Spontaneous closure rate of ductus decreases as gestational age and birth weight decrease. Therefore, patent ductus arteriosus (PDA) is a very common finding in extremely preterm infants. Most popular questions discussed between neonatologists and pediatric cardiologists are: Whether the ductus is open or not, should we close it or not, when should we close it, and if we have decided to close: should we do it medical, transcatheter or by surgery? In this review we try to clarify patient selection for PDA closure, the main steps of percutaneous PDA closure, device selection, complications, transport, anesthesiology and main trick points in extremely low birth weight infants in the light of our clinical experience and the literature.

Objective: To evaluate serum 25-hydroxyvitamin D levels, demographic features, and anthropometric measurements at the first manifestation of disease in children and adolescents with multiple sclerosis (MS).
Methods: This retrospective study included patients with MS and healthy children and adolescents. Children and adolescents whose clinical and radiological findings were compatible with the McDonald 2017 criteria and who had vitamin D results during the first relapse were included. Having an acute or chronic disease was an exclusion criterion for healthy controls. Taking a supplementation including vitamin D is an exclusion criterion for both the MS and control groups. Age, gender, anthropometric measurements, and serum levels of 25-hydroxyvitamin D were extracted from the database.
Results: A total of 23 patients (female: 17, 73.9%) and 24 (female: 12, 50.0%) healthy children and adolescents were included. The median ages of the patient group and the control group were 16.33 (2.00), and 15.36 (2.29), respectively. There were no significant differences between the groups in terms of age, gender, weight-standard deviation score (SDS), height-SDS, and body mass index-SDS. Precisely, 87.0% of the patients had a vitamin D deficiency. The mean vitamin D values of the patients and the healthy controls were 12.76±5.52, and 18.75±5.86, respectively. Patients with MS had significantly lower levels of 25-hydroxyvitamin D than healthy controls (p<0.0001).
Conclusion: The current study showed that most (87.0%) of the children and adolescents had vitamin D deficiency at the first manifestation of MS. Moreover, the levels of 25-hydroxyvitamin D levels were significantly lower in patients with MS than in the healthy controls.

Objective: We analyzed the echocardiographic findings of children with septic shock who have a high mortality rate in pediatric intensive care units (PICU).
Methods: The study was conducted in the 3rd step PICU as a prospective observational study. Children aged 1 month-18 years, who were followed up with septic shock and started vasoactive medication, were included in the study. Echocardiography was performed within the first hour at the latest in patients diagnosed with septic shock. Echocardiographic findings were compared in non-surviving and surviving patients.
Results: There were 39 (38% female) children diagnosed with septic shock in this study. The median age of the patients was 20 months. The vasoactive medication was started in all patients. There was no statistically significant difference between the patients who non-surviving and those who survived in terms of echocardiographic findings. The ejection fraction (EF) of the patients who died was median 71.5% [minimum (min.) 40, maximum (max.) 79], and the EF of the surviving patients was 72.5 (min. 53, max. 81; p>0.05). The shortening fraction of non-surviving patients was 39.5 (min. 18, max. 46), and 40 (min. 26, max. 48) in surviving patients (p>0.05).
Conclusion: The reason why there is no difference between the echocardiographic findings of the patients who non-surviving and survived septic shock, may be due to the functioning of the compensation mechanisms in septic shock or the immediate initiation of vasoactive drug therapy. Prospective, multi-center, more comprehensive studies with a larger number of patients are needed to obtain clearer information on this subject.

Objective: Emergency departments are becoming increasingly crowded. Analyzing patients who refuse treatment in the emergency department is crucial to improve the quality of care and reduce overcrowding. This study determined why some parents who presented to the pediatric emergency department during the coronavirus disease-2019 (COVID-19) pandemic refused treatment for their children.
Materials and Methods: The study was conducted at the Kartal Dr. Lütfi Kırdar City Hospital, Pediatric Emergency Clinic. Patients who presented to the pediatric emergency department between November 1, 2021 and December 31, 2021 and whose parents refused treatment were analyzed retrospectively via telephone interviews. Demographic characteristics, diagnosis, and reasons for refusal to treatment were analyzed.
Results: Over the 2-month period, parents of 154 (0.3%) of 51.111 patients who presented to the pediatric emergency department refused treatment. Parents refused treatment for the following reasons: 68 (44%) parents refused treatment because the patient felt well, 36 (23%) wanted to continue treatment at home, and 18 (11%) wanted to avoid hospitalization. Of the patients who refused treatment, 16 (10%) returned to the pediatric emergency department within 72 h with the same symptoms, and 5 of them were hospitalized.
Conclusion: The COVID-19 pandemic has increased patients’ refusal to treatment because of the fear of infection. The inappropriate use of emergency services, which leaves physicians with insufficient time to explain medical examinations and treatments to the family members of patients in a clear and understandable language, as well as the patients’ right to re-present to hospitals after refusing treatment, are the main reasons. Actions should be taken to improve working conditions, increase satisfaction of healthcare professionals, raise awareness among patients and their family members and reduce overcrowding at emergency departments. These actions can prevent treatment refusal, even during the COVID-19 pandemic.

