Journal articles on the topic 'Pediatric respiratory diseases Case studies'
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Choirul Anam, Niarsari Anugrahing Putri, Rahmad Ramadhani, and Yasmin Musfirah. "Case distribution and survival rate in Pediatric Intensive Care Unit (PICU) at Banjarmasin, Indonesia." Pediatrics Sciences Journal 2, no. 2 (February 3, 2022): 44–47. http://dx.doi.org/10.51559/pedscij.v2i2.29.
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Introduction: Epidemiological studies about case distribution and survival in PICU is important to do. Knowledge of these epidemiological studies can assist in decision-making to improve patient quality of care. So far there is no data about the case distribution and survival rate of the patients in the PICU in Banjarmasin, Indonesia. This study aims to provide an overview of case distribution and survival rates of patients treated at the PICU of Ulin Hospital Banjarmasin.
Methods: A retrospective study was conducted at the PICU of Ulin Hospital Banjarmasin. Data was taken from patients’ records from January 2017 to December 2018.
Results: A total of 202 patients were admitted to the PICU, males 109 and females 93. The mortality rate was 17% with a survival rate, 83% with a mean length of stay of 10 days. The most common patient diagnosis was pneumonia 23%, meningoencephalitis 10%, and dengue shock syndrome 6%. The system commonly involved was respiratory system 26%, central nervous system 17%, and infection 13%. The median length of stay for overall admission was 9 days with a mean of 10 days. The cardiovascular and respiratory systems tend to have lower survival rates, 78%, and 79% respectively.
Conclusions: This study shows that respiratory, neurological, and infectious diseases are the most common diseases that cause children to be admitted to the PICU. The mortality rate in this study was 17% with a mean length of stay of 10 days. It is necessary to focus on medical facilities and interventions to reduce respiratory-related mortality.
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Mauritz, Maximilian David, Carola Hasan, Larissa Alice Dreier, Pia Schmidt, and Boris Zernikow. "Opioid-Induced Respiratory Depression in Pediatric Palliative Care Patients with Severe Neurological Impairment—A Scoping Literature Review and Case Reports." Children 7, no. 12 (December 21, 2020): 312. http://dx.doi.org/10.3390/children7120312.
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Pediatric Palliative Care (PPC) addresses children, adolescents, and young adults with a broad spectrum of underlying diseases. A substantial proportion of these patients have irreversible conditions accompanied by Severe Neurological Impairment (SNI). For the treatment of pain and dyspnea, strong opioids are widely used in PPC. Nonetheless, there is considerable uncertainty regarding the opioid-related side effects in pediatric patients with SNI, particularly concerning Opioid-Induced Respiratory Depression (OIRD). Research on pain and OIRD in pediatric patients with SNI is limited. Using scoping review methodology, we performed a systematic literature search for OIRD in pediatric patients with SNI. Out of n = 521 identified articles, n = 6 studies were included in the review. Most studies examined the effects of short-term intravenous opioid therapy. The incidence of OIRD varied between 0.13% and 4.6%; besides SNI, comorbidities, and polypharmacy were the most relevant risk factors. Additionally, three clinical cases of OIRD in PPC patients receiving oral or transdermal opioids are presented and discussed. The case reports indicate that the risk factors identified in the scoping review also apply to adolescents and young adults with SNI receiving low-dose oral or transdermal opioid therapy. However, the risk of OIRD should never be a barrier to adequate symptom relief. We recommend careful consideration and systematic observation of opioid therapy in this population of patients.
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Samoo, Urooj, Shaista Ehsan, and Farah Agha. "Frequency and pattern of respiratory diseases in children." International Journal of Contemporary Pediatrics 4, no. 5 (August 23, 2017): 1567. http://dx.doi.org/10.18203/2349-3291.ijcp20173765.
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Background: Respiratory tract infections are a major cause of morbidity and mortality in children. Therefore, it is imperative that research studies be conducted to determine the pattern of respiratory diseases in the pediatric age group. Present study was done to determine the outcome, frequency and pattern of respiratory infections in children admitted in a tertiary care hospital.Methods: This prospective, cross-sectional study was conducted from September 2014 to February 2016. Data was analyzed on SPSS 20.0. P value of <0.05 was observed noteworthy.Results: A total of 286 children were admitted with respiratory diseases. Out of these there were 180 cases of Pneumonia. Peak occurrence of Pneumonia was observed in first trimester of the year.Conclusions: Efforts are required to devise strategies to decrease the burden of respiratory diseases in children.
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Menezes, Fernanda Souza de, Heitor Pons Leite, Juliana Fernandez, Silvana Gomes Benzecry, and Werther Brunow de Carvalho. "Hypophosphatemia in critically ill children." Revista do Hospital das Clínicas 59, no. 5 (2004): 306–11. http://dx.doi.org/10.1590/s0041-87812004000500015.
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The purpose of this paper is to review clinical studies on hypophosphatemia in pediatric intensive care unit patients with a view to verifying prevalence and risk factors associated with this disorder. We searched the computerized bibliographic databases Medline, Embase, Cochrane Library, and LILACS to identify eligible studies. Search terms included critically ill, pediatric intensive care, trauma, sepsis, infectious diseases, malnutrition, inflammatory response, surgery, starvation, respiratory failure, diuretic, steroid, antiacid therapy, mechanical ventilation. The search period covered those clinical trials published from January 1990 to January 2004. Studies concerning endocrinological disorders, genetic syndromes, rickets, renal diseases, anorexia nervosa, alcohol abuse, and prematurity were not included in this review. Out of 27 studies retrieved, only 8 involved pediatric patients, and most of these were case reports. One clinical trial and one retrospective study were identified. The prevalence of hypophosphatemia exceeded 50%. The commonly associated factors in most patients with hypophosphatemia were refeeding syndrome, malnutrition, sepsis, trauma, and diuretic and steroid therapy. Given the high prevalence, clinical manifestations, and multiple risk factors, the early identification of this disorder in critically ill children is crucial for adequate replacement therapy and also to avoid complications.
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Ahmed, Mohamed, Abdellahi Weddih, Mohammed Benhafid, Mohamed Bollahi, Mariem Sidatt, Khattry Makhalla, Ali Mokdad, Jorg Heukelbach, and Abdelkarim Filali-Maltouf. "Hospitalizations and Deaths Associated with Diarrhea and Respiratory Diseases among Children Aged 0–5 Years in a Referral Hospital of Mauritania." Tropical Medicine and Infectious Disease 3, no. 3 (September 17, 2018): 103. http://dx.doi.org/10.3390/tropicalmed3030103.
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Diarrhea and respiratory diseases are the leading causes of morbidity and mortality among <5-year-olds worldwide, but systematic data are not available from Mauritania. We conducted a hospital-based retrospective study. Data on admissions to Mauritania’s National Referral Hospital (the main pediatric referral center in the country), due to diarrhea and respiratory diseases, during 2011–2014, were analyzed. A total of 3695 children <5 years were hospitalized during this period; 665 (18.0%) due to respiratory diseases, and 829 (22.4%) due to diarrhea. Case fatality rates in the respiratory diseases and diarrhea groups were 18.0% (120/665) and 14.1% (117/829), respectively. The highest frequency of deaths due to diarrhea occurred in the age group 2–5 years (16/76; 21.0%), and due to respiratory diseases in the age group 6–12 months (32/141; 22.6%). We conclude that case fatality rates caused by respiratory diseases and diarrhea are extremely high in children hospitalized at the National Referral Hospital. These data call for intensified efforts to reduce deaths among hospitalized Mauritanian children, and also for integrated control measures to prevent and reduce the burden of both diseases. Additional studies are needed to show the effectiveness of the introduction of vaccination programs for pneumococcal diseases and rotavirus infection in the child population, which were launched in November 2013 and December 2014, respectively.
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Parri, Niccolò, Anna Maria Magistà, Federico Marchetti, Barbara Cantoni, Alberto Arrighini, Marta Romanengo, Enrico Felici, et al. "Characteristic of COVID-19 infection in pediatric patients: early findings from two Italian Pediatric Research Networks." European Journal of Pediatrics 179, no. 8 (June 3, 2020): 1315–23. http://dx.doi.org/10.1007/s00431-020-03683-8.
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Abstract Detailed data on clinical presentations and outcomes of children with COVID-19 in Europe are still lacking. In this descriptive study, we report on 130 children with confirmed COVID-19 diagnosed by 28 centers (mostly hospitals), in 10 regions in Italy, during the first months of the pandemic. Among these, 67 (51.5%) had a relative with COVID-19 while 34 (26.2%) had comorbidities, with the most frequent being respiratory, cardiac, or neuromuscular chronic diseases. Overall, 98 (75.4%) had an asymptomatic or mild disease, 11 (8.5%) had moderate disease, 11 (8.5%) had a severe disease, and 9 (6.9%) had a critical presentation with infants below 6 months having significantly increased risk of critical disease severity (OR 5.6, 95% CI 1.3 to 29.1). Seventy-five (57.7%) children were hospitalized, 15 (11.5%) needed some respiratory support, and nine (6.9%) were treated in an intensive care unit. All recovered. Conclusion:This descriptive case series of children with COVID-19, mostly encompassing of cases enrolled at hospital level, suggest that COVID-19 may have a non-negligible rate of severe presentations in selected pediatric populations with a relatively high rates of comorbidities. More studies are needed to further understand the presentation and outcomes of children with COVID-19 in children with special needs. What is Known:• There is limited evidence on the clinical presentation and outcomes of children with COVID-19 in Europe, and almost no evidence on characteristics and risk factors of severe cases. What is New:• Among a case series of 130 children, mostly diagnosed at hospital level, and with a relatively high rate (26.2%) of comorbidities, about three-quarter had an asymptomatic or mild disease.• However, 57.7% were hospitalized, 11.5% needed some respiratory support, and 6.9% were treated in an intensive care unit.
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Alfraik, Nasren Gamal Saleh. "Red Cell Distribution Width and Respiratory Diseases in Tobruk Pediatric In-tensive Care Unit." Al-Mukhtar Journal of Sciences 35, no. 1 (January 30, 2020): 19–25. http://dx.doi.org/10.54172/mjsc.v35i1.225.
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The red blood cell distribution width (RDW) is a simple and inexpensive parameter, which reflects the degree of heterogeneity of erythrocyte volume. This retrospective study aimed to detect the correlation between RDW and respiratory diseases and analyzed all patients admitted to the Pediatric Intensive Care Unit (PICU) at Tobruk Medical Center between January 2017 and January 2019. All patients below 16 years old with an available baseline RDW value on admission to PICU and had had a respiratory disease and needed oxygen therapy were eligible for inclusion. Of the 76 patients studied, 36.8% had elevated RDW. The median age was 97.5 days old, 60.5% were male, and 39.4% females. All patients were Libyan and 97.4% from Tobruk. Causes of admission were 52.6% bronchopneumonia, 29% acute broncholitis, 10.5% aspiration pneumonia, 5.3% bronchial asthma, and CHD with apnea were 2.7%. We noted a respiratory retraction in most of the cases, grunting and retraction in 35%, and cyanosis in 28% of cases. Reported complications of this study were sepsis 41%, aspiration 24%, pneumothorax 10.5%, convulsion 9%, apnea 8%, pleural effusion 7% and renal failure 1%. 62% of our patients had pulmonary infiltration on chest x-ray. Regarding the route of oxygen therapy, 60.5% were treated with nasal prongs, 38% with masks, and 1.3% needed a mechanical ventilator. 29% of patients received steroids. The RDW mean was 14.499 and there were significant correlations between RDW and signs of respiratory distress, length of hospital stay, and duration of oxygen therapy. 98% of our patients were discharged. We conclude there is a strong correlation between RDW and respiratory diseases as pneumonia, acute broncholitis and we recommend farther studies to study the correlation between RDW and other organ diseases in the pediatric age group.
