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Objective: Poisonings are significant causes of preventable morbidities and mortalities in pediatric patients hospitalized in pediatric intensive care units. In this study, we aimed to evaluate demographic and epidemiologic features, interventions, treatments, clinical course, and prognosis of patients hospitalized in pediatric intensive care unit for poisoning retrospectively. Methods: The recordings of 172 patients admitted to the pediatric intensive care unit with acute poisoning between 2015 and 2019 were evaluated retrospectively. Results: A total of 172 patients were admitted to our pediatric intensive care unit with the diagnosis of poisoning. Eighty-eight of them (51.2\%) were girl. The average age was 5.8 +/- 5.6 years, and mean length of stay was 2.9 days. It was noted that 72.1\% of patients with poisoning were accidental, whereas 27.9\% of them were suicidal. Majority of suicidal patients were girls (89.5\%), and the mean age was 13.1 +/- 4.9 years. However, only 36.2\% of patients with accidental poisoning were girls and the mean age was 3.1 +/- 2.6 years. Patients with poisoning were most commonly seen during spring. The most common cause of poisoning was drugs (76.7\%). Poisoning with multiple drugs were seen in 36 patients (20.9\%). Central nervous system drugs were the most common cause (32.7\%). Nausea-vomiting (17.4\%), altered mental status (12.7\%), and abdominal pain (7.5\%) were the most common symptoms. Thirteen patients required invasive mechanical ventilation. Five patients were treated with hemodialysis and eight patients treated with plasma exchange. Conclusion: Poisonings are important part of pediatric intensive care unit hospitalization. Accidental poisoning is common especially in children under five years of age. Taking preventive measures, educating parents about home accidents, storing medications in safe and locked places and keeping them out of reach of children can reduce the rate of accidental poisoning.

Reactive airway disease is a prevalent condition that can be detected in the early infancy period. The condition might also deteriorate into asthma in some cases. If infants do not respond to the treatment of persistent wheeze and coughing, other rare causes should be investigated. The complete form of vascular ring is an extremely uncommon congenital cardiovascular abnormality. Double aortic arch constitutes the most significant portion of the complete vascular ring anomalies. Clinical manifestations of the anomaly are mainly respiratory due to the tracheal compression and mimicking the conditions of asthma. There have not been many reports about the clinical presentations of double aortic arch being remarkably similar to the same clinical manifestations of asthma in the literature. As far as we can be sure, there have not been any reported cases about severe reactive airway disease that caused a patient to have a life-threatening condition in the pediatric intensive care unit. Herein, we present a 5-month-old girl who had double aortic arch. Her anatomical aberration was diagnosed by three-dimensional computed tomography angiography of thorax, and the anomaly mimicked the clinical characteristics of life-threatening severe reactive airway disease.

Objectives: Anticoagulation is used to prevent filter clotting in patients undergoing continuous renal replacement therapy. Regional citrate anticoagulation is associated with lower rates of bleeding complications and prolongs the filter life span; however, a number of metabolic side effects had been associated with this therapy. The aim of this study was to evaluate the effect and safety of citrate versus heparin anticoagulation for continuous renal replacement therapy in critically ill children. Methods: A retrospective comparative cohort study. Department of Pediatric Intensive Care, Acibadem Mehmet Ali Aydınlar University School of Medicine. Results: From August 2016 to August 2018, 45 patients (19 in the citrate group and 26 in the heparin group) were included. A total of 101 hemofilters were used in all therapies: 44 in the citrate group (total continuous renal replacement therapy time: 2699 h) and 57 in the heparin group (total continuous renal replacement therapy time: 2383 h). The median circuit lifetime was significantly longer for regional citrate anticoagulation (53.0; interquartile range, 40–70 h) than for heparin anticoagulation (40.25; interquartile range, 22.75–53.5 h; p = 0.025). Mortality rates were similar in both groups (31.58% vs 30.77%). The most common indication for dialysis was hypervolemia in both groups. Transfusion rates were 1.65 units (interquartile range, 0.5–2.38) with heparin and 0.8 units (interquartile range, 0.3–2.0) with citrate (p = 0.32). Clotting-related hemofilter failure occurred in 11.36% of filters in the citrate group compared with 26.31% of filters in the heparin group. Conclusion: Our study showed that citrate is superior in terms of safety and efficacy, with longer filter life span. Regional citrate should be considered as a better anticoagulation method than heparin for continuous renal replacement therapy in critically ill children.

Diabetic patients may experience more severe Staphylococcus aureus-related respiratory tract infections such as necrotizing pneumonia (NP). A 13-year-old girl with uncontrolled diabetes mellitus was admitted to pediatric intensive care unit (PICU) with diabetic ketoacidosis and respiratory distress. Her initial evaluation revealed diffuse pneumonic infiltration that progressed to NP within days. She was intubated and placed on mechanical ventilator (MV) support. Positive inotropes and broad-spectrum antibiotics were initiated. Methicillinresistant S. aureus was isolated from blood and pleural specimen cultures. In spite of aggressive medical treatment, infection could not be controlled and lobectomy was performed. However, the patient was fistulized and right total pneumonectomy was performed on the 16th and 29th days of PICU admission. She gradually got better and was weaned from MV. On the 59th day, she was discharged oxygen-free from the hospital. Early surgical intervention should be considered for the treatment of NP resistant to medical therapy.

Objectives: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. Design: the prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. Setting: Fifteen tertiary PICUs in Turkey. Patients: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. Interventions: Conventional mechanical ventilation Measurements and Main Results: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05-2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. Conclusions: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration., National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA, Drs. Sik, Yaman, and Kendirli disclosed government work. Drs. Yaman and Davutoglu received support for article research from the National Institutes of Health. the remaining authors have disclosed that they do not have any potential conflicts of interest.

Sik G, Annayev A, Demirbuga A, Deliceo E, Aydin S, Erek E, Demir HI, Citak A. Extracorporeal membrane oxygenation for the support of pediatric patients with acute fulminant myocarditis. Turk J Pediatr 2019; 61: 867-872. Acute fulminant myocarditis, is a severe, rapidly progressive disease. The clinical outcomes of children with severe acute myocarditis who are resist to medical treatment is not well known. We studied the clinical courses of patients with acute fulminant myocarditis supported by extracorporeal membrane oxygenation (ECMO). We performed a retrospective chart review of six children with acute fulminant myocarditis who were treated with ECMO. Demographic information, clinical and vital signs, as well as laboratory results were investigated. The median age of 63 months (13-140 months), the mean ECMO duration was 164 hours (79-402 hours), and median intensive care unit stay was 24 days. The most common symptoms were chest pain (66%) and fever (66%). Severe arrhythmia were seen in two patients. One patient received extracorporeal cardiopulmonary resuscitation. In two patients, right femoral arteries and right femoral veins were used, in others, right common carotid artery and right internal jugular veins were used. Five patients (83.3 %) survived to discharge. ECMO can be used effectively in pediatric patients with acute fulminant myocarditis to support the circulation while awaiting myocardial recovery. Timely use of ECMO can improve the survival rate and may be associated with better outcomes.

Extracorporeal membrane oxygenation (ECMO) is used in pediatric patients with severe cardiopulmonary failure who do not respond to conventional therapy; only a few studies have been conducted in Turkey. We present the experience of pediatric ECMO with the aim of showing factors affecting mortality. We retrospectively reviewed our ECMO database to identify patients who received ECMO from October 2015 to March 2018. Our population comprised 30 pediatric patients. The mean patient age was 41.31±53.35 months and 17 (56.7%) patients were male. The median duration of ECMO support was 8.9 (6.6-10.8) days. The rates of successful ECMO weaning and survival to discharge were 70.0% (n=21) and 66.7% (n=20), respectively. Indications for ECMO were respiratory failure (40.0%), cardiac failure (33.3%), and sepsis (26.7%). We found that pre-cannulation values of pH (p=0.034), leukocytes (p=0.029), C-reactive protein (p=0.045), creatinine (p=0.047), chloride (p=0.001) and post-cannulation pH (p=0.0001), bicarbonate (p=0.014), lactate (p=0.002), chloride (p=0.0001) were associated with mortality. The results showed that preexisting sepsis and renal conditions contributed to poor outcomes. Indications, ECMO onset time, and pre- and post-cannulation laboratory values such as leukocytes, CRP, creatinine, bicarbonate, lactate, and chloride are factors that affect outcomes.

