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

Evaluation of nutritional status in pediatric intensive care unit patients: the results of a multicenter, prospective study in Turkey

IntroductionMalnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies.Material and MethodIn this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined.ResultsOf the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% (n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% (n = 533) of the patients achieved the target calorie intake, and 81.65% (n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h (p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week (p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024).ConclusionTimely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score

Global respiratory syncytial virus–related infant community deaths

Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines

Soft tissue infection caused by Burkholderia cepacia in a child with polyarteritis nodosa

WOS: 000209048700018PubMed ID: 23692797Burkholderia cepacia belongs to a family of Burkholderia species previously described as Pseudomonas cepacia, especially in patients suffering from cystic fibrosis. There are also many studies about this agent in the last decade due to their life-threatening infections and ability to invade mucosal and cellular surfaces. Here, we report a case of soft tissue infection caused by B. cepacia in a child with an underlying condition of polyarteritis nodosa. Her complaints started at two months of age and she was on cyclosporine therapy. She was treated several times because of soft tissue infections especially in her extremities. The most common causative agents were Pseudomonas spp. and Escherichia coli, but recently, another soft tissue infection accompanied by fever and signs of sepsis had developed. All blood, urine and tissue (debrided from the necrotic area) specimens were incubated. Empirical antibiotherapy with clindamycin was started and cyclosporine therapy was discontinued. B. cepacia was grown in the tissue specimen culture and was only susceptible to carbapenems. Meropenem therapy was administered throughout 14 days with a daily dosage of 60 mg/kg, and she was treated successfully at least in this attack of soft tissue infection, which caused more severe sepsis and tissue damage than the previous infections with other agents

Whole Genome microRNA Expression Data in Childhood Acute Lymphoblastic Leukemia and Evaluation of microRNA Pathways Using Fuzzy C-means

Objective: Hard clustering approaches may cause some of the relationships to be overlooked due to their nature of algorithms especially in genetic datasets. But hidden relationships can be revealed by fuzzy approaches. Purpose of this study was evaluating effect of microRNAs (miRNA) on children with acute lymphoblastic leukaemia (ALL) by using miRNA expression data obtained from bone marrow samples with sets containing different numbers of elements of fuzzy Cmeans (FCM). Material and Methods: miRNA expression levels of 43 newly diagnosed ALL patients and 14 healthy subjects were analysed via FCM. Clusters containing different numbers of miRNAs were evaluated, common properties in messenger RNA (mRNA) pathways were investigated and new pathways associated with ALL and cancer were described via miRNA target prediction tools. Results: Significant miRNA profile was compared to control cases. Only 46 out of 108 miRNAs were found to be significantly upregulated or downregulated. Of forty six miRNAs: 8 miRNAs were labelled as tumour suppressor (17.4%), 17 miRNAs were labelled as onco-miR (37.0%) and 21 miRNAs could not be labelled (45.6%) for hematological malignancy. Fourteen (%30.4) miRNAs were found to be apoptosis-related, 27 miRNAs were in leukemia-related (58.7%) and 15 labelled miRNAs were related with cancer pathways (32.6%). hsa-miR-181b, hsa-miR- 146a, hsa-miR-155, hsa-miR-181c-5p, hsa-miR-7-1-3p, hsa-miR-708- 5p onco-miRs constituted a set. These miRNAs targeted 801 common mRNAs (p0.05). When this sub-cluster was searched in the literature and miRNA target prediction tools system, it was found to be involved in cancer-related pathways except ALL. Conclusion: Hidden relationships can be defined by fuzzy approaches and those pathways may provide guidance to open up new horizons in the field of miRNA studies

The utility of handheld metal detector in confirming metallic foreign body ingestion in the pediatric emergency department

WOS: 000283606200005PubMed ID: 20872326Background/aims: We aimed to identify the presence of ingested metallic foreign bodies with handheld metal detector in the pediatric population. Methods: All children (n=40) known or suspected to have ingested a MFB and who presented to the Emergency Department of the Children's Hospital of Ege University were prospectively ascertained. All patients underwent both radiographic evaluation and handheld metal detector scanning of the chest and abdomen on their presentation. In the present prospective study, we compared handheld metal detector scanning with plain radiography. Results: The end point of the study compared metallic foreign body findings with handheld metal detector vs radiological findings during an eight-month period. Forty subjects with possible metallic foreign body ingestion were enrolled into the study. The principle investigator scanned all subjects. Disease was defined by the presence of a foreign body in the gastrointestinal tract on radiograph. Radiographically, 35 foreign bodies were found, and handheld metal detector revealed 31 of them. The sensitivity of handheld metal detector was 88.6% (95% confidence interval [CV: 72.1%-96.5%), specificity 100% (95% CI: 61.8%-100%), positive predictive value (PPV) 100% (95% CI: 85.8%-100%), and negative predictive value 55.5% (95% CI: 34.3%-84.6%). Handheld metal detector revealed that 2 metallic foreign bodies (1 pushpin, I coin) were localized to the chest, which was confirmed by radiography, and urgent removal was performed with endoscopy. Conclusions: Handheld metal detector scanning is an accurate, inexpensive, radiation-free screening tool and should be used for evaluation of patients suspected of ingesting metallic foreign bodies

Inferior Petrosal Sinus Thrombosis in a Child due to Malposition of Central Venous Catheter: A Case Report

WOS: 000426011000013PubMed ID: 29080892Objective: To report a case of inferior petrosal sinus thrombosis associated with malposition of central venous catheterization (CVC). Clinical Presentation and Intervention: A 5-month-old boy was admitted to Sifa University Hospital because of pneumonia. When exophthalmos occurred in the right eye, he was referred to Ege University Hospital. Cranial magnetic resonance imaging and magnetic resonance venography confirmed that the catheter in the right inferior petrosal sinus caused the thrombosis. The catheter was extracted and anticoagulant treatment was started. Conclusion: In this case report, malpositioning of the CVC was the cause of the thrombosis. To minimize such complications, catheterization should be done with the supervision of an expert and postprocedure radiography should also be performed. (C) 2017 The Author(s) Published by S. Karger AG, Base