Neonatal sepsis remains one of the leading causes of mortality among newborns, with Klebsiella pneumoniae being one of the most common etiological agents. This article presents the first successful case in Kazakhstan of hemofiltration use in a neonate with sepsis caused by Klebsiella pneumoniae ESBL 10⁷ CFU/ml. The case highlights the clinical characteristics, decision-making process, and effectiveness of prolonged veno-venous hemofiltration (PVVHF) as adjunctive therapy. Hemofiltration contributed to hemodynamic stabilization, correction of metabolic acidosis, reduction of inflammatory markers, and successful extubation, demonstrating the potential role of extracorporeal therapies in critically ill neonates.

Background: Levosimendan is a calcium-sensitizing inotrope with vasodilatory properties, shown to improve cardiac output and reduce mortality in adults with advanced heart failure. However, data on its safety and efficacy in neonatal cardiac surgery are limited.Objective: To evaluate the intraoperative use of levosimendan in neonates with complex congenital heart defects (CHDs) undergoing open-heart surgery.Methods: We conducted a retrospective observational study of 59 neonates aged 2–30 days who underwent surgical correction of complex CHDs with cardiopulmonary bypass. Levosimendan was administered intracoronarily as part of the blood cardioplegia protocol in doses of 25–45 mcg/kg.Results: Compared to historical controls, the levosimendan group demonstrated a significant reduction in postoperative catecholamine requirements, including adrenaline and norepinephrine. In 12% of cases, surgery was completed without the use of any catecholamines. No rhythm disturbances were observed. The positive inotropic effect lasted up to 72 h without systemic hypotension. Median adrenaline doses were significantly lower (p < 0.05), and norepinephrine use was reduced from 12% to 5%.Conclusions: Intracoronary administration of levosimendan during neonatal cardiac surgery appears to reduce catecholamine dependence and support myocardial recovery without causing rhythm disturbances or hypotension. Further randomized controlled trials are needed to validate these findings.

Background: The global healthcare landscape is increasingly shaped by two pivotal trends: the adoption of international quality frameworks, such as Joint Commission International (JCI) accreditation, and the strategic shift towards resource-efficient models like outpatient surgery. While JCI is the gold standard for hospital risk management and outpatient surgery is a key driver of efficiency, a critical disconnect exists in both research and policy. The applicability and impact of hospital-centric JCI standards within the unique operational context of ambulatory surgery remain a critical blind spot. The present scoping review aims to systematically map the evidence regarding the association between JCI accreditation and outpatient surgery, identify critical knowledge gaps, and highlight implications for healthcare contexts. Methods: The scoping review was performed in accordance with the PRISMA-ScR guidelines. A comprehensive search of major databases (i.e., PubMed/MEDLINE, Scopus, and Web of Science) was conducted for the period 2000–2025. Data extraction was centered on study design, interventions, and key findings related to quality and risk management. Results: Our analysis of 80 included publications revealed a key finding: the literature on JCI accreditation and outpatient surgery exists in two separate, non-overlapping silos. A complete absence of empirical studies directly evaluating the implementation or effectiveness of JCI accreditation within outpatient surgery centers was identified. Conclusions: The review revealed a critical evidence gap concerning integrated risk management in ambulatory settings. This finding highlights an urgent need for further research to inform evidence-based healthcare policy and ensure patient safety in the growing field of outpatient surgery.

Background: The global healthcare landscape is being increasingly shaped by two pivotal trends: the adoption of international quality frameworks, such as Joint Commission International (JCI) accreditation, and the strategic shift towards resource-efficient models like outpatient surgery. While both areas have been extensively addressed in the healthcare literature, empirical evidence concerning their intersection remains limited. This scoping review aimed to systematically map the available literature, identify critical evidence gaps at the intersection of JCI accreditation and outpatient surgery, and examine implications for healthcare risk management and policy development. Methods: The scoping review was performed in accordance with the PRISMA-ScR guidelines. A dual-track evidence-mapping strategy was implemented across seven electronic databases and platforms (PubMed/MEDLINE, Scopus, Web of Science, Cochrane Library, eLIBRARY.ru, CyberLeninka, and Google Scholar) to search for publications published between January 2000 and May 2026. The final database searches were conducted on 15 May 2026. Data extraction was centered on study design, interventions, and key findings related to quality and risk management. Results: A total of 80 publications were included. The evidence comprised two complementary streams: literature concerning JCI accreditation and healthcare quality and safety, predominantly in hospital and general healthcare settings, and literature concerning outpatient, ambulatory, and day-surgery quality, safety, and hospital-substituting technologies. No empirical study directly evaluating the implementation or impact of JCI accreditation within outpatient surgery centers was identified. Conclusions: This scoping review identified a critical empirical evidence gap concerning the integration of accreditation and quality and risk-management frameworks in outpatient surgical settings. A hypothesis-generating conceptual framework is proposed to guide future empirical research evaluating whether and how JCI accreditation influences quality, safety, organizational, and economic outcomes in outpatient surgical settings.

Background: Multiple organ dysfunction syndrome (MODS) remains a major challenge in the intensive care of neonates and infants and is associated with substantial morbidity and mortality, particularly in the presence of sepsis and acute kidney injury. Conventional kidney replacement and detoxification strategies may be difficult to implement in neonates and low-weight infants because of technical and physiological limitations. Hemodiafiltration (HDF), which combines convective and diffusive clearance mechanisms, has emerged as a potential extracorporeal support modality for metabolic and inflammatory control while maintaining hemodynamic stability. Objective: To provide a structured narrative review of the available literature on the clinical applications, potential benefits, safety considerations, and technical aspects of hemodiafiltration in neonates and infants with multiple organ dysfunction syndrome. Methods: This study was conducted as a structured narrative review with systematic search elements. PubMed, Scopus, Web of Science, and the Cochrane Library were searched for publications from January 2018 to October 2025. Earlier landmark publications identified through reference-list screening were additionally included to provide historical and technical context. A structured search and descriptive selection process was used to identify publications relevant to extracorporeal blood purification in neonates and infants. Eligible populations included neonates (<28 days of life) and infants beyond the neonatal period (28 days to <12 months) weighing ≤8 kg with MODS, sepsis, hyperammonemia, or acute kidney injury. Observational studies, case series, registry reports, and review articles addressing HDF or continuous kidney replacement therapy (CKRT) were considered. Studies involving broader pediatric populations were included only when relevant data for eligible neonatal or infant subgroups were separately available. Publications lacking clinically relevant information were excluded from the descriptive synthesis. Owing to substantial heterogeneity in study designs, patient populations, and reported outcomes, findings were synthesized descriptively. Results: The reviewed literature suggests that HDF may be associated with metabolic stabilization, correction of acid–base disturbances, and improvement in electrolyte balance in selected neonates and infants. Limited case-based evidence has also described hemodynamic stabilization and reduced vasopressor support following extracorporeal therapy; however, these observations remain insufficient to establish a causal treatment effect. Clinical outcomes varied substantially across studies because of differences in patient characteristics, clinical indications, and treatment protocols. Reported complications included hypotension, circuit clotting, and coagulation abnormalities, although their frequency and clinical significance differed considerably among publications. Conclusions: Current evidence suggests that hemodiafiltration may represent a promising extracorporeal support strategy for selected neonates and infants with MODS, particularly for metabolic stabilization and organ support. However, the available evidence remains limited, heterogeneous, and predominantly based on observational studies and case series. Further multicenter prospective studies are required to clarify optimal indications, treatment protocols, and long-term outcomes.