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Background: This study evaluated of clinical characteristics, outcomes, and mortality risk factors of a severe multisystem inflammatory syndrome in children admitted to a the pediatric intensive care unit. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 41 PICUs in Turkey. The study population comprised 322 children diagnosed with multisystem inflammatory syndrome. Results: The organ systems most commonly involved were the cardiovascular and hematological systems. Intravenous immunoglobulin was used in 294 (91.3%) patients and corticosteroids in 266 (82.6%). Seventy-five (23.3%) children received therapeutic plasma exchange treatment. Patients with a longer duration of the PICU stay had more frequent respiratory, hematological, or renal involvement, and also had higher D-dimer, CK-MB, and procalcitonin levels. A total of 16 patients died, with mortality higher in patients with renal, respiratory, or neurological involvement, with severe cardiac impairment or shock. The non-surviving group also had higher leukocyte counts, lactate and ferritin levels, and a need for mechanical ventilation. Conclusions: In cases of MIS-C, high levels of D-dimer and CK-MB are associated with a longer duration of PICU stay. Non-survival correlates with elevated leukocyte counts and lactate and ferritin levels. We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality. Impact: MIS-C is a life-threatening condition.Patients need to be followed up in the intensive care unit.Early detection of factors associated with mortality can improve outcomes.Determining the factors associated with mortality and length of stay will help clinicians in patient management.High D-dimer and CK-MB levels were associated with longer PICU stay, and higher leukocyte counts, ferritin and lactate levels, and mechanical ventilation were associated with mortality in MIS-C patients.We were unable to show any positive effect of therapeutic plasma exchange therapy on mortality.

Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality.

Objective: This study aims to investigate modes of transmission and clinical features of coronavirus disease 2019 in healthcare workers in pediatric intensive care units. Materials and Methods: This multicenter descriptive study was conducted between March and November 2020. Patient demographics, clinical characteristics, origin of coronavirus disease 2019, treatment modalities, and loss of workdays were recorded. Results: Seven hundred and sixty-eight healthcare workers from 16 pediatric intensive care units were enrolled and 114 (14.8%) healthcare workers with a mean age of 29.7 +/- 6.7 years became coronavirus disease 2019 patients. Seventy-six (66.7%) patients were female. Approximately half (54.3%) of the patients were physicians, 34.2% were nurses, and 11.4% were ancillary staff. Transmission was deemed to occur through patient contact in 54.3% of the patients. Comorbid illness was present 10.5% of the patients. Transmission occurred during endotracheal intubation in 21%, cardiopulmonary resuscitation in 9.6%, and non-invasive ventilation in 12.2% of patients, while transmission was a result of multiple possible procedures in 43.8%. Intensive care admission was needed for 13.1% of the patients. Five patients needed oxygen by cannula, 7 needed oxygen with a non-rebreathing mask, 5 needed high-flow nasal cannula support, 5 needed non-invasive ventilation, and 3 needed invasive mechanical ventilation. Fortunately, no infected healthcare workers died. Conclusion: Coronavirus disease 2019 in healthcare workers is a significant problem in pediatric intensive care units. Transmission seems to occur particularly frequently during patient care procedures such as intubation, ventilation and aerosol therapy, which highlights the importance of proper use of full sets of personal protective equipment during all procedures during care of coronavirus disease 2019 patients. WOS:000744060100015

