Arterial hypertension is a major risk factor for increased morbidity and mortality from cardiovascular, cerebrovascular and renal disease, and it is shown that it has its roots in childhood. There is an obvious trend in the incidence of hypertension in the pediatric population, which follows the increase in the prevalence of obesity in this population. The de¿ nition of hypertension has undergone signi¿ cant changes over the past few decades. According to the modern de¿ nition, normal systolic and diastolic blood pressure in children above 90 percentile speci¿ c for age and gender. Given the great importance of the disease, both in medical and in the broader social context, it is necessary to establish clear diagnostic criteria and treatment protocols, and effective programs for prevention and early diagnosis of hypertension in children.

Pediatric population, particularly in neonatal age, because of their physiological characteristics (propensity to infection, anaemia and hypovolemia) are often candidates for supportive therapy with labile blood components and blood derivate. Good clinical assessment and laboratory testing are essential in identifying the primary disorder, in order to implement the optimal blood product, with an appropriate manner and in sufficient doses. New technological procedures in the preparation and processing of blood components, adherence to the principles of good manufacturing and laboratory practices, as well as permanent quality control of labile blood components, make transfusion with blood products safe and more efficient. In pediatric practice are now available the products obtained from whole blood units, which are concentrates of red cells, platelets, fresh frozen plasma and cryoprecipitate. All doses are adjusted to the body mass of the patients (small volume doses). According to our results, the most common reason for transfusion care for pediatric patients was anaemia. In spite the reason of hospitalisation (different diagnoses), during diagnostic procedures the diagnosis of anaemia was established. This condition required the supportive therapy with small volume concentrated erythrocytes. To avoid giving unnecessary blood products, it is necessary to comply with recommendations by national guidelines for the application of labile blood components. Multi-disciplinary approach should provide right time diagnosis of disorders and conditions with right time transfusion care. Because of that, treatment of paediatric patients was efficient and safe.

Parapneumonična efuzija kod dece definiše se obično kao nakupljanje pleuralne tečnosti u toku akutne bakterijske pneumonije, a ređe u sklopu virusne pneumonije i tuberkuloznog pleuritisa. Empijem označava prisustvo purulentnog sadržaja u pleuralnom prostoru. Pleuralna infekcija je kontinuum, ali klasično postoji podela u tri stadijuma: eksudativni, fibropurulentni i organizovani. Glavni bakterijski uzročnici su Pneumococcus, Streptococcus pyogenes i Staphylococcus aureus. Postoje dve kliničke prezentacije parapneumonične efuzije. Kada sumnjamo na pleuralni izliv, sprovodi se standardizovan terapijsko-dijagnostički postupak prema smernicama BTS vodiča. Ukoliko perzistira signifikantna količina pleuralne tečnosti i dođe do kompromitovanja plućne funkcije, tada govorimo o komplikovanoj parapneumoničnoj efuziji i indikovana je torakalna drenaža. Pri pojavi septacija i lokulacija u pleuralnom prostoru, neophodna je intrapleuralna instilacija fibrinolitika. Primena Streptokinaze je bezbedna, efikasna, smanjuje potrebu za hirurškim lečenjem i zajedno sa ostalim terapijskim merama dovodi do kompletnog oporavka deteta.

U pedijatrijskoj praksi poslednjih godina uočena je povećana učestalost pleuralnih efuzija. Prema načinu nastanka pleuralne efuzije su podeljene na eksudate i transudate. U grupi eksudata najčešće se sreću parapneumonične efuzije i empijem. Parapneumonična efuzija kod dece definiše se obično kao nakupljanje pleuralne tečnosti u toku akutne bakterijske pneumonije, a ređe u sklopu virusne pneumonije i tuberkuloznog pleuritisa. Empijem označava prisustvo purulentnog sadržaja u pleuralnom prostoru. Glavni bakterijski uzročnik pneumonija udruženih s izlivom je Streptococcus pneumoniae serotip 1. Kod 10% bolesnika ne dolazi do povlačenja pleuralne efuzije i pored konzervativnog lečenja. Tada sprovodimo standardizovan postupak prema smernicama BTS vodiča, sa algoritmom dijagnostičko-terapijskih mera. Signifikantna količina pleuralne tečnosti koja perzistira i kompromituje plućnu funkciju čini komplikovanu pleuralnu efuziju i indikovana je torakalna drenaža. Pri pojavi septacija i lokulacija u pleuralnom prostoru, neophodna je intrapleuralna instilacija fibrinolitika. Primena Streptokinaze je bezbedna, efikasna, smanjuje potrebu za hirurškim lečenjem i zajedno sa ostalim terapijskim merama dovodi do kompletnog oporavka deteta. Rana video-asistirana torakoskopija u kombinaciji sa fibrinoliticima verovatno će u budućnosti biti metoda izbora.