Background: This study investigated the relationship between initial lactate levels and both mortality and morbidity in critically ill pediatric trauma patients requiring intensive care.Methods: This retrospective study at tertiary center’s pediatric intensive care unit from January 2020 to June 2024 aimed to characterize trauma patients and assess admission lactate levels' prognostic value.Results: A total of 190 critically ill pediatric trauma patients were included in the study. The mortality rate was 7.9%, with most deaths occurring within the first 48 hours of admission. Initial lactate levels ≥6.9 mmol/L demonstrated moderate predictive power (area under the curve [AUC], 0.878) for mortality. Pediatric Risk of Mortality III (PRISM III) score showed good predictive ability (AUC, 0.922), while Pediatric Trauma Scores exhibited variable predictive performance (AUC, 0.863). Higher initial lactate levels were significantly associated with severe brain injury, the need for intubation, and an increased incidence of thoracic or abdominal injuries.Conclusions: Initial lactate levels and PRISM III score are effective predictors of mortality in critically ill pediatric trauma patients. Lactate levels ≥5 mmol/L upon admission should prompt close monitoring and consideration of aggressive management strategies.

Background: Influenza is a common cause of hospital admissions worldwide, and an increase in influenza cases has been observed following the COVID-19 pandemic. Our study investigated the epidemiological and clinical characteristics of pediatric patients with influenza infection admitted to pediatric intensive care units (PICUs) in Istanbul, Turkey, following the COVID-19 pandemic. Methods: We conducted a retrospective study of pediatric patients with confirmed influenza infection who were admitted to 1 of the 11 PICUs in Istanbul, Turkey, between July 1, 2022, and June 30, 2024. Data on demographic characteristics, risk factors, clinical presentations, microbiological findings, complications and outcomes were systematically collected. Results: A total of 108 children diagnosed with laboratory-confirmed influenza required admission to the PICUs. Sixty-five (60.2%) were diagnosed with influenza A and 43 (39.8%) patients were diagnosed with influenza B. Epidemiologic and clinical characteristics were similar in both influenza types, oxygen saturation was significantly higher in the influenza A group compared to the influenza B group. Severe neurological manifestations, including seizures and encephalitis, were significantly more common in the Influenza A group. In contrast, patients with Influenza B demonstrated a higher incidence of gastrointestinal symptoms, such as nausea, vomiting and abdominal pain. Pneumonia, sepsis and/or multiorgan dysfunction and liver failure were significantly higher in influenza B. Mortality was observed solely in the Influenza B group, with six patients resulting in death, corresponding to a mortality rate of 14%. Conclusions: Influenza virus infection can cause serious multisystem complications such as acute respiratory distress syndrome and encephalitis. Influenza A can present with isolated or predominant neurological manifestations. Mortality may be more common in influenza B.

Background In COVID-19, severe disease course such as need of intensive care unit (ICU) as well as development of mortality is mainly due to cytokine storm. In this study, we aimed to evaluate the high-dose intravenous anakinra treatment response and outcome in patients with severe and critically ill COVID-19 compared to standard of care. Methods This retrospective observational study was carried out at a tertiary referral center. The study population consisted of two groups as follows: the patients receiving high-dose intravenous anakinra (anakinra group) between 01.09.2021 and 01.02.2022 and the patients treated with standard of care (SoC, control group) as historical control group who were hospitalized between 01.07.2021 and 01.09.2021. Results After the propensity score 1:1 matching, 79 patients in anakinra and 79 patients in SoC matched and were included into the analysis. Mean ± SD patient age was 67.4 ± 16.7 and 67.1 ± 16.3 years in anakinra and SoC groups, respectively (p = 0.9). Male gender was 38 (48.7%) in anakinra and 36 (46.2%) in SoC (p = 0.8). Overall, ICU admission was in 14.1% (n = 11) and 30.8% (n = 24) (p = 0.013; OR 6.2), intubation in 12.8% (n = 10) and 16.7% (n = 13) patients (p = 0.5), and 14.1% (n = 11) and 32.1% (n = 25) patients died in anakinra and control groups, respectively (p = 0.008; OR 7.1). Conclusion In our study, mortality was lower in patients receiving anakinra compared to SoC. Intravenous high-dose anakinra is safe and effective treatment in patients with severe and critical COVID-19.

Vaccination programs become increasingly crucial during migratory movements driven by conflict and other disruptions. This study aims to determine the prevalence of childhood vaccination hesitancy among Syrian parents under temporary protection and identify areas for targeted interventions. A total of 227 Syrian parents attending three Immigrant Health Centers in Sultangazi were assessed using the Arabic version of the Parent Attitude about Childhood Vaccines (PACV) survey, conducted between October and December 2023. The prevalence of vaccine hesitancy among these parents was found to be 10.6%. An inverse correlation was observed between maternal education level and vaccine hesitancy, indicating that higher education levels were associated with lower levels of hesitancy. The observed rate of vaccine hesitancy among Syrian parents under temporary protection underscores the urgent need for targeted interventions. Tailored vaccination strategies for immigrant populations are essential to improve immunization rates and ensure the health and well-being of these communities.

Objective: Atropa belladonna, known as the deadly nightshade, is one of the most poisonous plants in the world. Deadly nightshade poisoning in both children and adults has been rarely reported and is mostly in the form of case reports. The aim of this study was to illuminate the findings of weed poisoning in childhood. Materials and Methods: Clinical and laboratory findings of 54 children with acute deadly nightshade and other weed poisoning followed in our center between January 2010 and January 2022, were retrospectively reviewed. Results: In the study analyzing 54 children admitted to the pediatric intensive care unit for poisoning, 24 cases (44.4%) were attributed to deadly nightshade, with the remaining cases involving other weed poisonings. The most common symptoms were flushing, vomiting, mydriasis, gibberish, dry mouth, and tachycardia. Three patients required mechanical ventilation. No patient was dead. Patients were categorized into 2 groups: mild/moderate (no encephalopathy, n : 46) and severe poisoning (with encephalopathy, n : 8). The severe poisoning group had a higher incidence of urinary retention, incoherent speech, dry mouth, agitation, lethargy, convulsions, and coma, which led to longer intensive care unit (ICU) stays and an increased need for respiratory support (P < .05). Furthermore, a statistically significant difference was observed between deadly nightshade poisoning and other weed poisonings, particularly in the presence of symptoms such as headache, flushing, mydriasis, incoherent speech, encephalopathy, convulsions, and coma, all of which contributed to extended ICU stays and elevated respiratory support requirements (P < .05). Notably, neostigmine was administered in all cases of deadly nightshade poisoning due to the unavailability of physostigmine. Our findings showed that the first signs and symptoms of acute deadly nightshade and other weed poisoning may be severe in some children, but no death was observed. Meaningless speech, mydriasis, coma, and lachrymation were negative prognostic signs in childhood weed poisoning. We believe that neostigmine may be an alternative for deadly nightshade poisoning in cases when physostigmine is unavailable. Conclusions: Our study highlights the severity of poisonings involving deadly nightshade and other weeds in pediatric patients. Despite the significant clinical manifestations observed, no fatalities were recorded. The findings underscore the importance of early recognition and appropriate management, emphasizing the need for heightened awareness among healthcare professionals and caregivers. Cite this article as: Botan E, Boyraz M, Yüce S, Erdem Torun Ş. Deadly nightshade (Atropa belladonna) and other weed poisonings in the pediatric intensive care unit: Analysis of 54 children. Turk Arch Pediatr. 2024;59(6):580-585.