Introduction: Shock is a common and life-threatening condition in pediatric intensive care units (PICUs). In catecholamine-resistant shock, current guidelines suggest adjunctive therapies such as hydrocortisone, vasopressin, angiotensin II, or extracorporeal membrane oxygenation (ECMO). Methylene blue (MB) has emerged as a potential alternative or adjunct therapy. We report our clinical experience administering MB to children who had refractory shock unresponsive to standard inotropes and vasopressors. Methods: We retrospectively reviewed children who were treated with MB between March and November 2023 at a tertiary PICU. Pre- and post-MB variables included vasoactive-inotropic score (VIS), systolic blood pressure (SBP), vasopressor requirements, concurrent continuous renal replacement therapy/ECMO use, and mortality. Hemodynamic parameters were evaluated before MB administration and up to 24 hours thereafter. Results: Ten patients were included (mean age 9.4 years; 70% with chronic comorbidities). Baseline VIS was 116.4±90.5 and SBP was 81.3±19 mmHg. At 24 hours after MB administration, VIS decreased to 109.9±74.6 and SBP increased to 96.5±18.2 mmHg, corresponding to an average absolute change of -6.5 points in VIS and +15 mmHg in SBP. Hemodynamic responses were heterogeneous: VIS decreased in five patients, remained unchanged in two, and increased in three, while SBP improved in all patients. No MB-related adverse effects were observed. Overall survival to hospital discharge was 10%. Conclusion: In children with catecholamine-resistant shock, MB administration was associated with short-term improvement in blood pressure, although the reduction in vasoactive burden was inconsistent and mortality remained high. Larger prospective studies are needed to define the optimal timing, dosing, safety, and efficacy of MB in pediatric vasodilatory shock.
Introduction: To discuss findings and interventions of patients followed in the pediatric intensive care unit due to trauma accompanied by thoracic injury over a seven-year period, including the February 2023 Türkiye earthquake, with case examples. Methods: Electronic health records of patients admitted to the pediatric intensive care unit due to trauma between March 2018 and 2025 were reviewed. Results: Among the 375 trauma patients, 29% had accompanying thoracic trauma. The most common causes of trauma were traffic accident, earthquake-related injuries and falls from height. Tube thoracostomy was performed in 53.2% of patients, surgical treatment in 11.9%, bronchoscopy in 8.26%, and mechanical ventilation in 33.9%. The most common findings observed in these patients were pulmonary contusion and pneumothorax. The most frequent accompanying injuries in patients with thoracic trauma were head trauma, femur fracture, and liver and/or spleen laceration. Clinical findings, radiological images and interventions on five representative cases of patients followed in the pediatric intensive care unit due to trauma with accompanying thoracic injury is presented in this study. Conclusion: During the primary assessment of patients, life-threatening conditions defined as the lethal six must be urgently investigated. In the presence of traumatic pneumothorax, hemothorax, or hemopneumothorax, early tube thoracostomy should be performed if the patient is symptomatic. Pulmonary contusion should be considered in blunt trauma, and pulmonary laceration in penetrating trauma. Persistent pneumothorax and hemothorax despite tube thoracostomy require surgical intervention. When pneumomediastinum and subcutaneous emphysema are detected, tracheobronchial injury should be suspected, and the patient should be evaluated for bronchoscopy.
Introduction: This study aimed to evaluate the demographic and epidemiological aspects of patients who underwent continuous renal replacement therapy (CRRT) in a pediatric intensive care unit to determine the appropriate CRRT model and to reveal the factors affecting survival. Methods: The demographic data of 85 patients who underwent CRRT in the Pediatric Intensive Care Unit of Çukurova University Faculty of Medicine Balcalı Hospital between September 2014 and January 2022 and data from 125 CRRT procedures were recorded and evaluated by statistical analysis. Results: 52.9% of the patients were female, the mean age was 63.8±67.6 (months), and the mean body weight was 18.9±17.8 kg. The most common, underlying primary disease was nephrological (37.6%). While 88.8% of the applied CRRT procedure was continuous venovenous hemodiafiltration, 11.2% was continuous venovenous hemodialysis. Complications were observed during the procedure in 68% of the patients. In our study, unfractioned heparin was applied to 44.8% of CRRT procedures and citrate to 14.4%. The filter life of the patients treated with heparin was determined to be considerably shorter (p=0.002). It was observed that low pH and HCO3 values and high lactate level, which are laboratory parameters obtained before CRRT, increased mortality (p=0.001, p=0.047, and p=0.001, respectively). Conclusion: The success of CRRT treatment was thought to depend on the clinical condition of the patient, the underlying treatable disease, the control of technical problems, and the experience of the teams. In order to support the findings obtained in our study with definitive data, multicenter randomized controlled studies are required.
