Multisystem Inflammatory Syndrome (MIS-C) is a new entity that emerges 2–4 weeks after the SARS-CoV-2 infection in children. MIS-C can affect all systems, the most severe of which is cardiac involvement. The duration of the cardiac symptoms is still uncertain and may be persistent or prolonged. The American College of Rheumatology Clinical Guidelines recommends cardiac magnetic resonance imaging (MRI) 2–6 months after the diagnosis of MIS-C in patients presenting with significant transient left ventricular (LV) dysfunction in the acute phase of illness (LV ejection fraction 50%) or persistent LV dysfunction. There are a few studies investigating cardiac MRI findings in MIS-C patients. In this study, we aimed to evaluate cardiac MRI findings, at the earliest 3 months after diagnosis, and compare these findings with the echocardiograms in children with MIS-C. A retrospective study including 34 MIS-C patients was conducted at a tertiary-level University Hospital between June 2020 and July 2021. Centers for Disease Control and Prevention criteria were used in the diagnosis of MIS-C. Cardiac MRI was performed at least 3 months after MIS-C diagnosis. The study included 17 (50%) boys and 17 (50%) girls with a mean age of 9.31 ± 4.72 years. Initial echocardiographic evaluation revealed cardiac abnormality in 13 (38.2) patients; 4 (11.8%) pericardial effusion, 4 (11.8%) left ventricular ejection fraction (LVEF) < 55%, and 5 (14.7%) coronary artery dilatation. Echocardiography showed normal LV systolic function in all patients during follow-up; coronary dilatation persisted in 2 of 5 (40%) patients at the 6th-month visit. Cardiac MRI was performed in 31 (91.2%) patients, and myocardial hyperemia was not detected in any patients (T1 relaxation time was < 1044 ms in all children). However, 9 (29%) patients’ MRI showed isolated elevated T2 levels, and 19 (61.3%) revealed at least one of the following findings: pericardial effusion, right ventricular dysfunction, or LVEF abnormality. In patients with MIS-C, a high rate of cardiac involvement, particularly pericardial effusion was determined by cardiac MRI performed at the earliest 2–6 months after diagnosis. Even if echocardiography does not reveal any abnormality in the initial phase, cardiac MRI should be suggested in MIS-C patients in the late period. This is the first study reporting cardiac MRI findings in the late period of MIS-C patients.

Background: Hemodynamically significant patent ductus arteriosus (hPDA) in premature infants is a common congenital cardiac anomaly associated with substantial morbidity and mortality. Traditional diagnostic methods like echocardiography face challenges such as expertise requirement and inconsistent accessibility. This study investigates the efficacy of the Random Forest machine learning model in predicting hPDA in premature infants, aiming to provide a non-invasive, objective, and reliable alternative. Methods: This retrospective study analyzed data from 657 premature infants hospitalized between 2014 and 2019. Patients were categorized into hPDA and asymptomatic PDA (aPDA) groups. The Random Forest classification model, implemented in JASP software, utilized prenatal, natal, and postnatal clinical data, including gestational week, birth weight, and the need for resuscitation at birth. Model performance was assessed using metrics such as accuracy, Area Under the Curve, F1 score, Matthews Correlation Coefficient, recall, precision, and feature importance. Results: The Random Forest model demonstrated strong predictive performance, achieving a test accuracy of 91.7%, an AUC of 0.950, an F1 score of 0.923, and an MCC of 0.775. Notably, the recall for the hPDA group was 100%. Gestational week, birth weight, and the need for resuscitation at birth were identified as the most significant predictors. The model also revealed complex relationships, showing variables deemed statistically insignificant by classical methods (e.g., gender, 5th-minute APGAR score, oligohydramnios) to be significant within the Random Forest framework. Conclusions: The Random Forest model effectively predicts hPDA risk in premature infants, offering superior predictive power compared to classical statistical analyses. This approach has the potential to enhance early detection, facilitate timely interventions, and support personalized treatment strategies, thereby improving patient outcomes. Further validation through large-scale, multi-center prospective studies is essential for its integration into clinical practice.

