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Mîndru DE, Țarcă E, Adumitrăchioaiei H, Anton-Păduraru DT, Ștreangă V, Frăsinariu OE, Sidoreac A, Stoica C, Bernic V, Luca AC. Obesity as a Risk Factor for the Severity of COVID-19 in Pediatric Patients: Possible Mechanisms-A Narrative Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:1203. [PMID: 39457167 PMCID: PMC11506776 DOI: 10.3390/children11101203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2024] [Revised: 09/23/2024] [Accepted: 09/27/2024] [Indexed: 10/28/2024]
Abstract
Obesity, the current pandemic, is associated with alarming rises among children and adolescents, and the forecasts for the near future are worrying. The present paper aims to draw attention to the short-term effects of the excess adipose tissue in the presence of a viral infection, which can be life-threatening for pediatric patients, given that the course of viral infections is often severe, if not critical. The COVID-19 pandemic has been the basis of these statements, which opened the door to the study of the repercussions of obesity in the presence of a viral infection. Since 2003, with the discovery of SARS-CoV-1, interest in the study of coronaviruses has steadily increased, with a peak during the pandemic. Thus, obesity has been identified as an independent risk factor for COVID-19 infection and is correlated with a heightened risk of severe outcomes in pediatric patients. We sought to determine the main mechanisms through which obesity is responsible for the unfavorable evolution in the presence of a viral infection, with emphasis on the disease caused by SARS-CoV-2, in the hope that future studies will further elucidate this aspect, enabling prompt and effective intervention in obese patients with viral infections, whose clinical progression is likely to be favorable.
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Affiliation(s)
- Dana Elena Mîndru
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania; (D.E.M.); (D.T.A.-P.); (V.Ș.); (O.E.F.); (A.-C.L.)
| | - Elena Țarcă
- Department of Surgery II—Pediatric Surgery, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania
| | - Heidrun Adumitrăchioaiei
- Department of Pediatrics, University of Medicine, Pharmacy, Sciences and Technology “George Emil Palade”, Târgu Mureș, Str. Gheorghe Marinescu Nr. 38, 540136 Târgu Mureș, Romania;
| | - Dana Teodora Anton-Păduraru
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania; (D.E.M.); (D.T.A.-P.); (V.Ș.); (O.E.F.); (A.-C.L.)
| | - Violeta Ștreangă
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania; (D.E.M.); (D.T.A.-P.); (V.Ș.); (O.E.F.); (A.-C.L.)
| | - Otilia Elena Frăsinariu
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania; (D.E.M.); (D.T.A.-P.); (V.Ș.); (O.E.F.); (A.-C.L.)
| | - Alexandra Sidoreac
- Emergency Clinical Hospital for Children “Sfanta Maria” Iasi, 700309 Iași, Romania; (A.S.); (C.S.)
| | - Cristina Stoica
- Emergency Clinical Hospital for Children “Sfanta Maria” Iasi, 700309 Iași, Romania; (A.S.); (C.S.)
| | - Valentin Bernic
- Department of Surgery II, “Saint Spiridon” Hospital, University Street, No 16, 700115 Iasi, Romania;
| | - Alina-Costina Luca
- Department of Mother and Child Medicine, University of Medicine and Pharmacy “Gr.T.Popa”, 700115 Iasi, Romania; (D.E.M.); (D.T.A.-P.); (V.Ș.); (O.E.F.); (A.-C.L.)
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Kulkarni D, Ismail NF, Zhu F, Wang X, del Carmen Morales G, Srivastava A, Allen KE, Spinardi J, Rahman AE, Kyaw MH, Nair H. Epidemiology and clinical features of SARS-CoV-2 infection in children and adolescents in the pre-Omicron era: A global systematic review and meta-analysis. J Glob Health 2024; 14:05003. [PMID: 38419461 PMCID: PMC10902805 DOI: 10.7189/jogh.14.05003] [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] [Indexed: 03/02/2024] Open
Abstract
Methods We searched MEDLINE, Embase, Global Health, CINAHL, China National Knowledge Infrastructure, Wanfang, CQvip, and the World Health Organization (WHO) COVID-19 global literature databases for primary studies recruiting children aged ≤18 years with a diagnosis of SARS-CoV-2 infection confirmed either by molecular or antigen tests. We used the Joanna Briggs Institute critical appraisal tools to appraise the study quality and conducted meta-analyses using the random effects model for all outcomes except for race/ethnicity as risk factors of SARS-CoV-2 infection. Results We included 237 studies, each reporting at least one of the study outcomes. Based on data from 117 studies, the pooled SARS-CoV-2 positivity rate was 9.30% (95% confidence interval (CI) = 7.15-11.73). Having a comorbidity was identified as a risk factor for SARS-CoV-2 infection (risk ratio (RR) = 1.33; 95% CI = 1.04-1.71) based on data from 49 studies. Most cases in this review presented with mild disease (n = 50; 52.47% (95% CI = 44.03-60.84)). However, 20.70% of paediatric SARS-CoV-2 infections were hospitalised (67 studies), 7.19% required oxygen support (57 studies), 4.26% required intensive care (93 studies), and 2.92% required assisted ventilation (63 studies). The case fatality ratio (n = 119) was 0.87% (95% CI = 0.54-1.28), which included in-hospital and out-of-hospital deaths. Conclusions Our data showed that children were at risk for SARS-CoV-2 infections and severe outcomes in the pre-Omicron era. These findings underscore the need for effective vaccination strategies for the paediatric population to protect against the acute and long-term sequelae of COVID-19. Registration PROSPERO: CRD42022327680.