Commotio cordis is a rare but potentially fatal condition characterized by sudden cardiac arrest following blunt, non-penetrating chest trauma, most commonly in adolescent males. Mortality is particularly high when the event occurs outside organized sports settings, where delayed cardiopulmonary resuscitation (CPR) and lack of immediate defibrillation are more common. A previously healthy 14-year-old male collapsed immediately after receiving a blunt chest impact caused by peer aggression at school. Bystander CPR was initiated, and return of spontaneous circulation was achieved after 25 minutes, following multiple defibrillation attempts. Despite stabilization of cardiac rhythm in the pediatric intensive care unit, the patient developed hypoxic-ischemic encephalopathy secondary to ventricular fibrillation-induced arrest, resulting in severe, persistent neurological sequelae, including spasticity and severe motor impairment. The Glasgow Coma scale score was 5, and the modified Rankin Scale score remained 5 at follow-up. Mortality and morbidity rates are higher in non-sport-related commotio cordis cases due to delayed recognition, limited access to automated external defibrillators (AEDs), and low public awareness. Early intervention significantly impacts both survival and neurological outcomes. This case highlights the potential severity of commotio cordis triggered by bullying and emphasizes the importance of rapid resuscitative efforts. Early diagnosis, prompt CPR, and timely defibrillation reduce mortality from commotio cordis. Post-arrest neurological monitoring is crucial for managing hypoxic complications. Implementing CPR training and ensuring AED availability in schools may reduce morbidity and improve survival in non-sport-related cases.
Klippel-Trenaunay syndrome (KTS) is a rare congenital vascular disorder associated with an increased risk of thromboembolic complications, including potentially life-threatening pulmonary embolism (PE). We report a case of an 8-year-old boy with KTS who was receiving sirolimus therapy and developed fatigue, tachypnea, and hypoxemia. Echocardiography demonstrated right heart strain, and computed tomography pulmonary angiography confirmed bilateral PE. The patient was hemodynamically stable and was classified as intermediate-risk PE. Treatment with intravenous unfractionated heparin and supportive intensive care was initiated. On day 4, anticoagulation was transitioned to subcutaneous enoxaparin, with near-complete regression of right ventricular dilatation on follow-up echocardiography. He was discharged on rivaroxaban for long-term thromboprophylaxis. This case highlights the role of early echocardiography in risk stratification, the importance of conservative anticoagulation in complex vascular disorders, and individualized long-term management of pediatric patients with KTS.
Introduction: Pediatric intoxications are frequently encountered in emergency departments and pediatric intensive care units and may lead to significant morbidity and mortality. This study aims to evaluate the etiological factors, clinical characteristics, treatment approaches, and outcomes of acute intoxication cases admitted to the pediatric intensive care unit of a tertiary care center and to describe the regional intoxication profile. Methods: This retrospective study included 391 children hospitalized with acute intoxication in the Pediatric Intensive Care Unit of Bolu Abant İzzet Baysal University Faculty of Medicine between 2012 and 2018. Demographic variables, type and intent of intoxication, route of exposure, time to presentation, clinical findings, treatments, length of stay, and outcomes were collected from hospital information systems and medical records. Statistical analyses were performed using IBM SPSS v22 with a significance level of p<0.05. Results: The mean age was 7.9±6 years; 52.4% were younger than five years, 39.6% were adolescents, and 62.4% were female. Most intoxications occurred at home (89%) and were accidental (66.4%), while intentional ingestions were significantly more common among adolescents and females (p<0.001). A seasonal increase was noted in summer. Oral ingestion was the predominant exposure route, and medications accounted for 70.8% of toxic agents, especially analgesics and central nervous system drugs. Rodenticide exposure was more frequent in younger children. Many patients were asymptomatic at presentation; hydration (60.6%), gastric lavage, and activated charcoal (58.8%) were the most common treatments. Antidotes, mechanical ventilation, and hyperbaric oxygen therapy were required in selected cases. The mean pediatric intensive care unit stay was 1.6±1.1 days, and the mortality rate was 0.5%. Conclusion: Accidental intoxications predominated in young children, whereas intentional ingestions were more common among adolescents. Medications were the leading toxic agents. Early recognition, appropriate decontamination, and intensive care support contributed to the low mortality. Strengthening family education, ensuring safe storage of toxic substances, regulating rodenticide use, and implementing preventive mental health programs for adolescents may help reduce pediatric intoxications.