To evaluate the clinical characteristics, risk factors, and prognosis ofPatients who were hospitalized in pediatric intensive care unit between January 2017 and January 2019 and diagnosed as havingEighteen patients were admitted to our pediatric intensive care unit with a diagnosis ofWe found that high leukocyte count, viral co-infection, and severe pulmonary hypertension were associated with mortality and morbidity inÇocuk yoğun bakım biriminde boğmaca tanısıyla izlenen hastaların klinik özelliklerini, risk etmenlerini ve seyri etkileyen etmenleri değerlendirmeyi amaçladık.Çocuk yoğun bakım birimimizde Ocak 2017–Ocak 2019 tarihleri arasında yatan ve boğmaca tanısı alan hastalar geriye dönük olarak değerlendirildi. Örnekler entübe olarak izlenen hastalarda trakeal aspirat materyalinden, diğer hastalarda nazofaringeal sürüntüden alındı.On sekiz hasta boğmaca tanısı ile çocuk yoğun bakım birimimize yatırıldı. Hastaların %55,5’i kızdı (n=10), tüm hastalar aşısızdı. Ortanca yaş 40 (38–47,5) gün, ortanca yoğun bakım yatış süresi 9 (5–14) gündü. Başvuru anında hastaların tümünde solunum sıkıntısı, 14 hastada (%77,7) öksürük, 4 hastada (%22.2) ateş, 3 hastada (%16,6) konvülziyon saptandı. Yedi hasta entübe edilerek izlendi. Üç hasta ekstrakorporeal tedavi yöntemleri uygulanmasına rağmen çoklu organ yetersizliği ve kardiyojenik şok nedeniyle kaybedildi. Ölen hastaların ikisinde respiratuar sinsityal virüs, birinde rhinovirüs ko-enfeksiyonu vardı. Toplam lökosit sayıları karşılaştırıldığında ölen hasta grubunda lökosit sayısı yaşayanlara göre belirgin oranda yüksekti. Hiperlökositoz nedeniyle 3 hastaya tam kan değişimi yapıldı. Ekokardiyografik inceleme ile en sık saptanan kardiyak patoloji pulmoner hipertansiyondu.Boğmaca tanısıyla yoğun bakımda izlenen hastalarda yüksek lökosit sayısı, eşlik eden viral enfeksiyon ve ciddi pulmoner hipertansiyonun mortalite ve morbidite ile ilişkili olduğunu saptadık.

Therapeutic plasma exchange (TPE) is an effective treatment method in selective indications. Secondary to access and technical features, it is more difficult to apply in pediatric population than adults. The aim of this study is investigate safety, clinical indications, and results of this method in critically ill pediatric patients who need TPE treatment. All of the TPE procedures performed in a pediatric intensive care unit providing tertiary care during 4 years (2015-2019) were evaluated retrospectively. TPE procedures (635) were performed for 135 patients. Median age was 34 months (10-108). Ninety-seven patients had mechanical ventilation support. Sepsis with multiple organ failure was the most frequent indication and accounted for 44.4% (n = 60) of the indications followed by hematological and neurological diseases (19.2% and 9.6% respectively). TPE was performed alone in 469 cases (73.9%), in combination with continuous renal replacement therapy in 154 cases (24.2%), and additional to extracorporeal membrane oxygenation in 12 cases (1.9%). Hematological disease and sepsis subgroups had the highest intubation rate, mechanical ventilation period, PRISM score, organ failure count, and mortality. Fresh frozen plasma (FFP) was the most frequently used replacement fluid in 90.4% of the procedures. The most frequent anticoagulant used in TPE was acid citrate dextrose solution (79.3%). Procedural complications were detected in 104 cases (16.3%) and occurred during TPE sessions. Overall survival rate was 78.5%. We found that the non-survivor group had significantly higher rates of organ failures (P = 0.0001), higher PRISM scores on admission (P = 0.0001), and higher rates of invasive ventilation support needed (P = 0.012). TPE is a treatment method which can be safely provided in healthcare facilities with necessary medical and technical requirements. Although it is riskier to provide such treatment to critically ill children, complications can be minimized in experienced healthcare facilities. Overall results are good and can vary depending on indication.

Purpose The aim of this study was to evaluate the efficacy of periurethral cleaning with 10% povidone-iodine, 0.05% chlorhexidine gluconate, or sterile water in preventing catheter-associated urinary tract infections (CAUTIs) prior to indwelling urinary catheter insertion in a pediatric intensive care unit. A secondary aim was to identify pathogens resulting in CAUTIs in this group. Design Randomized controlled trial. Subjects and setting One hundred twenty-two patients cared for in a pediatric intensive care unit of a university hospital between September 2012 and December 2013 participated in the study. Methods Subjects were randomly allocated to 1 of 3 groups: periurethral cleansing with 0.05% chlorhexidine; 10% povidone-iodine; or sterile water. The patients in each group were cleansed 3 times using different sterile pads and assigned cleansing solutions for as long as the patients were observed or until the urinary catheter was removed. Daily monitoring forms, which included physiologic and physical parameters and catheter-related infections, were completed for all patients. We used Centers for Disease Control and Prevention/National Health and Safety Network criteria to determine the presence of a CAUTI. Results CAUTIs occurred in 6 patients (15%) allocated to periurethral cleansing with povidone-iodine, 2 (4.8%) in the chlorhexidine gluconate group, and 3 (7.5%) in the sterile water group. Although more patients in the povidone-iodine group had CAUTI than in the other 2 groups, differences were not statistically significant (P > .05). Conclusion We found no statistically significant differences in CAUTI rates in the 3 groups. Further investigation with a larger study group is needed to more definitively identify any difference in CAUTI occurrences based on periurethral cleansing solution.

Background Bloodstream infections related to use of catheters are associated with increased morbidity and mortality rates, prolonged hospital lengths of stay, and increased medical costs. Objectives To compare the effectiveness of chlorhexidine-impregnated dressings with that of standard dressings in preventing catheter-related bloodstream infections. Methods A total of 100 children were randomly divided into 2 groups of 50 each: a chlorhexidine group and a standard group. Patient care was provided in accordance with prevention bundles. Patients were followed up for development of catheter-related bloodstream infections. Results Catheter colonization occurred in 4 patients in the standard group (8%) and in 1 patient in the chlorhexidine group (2%). Catheter-related bloodstream infections occurred in 5 patients in the standard group (10%) and in 1 patient in the chlorhexidine group (2%). Although more patients in the standard group had catheter-related bloodstream infections, the difference in infection rates between the 2 groups was not significant (P = .07). Conclusions Use of chlorhexidine-impregnated dressings reduced rates of catheter-related bloodstream infections, contamination, colonization, and local catheter infection in a pediatric intensive care unit but was not significantly better than use of standard dressings.