Amaç: Ondokuz Mayıs Üniversitesi Tıp Fakültesi, Çocuk Yoğun Bakım Ünitesi'nde (ÇYBÜ) invaziv olmayan ventilasyon (İOV) uygulanan hastaların demografik, klinik ve laboratuvar özellikleri ile İOV endikasyonları, ventilasyon parametreleri ve İOV başarısı başta olmak üzere hasta sonuçlarının geriye dönük olarak incelenmesidir.Yöntemler: 1 Mart 2015-1 Haziran 2016 tarihleri arasında Ondokuz Mayıs Üniversitesi Tıp Fakültesi, ÇYBÜ'de İOV uygulanan 61 hastanın tıbbi kayıtları geriye dönük olarak incelendi. Bulgular: Çalışmaya alınan hastaların 31'i (%50,8) erkekti ve ortanca yaş 14 ay idi. Kırk sekiz (%78,7) hasta komorbid bir hastalığa sahipti. En sık İOV endikasyonu akut solunum yetmezliği idi. Bunu invaziv mekanik ventilasyondan ayırma sırasında weaning modu ya da kurtarma tedavisi olarak İOV uygulaması izlemişti. Hastaların %77'sine bilevel pozitif havayolu basıncı (BPHB) ile %23'üne yüksek akışlı nazal oksijen (YANO) ile İOV uygulaması yapılmıştı. BPHB uygulanan hastaların %89,4'ünde İOV uygulaması tam yüz maskesi ile yapılmıştı. İOV uygulaması boyunca toplam üç hastada (%4,9) komplikasyon gelişmişti. Çalışmamızda İOV başarı oranı %60,6 olarak saptandı. Hastaların demografik özellikleri, klinik ve laboratuvar bulguları, İOV endikasyonu ve uygulama yöntemi yönünden başarılı ve başarısız olan gruplar arasında anlamlı fark saptanmadı. Sonuç: Çalışmamızın sonuçları pediyatrik hastalarda İOV'un invaziv mekanik ventilasyon gereksinimini azaltabileceğini ve mekanik ventilasyondan ayırmada weaning modu olarak güvenli bir şekilde kullanılabileceğini göstermektedir. Çalışmamızda hastaların demografik ve klinik özellikleri ile İOV uygulama yöntemlerinin, İOV başarısı üzerine etkili bulunmamıştır. Oral veya enteral beslenmenin sürdürülme oranı YANO uygulanan grupta BPHB uygulanan gruba göre daha yüksek bulunmuştur. Spesifik hasta grupları ve endikasyonlarda İOV başarısını etkileyen faktörlerin araştırıldığı prospektif kontrollü çalışmalara ihtiyaç vardır Introduction: To investigate demographic, clinical and laboratory features and to determine the indications for non-invasive ventilation (NIV), ventilation parameters and NIV success among patients who received NIV therapy at Ondokuz Mayıs University Pediatric Intensive Care Unit. Methods: Medical records of 61 patients who received NIV therapy at Ondokuz Mayıs University Faculty of Medicine Pediatric Intensive Care Unit between March 1, 2015-June 1, 2016 were analyzed retrospectively. Results: The median age of the patients was 14 (2.5-180) months and 31 patients (50.8%) were male. Forty-eight patients (78.7%) had a comorbid disease. The most common indication for NIV was acute respiratory failure followed by NIV as weaning mode or rescue therapy. NIV application was made with bilevel positive air pressure (BIPAP) in 77% and with high-flow nasal cannula (HFNC) in 23% of the patients. Full face mask was used in 89.4% of patients who received BIPAP. Complication occurred in three patients (4.9%) during NIV therapy. NIV success rate was found to be 60.6%. No statistically significant difference was found between NIV-responsive and unresponsive group in terms of demographic features, clinical and laboratory findings, NIV indications and type. Conclusion: The results of our study showed that NIV might reduce the need for invasive mechanical ventilation and it can be used safely as weaning mode in pediatric patients. In our study, demographicclinical features and NIV application methods had no effect on NIV success. Oral or enteral feeding maintenance rate was found to be higher in HFNC group than in BIPAP group. Prospective controlled studies investigating factors affecting NIV success in specific patient groups and indications are required.

