Figen Şahin

The effect of the baby-friendly hospital initiative on long-term breast feeding

The aim of this study was to evaluate the effects of ‘baby‐friendly hospital initiative’ (BFHI) on breast feeding.In the four consecutive months after BFHI in Gazi University Hospital (November 2002–February 2003), breast feeding status until the second year of life in 297 babies, born in the same hospital was compared with the values of 258 babies born before BFHI (November 2001–February 2002).The exclusive breast feeding rate in the first 6 months was higher in the babies born after BFHI. Cox regression analysis revealed that BFHI increases the duration of breast feeding 1.5 times. At the end of the second year, cumulative rate of breast feeding was higher in the group after‐BFHI (p = 0.0036).The rate of breast feeding was increased by BFHI implementation.

Cerebral infarct associated with prothrombin gene G 20210 A variant in a Turkish child with cystic fibrosis: an unusual coexistence.

To the Editor: Cystic fibrosis (CF) is an autosomal recessively inherited disease characterized with pancreatic insufficiency and chronic lung disease (1). Coagulation abnormalities may sometimes occur in CF and generally manifest as bleeding symptoms, related to decreased vitamin K dependent factors and in a lesser frequency due to increased fibrinolytic activity (2, 3) . Here we describe an unusual case with CF who developed a cerebral infarct, which seemed to be contributed by the presence of prothrombin gene G 20210 A variant, that has recently been shown to be a genetic risk factor for thromboembolism (4-7). A 14-month female infant was presented as unconscious. She had experienced an abrupt onset of convulsions 4 d before presentation. She was given diazepam and luminalized in a local hospital and referred to our center when she had become unconscious. In her past history she had meconium ileus at birth. Her parents were unconsanguineous. At the age of 2.5 months she was admitted to our hospital because of repeated pulmonary infections and diarrhea. The diagnosis of CF was established on the basis of sweat chloride concentrations > 100 mEq/l(13O-160 mEq/l) on numerous occasions. She was given supplemental pancreatic enzymes, fatsoluble vitamins and prophylactic antibiotic therapy. On this admission, although she seemed to be unconscious she was responsive to painful stimuli caused by moving her extremities. The pupils were isochoric and responsive to light. Except for her neurologic compromise all other physical examination findings were normal. There was no notified event such as a recent trauma or a family history that might have been relevant to her neurological status. Complete blood count findings, determination of serum electrolytes, glucose and calcium levels, liver and renal function tests, urine and cerebro-spinal fluid (CSF) analysis were all normal. Blood, urine and CSF cultures were sterile. Cardiac examination and echocardiography showed no abnormality. An electroencephalograph record showed active paroxismal activity originating from the left occipital region. Cerebral MRI revealed an infarcted area in the right parietotemporal region. Since neither evidence of a mass effect as seen in an acute infarct nor a volume loss due to encephalomalasia as defined in a chronic infarct was present, the lesion seen in MRI was diagnosed to be a subacute infarct (Fig. 1). In coagulation screening her PT was 11.40 s (N=11-14 s) and her APTT was 32.60 s (N=2540 s); protein C, protein S, antithrombin I11 and fibrinogen were all found to be normal. Anticardiolipin antibodies were negative. Heterozygosity for prothrombin gene G 20210 A variant was found by amplification of prothrombin gene (Factor 11) by polymerase chain reaction (PCR) and using a method described elsewhere (4). Over the following days her neurologic status improved partially. She was put on prophylactic coumadin therapy and discharged with some residual neurologic compromise, with an invitation to periodic controls. Coagulation abnormalities may sometimes occur in patients with CF. In patients with advanced pulmonary disease who have impaired liver functions and/or hepatosplenomegaly and malabsorption, decreased levels of vitamin K dependent factors (prothrombin and factor VII-X complex) may contribute to prolonged PT and PTT. Increased fibrinolytic activity and a mild thrombocytopenia due to hypersplenism were also reported in some children with CF (2). Coagulation abnormalities generally manifest as bleeding symptoms, and a thromboembolic phenomenon is quite uncommon in CF. Although protein C and protein S are also vitamin K dependent natural anticoagulants, thromboembolism related to their deficiency is not a defined complication in CF. In our patient the disease (CF) has been succesfully controlled. She was put on a supplemental therapy consisting of pancreatic enzymes

Growth status of children in well-baby outpatient clinics and related factors.

