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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.

Amaç: Mekanik ventilatörden ayrılması planlanan ve kendi solunumlarını tetikleyebilen aktif hastalarda özefageal basınç (Pes ), transpulmoner basınç (PL) ve zaman-basınç-ürününü (PTP) inceleyerek hastaların senkron veya asenkron oluşunun bu değerlere etkisini ortaya koymak. Gereç ve Yöntemler: Çalışmamıza mekanik ventilatörde izlenen ve kendi solunumunu tetikleyebilen, yakın zamanda mekanik ventilatörden ayrılması planlanan hastalar alınarak özefageal kateter yerleştirilmiş, ardından kateter dolum hacmi önce optimize ardından valide edilerek önce Pes ardından havayolu basıncından Pes’ın çıkarılmasıyla PL kayıt edilmeye başlanmıştır. Ventilatör üzerindeki kayıt cihazlarıyla hastaların mekanik ventilasyon parametreleri hem monitörizasyon değerleri hem de dalga formları olmak üzere kayıt altına alınmıştır. Daha sonra hasta başında klinisyen tarafından mekanik ventilasyon ayarları özefageal dalga formu referans alınarak yeniden düzenlenmiştir. Ardından bu hastaların dalga formları Matlab E2019a (Mathwoks, USA) yazılımı üzerinde incelenerek her soluk senkron-asenkron olarak işaretlenmiş ve asenkroni indeksi (AI) çıkarılmıştır. Buna göre hastanın asenkron ve senkron dönemleri tanımlanmış, aynı hastanın senkron ve asenkron dönemleri arasında ∆Pes, ∆PL, PTP-Pes, PTP-PL, PTP-Pes-dakika, PTP-PL-dakika değerleri yine Matlab yazılımı üzerinde hesaplanarak, senkron ve asenkron dönemler arasında bu değerlerin değişimleri SPSS istatistik programı ile incelenmiştir. Değişkenlerin dağılımının görsel ve analitik yöntemlerle (Shapiro-Wilk) incelenmesinin ardından istatiksel olarak gruplar arası farka bakılmıştır. Bulgular: Tüm hastaların senkron ve asenkron dönemleri kıyaslandığında senkron ve asenkron gruplar arasında, senkron grup lehine şu farklar bulunmuştur. ∆Peso [5,98 (3,55-9,08)] cmH2O, ∆PL [5 (2,7-7,25]cmH2O, ∆PTP-Peso [3,70 (2,81-4,6)]cmH2O*s, ∆PTP-PL [3,36 (1,39-4,18)]cmH2O*s, ∆PTP-Peso/dk [1,72 (1,02-2,67)]cmH2O*min , ∆PTP-PL/dk [1,25 (0,30-3,01)]cmH2O*min. Sonuç: Mekanik ventilatörden ayrılması planlanan ve kendi solunumunu tetikleyebilen aktif hastaların senkronizasyonunun hastaların ∆Peso, ∆Ptranspulmoner,PTP-Peso,PTP-Ptranspulmoner,PTP-Peso-dakika, PTP-Ptranspulmoner-dakika değerlerinde düşüşe yol açtığı yapılan istatistiki analizlerle de gösterilmiştir. Senkronizasyona dair bu bilgi litratürle korele edildiğinde, hastalarda Pes monitörizasyonu ve hastaların senkronizasyonu sözkonusu hastalarda oluşabilecek olan mekanik ventilasyon ilişkili akciğer hasarını önlemede ve dolayısıyla asenkroniye bağlı hastanede kalış süresi, ventilatörden ayırma başarısızlığı ve bunların sonucunda gelişebilecek olan mortalite ve morbiditeyi azaltmada faydalı olabilecek bir yöntemdir., Aim: To reveal the effect of synchronous or asynchronous patients on these values by examining the esophageal pressure (Pes ), transpulmonary pressure (PL), and time-pressure-product (PTP) in active patients who are planned to be weaned from the mechanical ventilator and can trigger their own respiration.Material and Methods: Patients who are monitored on a mechanical ventilator and who can trigger their own respiration, and who are planned to be separated from the mechanical ventilator in the near future, were taken and an esophageal catheter was inserted, then the catheter filling volume was first optimized and then validated, and PL was started to be recorded by removing Pes from the airway pressure. With the recording devices on the ventilator, the mechanical ventilation parameters of the patients were recorded as both monitoring values and waveforms. Then, the mechanical ventilation settings were rearranged by the clinician at the bedside with reference to the esophageal waveform. Then, the waveforms of these patients have examined on the Matlab E2019a (Mathworks, USA) software, and each breath was marked as synchronous-asynchronous and the asynchrony index (AI) was calculated. Accordingly, the asynchronous and synchronous periods of the patient were defined, and the values of ∆Pes, ∆PL, PTP-Pes, PTP-PL, PTP-Pes-minutes, PTP-PL-minutes between the synchronous and asynchronous periods of the same patient were calculated on Matlab software, and synchronous and The changes in these values between asynchronous periods were analyzed with the SPSS statistical program. After examining the distribution of the variables by visual and analytical methods (Shapiro-Wilk), the statistical difference between the groups was examined.Results: When the synchronous and asynchronous periods of all patients were compared, the following differences were found between the synchronous and asynchronous groups in favor of the synchronous group. ∆Peso [5.98 (3.55-9.08)] cmH2O, ∆PL [5 (2.7-7.25]cmH2O, ∆PTP-Peso [3.70 (2.81-4.6)) ]cmH2O*s, ∆PTP-PL [3.36 (1.39-4.18)]cmH2O*s, ∆PTP-Peso/min [1.72 (1.02-2.67)]cmH2O*min , ∆PTP-PL/min [1.25 (0.30-3.01)]cmH2O*min.Conclusion: It has also been shown by statistical analyzes that the synchronization of active patients who are planned to be weaned from mechanical ventilator and who can trigger their own respiration causes a decrease in the values of ∆Peso, ∆Ptranspulmonary, PTP-Peso,PTP-Ptranspulmonary, PTP-Peso-minute, PTP-Ptranspulmonary-minute. When this information about synchronization is correlated with the literature, Pes monitoring in patients and synchronization of patients prevent mechanical ventilation-related lung damage that may occur in these patients, and thus the duration of hospital stay due to asynchrony, failure to wean from the ventilator, and the consequences that may occur. It is a method that can be useful in reducing mortality and morbidity.

