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Aim This study was aimed at characterising the prevalence, management and outcomes of paediatric severe sepsis and septic shock in tertiary paediatric intensive care units (PICUs) in Turkey. Methods A point prevalence study was conducted on 5 days over the course of 1 year in 29 PICUs in Turkey. Outcomes included severe sepsis and septic shock point prevalence, therapies used, duration of PICU stay and mortality at day 28. Results Of the 1757 children who were admitted to the PICU during the study period, 141 (8.0%) children met the consensus criteria for severe sepsis and 23 (1.3%) children met the criteria for septic shock. Paediatric severe sepsis and septic shock accounted for 8% and 1.3% of all PICU admissions, respectively. The median age of the patients was 2.6 years (interquartile range [IQR], 0.7-8.6 years). Enteral nutrition (79.3%) was preferred compared to parenteral nutrition (31.1%) for the first 3 days after PICU admission. A total of 39 patients died while in the PICU, for a 23.8% mortality rate, which did not vary by age. Conclusion The mortality rate was similar to that in other studies. Hematologic-immunologic comorbidity, parenteral nutrition and the use of vasoactive drugs were independently associated with mortality.

Multisystem inflammatory syndrome in children (MIS-C) is a severe disease that can lead to death. There is no definitive treatment for MIS-C yet. It has been reported that intravenous immunoglobulin, intravenous methylprednisolone, fluid supplements, antibiotics, inotropics, extracorporeal membrane oxygenation (ECMO), plasmapheresis, biological therapy, and anticoagulation therapy can be used for treatment. In this article, we presented an 8-year-old girl child patient who survived due to timely administered ECMO and combined therapies including plasmapheresis without any sequela despite her life-threatening condition due to MIS-C.

Despite the clinical use of mechanical ventilation having well-documented benefits, it can be associated with complica- tions and adverse physiological effects that can impact mortality rates. There are few studies that examine complications associated with mechanical ventilation in children and the factors associated with complications in detail. This study aimed to investigate adverse events associated with mechanical ventilation in pediatric patients and to compare the epidemiology of complications associated with mechanical ventilation.The medical records of patients in a tertiary care pediatric intensive care unit who were mechanically ventilated between January 1, 2013, and July 31, 2017, were evaluated.A total of 187 patients were included in the study, 105 boys (56.1%) and 82 girls (43.9%), and 45 (24.1%) patients experienced complications. The total number of mechanical ventilation days was 1100. Atelectasis (12.3%), post-extubation stridor (8.5%), ventilator- associated pneumonia (5.4%), and pneumothorax (5.4%) were most commonly observed complications.Complications of mechanical ventilation in the pediatric population still occur frequently. In this study, the incidence of atelectasis was high, and also, incidences of ventilator-associated pneumonia and pneumothorax were low.

To determine the frequency of urinary system anomaly in children aged 0-18 y suffering from first urinary tract infection (UTI) and to establish which age group requires urinary ultrasonography (USG) screening.Age and gender, urine culture, urinary USG, and urological imaging results among 247 children in the 0-18 y age group with a first diagnosis of UTI were investigated retrospectively.Anomaly was detected at USG in 68 (27.5%) of the 247 patients suffering from first UTI. The most common anomaly was hydronephrosis. Non-E. coli micro-organisms were the pathogenic agents in 61.8% of patients with anomalies detected at USG. Being in the 0-5 y age group (OR: 0.524, 95% CI 0.284-0.970, p = 0.040) and presence of atypical UTI (OR: 4.746, 95% CI: 1.675-13.450, p = 0.003) emerged as independent predictive markers of severe urinary system pathologies on multiple regression analysis.Based on the data in the present study, routine USG screening is recommended for children suffering from first UTI under the age of 5 y and for the children suffering from atypical UTI at all ages.

Delirium has been associated with prolonged pediatric intensive care unit (PICU) stay and mechanical ventilation times as well as high hospital costs and mortality rates. This work aimed to examine pediatric delirium awareness and delirium management in Turkey. A total of 19 physicians responsible for their respective PICUs completed the survey. Most of the units (57.9%) did not use any assessment tool. Varying measures were applied in different units to reduce the prevalence of delirium. The number of units that continuously measured noise was very low (15.8%). Eye mask and earpiece usage rates were also very low. In pharmacological treatment, haloperidol, dexmedetomidine, benzodiazepines, and atypical antipsychotics were the most preferred options. Some units have reached a sufficient level of pediatric delirium awareness and management. However, insufficiencies in delirium awareness and management remain in general.

In the follow-up of ventilation, invasive blood gas analysis and noninvasive monitoring of end-tidal carbon dioxide (ETCO2) are used. We aimed to investigate the relationship between capillary partial pressure of carbon dioxide (PcCO2) levels and ETCO2 and also to investigate ETCO2's predictive feature of PcCO2 levels. This study included 28 female and 30 male pediatric patients; 28 patients were type-1 respiratory failure (RF), 16 patients were acute respiratory distress syndrome, and 14 patients were type-2 RF. Our results showed a significant correlation between ETCO2 and PcCO2. Although the strength of the correlation was weak throughout the measurements, the strength of this correlation increased significantly in type-2 RF.