Increased intracranial pressure syndrome (IIPS) is a condition in which intracranial pressure (ICP) rises above the upper limit of normal for age, leading to the development of symptoms and signs. Under normal conditions, the average ICP is 1.5-6 mmHg in infants, 3-7 mmHg in children, and 5-15 mmHg in adults. IIPS is defined as ICP remaining above 20 mmHg for more than 5 minutes. ICP may increase in the presence of increased blood, cerebrospinal fluid and brain tissue volume within the skull, or in the presence of space-occupying lesions. The purpose of this protocol is to provide pediatricians with general information on the diagnosis, monitoring, and treatment of ICP. This protocol does not replace the professional opinion of the physician.
In infants, humeral fractures are commonly caused by birth injuries, child abuse, and direct or indirect trauma. After the clavicle, the humerus is the second most common site of birth-related long bone fracture in neonates and is frequently associated with forced obstetric maneuvers in difficult vaginal or cesarean deliveries. A neonate, born to a primigravida after a difficult vaginal delivery, presented on postpartum day 16 with a painless localized firm swelling in his right mid-arm noticed for 4 days. Features of abuse, fall injury, and osteogenesis imperfecta were absent. X-rays confirmed a right mid-shaft humeral fracture with bridging callus at the fracture ends. A diagnosis of a birth-associated humeral diaphyseal fracture was made. The fracture healed completely with conservative management, without sequelae. The case highlights the diagnostic challenge associated with delayed neonatal presentation of a humeral shaft fracture with callus formation.
Introduction: This study examined nurses’ experiences and feelings when providing care to refugee children and parents in the pediatric emergency service. Methods: In this phenomenological research design, data were collected using a semi-structured interview form. The study was conducted among 12 nurses working in the pediatric emergency department of a university hospital in Türkiye between September and October 2022. Results: The average age of the nurses who participated in the study was 34.5 years, and the average duration of employment in the pediatric emergency services was 4 years. Based on content analysis, the themes of the study were identified as follows: (1) problems experienced (increased workload, communication problems, parents’ lack of health knowledge), (2) neglected child-related sadness (low socio-economic status, inadequate parental child care), (3) professional responsibility (professional awareness, professional ethics). Conclusion: Nurses stated that, with the addition of refugees to the country’s population, there are problems in the healthcare system and an increased workload. Problems faced by refugees regarding socio-economic status, language and communication, and health literacy are also emphasized. It has been determined that they feel sympathy for these problems, but they endeavor to continue providing care without discrimination due to their professional ethical responsibilities.
Adolescence is a critical developmental period characterized by rapid social, cognitive, and behavioral changes, during which risk-taking behaviors tend to increase. Social media-driven “challenge” activities can pose serious health threats, particularly when reinforced by peer pressure and group dynamics. This report presents two pediatric cases involving previously healthy adolescents who experienced life-threatening consequences as a result of engaging in such risky behaviors, one of which resulted in death. The first case involved a 12-year-old male who consumed approximately 4-5 liters of water in a short time as part of a peer challenge. He presented with seizures and altered mental status secondary to severe hyponatremia (Na+: 116 mmol/L) and was admitted to the pediatric intensive care unit. Following individualized fluid therapy and normalization of electrolytes, the patient recovered fully and was discharged. The second case involved an 11-year-old male who experienced sudden aspiration during a eating contest, leading to cardiac arrest. Despite immediate cardiopulmonary resuscitation, intensive support, and advanced resuscitative efforts, no neurological improvement was observed, and the patient was declared deceased on the third day of admission. Both cases underscore that life-threatening complications can arise in healthy adolescents due to risk-laden behaviors influenced by social media. These cases highlight the need for comprehensive risk assessment in adolescent patients, as well as the importance of implementing multidisciplinary preventive strategies in pediatric healthcare practice.