The aim of this study was to determine the association between the use of intravenous N-acetylcysteine (NAC) and hepatic healing in pediatric intensive care unit (PICU) patients with non-acetaminophen-induced hepatic injury, except for acute liver failure.The data of patients who received intravenous NAC as adjuvant therapy for transaminase levels more than sixfold normal values during their PICU stay between 2010 and 2014 were retrospectively collected from the medical records database. The patients who did not receive NAC with elevated transaminase levels during their PICU stay between 2014 and 2018 were also collected as the standard of care (SOC) cohort.More than 50% of the liver injuries were secondary to acute hypoxia, hypotension, sepsis, and inflammation. The median number of elevated transaminase period (ETP) days of the NAC and SOC groups were 5 (IQR: 4) and 4 (IQR: 4), respectively (p = 0.17). There was no significant difference between the groups in terms of minimum and maximum laboratory values during ETP. There was no significant difference in terms of ETP and maximum ALT levels between the NAC and SOC groups in the hypoxia-hypotension subgroup.This study did not show an association between indirect measures of hepatic healing and post-insult use of NAC in pediatric liver injury in the PICU setting.

Amaç: Pediyatrik Yoğun Bakım Ünitesinde yatan bedensel hastalığı olan çocuklarda davranışsal-duygusal psikopatolojiler sıklıkla gelişmektedir. Fiziksel hastalığa eşlik eden bu ruhsal durumlar tedaviyi uyumu bozarak olumsuz sonuçlara yol açabilmektedir. Bu çalışmada çocuk yoğun bakım ünitemizde kritik hastalık nedeniyle izlenen hastalar için son 3 yıl içinde istenen çocuk psikiyatri konsultasyonlarının değerlendirilmesi amaçlanmıştır Gereç ve Yöntem: Çalışmamızda 2019-2022 yılları arasında Dr. Behçet Uz Çocuk Hastanesi Çocuk Yoğun Bakım ünitesinde izlenen çocuk psikiyatrisi konsültasyonu istenen hastaların verileri geriye dönük olarak taranmıştır. Hastaların demografik özellikleri, bedensel hastalık tanıları, konsültasyonların istenme nedenleri, konsültasyon sonucunda saptanan psikiyatrik tanılar ve bunun sonucunda tedavi uygulanıp uygulanmadığı, verilen bir tedavi olması durumunda hangi medikal tedavilerin tercih edildiği, psikiyatrik tedavi ve izlem sürecine ilişkin veriler kaydedilmiştir Bulgular: Üç yıllık sürede çocuk yoğun bakımda izlenen çocukların 118’i (%4,9) için psikiyatri konsültasyonu istenmiştir. Konsültasyon istenenlerin çoğu kızdır (%61,9) ve 12 yaş veya üzeri yaşta % 71,4 hasta bulunmaktadır. En sık konsültasyon isteme nedeni özkıyım girişimleri (%33,1) ve depresif görünüm (%25,5) olarak saptanmış olup en sık konulan tanı majör depresif bozukluk ve uyum bozukluğudur. Olguların %31’inde psikotrop ilaç başlanmış olup erkekler ve kızlar arasında anlamlı fark saptanmamıştır. Sonuç: Bu çalışma bedensel hastalığı olan kritik çocuk yoğun bakım hastalarında ruhsal hastalıkların sık görülmesine rağmen psikiyatri konsültasyonu istenme oranlarının düşük olduğunu saptamıştır. Bu durum yoğun bakım hekimlerinin belirtileri anlama ve değerlendirme konusunda hastaların bilinç durumları ve primer hastalıkları nedeniyle güçlükler yaşadığına işaret etmektedir. Bu nedenle çocuk psikiyatrisi ile birlikte multidisipliner bir yaklaşım izlemeleri ve işbirliği içinde olmaları hastanın tedaviye uyumunu arttırarak yatış sürelerini kısaltacaktır.

Introduction:Nosocomial bloodstream infection (BSI) is an important problem in pediatric intensive care unit (PICU) due to high mortality rates, increased hospitalization and costs. We aimed to define the risk factors, incidence and the microorganisms of BSI in PICU in the present study.Methods:The patients admitted to Dokuz Eylül University PICU between January 2011 and January 2013 and stayed in hospital more than 48 hours were evaluated. The patients who had nosocomial BSI were determined and compared with the patients who did not have nosocomial infection during their hospitalization in terms of demographic data, hospitalization diagnoses and underlying chronic diseases, and the treatments applied. Microorganisms isolated in blood culture were also recorded.Results:Two hundred fifty two patients were admitted to the study and fifty-eight BSI episodes developed, 55% of population were male (M/F: 1.2) and the median of age was 10 months. The incidence rate of bloodstream infection was 14.7 per 1.000 patient-days. The median duration in PICU for development of BSI was 16.5 days. Nosocomial BSI was more common in patients with central venous catheter, mechanical ventilation, use of steroid treatments. In the presence of congenital heart disease, metabolic disease, neurological disease or genetic syndrome, the frequency of nosocomial BSI was increased. Risk factors for nosocomial BSI were genetic syndrome and longer hospitalization in PICU. The most common isolated agents were coagulase-negative Staphylococcus (48%), Klebsiella spp. (24%), Enterobacter spp. (9%) and Candida spp. (9%).Conclusion:It is important to know the risk factors for BSIs and taking precautions in this direction is particularly important in terms of reducing treatment costs and mortality. Since the risk increases as the number of days spent in intensive care increases, the length of stay should be kept as short as possible.

