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Neisseria meningitidis, also known as meningococcus, is a relatively uncommon cause of invasive infection, but when it occurs, it is frequently severe and potentially life-threatening. A ten-year-old female patient developed a purpuric rash with fever. Upon arrival to the pediatric intensive care department, she was unconscious and in a poor general condition. We combined treatment with antibiotics, volume resuscitation, hydrocortisone, and CytoSorb.½ therapy resulted in a stabilization of hemodynamics, as well as control of hyperinflammation. We observed a significant decrease in vasopressor dosage in this patient.

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.

Objective:Dilated cardiomyopathy (DC) results from dilatation of one or both ventricles and is caused by systolic dysfunction. Rickets are a rare cause of DC. Here, we present a case series of DC due to rickets, which was successfully treated.Materials and Methods:Patients were followed-up at paediatric intensive care unit (ICU) with the diagnosis of DC-related heart failure, which was retrospectively evaluated. Patients with a disease other than hypocalcaemia and low vitamin D levels, which can cause heart failure, were excluded from this study.Results:Six patients who developed rickets-related heart failure were included in this study. The mean age of the patients was 6.4±3.2 months. All patients had growth developmental delay. Although most of the patients were admitted to the hospital due to respiratory distress, congestive heart failure findings were detected at the first examination of all the patients. The vitamin D levels of all patients were low. While the pre-treatment mean ejection fraction (EF) of the patients was 35.16% (±10.66), the post-treatment mean EF was found to be 55% (±9.83). Significant improvement in left ventricular function was observed post-treatment.Conclusion:In patients admitted to the ICU due to the diagnosis of heart failure, rickets should be considered and treated, considering that it can cause many other complications, including vitamin D deficiency, cardiomyopathy and cardiac dysfunction.

Introduction:Status epilepticus is an important part of pediatric intensive care hospitalizations. In this study, it was aimed to investigate the general characteristics and to share the clinical and demographical features of patients who were hospitalized due to convulsive status epilepticus.Methods:One hundred-thirty one cases were included in this study. Identity information of patients, presence of acute and chronic diseases, duration of intensive care stay and hospitalization, first seizure type, where they were admitted, number of seizures during intensive care follow-up, antiepileptics used in treatment and other treatments and the status of discharge-mortality were recorded.Results:62.6% of cases were male and the mean age of all cases was 53.69±47.14 months. The most common chronic disease was epilepsy and the most common acute disease was lower respiratory tract infection. The first admission of 34.4% of the cases was due to status epilepticus, and the rate of cases accepted from other hospitals was 60.3%. During intensive care follow-up, no convulsions were observed in 77.1% of the cases. In the first treatment, benzodiazepine infusion was used in 77.1% of the cases. The median length of stay in intensive care unit was 4 days (minimum-maximum= 3-8 days) in the benzodiazepine infusion group, and 3 days (minimum-maximum=2-3 days) in the group that was not given benzodiazepine. The other most preferred antiepileptics were levetiracetam and phenytoin in 62.6% and 39.7% of the cases, respectively. The mortality rate was found as 2.3%.Conclusion:In our study, it was observed that the majority of the patients who were hospitalized in our pediatric intensive care unit due to convulsive status epilepticus were male, convulsive status epilepticus was more common in children with chronic neurological disease, benzodiazepine infusion was the first choice for treatment and Levetiracetam was the second most commonly used antiepileptic.

Intracranial aneurysms are very rarely encountered during childhood. In the clinics, they may be revealed after non-specific complaints or they may be observed as subarachnoid hemorrhage triggered by trauma. Today, endovascular treatment option is more prominent for their management. In this study, we aimed to present a case that we hospitalized in our service due to head trauma and consequently detected a ruptured aneurysm. A fourteen-year-old male patient was admitted to our emergency room as intubated after falling from a chair in his father's workplace. After the brain computerized tomography and brain angiography, he was hospitalized with a pre-diagnosis of head trauma. The patient, who was treated for the existing brain edema, was extubated on the seventh day of hospitalization. The patient underwent digital subtraction angiography with the thought of presence of ruptured aneurysm in the images examined and a focus of aneurysm was detected in the right posterior inferior cerebral artery. The patient whose aneurysm sac was filled with gas by coil embolization technique during the same session was discharged on the 20th day of his hospitalization without brain edema and new focus of bleeding during his control computed tomography. We wanted to share this case study, in which we reviewed the literature about intracranial aneurysm treatment and follow-up options.