Objectives To investigate the antimicrobial resistance patterns of multidrug-resistant Acinetobacter baumannii (MDRAB) in patients in pediatric intensive care units (PICU) in order to determine a guide for the empirical antibiotic treatment of MDRAB. Methods The authors retrospectively evaluated the medical records of patients with MDRAB infections in the PICU during a follow-up period, between January 2015 and January 2017. The identification of A. baumannii was performed using a BD Phoenix 100 Automated Microbiology System. A BD Phoenix NMIC/ID-400 commercial kit was used to test antibiotic susceptibility. All data was entered into Microsoft Excel, and the data was analyzed using SPSS version 23.0. Results The mean age of the patients was 8.1 ± 6.2 y. In all, 46 isolates were obtained from 33 patients. The most effective antimicrobial agents were colistin, trimethoprim/sulfamethoxazole, and tigecycline. Nevertheless, with the exception of colistin, no antibiotic was associated with a susceptibility rate of >45% for the isolates. Low sensitivities in 2015 to tigecycline, aminoglycosides, levofloxacin, and carbapenems had been lost in 2016. Conclusions Many drugs that were previously effective against MDRAB, have lost their effectiveness. Currently, there is no effective drug to fight MDRAB, apart from colistin. Thus, it is clear that new drugs and treatment protocols should be developed urgently.

Neonatal diabetes mellitus is a monogenic disease that can present with hyperglycemia, dehydration, failure to thrive, and ketoacidosis within the first six months of life. Neonatal diabetes mellitus can be transient or permanent. Here, we describe a 10-week-old infant with transient neonatal diabetes mellitus who presented with diabetic ketoacidosis and was found to have heterozygous a de novo mutation, p.Thr1381Asn in the ABCC8 gene, which encodes the SUR1 protein. There was no family history of diabetes mellitus and the parents were negative for the mutation at ABCC8. The patient started on insulin therapy and remission of diabetes occurred at 4 months of age. The patient remained euglycemic over a 2-year follow-up period without necessitating any medicine.

SIGNIFICANCE We determined decreases in choroidal thickness and retinal nerve fiber layer (RNFL) thickness in all quadrants. Our findings show that the choroid and RNFL are affected before the emergence of ocular symptoms in malnourished children. PURPOSE We aimed to determine whether the RNFL, a component of the neuronal structure, and the choroid, supplying the retina, are affected in children with malnutrition using spectral-domain optical coherence tomography. METHODS One hundred twenty-six malnourished patients without ocular symptoms, aged between 5 and 10 years, and 116 healthy children were included in the study. Age, sex, weight-for-age (WFA) z score, height-for-age z score, body mass index-for-age z score, and spectral-domain optical coherence tomography data were recorded. RESULTS Average RNFL thickness was 96.5 μm (82.0 to 128.0 μm) in the malnutrition group and 111.0 μm (95.0 to 128.0 μm) in the control group (P < .001). Retinal nerve fiber layer thickness was statistically significantly lower in all quadrants in malnourished patients compared with the control group. Median choroidal thickness in the foveal center was 304.0 μm (250.0 to 375.0 μm) in the malnutrition group and 345.0 μm (280.0 to 403.0 μm) in the control group (P < .001). Choroidal thickness in all quadrants was also statistically significantly lower in malnourished patients. Positive correlation was determined between average RNFL thicknesses and WFA z score. Average RNFL thickness decreased as WFA z score decreased (r = 0.730 and P < .001). Positive correlation was also observed between choroidal thickness in the foveal center and WFA z score. Foveal center choroidal thickness decreased in line with WFA z score (r = 0.786 and P < .001). CONCLUSIONS Our results show that the retinal nerve fiber layer and choroidal thickness decreased in malnourished children without clinically reported ocular symptoms. A decreased retinal nerve fiber layer and choroidal thickness may be an important clue to the prevention of retinal pathologies that may develop at later ages if the malnutrition is not addressed.

We assessed the effectiveness of laboratory markers in determining the presence of serious bacterial infection (SBI) in well-appearing children aged 3 months to 17 years with fever without source (FWS). One hundred eighteen patients aged between 3 months and 17 years presenting to the pediatric department due to fever and with no focus of fever determined through history and physical examination were included in this prospective study. SBI was determined in 14 (11.9%) of the 118 patients. No significant difference was determined between the two groups in terms of age, sex, degree of fever, duration of fever, and mean platelet volume. The neutrophil-to-lymphocyte ratio (NLR), C-reactive protein (CRP), and procalcitonin (PCT) were identified as independent predictive markers in a multivariate logistic regression analysis. PCT above 0.58 ng/mL emerged as the most sensitive and specific test at receiver operating curve analysis (sensitivity: 92.8%, specificity: 90.3%, area under the curve: 0.908, and p 0.58 ng/mL (95% CI:94.3–99.8). The NLR, CRP, and PCT were independent predictive markers in determining the presence of SBI in well-appearing children with FWS. PCT was the marker with the highest sensitivity and specificity in determining presence of SBI. The method with the highest positive predictive value was laboratory score, while PCT was the marker with the best negative predictive value.

