Criteria of admission and discharge in pediatric care units

These guidelines were summarized to provide a reference for preparing policies on admission and discharge for pediatric intensive care units. By using this document as a framework for multidisciplinary admission and discharge policies, utilization of pediatric intensive care units can be optimized and patients can receive the level of care appropriate for their conditions. (Turk Arch Ped 2010; 45: 82-5

Seizures associated with poisoning in children: tricyclic antidepressant intoxication

Background: The aim of this study was to examine the characteristics of seizure due to poisoning

Metabolic disturbances following the use of inadequate solutions for hemofiltration in acute renal failure

Continuous renal replacement therapy (CRRT) has become an important supportive therapy for critically ill children with acute renal failure. In Turkey, commercially available diafiltration and replacement fluids cannot be found on the market. Instead, peritoneal dialysis fluids for dialysis and normal saline as replacement fluid are used. The first objective of this study was to examine metabolic complications due to CRRT treatments. The second objective was to determine demographic characteristics and outcomes of patients who receive CRRT. We did a retrospective chart review of all pediatric patients treated with CRRT between February and December 2004. Thirteen patients received CRRT; seven survived (53.8%). All patients were treated with continuous venovenous hemodiafiltration. Median patient age was 71.8 +/- 78.8 (1.5-180) months. Hyperglycemia occurred in 76.9%. (n=10), and metabolic acidosis occurred in 53.8% (n=7) of patients. Median age was younger (48.8 vs.106.2 months), median urea level (106.2 vs. 71 mg/dl) and percent fluid overload (FO) (17.2% vs. 7.6%, respectively) were higher, and CRRT initiation time was longer (8.6 vs 5.6 days) in nonsurvivors vs. survivors for all patients, although these were not statistically significant. CRRT was stopped in all survivors, and four nonsurvivors (67%) were on renal replacement therapy at the time of death. Hyperglycemia and metabolic acidosis were frequently seen in CRRT patients when commercially available diafiltration fluids were not available. Using peritoneal dialysis fluid as dialysate is not a preferable solution. Early initiation of CRRT offered survival benefits to critically ill pediatric patients. Mortality was associated with the primary disease diagnosis

Acute colchicine intoxication in a child - A case report

Colchicine poisoning is an uncommon, but potentially life-threatening, toxicologic emergency. The clinical features associated with overdose and the options for treatment are discussed. Colchicine poisoning typically shows 3 phases: initially, gastrointestinal symptoms predominate; in the second phase, multiorgan failure may occur, possibly leading to death. If the patient survives, the third phase of recovery follows, during which the patient often presents with hair loss. Early fatality is due to cardiovascular collapse and respiratory failure; however, pancytopenia and overwhelming septicemia can occur later. All patients suspected of having colchicine intoxication because of its unpredictable outcome should be managed according to the principles of intensive care, irrespective of the actual degree of poisoning. In those patients who survive the initial phase of poisoning, filgrastim (granulocyte colony-stimulating factor) offers an effective method of treating pancytopenia and preventing overwhelming septicemia. Daily monitoring of the patients' hematological status is strongly recommended. We are reporting a case of previously healthy girl who developed a multisystem organ failure after colchicine intoxication. The patient recovered completely and had no residual outcome

Leptospirosis in Differential Diagnosis of Septic Shock in Children

Leptospirosis is one of the most common zoonotic infectious disease all over the world. The disease is caused by the spirochetes originated from Leptospira genus. Weil's disease, which is characterized by icterus, renal failure and disseminated hemorrhage, is seen in 510% of the patients and 515% are mortal. Two years and four months old female patient was admitted with fever, vomiting, confusion, tachypnea. Septic shock was determined and she had neurological, cardiovascular, hematological, renal and hepatic failure. As she has contact with untied animals and has a story of living in bad environmental conditions, leptospirosis was suspected. Leptospira IgM antibody was positive and leptospira were isolated in urine and blood cultures. Spirochetes were seen in the Giemsa stain and dark field examinations. All organ functions became normal except encephalopathy with supportive and medical therapy. Neurological symptoms and encephalopathy also became normal after two weeks. The patient was completely recovered. Leptospirosis should be thought, when a patient with environmental risk factors is admitted with shock, icterus and hemorrhagic diathesis in childhood. Early diagnosis and appropriate therapy are life saving. (J Pediatr Inf 2007; 1: 73-5