Objective: To prospectively investigate the predictive value of the modified Status Epilepticus Severity Score (STESS) for pediatric use (STEPSS) regarding unfavorable outcomes in the short term. Methods: Patients diagnosed as status epilepticus in the emergency department between January 2019 and June 2021 at a tertiary center of the University of Health Sciences, Dr. Behcet Uz Children's Hospital, were included in the study. The patients were followed up in the emergency department, neurology clinic, and pediatric intensive care unit until discharge. Demographic and clinical characteristics, STEPSS, and Pediatric Overall Performance Category Scale (POPC) scores were calculated. We defined a Pediatric Overall Performance Category Scale score ≥3 as an unfavorable outcome. We compared the effect of STEPSS on unfavorable outcomes and mortality. Results: 124 children were included. The median age was 33 months (interquartile range 16.2-84.7). Seventy-two (58.1%) patients had acute symptomatic etiology. We found that the STEPSS score with the receiver operating characteristic curve (area under the curve = 0.917, P 2 was the optimal cutoff point for an unfavorable outcome. We found STEPSS useful in predicting mortality (area under the curve = 0.853, P 2 was the optimal cutoff for mortality: sensitivity 0.90 (95% confidence interval [CI] 0.58-0.99), specificity 0.67 (95% CI 0.57-0.77), positive predictive value 0.21, negative predictive value 0.98, positive likelihood ratio 2.7, negative likelihood ratio 0.14. Conclusion: We determined that STEPSS can be predicted unfavorable outcomes and mortality. We think that STEPSS can be used as a useful clinical score with further studies and external validations.

Introduction:In recent years, advances in technology and medicine have led to an increase in the number of children with chronic diseases, while reducing the mortality rates of pediatric patients. In this study, it was aimed to evaluate the general characteristics and hospitalizations of pediatric patients receiving health care at home from our hospital.Methods:The study was carried out at the University of Health Sciences Turkey, İzmir Dr. Behçet Uz Children’s Hospital. The cases registered to the home health services unit between 2012 and 2018 were evaluated retrospectively. The demographic features, diseases, medical devices and technological dependence and hospitalization information of these patients were accessed from the hospital registration system. Data were recorded on SPSS program and evaluated statistically.Results:The average age of 124 patients enrolled in the home health services unit was 8.4 (0.6-17.8) years, and 56.5% were male. 71.8% of the patients were diagnosed with a primary neurological disease, especially cerebral palsy. Tracheostomy was present in 31.5% of the patients and 25% were receiving respiratory support by mechanical ventilation. Gastrotomy was present in 12.9% of the patients. While policlinic applications of those with primary neurological disease were significantly higher (p=0.04) compared to the patient group other than neurological disease, hospitalization rates were similar (p>0.05).Conclusion:The neurological group of patients, including pediatric patients with medical devices and technology dependence, is the main group among the patients who are monitored in the home health care unit. Specialized pediatric palliative care services need to be opened and developed in order to meet the medical, psychological and social needs of these patients and to reduce the workload and occupancy of special units such as intensive care.

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) and vancomycin-resistant Enterococcus (VRE) colonization and infections are important in the pediatric intensive care unit (PICU). This study aimed to investigate the effect of a 2% chlorhexidine gluconate (CHG) bath on VRE and CRE colonization. Materials and Methods: Skin bathing was performed every other day with 2% CHG as of April 2019. The frequency of CRE and VRE colonization pre and post-intervention was evaluated. Rectal swab samples were taken within 7 days before and after skin bathing with CHG. Besides, VRE and CRE spontaneously negation rates within 14 day periods were examined. Results: The number of CRE positive patients within the CHG group were detected as 10 (47.6%) before using CHG and as 8 (38%) after using (OR: 1.5, p= 0.131, 95% CI: 0.87-1.98). The number of VRE positive patients were detected within the CHG group as 15 (71.4%) before using CHG and as 10 (47.6%) after using (OR: 2.7, p= 0.044, 95% CI: 1.09-2.42). Also, when we compared the control group with the CHG group; there was no significant difference in CRE when comparing the negation rates (p= 0.804). There was a significant difference between the two groups in VRE (p= 0.048). Conclusion: It shows that performing skin bathing with 2% CHG every other day in the PICU significantly reduces VRE colonization but cannot decrease the risk of CRE colonization. We think that skin bathing with 2% CHG every other day in the PICU can be used as one of the resistant microorganism colonization and infection prevention methods.

Introduction: The efficacy of oral versus intramuscular (IM) vitamin D administration in obese children is debatable. The purpose of this study was to compare the efficacy of oral versus IM administration of a single dose of cholecalciferol (300,000 IU) in obese children with vitamin D deficiency. Methods In an open-label, randomized, and cross-sectional clinical study, 96 obese patients with vitamin D deficiency and body mass index (BMI) > + 2 standard deviation scores (SDS) for their age and gender were recruited. Sixty-one children received a single IM dose of cholecalciferol (300,000 IU), while 35 children received an oral single dose of cholecalciferol (300,000 IU). At the initial clinic visit, baseline serum calcium (Ca), phosphorus (PO4), alkaline phosphatase (ALP), parathyroid hormone (PTH), and 25-hydroxyvitamin D (25OHD) concentrations were measured. After 12 weeks, serum biochemical and hormone levels were determined. The study’s primary endpoint was a change in serum 25OHD hormone levels. Results There was no statistically significant difference between the IM and oral groups and baseline in the median 25OHD levels (8 (4) vs. 10.3 (1.8) ng/mL) and PTH levels (70 (28) vs. 68 (22) pg/ml). Compared to the oral group, the IM group showed a statistically significant increase in the 25OHD levels (IM Δ25OHD: 31 (10) vs. oral Δ25OHD: 20 (6.7) ng/ml, p