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Mendeluk, Gabriela Ruth, Sergio López Costa, Sergio Scigliano, Guillermo Menga, Sergio Demiceu, and Luis Alberto Palaoro. "A Rare Case of Respiratory Disorders Associated with Two Autosomal Recessive Diseases and Male Infertility." Allergy & Rhinology 4, no. 1 (January 2013): ar.2013.4.0038. http://dx.doi.org/10.2500/ar.2013.4.0038.
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The study of nasal ciliary beat frequency (CBF) and ultrastructure may contribute to the understanding of pathognomonic cases of male infertility associated with defects in sperm motility. This study was designed to report a particular case of male infertility, characterized by the association of two respiratory autosomal recessive genetic diseases (alpha-1-antitrypsin deficiency [AAT-D] and primary ciliary dyskinesia [PCD]). A 39-year-old patient with complete sperm immotility, AAT-D, and bronchiectasis was studied in the Laboratory of Male Fertility, the Department of Urology, the Respiratory Center of a Pediatric Hospital, and in the Department of Clinical Medicine of a Rehabilitation Respiratory Hospital. Family history, physical examination, hormonal analysis, microbial assays, semen analysis, nasal ciliary function, and structure study by digital high-speed video photography and transmission electron microscopy are described. A noninvasive nasal biopsy to retrieve ciliated epithelium lining the inferior surface of the inferior nasal turbinates was performed and CBF was determined. Beat pattern was slightly curved and rigid, not wide, and metacronic in all the observed fields analyzed. CBF was 8.2 Hz in average (reference value, 10–15 Hz) Ultrastructural assay revealed absence of the inner dynein arms in 97% of the cilia observed. The final infertility accurate diagnosis was achieved by the study of nasal CBF and ultrastructure contributing to the patient health management and genetic counseling while deciding fatherhood. Beyond this particular case, the present report may open a new field of studies in male infertility, mainly in cases of asthenozoospermia.
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Cuvelier, Geoff, Amged El-Hawrani, Hamdy El-Hakim, and Joan L. Robinson. "A Case of Atypical Croup." Canadian Journal of Infectious Diseases and Medical Microbiology 16, no. 6 (2005): 361–62. http://dx.doi.org/10.1155/2005/897936.
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Case Presentation A previously healthy eight-month-old girl was admitted to the pediatric intensive care unit at Stollery Children's Hospital (Edmonton, Alberta) following a waxing and waning course of respiratory distress. She had initially presented 11 days earlier to the emergency room with stridor and a brassy cough, and laryngotracheobronchitis was diagnosed. Treatment with racemic adrenaline and one dose of oral dexamethasone was effective and she was discharged after overnight observation. Nasopharyngeal aspirate was negative by direct fluorescent antibody and by viral culture for influenza A and B, parainfluenza and respiratory syncytial virus. Over the next three days, the child had increasing stridor and was admitted and again treated with racemic adrenaline and a four-day course of oral dexamethasone. She was subsequently discharged. White lesions were noted on the tongue and were treated with topical nystatin. Four days later, the child presented to the emergency room with recurrence of stridor and fever and new onset of drooling. She had a respiratory rate of 44 breaths/min, heart rate of 170 beats/min, blood pressure of 90/58 mmHg, oxygen saturation of 98% and temperature of 39.6°C. She was in moderate respiratory distress, with marked stridor. Examination of the oropharynx revealed ulcerative lesions on the anterior tongue, hard and soft palate, and posterior pharynx. Laboratory studies revealed a white blood cell count of 18.1x109/L (74% neutrophils, 23% lymphocytes and 3% monocytes). Other hematological values were normal. A laryngobronchoscopy was performed and revealed that the mucosa of the laryngopharynx was studded with discrete white lesions on a background of mucosal inflammation with severe reduction of airway calibre requiring intubation (Figure 1). The subglottis and the tracheobronchial tree were severely inflamed but had no discrete lesions.
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El Baroudy, Nevine R., Amira S. El Rifay, Tamer A. Abdel Hamid, Dina M. Hassan, May S. Soliman, and Lobna Sherif. "Respiratory Viruses and Atypical Bacteria Co-Infection in Children with Acute Respiratory Infection." Open Access Macedonian Journal of Medical Sciences 6, no. 9 (August 23, 2018): 1588–93. http://dx.doi.org/10.3889/oamjms.2018.332.
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BACKGROUND: Acute respiratory infections (ARI) are one of the prevalent pediatric diseases. Coinfections of respiratory viruses and atypical bacterial respiratory pathogens are common.AIM: This study aimed to determine the prevalence of co-infection between respiratory pathogens including viruses, bacteria and atypical bacteria in a sample of Egyptian children presenting with symptoms of acute respiratory tract infection.METHODS: This one-year prospective cohort study conducted in Abo El Rish Pediatric Hospital, Cairo University over one year included children presenting with symptoms of acute respiratory infection. Enrolled children were subjected to nasopharyngeal swabs or throat swabs and then processed to detect viral, bacterial and atypical bacterial causative agents by culture), retrotranscription polymerase, Monoplex polymerase chain reaction (PCR) and Multiplex PCR.RESULTS: Viral etiological agents were detected in 20 cases (20.8%), while 76 patients (79.2%) had no definite viral aetiology. The most abundant virus detected was Rhinovirus in 36 (27.3%), followed by 21 (15.9%) were positive for RSV, 12 (9.1%) were positive for HMPV, 6 (4.5%) were positive for adenovirus and 3 (2.3%) were positive for influenza B. For Atypical bacterial causes Mycoplasma were positive for 9 (6.8%) cases and one case was positive for Bordetella parapertussis. Viral and atypical bacteria Co infection were detected in 14 (10.6%) of cases.CONCLUSION: These results suggest that coinfection with bacteria or atypical bacteria in children with acute respiratory tract infection is common and this co-infection can induce serious illness. The multiplex reverse-transcriptase polymerase chain reaction should become an essential tool for epidemiological studies and can fill the gap between clinical presentation and definitive diagnosis.
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Pelizzo, Gloria, Serena Silvestro, Maria Antonietta Avanzini, Gianvincenzo Zuccotti, Emanuela Mazzon, and Valeria Calcaterra. "Mesenchymal Stromal Cells for the Treatment of Interstitial Lung Disease in Children: A Look from Pediatric and Pediatric Surgeon Viewpoints." Cells 10, no. 12 (November 23, 2021): 3270. http://dx.doi.org/10.3390/cells10123270.
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Mesenchymal stromal cells (MSCs) have been proposed as a potential therapy to treat congenital and acquired lung diseases. Due to their tissue-regenerative, anti-fibrotic, and immunomodulatory properties, MSCs combined with other therapy or alone could be considered as a new approach for repair and regeneration of the lung during disease progression and/or after post- surgical injury. Children interstitial lung disease (chILD) represent highly heterogeneous rare respiratory diseases, with a wild range of age of onset and disease expression. The chILD is characterized by inflammatory and fibrotic changes of the pulmonary parenchyma, leading to gas exchange impairment and chronic respiratory failure associated with high morbidity and mortality. The therapeutic strategy is mainly based on the use of corticosteroids, hydroxychloroquine, azithromycin, and supportive care; however, the efficacy is variable, and their long-term use is associated with severe toxicity. The role of MSCs as treatment has been proposed in clinical and pre-clinical studies. In this narrative review, we report on the currently available on MSCs treatment as therapeutical strategy in chILD. The progress into the therapy of respiratory disease in children is mandatory to ameliorate the prognosis and to prevent the progression in adult age. Cell therapy may be a future therapy from both a pediatric and pediatric surgeon’s point of view.
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Gruppo di lettura di Milano. "Attendere prima di usare l’antibiotico nelle infezioni delle vie respiratorie pediatriche non peggiora la prognosi e riduce il consumo di farmaci non necessari: i risultati di un RCT." PAGINE ELETTRONICHE DI QUADERNI ACP 28, no. 4 (2021): 1. http://dx.doi.org/10.53141/peqacp.2021.4.n1.
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Waiting before using the antibiotic in pediatric respiratory tract infections does not worsen the prognosis and reduces the consumption of unnecessary drugs: the results of an RCT The prescription of antibiotics in pediatric age is high and could be reduced as respiratory diseases often do not require pharmacological intervention. This pragmatic study carried out in primary care in Spain compared three intervention arms: delayed antibiotic prescription, immediate or no prescription; the 30-day follow-up revealed no differences in the duration of the disease or in the severity of symptoms in the three groups of children. Despite the good methodological quality, the RCT could be affected by a significant selection bias; nevertheless, several other studies on the subject lead to similar results.
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Bogdanova, Alevtina Viktorovna, Cyrendorzhi Valer`evich Zandakov, Artem Valer'evich Tishkov, Ludmila Alekszndrovna Zhelenina, Timofei Vladimirovich Sergeev, and Mariya Valentinovna Kuropatenko. "The medical informative systems in pediatric practice - problems and prospects." Pediatrician (St. Petersburg) 6, no. 4 (December 15, 2015): 140–46. http://dx.doi.org/10.17816/ped64140-146.
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Data on the use of modern medical information systems (MIS) in Russian medicine, including in pediatrics are presented. Advances and problems in creating a single unified MIS, diagnostic information systems are highlighted. Information about existing questionnaires in the area of life quality assessment of healthy and patients suffering from pulmonological profile are provided. The problems of diagnostics of chronic diseases of small bronchial tubes at children are observed. It is important to determine the probability of the diseases formation for the usage of financially-based and informative methods of research, aimed at timely identification of the disease are considered. Data of the studies of the prevalence of chronic diseases of the small bronchi of children with the help of specialized questionnaires which were hold in two regions of the Russian Federation are included. The results confirmed the high sensitivity of the methods used and showed a significant excess of the actual prevalence of bronchopulmonary diseases in children compared with statistical data on the uptake. These methods of diagnostics screening have no analogues in pediatrics. MIS with analysis possibility and decision support diagnostic decisions are rather rare, and absent in pulmonary practice. Thus, there is a need for the establishment of unified information systems for diagnostic use in medicine. In particular, in the field of pediatric pulmonology the introduction of an MIS developed on the basis of a proven questionnaire will help to solve the problem of timely detection of chronic allergic and non-allergic respiratory diseases in children in primary care.
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Sotelo, Jesus, Esra Akkoyun, Giselle S. Chery, Amal Aqul, Dev M. Desai, Paul K. Sue, and Alyssa Power. "931. Epidemiology and Clinical Outcomes of SARS-CoV-2 Infection Among Pediatric Solid Organ Transplant Recipients: A Single-Center Case Experience." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S558. http://dx.doi.org/10.1093/ofid/ofab466.1126.