OTO, ARZU/0000-0003-0229-2759; Sevketoglu, Esra/0000-0002-8330-2877, WOS: 000496521400006, PubMed: 31435144, Objectives:To analyze the course of seasonal viral infections of respiratory tract in patients hospitalized in pediatric intensive care units (PICU) of 16 centers in Turkey. Materials and methods: It is a retrospective, observational, and multicenter study conducted in 16 tertiary PICUs in Turkey includes a total of 302 children with viral cause in the nasal swab which required PICU admission with no interventions. Results: Median age of patients was 12 months. Respiratory syncytial virus (RSV) was more common in patients over one year of age whereas influenza, human Bocavirus in patients above a year of age was more common (p = 60 mm Hg. Conclusion: Our findings demonstrate that patients with neurological symptoms, tachycardia, hypoxia, hypotension, acidosis, impaired liver, and renal function at the time of admission exhibit more severe mortal progressions. Presence of acidosis and multiorgan failure was found to be predictor for mortality. Knowledge of clinical presentation and age-related variations among seasonal viruses may give a clue about severe course and prognosis. By presenting the analyzed data of 302 PICU admissions, current study reveals severity of viral respiratory tract infections and release tips for handling them.

Aim Healthcare-associated infections cause increased morbidity and mortality in intensive care units. In this study, it was aimed to compare infections with multi-drug resistance and extended drug resistance, while evaluating the characteristics of resistant Gram-negative infections in the pediatric intensive care unit in our university hospital. Material and methods In this study, pediatric patients who were found to have Gram-negative infections during hsopitalization in the pediatric intensive care unit in our faculty between January 2011 and December 2015, were evaluated retrospectively. Results One thousand thirty patients were internalized in our unit in the study period. The incidence for healthcare-associated infection was found as 17.2% and the incidence density was found as 32.7 per 1000 patient days. The incidence for healthcare-related infection per 1000 device days and the rate for device use were calculated as 66.9 and 0.59, respectively. One hundred thirty Gram-negative infection episodes were found in 79 patients whose median age was 22 (1-205) months. The most common infections included ventilator-related pneumonia (n=78, 60%) and bloodstream infections (n=38, 29.2%). The most common causative agents included Pseudomonas aeruginosa (n=50, 38.5%), Kleibsiella pneumonia (n=32, 24.6%) and Acinetobacter baumannii (n=28, 21.5%). Among A. baumannii isolates, the rates for resistance against piperacillin-tazobactam and meropenem were found as 96.4% and 89.3%, respectively. Empirical use of carbapenems, aminoglycosides, and fluoroquinolones, the presence of total parenteral nutrition and history of Gram-negative bacterial infections prior to pediatric intensive care unit admission were significantly more common among extended-drug Gram-negative bacterial infections. The late mortality rate was found to be higher in presence of extended drug resistance. History of Gram-negative infection was found to be an independent risk factor in terms of extended drug resistance. Conclusion Healthcare-associated infections are an important health problem and it is important for infection control committees of hospitals to determine and apply strategies according to hospital colonization in prevention.

To identify prognostic factors and indications in patients receiving continuous renal replacement therapy (CRRT) in the pediatric intensive care unit (PICU), and to demonstrate their effect on mortality. A total of 63 patients admitted between 2011 and 2014 were included in the study. The demographic information, pediatric risk of mortality (PRISM) scores, vasoactive-inotropic score, indication for CRRT, time of starting CRRT, presence of fluid overload, durations of CRRT, and pediatric intensive care unit (PICU) stay were compared between survivors and non-survivors. The overall rate of survival was 69,8%. The most common indication for CRRT was fluid overload (31.7%) followed by acute attacks of metabolic diseases (15.9%), and resistant metabolic acidosis (15.9%). The median duration of CRRT was 58 (IQR 24–96) h. The most common CRRT modality was continuous venovenous hemodiafiltration. The CRRT modality was not different between survivors and nonsurvivors. Sepsis, as the diagnosis for admission to intensive care unit was significantly related to decreased survival when compared to acute kidney injury and acute attacks of metabolic diseases. Patients with fluid overload had significantly increased rate of death, CRRT duration, use of mechanical ventilation, and PICU stay. The CRRT, can be effectively used for removal of fluid overload, treatment of acute attacks of metabolic diseases, and other indications in critically ill pediatric patients. It has a positive effect on mortality in high-risk PICU patients. This treatment modality can be used more frequently in pediatric intensive care unit with improved patient outcomes, and should be focused on starting therapy in early stages of fluid overload.

In our study, we aimed to clinically and epidemiologically evaluate respiratory tract infections the viral agents of which were detected by molecular methods and to compare influenza and other respiratory tract viruses in this context.The records of 178 patients aged above 2 years who presented to pediatric emergency outpatient clinic with fever and respiratory tract infection findings between December 2013 and April 2014 were examined retrospectively.At least one respiratory tract pathogen was detected by polymerase chain reaction in 78.6% (n=140) of the patients: influenza A 33.5%, influenza B 16.4%, respiratory syncytial virus 9.2%, adenovirus 7.8%, rhinovirus 7.1%, coronavirus 7.1%, human metapneumovirus 5.7%, human bocavirus 5.7%, parainfluenza virus 3.5%, coinfection 2.8%. The mean age of the patients was 6.3±3.6 years. Sixty-nine patients (49.2%) were aged between 2 and 5 years. Seventy-one patients (50.7%) were aged 5 years and above. Upper respiratory tract infection was found with a rate of 65.7% and lower respiratory tract infection was found with a rate of 34.2%. It was observed that the distribution of respiratory tract viruses showed variance by age groups. Influenza A infection was observed with the highest rate in both age groups. Influenza B was the second leading agent (p=0.008) above the age of 5 years and respiratory syncytial virus was the second leading agent in the 2-5 year age group (p=0.003). Influenza viruses were detected in 55.9% of 118 patients who were found to be compatible with the definition of "influenza-like illness" specified in the Center for Disease Control and Prevention guidelines and other viral agenst were detected in 44%. No difference could be found between the clinical pictures and radiological findings caused by influenza and other respiratory tract viruses.In this study, it was concluded that influenza and other respiratory viruses can not be differentiated definitely by clinical and radiological findings, though there are some differences.

Post-herpes simplex virus encephalitis relapses have been recently associated with autoimmunity driven by autoantibodies against N-methyl-d-aspartate (NMDA) receptors. Because it offers different treatment options, determination of this condition is important. Between 2011 and 2014, 7 children with proven diagnosis of herpes simplex virus encephalitis were identified in a university hospital of Istanbul. Two patients had neurologic relapse characterized mainly by movement disorders 2 to 3 weeks after initial encephalitis. The first patient received a second 14 days of acyclovir treatment together with antiepileptic drugs and left with severe neurologic sequelae. The second patient was found to be NMDA receptors antibody positive in the cerebrospinal fluid. She was treated with intravenous immunoglobulin and prednisolone. She showed substantial improvement, gradually regaining lost neurologic abilities. Post-herpes simplex virus encephalitis relapses may frequently be immune-mediated rather than a viral reactivation, particularly in children displaying movement disorders like choreoathetosis. Immunotherapy may provide benefit for this potentially devastating condition, like the case described in this report.

