Intensive Care Units In Turkey Research Articles

Molecular characterization and risk factors for carbapenem-resistant Gram-negative bacilli colonization in children: emergence of NDM-producing Acinetobacter baumannii in a newborn intensive care unit in Turkey

Multidrug-resistant Gram-negative bacilli are responsible for more than 50% of healthcare-associated infections. Colonization dynamics, characteristics, and risk factor data for CR-GNB are scarce in children. To examine the molecular characteristics of, and risk factors for nosocomial colonization with, carbapenem-resistant Gram-negative bacilli (CR-GNB) in hospitalized paediatric patients in a tertiary university hospital's paediatric units in Turkey. A prospective case-control study was performed at a university hospital in Istanbul, Turkey. A total of 1840 rectal swab specimens were collected from all 762 hospitalized children between March 2013 and October 2013. Among them, 176 (23%) patients were colonized with CR-GNB. Of these, 72 (9%) patients were colonized with carbapenem-resistant Enterobacteriaceae, 138 (18%) with CR-non-fermenter Gram-negative bacilli (CR-NF) and 34 (4%) with both. The median CR-GNB colonization time was 10 days (range: 1-116). The median duration of rectal colonization with CR-GNB was 8 days (range: 1-160). NDM (31%) was the second most frequent carbapenemase identified in Acinetobacter baumannii isolates, and has not previously been detected in Turkey. All of the 17 patients colonized with NDM-producing A. baumannii were newborns in the neonatal intensive care unit. Independent risk factors for CR-GNB colonization were: age <1 year, nasogastric tube placement, presence of underlying chronic diseases, ampicillin usage, surgical intervention, and carbapenem use. This is the first description of NDM in A. baumannii in newborn units in Turkey. Carbapenem usage is a common independent risk factor for both CRE and CR-NF colonization, which underscores the importance of antibiotic stewardship programmes.

Clinical characteristics, outcomes and risk factors of candidial infections with critically ill patients in respiratory intensive care unit in turkey

Results Median age was 70.1 ± 14.60 years (min 18 years, max 91 years). The median APACHE II score on admission was 21.28 ± 5.39. A total of 405 episodes were identified from 2007 to 2014. The rates of candidial infections were urinary tract infection (67.6%), blood stream infection (23.5%) and pneumonia (8.9%). The fungi identified were yeast (54.32%), C. albicans (26.40%), C. tropicalis (5.91%), C. glabrata (6.91%), C. parapsilosis (3.20%), C. krusei (1.23%), Candida kefyr (0.98%) and other Candida species (1.23%) (Table1). Candida albicans accounted for 57.29% of all Candida species. Fluconazole resistance was found in 35.42%. The susceptibility to amphotericine B was 96.94%. Itraconazole resistance was 70.22%. None of all patiens was using previously antifungal therapy. Primary therapy included monotherapy with fluconazole (n = 99), caspofungin (n = 14), anidulafungin (n = 8) and voriconazole (n = 8). Combination therapy was infrequently used (n = 6). The mortality rate was 77.6% (n = 184). The use of broad-spectrum antibiotics was 85.2%. The presence of an intravascular device was 70% (n = 164). The use of parenteral (n = 66), enteral nutrition (n = 46) and both (n = 98) were 27.8%, 19.4% and 41.4% respectively. The median mechanic ventilation days were 13.3 ± 15.96 days. The median RICU length of stay (LOS) was 24.8 ± 24.19 days. The most patients (61.18%) came to RICU from other departments and care units.

Brain death in a neurologic intensive care unit in turkey

The diagnosis of brain death (BD) is important in order to decrease the burden of futile care and procure vital and viable organs for donation. The aim of this study was to find clinical features of patients, diagnostic tools used, attitude to BD and donation rate in a teaching hospital for neurologic diseases in Istanbul.

The first six years of surveillance in pediatric and neonatal intensive care units in Turkey.

