2013-2014 Yılları Arasında Parenteral Nütrisyon Uygulanan Hastaların İzlemi

ABSTRACT Ozturk, Z., Follow up of the patients who received parenteral nutrition between the years 2013-2014. Hacettepe University Faculty of Medicine, Thesis in Pediatrics. Ankara, 2015. Parenteral nutrition (PN) may be defined as to maintain the nutrition support intravenously in case oral or enteral nutrition is not sufficient. Although it is an efficient and safe treatment method, it has many metabolic complications depending on the content of PN mixture and many complications associated with venous access. In this study, the data of 178 patients who received 230 episodes of PN was investigated in terms of PN indications, content of PN mixture, PN duration and the body weight changes, complications, management and outcomes of the complications. This study revealed that PN was given to the patients most commonly with the diagnoses of hematological malignancies, surgical diseases of gastrointestinal system and to the patients who were undergone hematopoietic stem cell transplantation. It was found that body weight increased in about one third of the patients, the patients who gained weight received more energy than the ones who lost weight and most of targeted energy could be given via central venous catheters (CVCs) than peripheral venous accesses. Hypokalemia (40,4%), hypophosphatemia (39,8%), hypomagnesemia (40,9%), hypertriglyceridemia (35,6%), elevated liver enzymes (55,2%), CVC related thrombosis (4,1%), microbial growth in blood culture obtained from CVC (31,3%) were the striking complications. Most of the electrolyte and mineral imbalances were seen in the first three days. 56% of ursodeoxycolic acid-treated group of the patients with elevated liver enzymes, recovered with treatment without any adverse reaction. In conclusion, PN was given to the children effectively and safely, the efficiency could be increased with CVCs. Key words: childhood, follow up, complication, parenteral nutritionÖZET Öztürk, Z., 2013-2014 yılları arasında parenteral nütrisyon uygulanan hastaların izlemi. Hacettepe Üniversitesi Tıp Fakültesi, Çocuk Sağlığı ve Hastalıkları Tezi. Ankara, 2015. Parenteral nütrisyon (PN), oral ya da enteral yoldan yeterli beslenmenin mümkün olmadığı durumlarda besin desteğinin damar yolu ile sağlanması olarak tanımlanabilir. Etkin ve güvenli bir tedavi yöntemi olsa da PN karışımının içeriğine bağlı metabolik ve damar yolu ilişkili birçok komplikasyonu mevcuttur. Bu çalışmada PN’nin sık kullanıldığı bir merkez olan Hacettepe Üniversitesi İhsan Doğramacı Çocuk Hastanesinde 2013-2014 yılları arasında toplam 203 kez PN uygulanan 178 hastanın dosyası incelenerek PN endikasyonları, PN karışımının içeriği, uygulanan süre ve bu süre boyunca hastaların vücut ağırlığındaki değişiklik, gelişen komplikasyonlar, komplikasyonların nasıl yönetildiği ve sonuçları değerlendirilmiştir. PN’nin en fazla hematolojik malignite, gastrointestinal sistemi ilgilendiren cerrahi hastalıklar ile hematopoietik kök hücre nakli yapılmış olan hastalara verildiği görülmüştür. Hastaların üçte birinin PN ile vücut ağırlığının arttığı, vücut ağırlığı artanlara, azalanlara göre daha fazla enerji verildiği ve hedeflenen enerjinin SVK’lar aracılığıyla periferik damar yollarına göre daha fazla verilebildiği saptanmıştır. Hipokalemi (%40), hipofosfatemi (%39,8), hipomagnezemi (%40,9), hipertrigliseridemi (%35,6), karaciğer testlerinde bozulma (%55,2), santral venöz kateter (SVK) ilişkili tromboz (%4,1), SVK’dan alınan kan kültürlerinde mikroorganizma üremesi (%31,3) en fazla dikkat çeken komplikasyonlar olmuştur. Elektrolit ve mineral bozuklukları en sık ilk üç gün içerisinde ortaya çıkmıştır. Karaciğer testlerinde bozulma olanlardan ursodeoksikolik asit verilenlerin %56’sında tedavi ile iyileşme sağlanmıştır, yan etki görülmemiştir. Sonuç olarak, PN çocuklarda etkin ve güvenli kullanılabilmiş, SVK’lar ile etkinlik artırılabilmiştir. Anahtar Kelimeler: çocukluk çağı, izlem, komplikasyon, parenteral nütrisyo

Mortality Risk Factors among Critically Ill Children with Acute COVID-19 in PICUs: A Multicenter Study from Turkish Pediatric Critical COVID-19 and MIS-C Study Group

© 2022 Lippincott Williams and Wilkins. All rights reserved.Background: During the coronavirus disease 2019 (COVID-19) pandemic, the world has a large number of reported COVID-19 cases and deaths. Information on characteristics and mortality rate of pediatric intensive care unit (PICU) cases with COVID-19 remains limited. This study aims to identify the risk factors for mortality related to COVID-19 in children admitted to PICU. Methods: A retrospective multicenter cohort study was conducted between March 2020 and April 2021 at 44 PICUs in Turkey. Children who were 1 month-18-year of age with confirmed COVID-19 admitted to PICU were included in the study. Children with multisystem inflammatory syndrome and asymptomatic for COVID-19 were excluded. Results: Of 335 patients with COVID-19, the median age was 6.8 years (IQR: 1.2-14) and 180 (53.7 %) were male, 215 (64.2 %) had at least one comorbidity. Age and gender were not related to mortality. Among 335 patients, 166 (49.5%) received mechanical ventilation, 17 (5.1%) received renal replacement therapy and 44 (13.1 %) died. Children with medical complexity, congenital heart disease, immunosuppression and malignancy had significantly higher mortality. On multivariable logistic regression analysis, organ failure index [odds ratio (OR): 2.1, 95 confidence interval (CI): 1.55-2.85], and having congenital heart disease (OR: 2.65, 95 CI: 1.03-6.80), were associated with mortality. Conclusions: This study presents detailed data on clinical characteristics and outcomes of patients with COVID-19 admitted to PICU in the first pandemic year in Turkey. Our study shows that having congenital heart disease is associated with mortality. In addition, the high organ failure score in follow-up predict mortality