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Roca C, Asturizaga A, Villca N, Cabrera R, Copana-Olmos R, Aguilera-Avendano V, Estrada-Villarroel C, Forest-Yepez MA, Torrez-Santos M, Magne-Calle AF, Foronda-Rios MO, Pena-Helguero LM, Montalvo M, Torrez D, Toco M, Cespedes M, Davalos I, Bowman NM. Relationship between sociodemographic, clinical, and laboratory characteristics and severity of COVID-19 in pediatric patients. PLoS One 2024; 19:e0283037. [PMID: 38713667 DOI: 10.1371/journal.pone.0283037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 03/01/2023] [Indexed: 05/09/2024] Open
Abstract
COVID-19 affects children less seriously than adults; however, severe cases and deaths are documented. This study objective is to determine socio-demographic, clinical and laboratory indicators associated with severe pediatric COVID-19 and mortality at hospital entrance. A multicenter, retrospective, cross-sectional study was performed in 13 tertiary hospitals in Bolivia. Clinical records were collected retrospectively from patients less than 18 years of age and positive for SARS-CoV-2 infection. All variables were measured at hospital entrance; outcomes of interest were ICU admission and death. A score for disease severity was developed using a logistic regression model. 209 patients were included in the analysis. By the end of the study, 43 (20.6%) of children were admitted to the Intensive care unit (ICU), and 17 (8.1%) died. Five indicators were independently predictive of COVID-19 severity: age below 10 years OR: 3.3 (CI95%: 1.1-10.4), days with symptoms to medical care OR: 2.8 (CI95%: 1.2-6.5), breathing difficulty OR: 3.4 (CI95%: 1.4-8.2), vomiting OR: 3.3 (CI95%: 1.4-7.4), cutaneous lesions OR: 5.6 (CI95%: 1.9-16.6). Presence of three or more of these risk factors at hospital entrance predicted severe disease in COVID-19 positive children. Age, presence of underlying illness, male sex, breathing difficulty, and dehydration were predictive of death in COVID-19 children. Our study identifies several predictors of severe pediatric COVID-19 and death. Incorporating these predictors, we developed a tool that clinicians can use to identify children at high risk of severe COVID-19 in limited-resource settings.
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Affiliation(s)
- Cristian Roca
- Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America
| | - Adriana Asturizaga
- Pediatric Pneumology Department, Caja de Salud de la Banca Privada, La Paz, Bolivia
| | - Nelson Villca
- Pediatric Pneumology Department, HODE Materno Infantil Hospital CNS, La Paz, Bolivia
| | - Ramiro Cabrera
- Pediatric Pneumology Department, Mario Ortiz Children's Hospital, Santa Cruz, Bolivia
| | - Raul Copana-Olmos
- Covid19 Intensive Care Unit, Manuel A. Villarroel Children's Hospital, Cochabamba, Bolivia
- Maternal Infant Department, Medicine Faculty San Simon University, Cochabamba, Bolivia
| | | | | | | | | | | | | | | | - Monica Montalvo
- Pediatric Pneumology Department, Mario Ortiz Children's Hospital, Santa Cruz, Bolivia
| | - Delina Torrez
- Pediatric Intensive Care Department, Materno Infantil Hospital CNS, Santa Cruz, Bolivia
| | - Mirna Toco
- Department of Pediatrics, Hospital Cooperación Corea, Oruro, Bolivia
| | - Miguel Cespedes
- Pediatric Department, Bolivian Japanese Hospital Materno Infantil, Trinidad, Beni, Bolivia
| | - Ingrid Davalos
- Pediatric Intensive Care Department, North Hospital, El Alto, La Paz, Bolivia
| | - Natalie M Bowman
- Division of Infectious Diseases, Department of Medicine, University of North Carolina, Chapel Hill, NC, United States of America
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Şahbudak Bal Z, Yildirim Arslan S, Guner Ozenen G, Şener Okur D, Kılıçaslan Ö, Demirbuga A, Afat Turgut E, Dalgıc N, Belet N, İnceli HB, Elvan-Tuz A, Tural Kara T, Bulbul B, Demirdag T, Çakıcı Ö, Bal A, Ergun D, Altug U, Arslan A, Kizmaz İsancli D, Hancerli Torun S, Çelik Ü, Yasar B, Erbas İC, Karadag Oncel E, Akbas A, Gudeloglu E, Şen S, Kacar P, Dede E, Petmezci E, Aksoy FD, Karbuz A, Öncel S, Tezer H, Devrim İ, Ciftci E, Hacimustafaoglu M, Kurugol Z. Adolescents With Breakthrough COVID-19 Infections Requiring Hospitalization: A Multicenter Retrospective Study. Cureus 2024; 16:e60940. [PMID: 38915988 PMCID: PMC11195320 DOI: 10.7759/cureus.60940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/11/2024] [Indexed: 06/26/2024] Open
Abstract
Background Vaccines have the most important role in the battle against the COVID-19 pandemic. With the widespread use of vaccines, COVID-19 has remarkably declined. Adolescents were vaccinated after approvals for this age group, which was later than adults, and a nationwide vaccination program was implemented in August 2021 in Turkey for adolescents ≥12 years of age. Therefore, we aimed to determine the effects of the COVID-19 nationwide adolescent vaccination program on adolescent hospitalizations due to COVID-19 and multisystem inflammatory syndrome in children (MIS-C) by comparing two periods, including the vaccination period (VP) and the pre-VP (PVP). The second aim of this study is to compare the clinical features and disease severity of vaccine-breakthrough COVID-19 hospitalizations with unvaccinated individuals in the VP. Methods A retrospective multicenter study was conducted to determine and compare the number of hospitalizations due to COVID-19 and MIS-C between the VP (September 1, 2021, to August 31, 2022) and PVP (September 1, 2020, to August 31, 2021). We also compared the characteristics, risk factors, and outcomes of breakthrough infections of adolescents aged 12-18, which required hospitalization with the same age group of unvaccinated hospitalized individuals during the VP. Results During the study period, 3967 children (0-18 years) were hospitalized in the PVP and 5143 (0-18 years) in the VP. Of them, 35.4% were adolescents (12-18 years) in the PVP, and this rate was 18.6% in the VP; relative risk was 0.6467 (95% confidence interval [CI]: 0.6058-0.6904; p < 0.001). Patients with breakthrough COVID-19 were older (201 vs. 175 months, p < 0.001) and less commonly hospitalized for COVID-19 (81.5% vs. 60.4%, p < 0.001, odds ratio [OR]: 0.347 [95% CI: 0.184-0.654]). The majority of these infections were asymptomatic and mild (32% vs.72.9%: p < 0.001, OR: 5.718 [95% CI: 2.920-11.200]), and PICU admission was less frequently required (p = 0.011, OR: 0.188 [95% CI: 0.045-0.793]). Most breakthrough COVID-19 infections occurred within three months after the last vaccine dose (54.2%). Conclusions This study demonstrated a significant decrease in adolescent hospitalizations due to COVID-19 and MIS-C after implementing COVID-19 vaccines in Turkey. Breakthrough cases were less severe and mostly occurred three months after the last dose. This study emphasizes the importance of COVID-19 vaccines and that parents' decisions may be changed, particularly those who hesitate to or refuse vaccination.
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Affiliation(s)
- Zümrüt Şahbudak Bal
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, TUR
| | - Sema Yildirim Arslan
- Department of Pediatric Infectious Diseases, Ege University Faculty of Medicine, İzmir, TUR
| | - Gizem Guner Ozenen
- Department of Pediatric Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Dicle Şener Okur
- Department of Pediatric Infectious Diseases, Pamukkale University, Denizli, TUR
| | - Önder Kılıçaslan
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Asuman Demirbuga
- Department of Pediatric Infectious Diseases, Istanbul University School of Medicine, İstanbul, TUR
| | - Elif Afat Turgut
- Department of Pediatric Infectious Diseases, Adana City Training Hospital, Adana, TUR
| | - Nazan Dalgıc
- Department of Pediatrics, Division of Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - Nursen Belet
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Dokuz Eylül University, İzmir, TUR
| | - Hatice Belkis İnceli
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ankara University, Ankara, TUR
| | - Aysegul Elvan-Tuz
- Department of Pediatrics, Division of Infectious Diseases, Health Sciences University Tepecik Training and Research Hospital, İzmir, TUR
| | - Tugce Tural Kara
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Akdeniz University, Antalya, TUR
| | - Beyhan Bulbul
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Uludag University, Bursa, TUR
| | - Tugba Demirdag
- Department of Pediatric Infectious Diseases, Gazi University, Ankara, TUR
| | - Özlem Çakıcı
- Department of Pediatrics and Child Health, Division of Pediatric Infectious Diseases, Section of Internal Medical Sciences, Faculty of Medicine, Kocaeli University, Izmit, TUR
| | - Alkan Bal
- Department of Pediatric Emergency, Manisa Celal Bayar University Faculty of Medicine, Manisa, TUR
| | - Deniz Ergun
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Umut Altug
- Department of Pediatrics, Medical School of Pamukkale University, Denizli, TUR
| | - Asli Arslan
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ege University, İzmir, TUR
| | - Didem Kizmaz İsancli
- Department of Pediatrics, Division of Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Selda Hancerli Torun
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Istanbul University, İstanbul, TUR
| | - Ümit Çelik
- Department of Pediatrics, Division of Infectious Diseases, Adana City Hospital, Adana, TUR
| | - Belma Yasar
- Department of Pediatrics, Division of Infectious Diseases, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - İrem Ceren Erbas
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Dokuz Eylül University, İzmir, TUR
| | - Eda Karadag Oncel
- Department of Pediatrics, Division of Infectious Diseases, Health Sciences University Tepecik Training and Research Hospital, İzmir, TUR
| | - Ali Akbas
- Department of Pediatrics, Medical School of Akdeniz University, Antalya, TUR
| | - Elif Gudeloglu
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Gazi University, Ankara, TUR
| | - Semra Şen
- Department of Pediatrics, Division of Infectious Diseases, Manisa Celal Bayar University, Manisa, TUR
| | - Pelin Kacar
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Elif Dede
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Istanbul University, İstanbul, TUR
| | - Ercument Petmezci
- Department of Pediatrics, Division of Intensive Care Unit, Sisli Hamidiye Etfal Training and Research Hospital, İstanbul, TUR
| | - Fatma Dilsad Aksoy
- Department of Pediatrics, Medical School of Uludag University, Bursa, TUR
| | - Adem Karbuz
- Department of Pediatric Infectious Diseases, Prof. Dr. Cemil Taşçıoğlu City Hospital, İstanbul, TUR
| | - Selim Öncel
- Department of Pediatrics and Child Health, Division of Pediatric Infectious Diseases, Section of Internal Medical Sciences, Faculty of Medicine, Kocaeli University, Izmit, TUR
| | - Hasan Tezer
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Gazi University, Ankara, TUR
| | - İlker Devrim
- Department of Pediatrics, Division of Infectious Diseases, University of Health Sciences Dr. Behcet Uz Child Disease and Pediatric Surgery Training and Research Hospital, İzmir, TUR
| | - Ergin Ciftci
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ankara University, Ankara, TUR
| | | | - Zafer Kurugol
- Department of Pediatrics, Division of Infectious Diseases, Medical School of Ege University, İzmir, TUR
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Hersh Z, Weisband YL, Bogan A, Leibovich A, Obolski U, Nevo D, Gilad-Bachrach R. Impact of Long-COVID in children: a large cohort study. Child Adolesc Psychiatry Ment Health 2024; 18:48. [PMID: 38622709 PMCID: PMC11020876 DOI: 10.1186/s13034-024-00736-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 03/20/2024] [Indexed: 04/17/2024] Open
Abstract
BACKGROUND The impact of long-term Coronavirus disease 2019 (COVID-19) on the pediatric population is still not well understood. This study was designed to estimate the magnitude of COVID-19 long-term morbidity 3-6 months after the date of diagnosis. METHODS A retrospective study of all Clalit Health Services members in Israel aged 1-16 years who tested positive for SARS-CoV-2 between April 1, 2020 and March 31, 2021. Controls, who had no previous diagnosis of COVID-19, were one-to-one matched to 65,548 COVID-19-positive children and teens, and were assigned the infection dates of their matches as their index date. Matching included age, sex, socio-economic score, and societal sector. Individuals were excluded from the study if they had severe medical conditions before the diagnosis such as cancer, diabetes, chronic respiratory diseases, and/or abnormal physiological development. Generalized Estimating Equations were used to estimate the associations between COVID-19 and the use of medical services. The analysis focused on the 3-6 months after the infection date. Adjustments were made for demographics and for the use of medical services 6-12 and 3-6 months before the infection date. The latter was necessary because of observed disparities in medical service utilization between the groups before the COVID-19 diagnosis, despite the matching process. RESULTS Statistically significant differences were only found for referrals for mental health services [adjusted relative-risk (RR) 1·51, 95%CI 1·15 - 1·96; adjusted risk-difference (RD) 0·001, 95%CI 0·0006 - 0·002], and medication prescriptions of any kind (RR 1·03, 95%CI 1·01-1·06; RD 0·01 95%CI 0·004 - 0·02). CONCLUSIONS The significant increase in medication prescriptions and mental health service referrals support the hypothesis that COVID-19 is associated with long-lasting morbidities in children and adolescents aged 1-16 years. However, the risk difference in both instances was small, suggesting a minor impact on medical services.
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Affiliation(s)
- Ziv Hersh
- Clalit Health Services, Tel-Aviv, Israel
| | - Yiska Loewenberg Weisband
- Clalit Health Services, Tel-Aviv, Israel
- Clalit Research Center, Innovation Division, Clalit Health Services, Tel Aviv, Israel
| | - Ariel Bogan
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
- Leadspace, Hod Hasharon, Israel
| | - Adir Leibovich
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel
- Strauss Water Ltd, Or Yehuda, Israel
| | - Uri Obolski
- Department of Preventive Medicine, School of Public Health, Faculty of Medicine, Tel Aviv University, Tel-Aviv, Israel
- Porter School of Environmental and Earth Sciences, Faculty of Exact Sciences, Tel Aviv University, Tel-Aviv, Israel
| | - Daniel Nevo
- Department of Statistics and Operations Research, Tel Aviv University, Tel-Aviv, Israel
| | - Ran Gilad-Bachrach
- Department of Biomedical Engineering, Tel Aviv University, Tel-Aviv, Israel.
- Sagol School of Neuroscience, Tel Aviv University, Tel-Aviv, Israel.
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Chan OW, Lee EP, Chou CC, Lai SH, Chung HT, Lee J, Lin JJ, Hsieh KS, Hsia SH. In-hospital care of children with COVID-19. Pediatr Neonatol 2024; 65:2-10. [PMID: 37989708 DOI: 10.1016/j.pedneo.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 01/18/2023] [Accepted: 02/01/2023] [Indexed: 11/23/2023] Open
Abstract
Children have been reported to be less affected and to have milder severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection than adults during the coronavirus disease 2019 (COVID-19) pandemic. However, children, and particularly those with underlying disorders, are still likely to develop critical illnesses. In the case of SARS-CoV-2 infection, most previous studies have focused on adult patients. To aid in the knowledge of in-hospital care of children with COVID-19, this study presents an expert review of the literature, including the management of respiratory distress or failure, extracorporeal membrane oxygenation (ECMO), multisystem inflammatory syndrome in children (MIS-C), hemodynamic and other organ support, pharmaceutical therapies (anti-viral drugs, anti-inflammatory or antithrombotic therapies) and management of cardiopulmonary arrest.
