Necrotizing fasciitis of the perineum.

BACKGROUND: Necrotizing fasciitis is a severe soft tissue infection characterized by rapidly progressing necrosis, involving subcutaneous tissues. This rare condition carries a high mortality rate and requires prompt diagnosis and urgent treatment with radical debridement and antibiotics; but early diagnosis, which is essential to successful treatment, remains a challenge. METHODS: Physical examination findings, preoperative and operative findings, histopathological results of the structure, and follow-up results of the patient are discussed with related reports. RESULTS: A 15-month old girl had a history of trivial perineal dermatitis after treatment of anemia and pneumonia. Perineal dermatitis progressed fastly as necrotizing fasciitis which was successfully managed with intensive medical treatment, surgical debridement and reconstructive surgery. CONCLUSIONS: Lack of cutaneous findings early in the disease makes the diagnosis challenging, so a high suspicion is essential. Recovery of the patient from this life-threatening condition needs a multi-disciplinary approach involving pediatrics, pediatric surgery, and plastic and reconstructive surgery.

The Cost Analysis of Preterm Infants from a NICU of a State Hospital in Istanbul.

OBJECTIVE: The objective of this study was assessment of hospital costs of 211 preterm babies admitted to NICU in a 12-month period. METHODS: Preterm babies with gestational age 28-37 GW hospitalized in Dr. L. Kirdar Kartal Research and Training Hospital NICU between November 1st, 2006 to October 31st, 2007 were included in this retrospective study. The financial records of the babies were plotted and investigational, interventional, consumable costs, drugs and ancillary costs were determined. The average daily cost of a preterm has been determined. Group I and II consisted of babies with gestational ages 37-33 GW and 32-28 GWs respectively. The length of stay, ventilation duration and costs of each group were compared. FINDINGS: The mean birth weight was 1689±497 gr. The mean length of hospital stay was 13.6±13.4 days. Hundred and four (49,5%) patients were found to be ventilated. The median ventilation day was 3 days. We found a statistically significant relation between length of hospital stay, ventilation duration, presence of intervention, RDS, sepsis and hospital costs. The mean total hospitalization cost and the daily cost of a preterm was determined as $4187 and $303 respectively. The highest intensive care costs of preterm neonates were found to be paid for interventional procedures, followed by NICU personnel salary and ancillary costs. Between two groups statistically significant difference was found for length of stay, duration of ventilation, interventional and consumable costs (P=0.014, P=0.019, P=0,001, P=0.03 respectively). CONCLUSION: Strategies for prevention of prematurity and early weaning from mechanical ventilation may shorten length of hospital stay leading to decreased NICU costs.

Hospitalizations for pediatric intoxication: a study from Istanbul.

The objective of this study was to describe the epidemiological features of pediatric patients hospitalized for intoxication. Data were collected from the medical records of children < or =14 years of age, admitted for intoxication in 2005-2007. Of the 2989 admissions, 330 (11%) were intoxication cases; 238 (72.1%) were <5 years old. Pharmaceutic agents were identified in 76.1%. Psychotropics were the most frequently ingested drugs (33.9%), and tricyclic antidepressants were the most common (27.1%). Non-pharmaceutic agents were identified in 79 (23.9%) patients, 54.4% of which were pesticides. The majority of all cases were accidental poisonings (90%), which occurred mostly in children <5 years old (71.5%), mainly by pharmaceutics, followed by self-inflicted intoxications (8.2%), which demonstrated the highest ratio in children >10 years old (6.7%). Intoxications are important especially among children <5 years old. Preventive measures such as implementation of the use of child-proof drug prescription bottles and efforts towards public education may reduce the risks.

Macrosomic newborns: a 3-year review.

The objective of this study was to determine the incidence, perinatal complications and the outcome of macrosomic infants. A retrospective analysis was made of macrosomic deliveries and of those admitted into the Neonatology Unit. A control group of 854 deliveries weighing between 2500-4000 g was randomly composed. The incidence of macrosomic deliveries, stillbirth rates, sex, parity, maternal age, mode of delivery, perinatal complications like birth traumas, hypoglycemia, polycythemia, asphyxia, admission rate into the neonatal intensive care unit (NICU), and outcome were analyzed. Among a total of 11,827 deliveries, 829 (7%) were macrosomic neonates. Statistical analysis showed male predominance (p = 0.0001), a significant increase in cesarean section (p = 0.0001), and higher parity for the macrosomic group (p = 0.0001). The mothers of macrosomic newborns were older (p = 0.0001). The admission frequency of macrosomic deliveries into the NICU was almost two-fold. Birth injuries were found in 53 (6.4%) macrosomic infants, and macrosomic deliveries had a two-fold risk for birth injuries. Statistical analysis showed a significant difference between macrosomics and the control group for the frequency of birth traumas (p = 0.0007), hypoglycemia (p = 0.0001) and polycythemia (p = 0.0006). There were two deaths in macrosomic group versus one among control cases. Regarding the high birth trauma and NICU admission rates of macrosomic infants, it is important to emphasize the significance of prenatal diagnosis of fetal macrosomia and of management of these high-risk pregnancies in tertiary level hospitals.