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.

Importance This study addresses the characteristics, kidney replacement therapy (KRT) modalities, and outcomes in children diagnosed with crush syndrome following an earthquake in Turkey. Objective To analyze the associations of different KRT modalities with long-term dialysis dependency and length of stay (LOS) in the pediatric intensive care unit (PICU). Design, Setting, and Participants This multicenter, prospective, and retrospective cohort study was conducted across 20 PICUs in Turkey. Participants included children diagnosed with crush syndrome after the 2023 Kahramanmara & scedil; earthquake, and eligibility criteria included age, diagnosis, and need for KRT. Data were analyzed from August to October 2024. Exposure Children diagnosed with crush syndrome who underwent KRT. Main Outcomes and Measures The primary outcome was dialysis dependency at discharge. Secondary outcomes included LOS in the PICU. Results The study included 183 pediatric patients (median [IQR] age, 158 (108-192) months; 49 [54.4%] males) with earthquake-related injury, of whom 90 required KRT. The median (IQR) time under the rubble was 25.7 (1-137) hours. At admission, 51 patients (56.6%) had stage 3 acute kidney injury, and the median (IQR) serum creatinine phosphokinase level was 15 555 (9386-59 274) IU/L. There was a significant association between the Kidney Disease-Improving Global Outcomes (KDIGO) stage at admission and serum creatinine phosphokinase level (area under the curve, 0.750; 95% CI, 0.621-0.879; P < .001). Among patients undergoing KRT, 33 (36.7%) received continuous venovenous hemodiafiltration, and 23 (25.6%) underwent intermittent hemodialysis (IHD). IHD treatment was the only independent factor associated with shorter PICU LOS (odds ratio [OR], 6.87; 95% CI, 1.54-30.67; P = .01). The dialysis dependency at discharge was higher in children who were transferred late to the PICU (beta = 0.003; 95% CI, 0.001-0.005; P < .001) and those with a high Pediatric Trauma Score (beta = 0.022; 95% CI, 0.003-0.041; P = 02). IHD was not statistically significantly associated with remaining dialysis-dependent at discharge (OR, 2.18; 95% CI, 0.53-8.98; P = .28). The overall mortality rate in the cohort was 6 patients (6.6%). Conclusions and Relevance This cohort study found that children who were transferred late to intensive care and those with a high trauma score after earthquake-related crush injury were more likely to remain dialysis-dependent at discharge. Furthermore, KDIGO stage at admission was associated with elevated serum creatinine phosphokinase levels. These findings highlight the critical importance of early intervention and appropriate treatment in children with AKI following prolonged entrapment.

Introduction:In traumatic brain injury (TBI), direct information can be obtained about cerebral blood flow, brain tissue oxygenation and cerebral perfusion pressure values. More importantly, an idea about the changes in these measurements can be obtained with multidimensional monitoring and widely used monitoring methods. Aim of the study:We aimed to evaluate the monitoring of critically ill children who were followed up in our pediatric intensive care unit (PICU) due to TBI. Material and Method:Twenty-eight patients with head trauma who were followed up in our tertiary PICU between 2018 and 2020 were included in the study. Cerebral tissue oxygenation, optic nerve sheath diameter (ONSD), Glasgow coma score (GCS) and Glasgow Outcome Score (GOSE) values were obtained from retrospective file records and examined. Results:Male gender was 71.4% (n=20). When we classified TBI according to GCS, 50% (n=14) had moderate TBI and 50% had severe TBI. On the first day in the poor prognosis group, ONSD and nICP were found to be higher than in the good prognosis group (for ONSD, p=0.01; and for nICP, p=0.004). On the second day of hospitalization, the ONSD and nICP were significantly higher in the poor prognosis group than in the good prognosis group (for ONSD p=0.002; and for nICP p= 0.001). Cerebral tissue oxygenation values measured on the first and second days decreased significantly on the second day in both the good and poor prognosis groups (p=0.03, 0.006). In the good prognosis group, a statistically significant decrease was found in ONSD and nICP measurements taken on the 2nd day compared to the measurements taken at the time of hospitalization (for ONSD p=0.004; for nICP p<0.001). Conclusion:The aim of multidimensional follow-up in traumatic brain injury is to protect the brain from both primary and secondary damage; for this reason, it should be followed closely with multimonitoring methods that are possibly multidisciplinary.

