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Öğe Çocukluk Çağı Zehirlenmelerinde Yoğun Bakım Yatış Gereksiniminin Değerlendirilmesi(2020) Ongun, Ebru Atike; Şimşek, CemileGiriş: Bu çalışmanın amacı, çocuk yoğun bakım (ÇYB) servisineyatırılan olguların demografik özelliklerini ve klinik seyirlerini analizederek, hastaların ne derecede kritik yoğun bakım servis desteğineihtiyaç gösterdiklerini araştırmaktır.Yöntemler: Ocak 2013-Aralık 2018 tarihlerinde ÇYB yatışı yapılan593 zehirlenme olgusunun dosyaları incelendi. Demografik özellikler,zehirlenme etkeni ve şekli, zehirlenme anından ÇYB ünitesi yatışınakadar geçen süre, ÇYB ünitesi ve hastane yatış süreleri, PRISM-3skoru, fizik muayene bulguları ve etkilenen organ sistemleri incelendi.Bulgular: Kazara zehirlenmelerin en sık 2-5 yaşta, erkeklerde(%51,2), yazın gerçekleştiği görüldü. Antipiretik/analjezikler veinsektisitler en sık etkenleri oluşturdu. Bilinçli zehirlenmelerin kızlardasık, çoğul ilaç alımının belirgin, PRISM-3 skorlarının yüksek, ÇYB ünitesive hastane yatış sürelerinin uzun olduğu görüldü (p<0,001, p<0,001,p=0,046, p=0,001, p<0,001). Otuz altı hastada (%6,1) 82 adet yanetki izlendi. Kardiyovasküler ve santral sinir sistemi en sık etkilenensistemler olup, taşikardi belirgindi (%4,22). Aritmi gözlenmezken, ikihastada hipotansiyon için adrenalin infüzyonu, iki hastaya bradikardinedeniyle atropin uygulandı. İki hastada böbrek işlevleri bozulsa dadiyaliz ihtiyacı olmadı. Hava yolu açıklığını koruyamayan bir hastaentübe halde dört gün izlendi. Olay anından ÇYB servisine kabulsüresi 6,21±2,86 saat idi. Toplam ÇYB yatış süresi 1,38±0,76 gün,hastane yatış süresi 3,45±1,49 gündü.Sonuç: Hastaların acil servise ilk başvuru muayene bulgularındanyola çıkarak, yoğun bakım ünitesi yatışına karar verilmesi içinzehirlenme şiddetini ön görecek ileri çalışmalara ihtiyaç vardır.Gereksiz ÇYB servis yatışının azaltılması ile, sınırlı sayıda olan üçüncübasamak yoğun bakım servis yatakları genel durumu kritik hastalariçin ayrılabilecek ve ekonomik açıdan sağlık harcamalarını en azaindirilebilecektir.Öğe Epidemiology and Nature of Suicide Attempts in Children and Adolescents at the Tertiary Care Pediatric Hospitals; a Multicentre Retrospective Study in Turkey(Journal of Critical and Intensive Care, 2022) Saraç Sandal, Özlem; Ongun, Ebru Atike; Uzun Çiçek, Ayla; Sarı, Seda Aybüke; Temel, Özlem; Ceylan, GökhanIntroduction: Suicide and suicide attempts are among the leading causes of morbidity and mortality in the youth population worldwide, with drastically increased rates over the past years. Objectives: We aimed to investigate the major risk factors, sociodemographic characteristics, and prevalence of psychiatric comorbidities in children that hospitalized in pediatric intensive care units (PICUs) for selfpoisoning suicide attempts through drug overdose. Methods: We performed a descriptive, cross-sectional retrospective study, including all the cases of suicide attempts that hospitalized at pediatric intensive care unit between January 2015 and December 2020. Results: In the study period, 356 children of self-poisoning suicide occurred, 20 cases were excluded from the study. The mean age of the study population was 14.98 ± 1.53 years. Seventy (20.8%) children were within 10-13 years with the predominance of female gender (female/male sex ratio: 3.35/1). Suicidal attempts were more common in females (p = 0.001). Considering the nature of attempt, toxic drug overdose (95.5%) appeared as the most frequent method of suicide, followed by intake of pesticides (4.5%). Antipyretics and antidepressants were the common pharmaceuticals involved in drug toxicity (21%, 19.3%). Conclusions: The present results showed that the majority of suicide attempts occurred during adolescence, with an increase in pre-adolescence at a considerable rate. Overall, it is important to increase the knowledge of pediatricians about suicide attempts in children and provide psychosocial support for children and their families as a preventive measure after their first attempt.Öğe Nutritional Status of Pediatric Intensive Care Patients with Chronic Disease(Galenos Publ House, 2022) Sandal, Ozlem Sarac; Ongun, Ebru Atike; Ceylan, GokhanObjective: This study aims to evaluate the relationship between enteral nutrition and mortality in children with chronic diseases who need to be hospitalized in the pediatric intensive care unit (PICU).Method: The data of the patients who were admitted to intensive care between January 2014 and December 2019 were retrospectively supplied from the hospital database. Demographic data, the presence of underlying diseases, the diagnoses during intensive care admission, the history of previous hospitalization, homecare requirement, the presence of gastrostomy, feeding type during homecare before hospitalization, the amount and type of nutrition were recorded.Results: A total of 186 patients hospitalized in the PICU due to an acute critical illness and with an underlying chronic disease were included in the study. The median age was 49 (17.75-104.5) months, it was observed that 53.8% of the patients were required homecare. The most common chronic disease was central nervous system pathologies accompanied by neurological impairment in swallowing functions (37. 