Aim: Polycystic ovary syndrome (PCOS) is increasingly recognized as a systemic disorder associated with metabolic abnormalities and chronic inflammation. In this study, we aimed to investigate the relationship between androgen levels and inflammatory markers in adolescents with PCOS. Materials and Methods: Eighty-nine patients with PCOS were analyzed retrospectively. Inflammatory markers, including neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and systemic immune-inflammation index (SII), were assessed. Androgen levels and metabolic parameters were also evaluated. Results: The inflammatory markers were not significantly associated with androgen levels or hyperandrogenism. No significant differences in NLR, PLR, or SII were observed between adolescents with and those without hyperandrogenism or between patients with obesity and those without obesity (all p>0.05). Body mass index (BMI) and BMI-standard deviation scores were not correlated with inflammatory markers. In contrast, homeostasis model assessment of insulin resistance showed a weak but statistically significant positive correlation with SII. Conclusion: Our findings demonstrate that inflammatory markers, including NLR, PLR, and SII, were not significantly associated with androgen levels. Furthermore, these markers did not differ according to the presence of obesity or hyperandrogenism.
Aim: The aim of this study was to evaluate whether clonidine, a centrally acting alpha-2-adrenergic agonist widely used in pediatric endocrinology for growth hormone (GH) stimulation testing, also induces copeptin release in children. Since copeptin is a stable, easily measurable marker of vasopressin, its stimulation could offer a practical diagnostic approach for distinguishing diabetes insipidus (DI) from primary polydipsia. Materials and Methods: We conducted a prospective diagnostic pilot study including ten otherwise healthy children (age 3-14 years) undergoing standardized clonidine stimulation testing for suspected GH deficiency. Following oral administration of clonidine, serial blood samples were collected at predefined intervals in order to measure plasma GH and copeptin concentrations. Additionally, blood pressure and heart rate were continuously monitored in order to assess hemodynamic effects and overall tolerability. Adverse events and subjective tolerability were documented systematically. Results: Administration of clonidine led to a significant reduction in systolic and diastolic blood pressure in all participants. However, contrary to expectations, copeptin levels decreased significantly in all subjects (p=0.013). No serious adverse events occurred, and overall tolerability of the test was rated as high, in line with clinical experience. Conclusion: Contrary to the initial hypothesis, clonidine does not stimulate copeptin secretion in children and is unsuitable as a diagnostic tool for DI. Nevertheless, its high tolerability and consistent copeptin suppression warrant further exploration of its neuroendocrine effects.
Aim: The restoration of intestinal continuity after colostomy closure is a critical step and postoperative recovery is influenced by nutritional strategies. This study aimed to evaluate the safety and efficacy of early versus conventional feeding in children undergoing sigmoid colostomy closure on postoperative recovery parameters. Materials and Methods: A prospective randomized observational study was carried out at a tertiary care hospital between January 2022 and October 2025. Fifty children (<16 years) undergoing stoma closure were randomized into two groups: Group A (early feeding within 48 hours postoperatively) and Group B (conventional feeding after return of bowel function or on postoperative day 5). Demographic data, perioperative parameters, and postoperative outcomes including time to initiation of feeding, time to full feeds, bowel function recovery, complications, and hospital stay were analyzed using SPSS v24.0. Results: Of the 50 patients (39 males, 11 females; mean age 1.1 years), 25 were allocated to each group. Feeding was initiated significantly earlier in Group A (mean 18.7 hours) compared with Group B (52.6 hours; p<0.001). Time to achieve full feeds was shorter in Group A (median 42.5 hours) versus Group B (72.5 hours; p<0.001). First bowel movement occurred earlier in Group A (mean 4.1 days) than Group B (5.9 days; p<0.01). Median hospital stay was reduced in Group A (4.5 days) compared with Group B (6 days; p<0.01). No anastomotic leaks or wound dehiscence were observed. Minor complications included transient vomiting and urinary tract infections, with no significant differences between the groups. Conclusion: Early enteral feeding after stoma closure in children with high anorectal malformation is safe, well tolerated, and associated with faster recovery and shorter hospital stays compared with conventional feeding.
