Pediatric palliative care (PPC) is an evolving field that focuses on supporting children with life-limiting conditions, where the quality of care is vital. This study is a retrospective observational investigation that examines the experiences of caregivers to inform health and social service planning and enhance PPC quality. Methods: Data of pediatric patients aged 3 months to 18 years admitted to a PPC inpatient unit over two years were retrospectively reviewed. Sociodemographic characteristics of primary caregivers, including age, gender, number of siblings, education, income, occupation, and marital status, were recorded. Caregiver burden and burnout were assessed using the Zarit Burden Interview and the Maslach Burnout Inventory, respectively. Associations between caregiver characteristics and these measures were analyzed. Results: A total of 118 patients and caregivers were evaluated; 54.2% of patients were male. The most common diagnoses were neurological diseases (44.9%), followed by syndromic–genetic disorders (28.8%). About 34% of patients required more than three medical devices. Most caregivers were female (91.5%), mainly mothers and 53% had only primary education. No significant differences in care burden or burnout were found based on caregiver gender, marital status, or child’s diagnosis. However, the use of nasogastric tubes and multiple medical devices was associated with higher burnout. Lower income was significantly linked to higher care burden, while longer caregiving duration correlated with both increased burden and burnout. A moderate positive correlation was found between Zarit and Maslach scores. Conclusions: The complexity of PPC patients’ care increases caregiver burden and burnout. Expanding specialized PPC services is crucial to support caregivers and sustain home-based care.

The Systemic Immune-Inflammation Index is a measurement of the systemic immune-inflammatory response (SII), which is used as both a diagnostic and predictive index for many diseases. Burns are a major public health problem among children. Infection caused by burns is the most important cause of mortality in children. In this study aims to investigate the predictive and diagnostic performance of SII for infection for pediatrics at the burn center and the causes of burns and responsible microorganisms and possible risk factors on infection. Data were collected retrospectively from 42 pediatric patients between 2013 and 2023 and analyzed in the burn center. Infected and uninfected burn patients were compared. Scalds were the most common cause of burns in both groups, (91.3%; 87%, respectively). The most frequently isolated microorganism was Pseudomonas aeruginosa (52,6%). Central venous catheter use was the biggest risk factor for infection (OR = 8,077; 95% CI 1,523 to 42,834). The AUC value demonstrated an acceptable diagnostic performance (AUC = 0,605; 95% CI 0,450 to 0,746) Similarly, the odds ratio suggested a potential relationship between SII and infection (OR = 2,057; 95% CI 0,489 to 8,657), but both failed to reach statistical significance. The results of this investigation indicate limited predictive and diagnostic utility for SII. CRP performed better diagnostically than SII (AUC = 0,877; 95% CI 0,747 to 0,955), suggesting that traditional inflammatory markers may still be a better way to predict infection in pediatric burns. Moreover, substantial disparities in hemoglobin levels, lymphocyte counts, CRP, and procalcitonin between infected and uninfected groups indicate that a multi marker strategy may prove more efficacious than dependence on a solitary index. While the SII showed a tendency to predict infection in pediatric burn patients, it did not achieve statistical significance in our research. These findings highlight the need for larger-scale studies to clarify the role of SII in infection prediction among pediatric burn patients. Further research with larger cohorts or multicenter studies could help determine whether SII has clinical utility in this population. Also, accurate identification of infectious agents, development of effective treatment strategies, avoidance of prophylactic antibiotic use, and strict adherence to isolation precautions will significantly reduce the risk of infection in centers where burn patients are followed up.

