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    Cardiac failure in a child with tuberculous meningitis as a complication of Paroxysmal sympathetic hyperactivity
    (Turkish J Pediatrics, 2022) Ozkaya, Pinar Yazici; Turanli, Ese Eda; Ari, Hatice Feray; Kurt, Serap; Karapinar, Bulent
    Background. Paroxysmal sympathetic hyperactivity (PSH) is a disorder due to the loss of regulation of autonomic activity. The most common condition predisposing to the development of PSH is traumatic brain injury (TBI), followed by anoxic brain injury, stroke, tumors, and infections. Awareness about the condition and early recognition is important to avoid life threatening complications. Case. We report a 4-year-old child with tuberculous meningitis with symptoms of PSH who developed cardiac failure. PSH episodes were treated with beta blocker, benzodiazepine, morphine, dexmedetomidine, baclofen, and tizanidine. Three weeks after readmission PSH episodes decreased and the patient was transferred to the general ward. Conclusions. PSH assessment tool has benefits such as monitoring the patient, evaluating response to treatment and early diagnosing PSH patients.
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    Characteristics of Pediatric Intensive Care Patients Following the 2020 Izmir Earthquake
    (Galenos Publ House, 2023) Turanli, Ese Eda; Ozkaya, Pinar Yazici; Koc, Gulizar; Ersayoglu, Irem; Karapinar, Bulent
    Aim: Unforeseeable disasters such as earthquakes can lead to significant catastrophes. Early and effective treatment methods are life-saving in reducing post-earthquake mortality and morbidity. The aim of this study was to evaluate the treatment and outcomes of patients with crush injuries in the Izmir earthquake. Materials and Methods: Eight patients, 2 male, and 6 female were admitted to the intensive care unit. The medical records of these 8 crush injury patients were retrospectively reviewed. Results: Eight children rescued from rubble were admitted to the pediatric intensive care unit, and one of them died. The median age of the patients was 148.5 (range, 35 to 210) months and the median PRISM score was 4 (interquartile range 0-31). The median duration of being trapped under the rubble was 23 (range: 4 to 92) hours. Conclusion: Crush syndrome is a life-threatening event. The authors believe that early transportation and immediate intensive care therapy would have improved survival rates.
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    First Successful Organ Procurement From a Pediatric Patient With a Nonpulsatile Ventricular Assist Device
    (Baskent Univ, 2022) Ozkaya, Pinar Yazici; Turanli, Ese Eda; Metin, Hamdi; Ari, Hatice Feray; Tuncer, Osman Nuri; Karapinar, Bulent
    Left ventricular assist devices have become an important therapeutic option as a mechanical circulatory support system in the treatment of end -stage heart failure. Organ transplants from brain dead donors on mechanical circulatory support are rare. In the literature, many successful solid-organ transplants have been reported using these donors. However, to our knowledge, this is the first report of successful solid-organ transplant from a child donor with a nonpulsatile ventricular assist device.
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    Impact of Decompressive Craniectomy on Diagnosing Brain Death in Children
    (Aves, 2024) Ekici, Betul; Ersayoglu, Irem; Ozkaya, Pinar Yazici; Cebeci, Kubra; Koc, Gulizar; Turanli, Ese Eda
    Objective: In this study, we aimed to evaluate the effects of decompressive craniectomy (DC) on the brain death (BD) determination process in the pediatric intensive care unit (PICU). Materials and Methods: All children who were diagnosed with BD in the PICU between 2009 and 2020 were included in this study. Patient demographics, causative mechanisms, BD examinations, and ancillary tests used were recorded. The time intervals (from PICU admission to first BD examination, from first BD examination to BD diagnosis) and number of BD examinations were compared between patients with and without DC. Results: During the study period, 70 pediatric cases were diagnosed with BD among 513 total deaths (13.6%). Their median age was 54.5 months [interquartile range (IQR): 24-140]. Transcranial Doppler ultrasound (TCD) was performed in 66 patients (94.3%). The most common combination of ancillary tests was the apnea test and TCD combination, which was performed in 56 patients (80%). Thirty-four children (48.6%) experienced immediate surgery for DC. Patients with DC had a higher median number of BD examinations than patients without DC [3 (IQR: 2-3) vs. 2 (IQR: 1-2), P < .001]. The patients with DC had a longer time interval between the first examination and declaration of BD than patients without DC [45.5 hours (IQR: 21.7-91.7) versus 15 hours (IQR: 2-31.2), P < .006]. Conclusion: Decompressive craniectomy may complicate BD determination and cause challenges for brain death diagnosis based on cerebral flow imaging techniques. The lack of specific recommendations for this patient group in the guidelines causes a delayed diagnosis of BD.
