Atypical foreign body aspiration in a pediatric palliative care patient: case report

The foreign body aspiration into the respiratory system is an emergency situation with a high mortality rate, when diagnosis and treatment are delayed which can cause complications and repeated hospitalizations. Although it is especially common in children under the age of five, it can be seen at any age in chronically ill children with neurological problems. However, it is rarely seen in pediatric patients with tracheostomy and dependent on a home mechanical ventilator due to their nutritional style and severe neurological retardation. In this study, foreign body aspiration that developed in a pediatric patient with tracheostomy who was followed up with a home mechanical ventilator and fed from gastrostomy was presented

Çocuk Yoğun Bakım Hastalarında Kullanılan Tıbbi Malzemelerin İdrar Bisfenol A Düzeylerine Etkisi

The exposure of pediatric intensive care patients to Bisphenol A may be different in acute sick children who were healthy beforehand, and chronically sick children, due to the use of multiple and various medical materials. This research aims to evaluate urinary total BPA (tBPA) levels and association with medical devices used on patients in pediatric intensive care units. This cross-sectional descriptive study included 117 critically ill children who were hospitalized in our pediatric intensive care unit. At least two or three urine samples (on the first day of intensive care, seven days later, and 30 days later or at discharge) were obtained from the patients. A patient form was created for each participant and all of the materials used (peripheral or central infusion catheters, infusion bags, total parenteral nutrition, nasogastric tube, intubation tube, tracheostomy cannula, chest tube, extraventricular drainage set, ventriculoperitoneal shunt, ventilation equipment, masks, nasal cannula) and procedures such as hemodialysis, plasma exchange, continuous venovenous hemodiafiltration, inhalation therapy, blood products transfusion were recorded in these forms. Urinary tBPA levels were determined using high-performance liquid chromatography. General estimating equations with repeated measures analyzed the effect of interventions and devices on urinary BPA levels. A total of 292 urine samples taken from 117 child intensive care patients were studied. When age, sex, and BMI for age z-scores were controlled, cases having endotracheal intubation showed significantly higher meanstandart error (SE) tBPA levels (162.8±28.0 g/g-creatinine) in comparison with no endotracheal intubation (61.8±14.6 g/g-creatinine) (p=0.003). Mean±SE tBPA levels (38.8±12.9 g/g-creatinine) of patients with permanent NG were significantly lower than those without (123.4 ±18.5 g/g-creatinine) (p<0.05). MeanSE urinary tBPA levels of the patients having hemodialysis were 225.8±113.2 g/g-creatinine, and it was 335.1±72.7 g/g-creatinine for those who had hemodialysis but finished it. These values were higher than the mean tBPA levels of patients who did not have hemodialysis (110.8±17.1 g/g-creatinine) (p=0.004). The mean tBPA level (44.3 ± 13.0 g/g-creatinine) of the patients with external drain (extraventricular drainage set, chest tube, surgical drain) was significantly lower than the mean tBPA levels of the patients without an external drain (134.5 ± 20.7 μg / g-creatinine) (p <0.001). The patients using both multiple iv treatment and more than four medical devices showed higher urinary tBPA levels than their counterparts (p=0.007 and p=0.028, respectively). The use of certain medical devices and interventions could increase BPA exposure in pediatric intensive care patients.Çocuk yoğun bakım ünitelerinde, öncesinde sağlıklı olan akut hasta çocukların ve kronik olarak hasta olan çocukların, çoklu ve çeşitli tıbbi materyallerin kullanımı nedeniyle Bisfenol A'ya maruz kalması farklı olabilir. Bu araştırma, pediatrik yoğun bakım ünitesinde yatan hastalarımızda idrar toplam bisfenol A (tBPA) düzeylerini ve kullanılan tıbbi cihazlarla ilişkisini değerlendirmeyi amaçlamaktadır. Kesitsel tipteki bu çalışmaya, pediatrik yoğun bakım ünitemizde yatan 117 çocuk hasta dahil edildi. Hastalardan en az iki veya üç idrar örneği (yoğun bakımın ilk gününde, yedi gün sonra ve 30 gün sonra (veya taburculuk sırasında) alındı. Her katılımcı için bir hasta formu oluşturuldu ve hemodiyaliz, plazma exchange, sürekli venö-venöz hemodiafiltrasyon, inhalasyon tedavisi, kan ürünleri transfüzyonu gibi uygulanan işlemlerle birlikte kullanılan materyallerin tümü (periferik veya santral infüzyon kateterleri, infüzyon torbaları, total parenteral nutrisyon, nazogastrik sonda, entubasyon tüpü, trakeostomi kanülü, göğüs tüpü, extraventriküler direnaj seti, ventriküloperitoneal şant, ventilasyon ekipmanları, maskeler, nasal kanül gibi) bu formlara kaydedildi. İdrar tBPA düzeyleri yüksek performanslı sıvı kromatografisi kullanılarak belirlendi. Toplam 117 çocuk yoğun bakım hastasından alınan 292 idrar örneği incelendi. Temasın akut ya da kronik olmasının tBPA düzeyini etkilemediği görüldü. Yaş, cinsiyet ve yaşa göre beden kitle indeksi Z skorları kontrol altına alındığında, endotrakeal entübasyonu olan hastalarda tBPA ortalamastandart hata (SH) düzeyi 162,8±28,0 g/g-kreatinin ile, endotrakeal entubasyon hiç yapılmamış olan (61,8±14,6 g/g-kreatinin) hastalara göre anlamlı olarak yüksekti (p=0,003). Kalıcı NG’si olan hastaların ortalama±SH tBPA düzeyleri (38,8±12,9 g/g-kreatinin), olmayanlara göre (123,4±18,5 g/g-kreatinin) anlamlı derecede düşüktü (p<0,05). İdrar tBPA ortalamaSH düzeyi, hemodiyaliz yapılmış olan hastaların 225,8±113,2 g/g-kreatinin, hemodiyaliz yapılmış ve bitmiş olan hastaların ise 335,1±72,7 g/g-kreatinin idi. Bu iki değer hemodiyaliz yapılmamış olanların ortalama tBPA düzeyi (110,8±17,1 g/g-kreatinin)’nden belirgin olarak yüksekti (p=0.004). Dış diren olarak adlandırdığımız (ekstraventriküler direnaj seti, göğüs tüpü, cerrahi dren) direnlerden herhangi birinin olması durumunda tBPA ortalamaSH düzeyi (44.3±13.0 g/g-kreatinin), dış dreni olmayan hastaların (134.5±20.7 g/g-kreatinin), ortalama tBPA düzeylerinden belirgin düşüktü (p<0,001). Çoklu iv tedavi alan ve dörtten fazla tıbbi cihaz kullanan vakalarda, kullanmayanlara göre daha yüksek idrar tBPA düzeyleri görüldü (sırasıyla p=0.007 ve p=0.028). Sonuç olarak bazı tıbbi cihazların ve müdahalelerin kullanımı, pediatrik yoğun bakım hastalarında BPA temasını artırabilir

