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Mentor G, Farrar DS, Di Chiara C, Dufour MSK, Valois S, Taillefer S, Drouin O, Renaud C, Kakkar F. The Effect of Age and Comorbidities: Children vs. Adults in Their Response to SARS-CoV-2 Infection. Viruses 2024; 16:801. [PMID: 38793682 PMCID: PMC11126068 DOI: 10.3390/v16050801] [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: 04/04/2024] [Revised: 05/09/2024] [Accepted: 05/14/2024] [Indexed: 05/26/2024] Open
Abstract
While children have experienced less severe coronavirus disease (COVID-19) after SARS-CoV-2 infection than adults, the cause of this remains unclear. The objective of this study was to describe the humoral immune response to COVID-19 in child vs. adult household contacts, and to identify predictors of the response over time. In this prospective cohort study, children with a positive SARS-CoV-2 polymerase chain reaction (PCR) test (index case) were recruited along with their adult household contacts. Serum IgG antibodies against SARS-CoV-2 S1/S2 spike proteins were compared between children and adults at 6 and 12 months after infection. A total of 91 participants (37 adults and 54 children) from 36 families were enrolled. Overall, 78 (85.7%) participants were seropositive for anti-S1/S2 IgG antibody at 6 months following infection; this was higher in children than in adults (92.6% vs. 75.7%) (p = 0.05). Significant predictors of a lack of SARS-CoV-2 seropositivity were age ≥ 25 vs. < 12 years (odds ratio [OR] = 0.23, p = 0.04), presence of comorbidities (vs. none, adjusted OR = 0.23, p = 0.03), and immunosuppression (vs. immunocompetent, adjusted OR = 0.17, p = 0.02).
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Affiliation(s)
- Girlande Mentor
- CHU Sainte-Justine, Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montreal, QC H3T 1C5, Canada; (G.M.); (O.D.)
| | - Daniel S. Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada (C.D.C.)
| | - Costanza Di Chiara
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada (C.D.C.)
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada
| | - Mi-Suk Kang Dufour
- Unité de Recherche Clinique Appliqué, Centre de Recherche du CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada;
| | - Silvie Valois
- Centre D’infectiologie Mère-Enfant, Centre de Recherche du CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.V.)
| | - Suzanne Taillefer
- Centre D’infectiologie Mère-Enfant, Centre de Recherche du CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.V.)
| | - Olivier Drouin
- CHU Sainte-Justine, Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montreal, QC H3T 1C5, Canada; (G.M.); (O.D.)
| | - Christian Renaud
- Département de Microbiologie et Immunologie, Faculté de Médecine, Université de Montréal, Montreal, QC H3T 1C5, Canada;
| | - Fatima Kakkar
- CHU Sainte-Justine, Département de Pédiatrie, Faculté de Médecine, Université de Montréal, Montreal, QC H3T 1C5, Canada; (G.M.); (O.D.)
- Centre D’infectiologie Mère-Enfant, Centre de Recherche du CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.V.)
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Jones-Nosacek C. Vaccine Mandates: Weighing the Common Good vs Personal Conscience and Autonomy. LINACRE QUARTERLY 2024; 91:147-167. [PMID: 38726310 PMCID: PMC11078137 DOI: 10.1177/00243639231213515] [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: 05/12/2024]
Abstract
COVID-19 is a serious illness with significant morbidity and mortality. Vaccines to immunize against it were developed in record time. Mandates followed. The question to be considered is when mandates are ethical. Mandates can be used to prevent spread of an infection, prevent overwhelming the healthcare system, or protect public safety, thereby protecting the vulnerable and allowing for full flourishing of the common good. At the same time, one must be careful about respecting autonomy by allowing those who consciences do not allow them to be vaccinated to refuse. Because COVID-19 knowledge is rapidly changing as more information is known and the virus mutates, the conditions under which mandates are ethical change as well. At present, since vaccines prevent severe infection and death in high-risk individuals with added benefit for those who are vaccinated and have a history of infection, mandates can be imposed on those individuals. With an estimated 95% of the US population believed to have been infected and prior history of infection shown to be as effective as vaccination, with immunity lasting at least 500 days, and ability to prevent spread unknown at present but limited at best in the past, the vaccines therefore cannot be ethically mandated for those who are low risk for the versions released September 2023 based on information as of October 2023.