BackgroundPatients in resourced-limited neonatal and pediatric intensive care units (NICU and PICU) are vulnerable to healthcare associated infections (HAI). We report the incidence of HAI, multidrug resistant microorganisms (MDROs) and the pattern of antibiotic usage in the first six years of a surveillance program in a teaching hospital in Turkey.MethodsBetween 2007 and 2012 surveillance data for HAI, MDROs and antibiotic usage were collected from the infection control department, pathology, hospital admissions and pharmacy. In 2009 hand hygiene auditing was introduced. Hand sanitizer usage was expressed as liters per 1000 patient-days. Antibiotic usage was presented as defined daily doses (DDD). Evidence of change in the incidence of HAI was tested using Poison regression modeling.ResultsThe rate of gram negative MDRO in PICU increased significant between 2007 and 2012 (IRR 1.5, P = 0.033) but remained unchanged in NICU (P = 0.824). By 2012 ceftriaxone prescribing in PICU had decreased while carbapenem prescribing increased by 80 %. In NICU carbapenem decreased by 42 % and betalactam decreased by 29 %. Hand hygiene compliance significantly improved in PICU (IRR 1.9, p < 0.001) and NICU (IRR 2.2, p < 0.001) but compliance remained modest after three years with inconsistent levels across the 5 moments.ConclusionThe early years of our infection control program highlights the endemicity of HAI and MDROs in our NICU and PICU. The consistent pattern of antibiotic usage, endemic MROs in PICU and modest hand hygiene clearly provide strategic focuses for intervention.

Moral distress in Turkish intensive care nurses.

Moral distress is a common problem among professionals working in the field of healthcare. Moral distress is the distress experienced by a professional when he or she cannot fulfill the correct action due to several obstacles, although he or she is aware of what it is. The level of moral distress experienced by nurses working in intensive care units varies from one country/culture/institution to another. However, in Turkey, there is neither a measurement tool used to assess moral distress suffered by nurses nor a study conducted on the issue. The study aims to (a) validate the Turkish version of the Moral Distress Scale-Revised to be used in intensive care units and to examine the validity and reliability of the Turkish version of the scale, and (b) explore Turkish intensive care nurses' moral distress level. The sample of this methodological, descriptive, and cross-sectional design study comprises 200 nurses working in the intensive care units of internal medicine and surgical departments of four hospitals in three cities in Turkey. The data were collected with the Socio-Demographic Characteristics Form and The Turkish Version of Moral Distress Scale-Revised. Ethical considerations: The study proposal was approved by the ethics committee of the Faculty of Medicine, Cumhuriyet University. All participating nurses provided informed consent and were assured of data confidentiality. In parallel with the original scale, Turkish version of Moral Distress Scale-Revised consists of 21 items, and shows a one-factor structure. It was determined that the moral distress total and item mean scores of the nurses participating in the study were 70.81 ± 48.23 and 3.36 ± 4.50, respectively. Turkish version of Moral Distress Scale-Revised can be used as a reliable and valid measurement tool for the evaluation of moral distress experienced by nurses working in intensive care units in Turkey. In line with our findings, it can be said that nurses suffered low level of moral distress. However, factors which caused the nurses in our study to experience higher levels of moral distress are inadequate communication within the team, working with professionals they considered as incompetent, and futile care.

The ProPre-Save Study: Effects of Probiotics and Prebiotics Alone or Combined on Necrotizing Enterocolitis in Very Low Birth Weight Infants

To test the efficacy of probiotic and prebiotic, alone or combined (synbiotic), on the prevention of necrotizing enterocolitis (NEC) in very low birth weight (VLBW) infants. A prospective, randomized, controlled trial was conducted at 5 neonatal intensive care units in Turkey. VLBW infants (n = 400) were assigned to a control group and 3 study groups that were given probiotic (Bifidobacterium lactis), prebiotic (inulin), or synbiotic (Bifidobacterium lactis plus inulin) added to breastmilk or formula for a maximum of 8 weeks before discharge or death. The primary outcome was NEC (Bell stage ≥2). The rate of NEC was lower in probiotic (2.0%) and synbiotic (4.0%) groups compared with prebiotic (12.0%) and placebo (18.0%) groups (P < .001). The times to reach full enteral feeding were faster (P < .001), the rates of clinical nosocomial sepsis were lower (P = .004), stays in the neonatal intensive care unit were shorter, (P = .002), and mortality rates were lower (P = .003) for infants receiving probiotics, prebiotics, or synbiotic than controls. The use of antenatal steroid (OR 0.5, 95% CI 0.3-0.9) and postnatal probiotic (alone or in synbiotic) (OR 0.5, 95% CI 0.2-0.8) decreased the risk of NEC, and maternal antibiotic exposure increased this risk (OR 1.9, 95% CI 1.1-3.6). In VLBW infants, probiotic (Bifidobacterium lactis) and synbiotic (Bifidobacterium lactis plus inulin) but not prebiotic (inulin) alone decrease NEC.

Anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit in Turkey.