Coronavirus disease 2019 (COVID-19) may affect the mental status of health care professionals. The purpose of our study is to evaluate the mental health effects of the COVID-19 epidemic on health care professionals in the pediatric intensive care units (PICUs).Our study was conducted prospectively between 01.04.20 and 10.04.20. The created questionnaire was applied to health care professionals through online platforms. Thus it was involved in 5 different institutions that participated from different regions of Turkey. With the questionnaire, we applied; the participants' age, gender, the general status of contamination and the level of COVID-19 knowledge were questioned. Besides; Beck Anxiety Scale, Acute Stress Scale (PCL-5), STAI-1 and STAI-2 (State and Trait Anxiety Inventory 1-2) scales were used to determine the anxiety levels.A survey of 210 participants, 86 (41%) doctors, 124 (59%) nurses, were included in our study. When we evaluate the Beck anxiety levels, the majority of the participants (44%) were normal, while about one third had mild anxiety. When we evaluated the acute stress scale, all participants had a certain amount of stress levels. The majority (80 people each (38%)) experienced mild and moderate acute stress. Being female and having chronic disease poses a high risk for anxiety (OR, 0.330; 95% CI, 0.087-1.250, p0.05 and OR, 0.246; 95% CI, 0.068-1.116, p0.05), preoccupation (OR, 0.603; 95% CI 0.261-1.395, p0.05 and OR, 0.433; 95% CI, 0.122-1.538, p0.05) and acute stress (OR, 0.294; 95% CI, 0.033-2.649, p0.05 and OR, 0.317; 95% CI 0.060-1.679, p0.05). Professional definition, marital status and having a child do not pose any risk factors.Our study has shown that the COVID-19 outbreak affects the mental status of health care professionals working at PICU at various levels.

Objective: Nitric oxide therapy is not routinely used in the treatment of pediatric acute respiratory distress syndrome (PARDS), but it is recommended to be used as an adjunctive therapy in some selected cases. In our study, we aimed to discuss patients with PARDS who were treated with inhaled nitric oxide (iNO) therapy. Methods: The data of patients who were hospitalized in the pediatric intensive care unit with a diagnosis of PARDS and received iNO treatment between January 2016 and January 2018 were retrospectively analyzed. Age, gender, length of stay, mortality, number of days on mechanical ventilation, use of vasoactive drugs, mortality scores, lactate levels, OI (oxygenation index), PaO2/FiO2, methemoglobin levels, iNO administration time, echocardiographic findings and underlying primary diseases were recorded. Results: It was determined that 9 patients who were followed up with the diagnosis of PARDS were given iNO treatment. Except for one patient, they were diagnosed with pneumonia developing on the basis of chronic disease and PARDS secondary to septic shock. Five patients died while receiving iNO therapy. Seven patients were ventilated with iNO in addition to conventional mechanical ventilation methods. Two patients who died were ventilated with HFOV (high frequency oscillatory ventilation). In 3 of 9 patients, inhaled nitric oxide treatment was successful. Conclusion: Although inhaled nitric oxide treatment is a known treatment used in different diseases, the level of its effect in PARDS patients continues to be investigated. We think that this treatment can be beneficial when applied in selected patients and experienced centers.

Objectives The objectives of this study were to evaluate the differences in the viral etiologies and variability in the clinical course between children with and without severe disability (SD) admitted to the pediatric intensive care unit (PICU) with acute respiratory illness (ARI). Methods The medical records of patients admitted to our PICU between June 2017 and July 2019 were retrospectively reviewed for viral etiology and clinical course. Results Forty-eight of 136 patients included in the study had SD. The rates of requiring positive pressure ventilation (43.5% vs. 20.5%) or inotropic support (39.9% vs. 15.9%), and the median length of stay (11 [10] vs. 5 [8]) were significantly higher in children with SD (p Conclusion In this present study, influenza was an important pathogen for children with SD, while RSV was the main cause of ARI-associated PICU admission in children without SD. By focusing on increasing the rate of immunization against influenza in children with SD and their caregivers the burden of influenza-associated PICU admissions could be decreased.

BACKGROUND Rhabdomyolysis; can occur due to toxic, infectious, metabolic, and genetic causes. Severe rhabdomyolysis may progress to several clinical manifestations such as cardiac arrest and may pose a risk of mortality if it is not treated timely. CASE In this article, we presented a 26-month-old patient who was admitted with an acute rhabdomyolysis attack and a venovenous hemodiafiltration (CVVHDF) was initiated on the 5th hour of hospitalization. Creatine kinase (CK) levels of the patient continued to increase (max: 943 452 IU/L) until the 5th day of treatment and hereafter began to decrease. As the common causes of rhabdomyolysis were excluded and the CK levels were the highest values reported in the literature, although, LPIN1 deficiency was the most suspected diagnosis, to facilitate the diagnostic procedures a whole-exome sequencing was performed. A homozygous [c.1696G > C p. (Asp566His)] mutation was detected on LPIN1 gene. This variant has not been described previously, however, when examined with programs such as SIFT and Mutation taster, it has been considered as pathogenic. CONCLUSION In the pediatric age group, especially in infants presenting with severe rhabdomyolysis, LPIN1 deficiency should also be considered; as early diagnosis and appropriate treatment may reduce mortality.

Objectives Data on the relationship between tracheotomy and ventilator-associated pneumonia (VAP) in children is very limited. We planned to evaluate the effect of tracheotomy on VAP rates in children. Materials and methods We evaluated patients who underwent tracheotomy during follow-up at the pediatric intensive care unit (PICU) of our hospital. Patients who were diagnosed as VAP at least once and followed by a mechanical ventilation (MV) for at least 30 days before and after tracheotomy were included in our study. The underlying diagnoses of the patients and the number of VAP diagnosis, VAP rates (VAP number x1000/day of MV) before and after tracheotomy were recorded. Logistic regression analysis was used to compare VAP rates before and following a tracheotomy. Results There were a total of 47 patients including 28 (59.6%) girls and 19 (40.4%) boys in our study. The duration of MV before tracheotomy was 74.9 ± 48.9 (31–295) days and after tracheotomy, it was 103.3 ± 102.8 (30–586) days. The number of VAP before tracheotomy was 0.9 ± 1.2 (0–8) and after tracheotomy, it was 0.6 ± 0.6 (0–3). The VAP rate before tracheotomy was 5.9 ± 6.3 (0–26.5) and the VAP rate after tracheotomy was 3.2 ± 3.8 (0–11.4). Ventilator-associated pneumonia rates were lower following tracheotomy (OR:0.91,95%CI:0.826–0.981,p = 0.017). Conclusion Tracheotomy decreased the VAP rate in children receiving long-term mechanical ventilatory support.