BackgroundTherapeutic plasma exchange (TPE) has been used as a primary or supportive treatment in critical paediatric patients during the clinical course of many diseases.ObjectivesThe objective of this study was to characterise the indications, complications, and outcomes of critically ill children who received TPE in a tertiary referral paediatric intensive care unit (PICU).MethodsThis retrospective observational study was conducted in a tertiary referral 13-bed PICU of a university hospital. Critically ill children, who received at least one TPE procedure, were retrospectively included in the study. TPE was utilised by the same paediatric intensivist in accordance with the American Society for Apheresis (ASFA) guideline between January 2005 and December 2022. The procedures were analysed in terms of technical aspects and complications. Multivariable logistic regression analysis was performed to identify independent risk factors for mortality.ResultsIn total, 1528 TPE sessions were performed on a total of 328 children. The overall TPE utility rate was 25 per 1000 PICU admissions. Primary indications for TPE were sepsis, neurological autoimmune, haematological diseases, acute liver failure, drug overdose, and autoimmune rheumatological disorders in 109 (33.2%), 90 (27.4%), 49 (14.9%), 43 (13.1%), 12 (3.7%), and 10 (3%) of patients, respectively. The distribution of TPE indications according to ASFA categories was as follows: 37 patients (11.3%) were in category I, 44 patients (13.4%) were in category II, and 211 (64.3%) were in category III. Complications were observed in 18.7% of sessions, and the most common complications were haemodynamic (10.8%) and circuit-/catheter-related (7.6%) complications. The mortality rate was 28.4% in the study. Moreover, both Pediatric Index of Mortality 3 score and number of organ failures were found as independent risk factors for mortality.ConclusionsOur results revealed that TPE may be an effective procedure even in critically ill children in accordance with ASFA recommendations. We also showed that mortality rate increased with Pediatric Index of Mortality 3 score at admission and number of organ failures.

Introduction: To evaluate the duration of pediatric intensive care stay, hospitalization and the factors affecting mortality in patients who were operated by pediatric surgery and followed up in pediatric intensive care unit (PICU) in the postoperative period. Methods: One hundred forty-three patients who were operated between September 2018 and January 2020 and hospitalized in the PICU for post-operative follow-up were included in the study. Results: The median age of the 143 patients included in the study was 31.00 (1-205) months, and 76 (53.1%) were male. Ninety-six patients had no comorbidity, 47 patients had at least one comorbidity. The most frequent developed post-operative complications were sepsis (n=7) and intra-abdominal hypertension (n=7). The presence of sepsis extended the intensive care unit stay by 4.46 days, the need for inotropes by 3.61 days, the development of intra-abdominal hypertension by 3.33 days, and the presence of comorbidity by 0.86 days. The presence of sepsis extended the hospitalization period 28.04 days, the need for respiratory support 21.78 days, and the presence of malnutrition 14.42 days. Conclusion: It would be more appropriate to follow-up patients, who are operated by pediatric surgery, especially those with comorbidity and malnutrition, who need intraoperative blood products or who have the risk of developing complications in the postoperative period in PICUs.