Objective:To compare the anxiety levels of mothers with newborns in a Neonatal Intensive Care Unit (NICU) and mothers with healthy newborns in a postpartum care service (PCS).Methods:This descriptive study was conducted in state and medical school hospitals located in Eskisehir and Afyon, Turkey. The first 200 mothers, including mothers with newborns in a PCS (n=100) and mothers with newborns in a NICU (n=100); participants were followed starting March 1, 2014. Questionnaires to determine the characteristics of mothers and newborns were used as data collection tools, including the State-Trait Anxiety Inventory Scale (STAI TX-1 – STAI TX-2).Results:Trait anxiety levels were not significantly different between mothers with newborns in the NICU and mothers with newborns in PCS (t=0.588, p=0.557), whereas state anxiety levels were significantly different between the two groups (t=-5.109, p=<0.001). The state anxiety levels of mothers whose infants were in the NICU were determined to be higher compared to those of mothers whose infants were in PCS.Conclusion:Being a mother of a sick newborn can elevate anxiety and lead to in mothers. During this challenging time, the support of nurses can increase mothers’ abilities to cope with the stress of a sick newborn.

Kritik Çocuk Hastalarda Kan Şekeri Kontrolü: Türkiye'de Çocuk Yoğun Bakım Ünitelerinde Çalışan Uzman Hekimlerin Yaklaşımlarına Yönelik Anket Çalışması

Amaç: Kritik hastalarda hedef kan şekeri düzeyleri ve glisemik kontrolün sağlanması konusunda hâlen bir fikir birliği bulunmamaktadır. Bu nedenle de çocuk yoğun bakım ünitelerinde çalışan hekimlerin kan şekeri kontrol yaklaşımları farklılıklar göstermektedir. Bu çalışmada, Türkiye'de çocuk yoğun bakım ünitelerinde çalışan uzman hekimlerin kritik hastalarda glisemik kontrol yaklaşımlarının araştırılması amaçlanmıştır. Gereç ve Yöntemler: Ankara'da 30 Nisan-4 Mayıs 2012 tarihleri arasında gerçekleştirilen 9. Ulusal Çocuk Acil Tıp ve Yoğun Bakım Kongresi'nde ''Kritik Çocuk Hastalarda Glukoz Kontrolü'' isimli sunumdan önce katılımcılara anket formu dağıtıldı. Sunuma başlanmadan önce sorular tek tek yansıda gösterilerek katılımcıların form üzerinde yanıtlamaları istendi. Çocuk yoğun bakım uzmanı ve çocuk yoğun bakımda çalışan pediatri uzmanı yanıtları değerlendirmeye alındı. Bulgular: Kırk dört katılımcıdan 23'ü çocuk yoğun bakım ve/veya pediatri uzmanı idi. Katılımcılar arasında hedef kan şekeri düzeyinin 110-150 mg/dL aralığında olması, artan kan şekeri düzeylerinde insülin infüzyon hızında artış yapılması ve kan şekeri takip sıklığının saatlik olması hususlarında fikir birliği saptandı (sırasıyla %52, %52 ve %64). Ancak, kritik olmayan ve kritik çocuk hastalarda kan şekeri düzeyi 200 mg/dL iken insülin infüzyonu başlanması, kan şekeri düşerken insülin infüzyonu kesilme düzeyi ve ciddi insülin dirençli vakalarda tedavi tercihi konularında çok daha düşük oranda fikir birliği mevcuttu. Sonuç: Ülkemizde gerçekleştirilen bu anket çalışmasında, kritik çocuk hastalarda glisemik kontrol yaklaşımlarının standart olmadığı görüldü. Bu hususta güncel kanıta dayalı tıp doğrultusunda ilgili otorite ve derneklerin geliştireceği ortak kılavuzların faydalı olacağı kanaatindeyiz.

Healthcare-Associated Infections in Pediatric Intensive Care Units in Turkey: a National Point-Prevalence Survey.

