Oya Halicioglu

Vitamin D deficiency in pregnant women and their neonates in spring time in western Turkey.

Although Turkey is located in a sunny region, vitamin D deficiency is still a serious health problem in pregnant women and their infants, especially among the low socio-economic status Turkish population. This study was carried out in order to measure serum 25-hydroxyvitamin D3 [25(OH)D] concentrations of the pregnant women in the last trimester and in their neonates at delivery and to determine the factors associated with maternal serum 25(OH)D concentrations. Among the patients visiting the Ege Obstetrics and Gynecology Hospital in the period March to May 2008, 258 healthy pregnant women ≥37 weeks of gestation were included in this study. The information on different characteristics such as the number of pregnancies and births, nutritional status, vitamin and mineral support during gestation, educational status, clothing style and the economic level of the family was collected from women. Blood samples from the mothers and umbilical cord of the newborns were taken to measure 25(OH)D. The mean 25(OH)D concentrations of the mothers and their infants were 11.5 ± 5.4 ng/mL and 11.5 ± 6.8 ng/mL, respectively. We found a strong positive correlation between maternal serum and umbilical cord blood 25(OH)D concentrations (r = 0.651, P < 0.001). The concentration of 25(OH)D was ≤20 ng/mL in 233 mothers (90.3%) and ≤10 ng/mL in 130 mothers (50.4%). Maternal serum 25(OH)D concentrations related strongly to factors such as uncovered dressing style, sufficient consumption of dairy products and multivitamin use during gestation (P < 0.05). About half (52.7%) of these women had a covered dressing style. 25(OH)D concentrations of these covered dressing mothers and their infants were 9.7 ± 5.1 ng/mL and 9.7 ± 5.6 ng/mL, respectively, which were significantly lower compared with those of uncovered mothers and their babies (P < 0.001). This study showed that, despite a sunny environment, vitamin D deficiency and insufficiency are highly prevalent among the mothers and their neonates. This is generally due to the life style and nutritional status of the mothers. These findings suggest that much more effective vitamin D prophylaxis programmes should be implemented for pregnant women as well as for their babies.

Multicenter Prospective Study on the Burden of Rotavirus Gastroenteritis in Turkey, 2005–2006: A Hospital-Based Study

Rotavirus is the main cause of gastroenteritis and dehydration requiring hospitalization among infants and children. Despite the high diarrhea-related mortality rate, there are limited studies describing the prevalence of rotavirus in Turkey. The disease burden of rotavirus gastroenteritis in Turkey was assessed by active, prospective surveillance conducted in accordance with a modified World Health Organization generic protocol from 1 June 2005 through 1 June 2006. A total of 411 children aged <5 years who were hospitalized for gastroenteritis in 4 centers were enrolled. Rotavirus was identified in 53% of samples from the 338 children tested; the range for individual centers was 32.4%-67.4%. Overall, 83.8% of rotavirus-positive children were aged <2 years. Rotavirus gastroenteritis occurred year-round but peaked in the winter. G1P[8] was the most widely prevalent strain (76% of strains), followed by G2P[4] (12.8%). G9P[8] was reported in samples from 3.9% of children. These data support the need for a rotavirus vaccine in Turkey.

Vitamin B12 and folate statuses are associated with diet in pregnant women, but not with anthropometric measurements in term newborns.

Objective: To investigate the frequencies of vitamin B12 and folate deficiencies in pregnant women in low socioeconomic group, the relation between the animal-source foods consumption and maternal vitamin B12-folate statuses, and their impacts on anthropometric measurements of the infants. Methods: A total of 208 pregnant women in the last trimester were included in the study. A questionnaire about socio-demographic status, consumption of meat, egg, milk-dairy products, multivitamin supplementation was used. Vitamin B12 and folate concentrations were studied by chemiluminescence method. The babies of Vitamin B12 deficient mothers were evaluated after birth. Results: The rate of vitamin B12 deficiency was 47.6% and folate deficiency was 17.3% of pregnant women. Animal food consumption was inadequate about half of pregnant women and vitamin B12 levels in these women were significantly low. There were no statistically significant relationships between the birth weight, birth length and head circumference measurements, and maternal vitamin B12 and folate concentrations. Conclusion: The rate of vitamin B12 deficiency in pregnant women in low socioeconomic population is high. Although there were no significant effects of the vitamin B12 and folate deficiencies on birth size, additional studies are required to elucidate the subsequent effects.