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Affiliation(s)
- Durga Kulkarni
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
| | - Nabihah Farhana Ismail
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Communicable Disease Control Unit, Public Health Department, Johor State, Malaysia
| | - Fuyu Zhu
- Schol of Public Health, Nanjing Medical University, China
| | - Xin Wang
- Schol of Public Health, Nanjing Medical University, China
| | | | | | | | | | - Ahmed Ehsanur Rahman
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- International Centre for Diarrhoeal Diseases Research, Bangladesh
| | | | - Harish Nair
- Centre for Global Health, University of Edinburgh, Edinburgh, United Kingdom
- Schol of Public Health, Nanjing Medical University, China
- MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Nieto-Rivera B, Saldaña-Ahuactzi Z, Parra-Ortega I, Flores-Alanis A, Carbajal-Franco E, Cruz-Rangel A, Galaviz-Hernández S, Romero-Navarro B, de la Rosa-Zamboni D, Salazar-García M, Contreras CA, Ortega-Riosvelasco F, López-Martínez I, Barrera-Badillo G, Diaz-Garcia H, Romo-Castillo M, Moreno-Espinosa S, Luna-Pineda VM. Frequency of respiratory virus-associated infection among children and adolescents from a tertiary-care hospital in Mexico City. Sci Rep 2023; 13:19763. [PMID: 37957308 PMCID: PMC10643542 DOI: 10.1038/s41598-023-47035-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 11/08/2023] [Indexed: 11/15/2023] Open
Abstract
Acute respiratory infections (ARIs) are a major cause of morbidity and mortality among children. The causative pathogens show geographic and seasonal variations. We retrospectively evaluated the frequency and seasonality of respiratory pathogens in children and adolescents (age: 0-19 years) with ARIs treated between January 1, 2021, and March 31, 2022, at a single center in Mexico. Out of 2400 patients, 1,603 were diagnosed with SARS-CoV-2 infection and 797 were diagnosed with other common respiratory pathogens (CRPs). Of the 797 patients, 632 were infected with one CRP and 165 with > 2 CRPs. Deaths occurred only in SARS-CoV-2-infected patients. Rhinovirus/Enterovirus, respiratory syncytial virus B, and parainfluenza virus 3 were the most prevalent in cases with single and multiple infections. CRP showed a high frequency between autumn and winter of 2021, with higher incidence of hospitalization compared to COVID-19. The main comorbidities were immunosuppression, cardiovascular disease (CD), and asthma. The frequency of CRPs showed a downward trend throughout the first half of 2021. CRPs increased in single- and co-infection cases between the fourth and fifth waves of COVID-19, probably due to decreased nonpharmaceutical interventions and changes in diagnostic tests. Age, cyanosis (symptom), and immunosuppression (comorbidity) were found to differentiate between SARS-CoV-2 infection and CRP infection.
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Affiliation(s)
- Brenda Nieto-Rivera
- Departamento de Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Zeus Saldaña-Ahuactzi
- Centro de Investigación en Biotecnología Aplicada, Instituto Politécnico Nacional, Santa Inés Tecuexcomac, Tepetitla de Lardizábal, Tlaxcala, México
| | - Israel Parra-Ortega
- Departamento de Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Alejandro Flores-Alanis
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ebzadrel Carbajal-Franco
- Departamento de Laboratorio Clínico, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Armando Cruz-Rangel
- Laboratorio de Bioquímica de Enfermedades Crónicas, Instituto Nacional de Medicina Genómica, Ciudad de México, México
| | | | - Benjamín Romero-Navarro
- Subdirección de Servicios Auxiliares de Diagnóstico, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Daniela de la Rosa-Zamboni
- Subdirección de Atención Integral al Paciente, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Marcela Salazar-García
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | - Carmen A Contreras
- Facultad de Medicina, Universidad Privada Antenor Orrego, Trujillo, Peru
| | | | - Irma López-Martínez
- Dirección de Diagnóstico y Referencia, Instituto de Diagnóstico y Referencia Epidemiológicos, Ciudad de México, México
| | - Gisela Barrera-Badillo
- Laboratorio de Virus Respiratorios, Instituto de Diagnóstico y Referencia Epidemiológicos, Ciudad de México, México
| | - Hector Diaz-Garcia
- Centro de Investigación en Malformaciones Congénitas, Hospital Infantil de México Federico Gómez, Ciudad de México, México
- Escuela Superior de Enfermería y Obstetricia, Instituto Politécnico Nacional, Ciudad de México, México
| | - Mariana Romo-Castillo
- Laboratorio de Investigación en COVID-19, Laboratorio de Investigación en Inmunología y Proteomica, Hospital Infantil de México Federico Gómez, Ciudad de México, México
| | | | - Victor M Luna-Pineda
- Laboratorio de Investigación en COVID-19, Laboratorio de Investigación en Inmunología y Proteomica, Hospital Infantil de México Federico Gómez, Ciudad de México, México.
