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Objetivo. Evaluar un novedoso marcador del estrés oxidativo (la homeostasis de tiol /disulfuro) en la sepsis pediátrica y determinar sus efectos sobre el pronóstico de esta afección. Métodos. En el estudio, se incluyeron pacientes con diagnóstico de sepsis y controles sanos. Se midieron las concentraciones de tiol total, tiol nativo, disulfuro, disulfuro /tiol total, disulfuro /tiol nativo y tiol nativo/tiol total en los grupos con sepsis y de referencia. Se compararon los parámetros entre los supervivientes y los no supervivientes del grupo con sepsis. Se midieron las concentraciones de hemoglobina, leucocitos, trombocitos, lactato y proteína C-reactiva en los pacientes con sepsis al momento del diagnóstico. Se utilizaron el puntaje de riesgo de mortalidad pediátrico (Pediatric Risk of Mortality, PRISM) y el puntaje de disfunción orgánica (Pediatric Logistic Organ Dysfunction, PELOD) para estimar la gravedad de la enfermedad. Resultados. En el grupo con sepsis se incluyó a 38 pacientes y en el de referencia, a 40 niños sanos. Las concentraciones plasmáticas de tiol en los pacientes con sepsis fueron significativamente inferiores que las del grupo de referencia (p < 0,001). Conclusión. La homeostasis de tiol/disulfuro fue anormal en los niños con sepsis en la unidad de cuidados intensivos pediátricos. The aim of this study is to evaluate a novel oxidative stress marker (thiol-disulphide homeostasis) in paediatric sepsis and to determine their effects on the prognosis of sepsis. Patients diagnosed with sepsis (n= 38) and healthy controls (n= 40) were incorporated in the study. Total thiol, native thiol, disulphide, disulphide/total thiol, disulphide/native thiol, and native thiol /total thiol levels were measured in the sepsis and control groups. Additionally, the parameters were compared between survivors and non-survivors in the sepsis group. The levels of hemoglobin, white blood cell, platelet, lactate, and C-reactive protein were measured in patients with sepsis at diagnosis. The paediatric risk of mortality and paediatric logistic organ dysfunction scores of the patients were used to estimate the disease severity. The plasma thiol levels of the patients with sepsis were significantly lower than the control group (p < 0.001). This study showed that thiol/disulphide homeostasis is abnormal in children with sepsis in Paediatric Intensive Care Unit.

Background: To determine the factors affecting the development of pneumothorax in critically ill children admitted to pediatric intensive care unit (PICU). Methods: This was a single-centered retrospective case control study comparing the clinical features of mechanically ventilated patients, who developed pneumothorax with matched control cases. Results: The study screened 2850 patients admitted to the PICU over a 3 year period. Among 1140 patients who were mechanically ventilated, 4.4% (n = 50) developed pneumothorax. Median age was 24 months. Patients with pneumothorax were found to have median pediatric risk of mortality (PRISM):26, Pediatric logistic organ dysfunction (PELOD):22 and multiorgan disfuction (MODS):3 whereas in the control group they were 15.5, 12, and 3, respectively. PRISM and PELOD were significantly higher in pneumothorax group. Pneumothorax was observed on the 11.6th day of mechanical ventilation (MV). Pneumothorax was mainly secondary to pneumonia (n = 18, 36%) and MV-related reasons (n = 13, 26%). The risk of pneumothorax was higher when P-mean was > 14 cmH2O and tidal volume (TV) was > 10 mL/kg (P < 0.05). The mean albumin level was 2.7 g/dL in the pneumothorax group compared with 3.6 g/dL in the control group (P < 0.001). The number of days on mechanical ventilator and the duration of hospital stay were statistically significant in pneumothorax group (P < 0.05). The mortality outcome was 44% (n = 22) in the pneumothorax group compared with 6.7% (n = 2) in the control group (P < 0.001). Conclusions: Pneumothorax in critically ill children was related to increased morbidity, mortality and prolonged length of stay in hospital. Higher pediatric risk of mortality (PRISM) and Pediatric logistic organ dysfunction (PELOD) scores were associated with increased risk of pneumothorax. Hypoalbuminemia as a reflection of malnutrition status of patients might be a risk factor.