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Jiang RM, Xie ZD, Jiang Y, Lu XX, Jin RM, Zheng YJ, Shang YX, Xu BP, Liu ZS, Lu G, Deng JK, Liu GH, Wang XC, Wang JS, Feng LZ, Liu W, Zheng Y, Shu SN, Lu M, Luo WJ, Liu M, Cui YX, Ye LP, Shen AD, Liu G, Gao LW, Xiong LJ, Bai Y, Lin LK, Wei Z, Xue FX, Wang TY, Zhao DC, Shao JB, Ng DKK, Wong GWK, Zhao ZY, Li XW, Yang YH, Shen KL. Diagnosis, treatment and prevention of severe acute respiratory syndrome coronavirus 2 infection in children: experts' consensus statement updated for the Omicron variant. World J Pediatr 2024; 20:272-286. [PMID: 37676610 DOI: 10.1007/s12519-023-00745-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 06/29/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Rong-Meng Jiang
- Diagnosis and Treatment Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China
| | - Zheng-De Xie
- Beijing Key Laboratory of Pediatric Respiratory Infection Diseases, Key Laboratory of Major Diseases in Children, Ministry of Education, National Clinical Research Center for Respiratory Diseases, Research Unit of Critical Infection in Children, Chinese Academy of Medical Sciences, 2019RU016, Laboratory of Infection and Virology, Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Yi Jiang
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Xiao-Xia Lu
- Department of Respiratory, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Run-Ming Jin
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yue-Jie Zheng
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Yun-Xiao Shang
- Department of Pediatric Respiratory, Shengjing Hospital Affiliated to China Medical University, Shenyang, 110004, China
| | - Bao-Ping Xu
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Zhi-Sheng Liu
- Department of Neurology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Gen Lu
- Department of Respiratory, Guangzhou Women and Children's Medical Center, Guangzhou, 510623, China
| | - Ji-Kui Deng
- Department of Infectious Diseases, Shenzhen Children's Hospital, Shenzhen, 518038, China
| | - Guang-Hua Liu
- Department of Pediatrics, Fujian Branch of Shanghai Children's Medical Center, Fujian Children's Hospital, Fuzhou, 350005, China
| | - Xiao-Chuan Wang
- Department of Clinical Immunology and Allergy, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Jian-She Wang
- Department of Infectious Diseases, Children's Hospital of Fudan University, National Center for Children's Health, Shanghai, 201102, China
| | - Lu-Zhao Feng
- School of Population Medicine and Public Health, Chinese Academy of Medical Science, Peking Union Medical College, Beijing, 100730, China
| | - Wei Liu
- Children's Hospital of Tianjin University, Tianjin Children's Hospital, Tianjin, 300134, China
| | - Yi Zheng
- Beijing Key Laboratory of Diagnosis and Treatment of Mental Disorders, National Clinical Research Center for Mental and Psychological Disorders, Beijing Anding Hospital, Capital Medical University, Beijing, 100088, China
| | - Sai-Nan Shu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, China
| | - Min Lu
- Department of Respiratory, Shanghai Children's Hospital, Shanghai, 200062, China
| | - Wan-Jun Luo
- Office of Infection Management, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Miao Liu
- Department of Pediatrics, Renmin Hospital of Wuhan University, Wuhan, 430060, China
| | - Yu-Xia Cui
- Department of Pediatrics, Guizhou Provincial People's Hospital, Guiyang, 550002, China
| | - Le-Ping Ye
- Department of Pediatrics, Peking University First Hospital, Beijing, 100034, China
| | - A-Dong Shen
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Gang Liu
- Department of Infectious Diseases, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Li-Wei Gao
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Li-Juan Xiong
- Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Yan Bai
- Department of Pediatrics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China
| | - Li-Kai Lin
- Hospital Management Institute of Wuhan University, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Zhuang Wei
- Children's Health Care Center, National Center for Children's Health, Beijing Children's Hospital, Capital Medical University, Beijing, 100045, China
| | - Feng-Xia Xue
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China
| | - Tian-You Wang
- Hematology and Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing, 100045, China
| | - Dong-Chi Zhao
- Department of Pediatrics, Zhongnan Hospital of Wuhan University, Wuhan, 430071, China
| | - Jian-Bo Shao
- Department of Radiology, Wuhan Children's Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430016, China
| | - Daniel Kwok-Keung Ng
- Department of Pediatrics, Hong Kong Sanatorium & Hospital, Hong Kong, 999077, China
| | - Gary Wing-Kin Wong
- Department of Pediatrics, Prince of Wales Hospital, Chinese University of Hong Kong, Hong Kong, 999077, China
| | - Zheng-Yan Zhao
- Department of Developmental Behavior, Children's Hospital, Zhejiang University College of Medicine, Hangzhou, 310051, China.