Günümüzde pediatrik palyatif bakıma olan talep ve gereksinim giderek artmaktadır. Bu nedenle, Mersin'deki pediatrik palyatif merkezinde son altı ay içinde yatan hastaların klinik ve demografik özelliklerini değerlendirmeyi ve bu alanda edindiğimiz deneyimleri paylaşmayı hedefledik. Mersin Şehir Eğitim ve Araştırma Hastanesi Çocuk Palyatif Bakım Servisi'nde, 01/06/2023 ile 01/01/2024 tarihleri arasında takip edilen, 1 ay ile 18 yaş aralığındaki yatan hastaların dosyaları retrospektif olarak incelendi. Çalışmaya dahil edilen 279 hastanın (%59.1 erkek, %40.9 kız) medyan yaşı 62 ay ve medyan yatış süresi 7 gün olarak belirlendi. En yaygın yatış tanısı %42.7 ile serebral palsi ve mental motor retardasyondu. Malignite ise %0.7 ile en az görülen yatış tanılarından biri idi. Yatış nedenleri arasında alt solunum yolu enfeksiyonları (%46.2) ve nöbet sıklığında artış (%20.8) öne çıkmaktaydı. Hastaların %32.6’sı yoğun bakım sonrası tedavi için kabul edilmişti. %69.5'i Türkiye Cumhuriyeti vatandaşı iken, şehir dışından gelen hasta sayısı %15.8'di. %67.4'ü çocuk acil servisinden, %32.6'sı yoğun bakım ünitelerinden kabul edilmişti. %17.2'sinde trakeostomi mevcuttu ve ev tipi mekanik ventilatör bağımlıydı. Beslenme gereksinimi olan hastaların %10'u nazogastrik tüp, %20'si ise perkütan endoskopik gastrostomi ile beslenmekteydi. Hastaların %11’inde ventriküloperitoneal şant mevcuttu. Bası yarası %6.5'inde tespit edildi. %93.2'si taburcu edilirken, %6.1'i çocuk yoğun bakım ünitesine devredildi. Sonuç olarak, 15 hasta yaşamını yitirdi. Onkolojik hastaların takibi ve desteklenmesi için daha fazla kaynağa ihtiyaç vardır. Pediatrik palyatif bakımın daha geniş kapsamda ele alınması ve bu alandaki eksikliklerin giderilmesi için ileri çalışmalara ihtiyaç duyulmaktadır.

Objective: Healthcare-associated infections (HAIs) remain a major cause of morbidity and mortality in neonatal intensive care units (NICUs), particularly in preterm and low birth weight infants. Candida species are among the most frequently isolated fungal pathogens in this vulnerable population. Study Design: This retrospective study was conducted in a tertiary NICU in Turkey between January 1, 2015, and December 31, 2023. Daily active surveillance was used to detect HAIs. Neonates with Candida-positive blood cultures were identified. Demographic characteristics, clinical risk factors, laboratory findings, and treatment outcomes were analyzed. Results: Among 9065 neonates admitted to the NICU during the 9-year study period, 26 (0.28%) developed Candida bloodstream infections. The majority of affected infants were premature (84.6%) and had a birth weight ≤2500 g (80%), with 30.8% weighing <1000 g. Predisposing risk factors included: central venous catheter use (92.3%), total parenteral nutrition (96.2%), and exposure to broad-spectrum antibiotics (88.4%). The most frequently isolated species were Candida parapsilosis (46.2%) and Candida albicans (42.3%), while fluconazole resistance was detected in 15.4% of isolates. The overall mortality rate was 38.5%. The median hospital stay was 14.5 days. Conclusions: Candida bloodstream infections are a serious complication in NICUs, particularly among extremely low birth weight and premature infants. Invasive procedures and parenteral nutrition remain major risk factors. The observed high mortality rate and resistance patterns underscore the need for enhanced infection control measures and antifungal stewardship programs in NICUs.

