INTRODUCTION: We aimed to compare the clinical features and outcomes between single and multiple viral pathogens in children with severe lower respiratory tract infections (LRTIs) in pediatric intensive care unit (PICU).
METHODS: This study was conducted retrospectively in patients who were admitted to PICU between March 2018 and March 2020. All the subjects were divided into two groups. Epidemiologic characteristics, clinical features, disease severity and outcomes compared between single and multiple viral infection groups.
RESULTS: During the study period, positive polymerase chain reaction (PCR) test was revealed in 136 (29%) children among 468 children admitted PICU with the diagnosis of LRTI. Rhinovirus and Respiratory Syncytial Virus (RSV) were the most commonly identified virus (respectively 44.1% and 35.2%). Thirty nine (28,6%) of samples were detected two viruses in PCR tests. Rhinovirus and RSV coinfection was the most common combination (10/39, 25.6%) in our cohort. Multiple viral infection group had higher Pediatric Risk of Mortality Score (PRISM) scores than single virus infection group (10 vs 7, respectively, p=0.009). In multiple viral infection group invasive ventilatory support rate (56.4% vs 36.1%, p=0.030) and noninvasive ventilatory support rate (43.5% vs 6.1%, p=0.018) were significantly higher than in single viral infection group.

DISCUSSION AND CONCLUSION: Lower respiratory multiviral infections are associated with increased invasive and noninvasive ventilatory support requirements. Close monitoring in a unit where these supports can be provided is essential for infants with multiviral LRTIs.

INTRODUCTION: To evaluate the knowledge levels and attitudes of physicians regarding acute management of seizures in pediatric patients.
METHODS: A self-administered questionnaire was distributed electronically to physicians. The participants were divided into 3 groups according to the estimated number of patients managed by the physician due to acute seizures per year; i) group-1: ≤10, ii) group-2: 11-50, iii) group-3: ≥51. Also, the participants were categorized whether they were pediatricians or not. Demographical features, and administration details regarding first- and second-line therapy were questioned. Rates of correct answers were compared between the groups.
RESULTS: A total of 400 physicians responded to the questionnaire. Precisely, 74.5% of participants were pediatricians. The time point t1 for tonic-clonic SE and focal SE with impaired consciousness were the least known details. Rates of correct answers to questions of the maximum number of benzodiazepines in case of ongoing seizures (p<0.001), intravenous diazepam dose (p=0.017), and diazepam infusion time (p=0.034) were significantly higher in group-3. Also, there was a tendency to administer lower doses of levetiracetam (p=0.003) and phenytoin (p>0.001), and prefer longer durations for phenytoin (p=0.003) in group-1 and group-2. Rates of correct answers to questions regarding the approach to patients who presented during the postictal period (p<0.001), the time point t1 for tonic-clonic SE (p=0.07), the maximum number of benzodiazepines in case of ongoing seizures (p<0.001), diazepam infusion time (p<0.001), and co-administered liquid for phenytoin (p=0.043) were higher in pediatricians. Additionally, there was a significant tendency to administer lower doses of levetiracetam (p<0.001) and phenytoin (p<0.001), and prefer longer durations for levetiracetam (p<0.001) and phenytoin (p<0.001) in physicians other pediatricians.
DISCUSSION AND CONCLUSION: There is a wide variation in knowledge levels and attitudes among physicians. Post-graduation education programs focusing on the least-known and important details are needed.

INTRODUCTION: Routes for surfactant administration for RDS has changed from bolus endotracheal administration together with ongoing mechanical ventilation, to INSURE method and finally to LISA. In this study our aim was to compare respiratory outcomes of LISA and INSURE methods for surfactant delivery in VLBW infants.
METHODS: This retrospective, single-center study was performed in a one year period inbetween March 2014-2015. Data of VLBW infants who had diagnosis of RDS and received surfactant treatment via LISA or INSURE techniques were analyzed. Primary outcome of the study was failure of non-invasive respiratory support. Secondary outcomes were bronchopulmonary dysplasia diagnosis and its severity, duration of mechanical ventilation via endotracheal tube, total number of surfactant administered, duration of hospitalization and duration of all sorts of non-invasive respiratory support. Noninvasive ventilatory support failure incidences of LISA group according to gestational ages were also analyzed.
RESULTS: 59 VLBW infants in LISA group and 55 VLBW infants in INSURE group were analyzed. Need for intubation/reintubation (noninvasive ventilatory support failure) was significantly lower in LISA group (31.6% vs 49%, p=0.043). Duration of intubation was significantly longer in INSURE group (0 vs 4 days (median), p=0.001). Both LISA and INSURE treated infants had similar moderate to severe BPD ratios (26.6% vs 32.7%, p=0.306). We did not observe any reported complications during application of both methods. Intubation ratios were lowest in the group with gestational ages 28-296 weeks (25%).
DISCUSSION AND CONCLUSION: LISA technique for surfactant delivery to preterms with RDS is a safe method ending with lower rates of need for intubation/reintubation. Even if no difference in BPD incidences inbetween the two groups was observed at the 36th corrected gestational week, intubation duration of infants was significantly lower in LISA group.