| | - Xing-Wang Li
- Diagnosis and Treatment Center of Infectious Diseases, Beijing Ditan Hospital, Capital Medical University, Beijing, 100015, China.
| | - Yong-Hong Yang
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China.
- Beijing Pediatric Research Institute, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China.
| | - Kun-Ling Shen
- Department of Respiratory, Shenzhen Children's Hospital, Shenzhen, 518038, China.
- Department of Respiratory, Beijing Children's Hospital, Capital Medical University, National Clinical Research Center for Respiratory Diseases, National Center for Children's Health, Beijing, 100045, China.
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Barry MC, Pathak EB, Swanson J, Cen R, Menard J, Salemi JL, Nembhard WN. Epidemiology of COVID-19 in Infants in the United States: Incidence, Severity, Fatality, and Variants of Concern. Pediatr Infect Dis J 2024; 43:217-225. [PMID: 38134379 DOI: 10.1097/inf.0000000000004201] [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: 12/24/2023]
Abstract
BACKGROUND The clinical spectrum of infant COVID-19 ranges from asymptomatic infection to life-threatening illness, yet epidemiologic surveillance has been limited for infants. METHODS Using COVID-19 case data (restricted to reporting states) and national mortality data, we calculated incidence, hospitalization, mortality and case fatality rates through March 2022. RESULTS Reported incidence of COVID-19 was 64.1 new cases per 1000 infant years (95% CI: 63.3-64.9). We estimated that 594,012 infants tested positive for COVID-19 nationwide by March 31, 2022. Viral variant comparisons revealed that incidence was 7× higher during the Omicron (January-March 2022) versus the pre-Delta period (June 2020-May 2021). The cumulative case hospitalization rate was 4.1% (95% CI: 4.0%-4.3%). For every 74 hospitalized infants, one infant death occurred, but overall COVID-19-related infant case fatality was low, with 7.0 deaths per 10,000 cases (95% CI: 5.6-8.7). Nationwide, 333 COVID-19 infant deaths were reported. Only 13 infant deaths (3.9%) were the result of usually lethal congenital anomalies. The majority of infant decedents were non-White (28.2% Black, 26.1% Hispanic, 8.1% Asian, Indigenous or multiracial). CONCLUSIONS More than half a million US infants contracted COVID-19 by March 2022. Longitudinal assessment of long-term infant SARS-CoV-2 infection sequelae remains a critical research gap. Extremely low infant vaccination rates (<5%), waning adult immunity and continued viral exposure risks suggest that infant COVID-19 will remain a persistent public health problem. Our study underscores the need to increase vaccination rates for mothers and infants, decrease viral exposure risks and improve health equity.
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Affiliation(s)
- Megan C Barry
- From the College of Public Health, University of South Florida, Tampa, Florida
| | | | - Justin Swanson
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Ruiqi Cen
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
| | - Janelle Menard
- Women's Institute for Independent Social Enquiry, Olney, Maryland
| | - Jason L Salemi
- From the College of Public Health, University of South Florida, Tampa, Florida
| | - Wendy N Nembhard
- Department of Epidemiology, University of Arkansas for Medical Sciences, Little Rock, Arkansas
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5
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Romagnoli BR, Phan TLT, Lewis AM, Alderfer MA, Kazak AE, Arasteh K, Enlow PT. The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study. J Pediatr Psychol 2024; 49:98-106. [PMID: 37930074 PMCID: PMC10874214 DOI: 10.1093/jpepsy/jsad078] [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: 02/27/2023] [Revised: 10/18/2023] [Accepted: 10/18/2023] [Indexed: 11/07/2023] Open
Abstract
OBJECTIVE Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families. METHODS A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables. RESULTS Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth. CONCLUSIONS Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.
