Süleyman Bayraktar

Pertussis resurged globally, after the relaxation of COVID-19 measures, underscoring its continued relevance as a public health concern, yet data remain li

Measles remains a major public health concern despite the availability of effective vaccines. Recent global resurgences, including in Türkiye, have been partly attributed to disruptions in routine immunization and declining vaccination coverage during the COVID-19 pandemic. Data on children with measles requiring pediatric intensive care are limited. We aimed to describe the clinical characteristics and outcomes of children with measles admitted to pediatric intensive care units (PICUs) in a large metropolitan area. This multicenter retrospective study included children < 18 years with laboratory-confirmed measles admitted to ten PICUs in Istanbul, Türkiye, between January and December 2023. Demographic data, vaccination status, clinical features, laboratory findings, treatments, and outcomes were collected. Patients were stratified by vaccination status. Among 5,685 PICU admissions, 53 children (median age 1.3 years) had laboratory-confirmed measles. Ten (18.9%) were vaccinated and 43 (81.1%) were unvaccinated. The median rash duration was longer in vaccinated children (3 vs. 2 days; p = 0.027). Rash onset most frequently involved the face in vaccinated children (70%), whereas trunk onset predominated in unvaccinated children (51.2%) ( p < 0.001). Unvaccinated children were admitted closer to rash onset, indicating a more rapidly evolving clinical course. Rhinorrhea was more common in unvaccinated children (69.8% vs. 20%; p = 0.009). Median oxygen saturation at PICU admission was lower in unvaccinated patients (91% vs. 95%; p = 0.015). Although ARDS, inotropic support, and invasive ventilation were more frequent in unvaccinated children, these differences were not statistically significant. In multivariable analysis, abnormal chest radiographic findings showed a trend toward association with respiratory support, although this did not reach statistical significance. Overall mortality was 2.3% (1/53), occurring in an unvaccinated infant. Conclusion : Measles continues to cause critical illness in young children requiring PICU care. Unvaccinated children tended to present with lower oxygen saturation at admission, suggesting more pronounced respiratory involvement. Maintaining high vaccination coverage remains essential to reduce severe measles-related morbidity. What is Known: • Measles outbreaks persist in areas with suboptimal vaccination coverage, with unvaccinated children at higher risk of severe complications. • Data on critically ill children with measles, particularly those requiring intensive care, remain limited. What is New: • This multicenter study provides contemporary PICU-based data from a recent measles outbreak in a large European metropolitan area, where most critically ill children were unvaccinated and very young. • Unvaccinated children showed trends toward lower oxygen saturation and more pronounced respiratory involvement, though findings should be interpreted cautiously due to the small sample size.

Aims: This study aimed to investigate the impact of the presence or absence of verbal communication skills in pediatric intensive care unit (PICU) patients who are unable to eat orally and are fed via enteral or parenteral methods, on the stress levels perceived by their parents. Methods: The study included 49 children hospitalized in the PICU with dysphagia and feeding difficulties. The participants’ information regarding tracheostomy, intubation, ability/inability to engage in verbal communication, and type of enteral feeding was recorded. Patients were retrospectively assessed using PRISM (pediatric risk of mortality) scores, and the Turkish version of the Parental Stress Scale was administered to one parent per patient. The participants were grouped based on their child’s verbal communication ability and feeding method (enteral vs. parenteral), and statistical comparisons were made using the Mann-Whitney U test. ROC (receiver operating characteristic) analysis was conducted to identify which of the recorded clinical variables had the most significant effect on parental stress. Results: The mean age of the children was 7.69 years, with 59.2% being male. Of the 49 children included, 31 (63.3%) were classified as non-verbal and 18 (36.7%) as verbal, according to their ability to communicate. While 81.6% were non-intubated, 42.9% had tracheostomies. Feeding methods included nasogastric tube (46.9%), total parenteral nutrition (38.8%), and percutaneous endoscopic gastrostomy (10.2%). The mean PRISM score was 4.0, and the average parental stress score was 69.1. Parents of non-verbal children reported significantly higher stress levels than those of verbal children (p=0.002). Although parental stress appeared higher in the parenteral nutrition group, the difference was not statistically significant (p=0.077). PRISM scores showed no significant differences between groups based on communication or feeding method. According to the ROC analysis [area under the curve (AUC)=0.728], the most significant indicator of parenteral stress was found to be the inability to engage in verbal communication. Conclusion: The findings demonstrate that the inability of children in PICU to verbally communicate significantly increases parental stress levels, independent of illness severity. Although feeding method did not significantly impact parental stress, a trend toward higher stress in parents of parenterally fed children was observed. These results emphasize the importance of preserving or supporting communication abilities in PICU patients. Implementing augmentative and alternative communication strategies (e.g., speaking valves, communication boards) and integrating psychosocial support for caregivers may contribute to improved family-centered care in pediatric critical care settings.