To evaluate the demographics, risk factors, correlation between carbon monoxide (CO) level and clinical findings, and laboratory findings determining the prognosis and ischemic myocardial injury due to CO intoxication in patients admitted to pediatric emergency department.Six hundred seventy-four patients were admitted with CO intoxication between May 2007 and October 2009, 288 patients who required hospitalization were enrolled into the study prospectively.Incidentally, 144 (50%) of the patients were evenly distributed as girls and boys. Their age ranged between 7 months and 17 years; mean age was 8.6 years. The mean CO level was 26.8. The high levels were detected regarding lactate in 199 (90.1%) patients, creatine kinase (CK)-MB in 130 (45.1%) patients, CK in 80 (27.8%) patients, cardiac Troponin I in 35 (17.2%) patients, and lactate dehydrogenase in 34 (15.7%) patients. There was a significant positive correlation when symptoms like syncope, loss of consciousness, and convulsion were compared with carboxyhemoglobin, lactate, CK, CK-MB, and lactate dehydrogenase levels (P0.05), whereas there was no correlation when compared with cardiac Troponin I (P0.05). To determine the accuracy of predicting severe CO intoxication, sensitivity of 52.6% and specificity of 85.7% were found in receiver operating characteristic analysis when the lactate level was 3.85 mmol/L, whereas sensitivity of 70.5% and specificity of 59.6% were found when the carboxyhemoglobin level was 27.1%. One hundred forty-six (%50.8) of the patients had normal electrocardiographic findings, whereas 135 (46.8%) had sinus tachycardia, 6 (2%) had right branch block, and 1 (0.34%) had atrioventricular block. In 34 patients who had high CK-MB and Troponin I levels, only sinus tachycardia was detected in electrocardiography, and there were no ST changes. Hyperbaric oxygen was necessary in 2 patients admitted with coma.In children admitted because of CO intoxication, the blood lactate levels may give more accurate information in terms of loss of consciousness and convulsion, lactate level could be taken as a measure of severe poisoning and may help to decide for hyperbaric oxygen treatment.

Objectives Lumbar puncture (LP) is fundamental for diagnosis and treatment; however, some parents do not provide consent for their children to undergo the procedure, which can make diagnosis and determination of the optimal treatment difficult. The present study aimed to describe the level of knowledge and attitudes toward LP of parents whose children were scheduled to undergo the procedure. Methods A prospective cross-sectional descriptive study of a convenience sample of parents of 84 children aged 2 months to 17 years scheduled for LP at a single academic children's hospital between 2015 and 2017. Parents were administered a written survey and interviewed by a physician other than the person who did the LP. Data on parental level of knowledge and attitudes regarding LP, in addition to reasons for refusal, were collected.The parents of 84 patients scheduled for LP due to various indications were administered a face-to-face survey interview. The survey was used to collect parental demographic data, as well as opinions and knowledge about LP and postinterventional complications. Results The mean age of the 84 patients (57% male and 43% female) was 6.4 ± 5.17 years. Lumbar puncture was planned for the presumptive diagnosis of neurological disease in 45.25% of the patients, central nervous system infection in 45.25%, and acute encephalopathy in 9.5%. Among the parents, 65% (n = 55) had no knowledge or attitude about LP prior to the survey interview. The most common parental concern related to LP was paralysis (25%), followed by infertility (2%), mental retardation (1%), and disease progression (1%). Only 4.7% of the parents did not provide consent for their child to undergo LP. Conclusions We found that most parents had little knowledge about LP, and the most common parental concern was paralysis. Despite this, in our study, only 5% of parents did not consent to LP.

Background/aim: The effectiveness of isotonic and hypertonic saline solutions used to open the nasal passage and improve clinical symptoms was compared in children under 2 years of age admitted with the common cold. Materials and methods: The study was performed as a randomized, prospective, and double-blind study. The study included 109 children. The children using saline (0.9%) and seawater (2.3%) as nasal drops (the patient group) and the control group (in which nasal drops were not administered) were compared. Seventy-four patients received nasal drops from package A (seawater) in single days and from package B (physiological saline) in double days. Results: The mean age of the patients was 9.0 ± 3.9 months and the numbers of boys and girls were 65 (59.6%) and 44 (40.4%), respectively. There was no significant difference between Groups A and B in terms of nasal congestion (P > 0.05). However, a significant difference was found between the control group and Groups A and B (P < 0.05). Conclusion: Relief was seen in nasal congestion, weakness, sleep quality, and nutrition with the use of both saline and seawater in children with the common cold. Seawater or saline drops may be added to standard treatment protocols.