Aim: In some settings, the diagnostic evaluation of cystic fibrosis (CF) may be delayed due to limited access to sweat chloride tests. This study aimed to describe the clinical and laboratory findings observed during the evaluation of children with positive newborn screening (NBS) results for CF. Materials and Methods: We retrospectively reviewed the data of children referred after positive NBS for CF who were evaluated at three pediatric pulmonology centers between 2015 and 2021. NBS was used as a referral tool, and the diagnosis of CF was established according to standard diagnostic criteria, including the sweat chloride test and/or genetic analysis. Demographic characteristics, clinical features, and laboratory findings were compared between those children diagnosed with CF after NBS and those not diagnosed with CF. Results: A total of 1,469 children were included, of whom 76 (5.2%) were diagnosed with CF. CF was more frequently observed in those children with parental consanguinity, a history of meconium ileus, steatorrhea, doll-like facial appearance, metabolic alkalosis, hyponatremia, hypokalemia, hypochloremia, and having a sibling with CF (all p<0.05). Conclusion: This large multicenter cohort study presents real-life data on the clinical and laboratory findings observed in those children with positive NBS for CF. This study does not propose an alternative diagnostic strategy to the sweat chloride test, but highlights supportive clinical features which may raise clinical suspicion and emphasizes the importance of timely referral and follow-up, particularly in settings where access to confirmatory testing may be delayed.
Aim: Mucopolysaccharidoses (MPS) are a group of lysosomal storage disorders characterized by the accumulation of glycosaminoglycans (GAGs) in various tissues. Particularly, the accumulation of GAGs in the soft tissues of the head and neck region contributes to obstructive respiratory problems and sleep disturbances. This study aimed to evaluate sleep-related respiratory symptoms in patients with different subtypes of MPS. Materials and Methods: This study included 25 patients diagnosed with MPS. The patients were evaluated in terms of their MPS subtypes, age, gender, duration of enzyme replacement therapy (ERT), and sleep questionnaire scores. Sleep-related respiratory problems were assessed using the “Pediatric Sleep Questionnaire: Sleep-Disordered Breathing (SDB) Subscale.” A mean score above 0.33 on the 22-item questionnaire was considered indicative of SDB. Results: This study included 25 patients diagnosed with MPS I (n=8), MPS II (n=1), MPS IIIA (n=2), MPS IIIB (n=2), MPS IVA (n=3), and MPS VI (n=9). Six patients were not receiving ERT. The median score on the Pediatric Sleep Questionnaire: SDB Subscale was 0.27 (range: 0.15-0.56). Eleven patients (44%) had SDB. No significant differences were found in the sleep questionnaire scores based on the patients’ MPS subtype (p>0.05). There was no correlation between ERT duration, age, and the sleep questionnaire scores. Polysomnography (PSG) was planned for those patients with SDB. Conclusion: In our study, we found that approximately half of the patients diagnosed with MPS had SDB. MPS patients should be routinely evaluated for sleep-related respiratory problems during follow-up visits, and those with symptoms of SDB should undergo PSG.
Aim: Neurologic complications are a significant cause of morbidity and mortality for children supported with extracorporeal membrane oxygenation (ECMO). Disruption of cerebral autoregulation (CAR) is associated with neurologic injury for children who require ECMO. The aim of this project was to identify the period of ECMO support which carries the greatest risk of neurologic injury. Materials and Methods: This retrospective cohort study was conducted in children supported on venovenous or venoarterial ECMO between 2020 and 2023 at a single quaternary center. CAR was measured by assessing the wavelet transform coherence of mean arterial blood pressure and cerebral oximetry. Disruption of CAR was assessed by the time-period of ECMO support and then compared between patients in order to determine the association between impaired CAR and neurologic injury determined by neuroimaging. Results: A total of 31 neonates and children who received ECMO support were included. Eleven children developed severe neurologic injury (35%). Peak disruption of CAR during the pre-cannulation period correlated with severe neurologic injury (R2=0.14, p=0.04). Peak disruptions of CAR in the peri-cannulation (R2=0.004, p=0.7) and post-cannulation periods (R2=0.04, p=0.28) were not significant. There were no significant differences in laboratory values or anticoagulation between the groups. There were no differences in CAR disruption between the neonates and the children [18.4 (8.6-35) p=0.09] or for extracorporeal cardiopulmonary resuscitation with respect to the other indications for ECMO [17.5 (6.5-35), p=0.5]. Conclusion: Impaired CAR in the 24 hours preceding ECMO support may represent the most critical window for neuroprotection in pediatric ECMO.