Holoprosencephaly is a rare congenital malformation resulting from an impaired midline division of the prosencephalon into distinct cerebral hemispheres. Hydrocephalus is a frequent problem among the few survivors with alobar holoprosencephaly (aHPE), its most severe form. The literature about neurosurgical management of hydrocephalus in this condition is limited and dispersed, and there are still some points that need to be resolved. We report the case of a newborn with aHPE, hydrocephalus, and central diabetes insipidus. We delineate the complexity of the management of these patients and emphasize the benefits of using an initial programmable shunt valve. Further discussion about management strategies includes reviewing previous reports and the benefits of shunting for hypothalamic osmoreceptor function.

Invasive and noninvasive mechanical ventilation (MV) applications are used for patients with respiratory insufficiency. Noninvasive MV has been increasingly used in pediatric intensive care units in recent years. For this purpose, high-flow nasal cannula (HFNC) oxygen therapy is a treatment method that has been increasingly used. Despite the numerous studies reporting the advantages of this method, there are also a few studies reporting that undesirable conditions can be observed. In this paper, in order to contribute to the literature, we present a 3-month-old baby who developed pneumothorax during HFNC implementation.

This study aimed to evaluate the risk factors for falls in hospitalized children in relation to their caregivers.This was a case control study to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. The children included in our study were at the hospital between June 2014 and June 2015. Demographic data of patients, caregivers, some habits; education level; and number of siblings were recorded.The data of 117 patients were evaluated, and there were 39 patients with a fall event and 78 patients who did not experience a fall. The mean age for the fall group and the non-fall group were 14.71±9.36 and 15.62±10.65months, respectively. The mean age for the caregivers of the fall group and the non-fall group were 29.33±5.89 and 29.53±5.56years, respectively. There was a statistically significant difference in fall risk related to the caregivers' education level (p0.01) and caregivers' habit of smoking (p0.01). The analysis of risk factors related to caregivers for pediatric inpatient falls, by multivariate logistic regression, showed that low educational level of caregivers (OR=0.361; CI=0.196-0.665; p0.01), caregivers' smoking (OR=4.863; CI=1.058-22.358; p0.05) and increased length of stay for the children (OR=1.994; CI=1.475-2.696; p0.01) carried a higher risk for pediatric inpatient falls.The data obtained in our study have shown that caregivers play a key role in fall events in hospitalized children. Nurses and other health workers should consider children's caregivers educational level and habits for prevention of hospitalized children falls.

Background Urinary tract infections (UTIs) are common infections affecting children. In this study, in order to determine a guide for the empirical antibiotic treatment of community-acquired UTIs, we aimed to investigate the etiology and antimicrobial resistance patterns of uropathogens and to evaluate epidemiological and clinical characteristics of patients. Methods A total of 158 children with a positive urine culture were included in the study. Antibiotic susceptibility testing was performed by Vitek 2 Compact for twenty eight commonly used antimicrobials. Results The mean age was 3.36 ± 3.38 years (45 days to 15 years). Escherichia coli (60.1%), and Klebsiella spp. (16.5%) were the most common uropathogens. For all Gram-negative isolates, a high level of resistance was found against ampicillin/sulbactam (60.1%), trimethoprim/sulfamethoxazole (44.2%), cefazolin (36.2%), cefuroxime sodium (33.5%), and amoxicillin/clavulanate (31.5%). A low level of resistance was found against cefepime (8.7%), ertapenem (4.6%), norfloxacin (1.3%), and meropenem (0.7%). There was no resistance against amikacin. Conclusions The results represent a high antibiotic resistance among the children with UTI. The patterns of antimicrobial resistance of uropathogens vary in their susceptibility to antimicrobials depending on region and time. Thus, the trends of antibiotic susceptibility patterns should be detected periodically to select the appropriate regimen for the treatment of UTIs. This article is protected by copyright. All rights reserved.

Simultaneous bilateral spontaneous pneumothorax (SBSP) is a very rare type of pneumothorax. Most reported cases are associated with underlying lung diseases. In a small number of pediatric studies, SBSP was found to be associated with human bocavirus bronchiolitis, Langerhans cell histiocytosis, and Mycoplasma pneumoniae infection. The present work examines an interesting case of type 2 congenital pulmonary airway malformation presenting with SBSP and bilateral multiple parenchymal cysts.

Background For children under 5 years of age, 1700 000 000 episodes of diarrhea are seen worldwide, and death occurs in 700 000 of these cases due to diarrhea. Rotavirus is an important cause of diarrhea in this age group, and many studies have shown that vitamin D plays a pivotal role in the immune system, as well as in antimicrobial peptide gene expression. In addition, lower vitamin D has been correlated with higher rates of infectious diseases such as respiratory tract infection, tuberculosis, and viral infection. Methods Seventy patients with rotaviral diarrhea and 67 healthy patients were enrolled in this study. Serum 25-hydroxy vitamin D3 (25(OH)D3), parathormone, calcium, phosphate, alkaline phosphatase, complete blood count parameters, and C-reactive protein were compared between pre-school children hospitalized due to rotaviral diarrhea and healthy children. Additionally, birthweight, feeding habits in the first 6 months of life, vitamin D and multivitamin supplements, and rotaviral vaccinations were also evaluated in each group. Results There were no differences between the groups with regard to gender and age, but 25(OH)D3 was significantly different: 14.6 ± 8.7 ng/mL in the rotaviral diarrhea patients versus 29.06 ± 6.51 ng/mL in the health controls (P < 0.001), and serum 25(OH)D3