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

Aim. To evaluate thiol/disulphide homeostasis as a new indicator of oxidative stress in AKI patients and to determine the effect of HD on antioxidant balance and oxidative stress through plasma thiols. Methods. This study was performed in patients aged between 12 months and 18 years prospectively who underwent hemodialysis due to AKI and were followed up for a year in a 22-bed tertiary pediatric intensive care unit. 20 patients and 39 controls were included. Results. No difference was present between the groups in terms of age and gender. Median values of plasma native thiol, total thiol, and percent thiol were significantly lower in AKI group both before and after dialysis when compared to control group. The median dynamic disulphide values were significantly lower in the AKI group of predialysis compared to the controls. When pre- and postdialysis values were compared, disulphide values were statistically higher after dialysis. When pre- and postdialysis native thiol, dynamic disulphide, total thiol, and percent thiol median values were compared, postdialysis values were significantly higher than the predialysis values. There was a positive correlation between albumin, total thiol, and native thiol values before dialysis in the patient group. Conclusion. AKI patients have low levels of thiol species showing the presence of oxidative stress and hemodialysis has a positive effect on thiol/disulphide balance. This new method may be an inexpensive and simple tool suitable for clinical studies and can be used in routine screening as a useful indicator to show oxidative stress.

Black tongue is a rare, benign, self-limiting disorder caused by certain conditions and some medications. We report the first case of a child diagnosed with black tongue associated with ranitidine use. We report our case to emphasize the rare side effect of this frequently used drug. Health care professionals should be aware of the likelihood of ranitidine-induced black tongue in clinical practice.

Objective: To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children. Methods: A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed. Results: Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p

The medical records of 16 patients diagnosed as intracardiac thrombus were searched. The size, location and outcome of thrombus together with demographic data of patients were assessed. The median age of the patients was 2.2 years. Six patients were newborn and two patients were infant. The median size of thrombus was 9 mm. The localization was right atrium in seven, right ventricle in five, left ventricle in one, pulmonary artery in one, and superior vena cava in two patients. There was prematurity in five, ciyanotic congenital heart disease in one, blood culture positivity in three, malignancy in four, nephrotic syndrome in one, indwelling catheters in 10, and acquired or genetic thrombophilia in six patients as risk factors. In the treatment, the first choice was tissue plasminogen activator in two patients, heparin infusion in one patient and low molecular weight heparin in remaining 12 patients. In nine patients, therapy included parenteral antimicrobials together with anticoagulants. The result was complete resolution in 15 patients and in one patient thrombus was surgically removed. The median time was 16 (2-70) days for 50% resolution and 26 (3-93) days for complete resolution. There was a statistically significant (P = .027 and r = 0.5) correlation between the size and the complete resolution time. There was no anticoagulant therapy related major complication. In patients with intracardiac thrombus, selection of anticoagulant therapy may decrease the risk of complications. Surgery is rarely required and thrombolytics are not usually necessary for resolution of thrombus.

Objective: Respiratory syncytial virus (RSV) is the most common and fatal cause of bronchiolitis and severe pneumonia, especially in infants. Its morbidity and mortality are unpredictably high in critically ill patients. The aim of our study is to identify high-risk patients for early diagnosis and treatment of RSV pneumonia in the pediatric intensive care unit and to reduce hospitalizations and mortality. We want to emphasize the importance of vaccination and followup for the protection of other viral or bacterial pneumonia once again.

Background The aim of the research is to determine the etiology and clinical features of seizures in critically ill children admitted to a pediatric intensive care unit (PICU). Methods A total of 203 children were admitted from June 2013 to November 2013; 45 patients were eligible. Age ranged from 2 months to 19 years. Seizures were organized as epileptic or acute symptomatic. Pediatric risk of mortality score III, Glasgow coma scale, risk factors, coexistent diagnosis, medications administered before admission, type and duration of seizures, drugs used, requirement and duration of mechanical ventilation, length of stay and neuroimaging findings were collected as demographic data prospectively. Results The male-female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients. Conclusion Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures.

The aim of this study was to determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children, and to investigate the effect of prophilaxis. The setting was a 14-beded, tertiary care PICU.Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded.The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM Score ≥10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28 (45.9%), sucralfate in 18 (29.5%), proton pomp inhibitors (PPIs) in 51 (83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (N.=21), in which 66.7% (N.=14) were mild, 23.8% (N.=5) were moderate, 4.8% (N.=1) was significant and 4.8% (N.=1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation was found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (P0.001) and coagulopathy/thrombocytopenia, PRISM III ≥10, renal and hepatic failure, hypotension, and heart failure/arrhythmia was found to be associated with the development of GIB in critically ill children (P0.05).GIB is a serious concern for PICU clinicians and intensivists are confused about the conflicting evidence supporting prophilaxis. We believe that prophylaxis could be beneficial for mechanically ventilated children. Also trauma, coagulopathy/thrombocytopenia, PRISM III≥10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting.

