Infants with macrosomia and infants of diabetic mothers have increased carotid artery intima-media thickness in childhood.

Incidence of diabetes during pregnancy is increasing worldwide, and intrauterine hyperglycemia exposure may have long-term adverse effects on the cardiovascular health of children. We investigated prospectively the risk of atherosclerosis and carotid intima-media thickness (CIMT) in infants born macrosomic and in infants of diabetic mothers (IDM) at the age of 8-9 years in 2021. A total of 49 infants of diabetic mothers (IDM group) and 13 macrosomic infants (macrosomic group) were included in the study. They were compared with 26 age-matched healthy children with birth weight appropriate for gestational age born to non-diabetic mothers (control group). Anthropometric measurements, atherosclerosis risk factors, and CIMT measurements were performed. There was no significant difference between the groups in terms of age, gender, actual anthropometric measurements, blood pressure measurements, laboratory parameters, or atherosclerosis risk factors. Gestational age was lower in the IDM group (p < 0.001), while birth weight was higher in the macrosomic group (p < 0.001). High-density lipoprotein cholesterol level was lower in the IDM group than the other groups. Duration of exclusive and total breastfeeding was lower in IDM group than in the control group (p < 0.001 for both). Body mass index, skinfold thickness, waist-to-hip ratio, and waist-to-height ratio were higher in those breastfed for less than 6 months in the IDM group. The CIMT values were statistically higher in IDM [0.43 ± 0.047 (0.34-0.60)] and macrosomic [0.40 ± 0.055 (0.33-0.50)] groups than control group [0.34 ± 0.047 (0.26-0.45)]. CONCLUSION: CIMT values were higher in IDM and macrosomic groups at 8-9 years old age compared to children born with normal birth weight. This indicates intrauterine exposure in both groups. And also, breastfeeding seems very important for IDMs. WHAT IS KNOWN: • Intrauterine hyperglycemia exposure has long-term adverse effects on the cardiovascular health of children. • Infants of diabetic mothers have higher carotid artery intima-media thickness at birth. WHAT IS NEW: • Both infants of diabetic mothers and infants with macrosomia have increased carotid artery intima-media thickness at the age of 8-9 years. • Duration of breast feeding is important especially in infants of diabetic mothers as body mass index, skinfold thickness, waist to hip and height ratio were higher in those breastfed less than 6 months.

Sonographic measurements of Inferior Vena Cava, Aorta, anda IVC/aorta ratio in healthy children.

Background: Assessment of intravascular volume status is important in pediatric patients admitted to the emergency departments and pediatric intensive care units. Inferior vena cava (IVC) diameter and collapsibility index are used to evaluate the intravascular volume status in adults. The normal range of IVC diameter is available for adults and the normal range considered for adults is between 1.7 to 2.1 cm, but such normative data is limited for children of all ages. Aims: Our aim in this study was to obtain the IVC and the aorta diameter reference values and the mean vena cava collapsibility index in healthy and normovolemic children. Subjects and Methods: Vena cava inferior and aorta images in B mode were obtained. IVC diameter in the inspiratory and the largest IVC diameter in the expiratory were recorded, and the vena cava collapsibility index was calculated. Results: Ultrasonographic measurements were performed in total on 1938 children. A significant positive correlation was found between IVC and aorta diameters with age. The collapsibility index was found as 37.2% (SD 11.8) in the overall study population. In addition, the reference values for the IVC and aorta diameters obtained from the measurements were also acquired. Conclusions: We believe that our IVC and aorta diameter measurements obtained from a large number of participants may be used as reference values in emergency departments and intensive care units.

Performance and analysis of four pediatric mortality prediction scores among critically ill children: A multicenter prospective observational study in four PICUs.