3%), while the most common cause of the acute disease was lower respiratory tract infections (48.9%). The overall mortality was 9.7%, and it was found that the majority of the patients who were died were the patients requiring homecare and fed with nasogastric tube at home (p=0.002, p=0.014).Conclusion: It is observed that patients with percutaneous endoscopic gastrostomy are relatively low, hence feeding tube is frequently preferred in children with dysphagia during homecare. However, it is demonstrated that the feeding tube is an independent risk factor for mortality.Öğe Sleeping Habits, Sleeping Problems and Affecting Factors in Children Aged 6-10(Tokat Gaziosmanpasa University, 2021) Ünsal, Gülşah; Korğalı, Elif Ünver; Tan, Ayça Kömürlüoğlu; Ongun, Ebru AtikeObjective: Sleep is associated with physical growth, emotional-behavioral development and academic performance in children. For a healthy life, children need adequate and quality sleep. The aim of this study was to examine the sleep habits of 6-10 year old primary school children, to determine sleep problems and the factors affecting it. Method: This descriptive, questionnaire study was conducted with parents of healthy children aged 0-6 years who presented at the General Pediatrics Polyclinic. The questionnaire includes questions about the sociodemographic characteristics, home and room conditions, bedtime routines and sleep patterns in infancy, as well as the short form of the 'Child Sleep Habits Questionnaire' (CSHQ). The children were divided into groups as those with sleep problems (Group 1; CSHQ> 41) and those without (Group 2; CSHQ≤ 41). Results: The average daily sleep time of the children (n=302) was 9.33±1.09 hours, while 60.9% of them went to bed at ≤22:00, 11.9% of them were >23.00 and 72.8% woke up at ≤08:00. In this study 62.9% of children have sleep problems. Group1 had a higher rate of household smokers (55.8% and 36.6%, p=0.001, respectively), and children had shorter daily sleep times (9.21±1.22 and 9.51±0.80 hours, respectively, p=0.008). Parent education, mother’s sleep problems, bedtime routines, sleep patterns in infancy, and the parents’ attitude towards sleep were found to be associated with sleep problems in children. If there is no sleep pattern in infancy (OR: 7.637, 95CL 2.28-25.53), no reading before bedtime (OR: 1.726, 95CL 1.07-2.79), and no rules about sleep in the family (OR: 2.426, 95CL 1.45-4.06), the possibility of sleep problems in children increases. Conclusion: Children between the ages of 6-10 have a high rate of sleep problems. In order for children to gain a healthy sleep habit; families should be made aware, bedtime routines should be established and the importance of sleep should be emphasized in child health follow-ups.Öğe The Predictive Factors for Prolonged Seizures and Status Epilepticus: A Single Center Study(Galenos Publ House, 2021) Ayanoglu, Muge; Ongun, Ebru AtikeObjective: To analyze the clinical features of prolonged seizures and status epilepticus and perform risk analysis on super refractory status epilepticus (SRSE) in pediatric intensive care unit (PICU) admissions. Method: Demographic features, underlying etiologies, treatment modalities, electroencephalographic and neuroimaging outcomes of intensive care unit admissions between 2015 and 2019 were analyzed. Results: Seventy-one children were enrolled. The most common etiologic factors for prolonged seizure were fever in 45.1%, (central nervous system infection: 16.9%, infection other than central nervous system: 28.2%), withdrawal of the antiepileptic medication in 40.9%, intoxications in 12.7% of the children and intracranial hemorrhage due to arteriovenous malformation in one (1.4%) patient. At admission hypoglycemia was detected in 23.9%, hypocalcemia in 18.3%, hyponatremia in 15.5%, acidosis in 35.2%, and increased lactate levels in 25.4% of the patients. The patients were grouped based on fever at admission and new- onset seizure. Approximately 45.1% of the population had fever at admission and consisted of younger children compared to their counterparts (p=0.023). Children with pre-existing epilepsy had frequent history of sibling death, while patients presented with newonset seizure had more often significant lactate elevations, acidosis, and required mechanical ventilation at admission (p=0.002, p=0.008, p=0.017). Twelve (16.9%) patients developed SRSE. Low serum sodium and calcium levels increased the risk of developing SRSE (OR: 10.800, 95%CI: 2.518-46.318; OR: 4.554, 95%CI: 1.159-17.892). However PRISM-3 score has been identified as the single independent risk factor for SRSE (OR: 1.174, 95% CI: 1.039-1.327). Three (4.2%) children died of secondary complications during their stay in intensive care unit. Tracheostomy cannulation was performed in two (16.7%) SRSE patients due to neurological incapability to maintain a patent airway. Conclusion: PRISM-3 score is the independent risk factor of SRSE. Electrolyte abnormalities (hyponatremia and hypocalcemia) are associated with developing SRSE.
