In Turkey and potentially other countries with similar health systems, short-term inservice training on child development can improve primary health providers' knowledge, perceived competence and skills related to child development. To decrease the disparities between high- and low- and middle-income countries in addressing child development, significant barriers within health systems need to be identified and addressed.

Background/aim: Physicians require information on the family centeredness of services for children with Down syndrome, one of the most frequently encountered disabilities in childhood. We aimed to determine the family-centeredness of services for young children with Down syndrome and using a bioecological theory framework we hypothesized that child, family and service-related factors would be associated with such services. Materials and methods: In a cross-sectional design, children with Down syndrome seen at Ankara University Developmental Pediatrics Division (AUDPD) in the sixmonths starting September 2019 were included if they had received services in the community for at least 12 months. Mothers responded to the Measure of Process of Care-20 (MPOC-20) used to measure family centeredness. Results: All 65 eligible children were included; 57% were boys and median age was 25.0 (IQR: 18.5-38.0) months. The MPOC-20 subscale scores were highest for the "respectful and supportive care (RSC)" (median 6.0; IQR: 4.8-6.8) and lowest for the "providing specific information" (median 3.0; IQR: 4.4-6.5) subscales. On univariate analyses, maternal education

Objective: To inform professionals pioneering developmental-behavioral pediatrics (DBP) services in low- and middle-income countries (LMICs), we aimed to examine referral trends in 2 pioneering DBP centers at different locations in Turkey and to ascertain whether the official establishment of DBP as a subspecialty affected these trends. Method: This longitudinal observational study included all children referred to Ankara (AUDPD) and Inonu (IUDPD) Universities' Developmental Pediatrics Divisions between 2010 and 2018. We examined the sources of referrals and the independent effects of time and the establishment of DBP as a subspecialty on referral volume using Negative Binomial Regression (NBR) models. Results: Of 8,051 children, most were boys (58%) and under 24 months of age (72%). Most referrals were from the pediatric and pediatric surgery department clinics (85%); less than 1% were from child and adolescent psychiatry, and none were from family physicians. The NBR models showed that yearly, the referral volume increased significantly, 1.18-fold (95% confidence interval [CI] = 1.09–1.28) and 1.48-fold (95% CI = 1.20–1.82) for AUDPD and IUDPD, respectively. Compared with the trend of referrals before, the trend after the establishment of DBP as a subspecialty increased significantly at AUDPD, but not IUDPD. Conclusion: The increase in referrals to DBP over time is encouraging to professionals working to advance DBP services and training in LMICs even if DBP is not officially established as a subspecialty. Additional efforts may be needed to improve recognition and use of DBP services by community physicians and allied disciplines that provide services to children.

No abstract

A 6-month-old girl was admitted to the intensive care unit of a tertiary pediatric hospital for shortness of breath and respiratory distress for three days following one month of cough. A er ve days antibiotics therapy (amoxicillin sulbactam for three days followed by meropenem for two days), chest CT scan showed severe pneumonia with local consolidation. A er beroptic bronchoscopy and alveolar lavage, she was intubated for ventilation and transported by ambulance to our hospital because of persistent cyanosis. e girl was gravida 2 para 2 and vaginal delivered spontaneously at full gestation age to a gravida 2 para 2 mother with Apgar score of 10 at rst minute and birth weight 4000 g. Her non-consanguineous parents and elder brother were healthy. ere was no family history of tuberculosis. She was vaccinated at birth for BCG and hepatitis B and no other vaccinations were given because of recurrent infections with oral herpes, bronchitis and pneumonia a er one month old.Physical examination revealed le sub-axillary lymphadenitis (Figure 1) and bilateral pulmonary rales, no rash and no hepatosplenomegaly were observed and failure to thrive (6000g at admission). Peripheral blood routine test showed: white blood cell counts 9.7 × 10 9 /L, lymphocytes di erential 8%, hemoglobin and platelet were normal. C-reactive protein, procalcitonin, serum electrolytes, biochemical enzymes of organs, liver and renal function and coagulation function were normal. Chest radiographs showed bilateral in ltration pneumonia. Abdominal sonography was normal. Super cial sonography showed le sub-axillary lymph node enlargement and liquefaction. High-throughput sequencing on Bronchoalveolar Lavage Fluid (BALF) identi ed 697 sequences of Mycobacteruim tuberculosis complex and 95146 sequences of Pneumocystis jiroveci, respectively.

