Severe head trauma in children: Analysis of 68 cases in light of current guidelines

Aim: To assess the characteristics of severe head trauma in the pediatric age group and to analyze its results under the currentguideline.Material and Methods: Eighty pediatric patients (<18 years) admitted to our hospital with the diagnosis of severe head trauma andtreated by neurosurgery and the pediatric intensive care unit (ICU) between 2014 and 2018 were analyzed retrospectively. Of these,68 patients who met the study criteria were selected. Besides the demographic data of the patients, the presenting neurologic, clinic,radiologic and laboratory findings were recorded. Then the association between these variables and 1-year Glasgow Outcome Scale(GOS) scores was analyzed.Results: There is a correlation between the presenting GCS scores and 1-year GOS scores of the patients when grouped as favorable(4-5) and unfavorable (1-3). Regarding the other admission findings, the patients with hypothermia, the patients with hyperglycemia,the patients to whom CPR was applied, the patients with pupillary areflexia, the patients with hypoxia and the patients with neurologicaldeterioration have lower 1-year GOS scores. There was no difference between the gender, age, type of injury, type of trauma (isolatedhead trauma or multiple trauma), presence of shock on admission, having hematoma surgery, having decompressive craniectomy,treatment with ICP monitoring and 1-year GOS scores. The overall mortality rate was 29.4% (20 patients), and the rate of poorprognosis (GOS 1-3) was 48.5% (33 patients).Conclusion: Children with severe head trauma should be treated at centers that are experienced in the field per updated guidelines.Since the morbidity and mortality rates of severe head trauma are still high, efforts toward improving preventive measures shouldalso be considered

Hyponatremia in a child with tuberculous meningitis in PICU: Cerebral salt wasting syndrome

Cerebral salt wasting syndrome (CSW) has been reported in cases with subarachnoid haemorrhage, infections, head injury, brain tumours, trans-sphenoidal pituitary surgery, and neurosurgery. It is characterized by extracellular fluid depletion and hyponatraemia caused by progressive natriuresis with concomitant diuresis.The relationship between tuberculous menengitis and CSW in children has been desciribed rarely. We describe a case of CSW in an eight years old child with tuberculous meningitis in Pediatric Intensive Care Unit (PICU) whose main biochemical findings were low serum sodium, excessive urine sodium loss and clinical evidence of a contracted extracellular fluid volume.It is essential that in any child with hyponatremia and meningitis in PICU, an evaluation to be undertaken to differentiate between syndrome of inappropriate antidiuretic hormone secretion (SIADH) and CSW. A wrong diagnosis might lead to inappropriate fluid restriction and worsen the hypovolemia in children with CSW. Supplements of sodium chloride and mineralocorticoids may be useful in managing children with CSW. PICU professionals must be aware of the clinical and laboratory features that distinguish CSW from SIADH

Depression Status in Children’s Parents During Hospitalization in the Pediatric Intensive Care Unit

Aim: The purpose of this research was to determine depression levels in parents of children hospitalized in the intensive care unit and to identify any variation between maternal and paternal depression levels. Method: The study was performed with 25 mothers and fathers of patients hospitalized between February and April 2015 in the Gaziantep University Faculty of Medicine Hospital, Pediatric Intensive Care Unit. The Beck Depression Inventory was used to evaluate the parents’ depression levels. Results: The mothers and fathers of 25 patients were included in the study. The mean age of the patients was 61.2 ± 53.8 months (range, 3-172 months). Nineteen (76%) of patients had poor socioeconomic status, 4 (16%) had average socioeconomic status, and 2 (8%) had good status. The mean Beck Depression Inventory score was 17.9 ± 11.1 among mothers and 17.1±9.95 among fathers. No correlation was determined between socioeconomic status and maternal or paternal depression level (p= 0.64 and p= 0.77, respectively). Similarly, there was no correlation between education level and maternal or paternal levels of depression (p= 0.37 and p= 0.77). Conclusion: Depression levels in both mothers and fathers of children hospitalized in the pediatric intensive care unit are significantly higher than those of the normal population. This study might now be repeated with wider patient groups. This study reveals the need for mothers and fathers of patients to be given psychological counseling and psychiatric support