Haemodialysis is a fast and efficient meth-od for removing toxins from the body in a straightforward manner. This has been a regular practice at the Paediatric Clinic in Sarajevo, Department of Paediatric In-tensive Therapy since January 2009. By December 2014 there were 34 patients treated by haemodialysis, who had un-dergone 253 haemodialyses in total. There were 18 (52.9%) primary nephrologic pa-tients, while 16 (41.05%) were patients whose renal failure was caused by other etiology. The main objective of this paper is to present the most common conditions in childhood that require haemodialysis in its treatment. The Department of Paediat-ric Intensive Therapy for this period had hospitalized 1,226 patients in total. Out of this number 2.77% of patients required the application of haemodialysis in their treat-ment. The results show that the most common renal causes to perform haemodialysis are: haemolytic uremic syndrome (HUS), chronic renal failure, nephrotic syndrome and congenital bilateral nephrolithiasis. For the others, the most common non-renal causes are multiple organ dysfunc-tion syndrome (MODS) that occurs as a result of cardiac insufficiency, hepatic in-sufficiency or after surgeries, as well as in hemato-oncologic diseases.

Introduction: Developmental hip dysplasia represents the most common deformation of locomotor system in children. Developmental modulation of the hip is expressed during first year of life which is important for early diagnosis and treatment. Therefore, in the practice, it is very important to set a diagnosis early with application of simple and convenient methods (ultrasound) in order to achieve fast and efficient therapeutical effect and avoid permanent disability. Aim: The aim of this paper is to point out the increase of prematurely born infants and their survival thanks to the development of Unit for Intensive Neonatal Care at the Pediatric Clinics in Sarajevo. Material and methods: Clinical investigation included 150 infants (77 girls and 73 boys) in whom the developmental hip dysplasia was diagnosed with clinical exam, ultrasound exam and x-ray of the hips. The exams were done in period of January 2012 to August 2014. Results: Two groups of patients were formed. The first one consisted of premature infants, total number of 75 (34 girls and 41 boys), with developmental hip dysplasia that was diagnosed at the first exam at the Ultrasound unit of the Pediatric clinics and at the Intensive Neonatal Care Unit of the Pediatric Clinics in Sarajevo. Second (control) group consistsed of patients-on term infants who had diagnosed one of developmental hip dysplasia, total of 75 (43 girls and 32 boys) during first exam in the Ultrasound unit of the Pediatric clinics in Sarajevo. Conclusion: The frequency of premature birth is between 5 and 10% of all labors and demonstrates increasing trend. We suggest ultrasound examination of hips in each newborn, term or premature, at the age of 6 weeks after birth.

Introduction: Application of a central venous catheter (CVC), as a temporary or permanent vascular access for hemodialysis, has been continuous practice at the Sarajevo Pediatric Clinic, Department of Pediatric Intensive Care. The main goal of the article is to present our experiences with central venous catheters in the treatment of these patients. Material and methods: In the period from January 2009 to December 2014 a total of 41 patients were treated and a total of 56 catheters were placed. Results: The results show the prevalence of the femoral venous catheter (69,64%), with significantly smaller participation of jugular (28,57%) and symbolic participation of subclavian catheters (1,78%). Frequency of infections of 8,92% in our article is lower than the percentage contained in the data of the National Nosocomial Infections Surveillance System, which provided data related to 17% of catheter related infections. The most common agents of the catheter related infections in our patients are gram-negative bacteria from the Klebsiella pneumoniae group. Conclusion: The issue of the higher complication percentage during the treatment is linked with hemostasis related to bleeding into or around the catheters in 28,57% of patients, and to clotting disorder in terms of thrombosis in 10,71% of patients.