OBJECTIVES:To examine citrate anticoagulation in continuous renal replacement therapy (CRRT) in the PICU. DESIGN:Post hoc analysis of a curated, multicenter dataset collected from January 1, 2022, to June 1, 2023. SETTING:Seven PICUs in Turkey. PATIENTS:PICU admissions in need of CRRT, 28 days to 18 years old. INTERVENTIONS:None. MEASUREMENTS AND MAIN RESULTS:In 128 filters used in 73 patients, the effective filter life (EFL) restricted to 72 hours was a median (interquartile range [IQR]) of 40.5 hours (IQR, 21-58 hr); total EFL was a median of 59 hours (IQR, 28-89 hr). Analysis of the receiver operating characteristic curve for initial citrate infusion dose (CID) and whether EFL reached 72 hours identified a cutoff level for initial CID of greater than 2.64 mmol citrate per liter of patient blood flow (mmol/L-bf). As expected, the two filter groups categorized by initial CID (≥ 2.7 vs. < 2.7 mmol/L-bf) showed filters in children receiving higher initial dosing had longer total EFL (72 hr [IQR, 48-104 hr] vs. 38.5 hr [IQR, 18-84 hr]; p = 0.03). We failed to identify an association between CRRT for over 24 or 48 hours and greater odds (odds ratio [OR], 95% CI) of citrate accumulation (OR, 2.23; 95% CI, 0.82-6.13; p = 0.118 or OR, 1.78; 95% CI, 0.84-3.8; p = 0.134, respectively). However, we cannot exclude up to 6.1- or 3.8-fold odds of citrate accumulation; of note, CRRT over 72 hours was associated with greater odds of citrate accumulation (OR, 2.17; 95% CI, 1.01-4.68; p = 0.04). Citrate lock syndrome occurred in eight of 128 (6.3%; 95% CI, 3-11.4%) filters, and resolved without termination of CRRT. On multivariable analysis, a higher patient initial lactate concentration was associated with an 18% (95% CI, 7-30%) greater hazard of developing citrate accumulation. CONCLUSIONS:Citrate anticoagulation for CRRT is an option for children. Choosing an initial CID greater than or equal to 2.7 mmol/L-bf provides longer EFL but with the associated potential of citrate accumulation. Further studies are needed on initial CID and duration of EFL.

Abstract Backgroud: Acute Flaccid Paralysis (AFP) is a syndrome characterized by decreased tone (flaccidity), often presenting with respiratory and bulbar system failure, rapid onset, and weakness in the extremities. Methods: From January 1, 2018 to January 1, 2023, the clinical findings, treatment results, intensive care processes and prognoses of 68 children diagnosed with AFP who applied were evaluated retrospectively. Results: The age range of patients was between one month and 18 years, with a mean age of 7.9 ± 4.5 years. Out of the patients, 33 were male (48.5%).The average pediatric intensive care unit (PICU) stay for all AFP patients was 15.4 ± 19.5 days, and the average hospital stay was 23.3 ± 21.1 days. Among all AFP patients, 42 (61.8%) required respiratory support. All patients received intravenous immunoglobulin (IVIG) treatment. Twenty-five out of 43 Guillain-Barré syndrome (GBS) patients, seven out of 11 and transverse myelitis (TM) patients, and 11 out of 14 acute disseminated encephalomyelitis (ADEM) patients received therapeutic plasma exchange (TPE). Among the 14 intubated GBS patients, five received IVIG treatment for two days or less, and nine received IVIG treatment for four days or more. The invasive mechanical ventilation (MV) durations (in days) showed that patients who received IVIG treatment for four days or more had a significantly longer intubation period (p: 0.044). Out of GBS patients, received only IVIG (monotherapy), and received IVIG and TPE (combined) treatment. The combined treatment group had a longer PICU stay (p: 0.001). Conclusion:In our study revealed that combination therapies (IVIG and TPE or steroid and TPE) led to prolonged MV and PICU stay durations compared to monotherapies (IVIG or steroids) in AFP patients. Moreover showed that in intubated GBS cases, administering 2 g/kg/day IVIG for two days significantly reduced the duration of invasive MV.