Brain Death And Organ Donation In Paediatric Intensive Care Unit

Objective The purpose of the present study was to retrospectively analyse the brain death (BD) cases that were specified within the last 8 years in the paediatric intensive care unit of our hospital. Methods Archive files and computer records of 23 paediatric cases were analysed. Data on age, gender, conditions that caused BD, paediatric risk of mortality (PRISM III) scores, time between suspicion of BD and issuing of BD report, confirmatory tests used, complications that occurred following the diagnosis of BD and time to cardiac arrest development after diagnosis of BD were recorded. Results The average age of the patients was 6.8±5.5 years. The most frequent cause of BD was intracranial haemorrhage (30.4%). The mean time to diagnosis after BD suspicion was 5.9±6.2 days. Electroencephalography was performed in 61% of the patients in addition to the apnoea test. Radiological imaging methods were used in 39% of the patients (n=9). Of the cases, 34.7% developed hypothermia, and 4.3% developed diabetes insipidus (DI). Among them, 43.4% had both DI and hypothermia. The mean PRISM score was calculated as 22±9.2. The donation rate of the families was 17%. The mean time to cardiac arrest development after diagnosis of BD was 6.9±7.4 days in non-donor cases where medical support had been reduced. Conclusion Any patient with a neurologically poor prognosis in the intensive care unit should be considered to develop BD and diagnosed with BD without delay. The donation rate will increase if family interviews are done by an experienced and educated coordinator.PubMedWoSScopu

Which factors accompany maternal acceptance-rejection in children with specific learning disabilities?