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Affiliation(s)
- Oi-Wa Chan
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - En-Pei Lee
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Cheng-Che Chou
- Division of Paediatric Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
| | - Shen-Hao Lai
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Pulmonology, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Hung-Tao Chung
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric Cardiovascular Internal Medicine, Department of Pediatrics, Chang Gung Memorial Hospital, Taoyuan, China
| | - Jung Lee
- Chang Gung University College of Medicine, Taoyuan, Taiwan; Division of Pediatric General Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linko, Kweishan, Taoyuan, Taiwan, ROC
| | - Jainn-Jim Lin
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Kai-Sheng Hsieh
- Center of Structure and Congenital Heart Disease/Ultrasound and Department of Cardiology, Children's Hospital, China Medical University, Taichung, Taiwan; Department of Pediatrics and Structural, Congenital Heart and Echocardiography Center, School of Medicine, China Medical University, Taichung, Taiwan.
| | - Shao-Hsuan Hsia
- Division of Pediatric Critical Care Medicine, Department of Pediatrics, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan; Chang Gung University College of Medicine, Taoyuan, Taiwan.
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Malveste Ito CR, Moreira ALE, Silva PAND, Santos MDO, Santos APD, Rézio GS, Brito PND, Rezende APC, Fonseca JG, Peixoto FADO, Wastowski IJ, Goes VM, Estrela MC, Souza PZD, Carneiro LC, Avelino MAG. Viral Coinfection of Children Hospitalized with Severe Acute Respiratory Infections during COVID-19 Pandemic. Biomedicines 2023; 11:biomedicines11051402. [PMID: 37239073 DOI: 10.3390/biomedicines11051402] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2023] [Revised: 04/24/2023] [Accepted: 04/26/2023] [Indexed: 05/28/2023] Open
Abstract
The main pathogens of severe respiratory infection in children are respiratory viruses, and the current molecular technology allows for a rapid and simultaneous detection of a wide spectrum of these viral pathogens, facilitating the diagnosis and evaluation of viral coinfection. METHODS This study was conducted between March 2020 and December 2021. All children admitted to the ICU with a diagnosis of SARI and who were tested by polymerase chain reaction on nasopharyngeal swabs for SARS-CoV-2 and other common respiratory viral pathogens were included in the study. RESULTS The result of the viral panel identified 446 children, with one infected with a single virus and 160 co-infected with two or more viruses. This study employed descriptive analyses, where a total of twenty-two coinfections among SARI-causing viruses were identified. Thus, the five most frequent coinfections that were selected for the study are: hRV/SARS-CoV-2 (17.91%), hRV/RSV (14.18%), RSV/SARS-CoV-2 (12.69%), hRV/BoV (10.45%), and hRV/AdV (8.21%). The most significant age group was 38.1%, representing patients aged between 24 and 59 months (61 individuals). Patients older than 59 months represented a total of 27.5%, comprising forty-four patients. The use of oxygen therapy was statistically significant in coinfections with Bocavirus, other CoVs, Metapneumovirus, and RSV. Coinfections with SARS-CoV-2 and the other different coinfections presented a similar time of use of oxygen therapy with a value of (p > 0.05). In the year 2020, hRV/BoV was more frequent in relation to other types of coinfections, representing a total of 35.1%. The year 2021 presented a divergent profile, with hRV/SARS-CoV-2 coinfection being the most frequent (30.8%), followed by hRV/RSV (28.2%). Additionally, 25.6% and 15.4% represented coinfections between RSV/SARS-CoV-2 and hRV/AdV, respectively. We saw that two of the patients coinfected with hRV/SARS-CoV-2 died, representing 9.52% of all deaths in the study. In addition, both hRV/hBoV and hRV/RSV had death records for each case, representing 8.33% and 6.67% of all deaths, respectively. CONCLUSION Coinfections with respiratory viruses, such as RSV and hBoV, can increase the severity of the disease in children with SARI who are admitted to the ICU, and children infected with SARS-CoV-2 have their clinical condition worsened when they have comorbidities.
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Affiliation(s)
- Célia Regina Malveste Ito
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - André Luís Elias Moreira
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - Paulo Alex Neves da Silva
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - Mônica de Oliveira Santos
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - Adailton Pereira Dos Santos
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - Geovana Sôffa Rézio
- State Emergency Hospital of the Northwest Region of Goiânia Governador Otávio Lage de Siqueira (HUGOL), Anhanguera Avenue, 14.527-Santos Dumont, Goiânia 74463-350, GO, Brazil
| | - Pollyanna Neta de Brito
- State Emergency Hospital of the Northwest Region of Goiânia Governador Otávio Lage de Siqueira (HUGOL), Anhanguera Avenue, 14.527-Santos Dumont, Goiânia 74463-350, GO, Brazil
| | - Alana Parreira Costa Rezende
- State Emergency Hospital of the Northwest Region of Goiânia Governador Otávio Lage de Siqueira (HUGOL), Anhanguera Avenue, 14.527-Santos Dumont, Goiânia 74463-350, GO, Brazil
| | - Jakeline Godinho Fonseca
- State Emergency Hospital of the Northwest Region of Goiânia Governador Otávio Lage de Siqueira (HUGOL), Anhanguera Avenue, 14.527-Santos Dumont, Goiânia 74463-350, GO, Brazil
| | | | - Isabela Jubé Wastowski
- Molecular Immunology Laboratory, Goiás State University, Laranjeiras Unity Prof. Alfredo de Castro St., 9175, Parque das Laranjeiras, Goiânia 74855-130, GO, Brazil
| | - Viviane Monteiro Goes
- Institute of Molecular Biology of Paraná (IBMP), Professor Algacyr Munhoz Mader St, 3775-Industrial City of Curitiba, Curitiba 81350-010, PR, Brazil
| | - Mariely Cordeiro Estrela
- Institute of Molecular Biology of Paraná (IBMP), Professor Algacyr Munhoz Mader St, 3775-Industrial City of Curitiba, Curitiba 81350-010, PR, Brazil
| | - Priscila Zanette de Souza
- Institute of Molecular Biology of Paraná (IBMP), Professor Algacyr Munhoz Mader St, 3775-Industrial City of Curitiba, Curitiba 81350-010, PR, Brazil
| | - Lilian Carla Carneiro
- Microorganism Biotechnology Laboratory, Institute of Tropical Pathology and Public Health, Federal University of Goiás, 235 St. Leste Universitário, Goiânia 74605-050, GO, Brazil
| | - Melissa Ameloti Gomes Avelino
- Departament of Pediatrics, Federal University of Goiás, Universitaria Avenue, Leste Universitário, Goiânia 74605-050, GO, Brazil
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Akgun A, Gokcay G, Mungan NO, Sivri HS, Tezer H, Zeybek CA, Ezgu F. Expert-opinion-based guidance for the care of children with lysosomal storage diseases during the COVID-19 pandemic: An experience-based Turkey perspective. Front Public Health 2023; 11:1092895. [PMID: 36794069 PMCID: PMC9922761 DOI: 10.3389/fpubh.2023.1092895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 01/05/2023] [Indexed: 01/31/2023] Open
Abstract
This expert-opinion-based document was prepared by a group of specialists in pediatric inherited metabolic diseases and infectious diseases including administrative board members of Turkish Society for Pediatric Nutrition and Metabolism to provide guidance for the care of children with lysosomal storage disorders (LSDs) during the COVID-19 pandemic in Turkey. The experts reached consensus on key areas of focus regarding COVID-19-based risk status in relation to intersecting immune-inflammatory mechanisms and disease patterns in children with LSDs, diagnostic virus testing, particularly preventive measures and priorities during the pandemic, routine screening and diagnostic interventions for LSDs, psychological and socioeconomic impact of confinement measures and quarantines and optimal practice patterns in managing LSDs and/or COVID-19. The participating experts agreed on the intersecting characteristics of immune-inflammatory mechanisms, end-organ damage and prognostic biomarkers in LSD and COVID-19 populations, emphasizing the likelihood of enhanced clinical care when their interaction is clarified via further studies addressing certain aspects related to immunity, lysosomal dysfunction and disease pathogenesis. In the context of the current global COVID-19 pandemic, this expert-opinion-based document provides guidance for the care of children with LSDs during the COVID-19 pandemic based on the recent experience in Turkey.
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Affiliation(s)
- Abdurrahman Akgun
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Firat University, Elazig, Turkey
| | - Gulden Gokcay
- Division of Nutrition and Metabolism, Department of Pediatrics, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Neslihan Onenli Mungan
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Cukurova University, Adana, Turkey
| | - Hatice Serap Sivri
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Hasan Tezer
- Department of Infectious Diseases, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Cigdem Aktuglu Zeybek
- Division of Pediatric Metabolism, Department of Pediatrics, Faculty of Medicine, Istanbul University Cerrahpasa, Istanbul, Turkey
| | - Fatih Ezgu
- Division of Pediatric Metabolism and Division of Pediatric Genetics, Department of Pediatrics, Faculty of Medicine, Gazi University, Ankara, Turkey,*Correspondence: Fatih Ezgu ✉
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Casassola GM, Schmidt CJ, Affeldt GH, Morais DS, Alvarenga LKB, Miller C, Ziegler B. Functional status of hospitalized pediatric patients with COVID-19 in southern Brazil: a prospective cohort study. J Bras Pneumol 2023; 48:e20220153. [PMID: 36651435 PMCID: PMC9747171 DOI: 10.36416/1806-3756/e20220153] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 09/27/2022] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The present study aimed to assess the functional status of children diagnosed with COVID-19 at the time of hospitalization and the associations with clinical features. METHODS This prospective cohort study was carried out with children diagnosed with COVID-19 admitted to a tertiary hospital. The patients' functioning was assessed using the pediatric Functional Status Scale (FSS). RESULTS A total of 62 children with a median age of 3 years old were included in the study, and 70% had some comorbidity prior to the diagnosis of COVID-19. The median length of stay was nine days, during which period five patients died. The FSS assessment of the sample showed that approximately 55% had some functional alteration. The group of patients with the highest FSS scores presented a lengthier hospital stay (p = 0.016), required more oxygen therapy (p < 0.001), mechanical ventilation (p = 0.001), and intensive care unit admissions (p = 0.019), and had more cardiac (p = 0.007), neurological (p = 0.003), and respiratory (p = 0.013) comorbidities. In the multivariate analysis, there was an association between the dependent variable length of stay and the total FSS score (b = 0.349, p = 0.004) and the presence of comorbidities (b = 0.357, p = 0.004). CONCLUSIONS We observed that more than half of the children hospitalized due to COVID-19 had some level of functional change. Greater alterations in functional status were associated with the presence of previous comorbidities, a greater need for ventilatory support, and longer hospital stays.
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Affiliation(s)
| | | | - Guilherme Hoff Affeldt
- . Programa de Pós-Graduação em Pneumologia, Universidade Federal do Rio Grande do Sul, Porto Alegre (RS), Brasil
| | | | | | - Cristina Miller
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
| | - Bruna Ziegler
- . Hospital de Clínicas de Porto Alegre, Porto Alegre (RS), Brasil
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8
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Turco R, Russo M, Lenta S, Apicella A, Gagliardo T, Savoia F, Corona AM, De Fazio F, Bernardo P, Tipo V. Pediatric emergency care admissions for somatic symptom disorders during the COVID-19 pandemic. Eur J Pediatr 2023; 182:957-964. [PMID: 36459226 PMCID: PMC9716529 DOI: 10.1007/s00431-022-04687-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 10/25/2022] [Accepted: 10/31/2022] [Indexed: 12/03/2022]
Abstract
During the COVID-19 pandemic, children and adolescents with psychiatric disorders experienced an exacerbation of their symptoms with more access to the emergency department (ED). However, little is known about the experience of somatic symptom disorders (SSDs) during the COVID-19 pandemic in children. Therefore, we aimed to compare the rates of pediatric ED admissions for SSDs before and during the COVID-19 pandemic and to understand whether the relative risk of ED admissions for SSDs changed between the two periods. We retrospectively enrolled all children between 4 and 14 years admitted for SSDs in the pediatric ED of Santobono-Pausilipon Hospital, Naples, Italy, from March 11th, 2020, to March 11th, 2021 (pandemic period), and in the same time period of the previous year (pre-pandemic period). We identified 205/95,743 (0,21%) children with SSDs presenting in ED in the pre-pandemic year and 160/40,165 (0,39%) in the pandemic year (p < 0.05). Considering the accesses for age, we observed a relative decrease of the accesses for SSDs over 12 years old (IRR 0,59; CI 0,39-0,88), while we found no differences under 12 years old (IRR 0,87; CI 0,68-1,10). Conclusion: In this study, we found that despite the massive decrease in pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders' admissions to the pediatric ED increased, suggesting an impact of the pandemic also on pediatric psychiatric disorders. What is Known: • During the COVID -19 pandemic, children and adolescents with a psychiatric disorder experienced exacerbation of their symptoms with more accesses in Emergency Department. What is New: • We found that despite the massive decrease of the pediatric admissions due to the COVID-19 pandemic, somatic symptom disorders admissions in healthy children to the pediatric Emergency Department increased ,suggesting an impact of the pandemic also on the pediatric psychiatric disorders.
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Affiliation(s)
- R. Turco
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - M. Russo
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - S. Lenta
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - A. Apicella
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - T. Gagliardo
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - F. Savoia
- grid.415247.10000 0004 1756 8081Childhood Cancer Registry of Campania, Santobono-Pausilipon Children’s Hospital, 80129 Naples, Italy
| | - A. M. Corona
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - F. De Fazio
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
| | - P. Bernardo
- grid.415247.10000 0004 1756 8081Department of Neurosciences, Pediatric Psychiatry and Neurology, Santobono-Pausilipon Children’s Hospital, 80120 Naples, Italy
| | - V. Tipo
- grid.415247.10000 0004 1756 8081Pediatric Emergency Unit, Santobono-Pausilipon Children’s Hospital, Naples, Italy
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9
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Karaahmetoğlu FS, Pehlivan E, Özcan ZB. The activity levels and quality of life of physically disabled children who continued or did not continue rehabilitation during the COVID-19 pandemic. Work 2023; 76:1285-1291. [PMID: 37393478 DOI: 10.3233/wor-220705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/03/2023] Open
Abstract
BACKGROUND Social isolation during the COVID-19 pandemic had a harmful impact on the psychological and physical health of children and teenagers. It is known that interruptions in rehabilitation can cause soft tissue contractures, bone deformities and a decline in motor functions among other complications. OBJECTIVE The aim of this study was to compare the quality of life and physical activity levels of physically disabled children who continued and did not continue rehabilitation during the COVID-19 pandemic. METHOD The gross motor levels of 18 children who continued special education and rehabilitation during the COVID-19 pandemic and 18 children who did not continue were determined with the Gross Motor Function Classification System (GMFCS). The International Physical Activity Questionnaire Short Form (IPAQ) and Children's Quality of Life Scale (PedsQL) questionnaires were administered. RESULTS The study participants comprised 54.1% females and 45.9% males with a mean age of 9.02 years. No significant differences were detected between the two groups in respect of demographic, clinical and functional characteristics (p > 0.05). The walking parameters of PedsQL (p = 0.02) and IPAQ-SF scores (p = 0.03) were determined to be statistically significantly better in the group that continued rehabilitation. CONCLUSION The results of this study demonstrated that the quality of life and walking capacity of children who continued rehabilitation during the COVID-19 pandemic were better. Methods should be developed to ensure that rehabilitation is not interrupted during isolation periods of any future pandemic.