A 13-month-old boy presented with a tonic-clonic seizure after bupropion intake. Physical examination revealed tachycardia, tachypnea, dry oral mucosa, and dilated pupils. The patient with status epilepticus and cardiac involvement was treated with intravenous thiopental infusion and lipid emulsion therapy. We observed focal seizures in the form of licking and perioral clonic contractions showing bilateral temporal epileptic activity in electrocardiography. As known, there are many reported cases of status epilepticus associated with bupropion poisoning; however, none of them had late focal seizures and our case is the youngest patient in the literature.

Background: Tal et al. severity score (TSS) and Modified Wood’s Clinical Asthma Score (M-WCAS) are used to evaluate the severity of the disease in children with bronchiolitis. It has recently been suggested that there is a relationship between bronchiolitis severity and hyponatremia. Aims and Objective: This study aimed to evaluate the relationship between both of scores and hyponatremia in children with bronchiolitis. Materials and Methods: This prospective observational study included 172 patients (age range: 1-24 months) admitted to the hospital with bronchiolitis diagnosis. Demographic and clinical features of patients were recorded, and the TSS and the M-WCAS were calculated. These values and their components were compared with serum sodium (Na) results obtained at hospital admission. Results: Of the 172 patients, 114 (66.3%) were male, and the mean age was 5.5 ± 4.6 months. The mean TSS and M-WCAS of the patients were 6.73±1.9, and 3.34±1.4, respectively. Hyponatremia (Na

Spontaneous pneumomediastinum is an uncommon, benign, and self-limiting disease based on the presence of free air in the mediastinal cavity. It can occur after a forced Valsalva’s maneuver due to a cough, emesis or during an asthma exacerbation. We present a 4-month-old girl infant with an autoimmune hemolytic anemia and lymphopenia, who was admitted to the pediatric intensive care unit due to respiratory distress. A suspected pneumomediastinum image on chest X-ray was documented by the chest tomography. A polymerase chain reaction of the nasopharyngeal secretions was positive for a respiratory syncytial virus and human bocavirus. Additionally, she was examined for an immune deficiency due to her lymphopenia. The patient required mechanical ventilatory support for 26 days. She was treated with antibiotics, antiviral, and antifungal agents and corticosteroids. Intravenous immunoglobulin, trimethoprim sulfamethoxazole, and fluconazole prophylaxis were continued because of the ongoing lymphopenia. At the end of five weeks, the patient was discharged with a normal lymphocyte count and without any respiratory distress. In immunosuppressed patients, respiratory diseases may be severe and long. Therefore, complications including pneumomediastinum can be seen more frequently in this group of patients.

Hydatid cyst disease is still endemic in our country. It may present with non-specific complaints such as abdominal pain and jaundice as well as anaphylactic reactions due to cyst rupture. In this report, we aimed to present a case of anaphylactic shock with cyst rupture in a hydatid cyst operation. A 13-year-old male patient was admitted to our emergency department with abdominal pain. Abdominal magnetic resonance imaging was consistent with hydatid cyst lesions in the liver. After three weeks of pharmacological treatment, surgical treatment was decided. During the operation, the cyst ruptured while the posterior cyst was being removed, and then the patient developed anaphylactic shock characterized by wide spread rash, swelling and sudden hypotension. The first treatment was performed with intravenous adrenaline and steroid. Adrenalin and noradrenaline infusions were used in the pediatric intensive care follow-up. Hydatid cyst is a disease that can be easily diagnosed by simple history and non-invasive imaging methods. We decided to present this case so that early diagnosis could prevent fatal complications such as anaphylactic shock and review what should be done when faced with such a situation.

Introduction:Transfusion of blood components, including red blood cells (RBC), platelets and plasma, is the fastest way to improve the haematological state of critically ill patients and can be a lifesaving intervention. Although transfusion is a common practice in paediatric intensive care units (PICUs), its adverse effects are not clearly defined. Therefore, we aimed to evaluate the incidence and predictors of RBC transfusion in mechanically ventilated children.Methods:Data of patients admitted to PICUs from January 2014 to April 2019 were extracted. The mechanically ventilated patients were categorised into two groups, and the relationship between transfusion and prognostic factors was examined.Results:This study investigated 373 children with a mean age of 3.86±4.86 years. Among these children, 239 received RBC transfusion (64.1%). Inotropic drug usage, acute kidney injury, continuous renal replacement therapy (CRRT), mortality, length of mechanical ventilation, and duration of PICU stay were associated with RBC transfusion. Logistic regression analysis revealed that inotropic drug usage increased the RBC transfusion requirement by 5.168 fold, and CRRT increased it by 2.804 fold.Conclusion:Blood transfusion is an associated adversity in critically ill children. Therefore, patients who need transfusion should be followed up more carefully and closely.