OBJECTIVE: We aimed to evaluate and compare the prognostic performance of common pediatric mortality scoring systems (the Pediatric Index of Mortality 2 [PIM2], PIM3, Pediatric Risk of Mortality [PRISM], and PRISM4 scores) to determine which is the most applicable score in our pediatric study cohort. METHODS: This prospective observational multicenter cohort study was conducted in four tertiary-care pediatric intensive care units (PICUs) in Turkey. All children, between 1 month and 16 years old, admitted to the participating PICUs between October 1, 2019, and March 31, 2020, were included in the study. Discrimination between death and survival was assessed by area under the receiver operating characteristic plot (AUC) for each model. The Hosmer-Lemeshow goodness-of-fit (GOF) test was used to assess the calibration of the models, RESULTS: A total of 570 patients (median age 35 months) were enrolled in the study. The observed mortality rate was 8.2% (47/570). The standardized mortality ratio (SMR) of PIM2, PIM3, PRISM, and PRISM4 with 95% confidence interval (CI) were 0.94 (0.68-1.23), 1.27 (0.93-1.68), 0.86 (0.63-1.13), and 1.5 (1.10-1.97), respectively. The AUC with 95% CI was 0.934 (0.91-0.96) for PIM2, 0.934 (0.91-0.96) for PIM3, 0.917 (0.88-0.95) for PRISM, and 0.926 (0.88-0.97) for PRISM4 models. The Hosmer-Lemeshow test showed that the difference between observed and predicted mortality by PIM3 (p = 0.003) and PRISM4 (p = 0.008) was statistically significant whereas PIM2 (p = 0.28) and PRISM (p = 0.62) showed good calibration. CONCLUSION: The overall performance of (both discrimination and calibration) PRISM and PIM2 scoring systems in Turkish pediatric patients aged 1 month to 16 years was accurate and had the best fit for risk groups according to our study. Although PIM3 and PRISM4 have good discriminatory power, their calibration was very poor in our study cohort.

A rare complication of pica: Stone aspiration with severe respiratory distress.

Tracheobronchial foreign body aspiration (FBA), a common pediatric presentation to emergency departments, is still a public healthcare problem affecting children all over the world. There are several types of foreign bodies reported from different parts of the world, including both organic or nonorganic substances. Pica, another interesting clinical entity, is characterized by persistent eating of nonnutritive substances, which is inappropriate for the maturation stage of the individual. A 3-year-old pediatric patient was admitted to our emergency department with a 3-day history of coughing and new onset respiratory distress. A chest X-ray was performed and it showed a suspicious radiopaque foreign body in the localization of left bronchi. Urgent rigid bronchoscopy was performed. The foreign body in the left main bronchi was, surprisingly, a 0.5-1 cm diameter, irregularly shaped stone particle. The laboratory evaluations and patient history revealed the diagnosis of severe iron deficiency anemia and accompanying pica. Stone aspiration, as an FBA, is a rare but potentially life-threatening complication of pica. Iron deficiency anemia accompanied by pica should be diagnosed and treated in the early stage of the disease because of their complications. According to our knowledge and literature search, this is the first case of stone aspiration as a complication of severe iron deficiency anemia and pica.

Paediatric community-acquired septic shock: results from the REPEM network study.

UNLABELLED: INTRODUCTION AND PURPOSE OF THE STUDY: With this study we aimed to describe a "true world" picture of severe paediatric 'community-acquired' septic shock and establish the feasibility of a future prospective trial on early goal-directed therapy in children. During a 6-month to 1-year retrospective screening period in 16 emergency departments (ED) in 12 different countries, all children with severe sepsis and signs of decreased perfusion were included. RESULTS: A 270,461 paediatric ED consultations were screened, and 176 cases were identified. Significant comorbidity was present in 35.8 % of these cases. Intensive care admission was deemed necessary in 65.7 %, mechanical ventilation in 25.9 % and vasoactive medications in 42.9 %. The median amount of fluid given in the first 6 h was 30 ml/kg. The overall mortality in this sample was 4.5 %. Only 1.2 % of the survivors showed a substantial decrease in Paediatric Overall Performance Category (POPC). 'Severe' outcome (death or a decrease ≥2 in POPC) was significantly related (p < 0.01) to: any desaturation below 90 %, the amount of fluid given in the first 6 h, the need for and length of mechanical ventilation or vasoactive support, the use of dobutamine and a higher lactate or lower base excess but not to any variables of predisposition, infection or host response (as in the PIRO (Predisposition, Infection, Response, Organ dysfunction) concept). CONCLUSION: The outcome in our sample was very good. Many children received treatment early in their disease course, so avoiding subsequent intensive care. While certain variables predispose children to become septic and shocked, in our sample, only measures of organ dysfunction and concomitant treatment proved to be significantly related with outcome. We argue why future studies should rather be large multinational prospective observational trials and not necessarily randomised controlled trials.

