The use of N-terminal (1-76) pro-brain natriuretic peptide in the aetiology of severe respiratory distress in the paediatric emergency department.

INTRODUCTION: Acute respiratory distress is one of the most common reasons for paediatric emergency visits. Paediatric patients require rapid diagnosis and treatment. Our aim in this study was to use N-terminal (1-76) pro-brain natriuretic peptide to differentiate respiratory distress of cardiac and pulmonary origin in children. Our aim was to investigate the role of N-terminal (1-76) pro-brain natriuretic peptide in the detection of patients with new-onset heart failure in the absence of an underlying congenital heart anomaly. METHODS: All children aged 0-18 years who presented to the paediatric emergency department due to severe respiratory distress were included in the study prospectively. The patients' demographic characteristics, presenting complaints, clinical findings, and N-terminal (1-76) pro-brain natriuretic peptide concentrations, were investigated. In patients with severe Pediatric Respiratory Severity Score, congestive heart failure score was calculated using the modified Ross Score. RESULTS: This study included 47 children between the ages of 1 month and 14 years. The median N-terminal (1-76) pro-brain natriuretic peptide concentration was 5717 (IQR:16158) pg/mL in the 25 patients with severe respiratory distress due to heart failure and in the 22 patients with severe respiratory distress due to lung pathology was 437 (IQR:874) pg/mL (p < 0.001). In the 25 patients with severe respiratory distress due to heart failure, 8281 (IQR:8372) pg/mL in the 16 patients with underlying congenital heart anomalies, and 1983 (IQR:2150) pg/mL in the 9 patients without a congenital heart anomaly (p < 0.001). The 45 patients in the control group had a median N-terminal (1-76) pro-brain natriuretic peptide concentration of 47.2 (IQR:56.2) pg/mL. CONCLUSION: Using scoring systems in combination with N-terminal (1-76) pro-brain natriuretic peptide cut-off values can help direct and manage treatment.

Sepsis associated acute kidney injury in pediatric intensive care unit.

BACKGROUND: We aimed to compare the acute kidney injury (AKI) incidence in pediatric septic shock patients according to the three different classifications. METHODS: We analyzed retrospectively 52 patients with severe sepsis between January 2019 and December 2019. RESULTS: While 21 patients have been diagnosed with SA-AKI according to the pRIFLE criteria, 20 children have been diagnosed according to the AKIN criteria, and 21 children have been diagnosed according to the KDIGO criteria. Older age, lower platelet count were determined as independently risk factor for SA-AKI. Older age and higher PRISM score were associated with mortality. According to Canonical correlation coefficients, pRIFLE is the most successful classification to distinguish AKI state. The canonical correlation coefficients for pRIFLE, KDIGO, and AKIN were 0.817, 0.648, and 0.615, respectively. CONCLUSION: Although AKI incidence was similar between the three classifications, pRIFLE was the most successful classification to distinguish AKI state.

A Prospective Investigation of Factors Influencing Neonatal Visits to a Tertiary Emergency Department.

OBJECTIVE: Although emergency complaints in newborns are very rare and benign, pediatric emergency department (ED) admissions in Turkey are increasing due to early postpartum discharge and insufficient prenatal care. We aimed to analyze the factors affecting neonatal admissions to ED and to evaluate progress and outcomes following discharge, and hospitalization rates. MATERIALS AND METHODS: All neonates aged 28 days or less admitted to the pediatric ED were included prospectively. Demographics, perinatal-maternal features, and social factors were recorded. Complaints, clinical findings and diagnoses, hospitalization referral rates, and readmission frequencies were analyzed. RESULTS: A total of 2109 neonates were enrolled; the median age was 6 days and 55.7% were males. More than half the newborns (67.5%) visited the ED out of hours, and 99% were non-referral. The frequency of multiparity and cesarean delivery were 48.9% and 57.4%, respectively. The most common complaints were jaundice (66.3%), irritability (9.3%), vomiting (3.4%), and fever (2.6%). While the hospitalization rate was 13%, 12.8% had a serious illness (sepsis, pneumonia, bronchiolitis, etc.). Serious diseases and hospitalization rates were higher among neonates with low birth weight and prematurity (P < .005, P < .001). Mothers who were primiparous and had their pregnancy at a younger age (<21 years) used EDs frequently for non-serious conditions (P < .05, P < .05, respectively). Early postpartum discharge, admission out of hours, age ≤ 7 days, residence in proximity to the hospital, and primiparity were significantly associated with readmission to the ED within 24 hours (P = .001, P < .001, P < .001, P = .014 and P < .001, respectively). CONCLUSION: The admission of neonates to family care physicians and sufficient prenatal and postpartum care will prevent unnecessary referrals to ED and increase the physicians' quality of care for serious diseases in neonates.