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Background: The most underdeveloped area in the care of critically-ill-children (CIC) is the prehospital period. Appropriate prehospital assessment and life-saving-interventions (LSI) of this population are challenging and require dedicated resources to ensure the best outcomes. We aimed to determine the characteristics and outcomes of CIC transported to the Turkish Pediatric Emergency Departments (EDs). The frequency and distribution of LSI administered by prehospital providers on route and in the EDs were also investigated., Methods: This prospective study was conducted at 4 metropolitan cities and 9 tertiary pediatric EDs between August 2014-August 2015. A survey based study evaluated all CIC who were brought by ambulance to the participant EDs. CIC were defined as a patient who requires LSI or needs intensive care admission for any reason. Patient demographics, clinical features, reason for transport, performed procedures in the ambulance or ED were sought. Finally, the short-term outcomes of transported CIC and transport-associated risks were analyzed., Results: During the study period, a total 2094 children were brought by ambulance to all participant EDs. Only 227 (10.8%) of them were critically-ill. Emergency Medical Services (EMS) providers were less likely to perform procedures in CIC if they were staffed with paramedics (p < 0.001). Most procedures were performed on children aged one or older (p < 0.001). No procedure was performed in the ambulance for nearly one fourth of patients who received LSI in the EDs. If the EMS did not have a physician, prehospital providers were less likely to provide immediate LSIs (p < 0.001). CIC were more likely referred from secondary/tertiary care hospitals. The short-term mortality rate was higher if the ambulance was staffed by only paramedics., Conclusion: This study demonstrated that Turkish prehospital pediatric emergency care is deficient. We offer a clinical overview of pediatric emergencies to aid EMS directors, policymakers, and ED directors in planning the care of CIC.

Kurt F, Kendirli T, Gündüz RC, Kesici S, Akça H, Şahin Ş, Kalkan G, Derbent M, Tuygun N, Ödek Ç, Gültekin-Keser A, Oğuz S, Polat E, Derinöz O, Tekin D, Tekşam Ö, Bayrakcı B, Suskan E. Outcome of out-of-hospital cardiopulmonary arrest in children: A multicenter cohort study. Turk J Pediatr 2018; 60: 488-496. The aim of this study was to evaluate the demographic characteristics of children who experienced out-of-hospital cardiopulmonary arrest (CPA), and to assess the impact of the bystander cardiopulmonary resuscitation (CPR) on the survival rate of witnessed arrests and the effects of the arrest and CPR durations on the neurological outcomes. This multicenter, retrospective study included a total of 182 patients who underwent CPR for out-of-hospital CPA between January 2008 and December 2012 at six centers in Ankara, Turkey. The median [interquartile range (IQR)] age was 22 (5-54) months; 60.4% of the patients were males, and 44% were younger than one year of age. The witnessed arrest rate was 75.8% (138/182) and the rate of bystander CPR was 13.9% (13/93). In these patients the rate of the return of spontaneous circulation (ROSC) was higher (76.9%). Following resuscitation in the patients for whom the spontaneous circulation was able to be returned, the median (IQR) duration of arrest was 5 (1- 15) min, while it was 15 (5-40) min for the remaining patients (p < 0.001). The ROSC rate was 94.9% in patients who underwent CPR for less than 20 min and 22% in patients requiring CPR longer than 20 min (p < 0.001). Survival to hospital discharge was 14.3%. Of these patients, 57.7% experienced neurological disability. The short duration of an arrest and the presence of CPR are both critical for survival. We suggest that a witness to the CPA, performing early and efficient CPR, yields better results.

Synthetic cannabinoid receptor agonists are becoming increasingly popular in adolescent age group as an abused substance. Therefore, pediatric emergency physicians should be prepared for Bonzai utilizations which are being more common day by day. The aim of the study is to investigate cases who admitted to a pediatric emergency service with use of Bonzai.

The aim of this study was to elucidate the clinical presentations, diagnostic clues and management of deep neck infections (DNI) in pediatric patients. Demographic characteristics, clinical manifestations, predisposing factors, duration of symptoms before presentation, history of previous antibiotic use, duration of hospitalization, laboratory and radiographic evaluations, management, complications, and outcomes of 25 patients (19 male/6 female; mean age: 47.9±39.0 months) diagnosed with DNI were analyzed retrospectively. Retropharyngeal abscesses occurred especially in preschool children, whereas peritonsillar abscesses occurred especially in school children. Nine of 25 (36%) patients underwent surgical intervention in addition to medical therapy. Contrast-enhanced computed tomography provided additional information in half of the patients. DNIs should be considered in the differential diagnosis of children who present with fever and neck mass even in the absence of more specific findings. Medical treatment can be considered an option to surgical treatment by utilizing the advantages of imaging techniques and empirical antibiotics.

We aimed to measure the psychosocial status and quality of life in mothers of babies with infantile colic (IC). Mothers and their newborns were stratified into Group 1 (colicky infant-mother dyad [n: 39]) and Group 2 (non-colicky infant-mother dyad [n: 39]). Maternal symptoms of depression and anxiety were assessed using the Beck Depression Inventory (BDI) and State-Trait Anxiety Inventory (STAI), respectively. The Short Form-36 (SF36) was used to measure quality of life. Mean BDI score in Group 1 (14.7 ± 12.9) was significantly higher than in Group 2 (7.7 ± 5.5) (p=0.020). Mothers in Group 1 had lower Short Form- 36 physical functioning (26.6 ± 4.3 vs. 28.7 ± 2.6; p=0.010) and social functioning (7.4 ± 2.5 vs. 8.9 ± 3.2, p=0.024) domain scores. Infantile colic (IC) was associated with higher maternal depression symptom scores and lower quality of life scores. As such, we think that mothers who have babies with IC should be closely monitored.

Recurrent bacterial meningitis is an uncommon but life-threatening condition. The aim of this study was to evaluate the demographic, clinical, microbiological, and radiological features of recurrent bacterial meningitis in children. Fourteen patients (10 male, 4 female) treated for recurrent bacterial meningitis were reviewed. The mean age of the patients was 87 months (range: 6 months to 13 years). There were 67 episodes of meningitis documented in these 14 patients. Six patients had developmental anatomical defects, five had traumatic anatomical defects and three had primary immune deficiency diseases as predisposing conditions. We suggest that, in a case of recurrent meningitis, a pediatrician should question and examine the patient carefully in search of a possible anatomical defect or immunodeficiency. Vaccination and surgical treatment of the anatomical defects may be important.

We report the case of an eight-year-old boy with hypereosinophilia who presented with a swelling under his right armpit that had persisted for more than four weeks. A second-stage larva of Wohlfahrtia magnifica was found, leading to the diagnosis of cutaneous myiasis. Following removal of the larva, the clinical and hematological manifestations returned to normal. Diagnosis of myiasis should always be kept in mind in the event of clinical signs of furuncular lesions, which may be accompanied by eosinophilia.

We describe a seven-year-old girl with severe pneumonia probably associated with Mycoplasma pneumoniae who developed right-sided hemiparalysis and right central facial paralysis soon after the onset of the disease. Cerebral magnetic resonance imaging revealed left corpus striatum acute infarction and magnetic resonance angiography demonstrated left internal carotid artery occlusion. She also had positive antiphospholipid and anticardiolipin antibodies and increased fibrinogen and D-dimer levels.