Turkish archives of pediatrics最新文献

Objective: To evaluate the frequency of micronutrient deficiencies and assess their association with the duration of hospital stay in pediatric palliative care (PPC) patients.

Materials and methods: This retrospective study analyzed 81 children hospitalized in the PPC unit of Dr. Ali Kemal Belviranlı Obstetrics and Gynecology Hospital. Data included demographics, clinical characteristics, nutritional status, and serum levels of ferritin, vitamin D, vitamin B12, and folate. Hospital stay was categorized as short (≤5 days) or long (>5 days) based on median duration. Clinical and laboratory parameters were compared between groups, and multivariate logistic regression was used to identify independent predictors of prolonged hospitalization.

Results: The median age was 51 months, and 58.02% of the patients were male. Neurological or neuromuscular conditions were the most common underlying diagnoses (66.67%). At least 1 micronutrient deficiency was observed in 45.68% of patients. The frequency of folate, ferritin, vitamin D, and vitamin B12 deficiencies was 9.88%, 12.35%, 7.41%, and 1.23%, respectively. Patients with prolonged hospital stays had significantly higher ferritin levels (127.5 vs. 43.8 ng/ mL; P = .001) and lower vitamin D levels (26.68 ± 9.70 vs. 31.77 ± 11.36 ng/mL; P = .033). In multivariate analysis, nutritional support via nasogastric or gastrostomy tube (odds ratio [OR]: 4.931; 95% confidence interval [CI]: 1.310-17.385; P = .018) and lower vitamin D levels (OR: 0.937; 95% CI: 0.896-0.991; P = .020) were independently associated with prolonged hospitalization.

Conclusion: Lower vitamin D levels and enteral nutrition support are linked to prolonged hospitalizations in PPC patients. Routine screening and timely interventions may help improve outcomes.

Objective: The advantages and acceptance of resident-led subspecialty journal clubs are understudied. The study aimed to implement a resident-led virtual subspecialty journal club in a pediatric residency program to assess its perceived benefits and acceptability.

Materials and methods: This prospective pilot study, conducted from January 2023 to June 2024, involved all pediatric residents at the institution State University of New York (SUNY) Downstate, Health Sciences University, Brooklyn, New York. It consisted of 2 phases: implementation of a resident-led, attending-supervised virtual journal club and a subsequent resident survey. The biweekly journal club reviewed a range of articles-including basic science, clinical trials, and systematic reviews-focused on neonatology and infant health. After 20 sessions, an anonymous online survey was distributed to residents across all postgraduate years to assess perceived educational benefits.

Results: Out of 84 residents, 73 responded to the survey, and 83.5% (61/73) attended at least 1 session. More than 60% of residents indicated that the journal club facilitated staying updated on literature and improving medical knowledge. Over half of the residents noted that the journal club aided in understanding methodology, statistics, and bolstered confidence in reviewing literature.

Conclusion: The resident-led journal club garnered positive feedback, with most residents reporting multiple perceived benefits.

Objective: Real-time bedside ultrasound-guided catheterization of the internal jugular vein (IJV) offers potential benefits for critically ill neonates, especially those with low birth weight and preterm delivery. The aim of this study was to evaluate the feasibility, safety, and success rates in a high-risk neonatal population.

Materials and methods: Fifty-four neonates (birth weight 500-4010 g; 61% preterm) who underwent ultrasound-guided IJV catheterization were retrospectively analyzed in the Şişli Hamidiye Etfal Training and Research Hospital. The primary outcome is successful usage of the catheter. Other key outcomes include first session and overall successful catheterization rates, number of attempts, catheter dwell time, and complication rates. Subgroup analyses were performed based on birth weight (<2500 g vs. ≥2500 g) and gestational age (preterm vs. term).

Results: First-session catheterization success was 88.5%; overall success increased to 94.4% by the third attempt. The median number of attempts was 1. Median catheter dwell time was 13.7 ± 5.1 days. Successful usage of the catheter by completion of therapy without removal was achieved in 81.5% of cases; premature removal due to occlusion or dislodgement occurred in 13%, and catheter-related complications in 5.6%. Subgroup comparisons showed no statistically significant differences in success rate, number of attempts, or complication rates based on birth weight or gestational age.

Conclusion: Bedside ultrasound-guided IJV catheterization is a feasible, effective, and safe alternative to operating-room procedures, even in fragile neonates. High success rates, minimal complications, and avoidance of general anesthesia support its adoption in routine neonatal intensive care unit practice.

Objective: Sepsis remains a major cause of morbidity and mortality in pediatric intensive care units (PICUs). Community-acquired sepsis presents distinct challenges in children due to immature immunity, variable clinical features, and emerging antimicrobial resistance. This study aimed to evaluate the clinical characteristics, microbiological profile, treatment, and mortalityrelated possible risk factors for mortality in pediatric community-acquired sepsis.

Materials and methods: This retrospective single-center study included 107 previously healthy children diagnosed with community-acquired sepsis and admitted to the PICU between February 2020 and June 2023. Demographic, clinical, laboratory, and microbiological data were retrieved from electronic medical records. Patients were analyzed based on culture positivity and survival status.

Results: Among 1853 PICU admissions, 107 met the inclusion criteria. The median age was 2.5 years, and the overall mortality rate was 6.5%. Blood culture positivity was 14%, with Staphylococcus aureus as the most common pathogen (46.7%), followed by Pseudomonas and Acinetobacter species (13.3% each). Pulmonary involvement was the most common infection site (28%). Mortality was significantly associated with acute kidney injury (AKI), invasive mechanical ventilation, and longer ventilation duration. Culture positivity correlated with longer hospital and noninvasive ventilation duration.