Objective: Fever, one of the most common symptoms of childhood, is a complaint that the families worried about the most. The families want to know its reason, and it constitutes a significant part of visits to emergency department. In this study, it has been aimed to investigate the knowledge, attitude, antipyretic drug status of the families who bring their children with the complaint of fever, the doses of antipyretic drug and the factors affecting them. Methods : The mothers of 300 children without known chronic disease, who were brought to the Children's Emergency Department of our hospital with complaints of fever between 1-31 March and between the hours of 08:00 to 16:00 and who agreed to complete a questionnaire, were included in the study. Results: One hundred and twenty-seven (42.3%), 173 (57.7%) and 52% of 300 patients enrolled in the study were female, male and under the age of three, respectively. It has been determined that 96% of mothers thought that fever was harmful to children and the cause of the most common fear due to fever for 95% of them was the risk of febrile convulsion. As the level of education of mothers was increasing, the rate of measuring the temperature at home was found to be higher (p = 0.01). It has been observed that more than half of the mothers measured the temperature once an hour, but the frequency of temperature measurement was independent of mothers' education level (p = 0.76). It has been determined that the statistical rate of giving antipyretic with the recommendation of a doctor significantly increased as the maternal education level decreased (p < 0.01). The rate of usingantibiotics without a doctor's recommendation was significantly higher in mothers having sons than mothers having daughters (p = 0.02). Conclusion: It has been determined that the fear of fever was common in mothers; this concern has negatively affected the state of children with fever, increased unnecessary visits and unnecessary treatments of the emergency department. Health workers should inform the mothers one to one about fever during hospital admission in order to rectify this situation caused by the mothers’ lack of knowledge. In addition, the fear of mothers about fever may be reduced by using the mass media with the help of health education programs, which will be organized, by reaching more people and this contributes to the prevention of erroneous procedures. However, more studies are needed to be conducted on how all of these information and training should be done and the effectiveness of these initiatives.

Hydrogen peroxide solutions are often used in daily life as a household disinfectant and in cosmetic products and are therefore a common source of intentional poisonings, especially for children. When ingested in small amounts, it may cause severe central nervous system damage as a result of arterial emboli like our case. The benefit of hyperbaric oxygen treatment in this situation is known, but the neurologic deficits of our case did not improve with this method and finally brain death occurred. This is may be related by the timing of treatment after the event. We would like to emphasize that every clinician must be aware of the dangers of hydrogen peroxide ingestion and hyperbaric oxygen treatment may be of benefit if it is performed immediately.

Purpose To determine the aetiology and clinical features of seizures in critically ill children admitted to paediatric intensive care unit (PICU). Methods A total of 203 children were admitted from June to November 2013, 45 patients were eligible. Age ranged from 2 months to 19 years. Seizures were organised as epileptic or non-epileptic. Demographic data, PRISM III, GCS, risk factors, coexistent diagnosis, medications administered before admission, type and duration of seizures, drugs used, requirement and duration of mechanical ventilation, length of stay and neuroimaging findings were collected prospectively. Results The male-female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were non-epileptic. Most frequent coexistent diagnosis was infectious diseases and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalised in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first line therapy in 48.9%. Non-epileptic seizures were usually new onset and duration was shorter. Epileptic seizures tended to be recurrent and likely to progress to status epilepticus. However, type of seizures didn’t change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay was not significant between epileptic/non-epileptic patients. Conclusion Seizures in critically ill children that may evolve into status epilepticus is an important condition requiring attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures.

Objective To determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children and to investigate the effect of prophilaxis. Setting 14-beded, tertiary care PICU Methods Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded. Results The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM score ≥ 10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28(45.9%), sucralfate in 18(29.5%), proton pomp inhibitors (PPIs) in 51(83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (n = 21), in which 66.7% (n = 14) were mild, 23.8% (n = 5) were moderate, 4.8% (n = 1) was significant and 4.8% (n = 1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation were found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (p Conclusions GIB is a serious concern for PICU clinicians and intensivists are confused about the conflicting evidence supporting prophilaxis. We believe that prophylaxis could be beneficial for mechanically ventilated children. Also trauma, coagulopathy/thrombocytopenia, PRISM III ≥ 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting.

