Turkish archives of pediatrics最新文献

The management of Gram-negative bacterial infections poses a significant challenge due to the emergence of highly effective antibiotic-resistant mechanisms, leading to treatment failures, particularly among hospitalized children. This patient population experiences elevated rates of both mortality and morbidity, and the available antibiotic options against these bacteria are limited. Carbapenems, such as meropenem, represent one of the choices for treatment. While meropenem is highly effective against Gram-negative bacteria, the prevalence of multidrug-resistant infections in hospitals has become a growing concern. In response to this challenge, exploring innovative strategies is crucial. One such strategy is the implementation of high-dose extended meropenem infusion treatment. Researchers propose that extended meropenem treatment may offer a viable solution to combat resistant bacteria. Despite a limited number of studies focusing on the effectiveness of this strategy in children, our comprehensive review of the literature revealed promising findings. Our examination specifically compared extended infusion with standard infusion approaches. The evidence suggests that extended infusion of meropenem provides more benefits compared to standard infusion methods. Researchers consistently reported positive results in their observations, with the exception noted in very low birth weight neonates and children with infections caused by carbapenem-resistant Enterobacteria and Acinetobacter baumannii spp. In conclusion, extended meropenem infusion treatment emerges as a promising option for managing resistant infections. However, it is essential to underscore the need for further studies to robustly support the observed benefits of this treatment regimen.

In emergencies, infants and young children are at risk of morbidity and mortality, which is increased by malnutrition. Environmental factors, food insecurity, household needs, misconceptions regarding breastfeeding, uncontrolled distribution of breast-milk substitutes, and psychological trauma make it difficult to implement proper feeding practices during disasters. Breastfeeding reduces the risk of infectious diseases and mortality in emergencies and is the safest way of feeding. Therefore, breastfeeding should be supported and promoted under all circumstances. When breastfeeding is not possible, relactation, wet nursing, or donor human milk should be considered as alternatives. If these options are not feasible, infant formula should be used. Formula should be provided only for infants in need, based on individual assessment. Donations of breast-milk substitutes should not be accepted; when needed, the procurement and distribution should be conducted by a single center under strict control, adhering to the requirements of the Code and Codex Alimentarius. Education and support should be provided to the family for the safe use of formulas. For infants older than 6 months, appropriate complementary feeding should be started. Complementary foods should contain nutrients that support the growth and development of infants, and they should be stored, prepared, and served safely. In conclusion, nutrition of infants and young children should be given priority in disasters as part of all emergency interventions. Determining the infants needs and ensuring proper nutrition, overcoming environmental challenges, and supporting parents will reduce nutrition-related risks and protect the health and well-being of infants and young children in emergencies.

Objective: This study aimed to compare high-flow nasal cannula oxygen therapy (nc-HFOT) and non-invasive nasal cannula ventilation (nc-NIV) in terms of intubation requirements.

Materials and methods: The study was conducted retrospectively on cases followed up in the pediatric intensive care unit (PICU) between October 2019 and December 2021.

Results: Of all cases, 43 (55.8%) were male, and the median age was 16 months. The median PRISM-3 score for all cases was 2.5 (range: 0-3). Among the cases 45 cases (58.4%) received nc-HFOT treatment, and 32 cases (41.6%) received nc-NIV treatment. The median duration of respiratory support for all cases was 2 days, and 14 cases (18.2%) needed intubation. The median PICU stay day for all cases was 7 days, and the median hospital stay day was 11 days. The median age, PICU, and hospital stay days of the nc-NIV group were significantly higher (P < .05). In the logistic regression analysis, the probability of requiring intubation in cases initially nc-NIV was performed was found to be 4.95 times higher than those using nc-HFOT (OR: 4.95, 95% CI: 1.3-18.8, P = 0.01). Additionally, cases with underlying chronic diseases were found to have a 5.9 times increased likelihood of requiring intubation compared to those without (OR: 5.9, 95% CI: 1.41-24.5, P = .01). Five cases (6.5%) were lost during intensive care stay.

Conclusion: The application of nc-NIV increases intubation by 4.95 times compared to the application of nc-HFOT. The intubation rate in cases with underlying chronic diseases is also 5.9 times higher than those without.

Objective: We aimed to analyze the clinical presentation, imaging, histopathology, and surgical management of pediatric intraabdominal cysts, which are relatively common but diverse lesions that pose diagnostic challenges.

Materials and methods: We conducted a retrospective analysis of pediatric intraabdominal cysts from 2010 to 2021 in a single tertiary center. We collected data on demographics, symptoms, radiological findings, surgical approaches, and histopathological diagnoses and compared them with the current literature.