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Affiliation(s)
| | - Thao-Ly T Phan
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Amanda M Lewis
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Melissa A Alderfer
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Anne E Kazak
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
| | - Kamyar Arasteh
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
| | - Paul T Enlow
- Division of Behavioral Health, Nemours Children’s Health, USA
- Center for Healthcare Delivery Science, Nemours Children’s Health, USA
- Department of Pediatrics, Sidney Kimmel Medical College, Thomas Jefferson University, USA
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6
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Alshehri SS, Minhaji BI, Pasha MR, Fouda D, Joseph J, Ahmed N. Characteristics and Outcomes of Children With Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection Admitted to a Quaternary Hospital: A Single-Center Experience. Cureus 2024; 16:e52532. [PMID: 38371066 PMCID: PMC10870100 DOI: 10.7759/cureus.52532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2024] [Indexed: 02/20/2024] Open
Abstract
Objectives In the setting of the recent global pandemic, children infected with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus causing the coronavirus disease 2019 (COVID-19) presented to our hospital with a variety of symptoms ranging from mild to severe disease including multiorgan dysfunction. Our objective was to study the clinical profile, risk factors, complications, and outcomes in pediatric patients admitted to our center with SARS-CoV-2 infection. Methods This retrospective observational study was conducted at a large quaternary center in Riyadh between May 2020 and September 2021. The study population was comprised of children between 0 and ≤14 years with SARS-CoV-2 suspicion or positivity. Results One hundred and fifty-six children were included in the study, the majority of whom were 1-10 years old. One hundred and twenty of them (76.93%) were SARS-CoV-2 positive. Fifty-nine patients (37.18%) were labelled as multisystem inflammatory syndrome in children (MIS-C) based on clinical and lab criteria, of whom 35 (22.44%) tested SARS-CoV-2 positive. Hematological disease was found to be the most common comorbidity, followed by neurological and chronic lung diseases. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Eighty patients (51%) required pediatric intensive care unit (PICU) admission (length of stay: 5-12 days), among whom 32 (40%) required ventilation, 26 (32.5%) needed hemodynamic support, and three patients (3.75%) underwent continuous renal replacement therapy (CRRT). The overall mortality rate was 4.5% (seven patients) among the studied population. The most frequent lab abnormalities were found to be elevated serum ferritin, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and lactate dehydrogenase (LDH) levels. Ninety-one percent received antibiotics, and prophylactic anticoagulant was used in 32%. In the MIS-C subset, 80.5% received steroids, 71.43% intravenous immunoglobulin (IVIG), and 5.17% (three patients) tocilizumab. Conclusion The SARS-CoV-2 infection presented with a range of severity among our cohort of children; however, most of the patients responded well to appropriate supportive treatment. A slight male preponderance was noted. The most common symptoms encountered were fever, cough, vomiting, fatigue, and diarrhea. Inflammatory markers such as ESR, CRP, serum ferritin, and LDH levels were found to be elevated in nearly all patients. Raised serum lactate and serum creatinine and lymphopenia were of significant note in patients with MIS-C. Higher mortality rates were observed in patients with MIS-C and those requiring respiratory support. In addition to these two factors, the presence of comorbidities and the need for CRRT were associated with prolonged PICU length of stay.