Neonatal pulmonary hypertension(PHT) is a significant cause of morbidity and mortality in newborns. Early diagnosis and treatment of pulmonary hypertension are critical for preventing long-term respiratory and cardiovascular complications. The aim of this study is to contribute to the literature by investigating the differences between neonates with PHT who receive medical treatment and those who do not, the relationship between echocardiographic measurements and the initiation of treatment, and the differences between preterm and term neonates. In this retrospective cohort study, 75 neonates diagnosed with pulmonary hypertension and treated in the neonatal intensive care unit were retrospectively analyzed. The diagnosis of PHT was established by echocardiography with estimation of pulmonary artery pressure via tricuspid regurgitation jet velocity measurement. Right Ventricular Systolic Pressure(RVSP)measurements were recorded as RVSP1 for the first two days, RVSP2 between days 3-7, and RVSP3 after 7 days. For statistical evaluation, patients were divided into two groups based on whether they received medical treatment for PHT and were compared. The group receiving PHT treatment was further divided into preterm (< 37 weeks) and term (≥ 37 weeks) neonates and compared. Among the 7578 patients in the neonatal intensive care unit, 75 (1.07%) were diagnosed with pulmonary hypertension. 47 of these patients received PHT treatment. The treatment group had a greater gestational age and higher birth weight. There was no significant difference in laboratory parameters between the groups receiving and not receiving PHT treatment. However, in the group not receiving PHT, patients with low RVSP measurements had lower CRP values. The duration of invasive and non-invasive mechanical ventilation was longer in the group receiving PHT treatment. RVSP2 and RVSP3 values were higher in the treatment group. The RVSP1-2 difference was significant in the treatment group. In echocardiographic evaluation, persistently elevated pulmonary artery pressure measured by tricuspid regurgitation jet velocity after the third day is strongly associated with PHT treatment. Neonates with initial RVSP lower than 40 mmHg and negative CRP did not require pulmonary hypertension treatment.

Hemodynamic Effects of an Augmented Low-dose Dexamethasone Protocol in Preterm Infants with Bronchopulmonary Dysplasia - Anatolian Journal of General Medical Research

Aim: Acute dehydration due to gastroenteritis is a significant and preventable cause of childhood mortality worldwide. "We used bedside ultrasonography to compare inferior vena cava/Abdominal aorta (IVC/Ao) diameter ratios before and after treatment in patients with acute dehydration and controls, offering a novel, rapid, and objective assessment tool. Material and Method: This study included 68 children admitted to Düzce University Medical Faculty Hospital Pediatric Emergency. 34 of them were patients had acute severe dehydration, and the other 34 case were in the healthy Control Group (CG). IVC and Ao were measured in the transverse plane below the xiphoid process using bedside ultrasonography (USG). Results: A significant difference was found in the IVC/Ao ratio between the Patient Group (PG) and CG (p<0.001). When PG pre- and post-treatment measurements were compared, the results were highly significant (p<0.001). The lack of correlation between the IVC/Ao ratio and age and weight demonstrated that it could be used in the assessment of children of all ages and weights. Conclusion: The IVC/Ao ratio is a rapid and innovative assessment method that can be applied across various age groups and weight categories.

Objective: This study aims to assess the impact of complications of the Fontan operation, such as protein-losing enteropathy and thrombosis, on patients’ quality of life. We hypothesize that alterations in the diameter and flow of the inferior vena cava (IVC) and femoral vein (FV) are associated with these complications. The goal is to evaluate the influence of venous structural modifications on Fontan operation outcomes by analyzing Doppler time measurements of the IVC, FV, aorta (Ao), and femoral artery (FA). Materials and Methods: We retrospectively analyzed the recorded images of patients who had undergone Fontan palliation at least two years prior to presentation at our outpatient clinic between January 2022 and January 2023. Patients with chest pain but no cardiac pathology served as controls. Demographic and physical examination data were collected retrospectively. In patients with a normal single-ventricular ejection fraction, we measured the widest IVC diameter and Doppler values, the descending aortic diameter in systole, the widest FV diameter and Doppler values, and the femoral artery diameter in systole. Results: The study included 25 Fontan patients: 7 had an extracardiac Fontan, 4 had a fenestrated extracardiac Fontan, and 14 had an intra-extracardiac fenestrated Fontan. A significant difference (p=0.019) was found in the age at Fontan between patients with NYHA stages 1-2 and those with NYHA stages 3-4. A pathologic microalbumin/creatinine ratio (>15) was correlated with pre-Fontan pulmonary artery pressure >15 mmHg. The IVC/BSA (p=0.031) and FV/BSA ratios differed significantly between groups with and without complications, with lower ratios observed in the group with complications. Conclusion: Age at Fontan palliation is a risk factor for complications. High pre-Fontan pulmonary pressure is associated with microalbuminuria. IVC/BSA and FV/BSA are inversely associated with mid- to long-term complications following Fontan palliation.