Posterior reversible encephalopathy syndrome (PRES) is a clinico-radiological syndrome due to disturbances in the blood-brain barrier that cause vasogenic oedema. It has been postulated that PRES is caused by disturbances of cerebral autoregulation secondary to acute hypertension, and this is often seen in patients with acute kidney injury. We report a case of PRES in a 6-year-old girl with severe polyserositis and acute kidney injury. She had no neurological symptoms at presentation, and was covered initially for sepsis despite no positive culture. The autoimmune screen was negative. On day 13 of admission, she developed right-sided focal seizures. Clinical examination showed upper motor neuron signs. Pupils were reactive, and consciousness was intact. A contrast-enhanced computed tomography of the brain suggested vasogenic oedema with prominent sulci and ventricles. Subsequently, magnetic resonance imaging of the brain confirmed the diagnosis. She was started on intravenous phenytoin, and no further seizures were observed. A clinical examination one week later showed normal neurological findings. Consequently, phenytoin was gradually tapered, and she remains well with no sequelae. Symptoms of PRES are typically preceded by hypertension or pronounced fluctuations in blood pressure. There are limited reports of PRES in pediatric patients with normal blood pressure. Despite clinical suspicion of an autoimmune disorder, this patient did not fulfil the criteria for systemic lupus erythematosus, and all autoimmune markers were negative. She was later subsequently diagnosed with diffuse large B-cell lymphoma and succumbed to the disease one year later. Furthermore, this patient demonstrates frontal lobe involvement and microhemorrhages, which are absent in adult cohorts but are consistent with previous reports in children with PRES. The clinical and radiological manifestations of PRES remain elusive in the pediatric population and warrant further research.
Non-invasive ventilation (NIV) supports breathing without endotracheal intubation, lowering the risk of airway injury, sedation-related instability, hospital-acquired infections, and ventilator-associated complications. Growth in publications accelerated during and after the coronavirus disease-2019 (COVID-19) pandemic, yet regional representation of evidence remains uneven. Bibliometric synthesis is useful to clarify research structure, influence, collaboration intensity, and unmet scientific priorities in pediatric NIV. To analyze global publication trends, thematic clusters, and research-collaboration networks in pediatric NIV literature from 2013 to 2023. A systematic search of Scopus metadata was performed on July 23, 2024, using TITLE-ABS-KEY (non-invasive AND mechanical AND ventilation AND pediatric) and restricted to English-language publications (2013-2023). A total of 358 records were analyzed using Scopus analytics to assess annual output, author and institutional productivity, country contributions, keyword co-occurrence, and international co-authorship mapping. Frequently cited studies underwent a narrative review to provide clinical-translational context. Of the 358 documents, 276 (77.1%) were research articles and 55 (14.4%) were reviews. Publication output fluctuated between 2013 and 2018, followed by a steep and sustained rise from 2019 to 2023. The most prolific countries were the United States, Canada, and Spain, whereas Southeast Asia contributed a smaller share, highlighting opportunities for expansion in that region. Highly productive authors included Emeriaud G., Jouvet P., and Essouri S. Four major keyword clusters were identified: respiratory insufficiency, mechanical ventilation, continuous positive airway pressure (CPAP)/bronchiolitis, and acute respiratory distress syndrome/extubation failure. Overlay mapping revealed an increasing interest in CPAP, weaning/extubation outcomes, viral infection (COVID-19), and mortality-related metrics from 2020 to 2023. Pediatric NIV research is expanding, evolving from neonatal oxygenation and interface topics toward broader prognostication, de-escalation safety, and hard clinical outcomes. Underrepresented regions, including Southeast Asia, present clear potential for collaborative research. Future work should standardize criteria for early NIV success and failure and directly compare high-flow nasal cannula with CPAP/non-invasive positive pressure ventilation across diverse pediatric settings.
