Ebru Azapağası

Objectives: We aimed to describe the use of platelet transfusions among critically ill children managed in Türkiye in late 2024. Secondarily, we sought to determine these practices in relation to the 2022 Transfusion and Anemia Expertise Initiative-Control/Avoidance of Bleeding (TAXI-CAB) recommendations for critically ill pediatric patients. Design: Prospective study (October–December 2024). Setting: 22 PICUs in Türkiye and Northern Cyprus. Patients: Patients of 1 month to 18 years who received at least one platelet transfusion in the PICU. Interventions: None Measurement and Main Results: Out of 2693 PICU admissions, 200 patients (7.4%) received 577 platelet transfusions. Of the transfusions, 383 of 577 transfusions (66.4%) were for prophylaxis, most frequently for isolated thrombocytopenia (194/383, 50.7%). Regarding the transfusion threshold for prophylaxis, in the 194 cases of isolated thrombocytopenia, the median (interquartile range [IQR]) pretransfusion platelet count was 24 (IQR, 16–38) × 10 ⁹ /L, which differed from the TAXI-CAB consensus statement guidance of less than 10 × 10 ⁹ /L. Platelet transfusion, as opposed to not, was associated with 20-fold greater odds of 28-day mortality ( p < 0.001), and among the 200 patients receiving platelets, multivariable analysis showed that lower pretransfusion platelet count, support with invasive mechanical ventilation, and hospital-acquired infections collectively accounted for 34% of the variance in model performance for classifying 28-day mortality. Conclusions: Our 2024 national, multicenter PICU study across Türkiye and Northern Cyprus shows that around two-thirds of transfusion episodes were for prophylaxis, and multivariable logistic regression modeling identified patient factors associated with greater odds of 28-day mortality. The median pretransfusion threshold for isolated thrombocytopenia was around 20 × 10 ⁹ /L, which is double the less than 10 × 10 ⁹ /L in the 2022 TAXI-CAB consensus statement. Given the heterogeneity of critically ill patients and practice environments, understanding the reasons behind these practices may help inform future research and consensus recommendations.

Amaç: Bu çalışmada çocuk yoğun bakım ünitelerinde ultrasonografi eşliğinde yapılmış olan santral venöz kateter uygulamalarının değerlendirilmesi ve ultrason kullanılmadan takılan kateterizasyonlarla karşılaştırılması amaçlanmıştı.Gereç ve Yöntemler: Hastalar, kullanılan tekniğe göre iki gruba ayrıldı: Ultrason kullanılmayan hasta grubu (459 hasta) ve US kullanılan hasta grubu (200 hasta). Başarı oranını, girişim sayısını ve komplikasyon oranlarını her hastanın yaşına ve kilosuna göre değerlendirdik.Bulgular: SVK’nın başarılı bir şekilde yerleştirilmesi için gereken süre iki grup arasında önemli ölçüde farklıydı: Ultrason kullanılmayan grupta 10.9±10.8 dakika ve ultrason kılavuzluğundaki grupta 8.1±7.6 dakika (p=0.012). Ek olarak, başarılı kateterizasyon için ortalama girişim sayısı, ultrason kılavuzluğundaki grupta 1.8±0.8’di; ultrason kullanılmayan grupta 2.5±1.4 (p=0.024). Toplam 115 (%17.3) komplikasyon kaydedildi: Ultrason kullanılan grupta 24 (%3.6) ve ultrason kullanılmayan grupta 91 (%13.7) (p=0.014). Hastaların yaşı ve kilosu arttıkça komplikasyon sıklığı azaldığı saptandı. Ultrason kullanılarak takılan kateterler değerlendirildiğinde %59.5’inin ultrason eğitimi almış klinisyenler tarafından, %40.5’inin ultrason eğitimi almamış klinisyenler tarafından yerleştirildiği görüldü. Ultrason eğitimi almış ve almamış klinisyenler arasında komplikasyon oranı, girişim sayısı ve başarı oranları açısından anlamlı fark yoktu (p=0.476).Sonuç: Çalışmamız çocuklarda ultrason eşliğinde ve ultrason kullanılmadan SVK yerleştirmesini karşılaştıran en büyük çok merkezli çalışmadır. Ultrason eşliğinde takılan SVK işleminin daha güvenli ve daha az zaman aldığına inanıyoruz. Ayrıca, yatakbaşı ultrason pediatrik yoğun bakım uzmanları için yararlı ve kolayca elde edilebilir bir yöntemdir.

