Should aortic stiffness parameters be used in MIS-C patient follow-up?

We evaluated the short- and long-term effects of multisystem inflammatory syndrome in children (MIS-C) on their cardiovascular system. The study population consisted of 38 MIS-C patients and 55 control patients. Standard echocardiographic measurements and aortic stiffness parameters were compared between the two groups at different time points. During the standard echocardiographic examination at the time of diagnosis, mitral valve insufficiency was detected in 42% of the cases, left ventricular systolic dysfunction in 36%, aortic valve insufficiency in 3%, tricuspid valve insufficiency in 13%, and coronary artery dilatation in 31%. The ejection fraction, pulse pressure of the experimental group were significantly lower than the control group (p < 0.01, p = 0.045, respectively). When aortic stiffness parameters were compared, it was seen that the parameters increased in the experimental group and the difference was significant for aortic distensibility. (p = 0.105, p = 0.029 respectively). When comparing the experimental group's results at diagnosis and at the sixth month, there was a decrease in aortic stiffness parameters at the sixth month compared to the time of diagnosis, but the difference wasn't significant (p = 0.514, p = 0.334). However, no statistically significant difference was detected when comparing the aortic distensibility results of the experimental group with the control group at the sixth month (p = 0.667). Our results showed that many pathological echocardiographic findings detected at diagnosis in MIS-C patients returned to normal within six months. Therefore, we believe that the cardiovascular follow-up period of MIS-C cases should be at least six months.

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey.

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

Evaluation of Patients with Acute Respiratory Distress Syndrome Followed on Mechanical Ventilator in a Tertiary Pediatric Intensive Care and the Factors That May Be Associated with Death in These Patients.

OBJECTIVE: We aimed to evaluate the clinical, demographic, and laboratory characteristics of the patients followed up with pediatric acute respiratory distress syndrome in our pediatric intensive care unit and to determine the factors that have an effect on the outcomes. MATERIALS AND METHODS: The medical records of 40 patients with acute respiratory distress syndrome who were followed up on mechanical ventilators in the pediatric intensive care unit of Adiyaman University were retrospectively scanned. From the medical records, the demographic data, clinical features, and laboratory characteristics were recorded. RESULTS: Eighteen of the patients were female and 22 were male. The mean age was 45.25 ± 56.63 months. A total of 27 (67.5%) of the patients were classified as pulmonary and 13 (32.5%) as extrapulmonary acute respiratory distress syndrome. Sixteen (40%) patients were followed in pressure-controlled mode only, 2 (5%) patients in volume-controlled mode only, and 22 (55%) patients in alternate modes. A total of 17 (42.5%) patients died. The median pediatric index of mortality, pediatric index of mortality-II, pediatric risk of mortality, and pediatric logistic organ dysfunction score values of the surviving patients were significantly lower than the dead patients. Median aspartate aminotransferase (P = .003) and lactate dehydrogenase (P = .008) values were found to be significantly higher in patients who died, while median pH values (P = .049) were found to be lower. The median length of stay in pediatric intensive care unit and duration of mechanical ventilators were significantly shorter in patients who died. Also, the median pediatric index of mortality, pediatric index of mortality-II, pediatric risk of mortality, and pediatric logistic organ dysfunction values of pulmonary acute respiratory distress syndrome patients were significantly lower than those of extrapulmonary acute respiratory distress syndrome patients. CONCLUSION: Despite advances in follow-up and management, mortality due to acute respiratory distress syndrome is still high. Mechanical ventilator duration, length of stay in pediatric intensive care unit, some mechanical ventilator parameters, mortality scores, and laboratory tests were associated with mortality. Alternatively, mechanical ventilator applications may reduce mortality rates.

Ultrasonography Results in First Urinary Tract Infection During Childhood: Which Age Group Should Be Screened?

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

Incidence of Mechanical Ventilation Adverse Events in Critically Ill Children in a Tertiary Pediatric Intensive Care Unit.

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

Epidemiology of pediatric severe sepsis and septic shock in Turkey: Prevalence, Results and Treatments Study.

AIM: This study was aimed at characterizing the prevalence, management, and outcomes of pediatric severe sepsis and septic shock in tertiary pediatric intensive care units (PICUs) in Turkey. METHODS: A point prevalence study was conducted on five days over the course of one 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. Pediatric 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.

Evaluation of Pediatric Delirium Awareness and Management in Pediatric Intensive Care Units in Turkey.

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

Determination of predictive risk factors for severe bronchiolitis.