Objective: Vital signs and trauma scores of pediatric trauma patients affect morbidity and length of stay in the intensive care unit (ICU); treatment and follow-up of appropriate trauma patients in experienced centers is of great importance. This study aimed to determine the demographic data, clinical findings and scoring systems, and respiratory and circulatory support requirements of trauma patients during their follow-up in the pediatric ICU (PICU) and investigate the effects of these factors on the length of PICU and hospital stay and mortality. Materials and Methods: Demographic and clinical findings of 49 pediatric patients who were hospitalized in the PICU because of trauma were prospectively recorded for 16 months. Data on the length of PICU and hospital stay, trauma mechanisms, and affected organ systems were collected. Results: The most frequent etiology of trauma was falling from heights in 36.7% of the patients. Mechanical ventilation (MV) was necessary in 18.4% of the cases, and the mean duration for MV was 48 (12-306) hours. When MV need was evaluated concerning vital findings, the findings showed that patients with bradypnea needed MV more (p=0.004). MV was needed in 66.7% of hypotensive patients, and there was a statistically significant difference between blood pressure and MV requirement (p=0.005). Glasgow coma score and length of PICU stay were correlated (p=0.02). PICU (p=0.005, p=0.005, p=0.001) and hospital stay (p=0.02, p=0.01, p=0.04) were statistically significantly longer in patients who had blood products, inotropic agents and MV. Conclusion: The effects of initial vital signs and trauma scores on morbidity and length of PICU stay of pediatric trauma patients, as well as the importance of treatment and follow-up of appropriate patients in experienced centers, have been shown in our study.

We aimed to ascertain the prevalence of venous and arterial thrombus, potential thrombosis-inducing factors, and underlying medical conditions in critically ill pediatric patients admitted to our pediatric intensive care unit. We included patients who were admitted to our tertiary pediatric intensive care unit for 24 hours between June 2016 and June 2021 and had venous or arterial thrombosis confirmed by Doppler ultrasonography. Thirty patients with confirmed thrombosis who underwent Doppler ultrasonography and thirty patients without thrombosis, matched based on age and gender, were included in the control group. The female gender accounted for 63.3% of the patients in the thrombosis group. There was no significant gender difference between the thrombosis group and the control group. Age (in months), height, weight, and body mass index measurements were similar in both groups. The most common reason for hospitalization in the thrombosis group was post-operative care (n = 7; 23.3%). Thrombosis typically occurred after a mean of 6.9 +/- 4.9 days of hospitalization. Coagulation parameters, Protein C, Protein S, homocysteine levels, pediatric mortality index (PIM), pediatric risk of mortality (PRISM-2), and Braden Q scores evaluating pressure ulcersdid not differ significantly between the two groups. Eleven patients in the thrombosis group were screened for the prothrombin 20210A mutation, with all results being normal; eleven patients in the patient group were tested for Factor V Leiden mutation, and nine patients in the control group had no mutation. The thrombosis group had a significantly lower rate of mechanical ventilation and hemodialysis. Factors such as trauma, infection, heart failure, malignancy, history of chemotherapy, immobilization, presence of central catheter, history of surgical intervention, family history, and nephrotic syndrome were not significantly associated with thrombosis development. Central venous and arterial catheterization was identified as the most crucial acquired risk factor for thrombosis.

Klebsiella pneumoniae is a significant cause of healthcare-associated infections, resulting in high morbidity and mortality rates due to limited treatment options. In this study, we aimed to evaluate the treatment outcomes and the safety of Ceftazidime-avibactam in infections caused by extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae in pediatric patients. This study included pediatric patients who received ceftazidime-avibactam treatment due to extensively drug-resistant or pandrug-resistant Klebsiella pneumoniae infections, monitored in the pediatric intensive care, neonatal intensive care, and pediatric wards of Cukurova University Faculty of Medicine between 2022 and 2023. Patients' microbiological responses, clinical responses, medication side effects, and 30-day survival rates were evaluated. Eleven pediatric patients were included in the study, of whom nine were male (81.8