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    Impact of the COVID-19 Pandemic on Pediatric Intensive Care Unit Admissions: A Single Centre Experience
    (Galenos Yayincilik, 2022) Ozkaya, Pinar Yazici; Ari, Hatice Feray; Bas, Ilke; Turanli, Ese Eda; Karapinar, Bulent
    Aim: During the coronavirus disease-2019 (COVID-19) pandemic, pediatric emergency department visits and pediatric intensive care unit (PICU) admissions were significantly decreased. This study aimed to evaluate the impact of prevention strategies on PICU admissions during the COVID-19 outbreak. Materials and Methods: We included all patients admitted to a PICU from March 15th to September 15th 2020, and those admitted in the same period in 2019. Incidence rates ratios (IRR) between the 2019 and 2020 cohorts (IRR-1) and restriction periods (March 2020-June 2020) and post-restriction periods (July 2020-September 2020) (IRR-2) were computed using Poisson modelling according to the data distribution. We analyzed the number of PICU admissions and the patient characteristics. Results: A total of 437 patients from 465 admissions were included. In 2020, the number of PICU admissions significantly decreased by 65% compared to 2019 [0.355 (0.287-0.440)]. During the restriction period, the number of PICU admissions was significantly tower by 40.3% compared to the post-restriction period [0.597 (0.493-0.722)]. Lower respiratory tract infections (LRTIs) significantly decreased by 19% in the post-restriction period compared to the restriction period [0.811 (0.684-0.960)]. Cardiopulmonary arrests before PICU admission were significantly higher during the restriction period compared to the post-restriction period (15.5% vs 4.8%, p<0.015). Conclusion: It was shown that there was a significant decrease in all PICU admissions, especially those due to LRTIs during the COVID-19 period. During the restriction period, cardiopulmonary arrest prior PICU admission was higher compared to the post restriction period and 2019. Our study does not reveal an increase in illnesses severity scores but the significant increase in cardiopulmonary arrest may be explained by a delay in health care access and fear of COVID-19 transmission.
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    Severe influenza virus infection in children admitted to the PICU: Comparison of influenza A and influenza B virus infection
    (Wiley, 2022) Yazici ozkaya, Pinar; Turanli, Ese Eda; Metin, Hamdi; Aydin Uysal, Ayca; cicek, Candan; Karapinar, Bulent
    Although the influenza virus usually causes a self-limiting disease, deaths are reported even in children without risk factors. We aimed to identify the clinical features, mortality associated with severe influenza A and B virus infections of children admitted to the pediatric intensive care unit (PICU). We conducted a retrospective study of children with confirmed influenza infection between 2012 and 2019 who were admitted to the PICU. Demographic features, risk factors, clinical data, microbiological data, complications, and outcomes were collected. Over seven influenza seasons (2012-2011 to 2015-2016), 713 children diagnosed with laboratory-confirmed influenza-related LRTI, and PICU admission was needed in 6% (46/713) of the patients. Thirty-one patients (67.4%) were diagnosed with influenza A and 15 patients were diagnosed with influenza B. Epidemiologic and clinical characteristics were similar in both influenza types, lactate dehydrogenase levels were significantly higher for influenza A than for influenza B infections. Although the influenza A to B ratio among the patients admitted to the PICU was 2.06, the percentage of cases requiring PICU admission was nearly two times higher in influenza B cases. There was no statistically significant difference in disease severity and complications in patients with influenza A and influenza B.