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Abstract Background The impact of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) infection among pediatric solid organ transplant (SOT) recipients remains unclear. We sought to characterize the clinical epidemiology and outcomes following SARS-CoV-2 infection among pediatric SOT recipients in Dallas, TX. Methods Retrospective review of all SOT recipients with laboratory confirmed COVID-19 infection from March 1, 2020 –March 31, 2021. Demographic, clinical, and outcome data were stratified by transplant type and disease severity. Fischer’s exact test and Kruskall-Wallis test were used to evaluate risk factors for more severe disease among hospitalized children. Results Twenty-six SOT recipients with a median age of 14 years were included in the study. Fifteen (58%) were female, eighteen (69%) were Hispanic and thirteen (50%) were overweight/obese. Median time post-transplant was 3.6 years (1311 days, interquartile range (IQR) 394-2881). Fourteen patients were liver recipients, seven kidney, three heart, and two multiorgan. The majority of patients (65%) had a known community exposure and presented with fever (50%), cough (38%) and GI symptoms (19%). Half of all cases were hospitalized (n=13), with 2 requiring intensive care unit (ICU) admission, but no patients required positive pressure ventilation. Median hospital stay was 3 days. Five of the thirteen hospitalized patients were categorized as having moderate disease. No patients developed severe disease and there were no deaths. Older children, as well as children with multiple co-morbidities were noted on univariate analysis to be at higher risk for moderate, as compared to mild, disease. Conclusion SARS-CoV-2 infection among pediatric SOT recipients are at increased risk for hospital admission but demonstrate an overall mild /moderate disease course. Larger studies are required to elucidate the risk of morbidity between pediatric SOT recipients and immunocompetent children with SARS-CoV-2. Disclosures Amal Aqul, MD, Albireo pharma Inc. (Consultant)
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Mazur, Natalie I., Yvette N. Löwensteyn, Joukje E. Willemsen, Christopher J. Gill, Leah Forman, Lawrence M. Mwananyanda, Dianna M. Blau, et al. "Global Respiratory Syncytial Virus–Related Infant Community Deaths." Clinical Infectious Diseases 73, Supplement_3 (September 1, 2021): S229—S237. http://dx.doi.org/10.1093/cid/ciab528.
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Abstract Background Respiratory syncytial virus (RSV) is a leading cause of pediatric death, with >99% of mortality occurring in low- and lower middle-income countries. At least half of RSV-related deaths are estimated to occur in the community, but clinical characteristics of this group of children remain poorly characterized. Methods The RSV Global Online Mortality Database (RSV GOLD), a global registry of under-5 children who have died with RSV-related illness, describes clinical characteristics of children dying of RSV through global data sharing. RSV GOLD acts as a collaborative platform for global deaths, including community mortality studies described in this supplement. We aimed to compare the age distribution of infant deaths <6 months occurring in the community with in-hospital. Results We studied 829 RSV-related deaths <1 year of age from 38 developing countries, including 166 community deaths from 12 countries. There were 629 deaths that occurred <6 months, of which 156 (25%) occurred in the community. Among infants who died before 6 months of age, median age at death in the community (1.5 months; IQR: 0.8−3.3) was lower than in-hospital (2.4 months; IQR: 1.5−4.0; P < .0001). The proportion of neonatal deaths was higher in the community (29%, 46/156) than in-hospital (12%, 57/473, P < 0.0001). Conclusions We observed that children in the community die at a younger age. We expect that maternal vaccination or immunoprophylaxis against RSV will have a larger impact on RSV-related mortality in the community than in-hospital. This case series of RSV-related community deaths, made possible through global data sharing, allowed us to assess the potential impact of future RSV vaccines.
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Breuer, Ryan K., Frank Carnevale, Jessica Donhauser, Mika Iwano, Bree Kramer, Vanessa Marthia, Kirsten Nutty, Nikhil Patankar, Scott Wilkowski, and Amanda B. Hassinger. "Pediatric Sepsis in Our Community: A Point Prevalence Study." Journal of Pediatric Infectious Diseases 15, no. 01 (October 21, 2019): 039–47. http://dx.doi.org/10.1055/s-0039-1698442.
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Abstract Objective Hospital-based studies are the main sources of epidemiologic data on pediatric sepsis, underrepresenting those managed as outpatients. This may disadvantage community providers, especially when determining triage, referral, and follow-up. Our objective was to characterize sepsis in nonhospitalized children and describe resources allocated to their care. Methods This was a point prevalence study conducted in 11 primary care (PC) offices, 2 urgent care (UC) centers, and 1 pediatric emergency department (ED) serving Western New York. Patients aged 18 years and younger evaluated at a participating site on one of four study dates over a 12-month period were eligible to participate. Patients were included if temperature and heart rate and/or respiratory rate were documented during their visit. The primary outcome was the prevalence of sepsis in participating sites. Results Of 3,269 eligible children, 52.6% (n = 1,719) met inclusion criteria, 91% of whom (n = 1,576) were evaluated for acute infection. Sepsis criteria were met by 8.8% of these patients (22.4% in ED, 13.0% in UC centers, and 1.6% in PC offices). Most (74%) patients with sepsis were managed solely by initial site and sent home. However, meeting sepsis criteria was associated with higher odds of escalation of care beyond initial site (adjusted odds ratio [aOR]: 2.59, 95% confidence interval [CI]: 1.62–4.17). The presence of tachycardia (aOR: 2.88, 95% CI: 1.70–4.90) or a lower respiratory tract infection (aOR: 3.69, 95% CI: 2.28–5.99) was also independently associated with higher odds of care escalation. Conclusion Nearly 1 in 10 children seeking outpatient evaluation for infection met sepsis criteria. While most were managed without transfer or hospital admission, the diagnosis did carry higher odds of care escalation. Tachycardia and lower respiratory tract infections also conveyed an increased likelihood, suggesting additional screening possibilities for outpatient clinicians.
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Victora, C. G., P. G. Smith, J. P. Vaughan, L. C. Nobre, C. Lombardi, A. M. B. Teixeira, S. M. Fuchs, L. B. Moreira, L. P. Gigante, and F. C. Barros. "Influence of Birth Weight on Mortality From Infectious Diseases: A Case-Control Study." Pediatrics 81, no. 6 (June 1, 1988): 807–11. http://dx.doi.org/10.1542/peds.81.6.807.
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The association between birth weight and infant mortality from infectious diseases was investigated in a population-based case-control study in two urban areas in southern Brazil. All deaths of children, seven to 364 days of age, occurring in a year were studied and the parents of the 357 infants dying of an infectious cause were interviewed, as were the parents of two neighborhood control infants for each case. Low birth weight infants (<2,500 g) were found, after allowing for confounding factors, to be 2.3 (90% confidence interval = 1.6 to 3.4) times more likely to die of an infection than those of higher birth weight. The odds ratios were 2.0 (1.1 to 3.6) for deaths due to diarrhea, 1.9 (1.0 to 3.6) for respiratory infections, and 5.0 (1.3 to 18.6) for other infections. These estimates of the risks associated with low birth weight are considerably lower than those from studies in developed countries.
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Parker, Madeline, Olivia Griffin, Félix Lévesque, Ayisha Kurji, and Erin Woods. "91 The impact of non-pharmaceutical public health interventions on hospital admissions and mortality from common causes of pediatric respiratory distress: a single center perspective." Paediatrics & Child Health 27, Supplement_3 (October 1, 2022): e43-e43. http://dx.doi.org/10.1093/pch/pxac100.090.
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Abstract Background In response to the COVID-19 pandemic, jurisdictions around the world implemented policies to reduce COVID-19 transmission through public masking, travel restrictions, and closure of non-essential businesses. Collectively known as non-pharmaceutical interventions (NPI), these strategies reliably reduce the spread of COVID-19. International data suggests NPI also reduce hospitalizations for pediatric respiratory infections and their consequences, particularly asthma exacerbation. However, few Canadian studies have examined the impact of NPI on hospitalizations for common causes of pediatric respiratory distress. Objectives This study describes the impact of NPI on admissions for bronchiolitis, pneumonia, and asthma at a Canadian pediatric tertiary care centre. Design/Methods A retrospective chart review was conducted including all pediatric patients <18 years admitted to the general pediatric and pediatric intensive care units with bronchiolitis, pneumonia, or asthma. Data regarding diagnosis, length of hospitalization, and mortality were collected before (September 2016-March 2020) and in the 6 months after provincial NPI implementation (March 2020-September 2020). NPI were present throughout this period, however, specific measures varied due to evolving public health orders. Chi-squared testing was conducted to describe the impact of NPI on number of admissions, length of hospitalization, and mortality. Results Participants (n=1631) included 111 (6.8%) patients <1 month, 878 (53.8%) patients 1-23 months, 331 (20.3%) patients 24 months-4 years, and 311 (19.1%) patients ≥5 years. A mean of 205 patients were admitted every 6 months with respiratory distress (bronchiolitis, pneumonia, and/or asthma) prior to NPI implementation. During this timeframe, the 6-month mean admissions due to asthma, pneumonia, and bronchiolitis were 48, 56, and 101, respectively. In the 6 months following NPI implementation, there were 56 admissions for respiratory distress, including 15 for asthma, 19 for pneumonia, and 22 for bronchiolitis. Mean length of stay increased following the implementation of NPI from 8.49 to 11.68 days, whereas 6-month mean mortality decreased from two to zero deaths. Results did not attain statistical significance (p>0.05). Conclusion Results suggest NPI reduce hospitalizations and mortality from bronchiolitis, pneumonia, and asthma. Given the similar seasonality of these conditions, periodic use of NPI beyond the COVID-19 pandemic may reduce pediatric morbidity and mortality from common causes of respiratory distress. However, additional research is needed to describe the relationship between NPI and length of hospitalization. Future studies should also examine the impact of NPI on other pediatric infectious diseases to better characterize their utility.
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Ammirabile, Angela, Danilo Buonsenso, and Antonio Di Mauro. "Lung Ultrasound in Pediatrics and Neonatology: An Update." Healthcare 9, no. 8 (August 7, 2021): 1015. http://dx.doi.org/10.3390/healthcare9081015.
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The potential role of ultrasound for the diagnosis of pulmonary diseases is a recent field of research, because, traditionally, lungs have been considered unsuitable for ultrasonography for the high presence of air and thoracic cage that prevent a clear evaluation of the organ. The peculiar anatomy of the pediatric chest favors the use of lung ultrasound (LUS) for the diagnosis of respiratory conditions through the interpretation of artefacts generated at the pleural surface, correlating them to disease-specific patterns. Recent studies demonstrate that LUS can be a valid alternative to chest X-rays for the diagnosis of pulmonary diseases, especially in children to avoid excessive exposure to ionizing radiations. This review focuses on the description of normal and abnormal findings during LUS of the most common pediatric pathologies. Current literature demonstrates usefulness of LUS that may become a fundamental tool for the whole spectrum of lung pathologies to guide both diagnostic and therapeutic decisions.
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Ionescu, Marcela Daniela, Mihaela Balgradean, Catalin Gabriel Cirstoveanu, Ioana Balgradean, Loredana Ionela Popa, Carmen Pavelescu, Andrei Capitanescu, Elena Camelia Berghea, and Cristina Filip. "Myopericarditis Associated with COVID-19 in a Pediatric Patient with Kidney Failure Receiving Hemodialysis." Pathogens 10, no. 4 (April 17, 2021): 486. http://dx.doi.org/10.3390/pathogens10040486.
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The outbreak of COVID-19 can be associated with cardiac and pulmonary involvement and is emerging as one of the most significant and life-threatening complications in patients with kidney failure receiving hemodialysis. Here, we report a critically ill case of a 13-year-old female patient with acute pericarditis and bilateral pleurisy, screened positive for SARS-CoV-2 RT-PCR, presented with high fever, frequent dry cough, and dyspnea with tachypnea. COVID-19-induced myopericarditis has been noted to be a complication in patients with concomitant kidney failure with replacement therapy (KFRT). This article brings information in the light of our case experience, suggesting that the direct effect of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on cardiac tissue was a significant contributor to myopericarditis in our patient. Further studies in this direction are required, as such associations have thus far been reported.
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Dutcher, Lauren, Yun Li, Giyoung Lee, Robert Grundmeier, Keith W. Hamilton, and Jeffrey Gerber. "162. The Impact of the COVID-19 Pandemic on Antibiotic Prescribing in Pediatric Primary Care." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S97—S98. http://dx.doi.org/10.1093/ofid/ofab466.162.