Aim: Curcumin is a Chinese plant known for its anti-inflammatory, antioxidant, and anti-tumour activity. Its efficacy and safety in children with end-stage renal disease (ESRD) have not yet been established. This study aimed to evaluate curcumin's effects on inflammatory and oxidative stress biomarkers in children on regular hemodialysis (HD), and to investigate the effects of curcumin supplementation in children with ESRD undergoing regular HD. Materials and Methods: This randomized, placebo-controlled, double-blind, pilot study was conducted on 28 children with ESRD on regular HD. This study was conducted between March 2022 and December 2022 at a pediatric HD unit. The patients were randomly assigned to either one gram of curcumin (the active group) or a starch-based placebo once a day (the placebo group), with both groups having 14 patients. Patient history, organ function assessment, tumor necrosis factor (TNF) as an inflammatory biomarker, malondialdehyde (MDA) as an oxidative stress factor, and coagulation biomarkers such as prothrombin time, partial thromboplastin time, and international normalized ratio were assessed and followed for 6 months. Results: At 3 months, the curcumin group showed a significant reduction in MDA levels when compared to the placebo group (median 4.97 vs. 13.60 nmoL/mL, p=0.001). TNF-alpha levels had declined significantly within the curcumin group at 6 months (p=0.030). A significant decrease in uric acid levels was also observed at 3 months in the curcumin group (p=0.008). Hemoglobin levels showed a modest but statistically significant increase at 6 months (p=0.0232). No significant changes were noted in high sensitivity C-reactive protein, estimating glomerular filtration rate, creatinine, alanine transaminase, or coagulation parameters when compared to the placebo. Conclusion: Curcumin may have potential benefits in pediatric patients on HD due to its considerable effects in decreasing inflammatory as well as oxidative stress biomarkers.
Aim: Diagnosing ureteropelvic junction obstruction (UPJO) is challenging due to the lack of a definitive test. The “increase in hydronephrosis” is an important but ambiguous sign, so multiple sonographic parameters are used together for evaluation. We aimed to assess kidney length change as an early indicator of increasing hydronephrosis and investigated whether monitoring patients with kidney length nomograms can aid in its follow-up. Materials and Methods: This study included patients with high-grade hydronephrosis due to UPJO who had undergone at least three sonograms between 2012 and 2022. Kidney long-axis diameters in consecutive sonograms were plotted on a nomogram curve, and deviation from the individual’s percentile was considered as an abrupt length increase. Results: A total of 128 patients (84 operated on and 44 managed conservatively) were included. In initial sonography, 23 patients in the pyeloplasty group and 13 patients in the non-obstructive dilatation (NOD) group were already above the 97th percentile. An abrupt increase in length was observed in 63 patients, with 57 (94%) in the pyeloplasty group and 6 (19%) in the NOD group. Regarding the timing of surgery, 33 patients underwent surgery at a median of 7 (3-11.5) months after the abrupt increase, as there was no significant change in either anteroposterior diameter (p=0.076) or parenchymal thickness (p=0.240) at that time. Conclusion: Our study revealed a notable abrupt increase in kidney length in most UPJO patients who underwent pyeloplasty. Our findings suggest the potential for an objective criterion using the change in kidney length in the decision for surgery.
Aim: In T & uuml;rkiye, vaccine hesitancy has been increasing, with a growing number of parents refusing childhood vaccinations. Understanding the underlying factors of this issue is essential for designing effective interventions. This study aimed to investigate the reasons underlying childhood vaccine hesitancy among parents in Antalya, T & uuml;rkiye. Materials and Methods: This cross-sectional study included 172 parents in Antalya who refused at least one childhood vaccine in 2023. Data were collected using a structured questionnaire administered via phone interviews. Descriptive statistics and chi-square tests were performed. In addition, responses to open-ended questions about their reasons for refusal were grouped thematically. Results: Among the participants, 59.9% had a university-level education, and 69.8% of respondents were mothers. The most common themes influencing hesitancy included perceived adverse events following vaccination, misinformation from social media, and distrust in vaccine contents. A significant proportion (87.8%) stated that the coronavirus disease-2019 (COVID-19) period negatively affected their trust in vaccines. Mothers were significantly more resistant to positive change compared to fathers (p=0.015). Parents aged 34 years and younger were also more resistant to positive change than older parents (p=0.044). Conclusion: This study highlights that vaccine hesitancy in Antalya is strongly influenced by misinterpretations of adverse events, misinformation originating from social media, and distrust regarding vaccine components. Targeted education on vaccine safety, efforts to address COVID-19 related misinformation, and greater involvement of the fathers in vaccination decisions may help reduce hesitancy. Importantly, while social media is a major driver of misinformation, it may also serve as a powerful tool to strengthen public health communication and awareness.