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Ali M, Phillips L, Kaelber DC, Bukulmez H. Characteristics of pediatric COVID-19 infections and the impact of influenza and COVID-19 vaccinations during the first two years of the pandemic. Front Pediatr 2023; 11:1046680. [PMID: 37900675 PMCID: PMC10600516 DOI: 10.3389/fped.2023.1046680] [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: 09/16/2022] [Accepted: 09/25/2023] [Indexed: 10/31/2023] Open
Abstract
The data regarding the demographics of SARS-CoV-2 in the pediatric population has been published based on several single-center experiences or on metanalyses over short time frames. This article reports data on the demographics of pediatric patients with COVID-19 on a global scale using the TriNetX COVID-19 Research Network. In addition, we examined the risk of COVID-19 infection in relation to the body mass index (BMI) category and the protective value of influenza and COVID-19 immunization against COVID-19 infection. The incidence of COVID-19 infection was higher in the younger age group (≤6 years old), but no gender differences. The incidence of COVID-19 infection was higher among African Americans/Black race (28.57%) White race (27.10%), and obese patients; across all age groups, all genders, all races, and ethnicities (p < 0.0001). The incidence of MIS-C was also higher in patients with obesity (OR 1.71, CI 1.36-2.14). We found that the patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses compared to those who received influenza vaccine only, had significantly higher odds for hospitalization (OR 1.19, CI 1.18-1.21), development of MIS-C (OR 1.52, CI 1.32-1.74), and more importantly mortality (OR 1.47, CI 1.26-1.71). In addition, those patients who were neither vaccinated for COVID-19 nor influenza within one year before their COVID-19 diagnoses, compared to those who received at least one dose of COVID-19 vaccine, had significantly higher odds for hospitalization (OR 1.11, CI 1.04-1.19). However, those patients who did not receive the influenza vaccine within one year before their COVID-19 diagnoses nor received the COVID-19 vaccine had much higher odds for hospitalization (OR 1.46, CI 1.41-1.51), MIS-C (OR 3.72, CI 2.11-6.56), and mortality compared to those who received both vaccinations (OR 13.55, CI 1.91-9.62). Using the multiplicative interaction scale, we found a positive interaction between the COVID-19 vaccine and the influenza vaccine; they both combined have a larger effect than each separately. Our study is the largest of its kind (to date) examining the global demographic of the pandemic and the first of a kind to find a link between influenza vaccine and COVID-19-related hospitalization, MIS-C, and mortality in the pediatric population.
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Affiliation(s)
- Mahmoud Ali
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Lynette Phillips
- College of Public Health, Kent State University, Kent, OH, United States
| | - David C. Kaelber
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
- The Departments of Internal Medicine and Population and Quantitative Health Sciences and the Center for Clinical Informatics Research and Educations, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
| | - Hulya Bukulmez
- The Department of Pediatrics, The MetroHealth System, Case Western Reserve University, Cleveland, OH, United States
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MacKay MM, Powers K, Jordan K. The COVid-19 pandemic through the eyes of pediatric nurses: A qualitative study. J Pediatr Nurs 2023; 68:52-59. [PMID: 36357232 PMCID: PMC9638949 DOI: 10.1016/j.pedn.2022.09.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/10/2022] [Accepted: 09/20/2022] [Indexed: 11/09/2022]
Abstract
PURPOSE This study explored pediatric nurses' lived experiences during the first calendar year (2020) of the COVid-19 pandemic. DESIGN AND METHODS An electronic survey used an exploratory-descriptive qualitative approach to gather data from 231 pediatric nurses working in a variety of settings across the United States. The survey consisted of seven open-ended questions to capture participants' experiences in the workplace. Thematic analysis was conducted to identify themes and associated subthemes. RESULTS Seven themes emerged: Unique Aspects of COVid-19 in the Pediatric Population; Visitor Restrictions and Isolation Increased Stress; Navigating Changing Knowledge and Misinformation; Personal Protective Equipment Challenges; Living in Fear; Pride in the Profession; and Profession at Risk. CONCLUSIONS Pediatric nurses working in the initial year of the COVid-19 pandemic faced numerous challenges consistent with those shared by the profession at large in addition to some unique to their patient population. Of greatest concern is the dismay many participants conveyed in their perception of administrative and public support and in their flagging commitment to the profession. PRACTICE IMPLICATIONS This study highlights the need for nurse self-care, cultural reform in healthcare settings to engage front line providers in decision making, and proactive strategies to recruit and retain professional nurses.