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Abstract Background With the onset of the coronavirus disease 2019 (COVID-19) pandemic, pediatric primary care delivery changed rapidly. Prior studies have demonstrated a reduction in ambulatory encounters and antibiotic prescriptions with the pandemic onset; however, the durability of these reductions in pediatric primary care in the United States has not been assessed. Methods We conducted a retrospective cohort study to assess the impact of the COVID-19 pandemic and associated public health measures (e.g. social distancing, masking, school closures, and increased availability of telemedicine) on antibiotic prescribing and encounter volume in 27 pediatric primary care practices, and the duration of these changes. Patients under age 19 with an encounter from January 1, 2018 through December 31, 2020 were included. The primary outcome was monthly antibiotic prescriptions per 1000 patients, in the overall population and a subset of encounters with infectious diagnoses, including respiratory tract infections (RTIs). Interrupted time series (ITS) analysis was performed. Results There were 60,562 total antibiotic prescriptions from April to December in 2019 and 14,605 antibiotic prescriptions during the same months in 2020, a 76% reduction. The reduction in RTI encounter prescriptions accounted for 91.5% of the overall reduction in prescriptions from 2019 to 2020. Using ITS analysis, there was an immediate decrease from 31.6 to 7.4 prescriptions/1000 patients (predicted means) in April 2020 (-24.2 prescriptions/1000 patients; 95% CI: -31.9, -16.4) (Figures 1 and 2). This was followed by a stable rate of antibiotic prescriptions that remained flat through December 2020. For RTI encounters, a similar pattern was seen, with a decrease by 21.8 prescriptions/1000 patients; 95% CI: -29.5, -14.2) (Figures 1 and 2). Encounter volume also decreased immediately, and while overall encounter volume began returning to a pre-pandemic baseline volume toward the end of the study period, RTI encounter volume remained persistently lower through December 2020 (Figure 3). Figure 1. Antibiotic prescriptions per 1000 patients prescribed by month from January 2018 to December 2020, overall and for disease-specific subgroups RTI = respiratory tract infection; UTI = urinary tract infection; SSTI = skin and soft tissue infection. Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Interrupted time series analysis for antibiotic prescriptions per 1000 patients by month from January 2018 to December 2020 for (A) all antibiotics as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Intervention starts in April 2020 (dashed line). Months are numbered sequentially, starting with January (number 1). Dashed line indicates first full month of the pandemic, April 2020. Antibiotic prescriptions per 1000 billed encounters by month from January 2018 to December 2020 for (A) all encounters, as well as antibiotics prescribed at encounters with (B) respiratory tract infections (RTIs), (C) urinary tract infections (UTIs), and (D) skin and soft tissue infections (SSTIs) Months are numbered sequentially, starting with January (number 1). Conclusion Dramatic reductions in antibiotic prescribing in pediatric primary care during the COVID-19 pandemic were sustained through 2020, primarily driven by reductions in RTI encounters. Disclosures All Authors: No reported disclosures
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Quach, Caroline, Rita Shah, and Lorry G. Rubin. "Burden of Healthcare-Associated Viral Respiratory Infections in Children’s Hospitals." Journal of the Pediatric Infectious Diseases Society 7, no. 1 (December 31, 2016): 18–24. http://dx.doi.org/10.1093/jpids/piw072.
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Abstract Objective Although healthcare-associated (HA) viral respiratory infections (VRIs) are common in pediatrics, no benchmark for comparison exists. We aimed to determine, compare, and assess determinants of unit-specific HA-VRI incidence rates in 2 children’s hospitals. Methods This study was a retrospective comparison of prospective cohorts. The Montreal Children’s Hospital and the Cohen Children’s Medical Center of New York perform prospective surveillance for HA-VRI using standardized definitions that require the presence of symptoms compatible with VRI and virus detection. Cases detected between April 1, 2010, and March 31, 2013, were identified using surveillance databases. Annual incidence rates were calculated, and a generalized estimating equation model was used to assess determinants of HA-VRI rates. Results The overall HA-VRI rate during the 3-year study period was significantly higher at Montreal Children’s Hospital than that at Cohen Children’s Medical Center of New York (1.91 vs 0.80 per 1000 patient-days, respectively;P < .0001). Overall, the HA-VRI incidence rate was lowest in the neonatal intensive care unit. Rates in the pediatric intensive care, oncology, and medical/surgical units were similar. The most common etiology of HA-VRI at both institutions was rhinovirus (49% of cases), followed by parainfluenza virus and respiratory syncytial virus. Hospitals with less than 50% single rooms had HA-VRI rates 1.33 (95% confidence interval, 1.29–1.37) times higher than hospitals with more than 50% single rooms for a given unit type. Conclusions HA-VRI rates were substantial but different among 2 children’s hospitals. Future studies should examine the effect of HA-VRI and evaluate best practices for preventing such infections.
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Duramaz, Burcu Bursal, Ozden Turel, Cigdem Korkmaz, Muhammed Talha Karadogan, Can Yilmaz Yozgat, Akin Iscan, Bilge Sümbül, and Ufuk Erenberk. "A Snapshot of Pediatric Patients with COVID-19 in a Pandemic Hospital." Klinische Pädiatrie 233, no. 01 (October 29, 2020): 24–30. http://dx.doi.org/10.1055/a-1263-1222.
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Abstract Aim Reports describing coronavirus disease 2019 (Covid-19) in children are fewer than adult studies due to milder clinical picture. We aimed to share our experience at a single center with an emphasis on collective decision making. Materials and Methods A suspected case was defined as the presence of symptoms suggestive of COVID-19 and/or positive contact history. SARS-CoV-2 PCR positive patients were defined as confirmed COVID-19. Between March 12, 2020, and May 15, 2020, all children presenting with fever, cough, or respiratory difficulty were investigated for COVID-19. A total of 719 children were examined at outpatient clinics, and 495 were tested with polymerase chain reaction (PCR) for suspicion of COVID-19. A team was organized for monitoring and treating patients either as outpatients or hospitalization. Patients were evaluated in terms of age, gender, travel history, epidemiological history, clinical symptoms and signs, laboratory and radiological findings, treatment, and outcome. Results Sixty patients were hospitalized for suspicion of COVID-19. Forty-three patients were diagnosed as probable or confirmed COVID-19. 21 of 43 patients (48.8%) were PCR confirmed. The remaining 22 were diagnosed by epidemiologic history, clinical assessment, and computerized thorax tomography (CT) findings. The median age was 126 and 78.5 months in PCR positives and PCR negatives, respectively and the youngest patient was a 28 days old baby. Nineteen of the patients had an upper respiratory infection (44.1%). Although five patients had no clinical signs, chest X-ray, or CT revealed pneumonia. Conclusions As previously reported, the clinical manifestations of COVID-19 in children are mostly mild. Even very young kids can become infected following exposure to sick family members. International and local guidelines are valuable for decision making since it is a new disease. A combination of chest disease, infectious diseases, and emergency care physicians approach will aid the appropriate management of cases.
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Fernandes, Debora Alves dos Santos, and Francisco José de Freitas. "Clinical-Homeopathic Profile in the Pediatric Ward at the University Hospital - Brazil." International Journal of High Dilution Research - ISSN 1982-6206 10, no. 36 (December 23, 2021): 206–8. http://dx.doi.org/10.51910/ijhdr.v10i36.495.
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Background: In 2004, the deployment of Homeopathy in the pediatric ward at the University Hospital of Gaffrée Guinle – UNIRIO (HUGG at the Federal University of the State of Rio de Janeiro) was initiated in conjunction with both the Pediatric and Homeopathy Service. A research project approved by the HUGG Ethics and Research Committee was prepared to survey the most prevalent diseases. A team composed of medical students and doctors participating in the homeopathy course was formed and underwent training, enabling them to use the established protocols of action. A partnership was established with the Fluminense Federal University(Universidade Federal Fluminense – UFF), for the supply of drugs. In early 2009, the research project started, followed by homeopathic treatment in the pediatric ward.
Aim: To demonstrate the diseases and treatment using homeopathic therapy on patients in the pediatric ward at the HUGG-UNIRIO-Brazil.
Methodology: A sectional clinical study was carried out on patients participating in a research approved and registered by the Brazilian Research Ethics Committee, named,"The study of the effect of Homeopathic Treatment as an Adjunct Therapy on patients Hospitalized in the Pediatric Ward of HUGG". Criteria of Inclusion: Newborns up to the age of 16 of both sexes were admitted to the pediatric ward of HUGG, from May to October 2009. The diagnosis for admission being: respiratory, gastrointestinal and/or dermatologic diseases. A consent form had to be accepted and signed by the person responsible. Inclusion depended on the availability of having the appropriate homeopathic medicine in stock. Criteria of Exclusion: Cases of discontinuation of the homeopathic treatment or medical records not completed correctly. The medical records were analyzed individually. Microsoft Office Excel 2007 was used for data collection and analysis.
Results: 32 patients admitted: 80% treated with Homeopathy; Diagnosis for admission: 73% respiratory, 11.5% dermatological, 4% gastrointestinal and 11.5% other diseases (malnutrition, adenomegaly, eyelid edema); 37% had secondary diseases. An average of 4.7 medicaments (min 01-max09) was used per patient, 31% repeated the medication in two different dinamizations. “Diagnosis for admission and medication usedâ€ÂÂ: a) respiratory: 79% Pulmao histaminum, 32% Antimonium tartaricum, 21% Natrum sulfuricum, 21% Sambucus nigra, 16% Ipecacuanha, 16% Nux vomica, 16% Medorrhinum; b) dermatological: 100% Apis mellifica, 33% Dulcamara, 33% Mezereum, 33% Psorinum, 33% Rhus toxicodendron, 33% Alumina; c) gastrointestinal: 100% Ipecacuanha, 50% Gambogia, 50% Alumina. Dinamizations used: 5, 6, 12, 30 and 200CH, and 200FC. 55.5% of the medication used were only local effect medicines, 45.5% of the medication used were in association with the general effect medicines.
Conclusion: The need to use several homeopathic medicines was obseved. The practice of inpatients was shown to be similar to the emergency outpatient when using medicine for local effect and medicine for general effect. Due to the positive results obtained with homeopathy, patients not initially foreseen in the research were included in this study on demand from parents or persons responsible for the children. This study demonstrates the need for a greater number of patients to allow the creation of prescription protocols and case-control studies to identify the most effective homeopathic prescription techniques.
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Alhumaid, Saad, Muneera Alabdulqader, Nourah Al Dossary, Zainab Al Alawi, Abdulrahman A. Alnaim, Koblan M. Al Mutared, Khalid Al Noaim, et al. "Global Coinfections with Bacteria, Fungi, and Respiratory Viruses in Children with SARS-CoV-2: A Systematic Review and Meta-Analysis." Tropical Medicine and Infectious Disease 7, no. 11 (November 15, 2022): 380. http://dx.doi.org/10.3390/tropicalmed7110380.