This study aimed to compare fasting lipid profiles in children and adolescents with type 1 diabetes mellitus and healthy controls. This systematic review and meta-analysis followed Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 guidelines and was registered in PROSPERO (CRD42024600840). A systematic search was conducted in PubMed, Scopus, SpringerLink, EBSCOhost, and Google Scholar. Eligible studies were observational and included children and adolescents aged 5-19 years with type 1 diabetes mellitus. Search terms combined “Lipid profile”, “Dyslipidemia”, “Cholesterol”, “HDL”, “LDL”, “Triglycerides”, “Child”, “Adolescent”, “Pediatric”, “Young people”, “Type 1 Diabetes”, and “Insulin Dependent Diabetes”. Study quality was assessed with the Newcastle-Ottawa Scale, and data were synthesized using RevMan 5.4. Eleven studies were included with a total of 1,529 participants. Compared with the controls, children and adolescents with type 1 diabetes mellitus showed higher total cholesterol [mean difference (MD)=14.3 mg/dL; 95% confidence interval (CI): 8.4-20.4], low-density lipoprotein-cholesterol (MD=11.0 mg/dL; 95% CI: 7.0-14.8), and high-density lipoprotein cholesterol (MD=2.66 mg/dL; 95% CI: 0.1-5.2). Triglycerides were slightly increased but not significantly (MD=8.6 mg/dL; 95% CI: -0.4-21.3). This meta-analysis reveals lipid alterations in pediatric type 1 diabetes mellitus. Routine lipid screening and timely interventions are warranted in order to guide preventive care for cardiovascular disease risk.
Aim: Previous research has indicated that children with autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) often display differences in temperament. However, the relationship between temperament and both symptom severity and quality of life in preschoolers remains poorly understood. Materials and Methods: Temperament was assessed in 27 preschoolers with ADHD and 27 with ASD, and the results were compared with those of 27 typically developing peers. For this purpose, the Children’s Behavior Questionnaire-Short Form and the Pediatric Quality of Life Inventory were administered. ASD symptom severity was measured using the Childhood Autism Rating Scale, while ADHD symptom severity was evaluated with the Parent Assessment of Preschool Behavior Scale. Results: In the ADHD group, symptom severity was positively associated with extraversion and negatively associated with effortful control. Higher levels of negative affectivity and higher extraversion were linked to poorer Pediatric Quality of Life scores. In the ASD group, greater effortful control correlated with both lower symptom severity and higher overall quality of life. Conclusion: Our findings suggest that temperament traits in preschoolers with ASD and ADHD are associated with both symptom severity and quality of life. Given the limited sample size of this study, longitudinal studies are needed in order to confirm and expand upon these results.
Aim: Celiac disease is an autoimmune disease affecting individuals of all ages, causing damage to the small intestines upon consuming gluten. This study aimed to assess changes in bone mineral density among children with celiac disease following dietary intervention and treatment compared to their pre-intervention levels, and also to determine the frequency of metabolic bone disease at the time of diagnosis. Materials andMethods:This study included pediatric patients with biopsy-proven celiac diseasewhounderwentdual-energy X-ray absorptiometry at diagnosis and after 12 months. Anthropometric measurements, serum calcium, phosphorus, alkaline phosphatase, parathyroid hormone, and 25-hydroxyvitamin D levels were recorded. Lumbar spine (L1-L4) bone mineral density was measured using a dual-energy X-ray device. Anthropometric measurements, dual-energy X-ray absorptiometry results, and biochemical laboratory findings were evaluated before and after treatment. All patients received standardized vitamin D (400-2,000 IU/day based on their deficiency status) and calcium supplementation (age-appropriate daily intake 800-1,300 mg/day) based on their baseline deficiency status, and their adherence to a gluten free diet was verified by clinical improvement and negative anti-tissue transglutaminase IgA at follow-up. Results: Sixty children (36 female, 24 male; mean age 8.82 +/- 3.90 years) were included in this study. At the initial evaluation, low bone mineral density was identified in 25% of the patients. During follow-up, some patients demonstrated worsening dual-energy X-ray absorptiometry findings despite adherence to the diet. Further assessment revealed that these patients had vitamin D deficiency and were non-compliant with the prescribed supplementation. Conclusion: These findings highlight the critical role of dietary management and appropriate supplementation in managing celiac disease, emphasizing the necessity for dual-energy X-ray absorptiometry screening at diagnosis and follow-up.