Boğulayazma çocuklar ve erişkinlerde yüksek morbidite ve mortalite nedeni olmaya devam etmektedir. Çocuk yoğunbakım ünitelerinin ve teknolojinin gelişmesiyle boğulayazma olgularının yaşatılabilirliği de artmıştır. Boğulayazmanınkısa vadeli sağ kalımındaki gelişmeye karşın, kurbanlarda akut solunum yetmezliği sendromu ve kalıcı hipoksik-iskemikmerkezi sinir sistemi hasarında artışa neden olmuştur. Bu nedenle, batma olayı sonrası kurbanların akut dönemdeyoğun bakımdaki tedavisi önemlidir. Bu yazıda, sodyum hipoklorit ve deterjan içeren su dolu kova içinde gerçekleşenboğulayazma olgusu sunulmuştur CAYD 2015;2(1):49-54. Near-drowning continuesto be associated with high mortality and morbidity in both children and adults. With the availability of sophisticated technologies and pediatric intensive care units, victims of near-drowning are now more likely to survive. However this improvement in short-term survival of near-drowning, victims after an acute submersion episode has also resulted in an increase of acute respiratory distress syndrome and persistent hypoxic-ischemic central nervous system injury. Therefore, it is important both to know the acute intensive care unit management of victims of neardrowning and also to understand the progression of the disease. We report a patient who had been near-drowned in bucket lled with sodium hypochlorite and detergent containing water CAYD 2015;2(1):49-54

Aim We aimed to study electrocardiographic changes in children with diabetic ketoacidosis and ketosis and to evaluate the relation of the changes with serum electrolyte levels and ketosis. Material and methods This study was performed in Istanbul Medical Faculty, Pediatric Emergency and Intensive Care Department between May 2008 and May 2009. The electrocardiographic parameters and QT length of children with diabetic ketoacidosis and ketosis were evaluated at diagnosis and after the treatment. Results Forty patients were included in the study; 16 (40%) were diagnosed as having diabetic ketosis and 24 (60%) had diabetic ketoacidosis. Twenty-four (60%) patients were male and 16 (40%) were female and the mean age was 9.21±4.71 years (range, 1-16 years). Twelve (30%) cases of diabetic ketoacidosis were mild, three (7.5%) were moderate, and nine (22.5%) were severe. One patient had premature ventricular beats, and four had ST depression. The electrocardiographic parameters were all normal beyond the QTC length prolongation. The mean QTC length was 447±45 ms (380-560 ms) at diagnosis and 418±32 ms (350-500 ms) after treatment. The change in the QTC length was statistically significant. None of the patients had significant electrolyte disturbance and the prolongation of QTc length was not correlated with serum electrolyte levels. The prolongation of QTc length was statistically correlated with anion gap (r=0.33, p=0.03). Conclusions In our study, we showed QTc length prolongation and the importance of performing electrocardiography during the diagnosis of diabetic ketoacidosis and ketosis. We also demonstrated that ketosis was responsible for the prolongation of QTc length.

Background Although studied widely in adulthood, little is known about endocrinological disorders during critical illnesses in childhood. The aims of this study were to define the endocrinological changes in patients admitted to pediatric intensive care unit (PICU) and to identify their effects on prognosis. Methods Forty patients with a mean age of 5.1 years admitted to PICU were enrolled in the study. Blood samples were taken at admission and at 24 and 48 h to measure cortisol, adrenocorticotropic hormone (ACTH), prolactin, growth hormone (GH), GH binding protein (GHBP), insulin-like growth factor-binding protein-3 (IGFBP-3) and interleukin-6 (IL-6). The severity of the patient's condition was assessed using pediatric risk of mortality (PRISM) and pediatric logistic organ dysfunction (PELOD) scores. Results PRISM and PELOD scores were significantly higher in non-survivors. Cortisol, ACTH, prolactin, GH, GHBP, IGFBP-3 and IL-6 were not significantly different between the survivors and non-survivors. There was a negative correlation between baseline IGFBP-3 and PRISM scores. A positive correlation was seen between cortisol level at 24 h and PRISM score. On multivariate linear regression analysis, PRISM score was best explained by ACTH and cortisol at 24 h. A positive weak correlation was detected between IL-6 at 24 h and PELOD scores. Conclusions Although there was no difference between survivors and non-survivors regarding the studied endocrine parameters, there were associations between cortisol, ACTH, IL-6 and IGFBP-3 and risk assessment scores, and, given that these scores correlated with mortality, these parameters might be useful as prognostic factors.

OZET Amitriptilin zehirlenmesi cocuk acil servislerinde sik karsilasilan zehirlenmelerden biridir. Amitriptilin zehirlenmesi, cesitli sistemleri etkileyen yan etkileri nedeniyle ciddi sorunlara yol acmakta ve hayati tehdit edebilmektedir. En ciddi etkileri santral sinir sistemi ve kardiyovaskuler sistem uzerine olmaktadir. Siddetli zehirlenmesi olan hastalarda kalp iletim bozukluklari, supraventrikuler tasikardi, ventrikuler disritmiler ve hipotansiyon gelisebilir. Bilinmeyen miktarda amitriptilin tablet aldiktan sonra ciddi kardiyak belirtiler (hipotansiyon, aritmi, ventrikuler fibrilasyon) gelisen onsekiz aylik kiz hasta yogun bakima alindi. Hastaya defibrilasyon, magnezyum sulfat, lidokain tedavileri uygulandi. Bu tedaviler ile tamamen duzelen hasta taburcu edildi (CAYD 2014; 1(1):39-42). Anahtar Kelimeler: Amitriptilin zehirlenmesi, aritmi, defibrilasyon, ventrikuler fibrilasyon

WOS: 000398493700005, Objective: To establish the effectiveness of noninvasive ventilation in cancer children with acute respiratory failure. Methods: The data of 33 cancer patients were obtained prospectively from six different pediatric intensive care units in Turkey between the years of 2012 and 2013. Results: The diagnosis was leukemias in 25 (75.8%), lymphomas in 3 (9.1%) and other solid tumors in 5 (15.1%) patients. Pneumonia in 12 (36.3%) and sepsis in 15 (45.4%) patients were seen as the common reasons of respiratory failure. The mean PaO2/ FiO2 ratios were (164.22 +/- 37.24) and (126.80 +/- 42.73) in noninvasive ventilation success and failure group, respectively. Noninvasive ventilation was successful in 18 (54.5%) patients. The failure group consisted of 15 patients required intubation. A total of 14 (42.4%) patients died. The clinical outcome in terms of success and failure was meaningful statistically (P = 0.0 00 1). Conclusions: Our results could encourage the use of noninvasive ventilation in children with cancer who develop acute respiratory failure. It should be considered as a useful therapeutic approach to avoid endotracheal intubation.

Background: Little is known about factors associated with carbapenem-resistant Klebsiella pneumoniae infections in pediatric patients, who are initally colonized with carbapenem-resistant Klebsiella pneumoniae. Materials and methods: A retrospective case–control study was conducted involving pediatric and neonatal intensive care units throughout a five-year period (January 2010–December 2014). Clinical and microbiological data were extracted from Hospital Infection Control Committee reports and patients’ medical records. Risk factors were assessed in carbapenem-resistant Klebsiella pneumoniae colonized patients who developed subsequent systemic infection (cases) and compared to carbapenem-resistant Klebsiella pneumoniae colonized patients who did not develop infection (controls). Results: Throughout the study period, 2.6% of patients admitted to neonatal intensive care units and 3.6% of patients admitted to pediatric intensive care units had become colonized with carbapenem-resistant Klebsiella pneumoniae. After a mean of 10.6 ± 1.9 days (median: 7 days, range: 2–38 days) following detection of colonization, 39.0% of the carbapenem-resistant Klebsiella pneumoniae colonized patients in pediatric intensive care units and 18.1% of carbapenem-resistant Klebsiella pneumoniae colonized patients in neonatal intensive care units developed systemic carbapenem-resistant Klebsiella pneumoniae infection. Types of systemic carbapenem-resistant Klebsiella pneumoniae infections included bacteremia (n = 15, 62.5%), ventilator-associated pneumonia (n = 4, 16.6%), ventriculitis (n = 2, 8.3%), intraabdominal infections (n = 2, 8.3%), and urinary tract infection (n = 1, 4.1%). A logistic regression model including parameters found significant in univariate analysis of carbapenem resistant Klebsiella pneumoniae colonization and carbapenem resistant Klebsiella pneumoniae infection groups revealed underlying metabolic disease (OR: 10.1; 95% CI: 2.7–37.2), previous carbapenem use (OR: 10.1; 95% CI: 2.2–40.1), neutropenia (OR: 13.8; 95% CI: 3.1–61.0) and previous surgical procedure (OR: 7.4; 95% CI: 1.9–28.5) as independent risk factors for carbapenem-resistant Klebsiella pneumoniae infection in patients colonized with carbapenem-resistant Klebsiella pneumoniae. Out of 24 patients with carbapenem resistant Klebsiella pneumoniae infection, 4 (16.6%) died of carbapenem-resistant Klebsiella pneumoniae sepsis. Conclusion: Asymptomatic colonization with carbapenem-resistant Klebsiella pneumoniae in intensive care units of pediatric departments should alert health care providers about forthcoming carbapenem-resistant Klebsiella pneumoniae infection. Those carbapenem-resistant Klebsiella pneumoniae colonized patients at risk of developing infection due to carbapenem-resistant Klebsiella pneumoniae may be targeted for interventions to reduce subsequent infection occurence and also for timely initiation of empirical carbapenem-resistant Klebsiella pneumoniae active treatment, when necessary. Keywords: Carbapenem resistant Klebsiella pneumoniae, Infection, Colonization, Pediatric/Neonatal intensive care