Introduction: Sepsis is an important risk factor for morbidity and mortality in children. Early recognition of sepsis as the most important step in reducing morbidity and mortality. Due to the limitations of current diagnostic tests (i.e., poor sensitivity and delayed results), new research is needed to identify sepsis biomarkers. High mobility group box protein-1 (HMGB1) is one of the late mediators of sepsis. Comparing serum HMGB1 levels between healthy children and those with sepsis is the main goal of our research. Methods: This prospective multicenter clinical trial. We prospectively collected 43 cases of sepsis treated (3 months to 17 years old) in two different pediatric intensive care units between January 1 and June 30, 2017. The sepsis group was subdivided into sepsis, severe sepsis, and septic shock. The patient and healthy control groups were compared (n=28). The following clinical situations were noted: Pediatric risk of mortality III (PRISM III) and pediatric logistic organ dysfunction (PELOD) scores; need for mechanical ventilation; presence of septic shock; need for plasmapheresis and renal replacement therapy; and death. Results: Patients with sepsis had significantly increased HMGB1 levels compared with the healthy controls. Serum HMGB1 level was not associated with PELOD and PRISM scores (p>0.05). Serum HMGB1 levels were higher in patients with mortality than in those who survived, but the difference was not statistically significant. Conclusion: Our study results showed that serum HGMB1 levels were higher in children with sepsis than in healthy children, and HMGB1 levels were also higher in patients with septic shock than in those without shock. More research is required to determine the response to therapy in children with sepsis in the pediatric critical care unit by serially measuring serum HGMB1 levels during the follow-up period.

Gaucher disease (GD) is the most frequent lysosomal storage disorder due to biallelic pathogenic variants in GBA gene. Only homozygous D409H variant has been associated with the cardiovascular phenotype which is also known as Gaucher disease type 3c. In this descriptive study, we presented phenotypic heterogeneity and a novel clinical finding among 13 patients with GD type 3c. Patients presented with varying degrees of cardiac valve and/or aortic calcifications (84,6%) and corneal opacities (76,9%) in addition to visceral (100%), hematological (92,3%), neurological (92,3%), and skeletal (30%) manifestations. Also, cervical dystonia (38,4%) and psychiatric disorders (46,1%) were not infrequent entities with respect to neurological involvement in GD type 3c. In this report, we highlight transient neonatal cholestasis (38,4%) as a novel finding in GD type 3c. Neonatal cholestasis is a finding associated with Gaucher type 2, but transient neonatal cholestasis has not been reported in GD patients, so far. The clinical features of GD type 3c are highly heterogeneous, from disease severity or age of onset to disease progression. Also, we concluded that phenotypic spectrum may be associated with age at onset of clinical symptoms. As, patients presenting in infancy or childhood had mainly visceral and hematological involvement and patients presenting in adolescence and adulthood had mainly cardiac, neurological involvement, and psychiatric behavioral disorders. Identifying the heterogeneous clinical course of these patients in this fatal disease, may lead a sufficient understanding of the pathophysiology which will enable targeted therapeutic interventions.

BACKGROUND:The aim of this study was to analyze the characteristics of pediatric posterior reversible encephalopathy syndrome (PRES) to determine clinical and radiologic differences between younger and older age groups, and to identify risk factors for development of any neurologic sequelae.METHODS:The study cohort consisted of confirmed pediatric PRES patients in a tertiary care university hospital from January, 2015, to December, 2020. Demographic and clinical properties, radiological manifestations, and neurologic outcomes were noted. Children aged ≤6 years were compared with those older than 6 years and factors affecting neurologic outcomes were evaluated.RESULTS:The most common underlying diseases were oncological (37%) and kidney diseases (29%). Epileptic seizures were the most frequent symptoms at initial clinical presentation. The regions in the brain that were most commonly involved were the occipital region (n = 65, 96%), the parietal region (n = 52, 77%), and the frontal lobe (n = 35, 54%). Magnetic resonance imaging (MRI) findings were consistent with atypical patterns in most of the study cohort (71%). Patients with unfavorable clinical outcomes (n = 13, 19.1%) had longer initial seizure times and longer encephalopathy times, lower leucocyte and absolute neutrophil counts, and lower neutrophil to lymphocyte ratios. No relationship was found between MRI findings, involvement patterns, and neurologic outcomes.CONCLUSIONS:No clinically specific differences between two different age groups were found. Atypical imaging manifestations of pediatric PRES in our study had an incidence that was as high as those found in earlier adult studies. Multivariate logistic regression analysis showed that the initial neutrophil to lymphocyte ratio, absolute neutrophil counts, and white cell counts could not predict poor neurologic outcomes.