Objectives: To investigate conventional mechanical ventilation weaning characteristics of patients requiring conventional mechanical ventilation support for greater than 48 hours within the PICU. Design: the prospective observational multicenter cohort study was conducted at 15 hospitals. Data were being collected from November 2013 to June 2014, with two designated researchers from each center responsible for follow-up and data entry. Setting: Fifteen tertiary PICUs in Turkey. Patients: Patients between 1 month and 18 years old requiring conventional mechanical ventilation for greater than 48 hours were included. A single-center was not permitted to surpass 20% of the total sample size. Patients with no plans for conventional mechanical ventilation weaning were excluded. Interventions: Conventional mechanical ventilation Measurements and Main Results: Pertinent variables included PICU and patient demographics, including clinical data, chronic diseases, comorbid conditions, and reasons for intubation. Conventional mechanical ventilation mode and weaning data were characterized by daily ventilator parameters and blood gases. Patients were monitored until hospital discharge. of the 410 recruited patients, 320 were included for analyses. A diagnosis of sepsis requiring intubation and high initial peak inspiratory pressures correlated with a longer weaning period (mean, 3.65 vs 1.05-2.17 d; p < 0.001). Conversely, age, admission Pediatric Risk of Mortality III scores, days of conventional mechanical ventilation before weaning, ventilator mode, and chronic disease were not related to weaning duration. Conclusions: Pediatric patients requiring conventional mechanical ventilation with a diagnosis of sepsis and high initial peak inspiratory pressures may require longer conventional mechanical ventilation weaning prior to extubation. Causative factors and optimal weaning for this cohort needs further consideration., National Institutes of HealthUnited States Department of Health & Human ServicesNational Institutes of Health (NIH) - USA, Drs. Sik, Yaman, and Kendirli disclosed government work. Drs. Yaman and Davutoglu received support for article research from the National Institutes of Health. the remaining authors have disclosed that they do not have any potential conflicts of interest.

Background: To evaluate the short-term effectiveness of reduced-osmolarity oral rehydration salt formulation (ORS) and propranolol in children diagnosed with postural orthostatic tachycardia syndrome (POTS) in head-up tilt testing (HUTT).Methods: Children were admitted with symptoms of orthostatic intolerance (OI) occurring in a standing position and disappearing in the supine position. Patients with heart rate increments of >= 40 bpm and symptoms of OI constituted the pediatric POTS group in HUTT. A total of 70 pediatric patients with POTS were included in the study. POTS patients were divided into two groups based on whether they were prescribed reduced-osmolarity ORS and propranolol or not. The study group comprised patients on a regimen of reduced-osmolarity ORS and propranolol (n = 34), while the control group comprised patients who were not prescribed any medication (n = 36). The frequency of symptoms and standardized symptom scores were analyzed before and after 3 months of treatment in both groups.Results: The post-treatment frequency of syncopal attacks was significantly reduced in both groups (P < 0.01 for both groups), but the post-treatment standardized symptom scores were significantly reduced in the pediatric study group compared with the control group (P < 0.01).Conclusion: The frequency of syncopal attacks was significantly reduced and the symptom scores for OI were improved in the study group. The improvement in OI symptom scores was better in the treatment group than in the control group. The control group symptoms persisted and caused extreme difficulty in their daily activities. In view of its clinical efficacy, we strongly advocate the use of combined treatment of reduced-osmolarity ORS and low-dose propranolol in pediatric patients with POTS. (C) 2020 French Society of Pediatrics. Published by Elsevier Masson SAS. All rights reserved.

OBJECTIVE: An electrical injury (EI) is an emergency that causes high morbidity and mortality each year. The aim of this study was to define the epidemiological, clinical, and laboratory factors that might predict severe patients and cardiac arrest in pediatric EI cases. METHODS: All of the patients' medical files were reviewed retrospectively through a 2-year period for the demographic, clinical, and laboratory findings. The patients were classified into the severe injury group or the mild injury group. The SPSS (Chicago, Ill) software was used to analyze the data. RESULTS: Among the 38 patients, 18 patients (47.4%) were in the mild group, and 20 patients (52.6%) were in the severe group. Low-voltage injuries were observed in 35 (92.1%) of the patients. Most of the severe patients were injured with low voltage (75%) and in household settings (85%). Plug and sockets were the most observed source of the injuries in all of the patients, whereas water-related injuries were most prevalent in the severe group. The source of injury was different in the mild and severe groups (P = 0.009). In the severe group, 13 patients (34.2%) were resuscitated after cardiopulmonary arrest. In the multivariate analysis of the demographic data, the most predictive parameters for cardiac arrest and the clinical severity in EIs are the factors of electrical cables and water. CONCLUSIONS: Electrical injuries are a significant concern in the pediatric population. Our results showed that low voltage and household electricity could cause morbidity and mortality. Language: en

WOS: 000429850300010, Pheochromocytoma is a rare disease that is characterized by the increased production and secretion of catecholamines from the adrenal medulla. The disease is autosomal dominant, and frequently sporadic and unilateral. Pheochromocytoma, which is diagnosed during childhood, mostly arises as a part of cancer susceptibility syndromes. Among these syndromes, von-Hippel Lindau (VHL) syndrome is dominantly inherited, and is frequently identified in childhood pheochromocytoma. VHL syndrome is clinically characterized with hemangioblastomas of the central nervous system and retina, renal cell carcinoma, and pheochromocytoma, and has been demonstrated to have a strong genotype-phenotype correlation. In this case report, we presented an 11-year-old male who was found to have early-onset isolated bilateral pheochromocytoma and V84L mutation in VHL. We aimed to emphasize that this rarely reported mutation is associated with VHL Type 2C that classically manifests with early-onset isolated bilateral pheochromocytoma.

