Demograpghic and Epidemiological Characteristics of Subacute Sclerosing Panencephalitis Patients in Pediatric Intensive Care Unit and Attitudes of Their Parents About Home Care

Introduction:Subacute sclerosing panencephalitis (SSPE) is a chronic, progressive, and degenerative infection of the central nervous system caused by measles virus. The first aim of this study was to assess the demographic and epidemiological characteristics of SSPE patients admitted to pediatric intensive care unit (PICU). The second aim was to determine the thoughts of their parents about home care.Methods:Patients with SSPE, who were admitted to our PICU between January 1, 2015 and June 30, 2015, were evaluated retrospectively.Results:Fourteen patients were admitted to the PICU for a total of 16 episodes. Ten (71%) patients were male and 4 (29%) were female. Male-to-female ratio was 2.5. The mean age of the patients was 16.25±1.14 years. Thirteen patients had received their first measles vaccine at the age of 9 months. Ten (71.4%) patients had measles infection at a later time after the vaccination and one (7.1%) patient had measles before vaccination. The mean age at the time of measles infection was 23.81±15.67 months. The mean age at the time of first symptoms was 8.64±3.33 years and the mean duration of latent period was 5.72±2.96 years. Thirteen (81.3%) patients were admitted to the PICU with pneumonia and respiratory failure, 1 (6.2%) was admitted with sepsis, and 2 (12.5%) patients were admitted with neurological problems. None of the parents accepted home care in the study period. Frequent power cuts (80%), poor housing and home conditions (70%), poverty (60%), worries of the parents about home care (60%), and household crowding (50%) were their reasons for not accepting home care.Conclusion:Patients with SSPE may require PICU admission and long PICU stays for respiratory failure and neurologic problems. Palliative care units may be an option when home care is not possible for these patients

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

Meningococemia in Pediatric Intensive Care Units:Demographic, Epidemiological and Clinical Features

Amaç: Meningokoksemi tanısıyla çocuk yoğun bakım ünitelerinde (ÇYBÜ) izlenen hastaları demogra?k, epidemiyolojik, klinik ve laboratuvar özellikleri açısından değerlendirmektir. Yöntemler: Dört farklı ÇYBÜ'de takip ve tedavisi yapılan, menenjitin eşlik ettiği veya tek başına meningokosemi tanısı almış 1 ay-18 yaş arası çocukların tıbbi kayıtları değerlendirildi. Bulgular: Çalışmaya toplam 33 hasta dahil edildi ve ortalama yaş 3.4±2.1 yıldı. Hastaların 22 (%67)'si erkekti. Hastaların %84'ünde ateş ilk semptomdu ve %97'sinde tanı anında meningokoksemiye ait döküntü saptandı. Lomber ponksiyon hastaların %45'ine yapıldı ve 7 (%21)'sinde eşlik eden menenjit olduğu görüldü. N. meningitidis 7 hastanın kan kültüründe ve 2 hastanın BOS kültüründe üretilebildi. Hastaların %93'ü hastaneye başvurduktan sonraki ilk 1 saat içerisinde ortalama 60 ml/kg sıvı bolusu aldı. İnotropik ve vazopressör tedavi olarak 18 (%54.5) hastaya dopamin, 9 (%27.2) hastaya dobutamin ve 4 hastaya (%12.1) epinefrin infüzyonu verildi. Hastaların %58'inde steroid, %12'sine ise dissemine intravasküler koagülasyon ve purpura fulminans nedeniyle heparin infüzyonu uygulandı. Ortalama yoğun bakım yatış süresi süresi 6 gün (1-29 gün), mortalite oranı %21'di. Sonuç: Çalışmamızdaki hastaların demogra?k, epidemiyolojik, klinik ve laboratuvar özellikleri daha önce yapılan çalış- malarla benzer olmakla birlikte, mortalite oranı yüksek olarak bulunmuşturCAYD 2015;2(1):7-12.Objective: The aim of this study was to review demographic, epidemiological, clinical, and laboratory characteristics of meningococcemia patients in pediatric intensive care units (PICU). Methods: Investigators from 4 di?erent PICUs reviewed the medical records of children aged between 1 month to 18 years and diagnosed with meningococcemia with or without meningitis. Results: There were a total of 33 patients in the study period. The median age at admission was 3,4±2.1 years. In all, 22 (67%) were male. Fever was the ?rst symptom in 84% of the patients and 97% of them had meningococcemic rashes at admission. Lumbar puncture was performed to 45% of the patients and 7 (21%) of them had meningitis with meningococcemia. N. meningitidis was cultured from 7 blood and 2 cerebrospinal ?uid samples. An average of 60 mL/kg ?uid bolus was given to 93% of the patients within the ?rst hour of hospital admission. Dopamine, dobutamine, and epinephrine were given to patients who required inotropic and vasopressor infusions (54.5%, 27.2%, 12.1% of the patients,respectively). Fifty-eight percent of the patients received steroid therapy and 12% of them received heparin infusion for disseminated intravascular coagulation and purpura fulminans. The mean length of PICU stay was 6 days (1 to 29 days) and the overall mortality rate was 21% (7 patients). Conclusion: Although demographic, epidemiological, clinical, and laboratory characteristics of our patients were similar to previous reports, mortality rate was higher CAYD 2015;2(1):7-12

International Nosocomial Infection Control Consortiu (INICC) report, data summary of 43 countries for 2007-2012. Device-associated module

We report the results of an International Nosocomial Infection Control Consortium (INICC) surveillance study from January 2007-December 2012 in 503 intensive care units (ICUs) in Latin America, Asia, Africa, and Europe. During the 6-year study using the Centers for Disease Control and Prevention's (CDC) U.S. National Healthcare Safety Network (NHSN) definitions for device-associated health care–associated infection (DA-HAI), we collected prospective data from 605,310 patients hospitalized in the INICC's ICUs for an aggregate of 3,338,396 days. Although device utilization in the INICC's ICUs was similar to that reported from ICUs in the U.S. in the CDC's NHSN, rates of device-associated nosocomial infection were higher in the ICUs of the INICC hospitals: the pooled rate of central line–associated bloodstream infection in the INICC's ICUs, 4.9 per 1,000 central line days, is nearly 5-fold higher than the 0.9 per 1,000 central line days reported from comparable U.S. ICUs. The overall rate of ventilator-associated pneumonia was also higher (16.8 vs 1.1 per 1,000 ventilator days) as was the rate of catheter-associated urinary tract infection (5.5 vs 1.3 per 1,000 catheter days). Frequencies of resistance of Pseudomonas isolates to amikacin (42.8% vs 10%) and imipenem (42.4% vs 26.1%) and Klebsiella pneumoniae isolates to ceftazidime (71.2% vs 28.8%) and imipenem (19.6% vs 12.8%) were also higher in the INICC's ICUs compared with the ICUs of the CDC's NHSN