Health care-associated infections (HCAIs) cause considerable morbidity and mortality in pediatric intensive care units (PICUs). The objective of this point prevalence study was to assess the burden of HCAIs in PICUs in Turkey. Fifty PICUs participated in this study. Data regarding demographics, microbiological findings, therapeutic interventions, and outcomes were collected for all PICU inpatients. A total of 327 patients participated in the study: 122 (37%) experienced 1 or more HCAI. The most frequently reported site of infection was lower respiratory tract (n=77, 63%). The most frequently isolated pathogens were Pseudomonas aeruginosa, Acinetobacter species, and Candida species. Two hundred and forty-seven patients (75%) were receiving antimicrobial therapy at the time of the survey, and the most frequently administered antimicrobials were third generation cephalosporins. Hospital type, male, PICU stay >7 days, and mechanical ventilation were found to be independent risk factors for HCAIs. At the 4-week follow up, 43 (13%) patients had died, 28 (65%) of whom died of HCAIs. Endotracheal intubation, urinary catheter, male, and HCAIs were independent risk factors for mortality. This national, multicenter study documented a high prevalence of HCAIs in Turkey. In light of the 'primum non nocere' principle, the prevention of these infections should be a priority of public health policy.

PO-0516 Healthcare-associated Infections In A Turkey Neonatal Intensive Care Unit

<h3>Aim</h3> The aim of this study was to determine the incidence of (Healthcare-associated infection) HAI, causative organisms, associated risk factors in a neonatal intensive care unit in Turkey. <h3>Methods</h3> A prospective cohort study was conducted on patients admitted to the neonatal intensive care unit (NICU) from July 2011 to June 2012. The criteria that were used to diagnose infection were in accordance with the Centres for Disease Control and Prevention. The incidence, causative organisms, risk factors and mortality of healthcare-associated infections were assessed. <h3>Results</h3> The study included 352 patients, 37 of these developed HAIs, totaling 60 HAI episodes. Overall HAI patient rate was 17.04%, and 11.51 HAIs per 1000 NICU days. The most frequent HAIs were bloodstream infections (70%) and nosocomial pneumonia (18.3%). The central venous catheter/umblical catheter-related bloodstream infections (CVC/UC BSIs) rate was 18.3/1,000 catheter days; the ventilator-associated pneumonia (VAP) rate was 13.6/1,000 ventilator days; and the catheter-associated urinary tract infections rate found was 14.9/1,000 catheter days. Prematurity, gestational age less than 32 weeks, birth weight &lt; 1500 g, mechanical ventilation, use of CVC/UC, use of urinary catheter, and total parenteral nutrition appeared to be associated with a significantly higher risk of HAI (p ≤ 0.05). The most frequent pathogens were <i>Enterobacter spp</i>. (18.5%) and <i>Acinetobacter baumannii</i> (13.8%). Overall mortality rate in neonates was 3.9%, and the mortality rate in neonates with HAI was 10.8%. <h3>Conclusions</h3> Healthcare-associated infection rates of our NICU were higher than international standards. The decrement of risk factors in newborns would help to improve the outcome.

Exchange transfusion for neonatal hyperbilirubinemia: an 8-year single center experience at a tertiary neonatal intensive care unit in Turkey

Objective: The aim of present study was to evaluate the indications and the complications associated with neonatal exchange transfusion (ET) performed for hyperbilirubinemia.Methods: This study included overall 306 neonates who underwent ET between 2005 and 2012. The demographic characteristics of patients, causes of jaundice and adverse events occurred during or within 1 week after ET were recorded from their medical files. Those newborns that underwent ET were classified as either “otherwise healthy” or “sick” group.Results: Of the 306 patients who underwent ET, 244 were otherwise healthy and had no medical problems other than jaundice. The remaining 62 patients were classified as sick that had medical problems other than jaundice ranging from mild to severe. The mean gestational age was 37.6 ± 2.5 weeks and the mean peak total bilirubin levels was 25.8 ± 6.6 mg/dl. The mean age at presentation was 5.4 ± 3.8 d for all infants. The most common cause of hyperbilirubinemia was ABO isoimmunization (27.8%). None of newborns died secondary to ET. Three infants had had necrotizing enterocolitis, and also three infants had had acute renal failure. The most common encountered complications of ET procedure were hyperglycemia (56.5%), hypocalcaemia (22.5%) and thrombocytopenia (16%).Conclusions: Our data showed that ABO isoimmunization was the most common cause of hyperbilirubinemia. Even mortality was not seen, very rare but major gastrointestinal and renal complications were associated with ET. The majority of adverse events associated with ET were laboratory abnormalities mainly hyperglycemia, hypocalcaemia and thrombocytopenia which were asymptomatic and treatable.

Evaluation report of pediatric intensive care units in Turkey.