WOS: 000451246700003, PubMed ID: 31149275, Objective. Ectopic posterior pituitary gland (EPP) is usually characterized by an abnormal pituitary stalk and hypoplasia of the anterior hypophysis. The genetic mechanisms involved in the development of EPP remain uncertain. The aim of this study is to determine whether mutations in the three genes, PROP-1, LHX2, and POU1F1, are associated with the risk for and the characteristics of EPP. Methods. In the Endocrinology Outpatient Clinic of "Dr. Behcet Uz" Children's Hospital, 27 patients with EPP were submitted to sequencing analyses of the PROP-1, LHX2, and POU1F1 genes. Results. Growth hormone, thyrotropin, corticotropin, gonadotropin, and vasopressin deficiency were observed in 22 (81.5%), 23 (85.2%), 17 (63%), 14 (51.9%), and two (7.4%) patients. Thirteen patients (48.1%) presented with hyperprolactinemia. Fourteen patients (51%) had a history of birth dystocia, and 12 cases (42.1%) had a history of breech presentation. Central nervous system abnormalities included five cases with corpus callosum agenesis, one case with schizencephaly, and one case with Chiari type 1 malformation. We identified a homozygous p.S109* mutation in exon 2 in one male patient with EPP and two different PROP] gene polymorphisms (A142T or c.109+3 G>A polymorphism) in thirteen patients. Conclusions. Our results suggest that PROP1 gene abnormalities might explain the genetic mechanisms involved in the development of EPP.

Baclofen is a derivative of gamma-aminobutyric acid, used mainly for the treatment of muscle spasticity. Baclofen overdose can result in severe respiratory depression, autonomic disturbances, seizures and coma. Here we report a 15-year-old girl who was found unresponsive, intubated and admitted to the PICU. On initial presentation, her Glasgow Coma Score was 3, with fixed dilated pupils. EEG revealed cerebral bioelectric activity and ground amplitudes significantly lower than normal. Supportive treatments were administered. On the 2nd PICU day, she regained consciousness and was able to follow commands. She was extubated and discharged on hospital day 3. Conclusively emergency physicians should consider baclofen overdose in children presenting with acute loss of consciousness, flaccidity, and hyporeflexia.

Objective: Isolated pulmonary valve stenosis is the most common cause of the right ventricular outflow tract obstruction, and balloon valvuloplasty (BVP) has been the treatment of choice in these subgroup of patients. In this study, we aimed to evaluate right ventricular functions of patients who underwent BVP for PS using two-dimensional, pulse wave (PW) Doppler and tissue Doppler echocardiography during an average of 4 years (2 months-11 years) of follow-up period.

Drowning is still one of the most important causes of the preventable mortality worldwide. Some patients should be treated with noninvasive ventilation immediately in the emergency department (ED). The practice of noninvasive ventilation has been increased recently in the paediatric ED. We present here three nonfatal drowning patients with pulmonary oedema and hypoxia who were successfully treated with noninvasive ventilation in the paediatric emergency department. All of the patients had aspirated sea water during swimming. In addition, two of the patients had aspirated water during snorkeling. Noninvasive ventilation was applied to the patients immediately in paediatric emergency service. All of the patient's clinical and radiological findings recovered rapidly. There are limited reports about use of noninvasive ventilation in nonfatal drowning cases in the paediatric emergency department. We emphasize that the early application of noninvasive ventilation should be a preventive method for reducing the morbidity of nonfatal drowning cases. (Hong Kong j.emerg.med. 2016;23:42-46)

Giriş: Ülkemizde ve dünyada, çocukluk çağında en önemli ölüm sebebi, motorlu araç kazalarıdır. Önleyici stratejiler ile motorlu araç kazalarına ikincil mortalite ve morbididte önemli ölçüde azalmaktadır. Araç güvenliği kullanımının arttırmak için ailelerin ve en sık başvurulan bilgi kaynağı olan hekimlerin yüksek bilgi düzeyine ve farkındalığa sahip olması gerekmektedir. Biz, travma hastası bakıyor olmanın hekimlerin bilgi düzeyi ve farkındalığı üzerine olumlu etkisi olabileceği fikrinden yola çıkarak çocuk hekimleri, acil hekimleri ve travma karşılayan hekimlerin çocuk araç koltuğu kullanımı hakkında farkındalığını ve bilgi düzeyini ortaya koymayı amaçladık.Yöntemler: Çalışma için 23 sorudan oluşan bir anket formu elektronik olarak hazırlandı. Anket formu üç bölümden oluşturuldu. Bu üç bölümde demografik veriler, çocuk araç güvenliği hakkında farkındalığı ve bilgi düzeyi sorgulandı. Üçüncü bölümde Amerikan Pediyatri Derneği’nin beş temel önerisi sorularak, bilgi düzeyinin ölçülmesi hedeflendi. Hekimler, travma hastası karşılayan ve karşılamayanlar olarak iki grupta karşılaştırıldı.Bulgular: Çalışmanın başında 641 anket formu elektronik olarak hekimlere gönderildi. Tüm katılımcıların 114’ü (%35,3) travma hastası karşılıyordu. Yüz doksan bir (%59,2) hekimin çocuğu vardı. Kendi bilgi düzeylerini orta derecede görenlerin sayısı travma bakan ve çocuğu olan hekimlerde istatistiksel olarak anlamlı şekilde yüksekti (sırasıyla; p0,05). İlginç olarak çocuğu olanların ise bilgi düzeyi grubun kalanına göre daha düşüktü (pSonuç: Bu anket çalışması, travma hastası bakan hekimlerin çocuk araç güvenliği konusunda yüksek bilgi düzeyine sahip olduğunu düşünmesine karşın aslında bilgi düzeylerinin diğer hekimler kadar olduğunu ortaya koymaktadır. Introduction: Motor vehicle crashes are the most common cause of the mortality in the pediatric population. Preventive strategies are the best approach to reduce mortality and morbidity due to motor vehicle crashes. Since parents mostly refer to them for guidance, doctors should have a high level of knowledge and awareness to increase the usage of car safety seats. We thought that providing care for trauma patients could have a positive effect on the physicians’ awareness and knowledge level. Based on this, we aimed to assess the awareness and knowledge of pediatricians and emergency physicians and trauma doctors.Methods: An electronic survey consisting of 23 questions was prepared. Demographic features, awareness and knowledge level of the physicians were assessed on three sections. Five suggestions in the guideline of the American Academy of Pediatrics were used to assess physicians’ knowledge level. The respondents were grouped as those providing clinical care for trauma patients and those do not.Results: The questionnaires were sent to 641 physicians and 323 who completed the questionnaire were included in the study. One hundred and fourteen (35.3%) of the respondents were providing clinical care for trauma patients. One hundred ninety (59.2%) respondents had children. Majority of the physicians had a satisfactory level of knowledge about car safety seat (CSS). The number of respondents reported having adequate self-awareness was found statistically significantly higher in the groups of doctors who have children and provide clinical care for trauma patients (p0.05). Interestingly, the knowledge level in physicians who had children was statistically significantly lower than in those with no children (pConclusion: Our survey revealed that physicians who provide clinical care for trauma patients think they have a high level of knowledge about CSS. Unfortunately, their knowledge level was low as other physicians in the study group.