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Affiliation(s)
- Fulya Senem Karaahmetoğlu
- Department of Physiotherapy and Rehabilitation, Hamidiye Institute of Health Sciences, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Esra Pehlivan
- Department of Physical Therapy and Rehabilitation, Faculty of Hamidiye Health Sciences, University of Health Sciences Turkey, Istanbul, Türkiye
| | - Zeynep Betül Özcan
- Department of Physiotherapy and Rehabilitation, Hamidiye Institute of Health Sciences, University of Health Sciences Turkey, Istanbul, Türkiye
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10
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Non-comorbid Respiratory Factor and Work of Breathing in Pediatric COVID-19 Patient: How is Their Synergistic Correlation with the Level of Care? NURSE MEDIA JOURNAL OF NURSING 2022. [DOI: 10.14710/nmjn.v12i3.45340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
Background: Work of breathing (WOB) and non-comorbidities factors in the respiratory system are the two probable findings in pediatric COVID-19 patients. However, the association of those factors with level of care was not well reported.Purpose: This study aimed to identify the relation between potential predictors including comorbidity, low nutritional fulfillment, infectious disease, shock, cough, O2 saturation reduction, abnormal blood gas analysis and sore throat with the level of care among pediatric COVID-19 patients. We also analyzed the synergistic correlation of non-comorbidities factors in the respiratory system and work of breathing to predict level of care in pediatric COVID-19 patients.Methods: A cross-sectional study was conducted in the six referral hospitals from July to September 2020 in four provinces in Indonesia. An observation checklist was used to collect data from the medical records of pediatric patients with COVID-19, including medical diagnosis, demographic, and clinical manifestation. This study included 423 participants aged from 0 to 18. The multivariate logistic regression was performed to test the adjusted odds ratios (AORs) with the 95% confidence intervals (CIs) of the association between WOB, non-comorbid respiratory, and level of care. Moreover, dummy variables (2x2) were made to analyze synergistic correlation of non-comorbid respiratory disease and WOB. The AOR with the 95% CIs was applied in the association between the complication of non-comorbid respiratory diseases and high work of breathing with level of care among pediatric patients with COVID-19.Results: Results showed that age, presence of comorbidity, nutritional fulfillment, infectious disease, shock, work of breathing, O2 saturation reduction, abnormal blood gas analysis, sore throat, and convulsive meningeal consciousness were significantly associated with the level of care (p<0.05). Pediatric patients with non-comorbid respiratory and increased work of breathing had a 15.59 times higher risk of requiring PICU care level (p<0.01). Meanwhile, pediatric patients who experienced both non-comorbid respiratory and increased work of breathing had a 5.76 times risk of requiring an intermediate level of care (p<0.05), and 9.32 times higher risk of requiring a PICU level of care (p<.05).Conclusion: It was found that both non-comorbid respiratory and increased WOB had a significant relationship with the level of care for pediatric patients with COVID-19. Nurse should take into account those clinical findings to increase the awareness in monitoring clinical deterioration in pediatric COVID-19 patients.
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11
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Kwolek EM. Does the light at the end of the tunnel shine for everyone? The need for early paediatric participation in vaccine trials during infectious pandemics. CLINICAL ETHICS 2022; 17:346-351. [PMID: 36471720 PMCID: PMC9659690 DOI: 10.1177/14777509211036661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
While most of the mortality associated with severe acute respiratory syndrome coronavirus 2 has been in elderly populations and adults with significant medical comorbidities, there has been death and morbidity in paediatric populations. As vaccine trial data is released to the public, many people look to the future with hope ; with good vaccine uptake there is the opportunity to reduce the spread of infectious pandemics. Initial vaccine trials were completed with adults and were expanded to include paediatric populations delaying paediatric COVID-19 vaccine initiatives. The exclusion of children from initial vaccine trials during a pandemic is not morally justifiable and fosters distrust with the pharmaceutical and medical industries and inevitably postpones vaccinating children when there is a surplus of available vaccines. The delayed vaccination of children under twelve may have significant public health and economic consequences as there may be ongoing viral transmission in the context of reopening strategies. The safety and efficacy of these candidate vaccines in children should be assessed expeditiously so that distribution to vulnerable paediatric populations is not impacted. Vaccine uptake compliance in the general population is important in establishing herd immunity and ensuring that there is thorough scientific evidence to support vaccination for children is important in establishing community trust.
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Affiliation(s)
- Erin M Kwolek
- Alberta Children’s Hospital, Canada
- Cumming School of Medicine, University
of Calgary, Canada
- Columbia University in the City of New
York, USA
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12
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Wong JJM, Abbas Q, Liauw F, Malisie RF, Gan CS, Abid M, Efar P, Gloriana J, Chuah SL, Sultana R, Thoon KC, Yung CF, Lee JH. Development and validation of a clinical predictive model for severe and critical pediatric COVID-19 infection. PLoS One 2022; 17:e0275761. [PMID: 36301941 PMCID: PMC9612577 DOI: 10.1371/journal.pone.0275761] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 09/22/2022] [Indexed: 01/24/2023] Open
Abstract
INTRODUCTION Children infected with COVID-19 are susceptible to severe manifestations. We aimed to develop and validate a predictive model for severe/ critical pediatric COVID-19 infection utilizing routinely available hospital level data to ascertain the likelihood of developing severe manifestations. METHODS The predictive model was based on an analysis of registry data from COVID-19 positive patients admitted to five tertiary pediatric hospitals across Asia [Singapore, Malaysia, Indonesia (two centers) and Pakistan]. Independent predictors of severe/critical COVID-19 infection were determined using multivariable logistic regression. A training cohort (n = 802, 70%) was used to develop the prediction model which was then validated in a test cohort (n = 345, 30%). The discriminative ability and performance of this model was assessed by calculating the Area Under the Curve (AUC) and 95% confidence interval (CI) from final Receiver Operating Characteristics Curve (ROC). RESULTS A total of 1147 patients were included in this analysis. In the multivariable model, infant age group, presence of comorbidities, fever, vomiting, seizures and higher absolute neutrophil count were associated with an increased risk of developing severe/critical COVID-19 infection. The presence of coryza at presentation, higher hemoglobin and platelet count were associated with a decreased risk of severe/critical COVID-19 infection. The AUC (95%CI) generated for this model from the training and validation cohort were 0.96 (0.94, 0.98) and 0.92 (0.86, 0.97), respectively. CONCLUSION This predictive model using clinical history and commonly used laboratory values was valuable in estimating the risk of developing a severe/critical COVID-19 infection in hospitalized children. Further validation is needed to provide more insights into its utility in clinical practice.
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Affiliation(s)
- Judith Ju Ming Wong
- Department of Pediatric Subspecialties, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
- * E-mail:
| | - Qalab Abbas
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Felix Liauw
- Division of Pediatric Emergency and Intensive Care, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
| | - Ririe Fachrina Malisie
- Child Health Department, Medical Faculty of Universitas Sumatera Utara, Kota Medan, Sumatera Utara, Indonesia
- Murni Teguh Memorial Hospital, Kota Medan, Sumatera Utara, Indonesia
| | - Chin Seng Gan
- Pediatric Intensive Care Unit, Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Muhammad Abid
- Department of Pediatrics and Child Health, Aga Khan University, Karachi, Pakistan
| | - Pustika Efar
- Division of Pediatric Emergency and Intensive Care, Harapan Kita Women and Children Hospital, Jakarta, Indonesia
| | - Josephine Gloriana
- Child Health Department, Medical Faculty of Universitas Sumatera Utara, Kota Medan, Sumatera Utara, Indonesia
- Murni Teguh Memorial Hospital, Kota Medan, Sumatera Utara, Indonesia
| | - Soo Lin Chuah
- Pediatric Intensive Care Unit, Department of Pediatrics, University Malaya Medical Centre, University of Malaya, Kuala Lumpur, Malaysia
| | - Rehena Sultana
- Center for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Koh Cheng Thoon
- Department of Pediatrics, Infectious Disease Service, KK Women’s and Children’s Hospital, Singapore, Singapore
| | - Chee Fu Yung
- Department of Pediatrics, Infectious Disease Service, KK Women’s and Children’s Hospital, Singapore, Singapore
- Lee Kong Chian School of Medicine, Nanyang Technological University, Singapore, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Jan Hau Lee
- Department of Pediatric Subspecialties, Children’s Intensive Care Unit, KK Women’s and Children’s Hospital, Singapore, Singapore
- SingHealth Duke-NUS Global Health Institute, Singapore, Singapore
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13
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Fonseca Y, Urbina E, Bhutta A. Expanding current guidelines for management of COVID-19 focusing on low- and middle-income countries. J Public Health Afr 2022; 13:1465. [PMID: 36313927 PMCID: PMC9614692 DOI: 10.4081/jphia.2022.1465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 05/28/2022] [Indexed: 01/24/2023] Open
Abstract
Within a short time, Coronavirus disease 2019 (COVID-19) has evolved into a pandemic spreading at a speed and scale that has been able to overwhelm even the most advanced health care systems quickly. Multiple guidelines published by organizations such as the WHO and US' CDC address the response to COVID-19 at the international, national, and local levels. Although these guidelines are meant to be globally accessible, implementing them is a challenge given the variability in the health care systems worldwide between low- and middleincome countries (LMIC) and high-income countries and even amongst different regions within each LMIC. We have chosen to evaluate the current guidelines focusing on LMIC and expand on the guidelines as necessary.
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Affiliation(s)
- Yudy Fonseca
- University of Maryland Medical Center, MD, Baltimore, USA,University of Maryland Medical Center, Baltimore, MD, USA. +1-410-328-6957;410-328-0680.
| | - Evangelina Urbina
- Hospitalidad de Especialidades Pediatricas, Tuxtla Gutierrez, Chiapas, Mexico,University of Maryland Medical Center, MD, Baltimore, USA
| | - Adnan Bhutta
- University of Maryland Medical Center, MD, Baltimore, USA
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14
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Qatawneh MA, Altarawneh M, Alhazaimeh R, Jazazi M, Jarrah O, Shorman A, Alsadah L, Mustafa M. Manifestations of COVID-19 infection in children with malignancy: A single-center experience in Jordan. World J Virol 2022; 11:321-330. [PMID: 36188736 PMCID: PMC9523322 DOI: 10.5501/wjv.v11.i5.321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 06/28/2022] [Accepted: 09/02/2022] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) has been the cause of a global health crisis since the end of 2019. All countries are following the guidelines and re-commendations released by the World Health Organization to decrease the spread of the disease. Children account for only 3%-5% of COVID-19 cases. Few data are available regarding the clinical course, disease severity, and mode of treatment in children with malignancy and COVID-19.
AIM To evaluate the treatment plan and outcome of children with malignancy who contracted COVID-19.
METHODS A retrospective study of the medical files of patients with malignancy who contracted COVID-19 between July 2020 and June 2021 was performed. The following data were reviewed for all patients: primary disease, laboratory data, admission ward, clinical status upon admission, disease course, treatment plan, and outcome. Eligible patients were those with malignancy who tested positive for COVID-19 by reverse transcription polymerase chain reaction.
RESULTS A total of 40 patients who had malignancy contracted COVID-19 from July 1, 2020 to June 1, 2021. Their primary diseases were as follows: 34 patients (85%) had hematological malignancies (30 had acute lymphoblastic leukemia, 2 had acute myeloblastic leukemia, and 2 had Hodgkin lymphoma), whereas 6 patients (15%) had solid tumors (2 had neuroblastoma, 2 had rhabdomyosarcoma, and 2 had central nervous system tumors). Twelve patients (30%) did not need hospitalization and underwent home isolation only, whereas twenty-eight patients (70%) required hospitalization (26 patients were admitted in the COVID-19 ward and 2 were admitted in the pediatric intensive care unit).
CONCLUSION COVID-19 with malignancy in the pediatric age group has a benign course and does not increase the risk of having severe infection compared to other children.
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Affiliation(s)
- Mousa Ahmad Qatawneh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Moath Altarawneh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Ruba Alhazaimeh
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Mais Jazazi
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Omaiema Jarrah
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Alaa Shorman
- Department of Neonatology, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Laila Alsadah
- Department of General Pediatrics, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
| | - Maher Mustafa
- Department of Hematology and Medical Oncology and Stem Cell Transplantation Unit, Queen Rania Children’s Hospital, Royal Medical Services, Amman 11183, Jordan
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15
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Cortés-Sarabia K, Cruz-Rangel A, Flores-Alanis A, Salazar-García M, Jiménez-García S, Rodríguez-Martínez G, Reyes-Grajeda JP, Rodríguez-Téllez RI, Patiño-López G, Parra-Ortega I, Del Moral-Hernández O, Illades-Aguiar B, Klünder-Klünder M, Márquez-González H, Chávez-López A, Luna-Pineda VM. Clinical features and severe acute respiratory syndrome-coronavirus-2 structural protein-based serology of Mexican children and adolescents with coronavirus disease 2019. PLoS One 2022; 17:e0273097. [PMID: 35969583 PMCID: PMC9377623 DOI: 10.1371/journal.pone.0273097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 08/02/2022] [Indexed: 12/24/2022] Open
Abstract
Severe acute respiratory syndrome (SARS)-coronavirus (CoV)-2 infection in children and adolescents primarily causes mild or asymptomatic coronavirus disease 2019 (COVID-19), and severe illness is mainly associated with comorbidities. However, the worldwide prevalence of COVID-19 in this population is only 1%–2%. In Mexico, the prevalence of COVID-19 in children has increased to 10%. As serology-based studies are scarce, we analyzed the clinical features and serological response (SARS-CoV-2 structural proteins) of children and adolescents who visited the Hospital Infantil de México Federico Gómez (October 2020–March 2021). The majority were 9-year-old children without comorbidities who were treated as outpatients and had mild-to-moderate illness. Children aged 6–10 years and adolescents aged 11–15 years had the maximum number of symptoms, including those with obesity. Nevertheless, children with comorbidities such as immunosuppression, leukemia, and obesity exhibited the lowest antibody response, whereas those aged 1–5 years with heart disease had the highest levels of antibodies. The SARS-CoV-2 spike receptor-binding domain-localized peptides and M and E proteins had the best antibody response. In conclusion, Mexican children and adolescents with COVID-19 represent a heterogeneous population, and comorbidities play an important role in the antibody response against SARS-CoV-2 infection.
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Affiliation(s)
- Karen Cortés-Sarabia
- Laboratorio de Inmunobiología y Diagnóstico Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Guerrero, México
| | - Armando Cruz-Rangel
- Laboratorio de Bioquímica de Enfermedades Crónicas, Instituto Nacional de Medicina Genómica, Mexico City (Ciudad de México), México
| | - Alejandro Flores-Alanis
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Mexico City (Ciudad de México), México
| | - Marcela Salazar-García
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Samuel Jiménez-García
- Laboratorio de Biomedicina Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Guerrero, México
| | - Griselda Rodríguez-Martínez
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Juan Pablo Reyes-Grajeda
- Laboratorio de Bioquímica de Enfermedades Crónicas, Instituto Nacional de Medicina Genómica, Mexico City (Ciudad de México), México
| | - Rosa Isela Rodríguez-Téllez
- Unidad de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Genaro Patiño-López
- Unidad de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Israel Parra-Ortega
- Laboratorio Central, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Oscar Del Moral-Hernández
- Laboratorio de Virología, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Guerrero, México
| | - Berenice Illades-Aguiar
- Laboratorio de Biomedicina Molecular, Facultad de Ciencias Químico Biológicas, Universidad Autónoma de Guerrero, Guerrero, México
| | - Miguel Klünder-Klünder
- Subdirección de Gestión de la Investigación, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Adrián Chávez-López
- Departamento de la Unidad de Terapia Intensiva Pediátrica, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
| | - Victor M. Luna-Pineda
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
- Unidad de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Mexico City (Ciudad de México), México
- * E-mail:
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16
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Wärnhjelm E, Lääperi M, Kuitunen M, Helve O, Puhakka L, Harve-Rytsälä H, Salmi H. Decrease in paediatric emergency room visits during the COVID-19 pandemic restrictions: a population-based study. Acta Paediatr 2022; 111:2165-2171. [PMID: 35899422 PMCID: PMC9353415 DOI: 10.1111/apa.16498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 07/01/2022] [Accepted: 07/26/2022] [Indexed: 11/28/2022]
Abstract
Aim To investigate paediatric emergency room (ER) visits to evaluate the immediate health effects of COVID‐19 pandemic restrictions on children. Methods We retrospectively examined paediatric ER visits in the Helsinki University Hospital (HUH) district during the first wave of the pandemic (1 March to 31 May 2020), and a 2‐month period immediately before and after. These periods were compared to the corresponding time periods in 2015–2019 (“reference period”). Results The total number of ER visits decreased by 23.4% (mean 6474 during the reference period, to 4960 during the pandemic period (incidence rate ratio [IRR] 0.75, 95% confidence interval 0.72 to 0.77; p < 0.001). This was due to a decrease in visits related to infectious diseases; visits due to surgical reasons did not decrease. The amount or proportion of patients triaged to the most urgent class (Emergency Severity Index 1) did not increase. Paediatric ER visits returned to baseline after lifting of restrictions. Conclusions Although paediatric ER visits substantially decreased during the pandemic restrictions, children seen at the ER were not more severely ill. Our results do not indicate immediate detrimental health effects of pandemic control measures on children.