Human coronavirus NL63 (HCoV-NL63) primarily infects the upper respiratory tract. However, it may cause severe lower respiratory tract infection, and the clinical course may be severe in immunocompromised patients. To our knowledge, child death due to HCoV-NL63 has not been reported. We present a fatal lower respiratory tract disease associated with HCoV-NL63 in a 7-month-old malnourished infant.

Aim: We aimed to examine whether there is any association between serum levels of 25-hydroxyvitamin D [25(OH)D3] and urinary tract infection (UTI) among children. Methods: White blood cell count, serum C-reactive protein, calcium, phosphorus, alkaline phosphatase, parathormone, and serum 25(OH)D3 levels were measured in 82 children experiencing a first episode of UTI, with no risk factors for UTI, and 64 healthy control children. Results: The mean serum levels of 25(OH)D3 among children with UTI were significantly lower than those of controls (11.7 ± 3.3 vs. 27.6 ± 4.7 ng/ml; p < 0.001). The serum levels of 25(OH)D3 were significantly lower in patients with acute pyelonephritis compared to patients with lower UTI (8.6 ± 2.8 vs. 14.2 ± 3.0 ng/ml; p < 0.001). Within the study group, mean serum levels of 25(OH)D3 among girls were lower than those of boys (10.9 ± 3.4 ng/ml vs. 13.2 ± 4.4 ng/ml; p < 0.001). Multivariate analysis showed that a serum 25(OH)D3 level of Conclusions: Our results suggest that vitamin D deficiency may be a risk factor for UTI in children.

Objective: To investigate the epidemiological and clinical characteristics of intoxications in our region, to illuminate measures, and to contribute to the national survey. Material and Methods: Medical records of 366 cases who were diagnosed as intoxications during 2013 in the pediatric emergency department were reviewed retrospectively. Results: A total of 80,833 patients were admitted to pediatric emergency department in 2013. The ratio of poisoning cases to all pediatric emergency admissions was 0.4%; 184 (50.2%) cases were female, 182 (49.8%) cases were male, and the mean age was 5.7±1.4 years. Also, 56.8% of patients were under 5 years old. Most (95.7%) cases were accidental, while 4.3% of them were suicides. The common causes of intoxication were medications and scorpion envenomation. The most common pharmacological agents that caused intoxication were analgesics and antidepressants. The most common clinical findings were vomiting (24.3%), nausea (20.2%), abdominal pain (13.6%) and headache (11.4%). Supportive treatments were applied to 90.1% of patients, and antidotes were used in 4.9% of patients. A patient with a scorpion sting died due to cardio-pulmonary insufficiency. Conclusion: In our region, the most common poisoning agents were drugs and scorpion stings. Education of parents may decrease acute intoxication cases causing morbidity and mortality. (JAEM 2014; 13: 166-71)

Background Acute pyelonephritis (APN) can lead to renal scar formation, high blood pressure, and end-stage renal failure. Prompt and early diagnosis of APN is important for preventing future complications. Our goal was to study the mean platelet volume (MPV) as a predictor of APN in children.

Objectives To assess whether mean platelet volume (MPV) can be used as a marker in the differential diagnosis of periodic fever, aphthous stomatitis, pharyngitis, adenitis (PFAPA) syndrome. Methods The leucocyte counts, thrombocyte counts, and MPV values of 57 children with PFAPA syndrome were recorded during an attack and an attack free period. These values were compared with a healthy control group of 55 individuals. Demographic features of the PFAPA patients group including age, gender and age of first attack, age at diagnosis, frequency of attacks, serum reactive protein (CRP) and erythrocyte sedimentation rate (ESR) were also recorded. Results The MPV values of the children with PFAPA both during an attack and attack free period were found significantly lower than the MPV values of healthy control group ( p p Conclusions The MPV values during an attack and attack free period of patients with PFAPA is lower than in controls. The MPV values may be used as a marker in the differential diagnosis of PFAPA syndrome but more studies are needed and they should be prospective in order to validate this data.

To investigate effectiveness and applicability of Doxazosin in the treatment of scorpion stings in patients who had systemic symptoms.The medical records of patients were retrospectively reviewed, and the following data were collected: age, sex, clinical symptoms (localized and systemic), vital signs, information on the date and place of the sting occurrence, the anatomical sting site, time between sting and arrival to the hospital, scorpion identification, severity of the symptoms and treatment.Of the victims, 48.5 % (n = 16) were males, and 51.5 % (n = 17) were females, with a mean age of 6.8 ± 4.2 y. The most common sting site was lower extremity 72.7 % (n = 24). Systemic toxicity (class II) was seen in 93.9 %, and two patients (6.1 %) manifested evidence of severe envenomation (class III). Both local and systemic effects were seen in the patients. Cold extremities persisted for 4.5 ± 1.5 h after administration of Doxazosin. Mean hospitalization time was 2.5 ± 1.5 d (range: 1.5 to 6 d). Thirty-two patients recovered without any sequel, whereas one patient died due to cardio-pulmonary insufficiency.Doxazosin, especially if Prazosin is not available, can be recommended as an effective drug in the treatment of serious scorpion envenomations with significant sympathetic symptoms.