To collect data from throughout Turkey in order to facilitate the organization of pediatric intensive care units (PICUs), and to develop short-term immediate action plans and draft long-term strategic plans. A total of 35 specialists including 17 pediatric critical care (PCC) specialists, 9 PCC fellows in training, and 9 pediatricians working in PICUs evaluated PICUs and their infrastructures, mortality rates, appropriateness of indications for PICU admissions, PICU bed numbers, and utilization of those PICU beds. PICU bed numbers, PCC specialist numbers, and PICU nurse numbers are insufficient in Turkey. The high percentage of inappropriate and inefficient use of current PICU beds is also another problem. In the light of this report, it is obvious that pediatric intensive care services are successful and efficient only in the presence of PCC specialists in PICUs. Studies for improving the infrastructure of PICUs and the training of PCC specialists and other health personnel should be started immediately.

Early extracorporeal life support experiences in 2 tertiary pediatric intensive care units in Turkey.

Extracorporeal membrane oxygenation (ECMO) is a unique life-support modality offered to patients unresponsive to optimal medical therapy. The aim of this study was to evaluate early experiences with ECMO support in 2 tertiary Turkish pediatric intensive care units (PICUs). We retrospectively evaluated a total of 10 ECMO-supported patients between March 2012 and March 2013 in Marmara and Ege University Hospital PICUs. We reported data regarding demographics, laboratory and diagnostic information, and the clinical course of the patients. The study consisted of 6 males and 4 females from 5 months to 14 years of age (mean age: 0.5 ± 5.01 years) supported with ECMO. Out of the 10 patients, 8 were on venovenous ECMO for respiratory failure and 2 received venoarterial ECMO for cardiac failure. Mean ECMO and intensive care duration was 11.1 ± 7.3 days and 23.5 ± 17.8 days, respectively. Bleeding was the most common complication (60%). Forty percent of the patients were weaned from ECMO, among which 50% were discharged in good health without sequelae. Initial experiences build the learning curve of institutions, and our early results are encouraging. Giving time to heal to the right patient at the right time is the key to success.

Device-Associated Nosocomial Infection Rates and Distribution of Antimicrobial Resistance in a Medical-Surgical Intensive Care Unit in Turkey

The aim of this study was to explore the rate of device-associated nosocomial infections (DANIs) and the distributions of causative agents and patterns of antibiotic resistance in the medical-surgical intensive care unit (ICU) over a 3-year period and to compare these rates with those reported by National Nosocomial Infections Surveillance System and International Nosocomial Infection Control Consortium. A total of 1,798 patients were hospitalized in our ICU for 13,942 days, of which 309 patients had DANIs, indicating an overall infection rate of 22.1 per 1,000 ICU-days. The central line-associated bloodstream infection rate was 6.4 per 1,000 catheter-days, whereas the ventilator-associated pneumonia rate was 14.3 per 1,000 ventilator-days and the catheter-associated urinary tract infection rate was 4.3 per 1,000 catheter-days. Overall, 87.4% of all Staphylococcus aureus DANIs were caused by methicillin-resistant strains. With respect to Pseudomonas aeruginosa, 30.9% of the strains were resistant to ciprofloxacin, 23.3% to amikacin, 43.1% to ceftazidime, 19.1% to piperacillin-tazobactam, and 34.7% to imipenem. Furthermore, 1.9% of the Enterococcus spp. were resistant to vancomycin, and 51.1% of Enterobacteriaceae were resistant to ceftriaxone. DANI rates decreased over the 3-year study period, which was likely in response to the infection control measures implemented in our ICU.

Epidemiological Features of Patients with Acute Respiratory Distress Syndrome and Factors Determining Mortality in These Patients in a Medical Intensive Care Unit in Turkey

Epidemiological Features of Patients with Acute Respiratory Distress Syndrome and Factors Determining Mortality in These Patients in a Medical Intensive Care Unit in Turkey