Abstract Background Children with specific learning disabilities (SLDs) and their parents experience many problems that may influence their interactions. The study aimed to evaluate the maternal acceptance/rejection status of children with SLDs and their associations with sociodemographic characteristics, and problem behaviors. Methods The Parental Acceptance-Rejection/Control Questionnaire (PARQ/C) and Strengths and Difficulties Questionnaire (SDQ) were applied to the mothers with children aged 7–17 years with a diagnosis of SLD. Results Among 266 children enrolled, the mean age was 10.2 years, and 61.7% were male, the mean score was 30.4 for warmth/affection, 25.8 for hostility/aggression, 22.9 for indifference/neglect, 16.3 for undifferentiated rejection, 95.4 for the total PARQ, and 40.8 for the control scales. Generalized linear models revealed that maternal depression, poor family income, parental smoking, and presence of dysgraphia, and poor total difficulties and prosocial scores of SDQ subscales were associated with the maternal acceptance-rejection. There was an interaction between the maternal control subscale and the school success of the child. Conclusion Mothers of children with SLDs had high maternal rejection scores which were associated with unfavorable characteristics of child and family. Early detection and giving appropriate support of these cases could improve the mother’s relationship with her SLD child

Seizures in a Pediatric Intensive Care Unit: A Prospective Study

Background: The aim of the research is to determine the etiology and clinical features of seizures in critically ill children admitted to a pediatric intensive care unit (PICU). Methods: A total of 203 children were admitted from June 2013 to November 2013; 45 patients were eligible. Age ranged from 2 months to 19 years. Seizures were organized as epileptic or acute symptomatic. Pediatric risk of mortality score III, Glasgow coma scale, risk factors, coexistent diagnosis, medications administered before admission, type and duration of seizures, drugs used, requirement and duration of mechanical ventilation, length of stay and neuroimaging findings were collected as demographic data prospectively. Results: The male-female ratio was 0.8. Mean age was 5.4. The most common causes of seizures were acute symptomatic. Most frequent coexistent diagnosis was infectious diseases, and 53.3% had recurrent seizures. Medications were administered to 51.1% of the patients before admission. Seizures were focal in 21 (46.7%), generalized in 11 (24.4%) and 13 (28.9%) had status epilepticus. Intravenous midazolam was first-line therapy in 48.9%. Acute symptomatic seizures were usually new-onset, and duration was shorter. Epileptic seizures tended to be recurrent and were likely to progress to status epilepticus. However, type of seizures did not change severity of the disease. Also, laboratory test results, medications administered before admission, requirement and duration of ventilation, mortality and length of stay were not significant between epileptic/acute symptomatic patients. Conclusion: Seizures in critically ill children, which may evolve into status epilepticus, is an important condition that requires attention regardless of cause. Intensified educational programs for PICU physicians and international guidelines are necessary for a more efficient approach to children with seizures.WoSScopu

Effects of Hemodialysis on Thiol-Disulphide Homeostasis in Critically Ill Pediatric Patients with Acute Kidney Injury

Aim. To evaluate thiol/disulphide homeostasis as a new indicator of oxidative stress in AKI patients and to determine the effect of HD on antioxidant balance and oxidative stress through plasma thiols. Methods. This study was performed in patients aged between 12 months and 18 years prospectively who underwent hemodialysis due to AKI and were followed up for a year in a 22-bed tertiary pediatric intensive care unit. 20 patients and 39 controls were included. Results. No difference was present between the groups in terms of age and gender. Median values of plasma native thiol, total thiol, and percent thiol were significantly lower in AKI group both before and after dialysis when compared to control group. The median dynamic disulphide values were significantly lower in the AKI group of predialysis compared to the controls. When pre- and postdialysis values were compared, disulphide values were statistically higher after dialysis. When pre- and postdialysis native thiol, dynamic disulphide, total thiol, and percent thiol median values were compared, postdialysis values were significantly higher than the predialysis values. There was a positive correlation between albumin, total thiol, and native thiol values before dialysis in the patient group. Conclusion. AKI patients have low levels of thiol species showing the presence of oxidative stress and hemodialysis has a positive effect on thiol/disulphide balance. This new method may be an inexpensive and simple tool suitable for clinical studies and can be used in routine screening as a useful indicator to show oxidative stress

Factors Affecting Development Of Pneumothorax In Critically Ill Children: A 3-Year Study