Objective: Patients in the pediatric intensive care unit (PICU) and neonatal intensive care unit (NICU) are at high risk for drug-related problems (DRPs). It is crucial to assess pharmacotherapy with the active involvement of clinical pharmacist (CP). The study aims to investigate the effect of CPs in identifying and resolving DRPs in the NICU and PICU settings. Method: This study with a retrospective and prospective design was conducted within the timeframe of October 2020 - August 2021 at the NICU (n=200) and PICU (n=200) of a university-affiliated state hospital in Türkiye. The Pharmaceutical Care Network Europe (PCNE) Classification V9.1. was used for classifications of the DRPs. DRPs identified by the CP and the regarding intervention proposals were communicated with the attending physician. Results: A total of 1247 DRPs were identified for all patients. The median (interquartile range [IQR]) number of DRPs per patient was 3 (1-6) for the pediatrics and 1 (0-1) for the neonates (p

Background: Influenza is a common cause of hospital admissions worldwide, and an increase in influenza cases has been observed following the COVID-19 pandemic. Our study investigated the epidemiological and clinical characteristics of pediatric patients with influenza infection admitted to pediatric intensive care units (PICUs) in Istanbul, Turkey, following the COVID-19 pandemic. Methods: We conducted a retrospective study of pediatric patients with confirmed influenza infection who were admitted to 1 of the 11 PICUs in Istanbul, Turkey, between July 1, 2022, and June 30, 2024. Data on demographic characteristics, risk factors, clinical presentations, microbiological findings, complications and outcomes were systematically collected. Results: A total of 108 children diagnosed with laboratory-confirmed influenza required admission to the PICUs. Sixty-five (60.2%) were diagnosed with influenza A and 43 (39.8%) patients were diagnosed with influenza B. Epidemiologic and clinical characteristics were similar in both influenza types, oxygen saturation was significantly higher in the influenza A group compared to the influenza B group. Severe neurological manifestations, including seizures and encephalitis, were significantly more common in the Influenza A group. In contrast, patients with Influenza B demonstrated a higher incidence of gastrointestinal symptoms, such as nausea, vomiting and abdominal pain. Pneumonia, sepsis and/or multiorgan dysfunction and liver failure were significantly higher in influenza B. Mortality was observed solely in the Influenza B group, with six patients resulting in death, corresponding to a mortality rate of 14%. Conclusions: Influenza virus infection can cause serious multisystem complications such as acute respiratory distress syndrome and encephalitis. Influenza A can present with isolated or predominant neurological manifestations. Mortality may be more common in influenza B.