Surfactant therapy in acute respiratory distress syndrome due to hydrocarbon aspiration.

Hydrocarbon aspiration causes acute lung injury, which may lead to acute respiratory distress syndrome. Surfactant has been shown to be beneficial in experimentally-induced hydrocarbon-associated acute respiratory distress syndrome. However, there has not been a clinical study evaluating the effect of surfactant application on hydrocarbon aspiration in humans. We report a 17-month-old boy with acute respiratory distress syndrome due to hydrocarbon aspiration and was successfully treated with surfactant application.

An unusual complication of femoral vein catheterisation: pneumoperitoneum.

A 2-month-old girl with severe pneumonia required a central venous line. Femoral vein catheterisation was attempted but insertion was difficult. Pneumoperitoneum developed, which is a rare complication of femoral vein catheterisation. It is important when undertaking femoral vein catheterisation to use the correct landmarks in the femoral triangle below the inguinal ligament and an appropriate size of catheter.

Hypertonic saline treatment in children with cerebral edema.

OBJECTIVE: To compare the efficacy and side effects of hypertronic saline and mannitol use in cerebral edema. DESIGN: Retrospective study. SETTING: Pediatric intensive care unit. SUBJECTS: 67 patients with cerebral edema. METHODS: Patients with cerebral edema treated with either mannitol or hypertronic saline (HS) (Group II: n = 25), and both mannitol and HS (Group III: n = 20) were evaluated retrospectively. Cerebral edema and increased intracranial pressure were based on the clinical and/or radiological (CT, MR) findings. When treating with both mannitol and HS (Group IIIA), if patients serum osmality was greater than 325 mosmol/L, mannitol was stopped and patients were treated with only HS (Group IIIB). All patients were closely monitored for fever, pulse, blood pressure, central venous pressure (CVP), oxygen saturation, volume of fluid intake and urine output. Mannitol was given at a dose of 0.25-0.5 g/kg while the hypertonic saline was given as 3% saline to maintain the serum-Na within the range of 155-165 mEq/L. RESULTS: There was no statistically significant difference in terms of Glasgow coma scale, age, gender, and etiologic distribution between the groups. And also distribution of the other treatments given for cerebral edema is not significiant. Mannitol was given for a total dose of 9.3 +/-5.0 (2-16) doses in Group I, and 6.5 +/-2.8 (2-10) doses in Group III. Hypertonic saline was infused for 4-25 times in Group II. Although there was no statistically significant difference in the highest serum Na and osmolarity levels of the groups, duration of comatose state and mortality rate were significantly lower in Group II and Group III A B. Patients who received only HS were subdivided according to their serum Na concentrations into 2 groups as those between 150-160 mEqL and those between 160-170 mEqL. The duration of comatose state and mortality was not different in patients with serum-Na of 150-160 mEqL and in patients with 160-170 mEqL in the hypertonic saline receiving patients. Four patients in the group II developed hyperchloremic metabolic acidosis and 2 patients in the group I had hypotension. As two patients in group II had diabetes insipidus and one patient had renal failure in group I, the treatment was terminated. The causes of death were septic shock, ventilator associated pneumonia with acute respiratory distress syndrome, progressive cerebral edema and cerebral edema with pulmonary edema. Multivariate analysis showed that age, gender, cause of cerebral edema, electrolyte imbalance, hyperglycemia and hyper-ventilation had no significant impact on outcome. CONCLUSION: Hypertonic saline seems to be more effective than mannitol in the cerebral edema.