ÖZET Premature bebekierin mortalité ve morbidité sonuçlariSon 30 yilda antenatal bakimda ve neonatal yogun bakim koçullarinda ilerlemelere bagli olarak da, özellikle gelijmi? (Jlkelerde, ozellikle 1000 gram ve altinda dogan ve 22-25 gestasyonel haftada dogan premature bebekierin perinatal momalitesi azalmijtir. Buna karçin, yapilan araçtirmalar bebekierin en az %20-25'lnin bir ya da daha fazla alanda içlevsel kisitliliklannin ve yaçama katilim ile ilgill sorunlannin oldugunu, bu sorunlarin erken bebekiik doneminden baçlayarak eriçkinlige dek uzanan dönemde farkii bulgular ve farkli hizmet gereksinimleriiile seyrettigini gostermiçtlr. Premature ve cok düjük dogum agirlikli (ÇDDA) bebekierin agir düzeyde ijlev kaybi ve yetiyitimi ile seyreden gelijimsel sorunlan serebral paisi, gorme ve içitme kaybi ve agir düzeyde biliçsel sorunlardir. Son yillarda yapilan çaliçmalarda bu bebekierde agir düzeyde geliçimsel sorun oranlan %14-17 ve hafif düzeyde gelijimsel sorun oranlan %5O-7O olarak bildirilmektedir. ABSTRACT Mortality and morbidity of premature infantsDue to advances in antenatal care and neonatal intensive care conditions, especially in developed countries, perinatal mortality of infants born under 1000 grams, and 22-25 weeks' gestational age was decreased. In contrast, studies showed that at least 20-25% of these infants had functional limitations in one or more developmental areas, having different findings and requiring different services from early infancy until adulthood. The developmental problems of premature and VLBW infants causing function limitations and disability are serebral palsy, vision and hearing loss and severe cognitive problems. In the recent studies, the rates of severe developmental problems has been reported as \4^\7%, and mild developmental problems has been reported as 50-70%.

Background: Pediatricians globally are in critical need of tools enabling comprehensive information about children and families while also saving face-to-face time. This study examined the applicability of the expanded version of the Guide for Monitoring Child Development (GMCD), a free-of-charge tool used in over 30 countries.The Expanded GMCD is a written tool incorporating the biopsychosocial model of healthcare delivery, bioecological theory of child development, and two World Health Organization frameworks: International Classification of Functioning, Disability and Health, and Nurturing Care. Methods: Parents of children attending Ankara University Developmental Pediatrics Division, Turkey, were given or digitally sent the Expanded GMCD to complete before their first assessment. The completeness of the responses to the four Expanded GMCD domains and factors associated with full completion were ascertained using multivariate analyses. Results: Of 480 children, 57% were boys, median age was 17.0 (IQR: 9.0-27.0) months. Completion rates were 78%, 87% and 92% for all four, at least three and at least two domains, respectively. All four domains “body structures and functioning,” “health conditions,” “activities and participation,” and “environmental factors” had completion rates >80%. The Expanded GMCD provided holistic information: 87% of children had developmental difficulties and special needs; 60% had chronic conditions requiring follow-up; over 20% of parents reported stigmatization and maternal depression; over 10% unemployment and financial difficulties, not getting enough support from friends and relatives, paternal depression; and 5% intra-family conflict. In the logistic regression analyses, parents of children ≤ 6 months more likely completed <4 domains compared to parents of older children (OR: 2.24; 95% CI: 1.25-3.72); maternal education less than high school (OR: 1.38; 95% CI: 0.87-2.20) and having multiple children (OR: 1.48; 95% CI: 0.94-2.35) were not significantly associated with the full completion of the Expanded GMCD.Conclusion:The applicability of the Expanded GMCD in this study in children with diverse health conditions and families with different educational levels implies its potential for applicability in other settings. Using the free-of-charge Expanded GMCD in healthcare delivery including telemedicine may address the gaps in the implementation of the theory, model and framework-based comprehensive tools for children and their families.

