Urinary tract infection (UTI) represents one of the most frequent infections with bacterial etiology during childhood. In infants and toddlers with fever without source UTI’ investigation should be carried out, since signs and symptoms are nonspecific. However, obtaining uncontaminated urine samples from these patients can be challenging and time consuming; all current collection methods (clean-catch, plastic collection bag, catheterization, etc) have disadvantages. Criteria for UTI definition are represented by the presence of significant number of a single uropathogen, this number being different depending on the collection method: at least 1000 colony-forming unit (CFU/ml) for catheter samples and at least 100.000 CFU/ml from midstream clean-catch samples or 50.000 CFU/ml and significant pyuria in a symptomatic or febrile child. Accurate diagnosis of UTI is essential to avoid any antibiotic overuse and expensive investigations. UTI caused by resistant bacterial strains has an increasing prevalence in children. In pediatric population, extended spectrum beta-lactamase-producing Enterobacteriaceae (ESBLPE) represent the etiology of around 15% of UTIs. Because of limited therapeutic options the reintroduction of some old antimicrobial agents is necessary, therefore Nitrofurantoin and Fosfomycin, can represent alternatives for oral treatment and prophylaxis of UTIs in children or in case of resistance suspicion to other drug classes. It is important to recognize patients at risk, such as children with recurrent UTIs, kidney abnormalities, like vesicoureteral reflux and previous antibiotherapy, in order to recommend adequate empiric treatment, especially against resistant bacteria.

No abstract

Introduction. Acute respiratory failure presents very high morbidity and mortality among the pediatric patients, being one of the most frequent causes of recurring to the emergency services and of hospitalization. Material and method. We performed a transversal retrospective study, on 153 patients diagnosed with acute respiratory failure, with the age between 2 weeks and 17 years, admitted in the Pediatrics Clinic 1 of the Emergency Clinical County Hospital Tg. Mures, between January 2015 and December 2016. Results. The ratio between genders favored the girls 1.12:1. Regarding the age, 4.57% were newborns, 32.67% were infants, 27.45% had the age between 1 and 3 years, 22.87% were preschool-aged children (4-6 years old), while 12.41% were between 7 and 17 years old. The laboratory data pointed out leukocytosis in 65.35% of the cases, neutrophilia in 70.58%, while 20.91% presented lymphocytosis, and 5.22% expressed eosinophilia. The value of C-reactive protein correlated significantly statistic with the value of erythrocyte sedimentation rate (p=0.002), and with the value of platelets (p=0.01), but not with the level of hemoglobin (p=0.15). The inflammatory biomarkers did not correlate significantly statistic with the severity of respiratory failure. The thoracic radiography pointed out pathological modifications in 75.16% of the patients, among whom 13.91% had a typical aspect of lung condensation, and 86.09% of interstitial pneumonia. In order to establish the severity of the disease, but also the patients' evolution, we calculated a prognostic score. According to this score, 10.45% had a very good prognosis, 68.62% a good prognosis and the rest of 20.93% presented a bad prognosis. Conclusions. The diagnosis of acute respiratory failure in pediatric patients presents both a complex and a multifactorial etiology.

Introduction: Venous thromboembolism is a rare condition in paediatrics that included both deep venous throm-

No abstract

No abstract

No abstract

Objective: The objective of this study was to analyze the performance of 2 stimulation tests used in the diagnosis of growth hormone deficiency.Method: A retrospective study was conducted on a non-random sample of 310 patients, between 2 and 20 years old, who were hospitalized in the Mureș County Hospital’s Endocrinology Department and in the National Institute of Endocrinology C.I. Parhon with short stature between 2009-2015. Inclusion criteria: all subjects who underwent growth hormone stimulation tests in accordance with the national protocol. Microsoft Office Excel was used for data collection and MedCalc v 12.5 was used for statistical analysis.Results: From the total of 310 patients, 102 were diagnosed in Târgu Mureș and 208 in Bucharest. Sex ratio favored boys (boys:girls 1.64:1). In 173 subjects growth hormone deficiency was confirmed. For both tests the percentage of maximum response was the highest for the 60 minutes blood sample regardless if the test were positive or not. Both tests have 100% sensitivity and negative predictive value, with the highest specificity for the 60 minutes clonidine and 30 minutes insulin. The false positive rate was 60% for the insulin test and 27.2% for clonidine for Târgu Mureș sample and 86.9% for the insulin test and 62.5% for clonidine for Bucharest sample. The concordance of the 2 tests was 49.36%.Conclusions: Stimulating growth hormone testing has a number of limitations but is still needed in some auxological circumstances. We recommend performing the clonidine test first to exclude idiopathic short stature and then the insulin tolerance test for the diagnosis of growth hormone deficiency.