Congenital inguinal abnormalities in females vary from benign to potentially life-threatening etiologies. Canal of Nuck hernia is one such condition. Cases with ovarian prolapse, though initially asymptomatic, pose a significant risk of torsion, potentially impacting future fertility and therefore warrant timely surgical management. Herein, we report a case of bilateral canal of Nuck hernia with ovarian herniation in a female infant with a history of prematurity. An appropriate presumptive diagnosis, in conjunction with confirmatory ultrasound, is mandatory to help general pediatricians, pediatric surgeons, and emergency physicians manage cases promptly, as early intervention can significantly reduce the anticipated morbidity.
Introduction: Childhood poisoning, resulting from exposure to various substances through ingestion, inhalation, or contact, is a major global health concern. In India, the increased availability of household, agricultural, industrial, and pharmaceutical chemicals has led to an increased incidence of accidental poisonings among children aged 1-5 years. This study examines the prevalence, types, and outcomes of childhood poisoning in India, highlighting the role of sociodemographic factors and parental behaviors. Hospital data underscore the need for improved education and safety practices, including effective counseling and strategies to support behavioral change, to reduce incidents and improve long-term outcomes. Methods: This prospective study was conducted in a tertiary-care hospital in North India from December 2022 to August 2023 to analyze the burden and types of childhood poisoning and to assess the influence of sociodemographic factors using the modified Kuppuswamy scale (2023). Secondary outcomes included clinical outcomes and post-counseling behavioral changes, assessed at the two-month follow-up. Follow-up, conducted through telephonic consultations, evaluated late sequelae, repeat poisonings, and changes in safety practices. Results: One hundred and two pediatric poisoning cases were enrolled, representing 1.53% of all pediatric emergencies (n=6630). Most cases occurred in children aged 1-5 years (74.7%, n=76), predominantly male (66.7%, n=68), with higher incidence in metropolitan areas (62.7%, n=64) and in lower socioeconomic groups (81.4%, n=83). Household cleaning agents (40.2%, n=41) and hydrocarbons (23.5%, n=24) were the leading causes, reflecting
Introduction Pediatric acute liver failure (PALF) is a life-threatening multisystem disorder characterized by rapid hepatic dysfunction. This study aimed to describe the etiologies, intensive care management, and outcomes of children with PALF admitted to a tertiary pediatric intensive care unit. Methods We retrospectively reviewed 53 children with PALF admitted to our pediatric intensive care unit between January 2014 and December 2019. Demographic characteristics, etiology, intensive care interventions, and clinical outcomes were analyzed. Results Toxic or drug-induced causes (43.4%) and indeterminate etiologies (32.1%) were most frequent. Twenty patients (37.7%) required invasive mechanical ventilation, 22 (41.5%) underwent plasma exchange, 11 (20.8%) received continuous renal replacement therapy, and 7 (13.2%) underwent liver transplantation. The mean pediatric intensive care unit stay was 7.4 +/- 9.0 days. Patients with toxic/drug-induced PALF required fewer interventions and had lower sepsis rates than those with other etiologies (p<0.01). Conclusion Early recognition and comprehensive supportive care improve outcomes in children with PALF. Toxic or drug-induced PALF is associated with a milder clinical course. Continuous assessment of prognostic indicators is essential to guide management and decisions regarding liver transplantation.
Introduction: The aim of this study was to determine the surgical risks in patients with Down syndrome (DS) and cardiac pathology. We aim to share our single-center experience and identify risk factors among patients with DS undergoing cardiac surgery. Patients under the age of 18 who underwent cardiac surgery at Hacettepe University between 1996 and 2019 were included. Methods: This retrospective cohort study included all pediatric patients with DS who underwent surgery for congenital heart disease (CHD). Results: A total of 175 patients were included in the study. Seventy-five patients (42.8%) were male and the median age of the patients was 7 months (1-86 months). The most common cardiac pathology was atrial septal defect (19.2%), followed by atrioventricular septal defect (18.7%) and ventricular septal defect (11.3%). According to the risk adjustment for congenital heart surgery classification, most patients were in category 2 (41.7%) and category 3 (42.3%). Sixty-one patients (34.9%) were diagnosed with systemic inflammatory response syndrome (SIRS) in the postoperative period. Seven patients (3.4%) needed extracorporeal membrane oxygenation. Overall mortality was 30.3%. Conclusion: This single-center study characterized the pattern of CHD in a specific cohort of patients with DS and identified risk factors associated with cardiac surgery. Postoperative SIRS and high-risk surgical procedures were associated with an increased risk of mortality.