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Affiliation(s)
- Elina Wärnhjelm
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Helsinki, Finland
| | - Mitja Lääperi
- University of Helsinki and Helsinki University Hospital, Paediatric Research Centre, Helsinki, Finland
| | - Mikael Kuitunen
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Helsinki, Finland
| | - Otto Helve
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Helsinki, Finland.,Finnish Institute for Health and Welfare, Helsinki, Finland
| | - Laura Puhakka
- University of Helsinki and Helsinki University Hospital, Children's Hospital, Helsinki, Finland
| | - Heini Harve-Rytsälä
- Department of Emergency Medicine and Services, University of Helsinki and Helsinki University Hospital
| | - Heli Salmi
- Department of Anaesthesia and Intensive Care, Children's Hospital, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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17
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YASMIN F, FARHAN SA, OCHANI RK, MANGI AR, AMANULLAH MM. An unusual inflammatory disease linked to SARS Coronavirus-2 in children: are we prepared enough? Minerva Pediatr (Torino) 2022; 74:478-479. [DOI: 10.23736/s2724-5276.20.06023-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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18
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Shin M. Confronting childism and prioritizing a holistic approach during the COVID-19 crisis. CONTEMPORARY ISSUES IN EARLY CHILDHOOD 2022; 24:226-231. [PMID: 37521251 PMCID: PMC8859471 DOI: 10.1177/14639491221076157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 08/01/2023]
Abstract
This colloquium discusses the crucial need to reconcile the ironic dilemma of enforcing social-distancing measures and social relationships simultaneously during the COVID-19 crisis. Young children have been exposed to multifaceted challenges during this time. However, their well-being, education, and safety have often been overlooked, ignored, or compromised. It is argued that society should abandon childism, which is prejudice and/or discrimination against children, and implement a holistic approach to protect and prioritize children's well-being, fundamental rights, and humanity.
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19
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Delgado-Miguel C, Muñoz-Serrano AJ, Miguel-Ferrero M, De Ceano-Vivas M, Calvo C, Martínez L. Complicated Acute Appendicitis during COVID-19 Pandemic: The Hidden Epidemic in Children. Eur J Pediatr Surg 2022; 32:268-273. [PMID: 33618382 DOI: 10.1055/s-0041-1723992] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
INTRODUCTION Since home confinement for novel coronavirus disease 2019 (COVID-19) pandemic began, pediatric visits to the emergency department (ED) have decreased, including consultation for abdominal pain. Our aim is to investigate the incidence of complicated acute appendicitis (AA; peritonitis or appendicular mass) during confinement for COVID-19 pandemic and to compare it with the previous 5 years. MATERIALS AND METHODS A retrospective study was performed in children with AA who underwent surgery between March 9 and April 13 from 2015 to 2020; patients were divided into six groups according to the year of surgery. We analyzed demographic variables, time from onset of symptoms, mean hospital stay, cumulative incidence, and incidence rate of complicated appendicitis. RESULTS A total of 168 patients were included with no differences in the number of patients, gender, and age between groups. Patients in 2020 (COVID-19 group) presented longer symptom progression time (46.8 hours; p = 0.046), higher rate of complicated appendicitis (48.4%; p = 0.004), longer mean hospital stay (4.9 days; p < 0.001), increased cumulative incidence (8.27 cases per 100,000 children per 0.1 years; p < 0.001), and increased incidence rate of complicated appendicitis (83 cases per 100,000 children; p < 0.001) when compared with other groups. CONCLUSION Delayed ED visit of children with AA during home confinement lead to an increased rate of complicated appendicitis. It is crucial to make parents aware of the importance of early diagnosis and treatment of abdominal pain.
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Affiliation(s)
| | | | | | | | - Cristina Calvo
- Pediatric Infectious Diseases Department, Fundación IdiPaz. Traslational Research Network in Pediatric Infectious Diseases, Madrid. Spain
| | - Leopoldo Martínez
- Department of Pediatric Surgery, La Paz Children's Hospital, Madrid, Spain.,Institute for Biomedical Resarch La Paz (IdiPaz), Network for Maternal and Children Health (SAMID), La Paz Children's Hospital, Madrid, Spain
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20
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Forrest CB, Burrows EK, Mejias A, Razzaghi H, Christakis D, Jhaveri R, Lee GM, Pajor NM, Rao S, Thacker D, Bailey LC. Severity of Acute COVID-19 in Children <18 Years Old March 2020 to December 2021. Pediatrics 2022; 149:185621. [PMID: 35322270 DOI: 10.1542/peds.2021-055765] [Citation(s) in RCA: 44] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/28/2022] [Indexed: 12/24/2022] Open
Abstract
This national study evaluated trends in illness severity among 82 798 children with coronavirus disease 2019 from March 1, 2020, to December 30, 2021.
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Affiliation(s)
- Christopher B Forrest
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Evanette K Burrows
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Asuncion Mejias
- Division of Infectious Diseases, Department of Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio
| | - Hanieh Razzaghi
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Dimitri Christakis
- Center for Child Health, Behavior and Development, Seattle Children's Hospital, Seattle, Washington
| | - Ravi Jhaveri
- Division of Infectious Diseases, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
| | - Grace M Lee
- Department of Pediatrics, Stanford University School of Medicine, Stanford, California
| | - Nathan M Pajor
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio
| | - Suchitra Rao
- Department of Pediatrics, University of Colorado School of Medicine and Children's Hospital Colorado, Aurora, Colorado
| | - Deepika Thacker
- Division of Cardiology, Nemours Children's Health, Wilmington, Delaware
| | - L Charles Bailey
- Applied Clinical Research Center, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
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21
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Mania A, Pokorska-Śpiewak M, Figlerowicz M, Pawłowska M, Mazur-Melewska K, Faltin K, Talarek E, Zawadka K, Dobrzeniecka A, Ciechanowski P, Łasecka-Zadrożna J, Rudnicki J, Hasiec B, Stani M, Frańczak-Chmura P, Zaleska I, Szenborn L, Horecka P, Sulik A, Szczepańska B, Pałyga-Bysiecka I, Kucharek I, Sybilski A, Sobolewska-Pilarczyk M, Dryja U, Majda-Stanisławska E, Niedźwiecka S, Kuchar E, Kalicki B, Gorczyca A, Marczyńska M. Pneumonia, gastrointestinal symptoms, comorbidities, and coinfections as factors related to a lengthier hospital stay in children with COVID-19-analysis of a paediatric part of Polish register SARSTer. Infect Dis (Lond) 2022; 54:196-204. [PMID: 34711132 PMCID: PMC8567279 DOI: 10.1080/23744235.2021.1995628] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 10/11/2021] [Accepted: 10/14/2021] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Although COVID-19 is associated with a mild course in children, a certain proportion requires admission to hospital due to SARS-CoV-2 infection and coexisting diseases. The prospective multicenter study aimed to analyze clinical factors influencing the length of the hospital stay (LoHS) in children with COVID-19. METHODS The study included 1283 children from 14 paediatric infectious diseases departments with diagnosed SARS-CoV-2 infection. Children were assessed in respective centres regarding indications for admission to hospital and clinical condition. History data, clinical findings, laboratory parameters, treatment, and outcome, were collected in the paediatric SARSTer register. The group of children with a hospital stays longer than seven days was compared to the remaining patients. Parameters with a statistically significant difference were included in further logistic regression analysis. RESULTS One thousand one hundred and ten children were admitted to the hospital, 763 children were hospitalized >24 h and 173 children >7 days. 268 children had comorbidities. Two hundred and eleven children had an additional diagnosis with coinfections present in 135 children (11%). Factors increasing the risk of higher LoHS included pneumonia [odds ratio-OR 3.028; 95% confidence interval-CI (1.878-4.884)], gastrointestinal symptoms [OR = 1.556; 95%CI (1.049-2.322)], or rash [OR = 2.318; 95%CI (1.216-4.418)] in initial clinical findings. Comorbidities [OR = 2.433; 95%CI (1.662-3.563)], an additional diagnosis [OR = 2.594; 95%CI (1.679-4.007)] and the necessity of the empirical antibiotic treatment [OR = 2.834; 95%CI (2.834-6.713)] were further factors related to higher LoHS. CONCLUSIONS The clinical course of COVID-19 was mild to moderate in most children. Factors increasing the risk of higher LoHS included pneumonia, gastrointestinal symptoms, comorbidities, an additional diagnosis, and the empirical antibiotic treatment.
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Affiliation(s)
- Anna Mania
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Maria Pokorska-Śpiewak
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Magdalena Figlerowicz
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Małgorzata Pawłowska
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Katarzyna Mazur-Melewska
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Kamil Faltin
- Department of Infectious Diseases and Child Neurology, Poznan University of Medical Sciences, Poznan, Poland
| | - Ewa Talarek
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Konrad Zawadka
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Anna Dobrzeniecka
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
| | - Przemysław Ciechanowski
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Joanna Łasecka-Zadrożna
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Józef Rudnicki
- Department of Paediatrics and Infectious Diseases, Regional Hospital in Szczecin, Szczecin, Poland
| | - Barbara Hasiec
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Martyna Stani
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Paulina Frańczak-Chmura
- Department of Children's Infectious Diseases, Provincial Jan Boży Hospital in Lublin, Lublin, Poland
| | - Izabela Zaleska
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Leszek Szenborn
- Department of Paediatrics and Infectious Diseases, Wroclaw Medical University, Wroclaw, Poland
| | - Paulina Horecka
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Bialystok, Poland
| | - Artur Sulik
- Department of Pediatric Infectious Diseases, Medical University of Bialystok, Bialystok, Poland
| | | | | | - Izabela Kucharek
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Paediatrics and Neonatology with Allergology Center, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Adam Sybilski
- 2nd Department of Paediatrics, Centre of Postgraduate Medical Education, Warsaw, Poland
- Department of Paediatrics and Neonatology with Allergology Center, Central Clinical Hospital of the Ministry of the Interior, Warsaw, Poland
| | - Małgorzata Sobolewska-Pilarczyk
- Department of Infectious Diseases and Hepatology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Urszula Dryja
- Department of Paediatric Infectious Diseases, Medical University of Lodz, Lodz, Poland
| | | | - Sławomira Niedźwiecka
- Department of Paediatric Infectious Diseases, Pomeranian Center of Infectious Diseases and Tuberculosis in Gdańsk, Gdańsk, Poland
| | - Ernest Kuchar
- Department of Paediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Bolesław Kalicki
- Department of Paediatrics, Paediatric Nephrology and Allergology, Military Institute of Medicine, Warsaw, Poland
| | - Anna Gorczyca
- The Ward of Pediatric Infectious Diseases and Hepatology, The John Paul II Hospital in Krakow, Krakow, Poland
| | - Magdalena Marczyńska
- Department of Children's Infectious Diseases, Medical University of Warsaw, Warsaw, Poland
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22
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Yu S, Cui S, Rui J, Zhao Z, Deng B, Liu C, Li K, Wang Y, Yang Z, Li Q, Chen T, Wang S. Epidemiological Characteristics and Transmissibility for SARS-CoV-2 of Population Level and Cluster Level in a Chinese City. Front Public Health 2022; 9:799536. [PMID: 35118044 PMCID: PMC8805998 DOI: 10.3389/fpubh.2021.799536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 12/09/2021] [Indexed: 11/17/2022] Open
Abstract
Background To date, there is a lack of sufficient evidence on the type of clusters in which severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is most likely to spread. Notably, the differences between cluster-level and population-level outbreaks in epidemiological characteristics and transmissibility remain unclear. Identifying the characteristics of these two levels, including epidemiology and transmission dynamics, allows us to develop better surveillance and control strategies following the current removal of suppression measures in China. Methods We described the epidemiological characteristics of SARS-CoV-2 and calculated its transmissibility by taking a Chinese city as an example. We used descriptive analysis to characterize epidemiological features for coronavirus disease 2019 (COVID-19) incidence database from 1 Jan 2020 to 2 March 2020 in Chaoyang District, Beijing City, China. The susceptible-exposed-infected-asymptomatic-recovered (SEIAR) model was fitted with the dataset, and the effective reproduction number (Reff ) was calculated as the transmissibility of a single population. Also, the basic reproduction number (R0) was calculated by definition for three clusters, such as household, factory and community, as the transmissibility of subgroups. Results The epidemic curve in Chaoyang District was divided into three stages. We included nine clusters (subgroups), which comprised of seven household-level and one factory-level and one community-level cluster, with sizes ranging from 2 to 17 cases. For the nine clusters, the median incubation period was 17.0 days [Interquartile range (IQR): 8.4-24.0 days (d)], and the average interval between date of onset (report date) and diagnosis date was 1.9 d (IQR: 1.7 to 6.4 d). At the population level, the transmissibility of the virus was high in the early stage of the epidemic (Reff = 4.81). The transmissibility was higher in factory-level clusters (R0 = 16) than in community-level clusters (R0 = 3), and household-level clusters (R0 = 1). Conclusions In Chaoyang District, the epidemiological features of SARS-CoV-2 showed multi-stage pattern. Many clusters were reported to occur indoors, mostly from households and factories, and few from the community. The risk of transmission varies by setting, with indoor settings being more severe than outdoor settings. Reported household clusters were the predominant type, but the population size of the different types of clusters limited transmission. The transmissibility of SARS-CoV-2 was different between a single population and its subgroups, with cluster-level transmissibility higher than population-level transmissibility.
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Affiliation(s)
- Shanshan Yu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shufeng Cui
- Chaoyang District Center for Disease Prevention and Control, Beijing, China
| | - Jia Rui
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Zeyu Zhao
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Bin Deng
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Chan Liu
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Kangguo Li
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Yao Wang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Zimei Yang
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Qun Li
- Public Health Emergency Center, Chinese Center for Disease Control and Prevention, Beijing, China
| | - Tianmu Chen
- State Key Laboratory of Molecular Vaccinology and Molecular Diagnostics, School of Public Health, Xiamen University, Xiamen, China
| | - Shan Wang
- Chaoyang District Center for Disease Prevention and Control, Beijing, China
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23
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Castellar-López J, Villamizar-Villamizar W, Amaranto-Pallares A, Rosales-Rada W, De Los Angeles Vélez Verbel M, Chang A, Jiménez FT, Mendoza-Torres E. Recent Insights into COVID-19 in Children and Clinical Recommendations. Curr Pediatr Rev 2022; 18:121-137. [PMID: 34872479 DOI: 10.2174/1573396317666211206124347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 06/30/2021] [Accepted: 09/01/2021] [Indexed: 01/08/2023]
Abstract
Pediatric coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) have been recognized in multiple countries globally. In this review, we provide recent insights into SARS-CoV-2 infection in children from epidemiological, clinical, and laboratory perspectives, including reports on the disease course and therapy. We highlight key features of SARS-CoV-2 infection in children, the relationship between MIS-C and Kawasaki disease, and summarize treatment guidelines for COVID-19 in children from institutional protocols from Colombia, case reports, recommendations based on expert consensus, and official statements from organizations such as the World Health Organization (WHO), United States Center for Disease Control (CDC), Colombian Association of Infectious Diseases, and the Colombian Society of Pediatrics. Finally, we discuss gaps in research with suggestions for future research on the pathogenesis underlying pediatric COVID-19.