Objective: Acute gastroenteritis is a major health problem associated with high morbidity and mortality in children. Group A rotavirus is the most common cause of acute gastroenteritis in childhood. The clinical signs are nonspecific; so, the analysis of viral antigen in the stool specimen is important for the diagnosis. In this study, we aimed to determine the frequency, seasonal distribution, and laboratory findings of rotavirus gastroenteritis in children 0-16 years old. Material and Methods: A total of 3607 children who applied between March 2012 and February 2013, with complaints of acute gastroenteritis, were investigated retrospectively. Patients with chronic disease, immune deficiency, malnutrition, and chronic gastroenteritis were excluded from the study. Rotavirus antigens were detected in the stool of 597 (16.5%) patients by qualitative immunochromatographic assay. It has a sensitivity of 92.2% and a specificity of 96.5% for detection of Rotavirus antigen. Laboratory findings were recorded from the patients’ charts. The frequency of rotavirus gastroenteritis was evaluated according to age and seasonal distribution. Statistical analysis was performed using Statistical Package of Social Science (SPSS), version 15.0. Results: Viral antigens were determined in 597 (16.5%) of 3607 patients. Three hundred fifty-six (59.6%) children were male. The incidence of rotavirus-positive cases was higher during autumn and spring and higher (18.8%) in 0-24-month-old pediatric groups (p

Morgagni hernisi nadir gorulen bir konjenital diyafragmatik herni turudur ve cogunlukla minimal bulgularla seyrettigi icin ancak ileri yaslarda tani konulabilmektedir. Bircok olgu asemptomatik oldugu icin, Morgagni hernisi literaturde soylendiginden daha sik olabilir. Bu herniler bebek ve cocuklarda daha az gorulmektedir. Cocuklarda major bulgu tekrarlayan akciger enfeksiyonlari olmakla beraber nadiren yenidogan doneminde akut solunum yetmezligi ile de karsimiza cikabilmektedir. Yan grafi ile tani konulabilir ve toraks tomografisi ile tani kesinlestirilir. Genellikle asemptomatik seyretse de ileride gelisebilecek komplikasyonlari onlemek amaciyla cerrahi onarim onerilmektedir. Burada iki hafta boyunca oksuruk sikayeti bulunan ve Morgagni hernisi tanisi konan 14 yasinda bir erkek olgu sunulmaktadir.

Abdominal epilepsy (AE) is characterized by paroxysmal gastrointestinal complaints, symptoms of central nervous system disturbance, abnormal electroencephalogram with findings specific for a seizure disorder, and improvement with anticonvulsant drugs. AE is a very rare cause of recurrent abdominal pain in children. In this article, we present the case of a 5.5-year-old patient with gastrointestinal and central nervous system disturbance symptoms who was diagnosed with AE. (JAEM 2015; 14: 44-6)

Nutritional rickets occurs more commonly in breastfed infants with rapid growth and limited exposure to sunlight. Hypocalcemic convulsions secondary to vitamin D deficiency occur largely in patients with rapid growth rates, such as children younger than 1 year and adolescents. Vitamin D deficiency seems to be an unrecognized and prevalent problem in school childhood. Whereas infants generally exhibit bony deformities, most school-aged children are asymptomatic. In this case, we present hypocalcemic convulsion in a 6-year-old boy with nutritional vitamin D deficiency in order to emphasize that hypocalcemia secondary to vitamin D deficiency can lead to convulsion in other children, as well as infants and adolescents. (JAEM 2014; 13: 206-8)