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Affiliation(s)
| | - Kelly Powers
- University of North Carolina Charlotte School of Nursing, USA
| | - Kathleen Jordan
- University of North Carolina Charlotte School of Nursing, USA
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Reiter AJ, Ingram MCE, Raval MV, Garcia E, Hill M, Aranda A, Chandler NM, Gonzalez R, Born K, Mack S, Lamoshi A, Lipskar AM, Han XY, Fialkowski E, Spencer B, Kulaylat AN, Barde A, Shah AN, Adoumie M, Gross E, Mehl SC, Lopez ME, Polcz V, Mustafa MM, Gander JW, Sullivan TM, Sulkowski JP, Ghani O, Huang EY, Rothstein D, Muenks EP, St. Peter SD, Fisher JC, Levy-Lambert D, Reichl A, Ignacio RC, Slater BJ, Tsao K, Berman L. Postoperative respiratory complications in SARS-CoV-2 positive pediatric patients across 20 United States hospitals: A Cohort Study. J Pediatr Surg 2022:S0022-3468(22)00716-3. [PMID: 36428183 PMCID: PMC9632239 DOI: 10.1016/j.jpedsurg.2022.10.048] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 10/20/2022] [Accepted: 10/25/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Data examining rates of postoperative complications among SARS-CoV-2 positive children are limited. The purpose of this study was to evaluate the impact of symptomatic and asymptomatic SARS-CoV-2 positive status on postoperative respiratory outcomes for children. METHODS This retrospective cohort study included SARS-CoV-2 positive pediatric patients across 20 hospitals who underwent general anesthesia from March to October 2020. The primary outcome was frequency of postoperative respiratory complications, including: high-flow nasal cannula/non invasive ventilation, reintubation, pneumonia, Extracorporeal Membrane Oxygenation (ECMO), and 30-day respiratory-related readmissions or emergency department (ED) visits. Univariate analyses were used to evaluate associations between patient and procedure characteristics and stratified analyses by symptoms were performed examining incidence of complications. RESULTS Of 266 SARS-CoV-2 positive patients, 163 (61.7%) were male, and the median age was 10 years (interquartile range 4-14). The majority of procedures were emergent or urgent (n = 214, 80.5%). The most common procedures were appendectomies (n = 78, 29.3%) and fracture repairs (n = 40,15.0%). 13 patients (4.9%) had preoperative symptoms including cough or dyspnea. 26 patients (9.8%) had postoperative respiratory complications, including 15 requiring high-flow oxygen, 8 with pneumonia, 4 requiring non invasive ventilation, 3 respiratory ED visits, and 2 respiratory readmissions. Respiratory complications were more common among symptomatic patients than asymptomatic patients (30.8% vs. 8.7%, p = 0.01). Higher ASA class and comorbidities were also associated with postoperative respiratory complications. CONCLUSIONS Postoperative respiratory complications are less common in asymptomatic versus symptomatic SARS-COV-2 positive children. Relaxation of COVID-19-related restrictions for time-sensitive, non urgent procedures in selected asymptomatic patients may be reasonably considered. Additionally, further research is needed to evaluate the costs and benefits of routine testing for asymptomatic patients. LEVEL OF EVIDENCE Iii, Respiratory complications.
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Affiliation(s)
- Audra J. Reiter
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States,Corresponding author
| | - Martha-Conley E. Ingram
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Mehul V. Raval
- Division of Pediatric Surgery, Department of Surgery, Ann and Robert H. Lurie Children's Hospital of Chicago, Surgical Outcomes and Quality Improvement Center, Northwestern University Feinberg School of Medicine, 633N. St. Clair St., 20th floor, Chicago, IL 60611, United States
| | - Elisa Garcia
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Madelyn Hill
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Arturo Aranda
- Division of Pediatric Surgery, Dayton Children's Hospital, Wright State University, Dayton, OH, United States
| | - Nicole M Chandler
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Raquel Gonzalez
- Division of Pediatric Surgery, Department of Surgery, John's Hopkins All Children's Hospital, St. Petersburg, FL, United States
| | - Kristen Born
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Shale Mack
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
| | - Abdulraouf Lamoshi
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Aaron M. Lipskar
- Department of Pediatric Surgery, Cohen Children's Medical Center, Northwell Health, New Hyde Park, NY, United States
| | - Xiao-Yue Han
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Elizabeth Fialkowski
- Division of Pediatric Surgery, Department of Surgery, OHSU School of Medicine, Doernbecher Children's Hospital, Portland, OR, United States
| | - Brianna Spencer
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Afif N. Kulaylat
- Division of Pediatric Surgery, Department of Surgery, Penn State Children's Hospital, Hershey, PA, United States
| | - Amrene Barde
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Ami N. Shah