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Affiliation(s)
- Jairo Castellar-López
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Barranquilla, Colombia
| | | | - Aldo Amaranto-Pallares
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
| | - Wendy Rosales-Rada
- Faculty of Exact and Natural Sciences, Grupo de Investigación Avanzada en Biomedicina, Universidad Libre Barranquilla, Barranquilla, Colombia.,Department of Medicine, Grupo de Investigación en Biotecnología. Division of Health Sciences. Universidad del Norte, Colombia
| | | | - Aileen Chang
- Department of Medicine, George Washington University, Washington D.C., USA
| | - Franklin Torres Jiménez
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
| | - Evelyn Mendoza-Torres
- Faculty of Health Sciences, Universidad Libre Seccional Barranquilla, Barranquilla, Colombia
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24
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Morin S, Lallemant M, Garcia-Prats A, Lewis L, Watkins M, Giaquinto C, Valentin M, Penazzato M, Reeder JC. Pediatric COVID-19 Therapeutics: Seizing the Right Research and Development Opportunities to Accelerate Access for Children. Pediatr Infect Dis J 2022; 41:e1-e5. [PMID: 34784302 PMCID: PMC8658058 DOI: 10.1097/inf.0000000000003331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/01/2021] [Indexed: 11/30/2022]
Abstract
Children, although at lower risk of poor outcomes from COVID-19 relative to adults, still stand to benefit from therapeutic interventions. Understanding of COVID-19 clinical presentation and prognosis in children is essential to optimize therapeutic trials design. This perspective illustrates how to collectively accelerate pediatric COVID-19 therapeutic research and development, based on the experience of the Global Accelerator for Paediatric Formulations.
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Affiliation(s)
| | - Marc Lallemant
- Faculty of Associated Medical Sciences, Chiang Mai University, Chiang Mai, Thailand
| | - Anthony Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Linda Lewis
- Department of Women and Child Health, University of Padova, Padova, Italy
| | - Melynda Watkins
- Department of Women and Child Health, University of Padova, Padova, Italy
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25
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Dorantes-Acosta E, Ávila-Montiel D, Domínguez Rojas J, Parra-Nigañez P, Velasco-Hidalgo L, Arias S, Gutiérrez-Rivera L, Juárez-Villegas L, Márquez-González H. Mortality in children with cancer and SARS-CoV-2 in Latin America: A systematic review. Front Pediatr 2022; 10:928612. [PMID: 36016876 PMCID: PMC9396238 DOI: 10.3389/fped.2022.928612] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2022] [Accepted: 06/27/2022] [Indexed: 12/02/2022] Open
Abstract
The new COVID-19 disease is caused by a novel coronavirus (SARS-CoV-2), that probably originated in Wuhan, China, and has currently infected 505,817,953 people and caused 6,213,876 deaths in the world. On the American continent, 152,265,980 cases and 2,717,108 deaths have been reported to WHO (World Health Organization). The Latin America and the Caribbean (LAC) region presents an epidemiological challenge due to its population's heterogeneity and socioeconomic inequality. A particularly vulnerable population is that of children with cancer, and their mortality from COVID-19 has been reported to be 3.6% globally. This work aimed to study the lethality of SARS-CoV-2 infection in children with cancer in the Latin American region. Our objective was to systematically review published scientific literature and search hospital databases in Latin America to explore mortality in this region. A median of mortality of 9.8% was found in the articles analyzed. In addition, we collected five databases from Latin American hospitals. We concluded that there was an underestimation in the mortality registry of this group of patients in the analyzed region. Therefore, although the causes are unknown, it is necessary to strengthen the case-reporting system to determine the reality in complex and particular areas such as Latin America.
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Affiliation(s)
- Elisa Dorantes-Acosta
- Biobanco de Investigación en Células Leucémicas, Hospital Infantil de México Federico Gómez, México City, Mexico.,Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Diana Ávila-Montiel
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Jesús Domínguez Rojas
- Unidad de Cuidados Intensivos Pediátricos, Hospital Nacional Edgardo Rebagliati Martins, Lima, Peru
| | - Patricia Parra-Nigañez
- Departamento de Oncología Pediátrica, Hospital del Niño "Dr. Ovidio Aliaga Uria", La Paz, Bolivia
| | - Liliana Velasco-Hidalgo
- Departamento de Oncología Pediátrica del Instituto Nacional de Pediatría, Ciudad de Mexico, Mexico
| | - Sergio Arias
- Departamento Programas de Salud, INER Emilio Coni, Epidemiología y Salud Pública, Facultad de Bioquímica y Ciencias Biológicas (FBCB), Universidad Nacional del Litoral (UNL), Santa Fe, Argentina
| | - Lourdes Gutiérrez-Rivera
- Oncología Pediátrica, Centro Médico Nacional Siglo XXI, UMAE Hospital de Pediatría, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
| | - Luis Juárez-Villegas
- Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.,Cardiopatías Congénitas, Centro Médico Nacional Siglo XXI, Hospital de Cardiología, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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26
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López-Medina E, Camacho-Moreno G, Brizuela ME, Dávalos DM, Torres JP, Ulloa-Gutierrez R, López P, Debbag R, Pérez P, Patiño J, Norero X, Mariño C, Luengas MA, Ensinck G, Daza C, Luciani K, Quintana Kuhner P, Rodriguez M, Rodríguez-Auad JP, Estrada-Villarroel A, Carnevale M, Mantese OC, Berezin EN, Castillo JI, Mascareñas A, Jimenez-Zambrano A, Dueñas L, Melgar M, Galvez N, Cantor E, Asturias EJ. Factors Associated With Hospitalization or Intensive Care Admission in Children With COVID-19 in Latin America. Front Pediatr 2022; 10:868297. [PMID: 35498776 PMCID: PMC9048675 DOI: 10.3389/fped.2022.868297] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 03/14/2022] [Indexed: 01/09/2023] Open
Abstract
BACKGROUND Limited data is available from low-middle and upper-middle income countries of the factors associated with hospitalization or admission to pediatric intensive care unit (PICU) for children with COVID-19. OBJECTIVE To describe the factors associated with hospitalization or PICU admission of children with COVID-19 in Latin America. METHOD Multicenter, analytical, retrospective study of children reported from 10 different Latin American countries to the Latin-American Society of Pediatric Infectious Diseases (SLIPE-COVID) research network from June 1, 2020, and February 28, 2021. Outpatient or hospitalized children <18 years of age with COVID-19 confirmed by polymerase chain reaction or antigen detection from the nasopharynx were included. Children with multisystem inflammatory syndrome in children (MIS-C) were excluded. Associations were assessed using univariate and multivariable logistic regression models. RESULTS A total of 1063 children with COVID-19 were included; 500 (47%) hospitalized, with 419 (84%) to the pediatric wards and 81 (16%) to the ICU. In multivariable analyses, age <1 year (Odds Ratio [OR] 1.78; 95% CI 1.08-2.94), native race (OR 5.40; 95% CI 2.13-13.69) and having a co-morbid condition (OR 5.3; 95% CI 3.10-9.15), were associated with hospitalization. Children with metabolic or endocrine disorders (OR 4.22; 95% CI 1.76-10.11), immune deficiency (1.91; 95% CI 1.05-3.49), preterm birth (OR 2.52; 95% CI 1.41-4.49), anemia at presentation (OR 2.34; 95% CI 1.28-4.27), radiological peribronchial wall thickening (OR 2.59; 95% CI 1.15-5.84) and hypoxia, altered mental status, seizures, or shock were more likely to require PICU admission. The presence of pharyngitis (OR 0.34; 95% CI 0.25-0.48); myalgia (OR 0.47; 95% CI 0.28-0.79) or diarrhea (OR 0.38; 95% CI 0.21-0.67) were inversely associated with hospital admission. CONCLUSIONS In this data analysis reported to the SLIPE research network in Latin America, infants, social inequalities, comorbidities, anemia, bronchial wall thickening and specific clinical findings on presentation were associated with higher rates of hospitalization or PICU admission. This evidence provides data for prioritization prevention and treatment strategies for children suffering from COVID-19.
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Affiliation(s)
- Eduardo López-Medina
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia.,Clínica Imbanaco, Grupo Quirón Salud, Cali, Colombia
| | - German Camacho-Moreno
- Pediatric Infectious Disease Unit, Fundación HOMI Hospital Pediátrico de la Misericordia and Universidad Nacional de Colombia, Bogotá, Colombia
| | - Martin E Brizuela
- Infectious Diseases Division, Hospital Zonal General de Agudos "Dr. Isidoro Iriarte", Buenos Aires, Argentina
| | - Diana M Dávalos
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Faculty of Health Sciences, Universidad Icesi, Cali, Colombia
| | - Juan Pablo Torres
- Department of Pediatrics, Facultas de Medicina, Hospital Luis Calvo Mackenna, Universidad de Chile, Santiago, Chile
| | - Rolando Ulloa-Gutierrez
- Servicio de Infectología, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera", Centro de Ciencias Médicas de la Caja Costarricense de Seguro Social, San José, Costa Rica
| | - Pio López
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Department of Pediatrics, Universidad del Valle, Cali, Colombia
| | - Roberto Debbag
- Department of Infectious Diseases and Epidemiology, Hospital de Pediatría, Buenos Aires, Argentina
| | - Paola Pérez
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Jaime Patiño
- Faculty of Health Sciences, Universidad Icesi, Cali, Colombia.,Fundación Valle del Lili, Cali, Colombia
| | - Ximena Norero
- Hospital del Niño Dr. José Renán Esquivel, Ciudad de Panamá, Panama
| | | | | | - Gabriela Ensinck
- Servicio de Infectología, Hospital de Niños Víctor J. Vilela de Rosario, Rosario, Argentina
| | - Carlos Daza
- Hospital Materno Infantil José Domingo de Obaldía, Chiriquí, Panama
| | - Kathia Luciani
- Department of Infectious Diseases, Hospital de Especialidades Pediátricas Omar Torrijos Herrera, Caja de Seguro Social, Ciudad de Panamá, Panama
| | | | - Mónica Rodriguez
- Hospital Central del Instituto de Previsión Social, Asunción, Paraguay
| | | | | | - Mayli Carnevale
- Hospital Universitario Pediatria Agustin Zubillaga, Barquisimeto, Venezuela
| | | | - Eitan N Berezin
- Department of Pediatrics, Santa Casa de São Paulo Medical School, São Paulo, Brazil
| | | | - Abiel Mascareñas
- Hospital Universitario "Dr. José Eleuterio González", Universidad Autónoma de Nuevo Leon, Monterrey, Mexico
| | | | - Lourdes Dueñas
- Hospital Nacional de Niños Benjamín Bloom, San Salvador, El Salvador
| | - Mario Melgar
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Nancy Galvez
- Hospital Roosevelt, Ciudad de Guatemala, Guatemala
| | - Erika Cantor
- Centro de Estudios en Infectología Pediátrica, Cali, Colombia.,Institute of Statistics, Universidad de Valparaíso, Valparaíso, Chile
| | - Edwin J Asturias
- Colorado School of Public Health, Center for Global Health, Aurora, CO, United States.,Department of Pediatrics, University of Colorado School of Medicine, Aurora, CO, United States
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Clinical Picture and Risk Factors of Severe Respiratory Symptoms in COVID-19 in Children. Viruses 2021; 13:v13122366. [PMID: 34960635 PMCID: PMC8703640 DOI: 10.3390/v13122366] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 11/17/2022] Open
Abstract
Children with COVID-19 develop moderate symptoms in most cases. Thus, a proportion of children requires hospital admission. The study aimed to assess the history, clinical and laboratory parameters in children with COVID-19 concerning the severity of respiratory symptoms. The study included 332 children (median age 57 months) with COVID-19. History data, clinical findings, laboratory parameters, treatment, and outcome, were evaluated. Children were compared in the groups that varied in the severity of symptoms of respiratory tract involvement. Children who required oxygen therapy represented 8.73%, and intensive care 1.5% of the whole cohort. Comorbidities were present in 126 patients (37.95%). Factors increasing the risk of oxygen therapy included comorbidities (odds ratio (OR) = 92.39; 95% confidence interval (95% CI) = (4.19; 2036.90); p < 0.00001), dyspnea (OR = 45.81; 95% CI (4.05; 518.21); p < 0.00001), auscultation abnormalities (OR = 34.33; 95% CI (2.59; 454.64); p < 0.00001). Lactate dehydrogenase (LDH) > 280 IU/L and creatinine kinase > 192 IU/L were parameters with a good area under the curve (0.804-LDH) and a positive predictive value (42.9%-CK). The clinical course of COVID-19 was mild to moderate in most patients. Children with comorbidities, dyspnea, or abnormalities on auscultation are at risk of oxygen therapy. Laboratory parameters potentially useful in patients evaluated for the severe course are LDH > 200 IU/L and CK > 192 IU/L.
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Akça H, Kurt F, Akça Çağlar A, Güngör AA, Kuruç AI, Gacal EB, Gişi S, Kanık-Yüksek S, Yakut Hİ, Dibek Mısırlıoğlu E, Şenel E. Evaluation of Suspected COVID-19 Patients in a Pediatric Emergency Department. J Pediatr Intensive Care 2021; 11:48-53. [PMID: 35186398 PMCID: PMC8843405 DOI: 10.1055/s-0041-1735493] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Accepted: 07/28/2021] [Indexed: 12/27/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is now a global pandemic. The aim of this study was to investigate the prevalence of COVID-19 in pediatric patients and to compare the characteristics of positive and negative patients. This study conducted from March to May 2020 in a tertiary children's hospital. Patients were included if they were under 18 years old and a SARS-CoV-2 polymerase chain reaction test had been performed. Of the 1,812 patients included in the study, 365 (20.1%) were positive for COVID-19. The median age was 102 months in the positive group, 70 months in the negative group ( p < 0.001). The sex distribution was almost equal. Nearly all positive patients had been in close contact with a COVID-19 infected family household member ( p < 0.001). The most common symptoms were fever (54.4%) and cough (38.6%). The asymptomatic patient rate was higher in the positive group ( p < 0.001). Lymphopenia (<1500/mm 3 ) was found in 29.9% of the positive children ( p = 0.005). When the groups were compared, white blood cell, neutrophil, lymphocyte, and platelet counts; neutrophil-to-lymphocyte ratio; and C-reactive protein level were lower in the positive group. Chest radiography was performed in 95.3% of the positive patients, and the results of 29.7% of them were interpreted as pathological ( p < 0.001). Most of the pediatric patients had a history of contact with COVID-19 positive individuals, and therefore, the diagnosis is generally suspected from a history of household exposure to COVID-19. Lymphopenia can help predict positivity. Awareness, reinforcing infection control measures, and performing health management within families are important steps to manage these patients.