Acute kidney injury in a single neonatal intensive care unit in Turkey

Although advances in perinatal medicine have increased the survival rates of critically ill neonates, acute kidney injury (AKI) is still one of the major causes of mortality and morbidity in neonatal intensive care units. This study aimed to determine the prevalence of AKI and analyze demographic data and risk factors associated with the mortality or morbidity. Of 1992 neonates hospitalized between January 2009 and January 2011, 168 with AKI were reviewed in the study. The diagnosis of AKI was based on plasma creatinine level >1.5 mg/dL, which persists for more than 24 hours or increases more than 0.3 mg/dL per day after the first 48 hours of birth while showing normal maternal renal function. The prevalence of AKI was 8.4%. The common cause of AKI was respiratory distress syndrome, followed by sepsis, asphyxia, dehydration, congenital anomalies of the urinary tract, congenital heart disease, and medication. The prevalence of AKI in neonates with birth weight lower than 1500 g was about three-fold higher than in those with birth weight higher than 1500 g (P<0.05). Pregnancy-induced hypertension, preterm prolonged rupture of membranes, and administration of antenatal corticosteroid were associated with increased risk of AKI (P<0.05). Umbilical vein catheterization, mechanical ventilation and ibuprofen therapy for patent ductus arteriosus closure were found to be associated with AKI (P<0.05). The overall mortality rate was 23.8%. Multivariate analysis revealed that birth weight less than 1500 g, mechanical ventilation, bronchopulmonary dysplasia, anuria, and dialysis were the risk factors for the mortality of infants with AKI. Prenatal factors and medical devices were significantly associated with AKI. Early detection of risk factors can reduce the mortality of AKI patients.

Long-term prostaglandin E1 use in newborns with duct-dependent congenital heart diseases: one year experience of a tertiary neonatal intensive care unit in Turkey

Long-term prostaglandin E1 use in newborns with duct-dependent congenital heart diseases: one year experience of a tertiary neonatal intensive care unit in Turkey

Distribution of congenital anomalies in a neonatal intensive care unit in Turkey

Background: Congenital anomalies are one of the important reasons of mortality and morbidity in newborns. The aim of this study is to determine the incidence, distribution and the mortality of the congenital anomalies in a single neonatal intensive care unit (NICU) from Turkey.Method: A retrospective analysis was performed between 2005 and 2012 in NICU using a computerized database. Variables including the type of anomaly, antenatal and postnatal history, gestational age, birth weight, consanguinity and other demographic, clinical and related laboratory variables were extracted from the computerized database using ICD-10 codes. Congenital anomalies were classified according to involved organ systems and also classified as single and multiple anomalies.Results: A total of 1024 newborns with congenital anomaly (CA) (13.7%) were identified among the 7450 hospitalized newborns in NICU. The most affected system was the cardiovascular system (68.8%). Most of the anomalies (67.1%) were single anomalies. Of all, 59.4% had single major, 7.7% had single minor, 9% had single major plus single minor, 18.4% had multiple major and 2% had multiple minor anomalies. On the other hand, 96.3, 1.9, 0.1 and 1.7% of the newborns had malformation, deformation, disruption and dysplasia, respectively. Chromosomal analysis was only performed 24.8% of the newborns with CA and among them, 65.3% of these were in normal limits. The most frequently detected chromosomal abnormality was trisomy 21. Overall, mortality rate was 15.5% among the newborns with CA.Conclusion: In conclusion, the most common and mortal CA was cardio-vascular malformations in our hospital. The overall prevalence of cardio-vascular malformations among the newborn was higher than previously reported studies in Turkey. Further, studies with larger sample size are needed to determine CA in Turkey.

Yenidoğan Otopsileri; Tek Merkez Deneyimi

Yenidoğan Otopsileri; Tek Merkez Deneyimi

Acute Peritoneal Dialysis in the Newborn Period: A 7-Year Single-Center Experience at Tertiary Neonatal Intensive Care Unit in Turkey

To evaluate the underlying causes and outcomes of neonates who underwent acute peritoneal dialysis (APD). This report describes a 7-year experience with APD in 77 neonates. Underlying causes requiring APD were acute tubular necrosis (ATN; n = 53), inborn error of metabolism (n = 18), bilateral renal vein thrombosis (n = 3), obstructive uropathy (n = 2; posterior urethral valve and neurogenic bladder), and bilateral renal artery thrombosis (n = 1). Fifteen of the 53 patients developed post-cardiac surgery ATN. The mean dialysis duration was 6.2 ± 10.7 days (range 1 to 90 days). Complications of procedure were hyperglycemia (n = 35), leaking of dialysate (n = 13), peritonitis (n = 10), catheter obstruction (n = 3), bleeding when inserting the catheter (n = 3), exit site infection (n = 2), and bowel perforation (n = 1). There were 57 deaths (74%) in this high-risk group due to underling causes. Of the 20 survivors, 16 patients showed a full renal recovery, but mild chronic renal failure developed in 1 patient and proteinuria with/without hypertension in 3 patients. Peritoneal dialysis is an effective means of renal replacement therapy in the neonatal period in the management of metabolic disturbances as well as renal failure. Although major complications of procedure are not so common, these patients have high mortality rates due to the serious nature of the primary causes.