No abstract

Giriş ve Amaç: Üst gastrointestinal sistem kanaması çocukluk çağında çoğunlukla hafif olmakla birlikte, hayatı tehdit eden ciddi kanama şeklinde de görülebilmektedir. Bu çalışmada klinik olarak anlamlı üst gastrointestinal sistem kanamasına işaret eden bulguların ve risk faktörlerinin belirlenmesi amaçlandı. Gereç ve Yöntem: Çalışmaya üst gastrointestinal sistem kanaması tanısı alan, 0-18 yaş aralığında çocuklar alındı. Tanı anındaki yaşı, cinsiyeti, kanama miktarı, hematemez, melena varlığı, başvuru anındaki yakınmaları, eşlik eden hastalıkları, kanamaya yatkınlık yaratan ilaç kullanımı, vital bulguları, kapiller dolum zamanı ve sistemik fizik muayene bulguları kaydedildi. Laboratuvar tetkiklerinden hemogram, biyokimya, koagülasyon testleri, endoskopik işlem bulguları, eritrosit transfüzyonu sayısı, uygulanan medikal ve/veya endoskopik tedaviler, acilde ya da serviste izlemleri ve kanama açısından konulan son tanısı kaydedildi. Sheffield skorlamasına göre 8 puan ve üzeri alanlar anlamlı üst gastrointestinal sistem kanaması olanlar olarak gruplandı, veriler gruplar arasında karşılaştırıldı. Bulgular: Elli beş çocuk [29 (%52.7) kız, 26 (%47.3) erkek; ortalama tanı yaşı 8.4±5.4 yıl] çalışmaya alındı. Başvuru anında 22 hastada anemi, 20 hastada kan üre azotu yüksekliği, 14 hastada eritrosit sayısında düşüklük, 5 hastada hipoalbüminemi vardı. Anlamlı kanaması olan 17 hastada; melena (%76.5 vs. %21.1, p

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No abstract

Pediatric palliative medicine is a multidisciplinary approach for finding solutions for end-of-life care of children with lifetreathening conditions or conditions which inevitably shorten life. Due to inadequate definition of special palliative care needs and its scope, pediatric palliative care has not been broadly applied in our country or in the world. These patients are cared for in Pediatric Intensive Care Units (PICU) which already have limited bed counts. Patients who receive palliative care have tracheostomies, gastrostomies, central venous catheters, ventriculoperitoneal shunts and such medical procedures done whilst their stay at PICU and this prolongs their stay and probabilty of exposure to multi-drug resistant hospital infections. No research has been done on patients in PICU who are receiving palliative care on pathogens and antibiotic resistance. In this study, we discuss patients in need of palliative care in PICU and data on their duration of care, surgical operations, cultures, antibiotherapies and cost. Patients who stayed in PICU more than 70 days were scanned from medical records retrospectively. Sixteen patients who were included in the study stayed an avarage of 195.4 days in PICU. Three (21.42%) of the patients were inside the PICU all their lives. Seven (50 %) of the patients stayed in the PICU for >25% of their lives. Most of the patients had a diagnosis of neuromuscular disease or were cared for a sequela from a perinatal condition. Half of the patients had a congenital disease or an anomaly. One of the patients had a malignancy and an another one was being care after drowning. Ten (71.24%) patients had tracheostomies, 9 (64.28%) had central venous catethers, 8 (57.14%) had gastrostomies done. Only one patient had no positive cultures while all other patients had many positive cultures for resistant bacteria species and received 11 different types of antibiotics and antifungals. Average cost per patient was 233,552.5 TL. Continued care for these patients in regular PICUs result in increase in nosocomial infections, antibiotic resistance and treatment costs. Establishment of more pediatric palliative care units will alleviate these problems and allow for parents to spend more time with their children. We shared our single center experience of patients in need of palliative care in our PICU. Studies done with a bigger population from multiple centers will define de quality of pediatric palliative care in our country.