- Division of Pediatric Surgery, Department of Surgery, Rush University, Chicago, IL, United States
| | - Maeva Adoumie
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Erica Gross
- Division of Pediatric Surgery, Department of Surgery, Stony Brook Children's Hospital, Stony Brook, NY, United States
| | - Steven C. Mehl
- Division of Pediatric Surgery, Department of Surgery, Texas Children's Hospital, Houston TX, United States
| | - Monica E. Lopez
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Valerie Polcz
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Moiz M. Mustafa
- Division of Pediatric Surgery, Department of Surgery, UF Health, University of Florida, Gainesville, FL, United States
| | - Jeffrey W. Gander
- Division of Pediatric Surgery, Department of Surgery, UVA Children's Hospital, Charlottesville, VA, United States
| | - Travis M. Sullivan
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Jason P. Sulkowski
- Division of Pediatric Surgery, Department of Surgery, Children's Hospital of Richmond at VCU, Richmond VA, United States
| | - Owais Ghani
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - Eunice Y. Huang
- Department of Pediatric Surgery, Vanderbilt University Medical Center, Monroe Carell Jr. Children's Hospital, Nashville TN, United States
| | - David Rothstein
- Division of Pediatric Surgery, Department of Surgery, Seattle Children's Hospital, Seattle WA, United States
| | - E. Peter Muenks
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Shawn D. St. Peter
- Division of Pediatric Surgery, Department of Surgery, Children's Mercy Kansas City, Kansas City MO, United States
| | - Jason C. Fisher
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Dina Levy-Lambert
- Division of Pediatric Surgery, Department of Surgery, Hassenfeld Children's Hospital at NYU Langone, New York City, NY, United States
| | - Allison Reichl
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Romeo C. Ignacio
- Division of Pediatric Surgery, Department of Surgery, Rady Children's Hospital, University of California San Diego School of Medicine, San Diego, CA, United States
| | - Bethany J. Slater
- Division of Pediatric Surgery, Department of Surgery, Comer Children's Hospital, University of Chicago, Chicago, IL, United States
| | - KuoJen Tsao
- Division of Pediatric Surgery, Department of Surgery, McGovern Medical School at University of Texas Health Science Center at Houston, Children's Memorial Hermann Hospital, Houston TX, United States
| | - Loren Berman
- Division of Pediatric Surgery, Department of Surgery, Nemours Children's Hospital - Delaware, Wilmington DE, United States
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Farrar DS, Drouin O, Moore Hepburn C, Baerg K, Chan K, Cyr C, Donner EJ, Embree JE, Farrell C, Forgie S, Giroux R, Kang KT, King M, Laffin Thibodeau M, Orkin J, Ouldali N, Papenburg J, Pound CM, Price VE, Proulx-Gauthier JP, Purewal R, Ricci C, Sadarangani M, Salvadori MI, Thibeault R, Top KA, Viel-Thériault I, Kakkar F, Morris SK. Risk factors for severe COVID-19 in hospitalized children in Canada: A national prospective study from March 2020–May 2021. THE LANCET REGIONAL HEALTH - AMERICAS 2022; 15:100337. [PMID: 35936225 PMCID: PMC9342862 DOI: 10.1016/j.lana.2022.100337] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Flores-Alanis A, Saldaña-Ahuactzi Z, Parra-Ortega I, López-Ramírez P, Salazar-García M, Alemán-García YP, Cruz-Rangel A, Moreno-Paredes A, Diaz-Rojas A, Maldonado-Bernal C, Quevedo-Moran J, Luna-Pineda VM. Clinical Characteristics of Coronavirus Disease (COVID-19) in Mexican Children and Adolescents. Viruses 2022; 14:v14102162. [PMID: 36298717 PMCID: PMC9611217 DOI: 10.3390/v14102162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2022] [Revised: 09/13/2022] [Accepted: 09/28/2022] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND We analyzed the demographic, clinical, and diagnostic data of children and adolescents in Mexico, from the first case of coronavirus disease (COVID-19) to 28 February 2022. METHODS Using the open databases of the Ministry of Health and a tertiary pediatric hospital, we obtained demographic and clinical data from the beginning of the COVID-19 pandemic until 28 February 2022. In addition, quantitative reverse-transcription polymerase chain reaction outputs were used to determine the viral load, and structural protein-based serology was performed to evaluate IgG antibody levels. RESULTS Of the total 437,832 children and adolescents with COVID-19, 1187 died. Of these patients, 1349 were admitted to the Hospital Infantil de Mexico Federico Gómez, and 11 died. Obesity, asthma, and immunosuppression were the main comorbidities, and fever, cough, and headache were the main symptoms. In this population, many patients have a low viral load and IgG antibody levels. CONCLUSION During the first 2 years of the COVID-19 pandemic in Mexico, children and adolescents had low incidence and mortality. They are a heterogeneous population, but many patients had comorbidities such as obesity, asthma, and immunosuppression; symptoms such as fever, cough, and headache; and low viral load and IgG antibodies.