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Affiliation(s)
- Halise Akça
- Department of Pediatric Emergency Medicine, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey,Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey,Address for correspondence Halise Akça, MD Department of Pediatric Emergency Medicine, Faculty of Medicine, Ankara Yildirim Beyazit UniversityAnkaraTurkey
| | - Funda Kurt
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | - Ayla Akça Çağlar
- Department of Pediatric Emergency Medicine, Ankara City Hospital, Ankara, Turkey
| | | | | | | | - Simge Gişi
- Department of Pediatrics, Ankara City Hospital, Ankara, Turkey
| | - Saliha Kanık-Yüksek
- Department of Pediatric Infectious Diseases, Ankara City Hospital, Ankara, Turkey
| | | | | | - Emrah Şenel
- Department of Pediatric Surgery, Ankara City Hospital, Ankara, Turkey,Department of Pediatric Surgery, Faculty of Medicine, Ankara Yildirim Beyazit University, Ankara, Turkey
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29
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Shaiba LA, Hadid A, Abdulghani SH, Hussain SA, Shah PS. SARS-CoV-2 Exposure from Health Care Workers to Infants: Effects and Outcomes. Am J Perinatol 2021; 40:799-806. [PMID: 34450672 PMCID: PMC10125677 DOI: 10.1055/s-0041-1735215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE This study aimed to evaluate the risk and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from positive health care workers (HCW) to infants in the neonatal intensive care unit (NICU) and the postnatal ward. STUDY DESIGN We conducted a retrospective analysis of infants in NICU and the postnatal ward postexposure to a COVID-19 positive HCW between May 1 and July 31, 2020. HCW had the detection of SARS-CoV-2 after being symptomatic. Infants exposed to these HCW were tested for SARS-CoV-2 and were classified as confirmed positive when test was positive 24 hours after exposure; confirmed negative when test was negative with no escalation of respiratory support provided; and probable if test was negative. However, infant required escalation of respiratory support. Infants were followed at 14 days postexposure then at the end of the study period for admitted infants. RESULTS A total of 31 infants were exposed to SARS-CoV-2 positive HCWs (42 exposure incidences). The median age at exposure was 21 days. None of the infants was confirmed positive. Nine infants were classified as probable cases of whom five infants with underlying chronic illnesses died, two were discharged home, and two were still admitted. Of the 22 confirmed negative cases, 15 were discharged and were well on follow-up, and 7 were still admitted. CONCLUSION No active transmission of infection from infected HCW to admitted infants was identified. Although some infants had respiratory escalation postexposure none were confirmed positive. Adhering to personal protective equipment by HCW or low susceptibility of infants to SARS-CoV-2 infection may explain the lack of transmission. KEY POINTS · There are no reported cases of transmission of SARS-CoV-2 infection from infected HCW to infants admitted to the NICU in our study.. · Adherence to personnel protective equipment is important to prevent transmission of SARS-CoV-2. · When an infant is exposed to a HCW who is positive for SARS-CoV-2 and has escalation of respiratory support, SARS-CoV-2 as a cause should be investigated.
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Affiliation(s)
- Lana A Shaiba
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Adnan Hadid
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Department of Pediatrics, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Sahar H Abdulghani
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Khalid University Hospital, King Saud University Medical City, Riyadh city, Saudi Arabia
| | - Shaikh A Hussain
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.,Neonatology, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Prakesh S Shah
- Department of Pediatrics, Mount Sinai Hospital, Toronto, Ontario, Canada.,Department of Pediatrics, Toronto University, Toronto, Ontario, Canada.,Maternal-infant Care Research Centre, Mount Sinai Hospital, Toronto, Ontario, Canada
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30
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Deyà-Martínez A, García-García A, Gonzalez-Navarro EA, Yiyi L, Vlagea A, Jordan I, Fumadó V, Fortuny C, Español M, Launes C, Esteve-Solé A, Juan M, Pascal M, Alsina L. COVID-19 in children and young adults with moderate/severe inborn errors of immunity in a high burden area in pre-vaccine era. Clin Immunol 2021; 230:108821. [PMID: 34391937 PMCID: PMC8359496 DOI: 10.1016/j.clim.2021.108821] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2021] [Revised: 08/02/2021] [Accepted: 08/06/2021] [Indexed: 12/24/2022]
Abstract
Background Information regarding inborn error of immunity (IEI) as a risk factor for severe COVID-19 is scarce. We aimed to determine if paediatric patients with moderate/severe IEI got COVID-19 at the same level as the general population, and to describe COVID-19 expression. Material and methods We included patients with moderate/severe IEI aged 0–21 years old: cross-sectional study (June2020) to determine the prevalence of COVID-19; prospective study (January2020-January2021) including IEI patients with COVID-19. Assays used: nasopharyngeal swab SARS-CoV-2 PCR and SARS-CoV-2-specific immunoglobulins. Results Seven from sixty-five patients tested positive (prevalence: 10.7% (7%–13%)) after the first SARS-COV-2 wave and 13/15 patients diagnosed with COVID-19 had an asymptomatic/mild course. Conclusions In our area, prevalence of COVID-19 in moderate/severe IEI paediatric patients after the first wave was slightly higher than in the general population. The majority of patients presented a benign course, suggesting a possible protective factor related with age despite IEI.
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Affiliation(s)
- A Deyà-Martínez
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain.
| | - A García-García
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - E A Gonzalez-Navarro
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - L Yiyi
- Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - A Vlagea
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - I Jordan
- Universitat de Barcelona, Spain; Paediatric Intensive Care Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - V Fumadó
- Universitat de Barcelona, Spain; Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain
| | - C Fortuny
- Universitat de Barcelona, Spain; Paediatric Infectious Diseases Unit, Hospital Sant Joan de Déu, Universitat de Barcelona, Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain; Translational Research Network in Paediatric Infectious Diseases (RITIP), Madrid, Spain
| | - M Español
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - C Launes
- Universitat de Barcelona, Spain; Institut de Recerca Sant Joan de Deu, Barcelona, Spain; Paediatrics Department, Hospital Sant Joan de Déu, Barcelona, Spain; CIBER of Epidemiology and Public Health, Madrid, Spain
| | - A Esteve-Solé
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain
| | - M Juan
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain
| | - M Pascal
- Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Department of Immunology-CDB, Hospital Clínic-IDIBAPS, Universitat de Barcelona, Barcelona, Spain; Spanish Network for Allergy - RETIC de Asma, Reacciones adversas y Alérgicas (ARADYAL), Madrid, Spain.
| | - L Alsina
- Study Group for Immune Dysfunction Diseases in Children (GEMDIP), Institut de Recerca Sant Joan de Déu, Barcelona, Spain; Clinical Immunology and Primary Immunodeficiencies Unit, Pediatric Allergy and Clinical Immunology Department, Hospital Sant Joan de Déu, Barcelona, Spain; Universitat de Barcelona, Spain; Clinical Immunology Program, Hospital Sant Joan de Déu-Hospital Clínic Barcelona, Barcelona, Spain; Immunotherapy Platform, Hospital Sant Joan de Déu-Hospital Clínic, Universitat de Barcelona, Barcelona, Spain.
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31
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Shenoy RD, Nayak P, Jacob AM, Rao SS, Hiremath S. Preparedness for Pediatric COVID-19 Using Systems Approach: Experience of a Health Care Facility from India. JOURNAL OF HEALTH AND ALLIED SCIENCES NU 2021. [DOI: 10.1055/s-0041-1731605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
AbstractA pandemic leads to disruption and stretching of an existing health care system and its resources. Coronavirus disease 2019 (COVID-19) data show distinct and severe manifestations in children necessitating critical care. Children need prioritization as they are susceptible to COVID-19 as part of the family cluster, varied presentations, and mortality. The purpose of this report is to discuss the optimization of the health care system for pediatric care. The key initiatives were to identify our objectives, bring out changes to the organizational processes, and integrate the same into the existing system. A systems approach to health care delivery by optimizing infrastructure, human resources, materials, funding, leadership, and governance was undertaken. This resulted in creation of distinct COVID-19 and non-COVID-19 service areas, management protocols, and trained health care workers. Partnership was forged with the public health system. This preparedness and continued responses to the demands of the health care system helped us manage children ranging from neonates to adolescents efficiently. Though the health care system is mostly open, acting upon the modifiable factors gave better preparedness in a short time.
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Affiliation(s)
- Rathika D. Shenoy
- Department of Pediatrics, K.S. Hegde Medical Academy, Nitte (deemed to be University), Mangaluru, Karnataka, India
| | - Praveen Nayak
- Department of Pediatrics, K.S. Hegde Medical Academy, Nitte (deemed to be University), Mangaluru, Karnataka, India
| | - Ankeeta Menona Jacob
- Department of Community Medicine, K.S. Hegde Medical Academy, Nitte (deemed to be University), Mangaluru, Karnataka, India
| | - Swathi Sunil Rao
- Department of Pediatrics, K.S. Hegde Medical Academy, Nitte (deemed to be University), Mangaluru, Karnataka, India
| | - Shivakumar Hiremath
- Department of Hospital Management, K.S. Hegde Medical Academy, Nitte (deemed to be University), Mangaluru, Karnataka, India
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Gavriliu LC, Murariu C, Potop V, Spătaru R. Characteristics of the pediatric patients diagnosed with SARS-CoV-2 infection in a Romanian children's hospital: a retrospective study. PeerJ 2021; 9:e11560. [PMID: 34141491 PMCID: PMC8183429 DOI: 10.7717/peerj.11560] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 05/13/2021] [Indexed: 02/06/2023] Open
Abstract
Background To date, information on COVID-19 pediatric patients is still sparse. We aimed to highlight the epidemiological and clinical data regarding SARS-CoV-2 infection in children and adolescents to improve the understanding of the disease in this age group and inform physicians during the ongoing COVID-19 pandemic. Methods We conducted a retrospective, observational study in “Marie Curie” Emergency Children’s Hospital from Bucharest, Romania. We analyzed clinical and epidemiological characteristics of the patients confirmed with SARS-CoV-2 infection, between April 1, 2020–October 31, 2020. Results A total of 172 patients aged 0–18 years were included, 79 (45.93%) female and 93 (54.07%) male patients. 28 (16.28%) patients had co-morbidities (more often identified in asymptomatic group; p < 0.0001). 47 (27.32%) had exposure to an identified source. 30 (17.44%) patients were asymptomatic; 142 (85.56%) had mild or moderate disease. The most frequent symptoms were: pyrexia (78.87%), digestive symptoms (50%), cough (40.14%). Chest X-ray was performed in 50 patients and it was abnormal in half of them, all being symptomatic. About 2/3 of the evaluated patients had normal leukocytes. The most common hematological change was lymphopenia; monocytes tended to be higher in symptomatic patients. About 40% of the patients were admitted; none required admission to ICU. No significant differences were found between symptomatic and asymptomatic patients regarding gender, age distribution, and exposure to a source. Conclusions All the patients had asymptomatic, mild or moderate disease. Patients with comorbidities, classically considered high risk patients, presented the same pattern of disease.
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Affiliation(s)
- Liana-Cătălina Gavriliu
- Carol Davila University of Medicine and Farmacy, Bucharest, Romania.,"Marie Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Carmen Murariu
- "Marie Curie" Emergency Children's Hospital, Bucharest, Romania
| | - Vladimir Potop
- University of Pitesti, Pitesti, Romania.,State University of Physical Education and Sport, Chisinau, Moldova
| | - Radu Spătaru
- Carol Davila University of Medicine and Farmacy, Bucharest, Romania.,"Marie Curie" Emergency Children's Hospital, Bucharest, Romania
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34
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Borrelli M, Corcione A, Castellano F, Fiori Nastro F, Santamaria F. Coronavirus Disease 2019 in Children. Front Pediatr 2021; 9:668484. [PMID: 34123972 PMCID: PMC8193095 DOI: 10.3389/fped.2021.668484] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Accepted: 04/28/2021] [Indexed: 01/08/2023] Open
Abstract
Since its appearance in Wuhan in mid-December 2019, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) related 19 coronavirus disease (COVID-19) has spread dramatically worldwide. It soon became apparent that the incidence of pediatric COVID-19 was much lower than the adult form. Morbidity in children is characterized by a variable clinical presentation and course. Symptoms are similar to those of other acute respiratory viral infections, the upper airways being more affected than the lower airways. Thus far, over 90% of children who tested positive for the virus presented mild or moderate symptoms and signs. Most children were asymptomatic, and only a few cases were severe, unlike in the adult population. Deaths have been rare and occurred mainly in children with underlying morbidity. Factors as reduced angiotensin-converting enzyme receptor expression, increased activation of the interferon-related innate immune response, and trained immunity have been implicated in the relative resistance to COVID-19 in children, however the underlying pathogenesis and mechanism of action remain to be established. While at the pandemic outbreak, mild respiratory manifestations were the most frequently described symptoms in children, subsequent reports suggested that the clinical course of COVID-19 is more complex than initially thought. Thanks to the experience acquired in adults, the diagnosis of pediatric SARS-CoV-2 infection has improved with time. Data on the treatment of children are sparse, however, several antiviral trials are ongoing. The purpose of this narrative review is to summarize current understanding of pediatric SARS-CoV-2 infection and provide more accurate information for healthcare workers and improve the care of patients.
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Affiliation(s)
| | | | | | | | - Francesca Santamaria
- Section of Pediatrics, Pediatric Pulmonology Unit, Department of Translational Medical Sciences, Università di Napoli Federico II, Naples, Italy
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35
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A literature review of 2019 novel coronavirus (SARS-CoV2) infection in neonates and children. Pediatr Res 2021; 89:1101-1108. [PMID: 32679582 DOI: 10.1038/s41390-020-1065-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Revised: 05/18/2020] [Accepted: 06/29/2020] [Indexed: 01/08/2023]
Abstract
At the time of writing, there are already millions of documented infections worldwide by the novel coronavirus 2019 (2019-nCoV or severe acute respiratory syndrome coronavirus 2 (SARS-CoV2)), with hundreds of thousands of deaths. The great majority of fatal events have been recorded in adults older than 70 years; of them, a large proportion had comorbidities. Since data regarding the epidemiologic and clinical characteristics in neonates and children developing coronavirus disease 2019 (COVID-19) are scarce and originate mainly from one country (China), we reviewed all the current literature from 1 December 2019 to 7 May 2020 to provide useful information about SARS-CoV2 viral biology, epidemiology, diagnosis, clinical features, treatment, prevention, and hospital organization for clinicians dealing with this selected population. IMPACT: Children usually develop a mild form of COVID-19, rarely requiring high-intensity medical treatment in pediatric intensive care unit. Vertical transmission is unlikely, but not completely excluded. Children with confirmed or suspected COVID-19 must be isolated and healthcare workers should wear appropriate protective equipment. Some clinical features (higher incidence of fever, vomiting and diarrhea, and a longer incubation period) are more common in children than in adults, as well as some radiologic aspects (more patchy shadow opacities on CT scan images than ground-glass opacities). Supportive and symptomatic treatments (oxygen therapy and antibiotics for preventing/treating bacterial coinfections) are recommended in these patients.
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Garcia-Prats AJ, Salazar-Austin N, Conway JH, Radtke K, LaCourse SM, Maleche-Obimbo E, Hesseling AC, Savic RM, Nachman S. Coronavirus Disease 2019 (COVID-19) Pharmacologic Treatments for Children: Research Priorities and Approach to Pediatric Studies. Clin Infect Dis 2021; 72:1067-1073. [PMID: 32594142 PMCID: PMC7337679 DOI: 10.1093/cid/ciaa885] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 06/23/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical trials of pharmacologic treatments of coronavirus disease 2019 (COVID-19) are being rapidly designed and implemented in adults. Children are often not considered during development of novel treatments for infectious diseases until very late. Although children appear to have a lower risk compared with adults of severe COVID-19 disease, a substantial number of children globally will benefit from pharmacologic treatments. It will be reasonable to extrapolate efficacy of most treatments from adult trials to children. Pediatric trials should focus on characterizing a treatment's pharmacokinetics, optimal dose, and safety across the age spectrum. These trials should use an adaptive design to efficiently add or remove arms in what will be a rapidly evolving treatment landscape, and should involve a large number of sites across the globe in a collaborative effort to facilitate efficient implementation. All stakeholders must commit to equitable access to any effective, safe treatment for children everywhere.