Results: A total of 36 cases were included. There were 30 females and 6 males, aged 1 to 16 years. Abdominal pain was the most common symptom, followed by tenderness and distention. Diarrhea and vomiting were also reported in some cases. The cysts varied in size, location, and origin and were diagnosed as lymphangioma, mucinous cystadenoma, paratubal cyst, lowgrade mucinous neoplasm, mature cystic teratoma, duplication cyst, mesothelial cyst, pseudocyst, serous cystadenoma, and simple hepatic cyst. The surgical management depended on the type and location of the cysts and involved excision, oophorectomy, appendectomy, or resection.

Conclusion: Pediatric intraabdominal cysts are heterogeneous lesions that require timely diagnosis and surgical resection. They may present with various symptoms and complications, depending on their size and location. Radiological and histopathological evaluation is essential for accurate diagnosis and optimal treatment.

Objective: Natural disasters cause enormous environmental, economic, and human losses. Children are the most vulnerable group and face severe consequences. While the primary cause of post-traumatic death is direct injury, the secondary cause is crush syndrome (CS). In this study, we aimed to share our experience in the management of children with CS during disasters by evaluating the clinical and laboratory outcomes of a group of 26 paediatric patients.

Materials and methods: Age, weight, length of time under rubble, laboratory results, and characteristics of crush injuries were assessed in 26 paediatric patients admitted to the emergency department after the earthquake. Diagnostic criteria for CS were established and the need for dialysis, hyperbaric oxygen or amputation and its determinants were assessed.

Results: Crush syndrome was observed in 10 of the 26 patients. Significant differences in creatinine, aspartate aminotransferase, alanine aminotransferase, creatine kinase, hematocrit, pH, HCO3, and myoglobin levels were observed between patients with and without CS. None of the individuals rescued from the rubble within the first 6 hours had symptoms associated with CS. These 10 patients who developed CS were rescued within the first 48 hours of the earthquake, while 2 siblings were rescued after 81 hours and did not develop CS.

Conclusion: The fact that the children were rescued from the rubble after 81 hours without developing CS shows the importance of patience in rescue operations. In addition, the very cold weather conditions during this earthquake may have prevented the development of dehydration and acute kidney injury and reduced the possibility of CS.

Objective: Biologic therapy has changed the prognosis of patients with rheumatologic disease. Despite all benefits of the biological agents, adverse events may occur due to their long-term use. The aim of this study is to analyze the adverse events observed in pediatric patients who received biological treatment.

Materials and methods: This retrospective observational cohort study was conducted between January 2010 and January 2022. File records of 139 patients used biological agents for rheumatologic diseases in a pediatric rheumatology clinic were evaluated. Diagnosis, received treatment, the rationale for stopping treatment, requirement of tuberculosis prophylaxis, presence of an adverse event, and results were recorded.

Results: The most used biological therapy was etanercept (41.7%). Anakinra, adalimumab, canakinumab were used in 30.9%, 27.3%, 23.7% of patients, and the others in less than 10%. Totally 491 adverse events (97.9/100 patient-years) were encountered during the duration of biological treatment. The most often adverse event was recurrent upper respiratory tract infection in the patients (31.9/100 patient-years). Elevated aminotransferase levels (10.4/100 patient-years), abdominal pain (7/100 patient-years), and headache (5.2/100 patient-years) were among the other common side effects. Isoniazid (INH) prophylaxis was needed before biological treatment in 20.9% of the patients. Tuberculosis developed in none of the patients followed-up for latent tuberculosis, however, it developed in a patient while receiving etanercept due to noncompliance with his scheduled outpatient visits during etanercept treatment.

Conclusion: The most commonly used biological treatments were TNFi and IL-antagonists, and the majority of side effects were infections and laboratory abnormalities. Although the rate of serious adverse events is quite low, close follow-up of patients receiving biological therapy is very important.

Many articles written on Kawasaki disease explain the disease and the history of an acute inflammatory dysregulation that typically affects preschool children and does not spare older ones. Six decades have passed since the discovery of the disease in Japan, yet there are parts of the world where the disease passes unacknowledged, diagnosis is delayed, or basic treatments are not readily available. The burden of Kawasaki disease is on every health-care provider who attends to children's health. It takes 5 days for the disease to initiate coronary artery injury in a child's heart, compared to 5 decades of lifetime atherosclerosis. Challenges facing patients, families, and physicians may not be overcome unless we advocate for the disease recognition and seek support for affordable, timely treatment, impactful research, and dissemination of knowledge. The purpose of this review is to provide a comprehensive review of the history of Kawasaki disease and how it has affected children's health worldwide over the last 6 decades. The review also raises current challenges facing the fight against Kawasaki disease. In an effort to bring Kawasaki disease advocates together in a landing zone, an internet hub for Kawasaki disease experts and enthusiasts has been created: the International Kawasaki Disease Society (presently a concept idea) and a dedicated website, www.ikds-org.