Introduction Traumatic brain injury (TBI) has become a significant cause of death and morbidity in childhood since the elucidation of infectious causes within the last century. Mortality rates in this population decreased over time due to developments in technology and effective treatment modalities.Aim of the study This retrospective cohort study aimed to describe the volume, severity and mechanism of all hospital-admitted pediatric TBI patients at a university hospital over a 5-year period. Material and Methods This was a single-center, retrospective cohort study including 90 pediatric patients with TBI admitted to a tertiary care PICU. The patients' demographic data, injury mechanisms, disease and trauma severity scores, initiation of enteral nutrition and outcome measures such as hospital stay, PICU stay, duration of mechanical ventilation, mortality, and Glasgow Outcome Scale (GOS) were also recorded. Late enteral nutrition was defined as initiation of enteral feeding after 48 hours of hospitalization. Results Of the 90 patients included in the cohort, 60% had mild TBI, 21.1% had moderate TBI and 18.9% had severe TBI. Their mean age was 69 months (3-210 months). TBI was isolated in 34 (37.8%) patients and observed as a part of multisystemic trauma in 56 (62.2%). The most commonly involved site in multisystemic injury was the thorax (33.3%). The length of hospitalization in the late enteral nutrition group was significantly higher than that in the early nutrition group, while the PICU stay was not significantly different between the two groups. The multiple logistic regression analysis found a significant relationship between GOS-3rd month and PIM3 score, the presence of diffuse axonal injury and the need for CPR in the first 24 h of hospitalization. Conclusion Although our study showed that delayed enteral nutrition did not affect neurologic outcome, it may lead to prolonged hospitalization and increased hospital costs. High PIM3 scores and diffuse axonal injury are both associated with worse neurologic outcomes.

Purpose: The aim of this study was to determine the drug-drug interactions that are frequently encountered in critically ill patients and the factors that predict these interactions. Materials and Methods: All patients who were admitted to the pediatric intensive care unit (13 bed) of a university hospital and used more than one drug in their treatment were included in this prospective and cross-sectional study. Patients' demographics, laboratory findings, and medications included in their treatment were evaluated daily by a clinical pharmacist. The UpToDate® database was used to detect potential drug interactions. Results: During the study, 797 potential drug-drug interactions were detected in 55 (83.33%) of 66 patients followed. All these interactions were evaluated by the clinical pharmacist and 114 recommendations were made to the physicians following the treatment regarding these potential interactions. Eighty-five (74.56%) of these recommendations were accepted by physicians. Within the scope of the study, each patient was followed up for a median of 9 (2-63) days, and the median value of potential drug interactions detected during this period was calculated as 7 (1-89). Conclusion: The existence of pDDIs was significantly associated with the number of prescribed medications. Exposure to pDDIs is frequent in critically ill pediatric patients and related to the number of medications. Daily and close cooperation between clinicians and clinical pharmacists is recommended to prevent harmful outcomes of DDIs. In order to minimize this risk, it is recommended to avoid polypharmacy as much as possible and to offer alternatives to inducer and inhibitor drugs in treatment.