INTRODUCTION: Objective: To determine the dermal progression of neonatal jaundice in newborns under 35 weeks of gestational age and risk factors that affect the dermal progression.


METHODS: Design: Cross-sectional analytical case study
Setting: NICU of the Dokuz Eylül University Hospital
Patients: Eighty-eight preterm newborns under 35 weeks of gestational age
RESULTS: We observed that there is no significant difference between capillary and transcutaneous bilirubin measurements on preterm newborns under 35 weeks of gestational age (Pearson’s rho>75 and p<0,05). And we also observed that transcutaneous bilirubin measurements on preterm newborns under 35 weeks of gestational age; the first day on the back, the fourth day on the forehead and the remaining days on the chest are higher than on the other sides (Friedman test). So for preterm newborns, jaundice progresses in a way rather than cephalocaudal direction wıth progressive hyperbilirubinemia. We didn’t observe the association between the existence of their cephalocaudal progression in preterm newborns and followed laboratory data factors associated with mother and baby. We didn’t observe the association between the existence of their cephalocaudal progression in preterm newborns and followed laboratory data factors associated with mother and baby (Mann-Whitney U p>0,05).

DISCUSSION AND CONCLUSION: Transcutaneous bilirubin measurements could be used for neonatal jaundice of newborns under 35 weeks of gestational age. And also, we need, further studies for comprehensive descriptions of preterm newborns' jaundice progression.

INTRODUCTION: Hospital acquired bloodstream infection (HA-BSI) is a major contributor to morbidity and mortality in preterm, very low birthweight infants, especially in low-to-middle- income countries (LMIC).
METHODS: We conducted a double-blind, placebo-controlled, randomized clinical trial to investigate the effect of a multi-strain probiotic formulation (LabinicTM) on the incidence and severity of HA-BSI in preterm neonates.
RESULTS: Two hundred neonates (100 per arm) were included in the trial. Fifteen neonates developed HA-BSI events (2 in the probiotic arm and 13 in the placebo arm). The median day of life at HA-BSI onset for the probiotic group was 10.5 ±3.54, and placebo group was 11.15 ±6.37. The incidence of HA-BSI in neonates receiving the probiotic was significantly lower compared to those receiving the placebo (0.93 versus 5.99 HA-BSI events/1000 neonate-days; incidence rate ratio (IRR) of 0.156 [95% CI: 0.017 to 0.691], p = 0.0046). Calculating the incidence rate per 1000 neonate-days, the incidence of sepsis/death events was 2.34 in the probiotic, and 6.45 in the placebo group. The IRR of probiotic relative to placebo sepsis/death events was 0.33 (95% CI: 0.11 to 0.97), p =0.043.
DISCUSSION AND CONCLUSION: The use of a multi strain probiotic shows great potential as a cost effective, very low side-effect method of reducing HA-BSI and subsequent mortality in preterm neonates. Multi-strain probiotics (through reduction in HA-BSI events) could potentially reduce the length of hospital stay in preterm neonates and thus be a resource and cost saving intervention. This study showed that a multi-strain probiotic (Lactobacillus acidophilus, Bifidobacterium bifidum and Bifidobacterium infantis) has the potential the reduce HA-BSI, morbidity as well as mortality.

INTRODUCTION: Reliable noninvasive methods are required for the diagnosis of indirect hyperbilirubinemia in infants. We compared the total serum bilirubin level with transcutaneous and bilicam methods.
METHODS: This analytical study was performed in a neonatal intensive care unit of a hospital in Turkey. We included 70 infants whose families gave voluntary and written consent, including infants with a low, medium, and high risk of hyperbilirubinemia, birth weight >1500 g, and late preterm infants. We measured the total serum bilirubin and compared it with bilirubin levels obtained via transcutaneous and bilicam measurement methods. The relationship between data were determined using descriptive statistical methods; continuous data showing normal distribution were analyzed using Pearson correlation coefficient; and data that were not normally distributed were analyzed using Spearman correlation analysis.
RESULTS: A statistically significant and positive correlation was observed between the levels of total serum bilirubin and transcutaneous bilirubin before phototherapy, whereas a moderate relationship was observed in these values after phototherapy (p < 0.01). A significant positive and moderate relationship was observed between the total serum bilirubin levels and bilirubin levels measured using bilicam before phototherapy (p < 0.01), and a weak relationship was observed between these values after phototherapy (p < 0.05).
DISCUSSION AND CONCLUSION: Our results show that considering measurement of total serum bilirubin as a reference method, transcutaneous and bilicam methods can be used as screening methods to detect indirect hyperbilirubinemia.