Growth hormone and insulin-like growth factor 1 levels and their relation to survival in children with bacterial sepsis and septic shock.

OBJECTIVES: Despite improved supportive care, the mortality of sepsis and septic shock is still high. Multiple changes in the neuroendocrine systems, at least in part, are responsible for the high morbidity and mortality. A reduced circulating level of insulin-like growth factor and an elevated level of growth hormone are the reported characteristic findings early in the course of sepsis and septic shock in adults. The aim of this study was to evaluate the changes of growth hormone/insulin-like growth factor 1 axis in sepsis and septic shock and investigate the relationship between these hormones and survival. METHODS: Fifty-one children with sepsis (S), 21 children with septic shock (SS) and 30 healthy, age- and sex-matched children (C) were enrolled in this study. Growth hormone, insulin-like growth factor 1 and cortisol levels of the sepsis and septic shock groups were obtained before administration of any inotropic agent. RESULTS: Growth hormone levels were 32.3 +/- 1.5 microIU/mL (range 4-56), 15.9 +/- 0.6 microIU/mL (range 11-28) and 55.7 +/- 2.7 microIU/mL (range 20-70) in S, C and SS groups, respectively. The difference between the growth hormone levels of the S and C groups, S and SS groups, and C and SS groups were significant (P < 0.001). Non-survivors (54.7 +/- 1.6 microIU/mL) had significantly higher growth hormone levels than survivors (29.4 +/- 1.5 microIU/mL) (P < 0.001). Insulin-like growth factor 1 levels were 38.1 +/- 2.1 ng/mL (range 19-100), 122.9 +/- 9.6 ng/mL (range 48-250) and 22.2 +/- 1.9 ng/mL (range 10-46) in the S, C and SS groups, respectively, and the difference between the insulin-like growth factor 1 levels of the S and C, S and SS, and C and SS groups were significant (P < 0.001). Non-survivors (8.8 +/- 1.1 micro g/dL) had significantly lower cortisol levels than survivors (40.9 +/- 2.1 microg/dL) (P < 0.001). We detected a significant difference between the levels of cortisol in non-survivors (19.7 +/- 1.8 microg/dL) and survivors (33.9 +/- 0.9 microg/dL) (P < 0.01). CONCLUSIONS: There were elevated levels of growth hormone with decreased levels of insulin-like growth factor 1 in children during sepsis and septic shock compared to healthy subjects. In addition, there were even higher levels of growth hormone and lower levels of insulin-like growth factor 1 in non-survivors than in survivors. We think that both growth hormone and insulin-like growth factor 1 may have potential prognostic value to serve as a marker in bacterial sepsis and septic shock in children. As there is insufficient data in the paediatric age group, more studies including large numbers of patients and additionally evaluating cytokines and insulin-like growth factor binding proteins are needed.

Correlation of simultaneously obtained capillary, venous, and arterial blood gases of patients in a paediatric intensive care unit.

