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.

Salicylate, also known as aspirin, is utilized in treating many conditions due to its anti-inflammatory, antipyretic and antiaggregant effects. Alongside this, it is infrequently applied topically in dermatological practices due to its fungicidal, keratolytic and bacteriostatic properties. It is important to note that a toxic intake of salicylate can be fatal and may result in a range of metabolic disorders. Salicylate toxicity should be considered in paediatric emergency department patients presenting with tachypnoea and metabolic acidosis on blood gas. A thorough history and physical examination should be selected as the initial evaluation step in approaching the patient. In this case report, we present a 50-day-old patient who was effectively treated with haemodialysis following topical salicylate use for cutaneous scabies.

Objective: The aim of the study was to evaluate respiratory syncytial virus (RSV) infections in cases followed in the pediatric intensive care unit (PICU). Materials and Methods: The study was designed as a prospective cohort in 6 PICUs. There were 3 groups: only RSV (+), RSV (v+) who were positive for another viral agent(s) in addition to RSV, and RSV (b+) who were positive for a bacterial agent(s) in addition to RSV. Results: A total of 119 cases were included in the study, 67 (56.3%) of whom were male. The RSV (+) group had a lower pH compared to the other groups and a higher rate of acute bronc hiolitis/bronchitis diagnoses compared to the RSV (v+) group. The RSV (v+) group had higher bicarbonate levels, higher creatinine levels, longer hospital stays, and higher Pediatric Risk of Mortality-3 scores (PRISM-3) compared to the RSV (+) group. Cases with RSV (b+) were younger and also had lower body weight compared to the other groups. Furthermore, the RSV (b+) group had higher C-reactive protein and Procalcitonin (PCT) levels and higher rates of High Flow Nasal Cannula-Oxygen Therapy (HFNC-OT) use. Multiple linear regression analysis revealed that PRISM-3 score, PCT levels, Pediatric Acute Respiratory Distress Syndrome diagnoses, inhaled steroid use, chronic illness status, and heart rate on admission were associated with the length of stay in the PICU. Conclusion:High flow nasal cannula-oxygen therapy continues to be the most frequently preferred respiratory support method in RSV infections. Viral infections accompanying RSV can increase the severity of the disease. Cite this article as: Koçoğlu Barlas Ü, Akçay N, Telhan L, et al. Respiratory syncytial virus infections in pediatric intensive care: Association of sociodemographic data and clinical outcomes with viral and bacterial co-infections. Turk Arch Pediatr. 2024;59(5):494-500.

Background: This study aims to evaluate the clinical course of human rhinovirus/enterovirus (HRV/EV) infections in the pediatric intensive care unit. Methods: The study was conducted as a multicenter, prospective observational study from September 2022 to December 2022. Cases with positive polymerase chain reaction testing for HRV/EV of nasopharyngeal swab samples within the first 24 hours of pediatric intensive care unit admission were recorded. There were 2 groups: 1–24 months and >24 months. Results: A total of 75 cases (39 male) were included in the study. The median age for all cases was 21 months. The highest polymerase chain reaction positivity rates were observed in October (37.33%). Among the cases, 32 (42.67%) presented with bronchopneumonia/pneumonia, 24 (32%) presented with acute bronchiolitis/bronchitis and 7 (9.33%) presented with sepsis/septic shock. The frequency of pediatric acute respiratory distress syndrome was found to be 6.67%. In the age group of 1–24 months, mean lymphocyte and liver enzyme levels were higher, while in the age group of >24 months, mean hemoglobin and mean kidney function test levels were higher (P ≤ 0.05). Continuous oxygen therapy was provided to 65.3% of the cases, noninvasive ventilation to 33.3%, high-flow nasal cannula-oxygen therapy to 32% and invasive mechanical ventilation to 16%. Conclusions: HRV/EV infections primarily affect the respiratory system and generally exhibit a clinical course with low mortality rates (1, 1.3%). In cases with underlying chronic diseases, more severe clinical conditions such as pediatric acute respiratory distress syndrome and septic shock may occur.

Background/Objectives: Early mortality after pediatric liver transplantation remains a clinical challenge, yet few studies have specifically addressed 30-day outcomes. Conventional pretransplant scores such as the age-appropriate MELD/PELD score were not designed for post-transplant risk prediction. We aimed to evaluate whether dynamic postoperative biomarker trajectories and novel composite ratios can identify high-risk patients. Methods: This single-center retrospective cohort study included 140 consecutive pediatric patients (30 days, n = 129). PRISM-III, PELOD-2, and age-appropriate MELD/PELD scores were evaluated. Serial laboratory parameters were collected at pretransplant and at 0, 24, and 72 h. Delta (Δ) values and composite ratios—including lactate clearance, lactate-to-albumin ratio (LAR), INR×lactate product, platelet ratio, and fibrinogen/INR—were calculated. Penalized logistic regression (Firth method) was used for multivariate analysis. Internal validation was performed using bootstrap resampling (1000 iterations) and leave-one-out cross-validation (LOO-CV). Because two of the three components of the multivariable model (ΔINR, ΔALT) were derived from 72-h values, the model is best understood as a 72-h landmark risk model rather than as an immediate post-transplant early-warning tool. Results: The 30-day mortality rate was 7.9% (11/140), with central nervous system complications as the leading cause (36.4%). PRISM-III demonstrated excellent discrimination (AUROC 0.957; cut-off ≥ 14); the age-appropriate MELD/PELD score, a pretransplant tool not designed for post-transplant prediction, showed near-chance performance (AUROC 0.513; p = 0.576). A distinctive biomarker crossover pattern was observed: non-survivors had paradoxically lower pretransplant INR, ALT, and LAR values, but trajectories diverged sharply by 24 h. The INR×lactate product achieved an AUROC of 0.981 at 72 h. LAR at 24 h achieved 0.909, and lactate clearance at 0 → 72 h achieved 0.783. Postoperative hypernatremia emerged as a strong predictor (AUROC 0.884). In multivariate analysis, PRISM-III (OR 4.00), ΔINR (OR 3.28), and ΔALT (OR 3.46) were independent predictors (apparent AUROC 0.989). Internal validation confirmed model stability: bootstrap-corrected AUROC was 0.978; LOO-CV AUROC was 0.957 (sensitivity 90.9%, specificity 96.9%). Conclusions: Dynamic postoperative factors—rather than pretransplant disease severity—appeared more strongly associated with 30-day mortality after pediatric liver transplantation in this single-center exploratory analysis. The INR×lactate product, a novel two-variable composite, showed very high apparent discrimination (AUROC 0.981) and is proposed as a hypothesis-generating candidate marker requiring prospective external validation before any clinical use. The combined PRISM-III + ΔINR + ΔALT model (best understood as a 72-h landmark risk model, since two of its three components are defined at 72 h postoperatively) demonstrated robust internal validation performance (LOO-CV AUROC 0.957); however, given the small number of events (n = 11) and the absence of external validation, the model should be regarded as exploratory.