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Affiliation(s)
- Alejandro Flores-Alanis
- Departamento de Microbiología y Parasitología, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México 04510, Mexico
| | - Zeus Saldaña-Ahuactzi
- Paul G. Allen School for Global Health, College of Veterinary Medicine, Washington State University, Pullman, WA 99164, USA
| | - Israel Parra-Ortega
- Laboratorio Central, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Pablo López-Ramírez
- Centro de Investigación en Ciencias de Información Geoespacial (CentroGeo), Ciudad de México 14240, Mexico
| | - Marcela Salazar-García
- Laboratorio de Biología del Desarrollo y Teratogénesis Experimental, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Yolanda P. Alemán-García
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Armando Cruz-Rangel
- Laboratorio de Bioquímica de Enfermedades Crónicas, Instituto Nacional de Medicina Genómica, Ciudad de México 14610, Mexico
| | - Alba Moreno-Paredes
- Unidad de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
- Licenciatura en Medicina, Facultad de Medicina, Benemérita Universidad Autónoma Puebla, Puebla 72410, Mexico
| | - Adrián Diaz-Rojas
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
- Licenciatura en Químico Farmacéutico Industrial, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
| | - Carmen Maldonado-Bernal
- Unidad de Investigación en Inmunología y Proteómica, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
| | - Jessica Quevedo-Moran
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
- Licenciatura en Químico Bacteriólogo Parasitólogo, Escuela Nacional de Ciencias Biológicas, Instituto Politécnico Nacional, Ciudad de México 11340, Mexico
| | - Victor M. Luna-Pineda
- Laboratorio de Investigación en COVID-19, Hospital Infantil de México Federico Gómez, Ciudad de México 06720, Mexico
- Correspondence:
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9
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Schober T, Caya C, Barton M, Bayliss A, Bitnun A, Bowes J, Brenes-Chacon H, Bullard J, Cooke S, Dewan T, Dwilow R, El Tal T, Foo C, Gill P, Haghighi Aski B, Kakkar F, Lautermilch J, Lefebvre MA, Leifso K, Le Saux N, Lopez A, Manafi A, Merckx J, Morris SK, Nateghian A, Panetta L, Petel D, Piché D, Purewal R, Restivo L, Roberts A, Sadarangani M, Scuccimarri R, Soriano-Fallas A, Tehseen S, Top KA, Ulloa-Gutierrez R, Viel-Theriault I, Wong J, Yea C, Yeh A, Yock-Corrales A, Robinson JL, Papenburg J. Risk factors for severe PCR-positive SARS-CoV-2 infection in hospitalised children. BMJ Paediatr Open 2022; 6:10.1136/bmjpo-2022-001440. [PMID: 36053578 PMCID: PMC9358955 DOI: 10.1136/bmjpo-2022-001440] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 06/19/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To identify risk factors for severe disease in children hospitalised for SARS-CoV-2 infection. DESIGN Multicentre retrospective cohort study. SETTING 18 hospitals in Canada, Iran and Costa Rica from 1 February 2020 to 31 May 2021. PATIENTS Children<18 years of age hospitalised for symptomatic PCR-positive SARS-CoV-2 infection, including PCR-positive multisystem inflammatory syndrome in children (MIS-C). MAIN OUTCOME MEASURE Severity on the WHO COVID-19 Clinical Progression Scale was used for ordinal logistic regression analyses. RESULTS We identified 403 hospitalisations. Median age was 3.78 years (IQR 0.53-10.77). At least one comorbidity was present in 46.4% (187/403) and multiple comorbidities in 18.6% (75/403). Eighty-one children (20.1%) met WHO criteria for PCR-positive MIS-C. Progression to WHO clinical scale score ≥6 occurred in 25.3% (102/403). In multivariable ordinal logistic regression analyses adjusted for age, chest imaging findings, laboratory-confirmed bacterial and/or viral coinfection, and MIS-C diagnosis, presence of a single (adjusted OR (aOR) 1.90, 95% CI 1.13 to 3.20) or multiple chronic comorbidities (aOR 2.12, 95% CI 1.19 to 3.79), obesity (aOR 3.42, 95% CI 1.76 to 6.66) and chromosomal disorders (aOR 4.47, 95% CI 1.25 to 16.01) were independent risk factors for severity. Age was not an independent risk factor, but different age-specific comorbidities were associated with more severe disease in age-stratified adjusted analyses: cardiac (aOR 2.90, 95% CI 1.11 to 7.56) and non-asthma pulmonary disorders (aOR 3.07, 95% CI 1.26 to 7.49) in children<12 years old and obesity (aOR 3.69, 1.45-9.40) in adolescents≥12 years old. Among infants<1 year old, neurological (aOR 10.72, 95% CI 1.01 to 113.35) and cardiac disorders (aOR 10.13, 95% CI 1.69 to 60.54) were independent predictors of severe disease. CONCLUSION We identified risk factors for disease severity among children hospitalised for PCR-positive SARS-CoV-2 infection. Comorbidities predisposing children to more severe disease may vary by age. These findings can potentially guide vaccination programmes and treatment approaches in children.