Objective: The authors of this study took part in a screening program in schools in Aydın province (unpublished study). This study assessed the final thyroid pathologies of these children with pathology detected during ultrasonography (USG) screening obtained as part of the screening program.
Methods: A handheld wireless point-of-care USG device was used to screen the thyroid gland. Children with thyroid pathology were invited to the hospital where detailed lab study and an USG was examined. The study obtained the thyroid measurements, parenchymal features, and noted the presence of nodules in the detailed USG examination. Nodules were classified according to the Thyroid Imaging Reporting & Data System (TI-RADS™) and an USG-guided fine needle aspiration (FNA) was performed according to TI-RADS.
Results: A total of 1,553 cases from 21 schools between the ages of 6-17 were evaluated in the screening program. Thyroid pathology was detected in 176 (11.3%) cases. One hundred twenty of 176 patients’ families agreed to attend our centre for further examination, where pathology was confirmed in 108 (90.0%) of the 120 cases. Among the 108 thyroid USG pathologies, 52 (48.1%) patients had a nodule and thyroiditis; 28 (25.9%) patients had only a nodule; 28 (25.9%) patients had only thyroiditis. Thyroiditis was present in 74.0% (n=80) of the cases, of those cases 56.3% (n=45) had peripheral thyroiditis, 31.3% (n=25) had diffuse thyroiditis and 12.5% (n=10) had overweight-related changes. Nodules were present in 73.4% (n=80) of the cases. A total of 9 USG-guided FNA were performed, and their pathology results were as followed; 55.6% (n=5) benign cytology, 11.1% (n=1) follicular adenoma, 11.1% (n=1) atypia of indeterminate significance, 11.1% (n=1) non-diagnostic cytology and 11.1% (n=1) papillary thyroid cancer.
Conclusion: This study showed that thyroiditis and nodules in the thyroid gland are common disorders in children. Thyroid nodules may also have a high malignancy potential and the chance of early diagnosis of thyroid cancers with screening is demonstrated.

Objective: In this study, we sought to assess pediatric residents’ level of knowledge about the diagnosis, treatment, and follow-up of urinary tract infection in children.

Methods: This survey was a descriptive study applied to pediatric residents. In the study, a questionnaire form prepared by researchers consisting of questions about socio-demographic features, about the diagnosis, treatment, and follow-up of urinary tract infection in children was used.

Results: Eighty-eight physicians participated in this research. The percentage of participants who correctly indicated urine culture based on the results of routine urinalysis in the diagnosis of urinary tract infection ranged from 95.5% to 96.6. 54.5% of participants (n=48) correctly identified the indication for ultrasonography in children with acute urinary tract infection. 67.0% (n=59) of the participants answered that Mercaptuacetyltriglycin was not appropriate for initial evaluation of recurrent urinary tract infection under the age of one year, while 33.0% (n=29) answered the question incorrectly. In clinical scenarios, 48.9% (n=43.0) participants made the proper decision for treatment of extended spectrum beta-lactamase-positive E. coli treatment.

Conclusion: In conclusion, pediatric residents had appropriate training and experience in the diagnosis of urinary tract infection in children. However, over half of the residents lacked sufficient training in the management of resistant bacteria and additional radiological imaging techniques. Considering this, we believe it will be good to keep the knowledge updated concerning the treatment and follow-up of children with urinary tract infection through in-service training and post-graduate education.

Familial hypocalciuric hypercalcemia (FHH) causes hypercalcemia by three genetic mechanisms: Inactivating mutations in the calcium-sensing receptor (CaSR), G-protein subunit α11 or adapter-associated protein complex 2, sigma 1 subunit. In other cases, hypercalcemia causes significant morbidity and mortality, while FHH usually follows a benign course. Failure to diagnose FHH may result in unwarranted treatment or surgery for a false diagnosis of primary hyperparathyroidism, given the significant overlap of biochemical features. Patients carrying a heterozygous loss-of-function mutation in the CaSR gene are typically referred to as FHH-type 1 (FHH1). Although FHH1 causes lifelong hypercalcemia, it is usually benign and asymptomatic. FHH is the most common syndrome of CaSR gene mutation; it may sometimes be associated with a hypercalciuric tendency depending on the variant. Although hypercalcemia is a frequently encountered condition in our clinical practice, FHH is a clinic that we do not often think of. This paper presents a family diagnosed with FHH, having heterozygous CaSR mutations in three generations.

The relationship between Multisystem Inflammatory Syndrome in Children (MIS-C) and genetic predisposition is not well established. The aim of this article emphasize the presence of genetic predisposition in MIS-C by presenting two sibling cases from two separate families with a diagnosis of MIS-C. The patients applied with complaints of fever, abdominal pain, diarrhea and maculopapular rash. While the coronavirus disease-2019 (COVID-19) polymerase chain reaction test was negative in all cases, three had both IgM and IgG positivity, and the other case had only IgG positivity. Patients who did not define any other infection were diagnosed with MIS-C according to the Centers for Disease Control and Prevention criteria. The patients were discharged with full recovery. The fact that siblings share the same genetic background and the same environmental factors suggests that MIS-C syndrome occur in individuals with a genetic predisposition. Further genetic studies with a large MIS-C series are needed to determine which genotypic trait may cause the development of MIS-C in COVID-19 infection.

Hodgkin lymphoma may present with nephrotic syndrome, but this coexistence is rare. Some hypotheses have been proposed, however, the reason of is not fully known. The patient was a 7-year-old boy who presented with the complaint of edema in the legs and around the eyes. Laboratory tests revealed hypoalbuminemia, hyperlipidemia, and nephrotic range proteinuria. Hodgkin lymphoma was found in the biopsy performed due to the detection of mediastinal enlargement and lymphadenopathy on X-ray and computed tomography. At the end of chemotherapy responding to Hodgkin lymphoma, nephrotic syndrome resolved without the need for other immunosuppressant treatment. Clinicians should keep in mind that the first evidence of Hodgkin lymphoma may be a nephrotic syndrome and the importance of the use of imaging methods.