This study aims to evaluate the clinical course of critical pertussis illness to the pediatric intensive care unit in Istanbul. The study was conducted as a multicenter, retrospective study between January 1, 2023, and December 31, 2023. Cases with positive polymerase chain reaction testing for Bordetella pertussis of nasopharyngeal swab samples within the first 24 h of pediatric intensive care unit admission were recorded. We divided the patients into exchange blood transfusion group and non-exchange blood transfusion group, comparing related factors and clinical characteristics among each group. A total of 50 children with severe pertussis were enrolled in the study, including 29 males (58%), with a median age of 9.14 weeks (range, 7.29–15.3 weeks). The mortality rate for severe pertussis was 8%. Exchange blood transfusion was performed in eight patients (16%). There were no significant differences between patients who received exchange blood transfusion and those who did not in terms of age, male gender, gestational age, birth weight, comorbidities, presenting symptoms, duration of cough, prior antibiotic use, vaccination status, coinfections, PICU length of stay, or mortality (p > 0.05). Children who underwent exchange blood transfusion had significantly higher white blood cell (WBC) counts, lymphocyte counts, neutrophil counts, and C-reactive protein (CRP) levels compared to those who did not receive the procedure (p < 0.05). Pulmonary hypertension was observed in 50% of the children who received exchange blood transfusion, while it was present in only 11.8% of those who did not undergo the procedure (p < 0.05). Additionally, patients who received exchange blood transfusion had higher incidences of respiratory failure, cardiac failure or arrest, inotrope requirement, and mechanical ventilation compared to those who did not receive the transfusion (p < 0.05). Conclusions: Pertussis can lead to severe complications and mortality in critically ill infants. Most severe pertussis occurred in young, unimmunized infants. Children admitted with pertussis with high CRP level, high WBC and lymphocyte, and cardiac and respiratory failure can need exchange blood transfusion. What is Known: • Pertussis is a highly contagious respiratory infection caused by Bordetella pertussis, which primarily affects infants. Despite vaccination efforts, pertussis remains a significant cause of morbidity and mortality in infants, particularly those too young to be fully vaccinated. What is New: • In pertussis, exchange blood transfusion may be considered in cases of severe pulmonary hypertension or cardiogenic shock, as indicated by echocardiographic findings, in conjunction with leukocytosis observed on laboratory tests.

Background: The inability to ensure adequate nutrition for patients, and failure to provide adequate calorie and protein intake, result in malnutrition, leading to increased morbidity and mortality. The present study assesses the two approaches to enteral nutrition—intermittent and continuous enteral feeding—in critically ill pediatric patients in Türkiye to determine the superiority of one method over the other. Methods: Included in this multicenter prospective study were patients receiving enteral nutrition via a tube who were followed up over a 3-month period. Anthropometric data, calorie and protein intake, and signs of feeding intolerance were evaluated in a comparison of the different feeding methods. Results: A total of 510 patients were examined. In the continuous enteral feeding (CEF) group, 20.2% of patients developed metabolic abnormalities, and 49.5% experienced enteral nutrition intolerance, both of which were higher than in the intermittent enteral feeding (IEF) group, and the differences were statistically significant. No significant differences were observed between the two feeding methods in terms of reaching the target calorie intake on days 2 and 7 (p > 0.05). On day 7, there were significant differences between the two feeding methods in terms of calorie and protein intake (p = 0.023 and 0.014, respectively). Conclusions: In the present study, assessing the IEF and CEF approaches to enteral nutrition, critically ill pediatric patients receiving intermittent feeding exhibited lower rates of enteral nutrition intolerance and metabolic abnormalities. Furthermore, the calorie and protein intake on day 7 were noted to be higher in the IEF group than in the CEF group. Further randomized controlled trials are needed to confirm the findings of the present study.

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.

Objective: The colostrum contains macrophage migration inhibitory factor (MIF), which plays an important role in protecting newborns from infections. As such, colostrum may be specifically important to prevent early onset neonatal sepsis among neonates born after premature rupture of membranes (PROM). However, the effect of PROM on the colostral MIF concentration has not been previously described. The aim of this study is to compare the concentration of MIF in the colostrum of mothers with and without PROM. Methods: The study group consisted of 44 women, 22 of whom had PROM. Colostrum was expressed and collected within 72 hours of birth. MIF concentration was measured using the enzyme-linked immunosorbent assay method and compared between mothers with and without PROM. Results: There were no differences between the two groups (PROM group n = 22, control group n = 22) with regard to the age of mothers, mode of delivery, neonatal gestational age, birth weight, and sex of the infants ( p > 0.05). The colostral MIF concentration was significantly higher among mothers with than without PROM ( p = 0.0001). There was a positive and significant correlation between the colostral MIF concentration and PROM duration ( r = 0.314, p = 0.038). Conclusions: PROM was associated with a higher colostral MIF concentration, with this concentration being positively correlated with the duration of PROM. This increased concentration may be important in offering these neonates additional protection against early onset infections, which is a risk associated with PROM.