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Affiliation(s)
- Saleh S Alshehri
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Bushra I Minhaji
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Mohsina R Pasha
- Pediatric Intensive Care Unit, King Saud Medical City, Riyadh, SAU
| | - Dina Fouda
- Pharmaceutical Care Services, King Saud Medical City, Riyadh, SAU
| | - Jency Joseph
- Nursing Administration, King Saud Medical City, Riyadh, SAU
| | - Nehad Ahmed
- Clinical Pharmacy, Prince Sattam bin Abdulaziz University, Alkharj, SAU
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Khoury M, Harahsheh AS, Raghuveer G, Dahdah N, Lee S, Fabi M, Selamet Tierney ES, Portman MA, Choueiter NF, Elias M, Thacker D, Dallaire F, Orr WB, Harris TH, Norozi K, Truong DT, Khare M, Szmuszkovicz JR, Pagano JJ, Manlhiot C, Farid P, McCrindle BW. Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2023; 6:e2346829. [PMID: 38064213 PMCID: PMC10709775 DOI: 10.1001/jamanetworkopen.2023.46829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Objective To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. Design, Setting, and Participants In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. Main Outcomes and Measures Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. Results Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. Conclusions and Relevance In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.
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Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ashraf S Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | | | - Nadine F Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Matthew Elias
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Frédéric Dallaire
- Department of Pediatrics, Universite de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, Ontario, Canada
| | | | - Manaswitha Khare
- University of California San Diego/Rady Children's Hospital San Diego
| | | | - Joseph J Pagano
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland
| | - Pedrom Farid
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
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8
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Brunetti MA, Griffis HM, O'Byrne ML, Glatz AC, Huang J, Schumacher KR, Bailly DK, Domnina Y, Lasa JJ, Moga MA, Zaccagni H, Simsic JM, Gaynor JW. Racial and Ethnic Variation in ECMO Utilization and Outcomes in Pediatric Cardiac ICU Patients. JACC. ADVANCES 2023; 2:100634. [PMID: 38938717 PMCID: PMC11198441 DOI: 10.1016/j.jacadv.2023.100634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 06/15/2023] [Accepted: 07/26/2023] [Indexed: 06/29/2024]
Abstract
Background Previous studies have reported racial disparities in extracorporeal membrane oxygenation (ECMO) utilization in pediatric cardiac patients. Objectives The objective of this study was to determine if there was racial/ethnic variation in ECMO utilization and, if so, whether mortality was mediated by differences in ECMO utilization. Methods This is a multicenter, retrospective cohort study of the Pediatric Cardiac Critical Care Consortium clinical registry. Analyses were stratified by hospitalization type (medical vs surgical). Logistic regression models were adjusted for confounders and evaluated the association between race/ethnicity with ECMO utilization and mortality. Secondary analyses explored interactions between race/ethnicity, insurance, and socioeconomic status with ECMO utilization and mortality. Results A total of 50,552 hospitalizations from 34 hospitals were studied. Across all hospitalizations, 2.9% (N = 1,467) included ECMO. In medical and surgical hospitalizations, Black race and Hispanic ethnicity were associated with severity of illness proxies. In medical hospitalizations, race/ethnicity was not associated with the odds of ECMO utilization. Hospitalizations of other race had higher odds of mortality (adjusted odds ratio [aOR]: 1.61; 95% CI: 1.22-2.12; P = 0.001). For surgical hospitalizations, Black (aOR: 1.24; 95% CI: 1.02-1.50; P = 0.03) and other race (aOR: 1.50; 95% CI: 1.17-1.93; P = 0.001) were associated with higher odds of ECMO utilization. Hospitalizations of Hispanic patients had higher odds of mortality (aOR: 1.31; 95% CI: 1.03-1.68; P = 0.03). No significant interactions were demonstrated between race/ethnicity and socioeconomic status indicators with ECMO utilization or mortality. Conclusions Black and other races were associated with increased ECMO utilization during surgical hospitalizations. There were racial/ethnic disparities in outcomes not explained by differences in ECMO utilization. Efforts to mitigate these important disparities should include other aspects of care.