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Affiliation(s)
- Anthony J Garcia-Prats
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Nicole Salazar-Austin
- Department of Pediatrics, Division of Infectious Diseases, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - James H Conway
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
| | - Kendra Radtke
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sylvia M LaCourse
- Departments of Medicine and Global Health, Division of Allergy and Infectious Diseases, University of Washington, Seattle, Washington, USA
| | | | - Anneke C Hesseling
- Desmond Tutu TB Centre, Department of Paediatrics and Child Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg, South Africa
| | - Rada M Savic
- Department of Bioengineering and Therapeutic Sciences, University of California San Francisco, San Francisco, California, USA
| | - Sharon Nachman
- Department of Pediatrics, Stony Brook Children’s, Stony Brook, New York, USA
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Szenes V, Bright R, Diotallevi D, Melendez G, Martinez C, Zakak N, Killinger J, Gilheeney S, Roberts SS, Kamboj M, Bender JG, Kung AL, Boulad F. Stepwise Strategic Mitigation Planning in a Pediatric Oncology Center During the COVID-19 Pandemic. J Pediatr Oncol Nurs 2021; 38:176-184. [PMID: 33684017 DOI: 10.1177/1043454221992301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) first reached the United States in January 2020. Located in New York City (NYC), MSK Kids, at Memorial Sloan Kettering Cancer Center services, is one of the largest pediatric cancer centers in the U.S., caring for children, teenagers, and young adults with cancer, immune deficiencies, and blood disorders. Methods: Implementation for infection mitigation and ongoing care of patients included: (1) the creation of a strategic planning team of physicians, advanced practice providers, nurses, and administrators to develop guidance and workflows, (2) continuous reassessment of patients' needs for hospital services and visit frequency, (3) the use of telemedicine to replace in-person visits, (4) the use of satellite regional centers to manage patients living outside NYC, (5) pre-screening of patients prior to visits for risks and symptoms of coronavirus disease 2019 (COVID-19) infection, (6) day-of-service screening for risks or symptoms of COVID-19 infection, (7) surveillance testing of children and their caregivers, and (8) creation of cohort plans for the management of COVID-19 positive and uninfected patients within the same institution, in both the outpatient and inpatient settings. Results: We describe the timeline for planning mitigation during the first weeks of the pandemic, and detail in a stepwise fashion the rationale and implementation of COVID-19 containment efforts in the context of a large pediatric oncology program. Discussion: Our experience offers a model on which to base strategic planning efforts at other pediatric oncology centers, for continued preparedness to combat the threat posed by SARS-CoV-2 worldwide.
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Affiliation(s)
- Victoria Szenes
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Rachel Bright
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Deborah Diotallevi
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Giselle Melendez
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Cassie Martinez
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Nicole Zakak
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - James Killinger
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen Gilheeney
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Stephen S Roberts
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Mini Kamboj
- Department of Medicine, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Julia Glade Bender
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Andrew L Kung
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
| | - Farid Boulad
- Department of Pediatrics, 5803Memorial Sloan Kettering Cancer Center, New York, NY, USA
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Bjornstad EC, Krallman KA, Askenazi D, Zappitelli M, Goldstein SL, Basu RK. Preliminary Assessment of Acute Kidney Injury in Critically Ill Children Associated with SARS-CoV-2 Infection: A Multicenter Cross-Sectional Analysis. Clin J Am Soc Nephrol 2021; 16:446-448. [PMID: 33144276 PMCID: PMC8011012 DOI: 10.2215/cjn.11470720] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Erica C. Bjornstad
- Division of Nephrology, Department of Pediatrics, Children’s of Alabama, University of Alabama Birmingham, Birmingham, Alabama
| | - Kelli A. Krallman
- Division of Nephrology and Hypertension, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - David Askenazi
- Division of Nephrology, Department of Pediatrics, Children’s of Alabama, University of Alabama Birmingham, Birmingham, Alabama
| | - Michael Zappitelli
- Division of Nephrology, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Stuart L. Goldstein
- Division of Nephrology and Hypertension, Center for Acute Care Nephrology, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rajit K. Basu
- Division of Critical Care, Department of Pediatrics, Children’s Healthcare of Atlanta, Emory University, Atlanta, Georgia
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Abstract
Coronavirus disease 2019 pandemic has spread rapidly to the world. The disease can vary from mild cases to severe respiratory distress; this may increase rapidly and overwhelm the pediatric intensive care units. Lately, there have been various reports about a de novo multisystem inflammatory syndrome in children or pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 infection. We classified the disease into 2 spectrums: the acute phase in severely ill patients and the postinflammatory phase. Neither of them could be classified as mild because there is enough evidence that supports a wide range of complications. The goals of this brief review were to summarize available literature and to give some awareness about the current status of the coronavirus disease 2019 in the severely ill patients during the active phase and postinflammatory phase.
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Affiliation(s)
| | - Richard G. Vaca
- School of Medicine, Universidad Católica de Santiago de Guayaquil, Guayaquil, Ecuador
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40
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Kim Y, Walser SA, Asghar SJ, Jain R, Mainali G, Kumar A. A Comprehensive Review of Neurologic Manifestations of COVID-19 and Management of Pre-existing Neurologic Disorders in Children. J Child Neurol 2021; 36:324-330. [PMID: 33112694 PMCID: PMC7859660 DOI: 10.1177/0883073820968995] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 09/25/2020] [Accepted: 10/04/2020] [Indexed: 12/12/2022]
Abstract
Since the first reports of SARS-CoV-2 infection from China, multiple studies have been published regarding the epidemiologic aspects of COVID-19 including clinical manifestations and outcomes. The majority of these studies have focused on respiratory complications. However, recent findings have highlighted the systemic effects of the virus, including its potential impact on the nervous system. Similar to SARS-CoV-1, cellular entry of SARS-CoV-2 depends on the expression of ACE2, a receptor that is abundantly expressed in the nervous system. Neurologic manifestations in adults include cerebrovascular insults, encephalitis or encephalopathy, and neuromuscular disorders. However, the presence of these neurologic findings in the pediatric population is unclear. In this review, the potential neurotropism of SARS-CoV-2, known neurologic manifestations of COVID-19 in children, and management of preexisting pediatric neurologic conditions during the COVID-19 pandemic are discussed.
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Affiliation(s)
- Yunsung Kim
- Penn State College of Medicine Medical Scientist Training Program, Hershey, PA, USA
| | | | - Sheila J. Asghar
- Department of Neurology, Louisiana State University Health,
Shreveport, LA, USA
| | - Rohit Jain
- Department of Hospital Medicine, Penn State Health Milton Hershey Medical Center, Hershey, PA, USA
| | - Gayatra Mainali
- Department of Pediatrics and Neurology, Penn State Health Milton Hershey Medical Center, Hershey, PA, USA
| | - Ashutosh Kumar
- Department of Pediatrics and Neurology, Penn State Health Milton Hershey Medical Center, Hershey, PA, USA
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Darlington AE, Morgan JE, Wagland R, Sodergren SC, Culliford D, Gamble A, Phillips B. COVID-19 and children with cancer: Parents' experiences, anxieties and support needs. Pediatr Blood Cancer 2021; 68:e28790. [PMID: 33219739 PMCID: PMC7744834 DOI: 10.1002/pbc.28790] [Citation(s) in RCA: 60] [Impact Index Per Article: 20.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Children with cancer were designated as clinically extremely vulnerable if they were to contract SARS-CoV-2 due to immune suppression in the early phase of the COVID-19 pandemic. Our aim was to explore experiences, information and support needs, and decision making of parents with a child with cancer in response to this phase in the United Kingdom. METHODS Parents of a child with cancer completed a survey at a time when the UK moved into a period of 'lockdown'. An online survey was developed by the research team to capture parents' experiences, information and support needs, and decision making, using closed statements and open text boxes. Descriptive quantitative analyses and qualitative thematic content analysis were undertaken. FINDINGS One hundred seventy-one parents/caregivers completed the survey. Eighty-five percent were worried about the virus and they were vigilant about the virus (92%) or cancer symptoms (93.4%). For two-thirds (69.6%), hospital was no longer considered a safe place. Eight overarching themes were identified related to the virus: (a) risk of infection; (b) information, guidance and advice; (c) health care provision; (d) fears and anxieties; or related to lockdown/isolation: (e) psychological and social impact; (f) keeping safe under lockdown; (g) provisions and dependence; and (h) employment and income. CONCLUSIONS This is the first study, to the best of our knowledge, to report experiences of parents of a child with cancer during the SARS-CoV-2/COVID-19 pandemic. The majority of parents were worried about SARS-CoV-2 and transmitting the virus to their child. Hospital was no longer perceived to be a safe place, and parents were worried about suboptimal cancer care. Parents described fear and anxiety and the psychological, social and economic impact of isolation.
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Affiliation(s)
| | - Jessica E. Morgan
- Centre for Reviews and DisseminationUniversity of YorkYorkUK,Department of Paediatric OncologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Richard Wagland
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | | | - David Culliford
- NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK
| | | | - Bob Phillips
- Centre for Reviews and DisseminationUniversity of YorkYorkUK,Department of Paediatric OncologyLeeds Teaching Hospitals NHS TrustLeedsUK
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Kilani MM, Odeh MM, Shalabi M, Al Qassieh R, Al-Tamimi M. Clinical and laboratory characteristics of SARS-CoV2-infected paediatric patients in Jordan: serial RT-PCR testing until discharge. Paediatr Int Child Health 2021; 41:83-92. [PMID: 32894032 DOI: 10.1080/20469047.2020.1804733] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Data on COVID-19 in children are limited. This study aimed to identify the clinical characteristics, laboratory results and longitudinal RT-PCR- testing pattern in children infected with theSARS-CoV2 virus and admitted to a hospital in Jordan. METHODS The study is a retrospective chart review of patients admitted between 16 March and 23 April 2020. All infected children in Jordan were hospitalised. Serial RT-PCR testing was undertaken 7 days after the first test and then on alternate days until discharge. The association between patient symptoms and laboratory results and whether there was a statistically significant median difference in the number of days until negative RT-PCR results between patients was studied. RESULTS Sixty-one patients with positive SARS-CoV2 swabs were admitted, 34 (55.7%) of whom were symptomatic. The most common symptom was nasal congestion (21/61, 34.3%), followed by generalised malaise and headache (12/6, 19.7%). A rash was detected in 5/61 (8.2%) of them. Fifty-five patients (90.1%) underwent investigations: 4 (7.4%) of them had lymphopenia, 4 (7.4%) had eosinopenia, 8 (14.5%) had eosinophilia, and platelets were elevated in 5 (9.1%) children. CRP was measured in 33/61 (54.1%) patients and all were normal. ESR levels were available for 11/61 (18%) patients and were elevated in 5 (45.5%). There was a statistically significant association between laboratory results and symptom expression (p = 0.011). The longest time until the first negative RT-PCR result was 39 days. CONCLUSION All children admitted who tested positive for SARS-CoV2 had mild symptoms and five had cutaneous manifestations. RT-PCR may remain positive for over one month.
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Affiliation(s)
- Muna M Kilani
- Department of Paediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mohanad M Odeh
- Clinical Pharmacy, Pharmacy Management, and Pharmaceutical Care Innovation Centre, Pharmacy School, Hashemite University, Zarqa, Jordan
| | - Marwan Shalabi
- Department of Paediatrics, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Rami Al Qassieh
- Department of Anaesthesiology, Faculty of Medicine, Hashemite University, Zarqa, Jordan
| | - Mohammad Al-Tamimi
- Department of Basic Medical Sciences, Faculty of Medicine, Hashemite University, Zarqa, Jordan
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Carroll AG, Quinn N, Byrne C, Kassab G, Whelan S, Colleran GC. Pneumomediastinum in a child with severe COVID-19. BJR Case Rep 2021; 7:20200062. [PMID: 33614114 PMCID: PMC7869130 DOI: 10.1259/bjrcr.20200062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 08/24/2020] [Accepted: 09/03/2020] [Indexed: 11/05/2022] Open
Abstract
The current global pandemic of the novel coronavirus SARS-CoV2 is a threat to the health and lives of millions of people worldwide. The latest statistics from the World Health Organisation show that there have been 6,515,796 confirmed cases worldwide with 387,298 confirmed deaths (last update 5 June 2020, 10:41 CEST). The majority of critically unwell patients with SARS-CoV2 are adults and the radiological findings associated with them are consistent throughout the literature. However, the reported paediatric cases are few, and as such, there is a limited body of evidence available. More international data is needed, not only on the clinical presentation, but also the radiological findings, so that health-care providers are better able to understand and diagnose this pandemic disease. We describe a case of a previously healthy 9-year-old female who presented to the Emergency Department with symptoms suggestive of raised intracranial pressure. Her CT revealed a medulloblastoma and post-operatively she tested positive for SARS-CoV2. She had a rapid deterioration in her clinical condition and required admission to the intensive care unit (ICU). We provide the supporting radiology along her clinical course in order to demonstrate important insights into this disease in children, including the unusual pnemomediastinum complications which occurred as part of her clinical course. This case is the first reported of its kind.
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Affiliation(s)
- Anne G Carroll
- Department of Radiology, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Nuala Quinn
- Emergency Department Research Group, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Carl Byrne
- Department of Paediatric Emergency Medicine, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Ghadir Kassab
- Department of Radiology, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Siobhan Whelan
- Department of Intensive Care Medicine, Children’s Health Ireland at Temple Street, Dublin, Ireland
| | - Gabrielle C Colleran
- Department of Radiology, Children’s Health Ireland at Temple Street, Dublin, Ireland
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Dorantes-Acosta E, Ávila-Montiel D, Klünder-Klünder M, Juárez-Villegas L, Márquez-González H. Survival and Complications in Pediatric Patients With Cancer and COVID-19: A Meta-Analysis. Front Oncol 2021; 10:608282. [PMID: 33552980 PMCID: PMC7861039 DOI: 10.3389/fonc.2020.608282] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2020] [Accepted: 12/02/2020] [Indexed: 12/24/2022] Open
Abstract
Background The pandemic caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected all age groups, including the pediatric population, in 3–5% of all cases. We performed a meta-analysis to understand the survival and associated complications in pediatric cancer patients as well as their hospitalization, intensive care, and ventilation care (supplemental oxygen/endotracheal intubation) needs. Methods A systematic search was performed using MEDLINE, TRIP Database, International Clinical Trials Registry Platform (WHO), The Cochrane Library, Wiley, LILACS, and Google Scholar. Additionally, a search using the snowball method was performed in Nature, New England Journal of Medicine, Science, JAMA, ELSEVIER editorial, Oxford University Press, The Lancet, and MedRxiv. Searches were conducted until July 18, 2020. A total of 191 cancer patients with coronavirus disease 2019 (COVID-19) were integrated from 15 eligible studies. In a sub-analysis, patients were stratified into two groups: hematological cancer and solid tumors. Outcome measures were overall survival, risk of hospitalized or needing intensive care, and need for ventilatory support in any modality. The random effects statistical analysis was performed with Cochran’s chi square test. The odds ratio (OR) and heterogeneity were calculated using the I2 test. Results The overall survival was 99.4%. There were no statistically significant differences in the risk of hospitalization between hematological malignancies and solid tumors (95% confidence interval [CI] 0.48–18.3; OR = 2.94). The risk of being admitted to the intensive care unit was also not different between hematological malignancies and other tumors (95% CI 0.35–5.81; OR = 1.42). No differences were found for the need of ventilatory support (95% CI 0.14–3.35; OR = 0.68). Although all the studies were cross-sectional, the mortality of these patients was 0.6% at the time of analysis. Conclusions In the analyzed literature, survival in the studied group of patients with COVID-19 was very high. Suffering from hematological neoplasia or other solid tumors and COVID-19 was not a risk factor in children with cancer for the analyzed outcomes.