Introduction: Pediatric head trauma is one of the leading causes of emergency visits and can result in serious complications. Parents, often the first responders in such situations, generally lack adequate knowledge of appropriate first-aid. Educational interventions may help bridge this gap and improve emergency preparedness. This study aimed to evaluate the effectiveness of a short-duration first-aid training program in improving parents' knowledge of pediatric head trauma. Methods: A pre-test-post-test interventional design was used to assess the effectiveness of first-aid training. The study was conducted among 101 parents at a primary healthcare center in T & uuml;rkiye. Participants received a 15-minute structured first-aid training focused on the signs and symptoms of pediatric head trauma and on appropriate emergency responses. A 13-item knowledge questionnaire was administered before and after the training. Data were analyzed using paired samples and independent-samples t-tests, as appropriate. Results: The mean total knowledge score increased significantly from 10.47 +/- 1.54 (pre-test) to 11.81 +/- 1.52 (post-test) (p<0.001). The effect size (Cohen's d =0.88) indicated a strong impact. Comparison of sociodemographic characteristics and average knowledge scores between groups showed statistical significance (p<0.001). Parents of children who had experienced head trauma or emergency department visits exhibited notably higher post-test scores. Conclusion: Short, structured first-aid training significantly improves parental knowledge of pediatric head trauma. Incorporating such programs into routine pediatric and community health services may enhance early recognition and response to head injuries.
Energy drinks are sugary beverages containing stimulant compounds that are marketed as providing mental and physical stimulation. Consumption of energy drinks has been associated with tachycardia, and in rare cases, myocardial infarction, myocardial injury and sudden cardiac arrest. In this study, we present the case of a 14-year-old male who experienced severe myocardial injury following repeated consumption of energy drinks. This previously healthy patient presented at the hospital complaining of palpitations, chest pain, breathlessness and vomiting following the consumption of four energy drinks. He was admitted to the intensive care unit due to clinical signs of cardiogenic shock and pulmonary oedema. His echocardiogram revealed ventricular dysfunction and his laboratory findings showed elevated cardiac enzymes and electrocardiogram evidence of myocardial injury. After excluding other possible infectious and non-infectious causes, myocardial injury due to energy drink consumption was suspected. The patient was given oxygen, intravenous fluids, epinephrine, milrinone and diuretics. His clinical and laboratory findings improved completely during follow-up and he was discharged in good health. In conclusion, we would like to emphasise that energy drinks, which are increasingly consumed during adolescence, can cause serious, life-threatening myocardial damage in children when consumed repeatedly and in large quantities.
Introduction As the benefit of many pharmacologic treatments for bronchiolitis is a source of debate, investigations of more effective, easy-to-apply treatment modalities of acute bronchiolitis remain up-to-date. Methods In this study, nebulised salbutamol plus standard oxygen (S) and HFNC (HF) therapies were administered to children younger than two years of age, with a respiratory clinical score (RCS) >= 4 points, who presented with a first episode of acute bronchiolitis. Results The mean age of 72 patients was 7.8 +/- 0.4, and 59.7% were younger than six months. The mean RCS of the patients at admission was 8.42 +/- 2.026 points. A significant decrease was observed in the mean RCS scores evaluated at 1-2-4-8 hours, from the first hour (p<0.05). The mean length of hospital stay and duration of oxygen therapy were 70 +/- 64.6 (4-288) and 67.7 +/- 62.2 (4-264) hours. Within the first few days after discharge, 50% of the patients returned to the pediatric emergency department (PED). The mean RCS showed a difference in favour of the HF group from the second hour of treatment (p=0.002). Expected improvement was not observed in 17.1% of the patients in the S group only, thus HF should be added. Patients in the HF group and patients in whom HF was added to S had higher hospitalisation rates (p=0.017), longer hospital stays (p=0.002), and longer duration of oxygen therapy (p=0.001). Re-admission to PED after discharge was observed in 64.2% of the cases in the S group only (p<0.001). Conclusion In this study, it may be said that HFNC treatment provides earlier and faster clinical improvement in children with bronchiolitis and reduces re-admissions related to the same disease.