AIMS: To investigate the correlation of pH, partial pressure of oxygen (PO2), partial pressure of carbon dioxide (PCO2), base excess (BE), and bicarbonate (HCO3) between arterial (ABG), venous (VBG), and capillary (CBG) blood gases. METHODS: Patients admitted to the paediatric intensive care unit (PICU) in Cukurova University between August 2000 and February 2002 were enrolled. RESULTS: A total of 116 simultaneous venous, arterial, and capillary blood samples were obtained from 116 patients (mean age 56.91 months, range 15 days to 160 months). Eight (7%) were neonates. Sixty six (57%) were males. pH, PCO2, BE, and HCO3 were all significantly correlated in ABG, VBG, and CBG. Correlation in PO2 was also significant, but less so. Correlation between pH, PCO2, PO2, BE, and HCO3 was similar in the presence of hypothermia, hyperthermia, and prolonged capillary refilling time. In hypotension, correlation in PO2 between VBG and CBG was similar but disappeared in ABG-VBG and ABG-CBG. CONCLUSIONS: There is a significant correlation in pH, PCO2, PO2, BE, and HCO3 among ABG, VBG, and CBG values, except for a poor correlation in PO2 in the presence of hypotension. Capillary and venous blood gas measurements may be useful alternatives to arterial samples for patients who do not require regular continuous blood pressure recordings and close monitoring of PaO2. We do not recommend CBG and VBG for determining PO2 of ABG.

Schwartz-Jampel syndrome: three pediatric case reports.

Schwartz-Jampel syndrome is a heterogeneous autosomal recessive syndrome defined by myotonia, short stature, bone dysplasia and growth retardation. Three types have been described: type 1A, usually recognized in childhood, with moderate bone dysplasia; type 1B similar to type 1A but recognizable at birth, with more prominent bone dysplasia and type 2, a rare, more severe form with increased mortality in the neonatal period. In this paper we report three pediatric cases, one with neonatal manifestation.

Amitraz poisoning, an emerging problem: epidemiology, clinical features, management, and preventive strategies.

BACKGROUND: Amitraz is a pharmaceutical, veterinary, and agricultural product which is used worldwide under numerous generic names as an acaricide and insecticide. Because of its widespread use amitraz poisoning has come emerged as a cause of childhood poisoning during the past decade, particularly more in certain countries such as Turkey. AIMS AND METHODS: To report the clinical features, the management, and the preventive strategies of amitraz poisoning in nine children, and review the previously reported 137 cases in humans. RESULTS: Five male and four female children aged 10 months to 8 years were admitted to our department. The estimated ingested dose ranged between 89.2 and 163 mg/kg and estimated time from ingestion to presentation was 30-120 minutes. The initial signs and symptoms were impaired consciousness, drowsiness, vomiting, disorientation, miosis, mydriasis, hypotension, bradycardia, tachypnoea, hypothermia, and generalised seizures. Hyperglycaemia, glycosuria, and minimal increase in transaminase levels were observed. None required mechanical ventilation. CNS depression resolved spontaneously within 4-28 hours in all. The length of hospital stay was two to three days; all had a good outcome. CONCLUSION: This review details preventive measures and management strategies of amitraz poisoning, including the importance of following patients closely in the intensive care unit, monitoring their respiratory, cardiovascular, and central nervous systems since they may occasionally experience serious cardiopulmonary side effects.

Evaluation of renal functions in children with congenital heart disease before and after cardiac angiography.

Radiocontrast nephrotoxicity, which has increased in incidence with widespread use of radiological methods in medicine, is a serious complication of radiocontrast materials. In this study, we have prospectively investigated whether children with cyanotic congenital heart disease are at risk for radiocontrast nephrotoxicity with the use of a nonionic low osmolar contrast agent. Thirty-five children (17 cyanotic and 18 acyanotic patients) who underwent diagnostic cardiac catheterization were subjects of the study. The age range was from five days to 13 years. The volume of contrast material was 3.11 +/- 1.37 ml/kg in cyanotic patients and 2.67 +/- 0.86 ml/kg in acyanotic patients. Blood samples and timed urine samples were taken from all patients 24 hours before and 48 hours after cardiac catheterization. Blood urea nitrogen, creatinine, sodium, and phosphorus in serum, and creatinine and N-acetyl-beta-D-glucosamine in urine were analyzed. There was not a statistically significant difference between the values before and after angiography. As a result, we could find no evidence of radiocontrast nephrotoxicity with the use of a nonionic contrast agent in cyanotic and acyanotic patients who underwent cardiac angiography.