely affected systems. We aimed to evaluate late respiratory complications and risk factors in pediatric and adolescent cancers. Materials and Methods: We examined the pulmonary complications of 50 cancer patients and 40 control cases. We asked about environmental exposures, physical examinations performed, and pulmonary function tests (PFT) spirometry, diffusing capacity of the lungs for carbon). X-ray was performed on all patients in the patient group and on patients with indications in the control group. Results: In the patient group, there was impairment of pulmonary function in 52%, [24% small airway disease (SAD)], 14% diffusion disorders (DD) and 14% combined disorders (CD) compared to 22.5% in the control group (p=0.007). There was a higher risk of restrictive disorder and/or SAD in those cancer patients who were diagnosed prior to 2 years of age. Additionally, there was a higher rate of SAD in those patients with soft tissue sarcomas and a higher rate of restrictive disease in those patients who had received high-dose alkylating agents. No significant PFT impairment was observed in the other patient groups. Conclusion: There is a high incidence of respiratory impairment in childhood and adolescent cancer survivors. They need to be followed up by a multidisciplinary team and be informed about the additional risk factors which may cause lung function loss. [ABSTRACT FROM AUTHOR]

Background/aim: The study aims to evaluate the neurodevelopmental outcomes of neonates with myelomeningocele (MMC) operated in the postnatal period. Materials and methods: This is a prospective follow-up study in a tertiary neonatal intensive care unit. Neurodevelopmental outcomes of term neonates operated for MMC and healthy term newborns were compared with the Bayley Scales of Infant and Toddler Development -Third Edition (BSID III) at 12–18 months. Results: A total of 57 cases were included in the study (patient group = 27; control group = 30). Demographic data between the groups were similar. Cognitive, linguistic, and motor composite scores of the patient group were lower than those of the control group (p < 0.001). In the patient group, those who underwent ventriculoperitoneal shunt had lower cognitive, language and motor scores than those without shunt (p < 0.05). The cognitive, linguistic, and motor composite scores in the patient group who underwent surgery before 72 h were better than those who underwent surgery after 72 h. Conclusion: In our study, it was found that the neurodevelopmental prognosis of MMC cases requiring ventriculoperitoneal shunt in the postnatal period was significantly worse than those without shunt. It is the first study in which the neurodevelopment of patients with MMC who were operated in the postnatal period was evaluated with BSID III evaluated and delays in all areas were shown in cases with MMC compared to normal cases. Better neurodevelopmental outcomes in patients operated in the first 72 h suggest that early surgery will improve neurodevelopmental outcomes in patients with MMC. [ABSTRACT FROM AUTHOR]

Background/aim: Congenital heart disease (CHD) is the most common congenital malformation group and is the leading cause of newborn mortality in developed countries. Most of the infants with CHD develop preoperative or postoperative acute kidney injury (AKI). Acute kidney injury may develop before the serum creatinine rise and oliguria. Urinary biomarkers such as kidney injury molecule-1 (KIM-1), neutrophil gelatinase-associated lipocalin (NGAL), interleukin (IL)-18, and cystatin C may predict AKI in patients with critical CHD (CCHD) before the serum creatinine rise. In this study, we aimed to determine the AKI incidence among newborn patients with CCHD and investigate the predictivity of urinary biomarkers for AKI. Materials and methods: Newborns with a gestational age >34 weeks and birth weight >1500 g with a diagnosis of CCHD were enrolled in the study. Blood and urine samples were collected at birth, during the first 24--48 h, and in the preoperative and postoperative periods. Results: A total of 53 CCHD patients requiring surgery during the neonatal period were enrolled in the study. The 24--48 h KIM-1 levels of the cases with exitus were higher (P = 0.007). The 24--48 h cystatin C and preoperative NGAL levels were higher in patients with postoperative AKI (P = 0.02). Conclusion: In newborns with CCHD, high KIM-1 levels may predict mortality, whereas high cystatin C and preoperative NGAL levels may be indicative of AKI. These biomarkers deserve further investigation in larger study populations. [ABSTRACT FROM AUTHOR]