Objective: Hyperbilirubinemia is a common problem of neonatal period that has high morbidity and mortality. Blood exchange is the most effective and urgent treatment modality for very high bilirubin levels that can lead to neurotoxicity called as kernicterus. The aim of this study was to compare 90 minutes exchange transfusion with that of 120 minutes. Methods: This study was performed at Dicle University Medical Faculty, Neonatal Unit between July 2007 and June 2008. A total of 36 term newborn (38 - 42 gestational week) without blood group incompatibility and with total serum bilirubin levels over 25 mg/dl were included. Newborns were randomly assigned in two groups each of them comprise 18 babies as Group 1 underwent 90 minute-exchange and Group 2 120 minute. Effectiveness and complications of exchange transfusion were recorded. Newborns with Rh, ABO or subgroup incompatibilities, prematurity or small for gestational age, septicemia, hypothyroidism, G6PD enzyme deficiency, intrauterine infections, diabetic mother\'s baby, hemolytic disease or metabolic diseases were excluded. Results: There were no significant differences in the body weight, gestational age, postnatal age, age of mother, total bilirubin and albumin levels, the number of blood exchange, hospital stay days and complications between two groups (p>0.05). However, mean phototherapy duration was significantly shorter in 120 minutes transfusion group compared with 90 minutes group (p, Amaç: Hiperbilirubinemi yenidoğan döneminde sık karşılaşılan, morbidite ve mortalitesi yüksek bir problemdir. Kan değişimi; kernikterus diye adlandırılan nörotoksisiteye yol açan yüksek bilirubin seviyeleri için en etkili ve acil tedavi yöntemidir. Bu çalışmada 90 dakika ve 120 dakika kan değişimin etkinliği ve komplikasyonlarının karşılaştırılması amaçlanmıştır. Yöntemler: Bu çalışmaya, Dicle Üniversitesi Tıp Fakültesi Yenidoğan Kliniği\'nde, Temmuz 2007-Haziran 2008 tarihleri arasında 36-42 gebelik haftasındaki, total serum bilirubin seviyeleri 25 mg/dl üzerinde olan ve kan grubu uyuşmazlığı bulunmayan 36 yenidoğan alındı. Onsekiz hastadan iki gruba rastgele olarak ayrılan hastalardan, 1. gruba 90 dakikada, 2. gruba ise 120 dakikada kan değişimi yapıldı. Tranfüzyonun etkinliği ve komplikasyonları kaydedildi. Rh, ABO ve subgrup uyuşmazlığı olan bebekler, gestasyonel yaşı küçük olanlar, sepsis, hipotiroidi, G6PD enzim eksikliği, intrauterin enfeksiyon, diabetik anne çocuğu, hemolitik yada metabolik hastalığı olanlar çalışmaya dahil edilmedi. Bulgular: Vücut ağırlığı, gestasyon yaşı, doğum sonrası yaşı, anne yaşı, total bilirubin ve albumin düzeyleri, kan değişim sayısı, hastanede kalma süresi ve komplikasyonlar açısından karşılaştırılan iki grup arasında belirgin bir fark saptanmadı. Ancak 120 dakika kan değişimi yapılan grupta fototerapi süresi belirgin şekilde daha kısaydı (p

Background Some studies in the literature support the use of either inhaled or systemic steroids for the treatment of chemical pneumonitis; however, no data have been published on the combined use of inhaled and intravenous (IV) steroids. Objectives This brief report describes the effective use of inhaled plus systemic steroids in managing six critical pediatric patients. Patients and methods Medical records of patients were analyzed retrospectively. Results Of the six patients, 83.3% (n = 5) were male and 16.7% (n = 1) were female, with a mean age of 2.1 ± 0.49 years. The most common clinical signs were dyspnea (83.3%), fever (66.6%), and vomiting (66.6%). Owing to supportive treatments and the combined steroid treatment, respiratory distress diminished and there was no need for oxygen in any of the patients after 5 days. All patients were discharged without any sequelae. Conclusions The use of steroids in treating hydrocarbon pneumonias is still controversial. However, we suggest that the combined use of inhaled and intravenous steroids had positive effects on the clinical and radiological recovery of our patients.

PURPOSE The purpose of this study was to determine whether there are differences in choroidal thickness in children with beta thalassemia major (β-TM). METHODS Thirty-five patients with β-TM and 38 healthy children aged between 3 and 16 years participated in the study. After complete eye examinations were conducted on the participants, choroidal thickness measurements were performed using optical coherence tomography. Correlations between choroidal thickness and laboratory and clinical parameters, such as age, sex, hemoglobin and ferritin levels, duration of disease, type and duration of chelating therapy, visual acuity, intraocular pressure, central corneal thickness, and axial length were also evaluated. RESULTS The mean ages for the study group and for the control group were 8.2 ± 2.7 and 7.9 ± 2.4 years, respectively. There were no statistical differences between groups in terms of visual acuity, intraocular pressure, central corneal thickness, or axial length (p > 0.05). Choroidal thicknesses at the foveal center were 286 ± 33 μm in β-TM patients and 335 ± 423 μm in the healthy control children. Choroidal thicknesses at each point within the horizontal nasal and temporal quadrants were thinner in the β-TM group. There was a positive correlation between choroidal thickness and hemoglobin levels and a negative correlation between choroidal thickness and ferritin levels (r = 0.924, p < 0.001 and r = -0.947, p < 0.001, respectively). There was no correlation between clinical or ocular characteristics and choroidal thickness. CONCLUSIONS Choroidal thickness was significantly thinner in all quadrants in children with β-TM. This thinning of the choroid may be the reason for the development of eye disorders in older patients with β-TM.