INTRODUCTION: Micafungin is one of three currently available echinocandin for treatment of candidiasis and candidemia.We aimed to discuss micafungin effectiveness and side effects to treat proven candidemia in children.
METHODS: In this study, children who were treated for micafungin for proven candidemia between May 2017 and October 2019 were included. The time to achieve negative culture, the liver and renal functions as well as blood counts were recorded using hospital data system.
RESULTS: Forty five patients (52.3%) who received micafungin for proven candidemia were included in the study. Median age of the children who received micafungin due to IC was 4 months ( range: 12 days-216 months). Of 45 invasive candidiasis patients, 10 (22.2%) were neonate, 19 (42.2%) were infant,11 (24.4%) were between 1-5 years old, 5 (11.1%) were between 10-18 years old. Median duration of micafungin treatment to culture negativity for C. albicans related (6, 1-26 days) candidemia episodes was shorter than non-albicans Candida spp related (7, 1-35 days) candidemia episodes (p=0.10). Culture negativity could not be achieved at the end of 14th day of micafungin treatment in 15 of the 45 (33.3%) candidemia episodes. The most commonly isolated Candida spp in patients with treatment failure was C. parapsilosis (n=6), followed by C. albicans (n=5), C. guilliermondii (n=1), C.tropicalis (n=2) and C. tropicalis and C. guilliermondii coinfection (n=1) respectively. None of the patients developed side effects due to micafungin treatment.
DISCUSSION AND CONCLUSION: Micafungin was found to be safe and effective for the treatment of culture proven candidemia in pediatric patients, including neonates.

INTRODUCTION: Overall, around 14-18% of Non-AIDS-related deaths are due to liver disease in HIV patients. With a prevalence of 15%, cirrhosis appears to be a more serious consequence. There are many non-invasive markers for assessing liver fibrosis but their utility in pediatric HIV patients has not been explored.
METHODS: To assess the occurrence of liver dysfunction and the levels of combination biomarkers of liver dysfunction (AST/ALT ratio, AST-to-platelet ratio index (APRI), and FIB-4 index) in HIV positive children. A total of 44 HIV positive children aged <15 years attending the ART clinic were enrolled and evaluated for liver dysfunction using noninvasive biomarkers and USG scoring.

RESULTS: Deranged biomarkers- AST/ALT ratios, APRI scores, and FIB-4 index were found in 95%, 6.8%, and 4.5% children respectively. 7% of children showed moderate to severe liver fibrosis on USG scoring.Also, anemia, nevirapine in ART regimen, longer ART duration, immunosuppression, and lower BMI values were found as risk factors associated with deranged biomarkers.
DISCUSSION AND CONCLUSION: Hepatic dysfunction is reflected by deranged AST/ALT ratios among HIV-positive children in this study. Further, the elevated APRI scores and FIB 4 index in some cases signal evolving liver fibrosis.

INTRODUCTION: Idiopathic nephrotic syndrome (NS) is the most common glomerular disorder of childhood. The prognosis is correlated with treatment responsiveness and not renal histopathology. Most of the children experience multiple relapses and there is a risk of long-term drug dependence with possible side effects. Hence there is always a need for markers to assess the long-term outcome even in steroid responders. Urine neutrophil gelatinase-associated lipocalin (u NGAL) is an early risk marker of acute kidney injury and also a marker of progression of chronic kidney disease. Our aim was to determine if urine NGAL could predict steroid responsiveness at the onset which will help in planning and monitoring of treatment in idiopathic nephrotic syndrome
METHODS: A prospective observational study was conducted in children diagnosed with the first episode of idiopathic nephrotic syndrome in a tertiary care teaching hospital from January 2019 to July 2020. Urinary NGAL was done before starting steroids.
RESULTS: Seventy-nine children satisfying the inclusion criteria were included in the study. The mean age was 7.18(±2.86) years. The male: female ratio was 1.25: 1. All 63 children who had urine NGAL less than 10ng/ml responded to the standard dose of steroids at 8 weeks and attained remission. Out of the 16 children with NGAL > 10 ng/ml, 56.3%(n=9) responded to steroids by 8 weeks (intermediate and late steroid responders) and 43.8% (n= 7) were steroid resistant nephrotic syndrome (SRNS). Urine NGAL below 10 ng/ml was associated with steroid responsiveness in the first episode of nephrotic syndrome at 3 months (P value < 0.001).
DISCUSSION AND CONCLUSION: Urine NGAL below 10 ng/ml is an early predictive biomarker of steroid responsiveness in the first episode of idiopathic nephrotic syndrome.

