Adolescent pregnants may start breastfeeding earlier when had planned pregnancy, educated and encouraged for breastfeeding from the family and medical staff. Therefore, strategies should be formed to improve breastfeeding programs.

Background: A higher incidence of depressive disorders and symptoms has been suggested among children suffering from obstructive sleep apnea (OSA). Yet, the extent to which OSA is related to increased depression is unclear. Objectives: To evaluate (a) the relationship between depressive symptoms and OSA in pediatric populations, and (b) the effi cacy of adenotonsillectomy (AT) for decreasing depressive symptoms among children with OSA. Methods: A meta-analysis was conducted to assess the relationship between depressive symptoms and OSA, and the effi cacy of AT for decreasing depressive symptoms. Studies reporting depressive symptoms of children with OSA through January 2013 were included. Results: Eleven studies assessed depressive symptoms in both children diagnosed with OSA (n = 894) and a comparison group (n = 1,096). A medium relationship was found between depressive symptoms and OSA (Hedges' g = 0.43, 95% CI: 0.22-0.64; p = 0.0005). Addressing the second question, 9 studies (n = 379 children) examined depressive symptoms pre-and post-AT. A medium improvement in depressive symptoms was found at follow-up (Hedge's g = 0.41, 95% CI: 0.20-0.62; p ≤ 0.001). Conclusion: Our fi ndings suggest that depressive symptoms are higher among children with OSA. Therefore, patients with depressive symptomatology should receive screening for sleep disordered breathing. Treatment of OSA with AT might decrease clinical symptoms of depression, reduce pharmacotherapy, improve sleep patterns, and promote better health. Keywords: Sleep disordered breathing, obstructive sleep apnea, depression, depressive symptoms, meta-analysis Citation: Yilmaz E; Sedky K; Bennett DS. The relationship between depressive symptoms and obstructive sleep apnea in pediatric populations: a meta-analysis.

Objective:To investigate the initation time of breastfeeding, exclusive breastfeeding rates, and complementary feeding practices during the first six months of life among mothers who gave birth in a baby-friendly hospital.Materials and Methods:A cross-sectional study was conducted with 350 mothers. Demographic characteristics, obstetric history and information about breastfeeding initiation were collected at the hospital. Information about factors affecting breastfeeding duration and feeding practices of the infants were obtained at the end of six months.Results:Some 97.4% of the mothers initiated breastfeeding, 60.1% within the first hour. Exclusive breastfeeding was maintained for six months in 38.9%. Low education levels of mother/father, random breastfeeding, rare breastfeeding at night, nipple problems, bottle/pacifier use, and lack of social support were found associated with early cessation. Planned pregnancy [odds ratio (OR=2.02)] and vaginal delivery (OR=0.3) were found as the most important factors in early initiation, whereas antepartum breastfeeding education (OR=7.17) was the most important factor for exclusive breastfeeding duration in the logistic analysis. More than half (61.1%) of the infants were partially/bottle fed for six months; the most common reason was the belief that breast milk was insufficient.Conclusion:Efforts to encourage mothers and society to breastfeed exclusively should be made as part of a primary public health strategy to prevent early cessation of breastfeeding.

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