AIM The aim of this study was to determine the state of growth during follow-up of healthy children and the factors affecting growth. MATERIAL AND METHODS The patient cards of the infants who were born in 2002 and followed up in the well-baby outpatient clinic in Gazi University, Medical Faculty regularly for at least 18 months were examined retrospectively. Their sociodemographic properties including age, education level, occupation of the parents, if the mother was working, caretakers and gender, gestational week, birth weight, birth height and mode of nutrition (breastmilk, formula, cows milk, period of feeding, etc.) and growth of the babies (month, percentile) were recorded. Number of siblings and ages of the siblings were also recorded and the children with and without growth problems were compared in terms of these properties. RESULTS It was found that 290 (39.3%) of 739 children who were followed up continued to grow up in the percentile in which they started (normal growth), 188 (25.4%) lost 2 or more percentiles in any month (growth retardation) and 261 (35.3%) lost less than 2 percentiles (decelerated growth). Deceleration/retardation in growth was observed most commonly in the 9(th) month. Deceleration in growth was found in the 6(th) month in 23.6% of the group with deceleration in growth, in the 9(th) month in 50.2%, in the 12(th) month in 15.8% and in the 18(th) month in 3.9%. Growth retardation was found in the 6(th) month in 35.8% of the group with growth retardation, in the 9(th) month in 38.0% and in the 18(th) month in 4.3%. It was found that receiving formula and presence of infection were the main risk factors in terms of deceleration of growth and unemployed mother, the lenght of the total time of breastfeeding and presence of infection were the main risk factors in terms of growth retardation. CONCLUSIONS This study shows the importance of follow-up of growth of children in outpatient clinics for healthy children. It was found that detailed examination and recording of non-organic causes is necessary in addition to investigation of pathological causes of growth retardation. Since it was observed that elimination of the defects determined and educating the family about nutrition and supporting growth had a positive impact on growth retardation, it was concluded that all children should be followed up regularly especially in the first years of life.

Çocuk istismarı ve ihmaline yaklaşımda hastane çocuk koruma birimleri Derleme

Cocuk istismari bebek ve cocuklardaki hastalanma ve olumun en onemli nedenlerinden birini olusturur Olasi istismar olgularini degerlendirmek tedavi etmek ve izlemek icin “Cocuk Koruma Birimi” gibi multidisipliner bir yaklasim saglanmalidir Son yillarda cocuk istismari ve ihmali konusuna toplumda ilginin artmis olmasi hastanelerde koruma birimlerinin olusturulmaya baslanmasi ulkemiz icin onemli gelismelerdir Hekimlerin ve diger saglik calisanlarinin mezuniyet oncesi ve sonrasi egitimlerinde cocuk istismari ve ihmalinin nbsp; yer almasi gereklidir Turk Ped Ars 2007; 42 Ozel Sayi: 16 8 Anahtar kelimeler: Cocuk istismari Cocuk Koruma Birimi

0-2 Yaş sağlıklı çocukların baş çevresine ilişkin gelişimin izlenmesi için büyüme eğrileri Growth curves for development monitoring related to head circumference of 0-2 aged healthy children

Amac: Bu calismada, 0-2 yas saglikli cocuklarin bas cevresine iliskin gelisimin izlenmesi icin buyume egrilerinin belirlenmesi amaclanmistir. Gerec ve Yontem: Bas cevresine iliskin veriler, 0-2 yas grubu saglikli cocuklara iliskin olup, Gazi Universitesi Tip Fakultesi Cocuk Sagligi ve Hastaliklari Anabilim Dali Saglam Cocuk Polikliniginden alinmistir. Bu veriler, 2 yil boyunca cocuklara iliskin belirli zamanlardaki olcumlere dayanmaktadir. Buyumenin izlenmesinde dogrusal olmayan Gompertz, Lojistik ve Monomolekuler modelleri kullanilmistir.Bulgular ve Sonuclar: Tahmin edilen Gompertz, Lojistik ve Monomolekuler gibi dogrusal olmayan modellere ait belirleme katsayisi degerleri 0.99’dan daha buyuk (R2 > 0.99) bulunmustur. Sonuclar, cocuklarin bas cevresine iliskin gelisimin izlenmesinde elde edilen buyume egrilerinin kullanilabilecegini gostermistir. Calismanin sonuclarina gore, buyumenin izlenmesinde dogrusal olmayan modellerin kullanilmasi onerilmektedir. Calismanin ilerleyen asamalarinda buyumenin izlenmesinde dogrusal olmayan iliskileri modelleyebilen yapay sinir aglari gibi istatistiksel yontemlerin kullanilmasi ile daha iyi sonuclar elde edilebilir.

Birinci Çocuk Acil ve Yoğun Bakım Hekimliği Çalışma Toplantısı Uzlaşı Raporu

Cocuk yas grubunda mortalitenin 80 i hastane ici ya da hastane disi ortamlarda gelisen acil durumlara baglidir Ulkemizde cocuk acil servisleri ve cocuk yogun bakim hizmetlerinin bugunku durumlarini degerlendirmek ve gelismeleri tartismak amaciyla 1 Cocuk Acil ve Yogun Bakim Hekimligi calisma toplantisi 28 Ocak 2000 tarihinde toplanmistir 19 tip fakultesinden 24 ogretim uyesinin katildigi toplantida cocuk acil servisleri ve cocuk yogun bakim servislerinde mutlaka cocuk hekimlerinin gorev almasi idari ve bilimsel sorumlulugun cocuk hekimlerinde olmasi universite hastanelerinden baslayarak tum egitim hastaneleri ve cocuk hastanelerinde cocuk acil servislerinden sorumlu ve kalici ekipler mumkunse ogretim uyesi olmazsa uzman duzeyinde kurulmasi gerek cocuk acil servisleri gerekse cocuk yogun bakim servislerinin eriskin servislerinden ses ve goruntu olarak uzakta yapilanmasi konularinda gorus birligine varilmistir Anahtar kelimeler: Cocuk Acil Servisi Cocuk Yogun Bakim Servisi Mortalite Morbidite