Aim: Obesity and iron deficiency represent two of the most prevalent nutritional disorders worldwide. Obesity is accompanied by chronic low-grade inflammation, with elevated circulating levels of pro-inflammatory cytokines, particularly interleukin 6 (IL-6). Obesity-related inflammatory pathways promote hepatic hepcidin synthesis, with IL-6 serving as a central mediator of hepcidin transcription under inflammatory conditions. Hepcidin is the principal regulator of intestinal iron absorption, and its increased expression contributes to impaired iron availability in obese individuals. This study aimed to examine the association between obesity and iron deficiency and to clarify the role of hepcidin in iron homeostasis among obese children. Materials and Methods: This case-control study enrolled 50 children with obesity [body mass index (BMI) >95th percentile] and 50 healthy non-obese children (BMI between the 5th and 95th percentiles), aged 8-18 years. The evaluated parameters included hemoglobin (Hb), mean corpuscular volume (MCV), serum iron, ferritin, total iron-binding capacity, transferrin saturation (TS), as well as serum hepcidin and IL-6 levels. Results: Obese children had significantly lower serum iron, Hb, MCV, ferritin, and TS (all p<0.05), and higher hepcidin and IL-6 levels (p=0.024 and p=0.032, respectively), compared to the controls. Hepcidin levels were directly correlated with IL-6 (p<0.001) and BMI standard deviation scores (p=0.019). Inverse correlations were observed between hepcidin and iron (p=0.024), hepcidin and Hb (p=0.001), and hepcidin and MCV (p=0.02). Conclusion: Chronic inflammation of obesity and elevated hepcidin levels result in the low iron states in obese children.
Morganella morganii (M. morganii) is a facultative anaerobic, gram-negative bacillus which uncommonly causes urinary tract infections in children. We report a rare pediatric case of M. morganii, highlighting the diagnostic and treatment challenges associated with this microorganism, its notable antimicrobial resistance profile, and the importance of antibiotic stewardship in guiding effective therapy.
Aim: The study aimed to assess whether pediatric Beh & ccedil;et's disease (PBD) eyes with a history of ocular inflammation in remission exhibit residual iris structural changes compared with BD eyes without ocular involvement and also healthy controls. Materials and Methods: Twenty PBD patients without ocular involvement (Group 1), 6 PBD patients with inactive ocular involvement (Group 2), and 24 age-sex-matched healthy controls (Group 3) were included in this study. Their demographic characteristics and the patients' anterior and posterior segment examination findings were recorded. Iris thicknesses at 1 mm, 2 mm, and 3 mm from the pupillary margin in the nasal and temporal areas were measured using spectral domain optical coherence tomography (SD-OCT). Iris area measurements in the 3 mm area were evaluated using the ImageJ program. Results: There was no statistical difference between the three groups in terms of their age or gender (p=0.920, p=0.482, respectively). There was no statistically significant difference between the three groups regarding their iris thicknesses at temporal and nasal 1 mm, 2 mm, and 3 mm (p>0.05). The three groups had no significant difference in their temporal and nasal 3 mm area measurements (p>0.05). Conclusion: In PBD eyes with a history of uveitis which were in remission at the time of imaging, iris thickness and area did not differ from those of non-ocular BD eyes or healthy controls. These findings suggest that no persistent iris structural damage is detectable by SD-OCT after the resolution of inflammation, although longitudinal follow-up during both active and inactive phases is warranted.