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Background: Coinfection with bacteria, fungi, and respiratory viruses has been described as a factor associated with more severe clinical outcomes in children with COVID-19. Such coinfections in children with COVID-19 have been reported to increase morbidity and mortality. Objectives: To identify the type and proportion of coinfections with SARS-CoV-2 and bacteria, fungi, and/or respiratory viruses, and investigate the severity of COVID-19 in children. Methods: For this systematic review and meta-analysis, we searched ProQuest, Medline, Embase, PubMed, CINAHL, Wiley online library, Scopus, and Nature through the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines for studies on the incidence of COVID-19 in children with bacterial, fungal, and/or respiratory coinfections, published from 1 December 2019 to 1 October 2022, with English language restriction. Results: Of the 169 papers that were identified, 130 articles were included in the systematic review (57 cohort, 52 case report, and 21 case series studies) and 34 articles (23 cohort, eight case series, and three case report studies) were included in the meta-analysis. Of the 17,588 COVID-19 children who were tested for co-pathogens, bacterial, fungal, and/or respiratory viral coinfections were reported (n = 1633, 9.3%). The median patient age ranged from 1.4 months to 144 months across studies. There was an increased male predominance in pediatric COVID-19 patients diagnosed with bacterial, fungal, and/or viral coinfections in most of the studies (male gender: n = 204, 59.1% compared to female gender: n = 141, 40.9%). The majority of the cases belonged to White (Caucasian) (n = 441, 53.3%), Asian (n = 205, 24.8%), Indian (n = 71, 8.6%), and Black (n = 51, 6.2%) ethnicities. The overall pooled proportions of children with laboratory-confirmed COVID-19 who had bacterial, fungal, and respiratory viral coinfections were 4.73% (95% CI 3.86 to 5.60, n = 445, 34 studies, I2 85%, p < 0.01), 0.98% (95% CI 0.13 to 1.83, n = 17, six studies, I2 49%, p < 0.08), and 5.41% (95% CI 4.48 to 6.34, n = 441, 32 studies, I2 87%, p < 0.01), respectively. Children with COVID-19 in the ICU had higher coinfections compared to ICU and non-ICU patients, as follows: respiratory viral (6.61%, 95% CI 5.06–8.17, I2 = 0% versus 5.31%, 95% CI 4.31–6.30, I2 = 88%) and fungal (1.72%, 95% CI 0.45–2.99, I2 = 0% versus 0.62%, 95% CI 0.00–1.55, I2 = 54%); however, COVID-19 children admitted to the ICU had a lower bacterial coinfection compared to the COVID-19 children in the ICU and non-ICU group (3.02%, 95% CI 1.70–4.34, I2 = 0% versus 4.91%, 95% CI 3.97–5.84, I2 = 87%). The most common identified virus and bacterium in children with COVID-19 were RSV (n = 342, 31.4%) and Mycoplasma pneumonia (n = 120, 23.1%). Conclusion: Children with COVID-19 seem to have distinctly lower rates of bacterial, fungal, and/or respiratory viral coinfections than adults. RSV and Mycoplasma pneumonia were the most common identified virus and bacterium in children infected with SARS-CoV-2. Knowledge of bacterial, fungal, and/or respiratory viral confections has potential diagnostic and treatment implications in COVID-19 children.
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Neu, Natalie, MariCris Nee, Joseph Savitt, Laura Schneider Connelly, JieSue Choi, and Linda Mosiello. "COVID-19 in Pediatric Long-Term Care: How Infection Control and Prevention Practices Minimized the Impact of the Pandemic on Healthcare Providers and Residents." Journal of the Pediatric Infectious Diseases Society 9, no. 5 (October 10, 2020): 626–29. http://dx.doi.org/10.1093/jpids/piaa122.
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Abstract Children in pediatric long-term care (LTC) facilities are commonly infected with respiratory tract viruses as they have many high-risk co-morbidities and require significant interactions with the healthcare team. From previous studies, we know that infected staff can often be the source of transmission of infection to the children. If instituted quickly, infection control practices can help mitigate the spread of infection. We will describe how Sunshine Children’s Home and Rehabilitation Center responded to federal and state infection control and prevention mandates in LTC for COVID-19. We will report our practice changes, staff and resident screening, and testing results as well as outcomes of the COVID-19-infected cases. The outcomes for COVID-19 infection among pediatric LTC staff and residents are in stark contrast to the data available for the adult providers and residents in adult nursing homes. Implementation and change in infection control practices and procedures resulted in much fewer cases of COVID-19 infection in our pediatric LTC residents.
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Mehta, Nisha S., Oliver T. Mytton, Edward W. S. Mullins, Tom A. Fowler, Catherine L. Falconer, Orla B. Murphy, Claudia Langenberg, Wikum J. P. Jayatunga, Danielle H. Eddy, and Jonathan S. Nguyen-Van-Tam. "SARS-CoV-2 (COVID-19): What Do We Know About Children? A Systematic Review." Clinical Infectious Diseases 71, no. 9 (May 11, 2020): 2469–79. http://dx.doi.org/10.1093/cid/ciaa556.
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Abstract Background Few pediatric cases of coronavirus disease 2019 (COVID-19) have been reported and we know little about the epidemiology in children, although more is known about other coronaviruses. We aimed to understand the infection rate, clinical presentation, clinical outcomes, and transmission dynamics for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), in order to inform clinical and public health measures. Methods We undertook a rapid systematic review and narrative synthesis of all literature relating to SARS-CoV-2 in pediatric populations. The search terms also included SARS-CoV and MERS-CoV. We searched 3 databases and the COVID-19 resource centers of 11 major journals and publishers. English abstracts of Chinese-language papers were included. Data were extracted and narrative syntheses conducted. Results Twenty-four studies relating to COVID-19 were included in the review. Children appear to be less affected by COVID-19 than adults by observed rate of cases in large epidemiological studies. Limited data on attack rate indicate that children are just as susceptible to infection. Data on clinical outcomes are scarce but include several reports of asymptomatic infection and a milder course of disease in young children, although radiological abnormalities are noted. Severe cases are not reported in detail and there are few data relating to transmission. Conclusions Children appear to have a low observed case rate of COVID-19 but may have rates similar to adults of infection with SARS-CoV-2. This discrepancy may be because children are asymptomatic or too mildly infected to draw medical attention and be tested and counted in observed cases of COVID-19.
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Anderson, Larry J., Robert A. Parker, Raymond A. Strikas, Jeffrey A. Farrar, Eugene J. Gangarosa, Harry L. Keyserling, and R. Keith Sikes. "Day-Care Center Attendance and Hospitalization for Lower Respiratory Tract Illness." Pediatrics 82, no. 3 (September 1, 1988): 300–308. http://dx.doi.org/10.1542/peds.82.3.300.
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To identify risk factors associated with hospitalization for acute lower respiratory tract illness, 102 children <2 years of age admitted to four Atlanta metropolitan area hospitals between December 1984 and June 1985 with the diagnosis of lower respiratory tract illness were studied. The most common causative agent associated with illness was respiratory syncytial virus, followed by other respiratory viruses, Haemophilus influenzae, and Streptococcus pneumoniae. The 102 case-patients were compared with 199 age- and sex-matched controls. A parent or guardian for each patient and control was interviewed by telephone regarding demographic data, care outside the home, breast-feeding, previous medical history, allergies, and smoking and illness in household members. Five factors were associated with lower respiratory tract illness in both a univariate analysis and a multiple logistic regression model (P < .05). These factors were the number of people sleeping in the same room with the child, a lack of immunization the month before the patient was hospitalized, prematurity, a history of allergy, and regular attendance in a day-care center (more than six children in attendance). Care received outside of the home in a day-care home (less than or equal to six children in attendance) was not associated with lower respiratory tract illness. The suggestion made by our study and other studies was that for children <2 years of age, care outside of the home is an important risk factor for acquiring lower respiratory tract illness, as well as other infectious diseases, and that this risk can be reduced by using a day-care home instead of a day-care center.
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Abdelqader, Rana, Hanan Hasan, and Lo’ai Alanagreh. "Epidemiology of Human Bocavirus in the Middle East and North Africa: Systematic Review." Pathogens 10, no. 11 (November 10, 2021): 1456. http://dx.doi.org/10.3390/pathogens10111456.
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The emergence of the COVID-19 pandemic highlighted the importance of studying newly emerging viruses that cause respiratory illnesses. Human bocavirus (HBoV) is one of the relatively newly discovered viruses that has been detected worldwide and causes respiratory and gastrointestinal infections, mainly in pediatric patients. However, little is known about the pathogenicity and evolution of HBoV. This systematic review was initiated to clarify the prevalence and circulating genotypes of HBoV in both respiratory and stool samples from patients of all age groups in the Middle East and North Africa (MENA) from 2005 to February 2021. We performed an electronic search through Science Direct, Scopus, PubMed, Mendeley and Cochrane Library databases. We included all studies reporting the detection rate of HBoV in the MENA region. Data were extracted, and the quality of the included articles was assessed. We included articles containing data on HBoV only or with other respiratory or gastrointestinal viral infections. Review articles, case studies, and animal and environmental studies were excluded. The final number of articles included in this study was 65 articles. The results showed that the HBoV prevalence in children was the lowest in Iran (0%) and the highest in Egypt (56.8%). In adults, the lowest and the highest prevalence were reported in Iran, with values of 0% and 6.6%, respectively. Regarding the respiratory cases, our findings revealed no significant difference between HBoV prevalence among the tested categories (p-value = 0.998). The present study has shown that HBoV is common in children and adults in the MENA region. This systematic review highlights the need for more data on the role of coinfection of HBoV and other viruses, for instance, SARS-CoV-2 in children with acute bronchiolitis.
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Vicentini, Costanza, Lorenzo Vola, Christian Previti, Valerio Brescia, Francesca Dal Mas, Carla Maria Zotti, and Fabrizio Bert. "Antimicrobial Stewardship Strategies Including Point-of-Care Testing (POCT) for Pediatric Patients with Upper-Respiratory-Tract Infections in Primary Care: A Systematic Review of Economic Evaluations." Antibiotics 11, no. 8 (August 22, 2022): 1139. http://dx.doi.org/10.3390/antibiotics11081139.
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Upper-respiratory-tract infections (URTIs) are among the main causes of antibiotic prescriptions in pediatric patients. Over one-third of all antibiotic prescriptions for URTIs in children are estimated to be inappropriate, as the majority of URTIs are caused by viral agents. Several strategies, including clinical scoring algorithms and different point-of-care tests (POCTs) have been developed to help discriminate bacterial from viral URTIs in the outpatient clinical setting. A systematic review of the literature was conducted following PRISMA guidelines with the objective of summarizing evidence from health–economic evaluations on the use of POCT for URTIs in pediatric outpatients. A total of 3375 records identified from four databases and other sources were screened, of which 8 met the inclusion criteria. Four studies were classified as being of high reporting quality, and three were of medium quality. Five out of eight studies concluded in favor of strategies that included POCTs, with an additional study finding several POCTs to be cost-effective compared to usual care but over an acceptable WTP threshold. This review found POCT could be a valuable tool for antimicrobial stewardship strategies targeted towards childhood URTIs in primary care.
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Kiral, Eylem, Ebru kacmaz, Gurkan Bozan, Ozgur Arslanoglu, Omer Kilic, and Ener Cagri Dinleyici. "261. A Rare Case of Meningitis and Symptomatic Hydrocephalus by Listeria Monocytogenes in Dermatomyositis: A Case Report." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S237—S238. http://dx.doi.org/10.1093/ofid/ofab466.463.
