Turkish J Pediatr
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Mechanical ventilation can be lifesaving, but > 50% of complications in conditions that require intensive care are related to ventilatory support, particularly if it is prolonged. We retrospectively evaluated the medical records of patients who had mechanical ventilation in the Pediatric Intensive Care Unit (PICU) during a follow-up period between January 2002-May 2005. Medical records of 407 patients were reviewed. ⋯ The complication ratio of mechanically ventilated children was 42.8%, and diversity of complications was as follows: 26.3% atelectasia, 17.5% ventilator-associated pneumonia, 13.1% pneumothorax, 5.4% bleeding, 4.3% tracheal edema, and 2.1% chronic lung disease. The mortality rate of mechanically ventilated patients was 58.3%, but the overall mortality rate in the PICU was 12.2%. In conclusion, there are few published epidemiological data on the follow-up results and mortality in infants and children who are mechanically ventilated.
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Comparative Study
Factors influencing outcome of inpatient pediatric resuscitation.
The aims of this study were: 1) To define the rate of long-term survivors (LTS) after cardiopulmonary resuscitation (CPR) in children; 2) To identify the predictors of survival in pediatric resuscitation; and 3) To assess the outcome six months after discharge. Three groups of patients were identified based on outcome: 1. Long-term survivors (LTS), who were discharged, 2. ⋯ Four patients had neurological sequelae. Less than 5 minutes' duration of CPR and reactive pupils at the onset of cardiopulmonary arrest (CPA) were the most important factors that predicted long term survival. We suggest that a positive pupillary light reflex at the onset of CPA and the duration of CPR should be considered as important predictors of survival in children with CPA.
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Case Reports
Successful bone marrow transplantation in an 8-month-old patient with chronic granulomatous disease.
An eight-month-old boy with chronic granulomatous disease (CGD) received HLA identical sibling bone marrow transplantation (BMT) following busulphan and cyclophosphamide conditioning. No graft-versus-host disease was demonstrated. Five years after transplantation, mixed chimerism was 60% in peripheral blood, and 85% of his neutrophils had normal oxidative burst activity. ⋯ In this period, he experienced no severe infectious diseases. To our knowledge, this is the first case of CGD who had BMT in Turkey. His successful outcome illustrates that BMT in a patient with CGD in the first years of life should be considered early if an HLA-matched donor is already available, before development of any recurrent life-threatening infections or irreversible organ damage.
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The appropriate treatment of ventilator-associated pneumonia (VAP) must be based on accurate diagnosis, which can be done by microbiological examination of the samples obtained from the respiratory tract by nonbronchoscopic bronchoalveolar lavages (NB-BAL). This study was designed to determine the effectiveness of NB-BAL in diagnosing VAP in newborns. Two hundred and seven NB-BAL samples were obtained from 145 intubated neonates for microbiologic and cytologic evaluation of the distal airway. ⋯ The sensitivity and specificity of PMNs in NB-BAL fluid for the diagnosis were 86% and 75%, respectively, and the positive and negative predictive values were 89% and 69%. We conclude that NB-BAL lavage is well tolerated and clinically useful in mechanically ventilated newborns. These results suggest that NB-BAL fluid microscopic examination and cultures can offer a sensitive and specific means to diagnose VAP in newborns and may provide relevant information about the causative pathogens.
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Acute hemorrhagic edema of infancy is a cutaneous leukocytoclastic vasculitis, clinically characterized by the acute development of peripheral edema and targetoid purpuric lesions on the face and extremities. The clinical picture has a violent onset with a short benign course followed by spontaneous complete recovery. We describe a five-month-old boy with acute hemorrhagic edema, in whom the disease appeared after antibiotic treatment for a cellulitis in front of the tragus.