No abstract

No abstract

Background:To report the effectiveness and safety of intravenous (IV) levetiracetam (LEV) in the treatment of critically ill children with acute repetitive seizures and status epilepticus (SE) in a children's hospital.Materials and Methods:We retrospectively analyzed data from children treated with IV LEV.Results:The mean age of the 108 children was 69.39 ± 46.14 months (1-192 months). There were 58 (53.1%) males and 50 (46.8%) females. LEV load dose was 28.33 ± 4.60 mg/kg/dose (10-40 mg/kg). Out of these 108 patients, LEV terminated seizures in 79 (73.1%). No serious adverse effects were observed but agitation and aggression were developed in two patients, and mild erythematous rash and urticaria developed in one patient.Conclusion:Antiepileptic treatment of critically ill children with IV LEV seems to be effective and safe. Further study is needed to elucidate the role of IV LEV in critically ill children.

Methods:Results: --2015;2(3):111-4.

Tolunay İ, Yıldızdaş RD, Elçi H, Alabaz D. Assessment of central venous catheterization and complications in a tertiary pediatric intensive care unit. Turk J Pediatr 2018; 60: 63-69. In catheter-using units as pediatric intensive care, it is important to know the complications that may occur during the insertion and use of central venous catheterization (CVC), and to take appropriate measures in order to reduce the mortality and morbidity of critical patients. The aim of this study was to evaluate CVC and catheter related complications in our tertiary pediatric intensive care unit. For this prospective study, 155 central venous catheters and/or hemodialysis catheters used with 106 patients, between August 2014 and August 2015 were evaluated. Demographic information about patients, catheter insertion procedure and catheter related complications were recorded. Sixty-two (58.5%) male and forty-four (41.5%) female patients were evaluated in this study. The median age was 67.5 months (1-212). The mean dwell time of catheters was 10.54±8 days. Twenty-two (14.2%) catheters were removed from patients because of catheter related complications. The mean dwell time of complicated catheters was 10.6±8.5 days and there was no statistically significant difference between complicated and non-complicated catheters. Catheter related blood stream infections was diagnosed in 5.1% (8/155) patients and these catheters were removed from patients. Including these patients, positive blood culture was found to be at 14.2% (22/155). The mean dwell time of catheters with positive blood culture was 14.25±7.3 days. The mean dwell time of catheters with positive blood culture was statistically significantly longer than catheters with negative blood culture. In the 3 patients who developed catheter thrombosis, 2 patients were followed up because of infection/sepsis and 1 patient had a neurological disease. Catheter thrombosis developed in 1 femoral vein and 2 internal jugular veins. The development of central venous catheter complications depends on many different factors and it is possible to reduce the complications with precautions taken during replacement and daily use.

Tetralogy of Fallot is the most common cyanotic congenital heart disease with decreased pulmonary blood flow. Right-to-left shunt and infundibular pulmonary stenosis in this disease lead to a decrease in arterial O(2) saturation. Hypoxia is a strong stimulus for angiogenesis; however, the reason for insufficiency in the pulmonary vascular growth in patients despite chronic arterial hypoxia is still not known. This study was planned considering that the impairment in vascular endothelial growth factor-receptor relationship or the vascular endothelial growth factor-receptor deficiency in the pulmonary vascular bed during development may cause insufficiency of pulmonary vascular growth. A total of 24 patients were grouped as cyanotic - including 13 patients with tetralogy of Fallot - and acyanotic - including 11 patients with left-to-right shunt lesions. During cardiac catheterisation, vascular endothelial growth factor measurements were performed; and oxygen saturations, pressures, and haemoglobin levels were measured. Perioperative lung biopsy for vascular endothelial growth factor receptors was performed in the cyanotic group. Vascular endothelial growth factor of the aorta was higher in the acyanotic group. There was a significant negative correlation between vascular endothelial growth factor levels and aortic O(2) saturation in the cyanotic group (p < 0.05). Vascular endothelial growth factor tissue staining was negative in 11 out of 13 (84.6%) patients. KDR/Flk-1 receptor was positive in four out of 13 (30.7%) patients; Flt-1 receptor was positive in six out of 13 (46.1%) patients. Vascular endothelial growth factor values were found to be lower than those of the acyanotic patients in this study. Low serum vascular endothelial growth factor levels of the cyanotic group, in spite of the hypoxia, demonstrated the importance of studying vascular endothelial growth factor tissue levels and vascular endothelial growth factor receptors in these patients.

Nokta prevalans çalışması ile Türkiye'nin 6. büyük şehri olan Adana'da çocuk yoğun bakım ve yenidoğan yoğun bakımlarda antibiyotik kullanımını saptamak. Gereç ve Yöntemler: Bu nokta prevalans çalışmasında Adana şehir merkezinde bulunan 6 hastanede çocuk yoğun bakım ve yenidoğan yoğun bakım ünitesinde yatmakta olan hastaların aynı gün içerisinde demografik bilgileri ve antibiyotik tedavilerine ait veriler toplandı. Bulgular: Çalışmaya toplam dört çocuk yoğun bakım (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi), altı yenidoğan bakım ünitesi (iki üniversite, bir eğitim ve araştırma hastanesi, bir devlet hastanesi, iki özel hastane) alındı. Çalışmanın yapıldığı gün yoğun bakımlarda 220 hasta yatmaktaydı. Hastaların 44'ü (%20) çocuk yoğun bakımlarda, 176'sı (%80) yenidoğan yoğun bakımlarda yatmaktaydı. Hastaların 146'sı (%66,4) antibiyotik kullanmaktaydı. Bu oran çocuk yoğun bakımlarda %72,7, yenidoğan yoğun bakımlarda %64,8 idi. Bir üniversite ve eğitim araştırma hastanesinde çocuk enfeksiyon hastalıkları uzmanı vardı. Çocuk enfeksiyon hastalıkları konsültasyonu yapılabilen kliniklerde antibiyotik kullanma oranı daha düşüktü (p=0,002). En sık ikili antibiyotik kombinasyonu tercih edilmişti. Yenidoğan yoğun bakımlarda en sık ampisilin tercih edilirken ikinci sıklıkta dönemsel

Background/aim: The ″Pediatric Acute Lung Injury Consensus Conference″ (PALICC) was convened in order to develop a taxonomy to define pediatric acute respiratory distress syndrome (ARDS). The Appraisal of Guidelines for Research and Evaluation (AGREE) assesses the quality of guidelines. The aim of this study is to evaluate the new pediatric ARDS guideline using the AGREE II instrument. To the best of our knowledge, this is the first assessment of the new pediatric ARDS clinical practice guideline in the English literature. Materials and methods: Four appraisers assessed the new pediatric ARDS guideline with the AGREE II instrument. At the end of the evaluation each appraiser rated the overall quality of the guidelines. Results: Results of the assessment were editorial independence 100%, clarity of presentation 94%, scope and purpose 89%, stakeholder involvement 78%, rigor of development 78%, and applicability 78%. Conclusion: The new pediatric ARDS guideline received good scores especially with respect to editorial independence and clarity of presentation. Our overall AGREE II review of the PALICC guideline indicates that it has been created using high quality methodology and should be recommended for use and implementation as currently published.