ÖzETAmaç: Prematüre bebekler, dil-bilişsel, sosyal-duygusal, ilişki kurma, iletişim ve hareket gelişimi alanlarında değişik düzeylerde sorunlarla karşılaşabilmektedirler. Bu bebeklerin gelişimsel durumlarının doğum ağırlığı, gestasyonel hafta, geçirdikleri perinatal riskler ve sağlık durumlarının yanı sıra, ev ortamlarındaki şefkatli bakım ve uyaranların yeterliliği, sosyoekonomik durum ve anne eğitim düzeyi ile de ilişkili olduğu araştırmalarda gösterilmektedir. Yüksek riskli prematüre bebeklerin gelişimlerinin uygun uyaranlarla desteklenmesi ve uygun olmayan uyaranların ortamdan uzaklaştırılması, beyin gelişimleri ve gelişimsel destekleri açısından önem taşımaktadır. Prematüre bebeklerin taburculuk sonrası sağlık izlemlerinde ev ortamlarında bulunan uyaranların değerlendirilmesi izlemin bir parçası olarak yer aldığında gelişimsel riskler ve kolaylaştırıcı etmenler saptanabilmektedir. Araştırmanın amacı, prematüre bebeklerin ev ortamlarındaki uyaranları belirlemek ve gelişimsel destek gereksinimlerini vurgulamaktır. Gereç ve Yöntemler: Ankara Çocuk Sağlığı ve Hastalıkları Hematoloji Onkoloji Eğitim ve AraştırmaHastanesi Gelişimsel Pediatri Ünitesi'ne gelişimsel değerlendirme ve izlem amacıyla ilk kez başvuran ≤ 32 gestasyon haftasında doğan prematüre çocukların ev ortamlarındaki uyaranları saptamaya yönelik sorular soruldu ve uygun/uygun olmayan uyaranların sıklığı ve bunları etkileyen etmenler değerlendirildi.Bulgular: Araştırmaya yaşları 1-36 ay arasında (%25-75 aralığı: 3-10) olan 96 çocuk alındı. Çocuklar ile karşılıklı oyun oynanması ve iletişim kurulması %72, birlikte kitap paylaşımı %4, çocukların bulunduğu ortamda televizyonun açık olma durumu ise %70 oranında bulundu. Anne eğitim düzeyi arttıkça uygun uyaran olarak tanımlanan karşılıklı oyun oynama ve ortamda televizyonun açık olmama durumunun anlamlı düzeyde arttığı belirlendi.Sonuç: Prematüre bebeklerin sağlık sistemi içindeki izlemlerinde ev ortamlarında bulunan uygun/uygun olmayan uyaranların sorgulanması, gelişimsel desteklerinin en üst düzeyde sağlanması ve gelişimsel risklerin saptanması açısından önem taşımaktadır.Anahtar Sözcükler: Gelişimi destekleyen ev ortamı, Prematüre ABSTRACT Objective: Premature babies may encounter problems at different levels in language, cognitive, social-emotional, relation and motor development. The developmental status of these infants is not only associated with their birth weight, gestational age, perinatal risks and health status but also with individualized nurturing care and appropriate stimulation provided at home, socioeconomic status of the family and maternal education level in the literature. It is suggested to support the development of high-risk premature infants by providing appropriate stimulation in the first years of life because of the rapid development of the brain in the early years. Premature infants are at high risk for developmental difficulties and hence it is important to question the stimulations provided in the home environment during the follow up visits. The purpose of this study was to ...