Pregabalin is a drug used to treat neuropathic pain, epilepsy, and fibromyalgia. However, the number of reported cases of pregabalin abuse is steadily growing. This case showed dystonia, an effect not previously documented as a consequence of pregabalin administration. A 16-year-old male patient with no known pre-existing medical conditions was admitted to the pediatric emergency department for the first time, complaining of drowsiness caused by pregabalin abuse. During the patient's follow-up, dystonia was observed, and biperiden was administered at a repeating dose. Subsequently, he was moved to the pediatric intensive care unit (PICU) for further tests and treatment. After three days of follow-up, the patient was discharged due to the absence of complaints. This case report presents dystonia resulting from pregabalin abuse, a condition that has not previously been documented in the literature.

Introduction Malnutrition is defined as a pathological condition arising from deficient or imbalanced intake of nutritional elements. Factors such as increasing metabolic demands during the disease course in the hospitalized patients and inadequate calorie intake increase the risk of malnutrition. The aim of the present study is to evaluate nutritional status of patients admitted to pediatric intensive care units (PICU) in Turkey, examine the effect of nutrition on the treatment process and draw attention to the need for regulating nutritional support of patients while continuing existing therapies. Material and Method In this prospective multicenter study, the data was collected over a period of one month from PICUs participating in the PICU Nutrition Study Group in Turkey. Anthropometric data of the patients, calorie intake, 90-day mortality, need for mechanical ventilation, length of hospital stay and length of stay in intensive care unit were recorded and the relationship between these parameters was examined. Results Of the 614 patients included in the study, malnutrition was detected in 45.4% of the patients. Enteral feeding was initiated in 40.6% ( n = 249) of the patients at day one upon admission to the intensive care unit. In the first 48 h, 86.82% ( n = 533) of the patients achieved the target calorie intake, and 81.65% ( n = 307) of the 376 patients remaining in the intensive care unit achieved the target calorie intake at the end of one week. The risk of mortality decreased with increasing upper mid-arm circumference and triceps skin fold thickness Z-score (OR = 0.871/0.894; p = 0.027/0.024). The risk of mortality was 2.723 times higher in patients who did not achieve the target calorie intake at first 48 h ( p = 0.006) and the risk was 3.829 times higher in patients who did not achieve the target calorie intake at the end of one week ( p = 0.001). The risk of mortality decreased with increasing triceps skin fold thickness Z-score (OR = 0.894; p = 0.024). Conclusion Timely and appropriate nutritional support in critically ill patients favorably affects the clinical course. The results of the present study suggest that mortality rate is higher in patients who fail to achieve the target calorie intake at first 48 h and day seven of admission to the intensive care unit. The risk of mortality decreases with increasing triceps skin fold thickness Z-score.

Crush syndrome due to traumatic rhabdomyolysis is one of the most significant problems to occur following earthquakes. On February 6, 2023, millions of people in Turkey were affected by two consecutive Kahramanmaraş earthquakes. The present study reports the analysis of clinical and laboratory findings of crush syndrome in pediatric earthquake victims admitted to our hospital from our region where the earthquake had a devastating effect. Clinical and laboratory findings concerning earthquake victims with crush syndrome were analyzed within the first week to determine what factors are predictive of kidney replacement therapy (KRT). The data of patients were retrospectively collected from medical records. A total of 310 children were admitted as earthquake victims to the pediatric emergency department. Ninety-seven (31

Distal intestinal obstruction syndrome (DIOS), also defined as the equivalent of meconium ileus, is a sign of complete or partial ileocecal obstruction with intestinal contents in patients with cystic fibrosis. DIOS may occur because of darkened intestinal secretions, pancreatic insufficiency, undigested food residues and sticky stool stasis. Patients apply with abdominal swelling, constipation, severe abdominal pain in the form of recurrent cramps and vomiting. In direct abdominal radiographs, dilated small intestines, air-fluid levels or foamy appearances are observed in the ileocecal region. Obstruction developed in patients with cystic fibrosis is treated with medical and surgical methods with a multidisciplinary approach depending on the degree of severity and symptoms. In this paper, two critically ill children with cystic fibrosis were presented who were followed up in the pediatric intensive care unit with a diagnosis of DIOS, with one treated conservatively and the other surgically; the treatment methods were also highlighted.