Background The aim of the study was to perform a neurodevelopmental evaluation of the children with cyanotic congenital heart disease and to determine the factors that affect the neurodevelopmental status. Methods The study was performed in the Pediatric Cardiology Department of Behcet Uz Children's Hospital between February and August 2013. Children between the age of six to forty-two months were included in the study and were evaluated in three groups (two patient groups and the control group). In group A, patients with isolated cyanotic congenital heart disease were enrolled. Group B consisted of the patients with cyanotic congenital heart disease with other concomitant diseases. Group C included the healthy control group. For the neurodevelopmental evaluation Bayley Scale of Infant Development- II (BSID-II) was used. Mental Developmental Index (MDI) and Psychmotor Developmental Index (PDI) scores were calculated. Factors possibly effective on neurodevelopment were evaluated. Results Thirty eight patients (32 in group A and 6 in group B) and 33 healthy subjects in group C were included in the study. Mean age of the patient group was 22.5±11.2 months. In group A mean MDI Score (82.5±14.7) was significantly lower than group C (92.3±6.9) (P=0.001). Similarly mean PDI Score in group A (82.0±18.2) was found significantly lower than group C (92.5±7.4) (P=0.003). When group A and B were compared, mean MDI and PDI scores were lower in group B, but the difference was not statistically significant. For group A, according to the psychomotor development index, 41.6% of the patients were found to be mildly to severely retarded. In terms of the mental development index, 34.4% of the patients had moderate or mild retardation. The sex, socioeconomic status, gestational age, birth weight, comorbidities, history of surgery and reoperation, length of stay in intensive care unit were not found influential on the MDI and PDI scores of the patients. Conclusions Mental-motor retardation is frequently encountered in children with cyanotic congenital heart disease. These patients may benefit from motor, language, speech, developmental and educational therapies. For this reason, these children have to be under regular follow up for neurodevelopmental status.

Aim: Although pediatricians are one of the leading professionals in public to consult with on childbearing, breastfeeding and child care, there is a lack of data about the attitude, choice and practice of pediatricians towards these issues. The aim of this study is to determine female pediatricians’ practices on childbearing, breastfeeding and child care and to discuss the possible differences from the general population. Materials and Methods: This is a descriptive study of women pediatricians’ attitudes who have children between 2 and 6 years old, about childbearing, breastfeeding and child care. The study group was surveyed about their demographic characteristics; breastfeeding practices and their general attitude toward mothering. The data were compared with the general population and similar groups in terms of education and socioeconomic status, previously reported in Turkey Demographic and Health Survey in 2013 (TDHS-2013). Results: The study group included 146 women pediatricians (mean age: 35.49±3.4) mothering children between 2 and 6 years [median age 3.5 (1.5)]. The median age at first birth of the study group [30 (4)] was significantly higher than in the general population. The rate of caesarean delivery of the study group was 91.8% and was significantly higher than reported previously. The median duration of exclusive and total breastfeeding were 5 (2) months and 13 (11) months respectively. The median duration of exclusive breastfeeding was significantly higher while the total breastfeeding duration was significantly lower than both groups reported in TDHS-2013. Conclusion: Women pediatricians’ choices on and experiences of childbearing, breastfeeding and child care differ from the general population in Turkey. This specific group of health professionals’ decisions must be well evaluated worldwide as they have an undeniable role on families, on children and thus on public health.

Background The knowledge of the size of the gap between esophageal ends in esophageal atresia (EA) before surgery is of clinical importance. The aim of this study was to compare the demographic characteristics between patients with short-gap esophageal atresia (SGEA) and long-gap esophageal atresia (LGEA).Patients and methods Medical records of all patients managed for EA spectrum in our department between 2003 and 2012 were evaluated, retrospectively. Demographic data included the maternal age, the number of parities and deliveries, the presence of polyhydramnios and the prenatal diagnosis, sex, the gestational age and prematurity, the type of delivery and the birth weight, age at the time of diagnosis and treatment, the presence of associated anomalies including VACTERL-type and non- VACTERL-type anomalies, the type of EA according to Gross classification, and discrepancies between the diameters of atretic esophageal ends. SGEA and LGEA were defined as a gap of less than three vertebral bodies or three or more vertebral bodies in length between the atretic esophageal ends, respectively.Results There were 99 patients treated for the diagnosis of EA spectrum during the study period: 81 in the SGEA group and 18 in the LGEA group. Most of the parameters studied did not differ between the two groups. Type-C EA was more prevalent in patients with SGEA (n= 77/81) and type-A was more frequent in children with LGEA (n= 8/18) (P < 0.05). The frequency of prenatal diagnosis (2.5% for SGEA vs. 22.2% for LGEA) was more common in the LGEA group (P < 0.05). Cesarean section compared with normal vaginal delivery was more commonly seen in both groups (56.8% for SGEA vs. 66.7% for LGEA).Conclusion Most of the demographic parameters were similar between the two groups of patients. However, the frequency of prenatal diagnosis was more common in patients with LGEA. Most of the patients in both groups were delivered by a cesarean section. Type-C EA was more prevalent in patients with SGEA and type-A was more frequent in children with LGEA. Further analysis of this topic is warranted and may be beneficial in revealing the true demographic differences between patients with SGEA and LGEA.