Ewing sarcoma is a highly aggressive malignant bone tumor which most commonly arises in the long bones and pelvis of adolescents and young adults. Craniofacial involvement, particularly of the mandible, is extremely rare and may mimic odontogenic or inflammatory lesions, leading to diagnostic delay. We report the case of a 14-year-old girl with histologically confirmed Ewing sarcoma of the left mandible. Clinical and initial radiological findings suggested an aggressive mandibular lesion with locoregional extension. For comprehensive baseline evaluation, an 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) was performed. It demonstrated intense metabolic activity of the mandibular mass, consistent with high tumor aggressiveness, while excluding cervical, thoracic, abdominal, and skeletal metastases. This case underlines the crucial role of 18F-FDG PET/CT not only in the initial staging of Ewing sarcoma but also in the differential diagnosis of atypical mandibular swellings in children and adolescents. By combining functional and anatomical data, PET/CT improves diagnostic confidence, guides therapeutic planning, and contributes to prognostic assessment in such uncommon presentations.
Mastitis beyond the neonatal period is an uncommon condition in children, with Staphylococcus aureus being the most frequently implicated pathogen. However, mastitis due to Mycobacterium bovis Bacillus Calmette-Gu & eacute;rin (BCG) has not been previously reported. Herein, we present the first case of mastitis following a BCG vaccination in a 6-month-old immunocompetent infant.
Aim: This research aimed to determine the characteristics of social media and mobile/web application usage in young people with type 1 diabetes (T1D) and to examine its effects on their metabolic control. Materials and Methods: We enrolled 206 young people with T1D (aged 10-25 years) in this cross-sectional study. Face-to-face interviews were used to assess the relationships between their social media use, health practices, and metabolic control. Results: The participants (55%girls) had a mean age of 13.33 +/- 4.40 years and a median diabetes duration of4.83 years (interquartile range=7.31). The last 1-year average hemoglobin A1c (HbA1c) values were 8.02 +/- 1.39%. It was observed that HbA1c increased as daily phone usage time increased (r=0.18; p=0.01). The primary reason for internet use was accessing social media (73%). Other prevalent uses included watching movies (42%), alongside using health apps, playing games, and online shopping (each at 38%), and accessing education/information (37%). Blood sugar monitoring was the most frequently used application with 67 users (27.9%). It was followed by a pedometer (60 users; 25.0%) and carbohydrates counting (56 users; 23.3%). Less common applications included continuous glucose monitoring (26 users; 10.8%), care reminders (13 users; 5.4%), and pulse rate monitoring (9 users; 3.8%). The HbA1c values of those who used a blood sugar monitoring app were lower than those who did not use it (7.71 +/- 1.38; 8.23 +/- 1.36 p=0.01, respectively). Participants who used a pedometer app had a higher body mass index standard deviation score than non-users (0.53 +/- 1.11 vs. 0.32 +/- 0.99, respectively); however, this difference was not statistically significant (p=0.237). Conclusion: Health applications may support diabetes management in young people with T1D, while excessive digital engagement may negatively impact metabolic outcomes.
Aim: Children with short bowel syndrome (SBS) frequently require long-term total parenteral nutrition (TPN), which increases the risk of progressive central vein thrombosis. Once conventional venous access is exhausted, direct right atrial catheterization becomes a necessary salvage technique. In addition to bypassing thrombosed veins, it allows for the placement of larger-caliber catheters than percutaneous approaches. Materials and Methods: This retrospective study included 17 pediatric SBS patients with end-stage vascular access who underwent direct right atrial catheterization via right anterior thoracotomy. Patient characteristics, vein thrombosis patterns, catheter duration, complications, and reinterventions were analyzed. Results: All patients (100%) had thrombosed jugular veins. Subclavian, hepatic, and femoral vein thrombosis was observed in 41.1%, 29.4%, and 23.6% of the patients, respectively. The median catheter duration was 14.8 months. Four patients (23.6%) developed catheter-related bloodstream infections, including one Candida parapsilosis infection which required complete catheter and port removal with reinsertion. One mechanical complication (5.9%) occurred due to port chamber torsion. Two patients (11.8%) required surgical reintervention. No cases of catheter-related sepsis, tamponade, or mortality were recorded. Larger-bore catheters were successfully implanted in all patients due to the direct atrial route. Conclusion: Direct right atrial catheterization is a safe, durable, and technically advantageous vascular access option in children with SBS and depleted venous anatomy. Its capacity to accommodate large-caliber catheters supports high-volume TPN delivery. This technique should be considered early in the multidisciplinary management of complex intestinal failure.