Hereditary angioedema (HA) is a rare, autosomal-dominant genetic disorder presenting with recurrent attacks of angioedema. The most commonly involved organs include the extremites, face, neck, upper respiratory tract, genital region and the gastrointestinal tract. Edema of the intestinal mucosa can cause temporary obstruction and severe abdominal pain that can be confused with acute abdomen. Pediatricians and emergency physicians should keep in mind this rare disease in the differential diagnosis of severe abdominal pain.

Sik G, Aydoseli A, Citak A. Intrathecal baclofen use in the management of tetanus related spasm: A case report. Turk J Pediatr 2019; 61: 126-129. Tetanus is an infectious disease of the central nervous system with high mortality rates characterized with respiratory distress and tonic muscle spasms. The most common cause of mortality is cardiovascular complications (40%) and respiratory distress (15%). Despite vaccination programs, tetanus remains to be a significant healthcare issue in developing nations. Prolonged sedation and administration of muscle relaxants prolongs the period on mechanical ventilation and duration of hospitalization in severe tetanus cases. However, intrathecal baclofen (ITB) therapy might shorten the duration of stay at intensive care units, improve patient outcomes, and constitute a treatment option alternative to paralytic agents and sedation. In this manuscript, we present a 12-years-old case diagnosed with tetanus and treated with ITB upon observation of spasms refractory to high dose sedation and muscle relaxants.

Background: Convulsive status epilepticus (CSE) may end fatally or leave serious sequelae. CSE treatment, invariably an emergency case, is based upon i.v. benzodiazepines as well as phenytoin, barbiturates or both. The present paper reports efficiency of lidocaine in CSE. Methods: The effects of lidocaine on patients with CSE due to infectious and non-infectious reasons were compared. Lidocaine was given in 29 episodes of CSE to 49 patients having failed to respond to first-line anticonvulsive drugs, such as diazepam, phenobarbital and phenytoin therapy. Lidocaine was given in doses of 2 mg/kg bolus i.v., and then in 4 mg/kg per h infusion. Results: Mean duration of lidocaine infusion was 14.6 ± 7.8 h. Effectiveness of lidocaine in patients with CSE was found to be 44.4%. Also, 11 patients responded to a single dose of lidocaine (37.9%), while another two (6.9%) required another dose to suppress their seizures. Patients with seizures attributable to infections were observed to have responded favorably to lidocaine when compared to those with seizures due to epilepsy (37.9% vs 6.8%; P

Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 ± 78.8 (1.5–180) months. Hyperglycemia occurred in 76.9% (n = 10), and metabolic acidosis occurred in 53.8% (n = 7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis.

Background We aimed to determine the frequency of vancomycin-resistant enterococci (VRE) infection occurrence in previously VRE-colonized children in a pediatric intensive care unit (PICU) and to identify associated risk factors. Methods Infection control nurses have performed prospective surveillance of health care–associated infections and rectal VRE carriage in PICUs from January 2010-December 2014. This database was reviewed to obtain information about VRE-colonized and subsequently infected patients. A case-control study was performed to identify risk factors associated with VRE infection development in previously VRE-colonized patients. Results Out of 1,134 patients admitted to the PICU, 108 (9.5%) were found to be colonized with VRE throughout the study period. Systemic VRE infections developed in 11 VRE-colonized patients (10.2%), and these included primary bloodstream infection (n = 6), urinary tract infection (n = 3), meningitis and bloodstream infection (n = 1), and meningitis (n = 1). Logistic regression analysis indicated long hospital stay (≥30 days) and glycopeptide use after detection of VRE colonization as risk factors for developing VRE infection in VRE-colonized patients (odds ratio [OR], 5.76; 95% confidence interval [CI], 1.6-15.8; P = .017 and OR, 12.8; 95% CI, 1.9-26.6; P = .012, respectively). Conclusions VRE colonization has important consequences in pediatric critically ill patients. Strict infection control measures should be implemented to prevent VRE colonization and thereby VRE infections. Furthermore, irrational antibiotic use and particularly glycopeptide use in VRE-colonized patients should be restricted.

PubMed ID: 26998605, No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher or, in the case of photocopying, direct payment of a specified fee to the Copyright Clearance Center. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.Background: The study aims to define the efficacy of continuous renal replacement therapy in acute metabolic decompensation treatment of maple syrup urine disease (MSUD). Methods: All the neonates, infants and children who have had life threatening conditions due to MSUD and were treated with continuous venovenous hemodiafiltration (CVVHDF) were analyzed retrospectively. Results: Fourteen patients underwent 15 sessions of CVVHDF (age range 15 days to 87 months, mean 40.8 ± 31.4 months). One patient required additional CVVHDF 1 week after cessation of CVVHDF. Twenty seven percent (n = 4) of the patients were intubated and mechanically ventilated. Twelve patients responded to treatment and dramatic neurological improvement was observed within 24 h. Two of the 14 patients required 36 h of CVVHDF for neurological improvement. The mean duration of CVVHDF was 20.2 ± 8.6 (9-36) h. The mean leucine level was 1,648 ± 623.8 (714-2,768) µmol/l before and was 256.5 ± 150.6 (117-646) µmol/l at the end of treatment. No mortality was observed. Conclusion: Continuous hemodiafiltration is an effective and safe method in correcting metabolic disturbances in MSUD. © 2016 © 2016 S. Karger AG, Basel. Copyright: All rights reserved.

Background: The aim of this study was to examine the characteristics of seizure due to poisoning. Methods: This was a retrospective analysis, throughout 4 years of hospital admissions for poisoning. Data of patients with seizures due to poisoning were evaluated with respect to the causes, frequencies and complications of seizures. Results: Among the 1561 admissions due to intoxication during the review period, seizures developed in 26 cases (1.6%). Tricyclic antidepressant overdose (n = 11, 42%) was the leading cause of seizure due to poisoning. Generalized tonic-clonic seizures were observed in 24 patients. Status epilepticus developed in six patients (23%). Mechanical ventilation was applied in 12 (46%) patients. Cardiac complications were observed in 11 (42%) patients with seizures. Two patients who had cardiac arrest due to acepromazin maleat and imipramine intoxication died. Conclusion: One of the causes of seizures in pediatric age group is intoxication. Seizures due to intoxications may cause serious clinical conditions. Intoxications should be thought when a patient is admitted with the diagnosis of afebrile seizure even if there is no history of drug intake.

