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. Cite this article as: Ekici B, Ersayoğlu İ, Yazıcı Özkaya P, et al. Impact of decompressive craniectomy on diagnosing brain death in children. Turk Arch Pediatr. 2024;59(1):93-97.

Objective To evaluate the effectiveness and safety of using tigecycline as a salvage therapy in critically ill children who did not respond to other antibiotics. Methods We conducted a retrospective cohort analysis that included children who received tigecycline for at least 48 hours and four doses during their pediatric intensive care unit admission. Demographic and clinical features of the subjects were evaluated through a comprehensive review of medical records. The effectiveness of tigecycline was assessed by thoroughly evaluating clinical and microbiological outcomes. Results During the study period, 72 pediatric patients with 88 episodes of infection received tigecycline according to antimicrobial susceptibility in 62.5% of cases and empirically in 37.5%. The median duration of tigecycline therapy was 10 days (range, 2–33 days). Klebsiella pneumoniae (n = 17, 30.9%) was the most frequently isolated pathogen, followed by Acinetobacter baumannii (n = 10, 18.1%). Ventilator-associated pneumonia was the most common infection (n = 29). Of the 55 isolated pathogens, 43 were multidrug-resistant (MDR), and 2 were extensively drug-resistant (XDR) gram-negative bacteria. Clinical response and microbiological clearance were achieved in 42 and 50.9% of episodes, respectively. The overall mortality was 40.9%, with an attributable mortality rate of 29.5%. Conclusion Tigecycline could be used as a salvage therapy for critically ill pediatric patients infected with MDR or XDR pathogens in the lack of alternative treatment options.

Antimicrobial resistance (AMR) among Gram-negative (GN) pathogens has emerged as a critical global threat, particularly in low- and middle-income countries where access to novel antimicrobials is limited. In Türkiye, colistin (CST) remains a last-resort therapy against multidrug-resistant (MDR) and carbapenem-resistant Gram-negative bacteria (CR-GNB) despite its nephrotoxic potential. This study aimed to evaluate the clinical characteristics, microbiological outcomes, and adverse events associated with CST therapy in pediatric patients over a nine-year period. We conducted a single-center retrospective cohort study including pediatric patients treated with CST for nosocomial MDR-GN infections at a tertiary university hospital between January 2016 and March 2025. Demographic, clinical, microbiological, and treatment-related data were collected. Univariable comparisons and multivariable logistic regression analyses were performed to identify factors associated with nephrotoxicity, treatment failure, and mortality. A total of 117 treatment episodes were identified among 112 patients (mean age: 75.9 ± 69.5 months; 65% male). The predominant pathogens were Klebsiella pneumoniae (39.7%), Pseudomonas aeruginosa (26.4%), and Acinetobacter baumannii (22.0%). CST was used in combination regimens in all episodes, most commonly with carbapenems (73.5%). Microbiological eradication was achieved in 70% of culture-confirmed episodes. The overall sepsis-related mortality rate was 18.8%. Nephrotoxicity occurred in 12.8% of patients and was associated with mortality and severity indicators in univariable analyses. In multivariable analysis, endotracheal intubation remained the only independent predictor of mortality (adjusted OR 23.98, 95% CI 4.47–128.52). Conclusions : CST remains a last-resort agent for MDR and CR-GNB infections in pediatric settings with limited access to novel antimicrobials. Although microbiological eradication was achieved in most cases, treatment outcomes were primarily driven by disease severity and host-related factors rather than antimicrobial combinations. Endotracheal intubation emerged as the strongest independent predictor of mortality. What is Known – What is New • CST is widely used as a last-resort option for pediatric MDR-GN infections. • Nephrotoxicity and variable clinical outcomes remain major concerns. • This study provides long-term real-world pediatric data on CST use. • Disease severity and host-related factors were the main determinants of treatment failure and mortality.

Pediatric candidemia is a major cause of invasive fungal infections in hospitalized children, but long-term data on epidemiology, management, and mortality predictors remain limited. We conducted an 18-year retrospective cohort study of 465 pediatric candidemia episodes at a tertiary referral center in western Turkey between 2008 and 2025. The primary outcome was crude 30-day mortality; associated factors were assessed using univariable analyses, Kaplan–Meier estimates, and multivariable logistic regression. Non-albicans Candida species predominated, with Candida parapsilosis as the most frequent isolate (46%). Central venous catheters were present in 88.4% of episodes. Crude 30-day mortality was 10.8%. Reduced survival was observed among patients without catheter removal and among those with thrombocytopenia, severe neutropenia, or immunosuppressive therapy. Among 341 episodes classified as central line-associated bloodstream infections, crude 30-day mortality differed significantly by catheter removal timing. Mortality was 4.8% with catheter removal within 72 h versus 13.1% without early removal (p = 0.022). Using a 48 h threshold, mortality was 3.1% with removal within 48 h versus 12.3% without removal within 48 h (p = 0.029). In multivariable analysis, failure to remove the catheter was the strongest independent factor associated with mortality (adjusted odds ratio, 6.63; 95% confidence interval, 2.85–15.42; p < 0.001). Antifungal resistance patterns were not consistently associated with mortality. In this large pediatric candidemia cohort, 30-day mortality was mainly associated with host vulnerability and modifiable management factors, underscoring the importance of timely source control.

Calcium channel blockers (CCBs’) and angiotensin receptor blockers (ARBs’) are widely used in clinical practice and are easily available. Intoxication with these drugs results in life-threatening deep vasoplegic shock, making them particularly dangerous, especially for children. Here, we report two patients who ingested amlodipine and irbesartan for suicidal attempts and were unresponsive to all conventional treatments. They were placed on venoarterial extracorporeal membrane oxygenation (VA-ECMO) and hemodynamically stable immediately after extracorporeal life support (ECLS). Patients were successfully decannulated and extubated. CCB and ARB poisoning that are resistant to medical therapy can be treated by ECLS successfully.