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Affiliation(s)
- Marissa A. Brunetti
- Department of Anesthesiology and Critical Care Medicine, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Heather M. Griffis
- Data Science and Biostatistics Unit, Department of Biomedical and Health Informatics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Michael L. O'Byrne
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children’s Hospital of Philadelphia, and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Leonard Davis Institute and Cardiovascular Outcomes, Quality, and Evaluative Research Center, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Andrew C. Glatz
- Division of Cardiology, Department of Pediatrics, University of Pennsylvania Perelman School of Medicine, Children’s Hospital of Philadelphia, and Center for Pediatric Clinical Effectiveness, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Jing Huang
- Department of Biostatistics, Epidemiology, and Informatics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
| | - Kurt R. Schumacher
- Department of Pediatrics, University of Michigan Medical School and C.S. Mott Children’s Hospital, Ann Arbor, Michigan, USA
| | - David K. Bailly
- Department of Pediatrics, University of Utah and Primary Children’s Hospital, Salt Lake City, Utah, USA
| | - Yuliya Domnina
- Division of Cardiac Critical Care Medicine, George Washington University School of Medicine and Children’s National Hospital, Washington, DC, USA
| | - Javier J. Lasa
- Divisions of Critical Care Medicine and Cardiology, Department of Pediatrics, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas, USA
| | - Michael Alice Moga
- Department of Critical Care Medicine, The Hospital for Sick Children, Toronto, Canada
| | - Hayden Zaccagni
- Section of Cardiac Critical Care Medicine, Department of Pediatrics, Children’s of Alabama and University of Alabama Medicine, Birmingham, Alabama, USA
| | - Janet M. Simsic
- The Heart Center at Nationwide Children’s Hospital, Columbus, Ohio, USA
| | - J. William Gaynor
- Department of Surgery, University of Pennsylvania Perelman School of Medicine and Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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9
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da Silva ACCAC, Luiz RR, de Moraes JR, Rocha PHV, Zeitoune RCG, Barbosa AP, Moreira JPDL. Hospital mortality from covid-19 in children and adolescents in Brazil in 2020-2021. Rev Saude Publica 2023; 57:56. [PMID: 37878842 PMCID: PMC10519682 DOI: 10.11606/s1518-8787.2023057005172] [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] [Received: 11/08/2022] [Accepted: 11/25/2022] [Indexed: 10/27/2023] Open
Abstract
OBJECTIVE To describe cases, deaths, and hospital mortality from covid-19 in children and adolescents in Brazil, according to age group, during the evolving phases of the pandemic in 2020 and 2021. METHODS Census of patients aged up to 19 committed with severe acute respiratory syndrome, due to covid-19 or unspecified, notified to the Brazilian Influenza Epidemiological Surveillance Information System, from January 1, 2020, to December 31, 2021. The two years were divided into six phases, covering the spread of the disease-first, second and third wave-as well as the impact of vaccination. The pediatric population was categorized into infants, preschoolers, schoolchildren, and adolescents. Hospital mortality was assessed by pandemic phase and age group. RESULTS A total of 144,041 patients were recorded in the two years, 18.2% of whom had confirmed cases of covid-19. Children under 5 years old (infants and preschoolers) accounted for 62.8% of those hospitalized. A total of 4,471 patients died, representing about 6.1 deaths per day. Infants were the ones who most progressed to the intensive care unit (24.7%) and had the highest gross number of deaths (n = 2,012), but mortality was higher among adolescents (5.7%), reaching 9.8% in phase 1. The first peak of deaths occurred in phase 1 (May/2020), and two other peaks occurred in phase 4 (March/2021 and May/2021). There was an increase in cases and deaths for younger ages since phase 4. Hospital mortality in the pediatric population was higher in phases 1, 4, and 6, following the phenomena of dissemination/interiorization of the virus in the country, beginning of the second wave and beginning of the third wave, respectively. CONCLUSION The absolute number of cases of covid-19 in children and adolescents is significant. Although complete vaccination in descending order of age provided a natural deviation in age range, there was a greater gap between the curve of new hospitalized cases and the curve of deaths, indicating the positive impact of immunization.