To the Editor, The third baby with harlequin ichthyosis (HI) of a family who lost their two babies because of HI previously, but did not receive genetic counselling was presented to emphasize the importance of prenatal diagnosis and genetic counselling. A female baby who was born by normal vaginal delivery with a birth weight of 2 600 g at the 34th gestational age as the third living baby from the fifth pregnancy of a 32-year old woman was admitted to the neonatal intensive care unit. No consanguineous marriage was reported in the familial history. It was learned that the patient had a healthy brother and a sister, but her two sisters were lost in the neonatal period because of HI. It was learned that these babies were born by normal vaginal delivery from the first and third pregnancies of the mother and they could live only for 18 and 3 days, respectively. The mother did not carry risk factors including hypertension and diabetes mellitus in this pregnancy and her previous pregnancies and did not have any pyretic disease. Although the family was recommended to receive genetic counselling, since they lost their two children because of HID previously, they did not receive genetic counselling and the mother did not attend follow-up visits during this last pregnancy. On physical examination of the patient, yellow-white thick plaques seperated from each other with deep clefts which appeared like a shield wrapping the skin surface tightly were obsreved (Figure 1). Severe ectropion was observed in the eyes and eclabium was observed in the lips (Figure 2). The auricles were not developed, the external auditory canal could not be observed bilaterally, the ears and nose appeared hypoplasic, only the vibrissa could be observed. Fish mouth finding was present. The hands and feet were hypoplasic and necrotic towards the ends. There were contractures in the extremities (Figure 3). Complete blood count findings were as follows WBC: 17 500/mm3, hematocrit: 53% and platelets: 286 000/mm3. Biochemical tests were found to be normal. The patient whose respiration was normal was placed in a humidified incubator and intensive fluid treatment was started by venous catheter. The skin was humidified with frequent vaseline applications. The body temperature was monitored closely. Ampicillin and amikacin treatment was started after obtaining blood culture samples. Oral retinoid treatment was started at a dose of 1 mg/kg/day. The patient was fed orally by orogastric route from the first day. Despite intensive fluid treatment and enteral feeding in the follow-up, marked weight loss developed. The patient was lost on the 8th day because of sepsis despite appropriate antibiotic treatment and compliance with hygiene rules. Figure 1. General appearance of the patient Figure 2. Marked eclabium and ectropion on the face of the patient Figure 3. Hypoplasia in hands and feet and necrotic appearance towards the ends Harlequin ichthyosis is an autosomal recessive disease. Mutations in the ABCA12 gene have been found (1). It is a very rare but generally fatal keratinization disorder (2). The main problem has been reported to be abnormality in lamellar granules which have an important role in desquamation (3). Preterm delivery is generally present. Plaques which wrap the skin like a shield and deep clefts are observed in this disease. Ectropion is observed in both eyes (the eyelids are turned outwards). Eclabium (the lips are turned outwards), fish mouth appearence and flattened ears and nose are present. The ears and nose appear hypoplasic. The hair and nails are not developed. The hands and feet are hypoplasic and necrosis may develop in the ends of the extremities because of the shield-like structure of the skin. Range of motion is limited in the joints. Patients with harlequin ichthyosis should be followed up in full-fledged intensive care units and with a multidisciplinary approach. The skin should be humidified very frequently to prevent fluid loss. Use of humidified incubators, compliance with hygiene rules, appropriate fluid treatment, providing heat balance and protection from infections are the main points in treatment. These patients are usually lost in the first days of life because of severe fluid loss, disruption of heat balance and sepsis (4). Vitamin A treatment gives good results in terms of skin findings, decreases hyperkeratosis and improves ectropion and eclabium (5). In survivors after the neonatal period, a very good neonatal intensive care and use of vitamin A have been reported to be efficient (6). Currently, it has been reported that the mutations in the genes which cause to this disease can be found by molecular methods, families can be given genetic counselling about pregnancy planning or family planning and gene-based therapies will be possible in the near future (7). Conclusively, prenatal diagnosis of HI syndrome which may mostly be fatal in the neonatal period is possible and genetic counselling should be absolutely given to families who have babies with HI.

Background Adolescent pregnancy is an important public health problem. Physiological maturity affects obstetric and perinatal outcomes. Almost all assessments of adolescent pregnancies are based on chronological age. Gynecologic age (GA) is defined as age in years at conception minus age at menarche and it is an indicator of physiological maturity. Aim To compare obstetric and perinatal outcomes between adult and adolescent pregnancies as categorized according to GA. Methods In this retrospective study, 233 adolescent pregnant women were divided into two groups based on GA ≤ 3 years (101 women) and GA > 3 years (132 women). Their obstetric and perinatal results were compared with 202 adult pregnancies who gave birth in the same period. Findings Gestational age at delivery, APGAR scores, birth weight, and incidence of preterm birth, admission to neonatal intensive care unit (NICU), intrauterine growth restriction, low birth weight, and premature rupture of membranes were significantly different between the study groups. Compared to adolescent pregnancies with GA > 3 years, adolescent pregnancies with GA ≤ 3 years had significantly lower birth weight, gestational age, APGAR scores, and significantly higher incidence of intrauterine growth restriction, low birth weight and admission to NICU. Conclusion Low GA is associated with an increased rate of obstetric and perinatal complications in adolescent pregnancies. Although the main aim is the prevention of adolescent pregnancies, a detailed evaluation of such pregnancies including determination of the gynecological age together with a multidisciplinary approach may decrease potential complications.