Objective Large-scale, sudden-onset natural disasters occur unexpectedly, causing widespread destruction, resulting in injuries and deaths. It is extremely important to determine the clinical profile of vulnerable child victims admitted in emergencies and the characteristics that are associated with the hospital stay. Therefore, we aimed to analyze the experiences of children admitted to a tertiary hospital to improve future preparedness in case of a sudden disaster. Methods A total of 356 children who were referred from the pediatric emergency department (PED) were included in the study. All patients were subjected to medical history, vital signs, state of hydration, pulse oximetry, physical examination, and routine laboratory tests. Chest X-ray, abdominal ultrasound, and Computed tomography were also documented. Demographics and physical examination findings, duration of hospitalization, surgical interventions, concomitant complications, and presence of life-threatening conditions like crush syndrome and fasciotomy/amputation were investigated. Medications and additional treatments like hemodialysis, and hyperbaric oxygen and the outcomes were also recorded. Results Of the patients, 56.5% were male and median age was 132 months. There was no statistical significance regarding the effect of age and gender on parameters such as hypothermia, dehydration, soft tissue injury, fracture, crush, need for surgery, amputation, length of stay, and need for PICU. Injuries such as falling objects/slipping were more common in boys (P < 0.05). Of the children, only 11.2% were admitted in the first 24 hours and 44.7% were admitted on the third day. 11.8% (n:42) had signs of dehydration, 15.2% had hypothermia and 7% had hypotension/shock. Crush was noted in 41 dehydrated patients, 53 patients having hypothermia, and 24 patients with hypotension/shock. The average length of hospital stay was 6.7 days. The most common injury was being trapped under rubble with 80.3% and the most common injury site was lower extremities at 60.4%. Compartment syndrome developed in 31.7% of the patients, bone fractures were detected in 34.3% of the patients and 2.8% (n:10) of the patients were amputated. Crush syndrome was detected in 75.3% of the patients, and the incidence was higher in patients admitted on the second day or later and the requirement of fasciotomy increased. Elevated creatine phosphokinase (CPK), increased crush injury 61 times and fasciotomy by 16.8 times, Also, elevation of Myoglobin and Uric acid levels were higher in patients with crush injury (P = 0.005). Of patients with crush syndrome, 28.9% (n:103) required/underwent fasciotomy due to compartment syndrome, and a significant relationship was found between crush injury and the need for fasciotomy (P < 0.001). The likelihood of fasciotomy was 26 times higher in crush injury. There was a strong relationship between dehydration and the development of crush injury and the need for fasciotomy (P < 0.001). Anemia, elevated uric acid, BUN and Creatin, and AST/ALT levels and development of crush syndrome and the need for fasciotomy/amputation were higher (P < 0.001). Conclusion Dehydration, and hypotension/shock were related to crush injury and fasciotomy. Compartment syndrome and bone fractures may develop in one-third of the children. Anemia and elevated biochemical laboratory parameters must be followed and elevated CPK, myoglobin, and uric acid levels are highly associated with fasciotomy and amputation. Therefore, for the development of preparedness, response, and recovery policies for future disasters the clinical outcomes of children are crucial and treatments like fasciotomy, hyperbaric oxygen, and hemodialysis/plasmapheresis must be administered timely to prevent amputation and development of sequelae.

Bordetella pertussis is a highly contagious respiratory infection affecting infants, particularly those in vulnerable populations. This study investigates the increase in pertussis cases following refugee influxes and natural disasters. This retrospective study analyzed 28 infants hospitalized in our hospital's pediatric ward due to whooping cough between December 27, 2023, and April 30, 2024. Demographics, vaccination status, clinical findings, treatments, and outcomes were reviewed. Of the 28 infants, 60.7% were male and 39.3% were of Syrian origin; 42.9% were unvaccinated. The mean age was 3.46 ± 3.48 months, and median hospitalization was 11 days. All presented with respiratory distress. Paroxysmal cough (96.4%), feeding difficulty (53.6%), and fever (32.1%) were common. Convulsions occurred in 10.7%, and apnea in 3.6%. B. pertussis was confirmed by PCR in all cases. Chest radiographs showed pneumonic infiltrates in 85.7%. Macrolide antibiotics were given to all. Leukocytosis (15,000-30,000/µL) was observed in 53.6%, extreme leukocytosis in 7.1%, and lymphocytosis in 64.3%. Respiratory support was needed in 78.6%. Four required ICU care; two intubated patients died of multiple organ failure. Pertussis remains a serious health threat, especially among unvaccinated and displaced infants. Strengthening immunization programs and ensuring early diagnosis and treatment are essential to reduce disease burden.