Çakan M, Aktay-Ayaz N, Gemici H, Annayev A, Çıtak A, Akçay A, Öztürk G. Sustained hyperferritinemia in a child with macrophage activation syndrome secondary to systemic juvenile idiopathic arthritis - perforinopathy: case based review. Turk J Pediatr 2018; 60: 598-603. Systemic juvenile idiopathic arthritis is a subtype of juvenile idiopathic arthritis and characterized by arthritis and many systemic features like fever, rash, hepatosplenomegaly, lymphadenopathy and serositis. Macrophage activation syndrome is the most dreadful complication of systemic juvenile idiopathic arthritis and can cause mortality and morbidity if not recognized and treated early and aggressively. Hemophagocytic lymphohistiocytosis (HLH) is characterized by diminished or absent activities of natural killer cells and cytotoxic T lymphocytes leading to cytokine storm and uncontrolled activation of T cells and macrophages. Primary (familial) HLH is a group of autosomal recessive disorders caused by mutations in the perforin and other related genes and distinctive for onset during early infancy and high rate of mortality. Secondary HLH may be caused by infectious, oncologic and rheumatologic disorders. The term Perforinopathy is used to describe cases with classical familial HLH and also for cases with familial HLH gene mutations but not following a classical familial HLH course. Herein we report a case of chronic perforinopathy in which clinical symptoms started with systemic juvenile idiopathic arthritis and severe macrophage activation syndrome that needed plasma exchange and extracorporeal membrane oxygenation during acute period and ongoing interleukin-1 blockage for sustained hyperferritinemia.

Izoniazid cocukluk cagi tuberkulozunun tedavi ve profilaksisi icin en sik kullanilan ilaclardan biridir. Yaygin bir sekilde kullanilmasina paralel olarak kaza veya kasitli olarak zehirlenme vakalari gorulmektedir. Konvulziyon, metabolik asidoz ve koma uclemesi ile basvuran hastalarda INH zehirlenmesi dusunulmeli ve hizla piridoksin tedavisi baslanmalidir. Oz kiyim ozellikle ergenlik doneminde sik karsilasilan durumlardan birsidir. Bu makalede oz kiyim amacli isoniazid zehirlenmesi ile gelen ergen bir vaka sunularak, izoniazid zehirlenmesine ve ergenlerin oz kiyim girisimlerine yaklasim degerlendirilecektir.

Background: It is critical to establish a safe and functional i.v. access in severely sick patients. We evaluated the frequency of application and complications of central venous catheters in a pediatric intensive care unit. Methods: Pediatric patients in whom central venous catheters were inserted between March 1997 and May 1999 in the Pediatric Emergency Room and Intensive Care Unit were enrolled in this study. Patients were evaluated with respect to age, sex, weight, central venous catheter indication, site, duration of catheter stay and complications. Results: During the study period a total of 156 central venous catheters were successfully inserted into 146 patients. Of the 156 central venous catheter attempts, 148 (94.9%) were placed into the subclavian vein, six were inserted into the femoral vein, and two into the jugular vein. In 156 attempts, arterial injuries ocurred in 20 cases (12.8%). Pneumothorax developed in two patients on mechanical ventilation. Three catheters had to be removed due to catheter related infections. The mortality rate was 0%. Conclusions: We concluded that subclavian central venous catheterization is a safe procedure with minimal complications in pediatric patients. Arterial injury was the most frequent complication. In experienced hands, the succes rate was 100%. Subclavian central venous catheter insertion may be considered as the first approach in critically ill patients.

Objective: Hemolytic uremic syndrome (HUS) is characterized by microangiopathic hemolytic anemia, thrombocytopenia and acute renal failure. The most common form of HUS in children is Shigatoxin-producing Escherichia coli (STEC) related HUS. HUS is the most common causeof acute renal failure in Europe whereas it was not observed in the same frequency in our country. However, in 2011, after the outbreak of Escherichia coli (E. Coli) gastroenteritis and HUS in Germany, we observed significantly increased cases of HUS in our country. In this retrospective study, we aimed to determine the clinical features and prognosis of HUS patients who admitted with a history of diarrhea during this breakout. MaterialsandMethods: We followed up 9 patients with diarrhea associated HUS in 2011. Blood cell count, peripheral blood smear, serum urea, creatinine, electrolytes, complement C3, direct Coombs test, cultures of urine as well as blood and stool, chest X-ray were performed. Results: The mean age was 5.8 ± 4.2 years (3 months-12 years). Six of the patients had complete anuria, the first urine appeared 2-7 days after the presentation. Mean duration of hospitalization was 17.66±13.77 days . In healing process, first platelet count increased. Urine out put appeared soon after the platelet count rose in the anuric patients, mean duration of anuria and oliguria were 7±3 days and 4±5 days , respectively. Conclusion: The results of our study indicate that it may be appropriate to accept as atypical HUS and treat the patients with low C3 levels, vital organ involvement, long-term renal failure and negative stool tests for verotoxin though it cannot be confirmed at the time of admission, Amaç: Hemolitik Üremik Sendrom (HÜS) mikroanjiopatik hemolitik anemi, trombositopeni ve akut böbrek yetersizliği ile tanımlanan bir tablodur. Çocuklarda HÜS etiyolojisinde Shiga toksin üreten Escherichiacoli’nin (STEC) neden olduğu HÜS en sık görülen formudur.Avrupa ülkelerinde akut böbrek yetersizliği etiyolojisinde en sık neden olarak belirtilen HÜS ülkemizde aynı sıklıkla görülmemektedir. Ancak 2011 yılında Almanya’da yaşanan Escherichiacoli (E.coli)gastroenteriti ve HÜS salgını sonrasında aynı yıl ülkemizde diyare sonrası gelişen HÜS vakalarında artış saptadık. Bu retrospektif çalışmada amacımız bu salgın sırasında diyare öyküsü ile başvuran HÜS tanılı hastalarımızın klinik özellikleri ve prognozunun belirlenmesidir.Gereç ve Yöntem: İkibinonbir yılında 9 HÜS hastası izlendi. Tam kan sayımı, periferik kan yayması, kan üre, kreatinin, elektrolitler, kompleman C3, direkt coombs testi, idrar, kan ve dışkı kültürleri ve akciğer grafisi yapıldı. Bulgular: Ortalama yaş 5,8±4,2 (3ay-12 yaş) yaştı. Altı hastada anüri mevcuttu ve ilk idrar çıkışı başvurudan 2-7 gün sonra görüldü. Ortalama hastanede yatış süresi 17,66±13,77 (8-52) gündü. İyileşme sürecinde ilk olarak trombosit sayısı yükseldi. Anürik hastalarda idrar çıkışı trombosit sayısının yükselmeye başlamasından hemen sonra görüldü. Ortalama oligüri ve anüri süresi sırasıyla 7±3 (3-10) ve 4±5 (1-14) gündü.Sonuç: Çalışmamızın sonuçları, serum C3 düzeyi düşük olan, hayati organ tutulumu gösteren, böbrek yetersizliği uzun süren ve dışkıda verotoksin negatif olan hastaların atipikHÜS nedenleri açısından tetkikleri tamamlanmamış olsa bile atipikHÜS gibi kabul edilerek tedavi edilmesinin uygun olacağını düşündürmektedir.

Background: Pharyngeal-cervical-brachial (PCB) variant is a rare form of Guillan-Barre Syndrome (GBS). Antibodies against other membrane proteins like GM1b and GD1a have been found only in a small number of patients with Guillan Barre syndrome variant. Case Report: Here, we report a 5.5 year-old boy diagnosed early with positive GD1a and GD1b gangliosides of Guillan-Barre syndrome pharyngeal cervical-Brachial variant, who improved and recovered fully in a short period. This is in contrast to those whose recovery period prolongs in spite of early diagnosis and appropriate treatment and/or those who experience incomplete recovery. Conclusion: In summary, diagnosis of PCB variant of GBS should be considered in infants with sudden onset bulbar symptoms and muscle weakness, and it should be kept in mind that early diagnosis and appropriate treatment can give successful outcomes. Turkish Başlık: Guillain-Barré Sendromunun nadir formu; Anti-GD1a ve Anti-GD1b antikor pozitifliği ile seyreden Faringeal-servikal-brakiyal varyantı çocuk Anahtar Kelimeler: Guillain-Barré sendromu, Faringeal-servikal-brakiyal varyantı, gangliozid antikorları, çocuk, acil servis Arkaplan: Faringeal-servikal-brakiyal variant, Guillain-Barré sendromunun nadir bir formudur. Guillain-Barré sendromu varyantı hastaların küçük bir kısmında GM1b ve GD1a gibi gangliozidlerin diğer membran proteinlerine karşı antikorlar saptanmıştır. Olgu Sunumu: Bu yazıda Guillain-Barré sendromu Faringeal-Servikal-Brakiyal varyantının GD1a ve GD1b gangliozid antikorları pozitif olan, tanısı erken konulan, erken ve uygun tedavi ile iyileşme fazı uzayan ve/veya tam olarak iyileşemeyen diğer benzerlerinden farklı olarak kısa sürede ve tamamen iyileşen 5.5 yaşında bir erkek olguyu sunuyoruz. Sonuç: Çocuklarda ani başlayan, bulbar semptomlar ve kas zayıflığı ile giden vakalarda GBS un PCB düşünülmeli, erken tanı, erken ve uygun tedavi ile başarılı sonuçlar alınabileceği akılda tutulmalıdır.