Objective:The aim of this study was to investigate the patients who had undergone tracheostomy during hospitalization in our pediatric intensive care unit (PICU), to learn the satisfaction of the families, and to evaluate the effect of tracheostomy on the number of hospitalizations.Methods:The medical records of 80 patients who underwent tracheostomy in the PICU between 2006-2016 were retrospectively analyzed.Results:Fourty-one of our patients were male (51.25%) and 39 were female (48.75%). The mean age of males was 46.98 months (1-209 months) and girls was 43.44 months (1-205 months). Neurological system diseases (42.5%) were on the first place according to the current chronic diseases. Seventy-five patients (93.75%) were followed up with invasive mechanical ventilation and the mean duration of mechanical ventilation was 22.47±13.91 days. Only one patient (1.25%) had complication in early period. Forty one patients were contacted via telephone. Twenty-three families (56%) were satisfied with tracheostomy and 10 (24.5%) were not. The mean age of the dissatisfied group was statistically lower than the satisfied group (p=0.018). Of the 41 patients, 18 (44%) reported a decrease in the number of hospitalizations between before and after the tracheostomy and four (10%) reported an increase in the number of hospitalizations. The group with an increased number of hospitalizations had a significantly higher number of hospitalizations before the tracheostomy (p=0.028).Conclusion:The satisfaction levels of the families will be increased by increasing the tracheostomy care trainings given before discharge from the hospital, improving the home care services and ensuring the ease of transportation of these patients to the hospitals.

Background. Tetanus is an infectious disease that can be seen in all age groups in underdeveloped and developing countries, where vaccination programs are inadequate. In developed countries, it is reported more frequently in the adult age group, where the protection of vaccination is diminished and the doses are delayed. Case. In this report, we present generalized tetanus, which was observed in two male patients aged 12 and 6 years, admitted at different times, together with clinical course and treatment approaches. Both patients belong to different nationalities, who immigrated a couple of months before their application to our hospital. They applied with similar histories and complaints and were not vaccinated during infancy. Conclusion. With the development of vaccination programs, this disease with high morbidity and mortality can be prevented.

Negative pressure pulmonary edema is a rare but potentially fatal complication that can be seen after upper and lower respiratory tract obstructions. In this paper, we aimed to present two cases of negative pressure pulmonary edema in a 18-months-old male and 3-years-old girl who were admitted to our pediatric emergency department with obstructive airway findings and did not respond to medical treatment. Both cases were admitted to the intensive care unit due to severe respiratory distress. They were intubated for low peripheral oxygen saturations and pending respiratory distress under non-invasive therapy. Significant pulmonary edema fluid observed in the tracheal tube after intubation revealed the presence of pulmonary edema additional to obstructive pathologies. The findings of pulmonary edema regressed within 48 hours by the mechanical ventilation therapy including high positive end expiratory pressure, and the cases were extubated on the third and fifth days, respectively. Patients with obstructive airway findings in pediatric emergency outpatient clinics are frequently seen and the presence of pulmonary edema may be concealed with current clinical findings and this can lead to fatal outcomes. We would like to attract attention to the importance of this kind of cases because satisfactory results can easily be seen with early diagnosis and early invasive and non-invasive treatment approaches.

Introduction: The aim of this study was to evaluate treatment approaches towards Guillain-Barré syndrome and treatment response in patients with Guillain-Barré syndrome admitted to the pediatric intensive care unit. Methods: We retrospectively evaluated patients aged between 1 month and 18 years who were admitted to our pediatric intensive care unit between January 2006 and January 2016 with the diagnosis of Guillain-Barré syndrome. Results: A total of 27 patients (10 girls; 37%) were included in this study. The mean age of the patients was 6.24 years (IQR: 4.07-10.03). Nine patients (33.3%) had a Hughes functional grading scale score of 3, 16 (59.3%) had 3 and 2 (7.4%) had 5. Electrophysiological studies were performed in 22 cases (81.4%) and acute inflammatory demyelinating polyneuropathy was detected in 10 cases (45.5%), acute motor axonal neuropathy in 9 cases (40.9%), and acute motor and sensory axonal neuropathy in 1 case (4.5%). Two (9.1%) patients were evaluated as normal. All the patients were administered intravenous immunoglobulin (IVIG). In 12 (52.17%) patients, plasmapheresis was performed for a median of 8 sessions (5-9) before IVIG. Mechanical ventilation was required in 6 patients (22.2%) and was performed for a median of 24 days (5-41). The mean period of time of the first supported sitting was 6 (3-10) days and the mean period of time of the first walking with aid was 9 (7-15) days. Conclusion: Although there have been studies claiming that plasmapheresis was more successful, it has been generally accepted that plasmapheresis and IVIG have the same efficacy. Under the conditions of our country, we believe that both plasmapheresis and IVIG can be safely used at experienced units in patients with Guillain-Barré syndrome who need intensive care treatment.