Scorpion envenomation is a public health problem in tropical and subtropical countries. The majority of scorpion sting cases present with local pain at the site of sting and follow a benign clinical course. Severe intoxication may include cardiac and respiratory dysfunction, leading to multi-system organ failure and death (1, 2). The deaths in scorpion sting envenomation (SE) are attributed to cardiopulmonary complications, such as myocarditis and acute pulmonary edema (3). Cases of SE are common in Turkey, especially in Southeast Anatolia, owing to its geographical location, climate and socioeconomic structure (4). However, there is a scarcity of epidemiologic data on SE in Turkey because of the underdeclaration of scorpion sting cases and paucity of studies on the subject. Therefore, this study aims to evaluate the children hospitalized owing to scorpion stings and their epidemiological and clinical characteristics in Adiyaman province. Medical records of 80 patients were retrospectively reviewed to collect the following data: age, gender, clinical symptoms (localized and systemic), vital signs, information about the date and place of the sting occurrence, anatomical sting site, time elapsed between the sting and arrival at the hospital, type of scorpion, severity of the patients’ symptoms, treatment modalities and outcomes. The diagnosis of SE was based on the history of scorpion sting. The scorpion type was identified based on the colour of the scorpion defined by the patient or bystander. A. crassicauda and M. eupeus are more commonly known as the black and yellow scorpions, respectively (4). Patients were classified into three classes according to clinical severity as follows: class I: local manifestations; class II: systemic involvement; and class III: cardiovascular, respiratory or neurological symptoms (such as cardiogenic shock, pulmonary edema, altered consciousness and convulsive crisis) (5). A total of 80 subjects were recruited for this study. Of these, 42 (52.5%) were male and 38 (47.5%) female, with a mean age of 6.5 ± 4.1 years (range: 6 months to 17 years). Moreover, 51 (63.7%) and 29 (36.3%) of these subjects were from rural and urban areas, respectively. In terms of the type of scorpion, 32 (40%) subjects were stung by black scorpions and 27 (33.7%) by yellow scorpions. In 13 (16.3%) cases, the patients could not identify the colour of the scorpions. The most common sting sites were lower extremity (n = 53, 66.2%), upper extremity (n = 17, 21.2%) and body (n = 7, 8.8%). The patients were mostly stung during the day (57.5%). The average time elapsed between being stung and admitted in the hospital was 100.3 ± 106.5 minutes (range: 20 to 490 minutes). Based on clinical severity, 34 (42.5%), 44 (55%) and 2 (2.5%) patients were classified into classes I, II, and III, respectively. Table 1 presents the demographic and epidemiological characteristics of the subjects. Table 1. Demographic and Epidemiological Characteristics of Patients a The majority of the cases (63.7%) were reported during summer. The monthly distribution of scorpion sting cases was as follows: 11.2% in May, 13.7% in June, 27.5% in July, 22.5% in August and 10% in September; this indicates that the number of scorpion sting cases peaked in July. Patients exhibited both local and systemic effects. The most common local symptoms were pain (n = 71, 88.7%), hyperemia (n = 43, 53.7%) and swelling (n = 23, 28.7%). The most common systemic symptoms included cold extremities (50%), pallor (16.2%), hypotension (7.5%), hypertension (7.5%), sweating (6.2%) and dry mouth (6.2%). The most common laboratory findings were high the most common laboratory findings were high lactate dehydrogenase (LDH) (n = 10), creatine phosphokinase (CPK) (n = 9), Aspartat aminotransferase (AST) (n = 2) and Alanine aminotransferase (ALT) (n = 2) levels. Leucocytosis was present in 9 (11.2%) cases and hypoglycaemia was observed in 1 (1.2%) case. An electrocardiogram (ECG) was conducted for all the patients. The most common electrocardiography sign was tachycardia (30%). Other ECG abnormalities were ST alterations (n = 5, 6.2%) and prolonged QT (n = 6, 7.5%). Table 2 presents the patients’ clinical and laboratory features. Table 2. Clinical and Laboratory Features of Patients a,b One 5 mL dose of scorpion polyvalent antivenom ampoule, steroid and antihistaminic, was administered to all the patients in emergency services before they were admitted to the hospital. The second antivenom application and a five-step treatment plan, which was suggested by Bawaskar (6), were administered based on the clinical findings in PICU. Before discharge, all the participants were immunized for tetanus. The mean hospitalization time was 2.1 ± 1.4 days (range: 6 hours to 6 days). Except for the one case, all other patients (n = 79) were discharged after recovery. The one patient (1.2%) who had died of cardiac and respiratory arrest manifested evidence of severe envenomation. In conclusion, this study reported on the epidemiological and clinical characteristics of scorpion poisoning in Adiyaman, Turkey during a one-year period. Although males were found to be more susceptible to scorpion stings than females, the difference was not statistically significant. The age of the majority of the scorpion sting victims was less than 10 years. The majority of scorpion stings occurred during daytime. The most common sting sites were the distal part of the extremities. The results of this study showed that intoxications caused by scorpions in Southeast Anatolia region mostly occurred in the summer months, especially July and August. Scorpionism in Adiyaman is essentially caused by two species of scorpions: A. crassicauda and M. eupeus. Both local and systemic effects were observed in clinical evaluations. The results of our study supported that although systemic toxicity signs due to scorpion stings appear frequently, life-threatening signs are rare. To decrease morbidity and mortality rates, patients should be monitored in PICU with an early and appropriate treatment approach.