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Affiliation(s)
- Elisa Dorantes-Acosta
- Biobanco de Investigación en Células Leucémicas, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Diana Ávila-Montiel
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Miguel Klünder-Klünder
- Subdirección de Investigación, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Luis Juárez-Villegas
- Departamento de Onco-Hematología, Hospital Infantil de México Federico Gómez, México City, Mexico
| | - Horacio Márquez-González
- Investigación Clínica, Hospital Infantil de México Federico Gómez, México City, Mexico.,Cardiopatías Congénitas. Hospital de Cardiología, Centro Médico Nacional Siglo XXI, Instituto Mexicano del Seguro Social (IMSS), México City, Mexico
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Charnaya O, Chiang TPY, Wang R, Motter JD, Boyarsky BJ, King EA, Werbel WA, Durand CM, Avery RK, Segev DL, Massie AB, Garonzik-Wang JM. Effects of COVID-19 pandemic on pediatric kidney transplant in the United States. Pediatr Nephrol 2021; 36:143-151. [PMID: 32980942 PMCID: PMC7519856 DOI: 10.1007/s00467-020-04764-4] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 09/07/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND In March 2020, COVID-19 infections began to rise exponentially in the USA, placing substantial burden on the healthcare system. As a result, there was a rapid change in transplant practices and policies, with cessation of most procedures. Our goal was to understand changes to pediatric kidney transplantation (KT) at the national level during the COVID-19 epidemic. METHODS Using SRTR data, we examined changes in pediatric waitlist registration, waitlist removal or inactivation, and deceased donor and living donor (DDKT/LDKT) events during the start of the disease transmission in the USA compared with the same time the previous year. RESULTS We saw an initial decrease in DDKT and LDKT by 47% and 82% compared with expected events and then a continual increase, with numbers reaching expected prepandemic levels by May 2020. In the early phase of the pandemic, waitlist inactivation and removals due to death or deteriorating condition rose above expected values by 152% and 189%, respectively. There was a statistically significant decrease in new waitlist additions (IRR 0.49 0.65 0.85) and LDKT (IRR 0.17 0.38 0.84) in states with high vs. low COVID activity. Transplant recipients during the pandemic were more likely to have received a DDKT, but had similar calculated panel-reactive antibody (cPRA) values, waitlist time, and cause of kidney failure as before the pandemic. CONCLUSIONS The COVID-19 pandemic initially reduced access to kidney transplantation among pediatric patients in the USA but has not had a sustained effect.
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Affiliation(s)
- Olga Charnaya
- Department of Pediatrics, Johns Hopkins University School of Medicine, 200 N Wolfe St., Room 3055, Baltimore, MD, 21287, USA.
| | - Teresa Po-Yu Chiang
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Richard Wang
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Jennifer D. Motter
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Brian J. Boyarsky
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Elizabeth A. King
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - William A. Werbel
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Christine M. Durand
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Robin K. Avery
- grid.21107.350000 0001 2171 9311Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Dorry L. Segev
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA ,Scientific Registry of Transplant Recipients, Minneapolis, MN USA
| | - Allan B. Massie
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA ,grid.21107.350000 0001 2171 9311Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD USA
| | - Jacqueline M. Garonzik-Wang
- grid.21107.350000 0001 2171 9311Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD USA
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Chong SL, Soo JSL, Allen JC, Ganapathy S, Lee KP, Tyebally A, Yung CF, Thoon KC, Ng YH, Oh JY, Teoh OH, Mok YH, Chan YH. Impact of COVID-19 on pediatric emergencies and hospitalizations in Singapore. BMC Pediatr 2020; 20:562. [PMID: 33353540 PMCID: PMC7755581 DOI: 10.1186/s12887-020-02469-z] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2020] [Accepted: 12/11/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) has impacted the provision of health services in all specialties. We aim to study the impact of COVID-19 on the utilization of pediatric hospital services including emergency department (ED) attendances, hospitalizations, diagnostic categories and resource utilization in Singapore. METHODS We performed a retrospective review of ED attendances and hospital admissions among children < 18 years old from January 1st to August 8th 2020 in a major pediatric hospital in Singapore. Data were analyzed in the following time periods: Pre-lockdown (divided by the change in Disease Outbreak Response System Condition (DORSCON) level), during-lockdown and post-lockdown. We presented the data using proportions and percentage change in mean counts per day with the corresponding 95% confidence intervals (CIs). RESULTS We attended to 58,367 children with a mean age of 5.1 years (standard deviation, SD 4.6). The mean ED attendance decreased by 331 children/day during lockdown compared to baseline (p < 0.001), attributed largely to a drop in respiratory (% change - 87.9, 95% CI - 89.3 to - 86.3, p < 0.001) and gastrointestinal infections (% change - 72.4, 95%CI - 75.9 to - 68.4, p < 0.001). Trauma-related diagnoses decreased at a slower rate across the same periods (% change - 40.0, 95%CI - 44.3 to - 35.3, p < 0.001). We saw 226 children with child abuse, with a greater proportion of total attendance seen post-lockdown (79, 0.6%) compared to baseline (36, 0.2%) (p < 0.001). In terms of ED resource utilization, there was a decrease in the overall mean number of procedures performed per day during the lockdown compared to baseline, driven largely by a reduction in blood investigations (% change - 73.9, 95%CI - 75.9 to - 71.7, p < 0.001). CONCLUSIONS We highlighted a significant decrease in infection-related presentations likely attributed to the lockdown and showed that the relative proportion of trauma-related attendances increased. By describing the impact of COVID-19 on health services, we report important trends that may provide guidance when planning resources for future pandemics.
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Affiliation(s)
- Shu-Ling Chong
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore.
- Duke-NUS Medical School, Singapore, Singapore.
| | | | - John Carson Allen
- Centre for Quantitative Medicine, Duke-NUS Medical School, Singapore, Singapore
| | - Sashikumar Ganapathy
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Khai Pin Lee
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Arif Tyebally
- Department of Emergency Medicine, KK Women's and Children's Hospital, 100, Bukit Timah Road, Singapore, 229899, Singapore
- Duke-NUS Medical School, Singapore, Singapore
| | - Chee Fu Yung
- Duke-NUS Medical School, Singapore, Singapore
- Department of KK Women's and Children's Hospital, Infectious Disease Service, Singapore, Singapore
| | - Koh Cheng Thoon
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yong Hong Ng
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medicine, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jean Yin Oh
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Oon Hoe Teoh
- Duke-NUS Medical School, Singapore, Singapore
- Department of Paediatrics, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yee Hui Mok
- Duke-NUS Medical School, Singapore, Singapore
- Children's Intensive Care Unit, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Yoke Hwee Chan
- Duke-NUS Medical School, Singapore, Singapore
- Division of Medicine, KK Women's and Children's Hospital, Singapore, Singapore
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47
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Tan TQ, Kullar R, Swartz TH, Mathew TA, Piggott DA, Berthaud V. Location Matters: Geographic Disparities and Impact of Coronavirus Disease 2019. J Infect Dis 2020; 222:1951-1954. [PMID: 32942299 PMCID: PMC7543383 DOI: 10.1093/infdis/jiaa583] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 09/11/2020] [Indexed: 11/12/2022] Open
Abstract
The COVID-19 pandemic in the United States has revealed major disparities in the access to testing and messaging about the pandemic based on the geographic location of individuals, particularly in communities of color, rural areas, and areas of low income. This geographic disparity, in addition to deeply rooted structural inequities, have posed additional challenges to adequately diagnose and provide care for individuals of all ages living in these settings. We describe the impact that COVID-19 has had on geographic disparate populations in the United States and share our recommendations to what might be done to ameliorate the current situation.
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Affiliation(s)
- Tina Q Tan
- Feinberg School of Medicine, Northwestern University, Department of Pediatrics, Division of Infectious Diseases, Chicago, Illinois, USA
| | | | - Talia H Swartz
- Icahn School of Medicine at Mount Sinai, Department of Medicine, Division of Infectious Diseases, New York, New York, USA
| | - Trini A Mathew
- Division of Infectious Diseases and International Medicine, Beaumont Hospital, Royal Oak, Michigan, USA
| | - Damani A Piggott
- Johns Hopkins University School of Medicine, Department of Medicine, Division of Infectious Diseases, Baltimore, Maryland, USA
| | - Vladimir Berthaud
- Meharry Medical College, Department of Medicine, Division of Infectious Diseases, Nashville, Tennessee, USA
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48
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Alfraij A, Bin Alamir AA, Al-Otaibi AM, Alsharrah D, Aldaithan A, Kamel AM, Almutairi M, Alshammari S, Almazyad M, Macarambon JM, Alghounaim M. Characteristics and outcomes of coronavirus disease 2019 (COVID-19) in critically ill pediatric patients admitted to the intensive care unit: A multicenter retrospective cohort study. J Infect Public Health 2020; 14:193-200. [PMID: 33486375 PMCID: PMC7837314 DOI: 10.1016/j.jiph.2020.12.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 11/23/2020] [Accepted: 12/03/2020] [Indexed: 01/28/2023] Open
Abstract
Background Characteristics of critical Severe Acute Respiratory Syndrome-related Coronavirus 2 (SARS-CoV-2) infection in children is not well understood. This study described the clinical characteristics of children admitted to intensive care units (ICU) and explored factors associated with the need for invasive ventilation or mortality. Methods A multicenter, retrospective, cohort study was conducted over eight medical centers, including all patients younger than 18 years of age and admitted to the ICU due to a direct consequence of coronavirus disease 2019 (COVID-19). Patients who were admitted to the ICU for any alternate reason and tested positive for SARS-CoV-2 by screening test, and patients who were admitted due to multi-inflammatory syndrome in children, were excluded. Demographic, laboratory, imaging, and clinical data were collected. Descriptive statistics were used to compare survivors and non-survivors. Fine and Gray’s hazard model was used to estimate the association between clinical variables and ICU death. Results During the study period, 25 pediatric COVID-19 patients received care in the ICUs. The median age was 2.78 years (IQR 0.21–8.51), and 60% were male. Only three patients were reported to be previously healthy at admission. Nine (36%) patients required invasive mechanical ventilation, including two were on extracorporeal membrane oxygenation. Four (16%) patients died during ICU care. In univariate analysis, the presence of comorbidity (HR 0.0001; 95%CI 0.00001–0.00016), platelets count (HR 0.99; 95% CI 0.98–0.99), elevated procalcitonin (HR 1.05; 95%CI 1.016–1.09), and circulatory compromise (HR 16.34; 95%CI 1.99–134.35), all at the time of ICU admission, were associated with in-ICU mortality. Conclusion Our findings suggest that children admitted to the ICU with SARS-CoV-2 infection, generally, have a favorable outcome. Low platelets count, elevated procalcitonin, presence of comorbidity, and shock at the time of ICU admission were associated with death. This study may shed more light on the disease dynamics of critical pediatric COVID-19.
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Affiliation(s)
- Abdulla Alfraij
- Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser Area, Kuwait.
| | | | | | - Danah Alsharrah
- Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser Area, Kuwait.
| | - Abdulrahman Aldaithan
- Pediatric Intensive Care Unit, Department of Pediatrics, Farwaniya Hospital, Sabah Al-Nasser Area, Kuwait.
| | - Ahmed M Kamel
- Clinical Pharmacy Department, Faculty of Pharmacy, Cairo University, Cairo, Egypt.
| | - Muna Almutairi
- Department of Pediatrics, Adan Hospital, Hadiyah, Kuwait.
| | | | - Mohammed Almazyad
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
| | - Jara Mia Macarambon
- Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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49
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Fabi M, Filice E, Andreozzi L, Conti F, Gabrielli L, Balducci A, Vergine G, Cicero, MD C, Iughetti L, Guerzoni ME, Corinaldesi E, Lazzarotto T, Pession A, Lanari M. Spectrum of Cardiovascular Diseases in Children During High Peak Coronavirus Disease 2019 Period Infection in Northern Italy: Is There a Link? J Pediatric Infect Dis Soc 2020; 10:714-721. [PMID: 33283237 PMCID: PMC7798942 DOI: 10.1093/jpids/piaa162] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 12/13/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND Children with coronavirus disease-2019 (COVID-19) have a milder clinical course than adults. We describe the spectrum of cardiovascular manifestations during a COVID-19 outbreak in Emilia-Romagna, Italy. METHODS A cross-sectional multicenter study was performed, including all patients diagnosed with Kawasaki disease (KD), myocarditis, and multisystem inflammatory syndrome in children (MIS-C) from February to April 2020. KD patients were compared with those diagnosed before the epidemic. RESULTS KD: 8 patients (6/8 boys, all negative for severe acute respiratory syndrome coronavirus-2 [SARS-CoV-2]): complete presentation in 5/8, 7/8 immunoglobulin (IVIG) responders, and 3/8 showed transient coronary lesions (CALs). Myocarditis: one 5-year-old girl negative for SARS-CoV-2 and positive for parvovirus B19. She responded to IVIG. MIS-C: 4 SARS-CoV-2-positive boys (3 patients with positive swab and serology and 1 patient with negative swab and positive serology): 3 presented myocardial dysfunction and pericardial effusion, and 1 developed multicoronary aneurysms and hyperinflammation; all responded to treatment. The fourth boy had mitral and aortic regurgitation that rapidly regressed after steroids. CONCLUSIONS KD, myocarditis, and MIS-C were distinguishable cardiovascular manifestations. KD did not show a more aggressive form compared with previous years: coronary involvement was frequent but always transient. MIS-C and myocarditis rapidly responded to treatment without cardiac sequelae despite high markers of myocardial injury at the onset, suggesting a myocardial depression due to systemic inflammation rather than focal necrosis. Evidence of actual or previous SARS-CoV-2 infection was documented only in patients with MIS-C.
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Affiliation(s)
- Marianna Fabi
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy,The corresponding author is Dr. Marianna Fabi, Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy. Via Massarenti 11. 40138 Bologna, Italy. Tel: +39 333 8351572. Fax +39 051 2143116.
| | - Emanuele Filice
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy
| | - Laura Andreozzi
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy
| | - Francesca Conti
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy
| | - Liliana Gabrielli
- Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola Hospital, University of Bologna, Italy
| | - Anna Balducci
- Pediatric Cardiology and Congenital Heart Disease Unit, S. Orsola Hospital, University of Bologna, Italy
| | | | - Cristina Cicero, MD
- Department of Pediatrics, AUSL, Guglielmo da Saliceto Hospital, Piacenza, Italy
| | - Lorenzo Iughetti
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | - Maria Elena Guerzoni
- Pediatric Unit, Department of Medical and Surgical Sciences for Mothers, Children and Adults, University of Modena and Reggio Emilia, Modena, Italy
| | | | - Tiziana Lazzarotto
- Operative Unit of Clinical Microbiology, Laboratory of Virology, St. Orsola Hospital, University of Bologna, Italy
| | - Andrea Pession
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy
| | - Marcello Lanari
- Department of Pediatrics, University of Bologna, S.Orsola Hospital, Bologna, Italy
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50
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SARS-CoV-2 in children: spectrum of disease, transmission and immunopathological underpinnings. Pathology 2020; 52:801-808. [PMID: 32888706 PMCID: PMC7437539 DOI: 10.1016/j.pathol.2020.08.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/05/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Abstract
As the SARS-CoV-2 pandemic unfolds across the globe, consistent themes are emerging with regard to aspects of SARS-CoV-2 infection and its associated disease entities in children. Overall, children appear to be less frequently infected by, and affected by, SARS-CoV-2 virus and the clinical disease COVID-19. Large epidemiological studies have revealed children represent less than 2% of the total confirmed COVID-19 cases, of whom the majority experience minimal or mild disease that do not require hospitalisation. Children do not appear to be major drivers of SARS-CoV-2 transmission, with minimal secondary virus transmission demonstrated within families, schools and community settings. There are several postulated theories regarding the relatively low SARS-CoV-2 morbidity and mortality seen in children, which largely relate to differences in immune responses compared to adults, as well as differences in angiotensin converting enzyme 2 distribution that potentially limits viral entry and subsequent inflammation, hypoxia and tissue injury. The recent emergence of a multisystem inflammatory syndrome bearing temporal and serological plausibility for an immune-mediated SARS-CoV-2-related disease entity is currently under investigation. This article summarises the current available data regarding SARS-CoV-2 and the paediatric population, including the spectrum of disease in children, the role of children in virus transmission, and host-virus factors that underpin the unique aspects of SARS-CoV-2 pathogenicity in children.
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