Pleuropulmonary blastoma is a malignant lung tumor affecting children. Pleuropulmonary blastoma is a rare entity having an incidence between 0.25-0.5% of all primary lung malignancies that occurs exclusively in children younger than 6 years. The tumor usually originates from pulmonary parenchyma, mediastin and pleura and especially presents as a solitary pulmonary mass in unilateral lung. In this case report, we present a 3.5-year-old boy who was admitted with fever, dyspnea, wheezing, abdominal pain, weight loss and was diagnosed as pleuropulmonary blastoma. As pleuropulmonary blastoma is rarely seen in childhood, relevant literature on pleuropulmonary blastoma is reviewed. Plöropulmoner blastoma çocukluk çağında oldukça nadir görülen malign tümörlerden biridir. Tüm primer akciğer malignitelerindeki insidansı %0.25- 0.5 arasındadır. Sıklıkla 6 yaş altında görülür ve özellikle akciğer parankimi, mediasten ve plevradan kaynaklanır. Genellikle tek taraflı soliter akciğer kitlesi şeklinde görülür. Bu olgu sunumunda ateş, solunum sıkıntısı, hışıltı, karın ağrısı, kilo kaybı gibi nonspesifik bulgularla başvuran, tek taraflı akciğer kitlesi saptanan ve plöropulmoner blastoma tanısı konulan 3.5 yaşındaki bir erkek olgu sunulmuştur. Sonuç olarak çocukluk çağında tek taraflı solit akciğer kitlesi tespit edilen olgularda nadir görülen plöropulmoner blastoma tanısı da akılda tutulmalıdır., Plöropulmoner blastoma çocukluk çağında oldukça nadir görülen malign tümörlerden biridir. Tüm primer akciğer malignitelerindeki insidansı %0.25- 0.5 arasındadır. Sıklıkla 6 yaş altında görülür ve özellikle akciğer parankimi, mediasten ve plevradan kaynaklanır. Genellikle tek taraflı soliter akciğer kitlesi şeklinde görülür. Bu olgu sunumunda ateş, solunum sıkıntısı, hışıltı, karın ağrısı, kilo kaybı gibi nonspesifik bulgularla başvuran, tek taraflı akciğer kitlesi saptanan ve plöropulmoner blastoma tanısı konulan 3.5 yaşındaki bir erkek olgu sunulmuştur. Sonuç olarak çocukluk çağında tek taraflı solit akciğer kitlesi tespit edilen olgularda nadir görülen plöropulmoner blastoma tanısı da akılda tutulmalıdır.

To define clinical spectrum of airway foreign body aspiration in children and to evaluate the outcome and complications.A total of 53 patients (27 girls, 26 boys) with a mean age of 30.0+/-32.7 months, who aspirated foreign bodies were treated with bronchoscopy were divided into two groups with respect to the time they were diagnosed as early (Group 1, n=22,/=24 h after aspiration) and late diagnosed group (Group 2, n24 h after aspiration). The two groups were followed up prospectively for complications.A total of 72% of patients were under a 3-year age group. Choking episode history was reported in 32% of patients but when families were questioned about it more in detail the rate increased to 51%. Acute episode of choking seemed trivial most of the families. Cough (69.8%), decreased breath sounds (52.8%) and wheezing (45.1%) were predominant symptoms. Sunflower seed (32. 1%) and peanuts (15.1%) were noted as common aspirated materials. Air trapping (59%) and consolidation (47%) were the most frequent radiological findings especially in the late diagnosed group (P0. 01). Patients who aspirated organic materials frequently developed pneumonia diagnosed in late period after aspiration.Pediatricians must be conscious to check for foreign body aspiration who have sudden onset of cough and wheezing episode. In any suspicion, a bronchoscopy should be considered even if there is not any positive history for aspiration. Children should be followed up after bronchoscopy for complications.

Purpose The aims of this study were to determine the prevalence of hypophosphatemia and to discuss the clinical implications of hypophosphatemia in critically ill children. Materials and Methods A retrospective review of the medical records of children admitted to the pediatric intensive care unit from December 2006 to December 2007 was conducted. Results In 60.2% (n = 71) of the patients, any serum phosphorous level at admission and at the third day or seventh day after admission to pediatric intensive care unit was in hypophosphatemic range. Sepsis was present in 22.9% (n = 27) of the children studied and was associated with hypophosphatemia ( P = .02). Hypophosphatemia was also associated with use of furosemide ( P = .04), use of steroid ( P = .04), use of β 2 agonist ( P = .026), and use of an H 2 blocker ( P = .004). There was a significant association between hypophosphatemia and the rate to attain target caloric requirements by enteral route ( P = .007). The median time to attain target caloric requirements by enteral route was 2.9 ± 1.9 (0.2-10) days in the normophosphatemic group and 4.4 ± 2.8 (0.3-12) days in the hypophosphatemic group. In the multiple regression model, solely the rate to attain the target caloric requirements by enteral route demonstrated independent association with hypophosphatemia ( P = .006; β = .27; 95% confidence interval, 0.02-0.09). Significant association was found between hypophosphatemia and the duration of mechanical ventilation and between hypophosphatemia and pediatric intensive care unit length of stay ( P = .02 and P = .001, respectively). Conclusions Critically ill pediatric patients are prone to hypophosphatemia, especially if they cannot be fed early by enteral route. Hypophosphatemia is associated with an increased duration of mechanical ventilation and increased length of stay in the pediatric intensive care unit, suggesting that active repletion might improve these parameters.