INTRODUCTION: Sustained release of inflammatory mediators, excessive inflammatory response and impaired intestinal epithelial restitution are well-known mechanisms in the pathogenesis of necrotizing enterocolitis (NEC). This study focused on the effect of resveratrol on these pathways.
METHODS: The rat crypt intestinal cell line (IEC-6) culture, application of lipopolysaccharide or a cytokine mixture and a scratch migration assay model was used. Nitric oxide synthase-2 (iNOS) and cyclooxygenase-2 (COX-2), focal adhesion kinase (FAK) and its phosphorylated form (pFAK) levels were assessed.
RESULTS: IEC-6 cells covered 88% of the denuded area in control, 54% in LPS, and 35% in cytomix groups at the 24th hour. The treatment with resveratrol at doses of 0.5, 1 and 5 µM/L before LPS resulted in the repair of 84%, 87% and 76% of the denuded areas, respectively. Likewise, with the cytomix it was 86%, 82%, and 78%. Resveratrol at the dose of 5 µM/L prevented the increase in iNOS levels. All three doses of resveratrol were effective in preventing the increase in COX levels. FAK or pFAK expression remained unchanged in all groups.
DISCUSSION AND CONCLUSION: Resveratrol, being known for the antioxidant features, suppresses excessive inflammatory response and help preservation of mucosal integrity by conservation of epithelial restitution.

INTRODUCTION: During the COVID-19 pandemic, visiting the hospital and getting regular infusions can be compelling for patients with chronic illnesses. Telemedicine may offer a good option for managing chronic diseases such as lysosomal storage diseases (LSD).
METHODS: The LSD patients were contacted by phone from April 2020 to March 2021 at the Unit of Metabolic Diseases of the Ege University during the COVID-19 pandemic. Telemedicine visits were performed at intervals every month or three months, depending on the patients' compliance with treatment.
RESULTS: 92 LSD patients (Mucopolysaccharidosis(MPS) I, MPS II, MPS IVA, MPS VI, MPS VII, Gaucher, Fabry, and Pompe) were included in the study. The total skipped treatment rate within one year was 17.1%. Most of the months of interruption were consonant with the time of social isolation. The treatment interruption in patients under 18 years was lower than in patients over 18 years. A positive correlation was detected between the age of patients and the interruption of treatment.
DISCUSSION AND CONCLUSION: The curfew periods might be one of the causes of missed treatment intervals. Telemedicine is a good option for increasing the continuity of treatments. This study showed that the number of interrupted enzyme replacement treatments could be decreased with ongoing telemedicine visits.

Seizure is a rare symptom of paraneoplastic syndrome seen in neuroblastoma without a previous history. A 4-month-old male patient who was following up with a preliminary diagnosis of an adrenal mass in pediatric oncology was admitted to the hospital with a seizure. A diagnosis of undifferentiated neuroblastoma was made with a biopsy from the adrenal mass. Seizures were resistant to antiepileptic therapy and they were completely under control with steroids on the 4th day of treatment. EEG disturbances disappeared and the neurologic deficit wasn’t detected. This case which was presented with isolated seizure symptoms of neuroblastoma and treated with steroids, was a very rare presentation in which symptoms and EEG disturbances disappeared. In neuroblastoma, autoimmunity may be involved in the pathogenesis of seizures, which is a rare finding of paraneoplastic syndrome and the option of immunotherapy should be considered.

The 45,X/47,XYY mosaicism is an extremely rare genetic disorder with highly phenotypic manifestations such as ovotesticular disorders of sexual development (DSD), mixed gonadal dysgenesis and Turner’ syndrome. Herein, we report two cases with very distinctive phenotypes despite having the same sex chromosome mosaicism of 45,X/47,XYY. It should be kept in mind that the rare type of sex chromosome mosaicism of 45,X/47,XYY may present with genital phenotype ranging from normal female to male characteristics.