Objective To define the demographic characteristics, clinical features and outcome of patients with brain death and to emphasise the importance of organ donation in children. Setting Centre I: 14-bed, tertiary care Paediatric Intensive Care Unit (PICU). Centre II: Tertiary care Intensive Care Unit (ICU), Trauma centre. Methods Data were collected from September 2009 to October 2012 retrospectively. Twenty children who were diagnosed as brain death were included. Data including demographics, disease leading to brain death, duration of brain death evaluation, ancillary tests to confirm the brain death, complications and outcome, duration of hospitalisation, status of survival and organ donation were collected for statistical evaluation. Results The mean age were 6.2 ± 5.3 (median:3.8) years. Male/female ratio was 1.85. Disease leading to brain death was traumatic brain injury in 11(55%) patients. The mean duration of brain death evaluation was 6.7 ± 6.4 (median:4) and 1.7 ± 1(median:1) days in Centres I and II respectively. The duration of hospitalisation was 12.5 ± 10.7 (median:7.5) days. Electroensefalography (EEG) was applied in 18(90%) patients. Complications included diabetes incipitus in 9(45%) cases. Duration of survival was 9.8 ± 9.4 (median:6) days. One of the patients’ parents give consent to organ donation in Centre I while 4 parents accepted organ donation in Centre II. The study demonstrated that duration of brain death evaluation in Centre I was longer when compared to Centre II (p 0.05). Conclusion The early diagnosis of brain death and prompt evaluation of the patients by the ICU physicians once the diagnosis is considered will probably yield better organs and reduce costs. Training of the PICU physicians, nurses and organ donation coordinators and increasing the awareness of the children via public means may increase the families’ acceptance rate for organ donation in future.

Objective To determine the indication and need for echocardiographic assessment according to clinical severity of patients and therapeutic interventions performed after echocardiographic evaluation in critically ill children. Design Prospective observational study. Setting 14-bed, tertiary care Paediatric Intensive Care Unit (PICU). Methods The PICU is a multidisciplinary referral centre. A total of 140 children; 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) who were admitted to our unit consecutively from March to August 2013 were included into the study. The indication for echocardiography and therapeutic interventions performed after cardiology consultation were recorded. For the estimation of severity of disease the paediatric risk of mortality score (PRISM) III was determined. The correlation between Prism III score and the need for echocardiographic evaluations were analysed. Results Ages of all patients were between 45 days to 18 years. The male-female ratio was 1.33. Echocardiography was indicated in 88% (n = 66) of MV and%46.2 (n = 30) of SB patients. In 35.4% (n = 34) of patients who underwent echocardiographic evaluation no definitive change occured in treatment strategy while in 64.6% (n = 62) of patients decisive/supplemental information was obtained. Echocardiographic evaluation was necessary in MV children (p Conclusion Echocardiographic evaluation is essential in mechanically ventilated children and the need for echocardiographic assesment increases according to clinical severity of patients. Basic training for intensivists in this technique is challenging and needs to be developed and supported in critically ill children.

Objective To evaluate the status and results of home health care services conducted for paediatric patients in our hospital and to identify the medical needs of patients for a better quality of service delivery. Materials and methods Paediatric patients recorded by our hospital’s Home Health Services Unit (HHSU) and followed-up regularly for one year were included. Demographic data like age, gender, diagnosis, number of doctor visits, non-physician health care visits and the reasons of requested visits were collected retrospectively between November 2012–December 2013. Results A total of 63 patients were included in the study. 54% of patients were male, 46% were female. The mean age of the patients was 8.87 ± 4.6. Diagnose of the patients was 58.7% of cerebral palsy (CP) and motor mental retardation (MMR) followed by subacute sclerosing panencephalitis (SSPE) in 11% of patients. Tracheostomy was present in 34.9% of patients, 13 patients (20.6%) with chronic respiratory failure had home ventilation and 14.2% of the patients was receiving oxygen from a tracheotomy. 28.6% of patients were not dependent on medical devices however, all of the patients were in need of physical therapy and rehabilitation. The mean number of doctor visits for a patient was 1.89 ± 1.23 (median: 2) times per year. The number of visits of non-physician health care professionals working in home health care services were 13.7 ± 14.8 (median: 10) times per year. In our study primary care was given by mother in 95.2% of the patients. Conclusion With home health care services, children with special health care needs can be followed at home and fascilitating hospital discharge. This condition reduces costs and brings many advantages in social aspects. Home health care service is very important in offering positive factors to patients and families. Identification of deficiencies in this service will improve quality in the future. The medical care of dental disease and eye disease in terms of home health care is necessary in the future for children with special health care needs. These services must include social services especially in children.