Aim: In the present study, the relationship between neonatal morbidity and cord vitamin D levels is investigated. Materials and Methods: Premature infants who were born before 32 weeks of gestation and admitted to our neonatal intensive care unit between January 2014 and January 2015 were included in the study. Vitamin D levels in the cord blood of infants were measured. Serum calcium, phosphorus and alkaline phosphatase levels were recorded in the first 24 hours. All neonates were followed up for neonatal morbidities until discharge. Results: The mean gestational age of the study subjects was 29.2±2.6 (23-32). The mean vitamin D level was 27.4±19.3 ng/mL (4-76). Fourteen (46.7%) infants had normal vitamin D levels; 2 infants (6.7%) had vitamin D insufficiency (20-30 ng/mL), 14 infants (46.7%) had vitamin D deficiency (<20 ng/mL), and 7 infants had severe vitamin D deficiency (23.3%). In 60% of infants with intrauterine growth restriction had vitamin D deficiency of p<0.05. Serum phosphorus levels on the first day of life were significantly lower in infants with vitamin D deficiency (p<0.001). Conclusion: In more than half of the study population vitamin D deficiency was determined. Infants with intrauterine growth restriction had vitamin D deficiency in more than half of the cases. Low levels of phosphorus may be a marker of vitamin D deficiency in the first days of life. [ABSTRACT FROM AUTHOR]

It is not exactly known the risks from infection with pandemic influenza (H1N1) 2009 in children with leukemia. Here the authors present their experience in 5 children with leukemia. Pandemic influenza (H1N1) 2009 was detected in 5 patients (F/M: 3/2) at their institution. The ages of these patients were between 2 and 16 years. Four had acute lymphoblastic leukemia (ALL) and 1 acute myeloblasic leukemia (AML). Three of the ALL patients had the diagnosis of pandemic influenza (H1N1) 2009 at the same time as they were diagnosed with ALL. The remaining 2 patients were receiving intensive chemotherapy. All patients had fever, rhinorrhea, and cough. Although bronchopneumonia was seen in 3 patients, only 1 revealed respiratory distress. Stomachache and diarrhea was seen in the patientwho had no pneumonia. All treated as inpatients, but none of them required hospitalization in intensive care unit. One to 3 days after the symptoms of influenza appeared, oseltamivir (Tamiflu) was given to all patients in combination with broad-spectrum antibiotics. Fever declined to normal ranges in 1 to 3 days after treatment was started. The patients received oseltamivir for 5 to 7 days. Cell culture tests were found to be positive for influenza A and polymerase chain reaction (PCR) revealed H1N1 for all 5 patients. Although this is a very small case series, pandemic influenza (H1N1) 2009 did not seem to be very dangerous for children with leukemia if the oseltamivir treatment was given early when symptoms of influenza appeared. [ABSTRACT FROM AUTHOR]

Introduction: Heart transplantation (HT) is the only treatment option in children with heart failure secondary to cardiomyopathies and non-reparable congenital heart diseases., Methods: We performed a retrospective clinical data review of all consecutive pediatric patients (aged 2-18 years) who underwent orthotopic HT for advanced heart failure at our institution between January 2007 and January 2023. Clinical, procedural, and follow-up data were collected and comprehensively analyzed., Results: We identified 27 children (66.7% males) with a median age of 15 years (IQR: 7-16) and a median weight of 45 kg (IQR: 22-66) at the time of the intervention. 24 patients (88.8%) were diagnosed with dilated cardiomyopathy, 2 (7.4%) with restrictive cardiomyopathy, and 1 (3.7%) with hypertrophic cardiomyopathy. On a median follow-up of 35.07 months (IQR: 13.13-111.87), arrhythmias were detected in 9 (33%) patients. Three patients developed symptomatic sinus node dysfunction at 18, 25, and 38 days and received permanent pacemakers. One patient developed a complete AV block during acute rejection at 76 months and received a temporary pacemaker. Two patients developed chronic sinus tachycardia at 4 and 16 months and were treated with Beta-blockers after eliminating all causes of sinus tachycardia. One patient developed a complete right bundle branch block at 12 months. One patient developed ventricular extrasystole at 10 months and was found to have grade 2 rejection. An Atrial extrasystole was detected in one patient at 96 months. We did not identify significant risk factors for arrhythmias post-HT., Discussion: After pediatric HT, early-onset rhythm disturbances, often attributed to surgery-related issues such as sinus node dysfunction, may necessitate invasive treatments like permanent pacemaker therapy. Close monitoring post-transplantation is crucial, and routine follow-up with Holter ECG is necessary to identify potential rhythm disorders even in the absence of symptoms. Rhythm disturbances that develop during follow-up can serve as early indicators of graft rejection and should be carefully evaluated., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (© 2024 Doğan, Ergin, Beyter, Kaşıkçı, Ön, Ay, Levent, Engin and Ülger.)