Horoz, Ozden Ozgur/0000-0001-7590-650X; dursun, oguz/0000-0001-5482-3780; erkek, nilgun/0000-0003-0271-232X; Sevketoglu, Esra/0000-0002-8330-2877; Kendirli, Tanil/0000-0001-9458-2803; Dursun, Oguz/0000-0001-5482-3780; KOROGLU, TOLGA F/0000-0002-9419-1578; ates, can/0000-0003-2286-4398; citak, agop/0000-0002-5108-3913; yildizdas, dincer/0000-0003-0739-5108 WOS: 000299073000003 PubMed: 21263368 Objectives: To outline the epidemiologic features, clinical presentation, clinical courses, and outcomes in critically ill children with pandemic influenza in pediatric intensive care units. Design: Retrospective, observational, multicenter study. Setting: Thirteen tertiary pediatric intensive care units in Turkey. Patients: Eighty-three children with confirmed infection attributable to pandemic influenza detected by reverse-transcriptase polymerase chain reaction assay between November 1 and December 31, 2009 who were admitted to critical care units. Interventions: None. Measurements and Main Results: During a 2-month period, 532 children were hospitalized with pandemic influenza and 83 (15.6%) needed critical care. For the 83 patients requiring critical care, the median age was 42 (range, 2-204) months, with 24 (28.9%) and 48 (57.8%) of patients younger than 2 and 5 yrs, respectively. Twenty (24.1%) patients had no underlying illness, but 63 (75.9%) children had an underlying chronic illness. Indications for admission to the pediatric intensive care unit were respiratory failure in 66 (79.5%), neurologic deterioration in six (7.2%), and gastrointestinal symptoms in five (6.0%) patients. Acute lung injury was diagnosed in 23 (27.7%), acute respiratory distress syndrome was diagnosed in 34 (41%), and 51 (61.4%) patients were mechanically ventilated. Oseltamivir was used in 80 (96%) patients. The mortality rate for children with pandemic influenza 2009 was 30.1% compared to an overall mortality rate of 13.7% (p = .0016) among pediatric intensive care unit patients without pandemic influenza during the study period. Also, the mortality rate was 31.7% in patients with comorbidities and 25.0% in previously healthy children (p = .567). The cause of death was primary pandemic influenza infection in 16 (64%), nosocomial infection in four (16%), and primary disease progression in five (20%) patients. The odds ratio for respiratory failure was 14.7 (95% confidence interval, 1.85-111.11), and odds ratio for mechanical ventilation was 27.7 (95% confidence interval, 0.003-200). Conclusions: Severe disease and high mortality rates were seen in children with pandemic influenza. Death attributable to pandemic influenza occurred in all age groups of children with or without underlying illness. Multiple organ dysfunction syndrome is associated with increased mortality, and death is frequently secondary to severe lung infection caused by pandemic influenza. (Pediatr Crit Care Med 2012; 13:e11-e17)

WOS: 000313196800018, PubMed ID: 22715953, Introduction: Hyperferritinemia is associated with increased mortality in pediatric sepsis, multiple organ dysfunction syndrome (MODS), and critical illness. The International Histiocyte Society has recommended that children with hyperferritinemia and secondary hemophagocytic lymphohistiocytosis (HLH) or macrophage activation syndrome (MAS) should be treated with the same immunosuppressant/cytotoxic therapies used to treat primary HLH. We hypothesized that patients with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS can be successfully treated with a less immunosuppressant approach than is recommended for primary HLH. Methods: We conducted a multi-center cohort study of children in Turkish Pediatric Intensive Care units with hyperferritinemia associated secondary HLH/sepsis/MODS/MAS treated with less immunosuppression (plasma exchange and intravenous immunoglobulin or methyl prednisolone) or with the primary HLH protocol (plasma exchange and dexamethasone or cyclosporine A and/or etoposide). The primary outcome assessed was hospital survival. Results: Twenty-three children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS were enrolled (median ferritin = 6341 mu g/dL, median number of organ failures = 5). Univariate and multivariate analyses demonstrated that use of plasma exchange and methyl prednisolone or intravenous immunoglobulin (n = 17, survival 100%) was associated with improved survival compared to plasma exchange and dexamethasone and/or cyclosporine and/or etoposide (n = 6, survival 50%) (P = 0.002). Conclusions: Children with hyperferritinemia and secondary HLH/sepsis/MODS/MAS can be successfully treated with plasma exchange, intravenous immunoglobulin, and methylprednisone. Randomized trials are required to evaluate if the HLH-94 protocol is helpful or harmful compared to this less immune suppressive and cytotoxic approach in this specific population.

Airway pressure release ventilation (APRV) is a relatively new mode of mechanical ventilation. The use of this model of ventilation in pediatrics has been limited. The authors describe their experience with this mode of ventilation in a series of pediatric hypoxemic respiratory failure patients. Three patients with acute hypoxemic respiratory failure (AHRF) were treated with APRV, when oxygenation did not improve with pressure control ventilation (PCV). The mean age of the patients was 5.8 ± 1.3 months. Fractional oxygen concentration decreased from 0.97 ± 0.02 for PCV to 0.68 ± 0.12 for APRV, peak airway pressure fell from 36.6 ± 11.5 cm H₂O for PCV to 33.3 ± 5.7 cm H₂O for APRV, mean airway pressure increased from 17.9 ± 5.9 cmH₂O for PCV to 27 ± 2.6 cm H₂O for APRV and release tidal volume increased from 8.3 ± 1.5 mL/kg for PCV to 13.2 ± 1.1 mL/kg for APRV after 1 h. APRV may improve oxygenation in pediatric AHRF when conventional mechanical ventilation fails. The APRV modality may provide better oxygenation with lower peak airway pressure.

Paraphenylenediamine (PPD) is an oxidative chemical allergen that can cause hypersensitivity reactions. PPD intoxication could cause severe systemic adverse effects like acute renal failure, rhabdomyolysis and multiple organ failure. In this text we present a 9 year-old female patient who developed multiple organ failure and cardiac arrhythmia as a result of extensive application of PPD added to henna to the skin. Plasma exchange (PE) and continuous venovenous hemodiafiltration (CVVHDF) were started. The patient died on day 4 after developing ventricular fibrillation that was resistant to antiarrhythmic treatment and defibrillation. In summary, the most commonly seen clinical signs in PPD intoxication are cervical, upper respiratory and muscle edema, intravascular hemolysis, rhabdomyolysis, severe cardiac arrhythmias and acute renal failure. These symptoms would be suggestive of PPD poisoning.

Our objective was to characterize the etiologic factors and outcome for stroke in children. We retrospectively reviewed the charts of patients between the ages of 40 days and 94 months (36.5 +/- 23.7 months) with stroke seen at Istanbul Medical Faculty, Department of Pediatrics between January 1995 and December 2003. We found 79 cases of stroke: 57 ischemic and 22 hemorrhagic strokes. Seventeen children had vitamin K deficiency dependent hemorrhage. In 14 children stroke occurred as a complication of cardiac disease, 7 had moyamoya disease, 3 had protein C deficiency, 2 had thalassemia, 2 had hyperhomocysteinemia (methylene tetrahydrofolate reductase gene mutation), 2 were heterozygote for factor V Leiden, 3 had Down's syndrome, 1 was diagnosed with antiphospholipid syndrome, 1 had glycogen storage disease, and in 28 children no underlying cause could be found. Multiple risk factors were found in 4 children. The outcome in all 79 stroke patients was as follows: asymptomatic 60%; symptomatic epilepsy or persistent neurologic deficit 37%; death 3%; and recurrent stroke 5%. Thus, an underlying cause for stroke was identified in 65% of the children in the study group; 40% of the children either died or suffered motor and/or cognitive sequelae.

Children with peripheral airways obstruction suffer the negative effects of intrinsic positive end-expiratory pressure: increased work of breathing and difficulty triggering assisted ventilatory support. We examined whether external positive end-expiratory pressure to offset intrinsic positive end-expiratory pressure decreases work of breathing in children with peripheral airways obstruction. The change in work of breathing with incremental pressure support was also tested. Prospective clinical trial in a pediatric intensive care unit. Eleven mechanically ventilated, spontaneously breathing children with peripheral airways obstruction. Work of breathing (using pressure-rate product as a surrogate) was measured in three tiers: (a) Increasing pressure support over zero end-expiratory pressure. (b) Increasing applied positive end-expiratory pressure and fixed pressure support. The level of applied positive end-expiratory pressure at which pressure-rate product was least determined the compensatory positive end-expiratory pressure. (c) Increasing pressure support over compensatory (fixed) positive end-expiratory pressure. Increases in pressure support alone decreased pressure-rate product from mean 724 ± 311 to 403 ± 192 cmH2O/min. Applied positive end-expiratory pressure alone decreased pressure-rate product from mean 608 ± 301 to 250 ± 169 cmH2O/min. The lowest pressure-rate product (136 ± 128 cmH2O/min) was achieved using compensatory positive end-expiratory pressure (12 ± 4 cmH2O) with pressure support 16 cmH2O. For children with peripheral airways obstruction who require assisted ventilation, work of breathing during spontaneous breaths is decreased by the application of either compensatory positive end-expiratory pressure or pressure support.