Conclusion: Staphylococcus aureus was the leading cause of pediatric community-acquired sepsis. Critical complications such as AKI, mechanical ventilation, and a higher number of red blood cell transfusions were linked to mortality. All children with proven gram-negative sepsis were under 1.5 years, and 2 were later diagnosed with primary immunodeficiency, suggesting that early gram-negative infections in infants may reflect an underlying immune defect, as immunodeficiencies predispose to sepsis caused by unusual or atypical pathogens. Timely diagnosis and careful management are vital for better outcomes in vulnerable patients.

Objective: This study aimed to investigate the causes, clinical presentations, and biochemical profiles of children with acute viral hepatitis (AVH) while identifying potential factors that may predict mortality in these cases.

Materials and methods: This study was conducted in the Bangabandhu Sheikh Mujib Medical University (currently Bangladesh Medical University) setting among 158 children between July 2022 and November 2024. Children (≤ 18 years) who exhibited symptoms of AVH were enrolled in the study. A comprehensive history, physical examination, and relevant investigations were documented. Patients were monitored until complete recovery, and the outcome was recorded. The data were analyzed using SPSS version 25 (IBM SPSS Corp.; Armonk, NY, USA).

Results: Hepatitis A was the most common etiology (76.6%) of AVH. Other etiologies include hepatitis E (1.6%), hepatitis C (0.6%), non-A-E hepatitis (6.3%), dengue hepatitis (1.9%), hepatitis A virus (HAV) + hepatitis E virus (4.4%), HAV + dengue (0.6%), and HAV + Salmonella (8.2%). A total of 41.1% of patients developed atypical features with complications. The overall mortality rate was 6.3% (10 children). Splenomegaly, ascites, bleeding manifestations, hemolysis, pleural effusion, features of encephalopathy and acute liver failure, raised serum bilirubin, prolonged PT (prothrombin time) and INR (international normalization ratio), and low albumin showed a significant difference between survivor and non-survivor groups.

Conclusion: Hepatitis A virus is the leading cause of AVH, and the overall prognosis is good. The mortality rate was notably higher among boys. Splenomegaly, ascites, bleeding manifestations, hemolysis, pleural effusion, features of encephalopathy and acute liver failure, raised serum bilirubin, prolonged PT and INR, and low albumin would serve as possible predictors of mortality in pediatric AVH.

Objective: The objective is to characterize the complete spectrum of fetal congenital anomalies across all organ systems using fetal magnetic resonance imaging (MRI) and to assess the comparative advantages of MRI and obstetric ultrasound.

Materials and methods: This retrospective descriptive study included all referral fetal MRI scans performed between January 2020 and February 2024. Demographic and clinical data were extracted from institutional records. All US examinations were performed by experienced perinatologists. All MRIs were interpreted by a pediatric radiologist using a standardized protocol on a 1.5T scanner. Anomalies were categorized as craniospinal, body, head/neck, or other, with further subclassification of central nervous system and body anomalies.

Results: A total of 271 fetuses from 249 women (including 22 twin pregnancies) were evaluated. The mean maternal age was 29.2 ± 5.8 years, and the mean gestational age at the time of MRI was 29.5 ± 3.3 weeks. Craniospinal malformations were present in 187 fetuses (69%), body anomalies in 30 (11.1%), head/neck abnormalities in 7 (2.6%), and other anomalies in 6 (2.2%). Twenty fetuses (7.4%) had intrauterine demise, and 38 (14%) were normal. Magnetic resonance imaging provided additional diagnostic information in 52 cases (19.2%), primarily refining cortical malformations or ruling out suspected anomalies, whereas US identified findings not visualized on MRI in 18 cases (6.6%), mainly vertebral segmentation and extremity anomalies.

Conclusion: Fetal MRI complements obstetric US by contributing additional diagnostic detail in approximately one-fifth of cases, particularly for cortical and CNS anomalies, and confirms or refines US findings. Integration of both modalities improves congenital anomaly detection and supports informed patient management.

Objective: To compare the clinical effectiveness of ventilator-derived continuous positive airway pressure (vCPAP) and modified bubble CPAP (mbCPAP) in the early management of respiratory distress among late preterm and term neonates in a neonatal transitional care unit (NTCU) setting.

Materials and methods: This retrospective cohort study included infants born at ≥34 weeks' gestation who developed respiratory distress shortly after birth and received CPAP in the delivery room between April 1, 2023, and January 25, 2024. Based on resource availability, infants received either vCPAP or mbCPAP. The primary outcome was neonatal intensive care unit (NICU) admission. Secondary outcomes included intubation, length of hospital stay, and complications such as pneumothorax, nasal septum injury, and mortality.

Results: A total of 141 infants were included (68 mbCPAP, 73 vCPAP). Baseline characteristics were similar between groups. The NICU admission was required in 39.7% of the mbCPAP group and 30.1% of the vCPAP group (P = .23). Intubation rates, duration of hospitalization, and complication rates were comparable between groups. No cases of pneumothorax, nasal septum injury, or mortality occurred in either group.

Conclusion: In neonates ≥34 weeks with early respiratory distress, vCPAP and mbCPAP were similarly effective in preventing NICU admission. The mbCPAP may serve as a feasible and safe alternative in resource-constrained delivery room settings.