Comparison of Bilateral Cerebro-Renal Tissue Oxygenations in Healthy Children.

OBJECTIVE: To investigate right and left cerebral tissue (ctSO2) and renal tissue oxygenations (rtSO2) in otherwise healthy children. METHODS: In this observational cross-sectional study, one hundred children seen as outpatients for well child care or common non-critical complaints, were included. Bilateral ctSO2 and rtSO2 were recorded simultaneously with INVOS™ 5100 device. RESULTS: The median age was 6.7 y (IQR 3-10.4) and median weight was 21 kg (IQR 13-33). Right and left sided ctSO2 and rtSO2 values were 78.7% ± 6.0% and 79.1% ± 5.7%; 81.5% ± 9.4% and 81.4% ± 9.5% respectively. There were no differences in right and left cerebral and renal near infrared spectroscopy (NIRS) values, and no age centered lateralization effect. Renal measurements were higher than cerebral counterparts in 63% of the children. Interaction between age and regional oxygenation was significant. For both sides, renal oxygenation was higher than that of cerebrum in older children, whereas the opposite held true with younger age. CONCLUSIONS: There are no right and left side differences in ctSO2 and rtSO2 values in otherwise healthy children. On the other hand, there seem to be differences between cerebral and renal regions with a significant age effect. Acknowledging its limitations, this study sheds light on laterality and cranial and renal NIRS measurements in otherwise healthy children, and may contribute to the interpretation of NIRS data in critically ill patients.

Veno-venous extracorporal membrane oxygenation in a deeply hypoxemic infant with persistent air leakages: The first successful pediatric veno-venous extracorporeal membrane oxygenation case report in Turkey.

In severe respiratory failure, extracorporal membrane oxygenation support is life-saving, but it has been started to be used in pediatric intensive care units in our country very recently. Here, we present a five-month old girl who developed acute respiratory distress and air leakages following removal of a foreign body obstructing the airway. Mechanical ventilation only increased the air leaks and - despite drainage-resulted in hypoxemia, acidosis and finally cardiopulmonary arrest. Initiation of veno-venous (VV) ECMO improved oxygenation as well as hemodynamics. The patient was weaned off extracorporal membrane oxygenation support on the 7th day with improvement in the lung parenchyma and ceasing of the air leakages; she was discharged on the 27(th) day of her hospitalization without any neurologicalsequela. As far as we know, this patient is the first pediatric patient who was discharged with success after application of venovenous-extracorporal membrane oxygenation with a respiratory indication in a pediatric intensive care unit in our country. We think that similar patients who need extracorporal membrane oxygenation can be cured with close collaboration of specialists of cardiovascular surgery and pediatric intensive care, dedicated nurses and perfusionist support when necessary.

Topsy-turvy heart: a very rare congenital rotational heart disease with tracheobronchial anomalies.

The topsy-turvy heart is characterized by a global 90°clockwise rotation around the heart's long axis. This rotation displaces all basal great arteries inferiorly and posteriorly, resulting in elongation and stretching of the brachiocephalic arteries and the bronchi. To date, reports of only four living cases have been published in the literature. We report here three new cases, with additional aortopulmonary window defects, and present their morphological details, clinical presentations, and our management.