Amaç: Boğmaca tanısı ile yatırılarak izlenmiş bebekle- rin klinik tablo ve prognozlarının değerlendirilmesi. Gereç ve Yöntemler: Hastanemiz Çocuk Enfeksiyon Hastalıkları Bilim Dalı’nda Mart 2008-Mart 2012 tarihleri arasında boğmaca tanısı ile yatırılarak izlenen hastalar retrospektif olarak değerlendirildi. Boğmaca tanımlama- sı için Dünya Sağlık Örgütü'nün sınıflaması kullanıldı. Bulgular: Toplam 40 olgu boğmaca tanısı ile izlendi. Hastaların 28’si kız, 12’si erkekti. Ortanca yaşı 1,9 (minimum-maksimum0,8-4) aydı. Başvuru öncesi öksürük süresi ortanca 15 (minimum- maksimum2-18) gündü. Olguların 17’si (%42) yaz mevsiminde başvur- muştu. Hastaların %45’inde aile de öksüren birey bulunuyordu. Vakaların %80’i aşısızdı, %20’sine tek doz aşı uygulanmıştı. Vakaların hepsinde nöbetler halinde gelen boğulur tarzda öksürük, 3 vakada (%7,5) ateş, 5 vakada (%12,5) akciğerde ral ve 4 vakada (%10) solunum sıkıntısı vardı. Başvuru anında labora- tuar bulgularında ortanca beyaz küre sayısı: 14400 (minimum-maksimum5420-106000)/mm3, hemoglo- bin: 11,5 (minimum-maksimum8-17)gr/dL, trombosit sayısı 417000 (minimum-maksimum150000-784000)/ mm3 idi. Boğmaca tanısı 6 vakada (%15) kültür ve polimeraz zincir reaksiyonu ile tanımlandı. İki olgu (%5) yoğun bakım servisinde izlendi, mekanik ventilatör desteği aldı ve bu hastalar multiorgan yetmezliği ile kaybedildi. Ortanca hastanede yatış süresi 7 (mini- mum-maksimum1-17) gündü. Sonuç: Yüksek aşılanma oranlarına rağmen boğmaca halen dünyada olduğu gibi ülkemizde de önemli bir sorundur. Özellikle henüz aşılanmamış ya da aşıları tamamlanmamış küçük bebeklerde uzun süreli hasta- nede yatışlara, komplikasyonlara ve mortaliteye neden olabilmektedir. Ülkemizde de adölesan ve erişkinlerin aşılanması hastalığın ağır seyrettiği küçük bebeklerin korunması açısından önemlidir. (J Pediatr Inf 2013; 7: 47-52) Objective: To evaluate clinical status and prognosis of hospitalized infants with pertussis. Material and Methods: Hospitalized patients diag- nosed with pertussis from March 2008 to March 2012 at the Department of Paediatric Infectious Diseases were assessed retrospectively. The WHO (World Health Organization) for the definition of pertussis was used. Results: During the study period 40 children (28 girls, 12 boys) with pertussis were evaluated. The median age was 1.9 (range 0.8-4) months. The median cough period until the application was 15 (range 2-18) days. Seventeen cases (42%) were admitted during the summer season; 45% of patients had a family mem- ber with a cough; 80% of cases were unvaccinated and 20% had been vaccinated only once. Coughing attacks were seen in all cases, fever in 2 (5%) cases, auscultatory crackles in 12 (30%) cases and difficulty breathing in 4 (10%) cases. At admission, the median values of laboratory tests were as follows: WBC count: 14400/mm3 (range 5420-106000), Hb: 11.5 g/ dL (range 8-17), Plt: 417000/mm (range 150000- 784000). Pertussis was confirmed in six cases (15%) by culture and PCR. Two cases (2%) were admitted to the intensive care unit for mechanical ventilation support and these patients died due to multiorgan failure. The median length of hospitalization was 7 (range 1-17) days. Conclusion: Despite high rates of pertussis vaccina- tion, pertussis remains an important problem in Turkey, as well as world wide. Pertussis causes long- term hospitalization, complications and mortality, especially in young children who have not been vac- cinated or were vaccinated incompletely. In Turkey, it is important to vaccinate adolescents and adults to protect young babies with severe trend. (J Pediatr Inf 2013; 7: 47-52)