Background We aimed to examine microvolt T wave alternans (MTWA) in 24-hour Holter electrocardiography (ECG) of children with repaired tetralogy of Fallot (TOF) to assess associations of MTWA with ventricular arrhythmias, ECG parameters, and echocardiographic findings. Methods Holter ECG records and archive files of 56 repaired TOF patients (62.5% male) who were analyzed retrospectively. Subjects’ ECG parameters and MTWA values were compared with age–sex-matched control group. T wave changes were analyzed by time-domain-modified moving average method from the three channels of 24-hour Holter ECG. Results Mean age was 123.4 ± 48.3 months. Median MTWA value was 55.5 μV in the control group, whereas 95.5 μV in patients group (P < 0.001). A significant weak positive correlation was found between the presence of ventricular extrasystoles and tricuspid regurgitation. There was no correlation between ECG parameters, echocardiographic findings, and MTWA. Conclusions MTWA was increased in children with repaired TOF as reported before. To our knowledge, this is the first study analyzing MTWA with 24-hour Holter ECG in repaired TOF patients.

Purpose The purpose of this study was to investigate fetal ductus venosus (DV) wave velocities, DV velocity ratios, and DV diastolic time intervals to derive additional information on fetal cardiac function in the presence of an intracardiac echogenic focus (IEF). Methods Seventy fetuses at 19–28 weeks of gestation with an IEF and 63 control fetuses were screened using two-dimensional and power Doppler echocardiography. DV wave velocities, DV velocity ratios, and diastolic time intervals were measured. The aortic peak velocity, pulmonary artery peak velocity, left ventricular shortening fraction, and right ventricular shortening fraction, atrioventricular early-diastolic filling velocity (E), atrial contraction velocity (A), and E/A ratio were also measured. Results The study and control groups were similar in terms of maternal age, body mass index, and gestational age in weeks at the time of examination (p > 0.05). Significant between-group differences were found in DV v-descent (p = 0.03) and a-wave velocities (p = 0.04). Conclusions Although the presence of an IEF in the fetal heart does not influence conventional measurements (DV velocity ratios and DV diastolic time intervals), it is associated with changes in DV v-descent and a-wave velocities. These changes may be indirectly related to reduced end-systolic relaxation and augmented atrial contraction in the fetal heart. We therefore suggest examination of DV flow velocities in fetuses with IEF. © 2015 Wiley Periodicals, Inc. J Clin Ultrasound 44:170–174, 2016

OBJECTIVE It has been documented that impaired heart rate variability (HRV) is related to life threatening arrhythmias in children with surgically repaired congenital heart disease. We aimed to analyze the balance of the cardiac autonomic functions by assessing HRV in children with arterial switch operation (ASO). METHODS In this observational cohort study, HRV analysis using 24-h Holter electrocardiography recordings was examined in 22 patients (mean age: 59.5±38.7 months, 18 male, 4 female) who had undergone ASO during the newborn period and 22 healthy children (mean age: 65.1±39.4 months, 18 male, 4 female). After Kolmogorov-Smirnov testing for normality, Student t-test and Mann-Whitney U test were used when appropriate. Chi-square was used for categorical data. RESULTS In 24-h HRV analysis showed that SDANN and VLF were significantly higher in patient group. Awake SDNN, rMSSD, pNN50, TP and VLF levels of patient group were significantly higher than those of control subjects. Awake LF/HF ratio in patient group was significantly higher than their counterpart in asleep group. In the patient group, awake rMSSD, pNN50, TP, LF and HF were significantly lower than their counterpart in the asleep group. CONCLUSION Children with transposition of the great arteries (TGA) following ASO have not decreased levels of time and frequency HRV parameters in the mid-term follow-up period. All HRV parameters reflecting vagal tone were increased in the patient group. It is suggested that vagal tone is more predominant than sympathetic tone for children with ASO.

The aim of this study is to detect preeclampsia-related cardiac dysfunction within 24-48 hours of delivery in newborns born from preeclamptic mothers. Forty newborns from mildly preeclamptic mothers formed the study group and the control group was formed by 40 healthy newborns. Cardiac function for the groups were evaluated using conventional echocardiography and myocardial performance index (MPI) within the first 24-48 hours of their lifetime and the results of both groups were compared. A significant difference between the groups was observed especially in the PW Doppler MPI measurements (the left ventricle MPI 0.37 ± 0.09 and 0.26 ± 0.11, p .001; the right ventricle MPI 0.29 ± 0.08 and 0.26 ± 0.07, p .035) for the control group and the study group. Elongation in the left and right ventricle MPI was detected to be more significant in terms of comparing systolic and diastolic functions to determine preeclampsia-related cardiac injury in newborns from preeclamptic mothers within the first 24-48 hours of their lifetime. Impact statement Today, the methods which may detect cardiac injury earlier than conventional echocardiographic methods are used for evaluating cardiac functions. Among them, myocardial performance index (MPI) measurement with PW Doppler is the most common ones. While studies are available in the literature evaluating foetal cardiac functions with MPI in foetuses of preeclamptic women, studies evaluating cardiac functions with MPI index within the first 24-48 hours in postnatal period are not available. This is the first study to detect cardiac injury by measuring cardiac functions of the newborns of preeclamptic babies using conventional echocardiography (EF, SF, mitral and tricuspid E/A) and myocardial performance index within the first 24-48 hours of life and compare these values with those of a control group composed of healthy newborns with similar demographic characteristics. According to the results of the study, elongation in right and left ventricle MPI was detected to be more significant compared to systolic and diastolic functions for determining preeclampsia-related cardiac injury in newborns of preeclamptic mothers within 24-48 hours of delivery. Ventricle functions of the newborns of preeclamptic mothers should also be evaluated with MPI measurement besides conventional echocardiographic measurements.