Thiamine (vitamin B1), which is a water-soluble vitamin, might lead to Wernicke’s encephalopathy (WE), wet beriberi, dry beriberi, and lactic acidosis when its serum concentration decreases (Polegato BF et al., Nutr Clin Pract 2019; 34: 558–564). WE is an acute syndrome that requires emergency treatment to prevent neurologic morbidity and death (Park SW et al., Korean J Pediatr 2014; 57: 496–499). It is rare in children and is characterized by the typical triad of ophthalmoplegia, ataxia, and confusion. Although most often associated with alcoholism, WE also occurs in the setting of prolonged parenteral nutrition without vitamin supplementation, prolonged starvation or unbalanced nutrition, gastric by-pass surgery, cancer treatment in pediatric patients, and transplantation (Arslan EA et al., Pediatr Neurol 2014; 51: 840–842, Parkin AJ et al., Brain Cogn 1991; 15:69–82). Thiamine deficiency (TD) can also lead to cardiovascular dysfunction called “wet beriberi,” which is characterized by tachycardia and hypotension (Long L et al., Am J Case Rep 2014; 15:52–55). Presumptive treatment should be initiated immediately if the presence of risk factors raises suspicion of this condition because there is no rapid diagnostic test for thiamine deficiency (Yin H et al., J Int Med Res 2019; 47: 4886–4894). In a systematic review, 110 papers covering 389 pediatric patients under the age of 19 with confirmed TD in high-income countries were documented. There were 22 (5%) malignancy patients with TD among the 389 pediatric cases (including leukemia and neuroblastoma). Hyperlactatemia was the most recognized finding in these individuals. Methotrexate and metronidazole use was linked to TD in three pediatric cases with cancer (Rakotoambinina B et al., Ann N Y Acad Sci 2021; 1498: 57–76). However, none of them showed concomitant clinical symptoms such as WE, severe lactic acidosis, and wet beriberi, in patients with TD. The objective of this report was to present a small child with Acute myeloid leukemia (AML ) who developed and recovered from severe lactic acidosis, encephalopathy, and heart failure during the neutropenic period following thiamine replacement. Article published online: 14 December 2023 © 2023. Thieme. All rights reserved. Georg Thieme Verlag Rüdigerstraße 14, 70469 Stuttgart, Germany

Microbiota composition might play a role in the pathophysiology and course of sepsis, and understanding its dynamics is of clinical interest. Invasive meningococcal disease (IMD) is an important cause of community-acquired serious infection, and there is no information regarding microbiota composition in children with meningococcemia. In this study, we aimed to evaluate the intestinal and nasopharyngeal microbiota composition of children with IMD. Materials and Methods: In this prospective, multi-center study, 10 children with meningococcemia and 10 age-matched healthy controls were included. Nasopharyngeal and fecal samples were obtained at admission to the intensive care unit and on the tenth day of their hospital stay. The V3 and V4 regions of the 16S rRNA gene were amplified following the 16S Metagenomic Sequencing Library Preparation. Results: Regarding the alpha diversity on the day of admission and on the tenth day at the PICU, the Shannon index was significantly lower in the IMD group compared to the control group (p = 0.002 at admission and p = 0.001, on the tenth day of PICU). A statistical difference in the stool samples was found between the IMD group at Day 0 vs. the controls in the results of the Bray–Curtis and Jaccard analyses (p = 0.005 and p = 0.001, respectively). There were differences in the intestinal microbiota composition between the children with IMD at admission and Day 10 and the healthy controls. Regarding the nasopharyngeal microbiota analysis, in the children with IMD at admission, at the genus level, Neisseria was significantly more abundant compared to the healthy children (p < 0.001). In the children with IMD at Day 10, genera Moraxella and Neisseria were decreased compared to the healthy children. In the children with IMD on Day 0, for paired samples, Moraxella, Neisseria, and Haemophilus were significantly more abundant compared to the children with IMD at Day 10. In the children with IMD at Day 10, the Moraxella and Neisseria genera were decreased, and 20 different genera were more abundant compared to Day 0. Conclusions: We first found alterations in the intestinal and nasopharyngeal microbiota composition in the children with IMD. The infection itself or the other care interventions also caused changes to the microbiota composition during the follow-up period. Understanding the interaction of microbiota with pathogens, e.g., N. meningitidis, could give us the opportunity to understand the disease’s dynamics.