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Abstract Background Listeria monocytogenes is a gram-positive, facultative anaerobic bacillus common in the intestinal flora of many animals and humans. We describe an unusual case of meningitis by Listeria monocytogenes (LM) complicated by hydrocephalus in a child with dermatomyositis. Methods A 15-year-old girl presented to an outside hospital (OH) after a three-day history of headache, fever and was hospitalized with a diagnosis of meningitis and lumbar puncture performed. CSF sample could not be evaluated clearly due to its hemorrhagic nature. Her past medical history was significant for dermatomyositis for five years. She had received induction of IVIG five days prior. She was also taking cyclosporin A and hydroxychloroquine. She was empirically treated with intravenous cefotaxime, vancomycin, and acyclovir. She was urgently transferred to the theatre for an external shunt placement in the right lateral ventricle. The interval between the first symptoms and the diagnosis of hydrocephalus was around 4 days. CSF from this catheter showed growth of LM with sensitivity to meropenem and resistance to erythromycin, ampicillin, and sulfamethoxazole-trimethoprim. Gram staining of CSF resulted negative for bacteria. Cefotaxime was switched to intravenous meropenem. Immunological screening of cellular and humoral immunity, complement, and blood iron levels were normal. SARS-Cov2 PCR and HIV tests were negative. Herpes virus, mycobacterium tuberculosis real-time PCR, respiratory viral panel studied in the CSF sample were negative. MRI and Angio of the brain showed no abnormality. She is being followed in the pediatric intensive care unit as intubated. Results In patients who received immunosuppressive medication, L. monocytogenes should be evaluated in the differential diagnosis of central nervous system infections. Even if effective antibiotic therapy has been initiated, this case highlights the need of recognizing early hydrocephalus as a consequence of Listeria meningitis in children with neurological deterioration a few days after initial presentation. Conclusion The literature on the management and outcome of Listeria meningitis-related hydrocephalus in children is limited. Disclosures All Authors: No reported disclosures
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Brigadoi, Giulia, Andrea Gastaldi, Marco Moi, Elisa Barbieri, Sara Rossin, Annalisa Biffi, Anna Cantarutti, Carlo Giaquinto, Liviana Da Dalt, and Daniele Donà. "Point-of-Care and Rapid Tests for the Etiological Diagnosis of Respiratory Tract Infections in Children: A Systematic Review and Meta-Analysis." Antibiotics 11, no. 9 (September 3, 2022): 1192. http://dx.doi.org/10.3390/antibiotics11091192.
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Fever is one of the most common causes of medical evaluation of children, and early discrimination between viral and bacterial infection is essential to reduce inappropriate prescriptions. This study aims to systematically review the effects of point-of-care tests (POCTs) and rapid tests for respiratory tract infections on changing antibiotic prescription rate, length of stay, duration of therapy, and healthcare costs. Embase, MEDLINE, and Cochrane Library databases were systematically searched. All randomized control trials and non-randomized observational studies meeting inclusion criteria were evaluated using the NIH assessment tool. A meta-analysis was performed to assess the effects of rapid influenza diagnostic tests and film-array respiratory panel implementation on selected outcomes. From a total of 6440 studies, 57 were eligible for the review. The analysis was stratified by setting and POCT/rapid test type. The most frequent POCTs or rapid tests implemented were the Rapid Influenza Diagnostic Test and film-array and for those types of test a separate meta-analysis assessed a significant reduction in antibiotic prescription and an improvement in oseltamivir prescription. Implementing POCTs and rapid tests to discriminate between viral and bacterial infections for respiratory pathogens is valuable for improving appropriate antimicrobial prescriptions. However, more studies are needed to assess these findings in pediatric settings.
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Chakravarty, Aparna, Jagannath Mohapatra, Richa Garg, and Shaurya Kumar. "Outcome analysis of a newly setup pediatric intensive care unit in a teaching hospital of northern India." International Journal of Contemporary Pediatrics 6, no. 5 (August 23, 2019): 2147. http://dx.doi.org/10.18203/2349-3291.ijcp20193742.
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Background: Pediatric intensive care units (PICU) have brought about dramatic increase in the survival of critically ill children. The aim of pediatric intensive care is not just to save lives but also to maximise the quality of those lives. Evaluation of the outcome of an intensive care unit is necessary as a measure of quality improvement in patient care.Methods: A retrospective observational study was done in a PICU of a teaching hospital between February 2017 to August 2018. Records of all admissions, transfer outs, discharges and deaths were collected along with age, sex, diagnosis, length of stay, and outcome.Results: Mean age of the 601 patients admitted over a period of nineteen months was 4 years. 36% patients were between 1-5 year and 32% were infants. Major indication for admission to the PICU was respiratory (30%) followed by neurological illnesses (25%) and infections (22%). Increased length of stay (LOS) (>5 days) was seen in respiratory, neurological diseases and infections. A significant relation (p value <0.05) was found between outcome and patients admitted with sepsis and the group classified as others. Patients admitted with involvement of nephrology system had a significant relation with LOS (p value <0.05). The mortality rate was 2%.Conclusion: The outcome analysis of our newly setup PICU is comparable with other studies in the Indian subcontinent. Active surveillance or audit of PICU admissions help capture lapses in management and bring a better outcome with available resources.
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Schlage, Sandy, Thomas Lehrnbecher, Reinhard Berner, Arne Simon, and Nicole Toepfner. "SARS-CoV-2 in pediatric cancer: a systematic review." European Journal of Pediatrics 181, no. 4 (January 10, 2022): 1413–27. http://dx.doi.org/10.1007/s00431-021-04338-y.
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AbstractThe outbreak of the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 in Wuhan challenges pediatric oncologists in an unexpected way. We provide a comprehensive overview, which systematically summarizes and grades evidence (QoE) on SARS-CoV-2 infections in pediatric cancer patients at 1.5 years of pandemic. A systematic literature search in PubMed combined with an additional exploratory literature review in other international databases was conducted to identify studies on children (aged < 18 years) with a malignant disease and COVID-19 infections. In total, 45 reports on 1003 pediatric cancer patients with SARS-CoV-2 infections were identified out of 1397 reports analyzed. The clinical course of COVID-19 was reported mild or moderate in 358 patients (41.7%), whereas 11.1% of patients showed severe COVID-19. In 12.7% of patients, chemotherapy was postponed, whereas 19% of patients with different underlying malignancies received chemotherapy during SARS-CoV-2 infection. Twenty-five patients with SARS-CoV-2 infections died, potentially related to COVID-19.Conclusion: Despite a favorable COVID-19 outcome in most pediatric cancer patients, the morbidity is reported higher than in children without comorbidities. However, no severe COVID-19 complications were associated to the continuation of chemotherapy in some cohort studies and reports on two patients. Therefore, the risk of cancer progress or relapse due to interruption of chemotherapy has carefully to be weighed against the risk of severe COVID-19 disease with potentially fatal outcome. What is Known:• Most of pediatric patients with malignant diseases show an asymptomatic, mild or moderate clinical course of SARS-CoV-2 infection. • Current need for a basis for decision-making, whether to stop or interrupt cancer treatment in a patient infected with SARS-CoV-2, and when to continue chemotherapy. What is New:• Review results comprising over 1000 pediatric COVID-19 cancer patients confirm mild courses of SARS-CoV-2 infection in most patients but also show the attributable mortality is at least 10 times higher compared to reports on hospitalized children without comorbidities.• Review identifies that chemotherapy was continued despite SARS-CoV-2 positivity in 18% of patients with individual chemotherapy modification according to the clinical course of SARS-CoV-2 infection and existing comorbidities. On this basis, no severe COVID-19 complications were associated to the continuation of chemotherapy in several cohort studies and two case reports.
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B., Rekha M., Hemamalini M. B., and Basavaraj Bhandare. "Pattern of drug utilization in pediatric out patient department of a tertiary care teaching hospital." International Journal of Basic & Clinical Pharmacology 9, no. 11 (October 21, 2020): 1661. http://dx.doi.org/10.18203/2319-2003.ijbcp20204490.
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Background: Drug utilization studies have special significance among paediatric age groups as infant and children represent about 42% of the population in developing countries. This is the vital period of rapid growth and development. Therefore, drugs should be used very cautiously and rationally among these sub groups. The present study is conducted to analyse the prescribing pattern of drugs in paediatric age group for various illnesses. Methods: It was a prospective observational study, conducted in paediatric outpatient department of Raja Rajeswari medical college and research hospital for a period of 6 months after obtaining approval from institutional ethical committee. Descriptive statistical was used to determine the frequency, percentages, mean and standard deviation.Results: In the present study, fever (30.8%) followed by respiratory diseases were most common diseases seen. The commonly used drugs include antipyretics (66%), antimicrobials (53.6%), cough syrups (34.4%), antihistaminic (31.2%) and nasal decongestants (23.2%). Prescribing indicator shows existence of polypharmacy. Prescribing drugs by generic name was seen only in 8.1% and 47.82% of the drugs were prescribed from EDL. The frequency of use of injectables in our study was 5.8%. Conclusions: Irrational use of antibiotics and polypharmacy needs to be curbed. Prescribing drugs in their generic name and prescribing drugs from EDL need to be promoted. The present prescribing pattern can be improved by advocating rational drug prescribing, patient education and improving hospitals.
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Pelizzo, Gloria, Maria Antonietta Avanzini, Stefania Croce, Anna Mandelli, Elisa Lenta, Andrea Farolfi, Chiara Valsecchi, et al. "Allogeneic Mesenchymal Stromal Cells as a Global Pediatric Prospective Approach in the Treatment of Respiratory Failure Associated with Surfactant Protein C Dysfunction." Children 10, no. 1 (January 14, 2023): 162. http://dx.doi.org/10.3390/children10010162.
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Mesenchymal stromal cells (MSCs) have been proposed as a new therapeutic strategy to treat congenital and acquired respiratory system diseases. We describe a case report of an 18-month-old male patient with progressive chronic respiratory failure, associated with mutations of the surfactant protein C gene (SFTPC) due to c.289G > T variant p.Gly97Ser (rs927644577) and c.176A > G variant (p.His59Arg), submitted to repeated intravenous infusions of allogeneic bone marrow (BM) MSCs. The clinical condition of the patient was monitored. Immunologic studies before and during MSC treatment were performed. No adverse events related to the MSC infusions were recorded. Throughout the MSC treatment period, the patient showed a growth recovery. Starting the second infusion, the patient experienced an improvement in his respiratory condition, with progressive adaptation to mechanical ventilation. After the third infusion, five hours/die of spontaneous breathing was shown, and after infusion IV, spontaneous ventilation for 24/24 h was recorded. A gradual decrease of lymphocytes and cell subpopulations was observed. No variations in the in vitro T cell response to PHA were determined by MSC treatment as well as for the in vitro B cell response. A decrease in IFN-γ, TNF-α, and IL-10 levels was also detected. Even though we cannot exclude an improvement of pulmonary function due to the physiological maturation, the well-known action of MSCs in the repair of lung tissue, together with the sequence of events observed in our patient, may support the therapeutic role of MSCs in this clinical condition. However, further investigations are necessary to confirm the result and long-term follow-up will be mandatory to confirm the benefits on the pulmonary condition.
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Shane, Andi L., Alice I. Sato, Carol Kao, Felice C. Adler-Shohet, Surabhi B. Vora, Jeffery J. Auletta, Sharon Nachman, et al. "A Pediatric Infectious Diseases Perspective of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and Novel Coronavirus Disease 2019 (COVID-19) in Children." Journal of the Pediatric Infectious Diseases Society 9, no. 5 (August 25, 2020): 596–608. http://dx.doi.org/10.1093/jpids/piaa099.
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Abstract Understanding the role that children play in the clinical burden and propagation of severe acute respiratory syndrome coronavirus 2, responsible for coronavirus disease 2019 (COVID-19) infections, is emerging. While the severe manifestations and acute clinical burden of COVID-19 have largely spared children compared with adults, understanding the epidemiology, clinical presentation, diagnostics, management, and prevention opportunities and the social and behavioral impacts on child health is vital. Foremost is clarifying the contribution of asymptomatic and mild infections to transmission within the household and community and the clinical and epidemiologic significance of uncommon severe post-infectious complications. Here, we summarize the current knowledge, identify resources, and outline research opportunities. Pediatric infectious diseases clinicians have a unique opportunity to advocate for the inclusion of children in epidemiological, clinical, treatment, and prevention studies to optimize their care as well as to represent children in the development of guidance and policy during pandemic response.
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Zepeda-Carrillo, Eloy A., Francisco M. Soria Saavedra, Maria B. Mercado Villegas, Alejandra López Alvarado, Jose Angel Regla-Nava, and Rafael Torres-Valadez. "SARS-CoV-2 and Dengue Virus Coinfection in a Mexican Pediatric Patient: A Case Report from Early Molecular Diagnosis." Pathogens 11, no. 11 (November 16, 2022): 1360. http://dx.doi.org/10.3390/pathogens11111360.