BACKGROUND: The aim of this study was to determine the predictive risk factors for development of severe bronchiolitis in patients with acute bronchiolitis with no previous chronic disease. METHODS: Four hundred forty children aged 1-24 months hospitalised with acute bronchiolitis, were examined between February 2018 and February 2019 in this prospective study. RESULTS: Eighty-five cases were regarded as severe bronchiolitis and 355 as mild-moderate bronchiolitis. Statistically significant differences were observed between the severe and mild-moderate bronchiolitis groups in terms of weight-for-age z-scores, history of bronchiolitis, haemoglobin levels, and time elapsed between the onset of symptoms and admission. Weight-for-age z-scores, the mean time interval between the onset of symptoms and admission, and mean haemoglobin values were lower in the severe bronchiolitis group while the mean number of bronchiolitis attacks was higher than in the mild-moderate bronchiolitis group. Logistic regression analysis determined that a low weight-for-age z-score increased the risk of severe bronchiolitis development 0.56-fold (CI: 0.409-0.760), a short duration between the onset of symptoms and admission increased the risk 0.62-fold (CI: 0.519-0.735), a frequent history of bronchiolitis increased the risk 1.81-fold (CI: 1.135-2.968) and low haemoglobin levels increased the risk 0.72-fold (CI: 0.537-0.969). CONCLUSION: Low weight-for-age z-scores, a short duration between the onset of symptoms and admission, a high number of previous attacks and low haemoglobin levels were identified as independent parameters of severe bronchiolitis development.

Comparison of Simultaneous Capillary Blood Gases and End-Tidal Carbon Dioxide in Mechanically Ventilated Pediatric Patients with Acute Respiratory Failure.

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

Susceptibility Patterns of Multidrug-Resistant Acinetobacter baumannii.

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

A novel de novo mutation at the ABCC8 gene in a newborn with transient diabetes mellitus.

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

Evaluation Using Spectral-Domain Optical Coherence Tomography of the Effects of Malnutrition on Ocular Parameters in Pediatric Patients.

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

Concurrence of Two Rare Conditions: Simultaneous Bilateral Spontaneous Pneumothorax and Congenital Pulmonary Airway Malformation.

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

Management Strategies for Hydrocephalus in Alobar Holoprosencephaly: A Case Report and Discussion.

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

The First Infant Death Associated With Human Coronavirus NL63 Infection.

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

Antibacterial resistance patterns of pediatric community-acquired urinary infection: Overview.

BACKGROUND: Urinary tract infection (UTI) is common in children. The aim of this study was therefor to construct a guide for the empirical antibiotic treatment of community-acquired UTI by investigating the etiology and antimicrobial resistance patterns of uropathogens and analyzing the epidemiological and clinical patient characteristics. METHODS: A total of 158 children with positive urine culture were included in the study. Antibiotic susceptibility testing was performed with Vitek 2 Compact for 28 commonly used antimicrobials. RESULTS: Mean age was 3.36 ± 3.38 years (range, 45 days-15 years). Escherichia coli (60.1%), and Klebsiella spp. (16.5%) were the most common uropathogens. For all Gram-negative isolates, a high level of resistance was found against ampicillin/sulbactam (60.1%), trimethoprim/sulfamethoxazole (44.2%), cefazolin (36.2%), cefuroxime sodium (33.5%), and amoxicillin/clavulanate (31.5%). A low level of resistance was noted against cefepime (8.7%), ertapenem (4.6%), norfloxacin (1.3%), and meropenem (0.7%). There was no resistance against amikacin. CONCLUSIONS: There is high antibiotic resistance in children with UTI. The patterns of uropathogen antimicrobial resistance vary in susceptibility to antimicrobials depending on region and time. Thus, the trends of antibiotic susceptibility patterns should be analyzed periodically to select the appropriate regimen for UTI treatment.

Risk Factors Related to Caregivers in Hospitalized Children's Falls.

PURPOSE: This study aimed to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. METHODS: This was a case control study to evaluate the risk factors for falls in hospitalized children in relation to their caregivers. The children included in our study were at the hospital between June 2014 and June 2015. Demographic data of patients, caregivers, some habits; education level; and number of siblings were recorded. RESULTS: The data of 117 patients were evaluated, and there were 39 patients with a fall event and 78 patients who did not experience a fall. The mean age for the fall group and the non-fall group were 14.71±9.36 and 15.62±10.65months, respectively. The mean age for the caregivers of the fall group and the non-fall group were 29.33±5.89 and 29.53±5.56years, respectively. There was a statistically significant difference in fall risk related to the caregivers' education level (p<0.01) and caregivers' habit of smoking (p<0.01). The analysis of risk factors related to caregivers for pediatric inpatient falls, by multivariate logistic regression, showed that low educational level of caregivers (OR=0.361; CI=0.196-0.665; p<0.01), caregivers' smoking (OR=4.863; CI=1.058-22.358; p<0.05) and increased length of stay for the children (OR=1.994; CI=1.475-2.696; p<0.01) carried a higher risk for pediatric inpatient falls. CONCLUSIONS AND PRACTICE IMPLICATIONS: The data obtained in our study have shown that caregivers play a key role in fall events in hospitalized children. Nurses and other health workers should consider children's caregivers educational level and habits for prevention of hospitalized children falls.

The Combined Use of Inhaled and Intravenous Steroids for Children With Chemical Pneumonitis After Ingestion of Paint Thinner.

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

Choroidal Thickness in Children with Beta Thalassemia Major.

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