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Affiliation(s)
- Amanda Cilene Cruz Aguiar Castilho da Silva
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Ronir Raggio Luiz
- Universidade Federal do Rio de JaneiroInstituto de Saúde ColetivaRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Instituto de Saúde Coletiva. Rio de Janeiro, RJ, Brazil.
| | - José Rodrigo de Moraes
- Universidade Federal FluminenseInstituto de Matemática e EstatísticaDepartamento de EstatísticaNiteróiRJBrazilUniversidade Federal Fluminense. Instituto de Matemática e Estatística. Departamento de Estatística. Niterói, RJ, Brazil.
| | - Pedro Henrique Vieira Rocha
- Universidade Federal FluminenseFaculdade de FarmáciaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Niterói, RJ, Brazil.
| | - Regina Célia Gollner Zeitoune
- Universidade Federal do Rio de JaneiroEscola de Enfermagem Anna NeryRio de JaneiroRJBrazilUniversidade Federal do Rio de Janeiro. Escola de Enfermagem Anna Nery. Rio de Janeiro, RJ, Brazil.
| | - Arnaldo Prata Barbosa
- Instituto D’Or de Pesquisa e EnsinoDepartamento de PediatriaRio de JaneiroRJBrazilInstituto D’Or de Pesquisa e Ensino. Departamento de Pediatria. Rio de Janeiro, RJ, Brazil.
| | - Jessica Pronestino de Lima Moreira
- Universidade Federal FluminenseFaculdade de FarmáciaDepartamento de BromatologiaNiteróiRJBrazilUniversidade Federal Fluminense. Faculdade de Farmácia. Departamento de Bromatologia. Niterói, RJ, Brazil.
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10
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Pajek J, Mancini K, Murray M. COVID-19 and children's behavioral health: An overview. Curr Probl Pediatr Adolesc Health Care 2023; 53:101491. [PMID: 38040607 DOI: 10.1016/j.cppeds.2023.101491] [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] [Indexed: 12/03/2023]
Abstract
The paper reviews the impact of the COVID-19 pandemic on children's and adolescents' well-being. A trauma-informed framework is employed to discuss the emerging evidence of notable changes in youth's psychological, developmental, academic, and social well-being since the start of the COVID-19 pandemic. Children and adolescents have been uniquely affected based on their age at the start of the pandemic. Despite multiple resiliency factors, COVID-19 and its ramifications have had an adverse effect on youth in general and have exacerbated preexisting racial and socioeconomic disparities. This review concludes with recommendations for child health clinicians.
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Affiliation(s)
- Julie Pajek
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
| | - Kathryn Mancini
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - Marsheena Murray
- MetroHealth Medical Center, Case Western Reserve University School of Medicine, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
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11
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Yeo JG, Teh KL, Chia WN, Book YX, Hoh SF, Gao X, Das L, Zhang J, Sutamam N, Poh SL, Lim AJM, Tay SH, Yaung KN, Ong XM, Leong JY, Wang LF, Albani S, Arkachaisri T. COVID-19 mRNA vaccine immunogenicity decay and breakthrough illness in adolescents and young adults with childhood-onset rheumatic diseases. Rheumatology (Oxford) 2023; 62:3101-3109. [PMID: 36661304 DOI: 10.1093/rheumatology/kead031] [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] [Received: 09/12/2022] [Revised: 12/15/2022] [Accepted: 01/10/2023] [Indexed: 01/21/2023] Open
Abstract
OBJECTIVES To evaluate the humoral immunogenicity for 6 months after the two-dose coronavirus disease 2019 (COVID-19) mRNA vaccination in adolescents and young adults (AYAs) with childhood-onset rheumatic diseases (cRDs). METHODS This monocentric observational study was conducted between August 2020 and March 2022. Humoral immunogenicity was assessed at 2-3 weeks after first vaccine dose and 1, 3 and 6 months after the second dose by the cPass™ severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) neutralization antibody (nAb) assay. An inhibition signal of ≥30% defined the seroconversion threshold and the readings were calibrated against the World Health Organization International Standard for SARS-CoV-2 antibodies. RESULTS. ONE HUNDRED AND SIXTY-NINE AYAs with cRDs were recruited [median age 16.8 years (interquartile range, IQR 14.7-19.5), 52% female, 72% Chinese]. JIA (58%) and SLE (18%) comprised the major diagnoses. After second vaccine dose, 99% seroconverted with a median nAb titre of 1779.8 IU/ml (IQR 882.8-2541.9), declining to 935.6 IU/ml (IQR 261.0-1514.9) and 683.2 IU/ml (IQR 163.5-1400.5) at the 3- and 6-month timepoints, respectively. The diagnosis of JIA [odds ratio (OR) 10.1, 95% CI 1.8-58.4, P = 0.010] and treatment with anti-TNF-α (aTNF) (OR 10.1, 95% CI 1.5-70.0, P = 0.019) were independently associated with a >50% drop of nAb titres at 6 months. Withholding MTX or MMF did not affect the vaccine response or decay rate. The COVID-19 breakthrough infection was estimated at 18.2 cases/1000 patient-months with no clinical risk factors identified. CONCLUSION Over half of AYAs with cRDs had a significant drop in SARS-CoV-2 nAb at 6-month despite an initial robust humoral response. JIA and aTNF usage are predictors of a faster decay rate.