Background: To determine the factors affecting the development of pneumothorax in critically ill children admitted to pediatric intensive care unit (PICU). Methods: This was a single-centered retrospective case control study comparing the clinical features of mechanically ventilated patients, who developed pneumothorax with matched control cases. Results: The study screened 2850 patients admitted to the PICU over a 3 year period. Among 1140 patients who were mechanically ventilated, 4.4% (n = 50) developed pneumothorax. Median age was 24 months. Patients with pneumothorax were found to have median pediatric risk of mortality (PRISM):26, Pediatric logistic organ dysfunction (PELOD):22 and multiorgan disfuction (MODS):3 whereas in the control group they were 15.5, 12, and 3, respectively. PRISM and PELOD were significantly higher in pneumothorax group. Pneumothorax was observed on the 11.6th day of mechanical ventilation (MV). Pneumothoraxwas mainly secondary to pneumonia (n=18, 36%) and MV-related reasons (n=13, 26%). The risk of pneumothorax was higher when P-mean was > 14 cmH(2)P and tidal volume (TV) was > 10 mL/kg (P < 0.05). The mean albumin level was 2.7 g/dL in the pneumothorax group compared with 3.6 g/dL in the control group (P < 0.001). The number of days on mechanical ventilator and the duration of hospital stay were statistically significant in pneumothorax group (P < 0.05). The mortality outcome was 44% (n=22) in the pneumothorax group compared with 6.7% (n = 2) in the control group (P < 0.001). Conclusions: Pneumothorax in critically ill children was related to increased morbidity, mortality and prolonged length of stay in hospital. Higher pediatric risk of mortality (PRISM) and Pediatric logistic organ dysfunction (PELOD) scores were associated with increased risk of pneumothorax. Hypoalbuminemia as a reflection of malnutrition status of patients might be a risk factor.WoSScopu

Clinical Impact And Efficacy Of Bedside Echocardiography On Patient Management In Pediatric Intensive Care Units (Picus): A Prospective Study

Objective: To determine the indication and necessity of echocardiographic assessment and therapeutic interventions in critically ill children. Methods: A total of 140 children, including 75 mechanically ventilated (MV) and 65 spontaneously breathing (SB) children, who were admitted consecutively from March to August 2013 were evaluated prospectively. Data regarding the indication for echocardiography and therapeutic approaches used were documented. For evaluating disease severity, the Pediatric Risk of Mortality Score III (PRISM) was ascertained. The correlation between PRISM score and the requirement of echocardiographic evaluations were analyzed. Results: Patients ages were between 45 days to 18 years. The male-to-female ratio was 1.33. In 35.4% patients who underwent echocardiographic evaluation, no definitive alteration occurred in treatment approach, whereas in the remaining 64.6% patients, decisive or supplemental information was gathered. Echocardiography was indicated in 88% MV children and 46.2% SB children. Echocardiographic evaluation was necessary in MV children and there was a positive correlation between the PRISM score and the requirement of echocardiographic assessment (p<0.001). Conclusion: Echocardiographic evaluation is an invaluable tool especially in MV children and the requirement of echocardiographic assessment increases according to clinical severity. Basic training for intensivists in this procedure is crucial and needs to be improved and supported in critically ill.PubMedWoSScopu

Stress induced gastrointestinal bleeding in a pediatric intensive care unit: which risk factors should necessitate prophilaxis?

Sahin, Sanliay/0000-0001-8418-1889WOS: 000384945400004PubMed: 25263241BACKGROUND: The aim of this study was to determine the frequency and the risk factors of stress induced gastrointestinal bleeding (GIB) in critically ill children, and to investigate the effect of prophilaxis. The setting was a 14-beded, tertiary care PICU. METHODS: Records of 182 children admitted consecutively from December 2012 to May 2013 were retrospectively reviewed. 136 patients were eligible. The age ranged from 40 days to 18 years. Diagnosis, demographic data, risk factors, administration of prophilaxis, drugs used in medication, prescence and degree of GIB and complications were recorded. RESULTS: The male-female ratio was 1.3. Mean age was 5.9. Mean PRISM III score was 12.2 and 49.3% had PRISM Score >= 10. Most frequent diagnosis was infectious diseases. Sixtyone (44.9%) children received prophylaxis in which antacids was used in 28 (45.9%), sucralfate in 18 (29.5%), proton pomp inhibitors (PPIs) in 51 (83.6%) and 5 (8.2%) received H2 reseptor antagonist. The incidence of GIB was 15.4% (N.=21), in which 66.7% (N.=14) were mild, 23.8% (N.=5) were moderate, 4.8% (N.=1) was significant and 4.8% (N.=1) was massive. In children who received prophylaxis 17 (27.9%) cases developed GIB. Mechanical ventilation was found to be the only risk factor significantly associated with stress induced GIB. Also; mechanical ventilation and trauma was strongly significant (P= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia was found to be associated with the development of GIB in critically ill children (P= 10, renal and hepatic failure, hypotension, and heart failure/arrhythmia must be kept in mind as risk factors requiring attention in PICU setting