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Aim: Although early enteral nutrition (EN) is strongly associated with lower mortality in critically ill children, there is no consensus on the definition of early EN. The aim of this study was to evaluate our current practice supplying EN and to identify factors that affect both the initiation of feeding within 24 h after paediatric intensive care unit (PICU) admission and the adequate supply of EN in the first 48 h after PICU admission in critically ill children., Methods: We conducted a prospective, multicentre, observational study in nine PICUs in Turkey. Any kind of tube feeding commenced within 24 h of PICU admission was considered early initiated feeding (EIF). Patients who received more than 25% of the estimated energy requirement via enteral feeding within 48 h of PICU admission were considered to have early reached target EN (ERTEN)., Results: Feeding was initiated in 47.4% of patients within 24 h after PICU admission. In many patients, initiation of feeding seems to have been delayed without an evidence-based reason. ERTEN was achieved in 43 (45.3%) of 95 patients. Patients with EIF were significantly more likely to reach ERTEN. ERTEN was an independent significant predictor of mortality (P < 0.001), along with reached target enteral caloric intake on day 2 associated with decreased mortality., Conclusions: There is a substantial variability among clinicians' perceptions regarding indications for delay to initiate enteral feeding in critically ill children, especially after the first 6 h of PICU admission. ERTEN, but not EIF, is associated with a significantly lower mortality rate in critically ill children., (© 2017 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

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.

Background/aims: The purpose of upper gastrointestinal endoscopy in gastroesophageal reflux disease is to detect the complications; both Barrett esophagus and erosive esophagitis are common in developed countries. We aimed to investigate the ratio of esophageal complications in gastroesophageal reflux disease and the relationship between reflux symptoms and erosive esophagitis., Methods: Six hundred forty-five consecutive adult patients presenting to the Reflux Outpatient Clinic were evaluated prospectively. One hundred sixty patients who underwent upper gastrointestinal endoscopy and who complained of heartburn or regurgitation occurring at least weekly were selected. The complaints and general features of patients were queried via a detailed questionnaire., Results: Twenty-seven patients (17%) had endoscopic evidence of erosive esophagitis. Barrett esophagus was found in 3 patients (2%). Neither esophageal stricture nor adenocarcinoma was found. Esophagitis was low grade (grades A and B) in 25 of the 27 (92%) with erosive esophagitis. Patients with erosive esophagitis consumed less alcohol than patients with non-erosive reflux disease. No difference was found between the severity of symptoms in patients with erosive esophagitis and non-erosive reflux disease., Conclusions: Barrett esophagus and erosive esophagitis were less common compared to the literature although the study was conducted in a tertiary reference center for gastroesophageal reflux disease. The presence of severe symptoms in gastroesophageal reflux disease is not an indication for upper gastrointestinal endoscopy. No impact of Helicobacter pylori on the severity of esophagitis or symptoms was shown.

Hypercalcemia is a well-recognized complication of neoplastic disorders. Herein, we report a hypercalcemic pediatric acute lymphoblastic leukemia case at presentation refractory to hydration, furosemide, pamidronate and calcitonin. Normal serum calcium levels were achieved with the initiation of chemotherapy protocol including vincristine, daunomycin and high-dose methylprednisolone. The impact of high-dose methylprednisolone in the correction of severe hypercalcemia in steroid-responsive tumors as an initial treatment approach or for cases refractory to other measures may be life-saving.