Background/aim: This study aimed to investigate the clinical features, modality, complications, and effecting factors on the survival of children weighing up to 10 kg who received continuous renal replacement therapy (CRRT). Materials and methods: This study was a retrospective observational study conducted in five pediatric intensive care units in tertiary hospitals in Turkey between January 2015 and December 2019. Results: One hundred and forty-one children who underwent CRRT were enrolled in the study. The median age was 6 (range, 2-12) months, and 74 (52.5%) were male. The median weight of the patients was 6 (range, 4-8.35) kg and 52 (36.9%) weighed less than 5 kg. The most common indication for CRRT was fluid overload in 75 (53.2%) patients, and sepsis together with multiorgan failure in 62 (44%). The overall mortality was 48.2%. Conclusion: Despite its complexity, CRRT in children weighing less than 10 kg is a beneficial, lifesaving extracorporeal treatment modality.

Aim: This study was aimed at characterising the prevalence, management and outcomes of paediatric severe sepsis and septic shock in tertiary paediatric intensive care units (PICUs) in Turkey.Methods: A point prevalence study was conducted on 5 days over the course of 1 year in 29 PICUs in Turkey. Outcomes included severe sepsis and septic shock point prevalence, therapies used, duration of PICU stay and mortality at day 28.Results: Of the 1757 children who were admitted to the PICU during the study period, 141 (8.0%) children met the consensus criteria for severe sepsis and 23 (1.3%) children met the criteria for septic shock. Paediatric severe sepsis and septic shock accounted for 8% and 1.3% of all PICU admissions, respectively. The median age of the patients was 2.6 years (interquartile range [IQR], 0.7–8.6 years). Enteral nutrition (79.3%) was preferred compared to parenteral nutrition (31.1%) for the first 3 days after PICU admission. A total of 39 patients died while in the PICU, for a 23.8% mortality rate, which did not vary by age.Conclusion: The mortality rate was similar to that in other studies. Hematologic‐immunologic comorbidity, parenteral nutrition and the use of vasoactive drugs were independently associated with mortality.

Amaç: Tipik hemolitik üremik sendrom (HÜS) hastalarının bazılarında, agresif tıbbi müdahaleye rağmen renal replasman tedavisi (RRT) gerekebilir. Bu çalışmanın amacı, tipik HÜS tanısı alan hastaların klinik ve laboratuvar bulgularının değerlendirilmesi, HÜS tanılı hastalarda periton diyalizi (PD) ile hemodiyalizin (HD) etkinlik ve güvenilirliğinin karşılaştırılmasıdır. Gereç ve Yöntemler: Tipik HÜS tanısı olan hastalar retrospektif olarak belirlendi ve RRT modalitelerinin renal sağ kalım üzerindeki etkisi değerlendirildi. Bulgular: Çalışmaya tipik HÜS tanılı 49 hasta dahil edildi ve ortalama yaşları 2.99 ± 1.88 yıldı. Nörolojik tutulum 15 (%30.6) hastada saptandı. Nötrofil/lenfosit oranı nörolojik tutulum olan grupta anlamlı olarak yüksek bulundu [olasılık oranı (OO) 15.42, %95 güven aralığı (GA) (3.39-70.1), p = 0.005]. Toplamda 43 (%87.7) hastaya RRT uygulandı ve ilk kaydedilen semptomdan RRT’ye kadar geçen ortanca süre 6 gündü (aralık 3-11). RRT boyunca hastaların %10.2’sinde mekanik ventilasyon desteği gerekti. Yirmi altı (%53.1) hastada PD, 17 (%34.6) hastada HD yapılmıştı. Takipte tüm hastaların %10.2’si kronik böbrek hastalığına (KBH) ilerledi, %6.1’inde proteinüri ve %4.08’inde hipertansiyon saptandı. PD yapılan hastalarda 3 aylık dönemde KBH riski HD yapılan hastalara göre anlamlı olarak daha düşüktü [ OO 7.69, %95 GA (0.77-76.07), p = 0.04]. Sonuç: Böbrek iyileşmesi açısından PD’in HD kadar etkili hatta daha güvenli olabileceği sonucuna vardık. Tipik HÜS vakalarında klinik özellikler ve inflamatuar belirteçler sayesinde nörolojik tutulum tahmin edilebilir.