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Mexico is an endemic region for dengue virus (DENV). The increase in this disease coincides with outbreaks of COVID-19, both of which are single-stranded positive RNA viruses. These characteristics make it difficult to distinguish each disease because they share clinical and laboratory features, which can consequently result in misdiagnoses. This is why the use of precision confirmatory tests (qRT-PCR) are crucial for early diagnosis. We herein report a pediatric patient who presented a coinfection for DENV and COVID-19, “SARS-CoV-2/Dengue”. This patient initially presented a fever, cough, and headache and, three days later, developed generalized pain and epistaxis. Blood studies revealed thrombocytopenia and leukopenia, and the patient was admitted to the hospital for a probable DENV infection. Within 48 h, qRT-PCR tests specific for SARS-CoV-2 and DENV were performed and resulted as positive. The patient immediately received pharmacological treatment with azithromycin, oseltamivir, and metamizole. During hospitalization (9 days), the patient had no signs of respiratory distress and maintained normal body temperature and normal blood oxygen saturation. This case warns of the need for early diagnosis and adequate clinical and pharmacological management in the face of a “SARS-CoV-2/Dengue” coinfection. Early molecular detection of both viruses and timely treatment helped the patient to achieve a favorable recovery.
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Babina, Y. M. "Anesthesia in children with comorbid pathology - clinical assessment of the most common pathological conditions in the practice of anesthesiologist." Pain medicine 3, no. 3 (November 23, 2018): 33–43. http://dx.doi.org/10.31636/pmjua.v3i3.4.
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Currently, there is an increase in the number of children who have multiple connected or “independent” pathological conditions, hospitalized to General hospitals with severe pain. It significantly worsens the disease course and complicates differential diagnosis in these patients, requires a deeper treatment approach. Thus, it requires attention and discussion and is urgent to cover the concept of comorbidity, combined with pain syndrome in Pediatrics. In this article is carried out the analysis of comorbid pathology in surgery from the point of view of the children’s anaesthetist. There were allocated comorbidities that are commonly encountered in daily practice and are of danger in surgical practice. We have analyzed analgesia for obesity, blood diseases, congenital heart defects, concomitant respiratory diseases – during surgery and in the postoperative period. To improve the efficiency of medical care for these patients it is important to develop an algorithm of physician's actions in the most common comorbid conditions. It is concluded that there is a need for additional studies for further clarifying the optimal management of pain and the effect of pain in case of comorbidities.
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Munawar, Husam, Abdulaziz Alolayan, Amnah Bashraheel, Ali Alqarni, Hind Bafagih, and Marwan Alrasheed. "Evaluating the Appropriate Use of Piperacillin /Tazobactam in Pediatric Intensive Care Unit of a Major Tertiary Care Hospital." Saudi Journal of Medical and Pharmaceutical Sciences 8, no. 5 (May 18, 2022): 247–51. http://dx.doi.org/10.36348/sjmps.2022.v08i05.006.
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Background: Piperacillin/Tazobactam(Pip/Taz) is a broad-spectrum antibacterial covering aerobic, and anaerobic microorganisms. Pip/Taz plays a major role in treating sepsis, respiratory infection, and intraabdominal infection. Many studies showed inappropriate use of Pip/Taz might increase the risk of resistance. This study aimed to evaluate the appropriateness use of Pip/Taz prescribing in pediatric patients in Peidatric Intensive Care Unit (PICU) at a major tertiary hospital. Method: A retrospective and observational study was conducted to evaluate the appropriateness use of Pip/Taz in PICU. The study included all neonates and pediatrics less than 14 years old in the PICU setting who had received at least dose of Pip/Taz during their admission for the period between Jan 2020 and Jan 2021. Assessment of antimicrobial appropriateness was evaluated according to Infectious Diseases Society of America (IDSA) guidelines. Data were retrieved from the hospital’s Electronic Medical Records (EMRs) and exported to Excel spreadsheet. Results: Of 124 Pip/Taz prescriptions, 34% were inappropriate. The common indications for using Pip/Taz empirically were with sepsis and suspecting of pneumonia. The reasons for inappropriate use of Pip/Taz were due to continue using the drug based on clinical condition even the results of cultures had no growth of organisms 71%, then starting the drug without taking culture 14%, then the drug continued without justification despite culture resulted with no growth 10%, and finally continued without following sensitivity 5%. Conclusion: This study showed that there was inappropriate use of Pip/Taz at PICU. The inappropriate use was attributed to not following the lab results, culture sensitivity and not requesting microbiology culture.
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Gagliardo, Christina, Eberechi I. Nwaobasi-Iwuh, Niva Shah, Aparna Prasad, Neeraja Kairam, Stephanie Chiu, Elizabeth DeSantis, Simona Nativ, Kathryn Laurie, and M. Cecilia Di Pentima. "331. Hospitalized COVID-19 infections in Infants < 1 Year of Age." Open Forum Infectious Diseases 8, Supplement_1 (November 1, 2021): S271—S272. http://dx.doi.org/10.1093/ofid/ofab466.533.
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Abstract Background Nearly 4 million children have tested positive for coronavirus disease 2019 (COVID-19) in the United States. Some studies suggest infants might be at increased risk for severe illness and hospitalization from COVID-19. Our objective was to describe the clinical and laboratory features of young infants admitted to a hospital system with COVID-19. Methods An observational retrospective study was performed in infants ≤1 year of age admitted with COVID-19 from March 1, 2020 to May 30, 2021. Data was extracted into a REDCap database and analyzed using descriptive statistics. Results Sixteen infants < 1 year were hospitalized with COVID-19. Fever, poor feeding, and respiratory symptoms were the most common presenting symptoms (Table 1). Two required pediatric intensive care unit (ICU) care, three required oxygen support, and one was intubated. There were no deaths. Five infants with echocardiograms performed showed normal findings. Four infants received Remdesivir without side effects. Conclusion Infants with COVID-19 can present with severe disease requiring ICU care and oxygen support. In our experience, a large proportion of infants developed hematologic abnormalities, but none had cardiac involvement. Preventive measures including vaccination will become critical to decrease transmission and severe disease in this young patient population. Disclosures All Authors: No reported disclosures
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Marzook, Noah, and Alexander Dubrovsky. "90 Lung ultrasound in pediatric asthma patients: A pilot study characterizing findings at baseline stat." Paediatrics & Child Health 26, Supplement_1 (October 1, 2021): e65-e66. http://dx.doi.org/10.1093/pch/pxab061.072.
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Abstract Primary Subject area Emergency Medicine - Paediatric Background Unlike the lung ultrasound (LU) findings of pneumonia, bronchiolitis, pleural effusions and pneumothorax, which have all been well described, the sonographic pattern of asthma remains unclear. Previous pediatric studies have shown that pediatric patients with acute asthma exacerbations had positive LU findings. It is also unclear whether these findings were the result of acute infections associated with the exacerbation or if the findings would be present at baseline, outside an exacerbation in an asthmatic patient. Objectives The primary objective of this study is to characterize lung ultrasound (LU) findings in stable asthma pediatric patients presenting in a tertiary care asthma or respiratory clinic. Design/Methods Eligible patients >6 years of age, underwent a LU by the study sonographer between December 19, 2017 to June 25, 2019, during their regular follow up visit at the pulmonology clinic or scheduled pulmonary function test. Patients were defined as asthmatic if they had a positive methacholine challenge test (MCT) or spirometry at the day of the visit or in the past. Patients were excluded if they had an upper respiratory tract infection in the past 4 weeks, or had any other known pulmonary diseases. Baseline demographic and asthma severity (ISAAC score, ACQ-7) questionnaires were filled out by the patients, following which they underwent a LU by a novice sonographer using a 6-zone protocol. A blinded expert sonographer interpreted the images offline. A positive LU was defined as presence of more than 3 B-lines, consolidation (<1cm or >1cm), absent lung slide, and/or presence of pleural fluid. Results Fifty-two patients were enrolled in the study and 19.2% (CI 8.31-30.15) of the asthma patients had positive LU findings. The positive LU findings were diverse including B-lines (80%), small consolidation (80%), pleural line anomalies (10%). Positive LU findings were not correlated to any demographic value. Conclusion In our study, 19.2% of asthma patients at baseline have a positive LU. Lung consolidations larger than 1 cm were rarely seen. There were no significant differences between demographic data in asthmatic patients with positive compared to those with negative LUS. This positive LU scan rate is in keeping with a prior study on LU in pediatrics.
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Perova, Yu A., N. Ramos Vicente, L. Alandete German, J. Izquierdo Alabau, G. Fernando Lascurain, J. Martinez Mendieta, and D. M. Sanchez Escobedo. "FEVER OF UNKNOWN ORIGIN: DESCRIPTIVE STUDY." Russian Archives of Internal Medicine 9, no. 3 (May 28, 2019): 194–200. http://dx.doi.org/10.20514/2226-6704-2019-9-3-194-200.
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Background: fever of unknown origin is one of the diagnoses more difficult in our area, because it involves monitoring of a complex algorithm of several procedures to establish its cause and con frequently takes too long before any explanation. Therefore, the objective is to get to your diagnosis etiologic and to do a particular series of steps.Objective: to describe the most frequent causes of classical fever of unknown origin in the hospital setting and make a simplified diagnostic search algorithm for this pathology.Methods: a case-series study of 85 patients admitted to the Hospital Obispo Polanco with a diagnosis of fever of unknown origin conducted from 2013 to 2018 in the therapeutic services except for pediatrics and surgery units. The study variables included age, sex, complementary studies (variables from humoral, microbiological and biopsies), results obtained, diagnosis of each patient, treatment.Results: of all patients, 23 (27 %) had infections, of which 14 (16 %) of respiratory focus, 6 (7 %) of urinary focus, 2 (2 %) of abdominal focus and 1 (1 %) of the skin focus. Seven patients (8 %) had neoplasms, three of which (3 %) of respiratory origin, three of digestive tract (3 %) and one of prostatic origin (1 %). In four patients (5 %) were diagnosed of the rheumatic diseases. In 51 (60 %) patients not be could diagnose any cause of fever of unknown origin.Conclusions: the first cause of fever of unknown origin is diseases of unknown etiology with 60 % (51 cases) without being able to identify the clear focus. Among the known etiologies, the most private pathology is infectious bacterial diseases of the respiratory and urinary tracts (27 % — 23 patients). The third place is occupied by oncological diseases with a predominance of malignant pulmonary neoplasms (8 % — 7 patients). Rheumatological diseases occupy the last place and, in this study, accounted for only 5 % (4 patients).
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Felix, A., F. Delion, E. Coignard, E. Martin, M. Mohamed Sahnoun, C. Hospice, E. Cuadro Alvarez, et al. "POS1295 SYSTEMIC AND AUTO-INFLAMMATORY DISEASES OF PEDIATRIC ONSET: THE EXPERIENCE OF THE FRENCH OVERSEAS DEPARTMENTS OF AMERICA." Annals of the Rheumatic Diseases 81, Suppl 1 (May 23, 2022): 984.2–985. http://dx.doi.org/10.1136/annrheumdis-2022-eular.431.