Introduction With improvement in postoperative care of surgical, cardiac, neurosurgical and other surgical paediatric patients, better outcome has been proven. Pts after surgery were transffered at Paediatric, Neonatal Intensive and Postintensive Cardiac Care Units at Paediatric clinic. Methods Retrospective evaluation of patients treated during January 2008–November 2013 period was performed. Patients were classified according to: sex, age, type of disease, total and specific mortality. Results Study included 468 postoperative patients. Paediatric surgery was represented with 64.9%. Cardiac surgery 21.7%, Neurosurgery 8.9%, and others 4.2%. Morbidity structure of surgical patients was: EA 12 (3.9%), gastroschisis 8 (2.6%), omphalocele 5 (1.6%), CDH 6 (2%), NEC 15(4.9%), urogenital procedures 75 (24.7%), GI tract-inflammations 41 (13.5%), congenital megacolon 9 (3%), bowel obstruction 72 (23.7%), tumour procedures 44 (14.5%). Cardiac structure: ToF 28(27.4%), VSD 24 (23.5%), ASD 14(13.7%), complex CHD 14 (13.7%), AVSD-a 8 (7.8%), TGA 3 (2.9%), AP stenosis 3 (2.9%), DAP 8 (7.8%). Hydrocephalus was present in 26 patients (66.6%). Total surgical mortality: 14.5%, specific paediatric surgery mortality was: 12.5%, cardiac:16.6%, neurosurgical: 23.8%, others 15%. In morbidity structure NEC was present in 26.3%, survival of 34%, CDH 50%, gastroschisis 62.5% and EA 75%. Survival post cardiac surgery was 100% for DAP, pulmonary artery stenosis 96%, VSD 93%, ASD 82%, ToF 75%, AVSD 57%, 34% for TGA. Survival of hydrocephalus with comorbidity was 20%. Conclusion Morbidity and mortality of postoperative care patients points for further improvement and development of children health care, having in mind that requres team’s work.

Introduction Ventilator-associated pneumonia (VAP) is a form of nosocomial infections - pneumonia which occurs in patients who are on mechanical ventilation for longer than 48 hours. It is very often complication on intensive unit care. Aim To evaluate prevalence VAP on Paediatric intensive care unit (PICU) and the most common causes. Subjects and methods: From mart 2009. till mart 2011., 42 patients age two months to eight years. Design of study: prospective Patients were divided according to age, gender, time of manifestations VAP, types of microorganisms isolated in cultures. Results From 42 investigated patients 22/42 (52.3%) were females. Patients were divided in the groups according to their age as follows: 0–6 months 9/42 (21.4%), 7–12 months 17/42 (40.4%), 1–3 years 11/42 (24.4%), 4–8 years 5/42 (11.9%)patients. According to time of manifestations VAP: between 48–96 hours of ventilations 14/42 (33.3%) patients, after 96 hours of ventilations 14/42 (33.3%) patients. According to types of microorganismus isolated in cultures: Klebsiella pneumoniae 12/42 (28.5%), Acinetobacter calcoaceticus 7/42 (16.6%), Staphylococcus aureus 7/42 (16.6%), Pseudomonas aeraginosa 4/42 (9.5%), Enterobacter4/42 (9.5%), Stenotrophomonas maltophilia 2/42 (4.7%), unknown 8/42 (19.2%).De-escalation therapy was administered in 30/42 (71.4%) patients. Dual antibiotic therapy was found in 22/42 (52.3%) patients. Mortality was 13/42 (30.9%) patients, in group therapy with deeskalation 7/13 (53.8%), whereas in the monotherapy group was 8/13 (61.5%) patients. Conclusion VAP is quite common complication on PICU. Previously taken cultures are very helpful in s timely selection antibiotics and successful recovery.

BiPAP mode was used among all patients. After the second hour of NPPV we observe reduction of respiratory rate (43.72 ± 13.46 b/min vs 34.25 ± 13.47, p < 0.01), heart rate (138.66 b/min vs 129.27 ± 24.21, p < 0.01) and improvement of the SPO 2 (86.17 ± 13.33 vs 94.85 ± 6.9, p < 0.01). We listed only 36 (33%) failures which had recourse to the intubation. Conclusion The NPPV is an interesting technique in PICU and the results are promising. The post-extubation ARF is probably a better indication for NPPV in paediatrics.

BiPAP mode was used among all patients. After the second hour of NPPV we observe reduction of respiratory rate (43.72 ± 13.46 b/min vs 34.25 ± 13.47, p < 0.01), heart rate (138.66 b/min vs 129.27 ± 24.21, p < 0.01) and improvement of the SPO 2 (86.17 ± 13.33 vs 94.85 ± 6.9, p < 0.01). We listed only 36 (33%) failures which had recourse to the intubation. Conclusion The NPPV is an interesting technique in PICU and the results are promising. The post-extubation ARF is probably a better indication for NPPV in paediatrics.