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Affiliation(s)
- Tilmann Schober
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Chelsea Caya
- Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
| | - Michelle Barton
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Ann Bayliss
- Department of Pediatrics, Trillium Health Partners, Mississauga, Ontario, Canada
| | - Ari Bitnun
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Jennifer Bowes
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Helena Brenes-Chacon
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Jared Bullard
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Suzette Cooke
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Tammie Dewan
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Rachel Dwilow
- Department of Pediatrics, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Tala El Tal
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Cheryl Foo
- Department of Pediatrics, Memorial University of Newfoundland, St. John's, Newfoundland and Labrador, Canada
| | - Peter Gill
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Behzad Haghighi Aski
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Fatima Kakkar
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Janell Lautermilch
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | | | - Kirk Leifso
- Department of Pediatrics, Queen's University, Kingston, Ontario, Canada
| | - Nicole Le Saux
- Department of Pediatrics, University of Ottawa, Ottawa, Ontario, Canada
| | - Alison Lopez
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Ali Manafi
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Joanna Merckx
- Department of Epidemiology, Biostatistics and Occupational Health, McGill University, Montreal, Quebec, Canada
| | - Shaun K Morris
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Alireza Nateghian
- Department of Pediatrics, Iran University of Medical Sciences, Tehran, Iran (the Islamic Republic of)
| | - Luc Panetta
- Department of Pediatrics, Universite de Montreal, Montreal, Quebec, Canada
| | - Dara Petel
- Department of Pediatrics, Western University, London, Ontario, Canada
| | - Dominique Piché
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rupeena Purewal
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Lea Restivo
- Department of Pediatrics, University of Calgary, Calgary, Alberta, Canada
| | - Ashley Roberts
- British Columbia Children's Hospital, Vancouver, British Columbia, Canada.,Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Manish Sadarangani
- Department of Pediatrics, The University of British Columbia, Vancouver, British Columbia, Canada.,Vaccine Evaluation Center, British Columbia Children's Hospital, Vancouver, British Columbia, Canada
| | - Rosie Scuccimarri
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada
| | - Alejandra Soriano-Fallas
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Sarah Tehseen
- Department of Pediatrics, University of Saskatchewan, Saskatoon, Saskatchewan, Canada
| | - Karina A Top
- Department of Pediatrics, Dalhousie University, Halifax, British Columbia, Canada
| | - Rolando Ulloa-Gutierrez
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | | | - Jacqueline Wong
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | - Carmen Yea
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Ann Yeh
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Adriana Yock-Corrales
- Department of Pediatrics, Caja Costarricense de Seguro Social (CCSS), Hospital Nacional de Ninos Dr Carlos Saenz Herrera, San Jose, San José, Costa Rica
| | - Joan L Robinson
- Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Jesse Papenburg
- Department of Pediatrics, McGill University, Montreal, Quebec, Canada .,Research Institute of the McGill University Health Centre, Montreal, Quebec, Canada
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10
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Essig R, Sundland R, Chokshi N. Lessons Learned from Extracorporeal Membrane Oxygenation Use During the COVID-19 Pandemic. Pediatr Ann 2022; 51:e281-e285. [PMID: 35858215 DOI: 10.3928/19382359-20220504-02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
With the rise of the coronavirus disease 2019 (COVID-19) respiratory pandemic, there has been an increased need to consider the use of extracorporeal membrane oxygenation (ECMO) technology. In the early phases of the pandemic, adults constituted most of the critically ill patients, and ECMO management strategies were developed for use in this population. During the course of the pandemic, there has been a rise in the number of critically ill children infected with COVID-19. Although ECMO has been used in the care of pediatric patients for more than half a century, it has been challenging to apply the lessons learned from adult patients with COVID-19 directly to critically ill children for whom ECMO is under consideration. This article reviews ECMO technology and highlights a number of important changes in pediatric ECMO regarding those patients infected with COVID-19. [Pediatr Ann. 2022;51(7):e281-e285.].
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11
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Obesity and COVID-19 in Children and Adolescents: Reciprocal Detrimental Influence—Systematic Literature Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137603. [PMID: 35805260 PMCID: PMC9266144 DOI: 10.3390/ijerph19137603] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 06/19/2022] [Accepted: 06/21/2022] [Indexed: 12/11/2022]
Abstract
The dramatic lifestyle changes forced by COVID-19-related lockdown promoted weight gain, with a stronger impact on obese subjects, at higher risk of severe infection. The PubMed database was searched to identify original studies assessing: (1) the extent and risk factors of lockdown-induced weight increase; and (2) the impact of obesity on the risk of hospital admission in children and adolescents. A systematic literature review and meta-analyses were performed. Twenty out of 13,986 identified records were included. A significant weight increase was reported in the majority of subjects, with no apparent gender or age differences. It was induced by a higher consumption of hypercaloric/hyperglycemic/junk food and/or the reduction of physical activity, often associated with an altered sleep–wake cycle. On the other hand, obesity increased the risk of hospitalization (OR = 4.38; 95% C.I. 1.46–13.19; p = 0.009; I2 = 96%) as compared to the normal weight population. COVID-19 and obesity represent epidemic conditions with reciprocal detrimental impact. Urgent public health interventions, targeting the various age and social strata, and involving governmental authorities, health care personnel, teachers and families are warranted to increase awareness and actively promote healthy lifestyles to contrast pediatric obesity and its detrimental consequences at a global level.
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12
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Simões e Silva AC, Vasconcelos MA, Colosimo EA, Mendonça ACQ, Martelli‐Júnior H, Silva LR, Oliveira MCL, Pinhati CC, Mak RH, Oliveira EA. Outcomes and risk factors of death among hospitalized children and adolescents with obesity and COVID-19 in Brazil: An analysis of a nationwide database. Pediatr Obes 2022; 17:e12920. [PMID: 35481672 PMCID: PMC9111581 DOI: 10.1111/ijpo.12920] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 03/22/2022] [Indexed: 12/24/2022]
Abstract
BACKGROUND Obesity is a well-recognized risk factor for critical illness and death among adult patients with SARS-CoV-2 infection. OBJECTIVE This study aimed to characterize the clinical outcomes and risk factors of death related to obesity in a cohort of hospitalized paediatric patients with COVID-19. METHODS We performed an analysis of all paediatric patients with obesity and COVID-19 registered in SIVEP-Gripe, a Brazilian nationwide surveillance database, between February 2020 and May 2021. The primary outcome was time to death, which was evaluated by using cumulative incidence function. RESULTS Among 21 591 hospitalized paediatric patients with COVID-19, 477 cases (2.2%) had obesity. Of them, 71 (14.9%) had a fatal outcome as compared with 7.5% for patients without obesity (hazard ratio [HR] = 2.0, 95% confidence interval [CI] 1.59-2.53, p < 0.001). After adjustment, the factors associated with death among patients with obesity were female gender (HR = 2.8, 95% CI 1.70-4.61), oxygen saturation < 95% (HR = 2.58, 95% CI 1.38-4.79), presence of one (HR = 1.91, 95% CI 1.11-3.26), and two or more comorbidities (HR = 4.0, 95% CI 2.21-7.56). CONCLUSIONS Children and adolescents with obesity had higher risk of death compared with those without obesity. The higher risk of death was associated with female gender, low oxygen saturation at admission, and presence of other comorbidities.