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BackgroundSystemic diseases of pediatric onset are more frequent in Afro-Caribbean population, especially Pediatric systemic lupus (pSLE).ObjectivesOur work is a retrospective study of patients followed in French overseas departments of America for systemic disease or auto-inflammatory syndrome of pediatric onset. It describes their clinical and biological specificities at diagnosis, during childhood and early adulthood.MethodsOur retrospective study was conducted between 01/01/2000 and 01/09/2021. Listings of adult patients with pediatric onset and pediatric patients were obtained in each center through computerized hospital archives, list of patients followed by referent pediatricians and adult specialists in internal medicine and the French National Registry for rare disease. Data were then gathered by going through their medical files. The spectrum of diseases studied included pSLE, Sjogren syndrome, antiphospholipid syndrome (APS), connectivitis, systemic scleroderma, dermatomyositis, Systemic juvenile idiopathic arthritis (sJIA), unclassified auto-inflammatory syndrome.Results2148 patients were identified on a 21 year-period, and 135 patients were included. Most patients diagnosed with a systemic pathology (102) suffered from pSLE (53%), followed by dermatomyositis (17%). Average follow up was 8.3 years (0.3 - 25 years), median age at last follow up was 21.2 (14 - 36.7). We found an increase in the number of new diagnoses throughout the years. For pSLE, sex repartition was 4/1 girl/boy and did not vary according to age (p= 0,31). At onset, patients had 10 Sclicc criteria (4-12) and median EULAR/ACR 2019 score was 38 (12 - 54). The combination of typical skin involvement, arthritis and fever was found for 87%. At onset, a third of patients had renal involvement, 15% had Neurolupus and 41% cardiac involvement. All patients had a positive ANA and Anti-DNA antibodies, followed by anti-Ssa/Ssb antibodies (78%), Anti-Sm (78%) and anti RNP (52%). During childhood, 54% had renal involvement and 26% suffered from Neurolupus. Patients suffered in median from 3 flares and 26% suffered from more than 5 flares during childhood. Pre-pubertal patients (26%) had worst outcomes, 93% had renal and / or neurological involvement, they had more flares (median at 5 p = 0,02) and needed an average of 4 background therapies (p = 0,04). Boys seemed to have better disease control at transition to adult care but gender was not an independent predictor of severity during childhood (p = 0,21). 17 patients had dermatomyositis, 29% of them had respiratory involvement during childhood. 33 patients had auto-inflammatory syndromes mostly sJIA (67%), 50% of them had hemophagocytic syndrome during childhood and their disease was controlled by steroids for 64%, 36% needed biotherapy. The overall mortality was 3%.ConclusionThis is a large cohort of patients of Afro-Caribbean origin with a higher frequency of pSLE. Although the outcomes for these patients were similar to western countries, they had loud symptoms at onset, not corelated to delay at diagnosis. Compared to ethnic studies of North America or Africa, the French health care system being universal and free, the bias related to socio-economic status was lower. This work will continue with the exploration by transcriptomic and genetic tests for early and severe forms to identify the extra-environmental causes. The environmental factors specific to these regions should be explored in additional prospective studies.Figure 1.Clinical and biological characteristics of patients with pediatric onset systemic lupus. Orange: clinical signs at onset, Green: immunological profile, Blue: evolutive profile and proportion of organ involvement during childhood. ANA: anti-nuclear antibody.Disclosure of InterestsNone declared
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Thaver, Danyal, and Mirza Beg. "Pulmonary Crohn's Disease in Down Syndrome: A Link or Linkage Problem." Case Reports in Gastroenterology 10, no. 2 (May 20, 2016): 206–11. http://dx.doi.org/10.1159/000445975.
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Crohn’s disease (CD) is an autoimmune inflammatory disorder that primarily affects the gastrointestinal tract. It may have pulmonary involvement, which has been rarely reported in pediatric patients. Down syndrome (DS) has been associated with increased frequency of autoimmune diseases. However, associations between CD and DS have been rarely reported. We present the case of a 5-year-old girl with known DS and a history of chronic intermittent abdominal pain who presented with persistent pneumonia. Her workup included a chest computed tomography (CT) scan that showed multiple noncalcified pulmonary nodules. An extensive infectious workup was done that was negative. CT-guided needle biopsy of the lung nodules showed necrotizing granulomas. This raised concern for primary CD with extraintestinal pulmonary manifestation. An esophagogastroduodenoscopy and colonoscopy were performed, and colon biopsies showed scattered epithelioid granulomas. Based on this information, there was consensus that her lung nodules were secondary to CD. She was started on standard therapy for CD, and her abdominal and respiratory symptoms gradually improved. However, she continues to have mild residual lung calcification and fibrosis. To our knowledge, this is the first reported case of pulmonary CD in a child with DS. The natural history of pulmonary CD in the pediatric population is not very well studied. Furthermore, since DS has been well known to be associated with increased frequency of malignancies and autoimmune conditions due to immune dysregulation, it is difficult to predict the severity and possible complications in this patient.
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Wormer, Jill R., Arti Shankar, Michael Boele Van Hensbroek, Ashna D. Hindori-Mohangoo, Hannah Covert, Maureen Y. Lichtveld, and Wilco C. W. R. Zijlmans. "Poor Adherence to the WHO Guidelines on Feeding Practices Increases the Risk for Respiratory Infections in Surinamese Preschool Children." International Journal of Environmental Research and Public Health 18, no. 20 (October 13, 2021): 10739. http://dx.doi.org/10.3390/ijerph182010739.
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Poor feeding practices in infants and young children may lead to malnutrition, which, in turn, is associated with an increased risk of infectious diseases, such as respiratory tract infections (RTIs), a leading cause of under-five mortality. We explored the association between RTIs and the WHO infant and young child feeding (IYCF) indicators: minimum dietary diversity (MDD), minimum meal frequency (MMF), and minimum acceptable diet (MAD), among infants and preschool children in Suriname. A validated pediatric food frequency questionnaire was used and data on RTIs, defined as clinical care for fever with respiratory symptoms, bronchitis, or pneumonia were obtained. Associations between feeding indicators and RTIs were explored using hierarchical logistic regression. Of 763 children aged 10–33 months, 51.7% achieved the MDD, 88.5% the MMF, and 46.5% the MAD. Furthermore, 73% of all children experienced at least one upper and/or lower RTI. Children meeting the MDD and MAD had significantly lower odds on RTIs (OR 0.53; 95%CI: 0.37–0.74, p < 0.001; OR 0.55; 95%CI: 0.39–0.78, p < 0.001, respectively). The covariates parity and household income were independently associated with RTIs. In conclusion, MDD and MAD were associated with (upper) RTIs. Whether these indicators can be used as predictors for increased risk for RTIs should be assessed in future prospective studies.
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Marseglia, Gian Luigi, Sara Manti, Elena Chiappini, Ilaria Brambilla, Carlo Caffarelli, Mauro Calvani, Fabio Cardinale, et al. "Chronic cough in childhood: A systematic review for practical guidance by the Italian Society of Pediatric Allergy and Immunology." Allergologia et Immunopathologia 49, no. 2 (March 1, 2021): 133–54. http://dx.doi.org/10.15586/aei.v49i2.44.
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The current systematic review presented and discussed the most recent studies on pediatric chronic cough. In addition, the Italian Society of Pediatric Allergy and Immunology elaborated a comprehensive algorithm to guide the primary care approach to a pediatric patient with chronic cough.Several algorithms on chronic cough management have been adopted and validated in clinical practice; however, unlike the latter, we developed an algorithm focused on pediatric age, from birth until adulthood. Based on our findings, children and adolescents with chronic cough without cough pointers can be safely managed, initially using the watchful waiting approach and, successively, starting empirical treatment based on cough characteristics. Unlike other algorithms that suggest laboratory and instrumental investigations as a first step, this review highlighted the importance of a “wait and see” approach, consisting of parental reassurance and close clinical observation, also due to interprofessional collaboration and communication between general practitioners and specialists that guarantee better patient management, appropriate prescription behavior, and improved patient outcome. Moreover, the neonatal screening program provided by the Italian National Health System, which intercepts several diseases precociously, allowing to treat them in a very early stage, helps and supports a “wait and see” approach.Conversely, in the presence of cough pointers or persistence of cough, the patient should be tested and treated by the specialist. Further investigations and treatments will be based on cough etiology, aiming to intercept the underlying disease, prevent potentially irreversible tissue damage, and improve the general health of patients affected by chronic cough, as well as the quality of life of patients and their family. Further high-quality randomized controlled trials are needed to validate this algorithm’s performance in real clinical practice.
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Vlasova, Galina V., and Pavel V. Pavlov. "Age aspects of the course of chronic otitis media with cholesteatoma in children (clinical and immunological characteristics)." Pediatrician (St. Petersburg) 10, no. 5 (January 28, 2020): 13–18. http://dx.doi.org/10.17816/ped10513-18.
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Cholesteatoma of the middle ear is the disease, the course and prognosis of which can not be considered without taking into account the patients age. In pediatric otorhinolaryngology, such patients require special attention due to the aggressiveness of cholesteatoma in children. The rapid growth and a high number of recurrences after surgical treatment are features of the course of this disease in children. The causes of the aggressiveness of this disease in children have not been studied. Objective: to identify clinical and immunological features in children with middle ear cholesteatoma in different age groups that contribute to the aggressive course of the disease. A retrospective analysis of 143 medical case reports of children from 1 to 17 years old who received surgical treatment of middle ear cholesteatoma was carried out in the Department of othorhinolaryngology (St. Petersburg State Pediatric Medical University) from 2000 to 2018. Comparative analysis of clinical manifestation, anamnesis of ear disease, concomitant diseases, immunological reactivity (the content of lymphocytes, their subpopulations and interleukin-2 in peripheral blood) and results of surgical treatment of middle ear cholesteatoma in different age groups has been performed. Cholesteatoma is more aggressive in young children. Frequent infections of the upper respiratory tract, eustachian tube dysfunctions, immune disorders in children under 7 years of age lead to an unfavorable course and prognosis of middle ear cholesteatoma.
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Esposito, Susanna, Claudia De Guido, Marco Pappalardo, Serena Laudisio, Giuseppe Meccariello, Gaia Capoferri, Sofia Rahman, Claudio Vicini, and Nicola Principi. "Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses." Children 9, no. 5 (April 26, 2022): 618. http://dx.doi.org/10.3390/children9050618.
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Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.
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Esposito, Susanna, Claudia De Guido, Marco Pappalardo, Serena Laudisio, Giuseppe Meccariello, Gaia Capoferri, Sofia Rahman, Claudio Vicini, and Nicola Principi. "Retropharyngeal, Parapharyngeal and Peritonsillar Abscesses." Children 9, no. 5 (April 26, 2022): 618. http://dx.doi.org/10.3390/children9050618.
Full textAbstract:
Deep neck infections (DNIs) include all the infections sited in the potential spaces and fascial planes of the neck within the limits of the deep layer of the cervical fascia. Parapharyngeal and retropharyngeal infections leading to parapharyngeal abscess (PPA) and retropharyngeal abscess (RPA) are the most common. DNIs remain an important health problem, especially in children. The aim of this narrative review is to describe the management of peritonsillar, retropharyngeal and parapharyngeal abscesses in pediatric age. Despite relatively uncommon, pediatric DNIs deserve particular attention as they can have a very severe course and lead to hospitalization, admission to the intensive care unit and, although very rarely, death. They generally follow a mild upper respiratory infection and can initially present with signs and symptoms that could be underestimated. A definite diagnosis can be made using imaging techniques. Pus collection from the site of infection, when possible, is strongly recommended for definition of diseases etiology. Blood tests that measure the inflammatory response of the patient may contribute to monitor disease evolution. The therapeutic approach should be targeted toward the individual patient. Regardless of the surgical treatment, antibiotics are critical for pediatric DNI prognosis. The diagnostic-therapeutic procedure to be followed in the individual patient is not universally shared because it has not been established which is the most valid radiological approach and which are the criteria to be followed for the differentiation of cases to be treated only with antibiotics and those in which surgery is mandatory. Further studies are needed to ensure the best possible care for all children with DNIs, especially in this era of increased antimicrobial resistance.