Local burns, embolism, and arrhythmia are the most common side effects observed after electrical shock treatments. However, systolic function may be rarely affected and pulmonary edema may develop. The cases of pulmonary edema after electrical shock treatments have been reported since 1960s and the proposed mechanism is the inadequacy of the left atrium cuff and ventricle. It was learned that a 7-year-old-girl without any known disease except vesicoureteral reflux had a ventricular fibrillation during general anesthesia induction and defibrillation at 2 joule/kg was attempted. It was also learned that the procedure was delayed and the patient was diagnosed with a long QT (QTc: 0.47 ms) and had respiratory distress and circulatory disturbances after four hours. Pulmonary edema and heart failure was determined, and due to hipoxemia (SpO2

Permanent junctional reciprocating tachycardia is a rare type of supraventricular tachycardia. Incessant tachycardia may result in dilated cardiomyopathy and the patients may have a diagnosis of idiopathic dilated cardiomyopathy. A 53-day-old female infant was brought to the hospital with sweating, rapid breathing, and rapid heartbeat. She was admitted to the intensive care unit with a suspicion of myocarditis. Electrocardiography showed a heart rate of 220/min consistent with narrow QRS complex tachycardia and negative p waves in inferior leads (II, III, and aVF). Medical treatment provided control of the tachycardia episode. In this report, we conclude that patients with a diagnosis of dilated cardiomyopathy should be thoroughly investigated in terms of reversible arrhythmia causes.

Complement mediated hemolytic uremic syndrome which is caused by excessive activation of the alternative complement system is a thrombotic microangiopathy. The disease frequently occurs as a result of mutations in the genes that regulates complement proteins. Complement factor H gene has the most common mutations. A nine-month-old male patient was transferred to pediatric intensive care unit with the diagnosis of hemolytic uremic syndrome. Nonsense heterozygous p.Arg1215X mutation in the complement factor H gene was detected. The patient who had pulmonary, intestinal and hepatic involvement accompanying acute renal failure was successfully treated with therapeutic plasma exchange and eculizumab. Nonsense heterozygous p.Arg1215X mutation is extremely rare and can cause severe hemolytic uremic syndrome. As far as we know, our patient is the third case with this mutation in the literature.

Background and objective: Severe sepsis and septic shock are life-threatening organ dysfunctions and causes of death in critically ill patients. The therapeutic goal of the management of sepsis is restoring balance to the immune system and fluid balance. Continuous renal replacement therapy (CRRT) is recommended in septic patients, and it may improve outcomes in patients with severe sepsis or septic shock. Therapeutic plasma exchange (TPE) is another extracorporeal procedure that can improve organ function by decreasing inflammatory and anti-fibrinolytic mediators and correcting haemostasis by replenishing anticoagulant proteins. However, research about sepsis and CRRT and TPE in children has been insufficient and incomplete. Therefore, we investigated the reliability and efficacy of extracorporeal therapies in paediatric patients with severe sepsis or septic shock. Materials and methods: We performed a multicentre retrospective study using data from all patients aged Results: Between January 2014 and April 2019, 168 septic patients were enrolled in the present study. Of them, 47 (27.9%) patients underwent CRRT and 24 underwent TPE. In patients with severe sepsis, the requirement for CRRT was statistically associated with mortality (p < 0.001). In contrast, the requirement for TPE was not associated with mortality (p = 0.124). Conclusion: Our findings revealed that the requirement for CRRT in patients with severe sepsis is predictive of increased mortality. CRRT and TPE can be useful techniques in critically ill children with severe sepsis. However, our results did not show a decrease of mortality with CRRT and TPE.