Epidemiological study of negative childhood experiences in three provinces of Turkey.

AIM This study aimed to determine the frequencies of negative childhood experiences in the past years and negative childhood experiences throughout life in 11, 13 and 16 year-age group children who attended school in three separate provinces. MATERIAL AND METHODS Approval was obtained from the provincial National Education Directorates and educated investigators applied the ISPCAN child abuse screening tool questionnaire form which measures negative childhood events experienced at home in children. Statistical analysis was performed with chi-square test using SPSS 16.0 program. Approval from the ethics committee was obtained from İzmir Tepecik Education and Research Hospital Chief Physician Office Local Ethics Committee (29/11/2011-29). RESULTS The study was conducted with 7 540 children in İzmir, Denizli and Zonguldak. The frequency of psychological and physical negative childhood experiences and neglect throughout life was found to be 70.5%, 58.3% and 42.6% in the 11, 13 and 16-year age groups, respectively; the frequencies in the last one year was found to be 62.7%, 46.0% and 37.5%, respectively. Psychological negative childhood experiences were found with a higher rate in children who lived in urban areas compared to children who lived in rural areas. Neglect was found with a higher rate in girls and physical negative childhood experiences were found with a higher rate in boys. The frequency of negative childhood experiences increased proportionally with the age of the child independent of the type of experience. CONCLUSION The frequencies of negative childhood experiences for the last one year and for the life-long period were determined using ISPCAN child abuse screening tool in Turkey for the first time in three provinces and in such a large population. The frequency of negative childhood experiences related with child abuse and neglect screened were found to be 42%-70% and it was elucidated that we are confronted with a very significant public health problem and adult health risk in these regions of Turkey.

Hepatitis A seroprevalence in children and adolescents aged 1-18 years among a low socioeconomic population in Izmir, Turkey.

The age-specific prevalence of hepatitis A virus (HAV) infection and risk factors were evaluated in a low socioeconomic population in Izmir. Children and adolescents 1-18 years of age admitted to the outpatient clinics for follow-up visits, or healthy children between April-December 2009 were investigated for anti-HAV antibodies by a cross-sectional study. A questionnaire on sociodemographic and hygiene information was obtained from the parents. All unvaccinated children against HAV were grouped according to their age. Seven hundred and twenty-nine children were enrolled in the study. Total HAV IgG seropositivity was 29.5% while age related values were as follows: 1-2 years, 21.4%; 2.1-5 years, 15.1%; 5.1-8 years, 20.1%; 8.1-11 years, 32.6%; 11.1-14 years, 44.3% and 14.1-18 years, 52.4%. The presence of anti-HAV IgG was associated significantly with low family income and lack of education of parents and living in a crowded family. HAV infection was endemic in a population of children living in Izmir. Anti-HAV vaccination should be considered for preschool children because teenagers are at risk of infection in this region.