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Affiliation(s)
- Ana Cristina Simões e Silva
- Division of Pediatric Nephrology, Hospital das ClínicasFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil,Department of Pediatrics, Health Sciences Postgraduate Program, School of MedicineFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Mariana A. Vasconcelos
- Division of Pediatric Nephrology, Hospital das ClínicasFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Enrico A. Colosimo
- Department of StatisticsFederal University of Minas GeraisBelo HorizonteBrazil
| | - Ana Carmen Q. Mendonça
- Division of Pediatric Nephrology, Hospital das ClínicasFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Hercílio Martelli‐Júnior
- Health Science/Primary Care Postgraduate ProgramState University of Montes Claros (Unimontes)Montes ClarosBrazil
| | - Ludmila R. Silva
- Health Science/Postgraduate Program in Nursing, School of NursingFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Maria Christina L. Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of MedicineFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Clara C. Pinhati
- Division of Pediatric Nephrology, Hospital das ClínicasFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
| | - Robert H. Mak
- Division of Pediatric Nephrology, Rady Children's HospitalUniversity of CaliforniaSan DiegoCaliforniaUSA
| | - Eduardo A. Oliveira
- Division of Pediatric Nephrology, Hospital das ClínicasFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil,Department of Pediatrics, Health Sciences Postgraduate Program, School of MedicineFederal University of Minas Gerais (UFMG)Belo HorizonteBrazil
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13
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Clinical Factors Associated with COVID-19 Severity in Chronic Hospitalized Infants and Toddlers: Data from a Center in the West Part of Romania. Healthcare (Basel) 2022; 10:healthcare10050808. [PMID: 35627944 PMCID: PMC9140587 DOI: 10.3390/healthcare10050808] [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: 03/22/2022] [Revised: 04/20/2022] [Accepted: 04/25/2022] [Indexed: 02/01/2023] Open
Abstract
Background: The risk factors for developing a severe form of COVID-19 in young children are poorly understood. Methods: A single-center retrospective study was conducted to quantify and analyze the clinical risk profile of children admitted to the Pediatric Clinic for Nutritional Recovery. Results: Overall, 51.5% (n = 17) of children were infected with SARS-CoV-2, all symptomatic, and five of them (29.4%) developed a severe form. A positive clinical pulmonary exam was only associated with the severe outcome (OR: 2.00; 95% CI, 0.33–5.66; p = 0.02). Other factors such as age under 3 months, prematurity, birth weight, malnutrition or positive history of congenital cardiac, neurodevelopmental, or genetic diseases, fever, temperature, cough, and digestive symptoms were not found to be significant risk factors. Conclusions: Clinical guidelines based on risk stratification for SARS-CoV-2 infection in children are needed in order to manage, monitor and establish priority access for some groups to high medical care.
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14
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Manolis AS, Manolis AA, Manolis TA, Apostolaki NE, Melita H. COVID-19 infection and body weight: A deleterious liaison in a J-curve relationship. Obes Res Clin Pract 2021; 15:523-535. [PMID: 34799284 PMCID: PMC8563353 DOI: 10.1016/j.orcp.2021.10.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 10/10/2021] [Accepted: 10/29/2021] [Indexed: 02/07/2023]
Abstract
During the course of the COVID-19 pandemic, obesity has been shown to be an independent risk factor for high morbidity and mortality. Obesity confers poor outcomes in younger (<60 years) patients, an age-group considered low-risk for complications, a privilege that is negated by obesity. Findings are consistent, the higher the body mass index (BMI) the worse the outcomes. Ectopic (visceral) obesity also promotes proinflammatory, prothrombotic, and vasoconstrictive states, thus enhancing the deleterious effects of COVID-19 disease. Less, albeit robust, evidence also exists for a higher risk of COVID-19 infection incurred with underweight. Thus, the relationship of COVID-19 and BMI has a J-curve pattern, where patients with both overweight/obesity and underweight are more susceptible to the ailments of COVID-19. The pathophysiology underlying this link is multifactorial, mostly relating to the inflammatory state characterizing obesity, the impaired immune response to infectious agents coupled with increased viral load, the overexpression in adipose tissue of the receptors and proteases for viral entry, an increased sympathetic activity, limited cardiorespiratory reserve, a prothrombotic milieu, and the associated comorbidities. All these issues are herein reviewed, the results of large studies and meta-analyses are tabulated and the pathogenetic mechanisms and the BMI relationship with COVID-19 are pictorially illustrated.
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