Evaluation of endocrine function in children admitted to pediatric intensive care unit

Background Although studied widely in adulthood, little is known about endocrinological disorders during critical illnesses in childhood. The aims of this study were to define the endocrinological changes in patients admitted to pediatric intensive care unit (PICU) and to identify their effects on prognosis. Methods Forty patients with a mean age of 5.1 years admitted to PICU were enrolled in the study. Blood samples were taken at admission and at 24 and 48h to measure cortisol, adrenocorticotropic hormone (ACTH), prolactin, growth hormone (GH), GH binding protein (GHBP), insulin-like growth factor-binding protein-3 (IGFBP-3) and interleukin-6 (IL-6). The severity of the patient's condition was assessed using pediatric risk of mortality (PRISM) and pediatric logistic organ dysfunction (PELOD) scores. Results PRISM and PELOD scores were significantly higher in non-survivors. Cortisol, ACTH, prolactin, GH, GHBP, IGFBP-3 and IL-6 were not significantly different between the survivors and non-survivors. There was a negative correlation between baseline IGFBP-3 and PRISM scores. A positive correlation was seen between cortisol level at 24h and PRISM score. On multivariate linear regression analysis, PRISM score was best explained by ACTH and cortisol at 24h. A positive weak correlation was detected between IL-6 at 24h and PELOD scores. Conclusions Although there was no difference between survivors and non-survivors regarding the studied endocrine parameters, there were associations between cortisol, ACTH, IL-6 and IGFBP-3 and risk assessment scores, and, given that these scores correlated with mortality, these parameters might be useful as prognostic factors

Multicenter Prospective Study on the Burden of Rotavirus Gastroenteritis in Turkey, 2005-2006: A Hospital-Based Study

WOS: 000270655100026PubMed ID: 19817603Rotavirus is the main cause of gastroenteritis and dehydration requiring hospitalization among infants and children. Despite the high diarrhea-related mortality rate, there are limited studies describing the prevalence of rotavirus in Turkey. The disease burden of rotavirus gastroenteritis in Turkey was assessed by active, prospective surveillance conducted in accordance with a modified World Health Organization generic protocol from 1 June 2005 through 1 June 2006. A total of 411 children aged <5 years who were hospitalized for gastroenteritis in 4 centers were enrolled. Rotavirus was identified in 53% of samples from the 338 children tested; the range for individual centers was 32.4%-67.4%. Overall, 83.8% of rotavirus-positive children were aged <2 years. Rotavirus gastroenteritis occurred year-round but peaked in the winter. G1P[8] was the most widely prevalent strain (76% of strains), followed by G2P[4] (12.8%). G9P[8] was reported in samples from 3.9% of children. These data support the need for a rotavirus vaccine in Turkey.GlaxoSmithKline Biologicals, Rixensart, BelgiumGlaxoSmithKline [104377]; GAVI AllianceFinancial support: research grant from GlaxoSmithKline Biologicals, Rixensart, Belgium (eTrack 104377).; Supplement sponsorship: This article was published as part of a supplement entitled "Global Rotavirus Surveillance: Preparing for the Introduction of Rotavirus Vaccines," which was prepared as a project of the Rotavirus Vaccine Program, a partnership between PATH, the World Health Organization, and the US Centers for Disease Control and Prevention, and was funded in full or in part by the GAVI Alliance

Multicenter Prospective Study on the Burden of Rotavirus Gastroenteritis in Turkey, 2005-2006: A Hospital-Based Study

Rotavirus is the main cause of gastroenteritis and dehydration requiring hospitalization among infants and children. Despite the high diarrhea-related mortality rate, there are limited studies describing the prevalence of rotavirus in Turkey. The disease burden of rotavirus gastroenteritis in Turkey was assessed by active, prospective surveillance conducted in accordance with a modified World Health Organization generic protocol from 1 June 2005 through 1 June 2006. A total of 411 children aged <5 years who were hospitalized for gastroenteritis in 4 centers were enrolled. Rotavirus was identified in 53% of samples from the 338 children tested; the range for individual centers was 32.4%-67.4%. Overall, 83.8% of rotavirus-positive children were aged <2 years. Rotavirus gastroenteritis occurred year-round but peaked in the winter. G1P[8] was the most widely prevalent strain (76% of strains), followed by G2P[4] (12.8%). G9P[8] was reported in samples from 3.9% of children. These data support the need for a rotavirus vaccine in Turkey