Evaluation of maternal knowledge level about neonatal jaundice

Objective: To evaluate the knowledge of mothers on neonatal jaundice. Methods: This study was conducted on 161 mothers who had given birth to healthy newborns at Izmir Aegean Gynecology and Obstetrics Hospital between January 2010 and April 2010. A questionnaire was used to assess the mothers’ knowledge on neonatal jaundice. Knowledge was evaluated as “sufficient” or “insufficient” based on responses. Sufficiently informed mothers were compared with insufficiently informed group for the knowledge level about neonatal jaundice. Results: The rate of insufficiently informed mothers was 53.6%. Logistic regression analysis showed that education level and having a previous offspring with jaundice were independent variables affecting the mothers’ knowledge level. Low education level was found to increase the probability of the mothers’ knowledge level to be insufficient by 2.1 folds (OR 2.1, 95% CI 1.3–3.4; p = 0.003). Being informed beforehand by a previous offspring with jaundice increased the probability of the mothers’ knowledge to be sufficient by twofolds (OR 2, 95% CI 1.1–3.7; p = 0.03). Conclusion: It is found that the mothers’ knowledge about neonatal jaundice is insufficient. Maternal education level and having a previous offspring with jaundice are major factors affecting the knowledge of the mothers on hyperbilirubinemia.

Nutritional B12 Deficiency in Infants of Vitamin B12-Deficient Mothers

AIM Nutritional vitamin B₁₂ deficiency in infants may occur because the maternal diet contains inadequate animal products. Clinical presentations of the infants who had nutritional vitamin B₁₂ deficiency were analyzed in this study. SUBJECTS AND METHODS Patients with nutritional vitamin B₁₂ deficiency were enrolled in the study between 2003 and 2010. The diagnosis was based on a nutritional history of mothers and infants, clinical findings, hematological evaluation, and low level of serum vitamin B₁₂. RESULTS Thirty children aged 1 - 21 months constituted the study group. Poverty was the main cause of inadequate consumption of animal products of the mothers. All infants had predominantly breastfed. The most common symptoms were developmental delay, paleness, apathy, lethargy, anorexia, and failure to thrive. Hematological findings were megaloblastic anemia (83.3 %), thrombocytopenia (30 %), and severe anemia (13.3 %). All of the mothers had low serum B₁₂ levels; eight of them had megaloblastic anemia. CONCLUSION The unusual clinical manifestations of vitamin B₁₂ deficiency may also be seen apart from neurological and hematological findings. Nutritional vitamin B₁₂ deficiency due to maternal deficiency might be a serious health problem in infants. Therefore, screening and supplementation of pregnant and lactating women to prevent infantile vitamin B₁₂ deficiency should be considered.

Neurodevelopmental follow-up results in very low birth weight premature infants and influential factors.

Objective: To investigate the frequency of long-term neurodevelopmental disorders and evaluate risk factors it was aimed for growth, and developmental retardation in very low birth weight infants who were discharged from Neonatal Intensive Care Unit. Methods: Sixty-one preterm infants with birth weights under 1500 grams hospitalized in Neonatal intensive Care Units at Izmir Tepecik Teaching and Research Hospital between January and December 2007 were retrospectively evaluated. Demographical features, complications encountered during hospitalization and clinical risk factors affecting growth retardation were recorded. Infants were examined for growth and neurological development corrected for 18 and 24 months of age and Denver Developmental Screening Test was used for determining neurological development. Results: The main findings were as follows: 45.9% of the cases was male, the mean gestational age was 29 ± 2.1 weeks and mean birth weight was 1205 ± 214 grams. Risk factors that influenced the neurodevelopmental prognosis were respiratory distress syndrome (80.3%), clinical sepsis (50.8%), monitorization with mechanical ventilation (39.3%) and need for surfactant (37.7%). Denver Developmental Screening test found smaller head circumference and height of infants with growth retardation at 18., and 24. months of age relative to their peers with normal neurodevelopmental status.The rates of clinical sepsis, surfactant administration, mechanical ventilation, bronchopulmonary dysplasia and intraventricular hemorrhage were statistically significant height in very low birth weight infants with abnormal neurodevelopment corrected for 24 months of age (p<0,05). These infants also showed growth retardation both at 18 and 24 months of age (p<0,05). Conclusion: Clinical sepsis, surfactant need, monitorization with mechanical ventilation, bronchopulmonary dysplasia and severe intraventricular hemorrhage are risk factors that influence neurodevelopmental prognosis in very low birth weight preterm infants.