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Affiliation(s)
- Joo Guan Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Kai Liang Teh
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Wan Ni Chia
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Sook Fun Hoh
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Xiaocong Gao
- Division of Nursing, KK Women's and Children's Hospital, Singapore, Singapore
| | - Lena Das
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
| | - Jinyan Zhang
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Nursyuhadah Sutamam
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Su Li Poh
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Shi Huan Tay
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Katherine Nay Yaung
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Xin Mei Ong
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Jing Yao Leong
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
| | - Lin-Fa Wang
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
- SingHealth-Duke-NUS Global Health Institute, Singapore, Singapore
| | - Salvatore Albani
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre, Singapore, Singapore
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialties, KK Women's and Children's Hospital, Singapore, Singapore
- Paediatric Academic Clinical Programme, Duke-NUS Medical School, Singapore, Singapore
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12
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Affiliation(s)
- Tamara S Hannon
- From the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis (T.S.H.); and the Center for Pediatric Research in Obesity and Metabolism and the Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.)
| | - Silva A Arslanian
- From the Department of Pediatrics, Division of Pediatric Endocrinology and Diabetology, Indiana University School of Medicine, Indianapolis (T.S.H.); and the Center for Pediatric Research in Obesity and Metabolism and the Division of Pediatric Endocrinology, Metabolism, and Diabetes Mellitus, UPMC Children's Hospital of Pittsburgh, Pittsburgh (S.A.A.)
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13
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Yang YK, Lin F, Lin JF, Lin CF, Liu LL, Ma YB, Wang XY, Liao YW, Huang YC, Zeng GK, Xiao BR, Huang SH, Xu YM, Chen YE, Cao YB, Yang LY. Covid-19 omicron variant infection in neonates of Guangdong province-a report of 52 cases. Front Pediatr 2023; 11:1191651. [PMID: 37416819 PMCID: PMC10322182 DOI: 10.3389/fped.2023.1191651] [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: 03/22/2023] [Accepted: 06/08/2023] [Indexed: 07/08/2023] Open
Abstract
Objective To analyze the clinical characteristics of neonatal infection during the outbreak of COVID-19 omicron variant in Guangdong province of China. Method The clinical data of neonates infected with COVID-19 omicron variant were collected from three hospitals of Guangdong province, their epidemiological history, clinical manifestation and prognosis were summarized. Results From December 12, 2022 to January 15, 2023, a total of 52 neonates with COVID-19 infection were identified across three hospitals in Guangdong Province, including 34 males and 18 females. The age of diagnosis was 18.42 ± 6.32 days. 24 cases had clear contact history with adults who were suspected to be infected with COVID-19. The most common clinical manifestation was fever (43/52, 82.7%), the duration of fever was 1-8 days. The other clinical manifestations were cough (27/52, 51.9%), rales (21/52, 40.4%), nasal congestion (10/52, 19.2%), shortness of breath (2/52, 3.8%), and vomiting (4/52, 7.7%). C-reactive protein was only increased in 3 cases. Chest radiological examination was performed in 42 neonates, twenty-three cases showed abnormal chest radiographic findings, including ground-glass opacity and consolidation. Fifty cases were admitted with COVID-19 presentation, two cases were admitted for jaundice. The hospital stay was 6.59 ± 2.77 days. The clinical classification included 3 cases of severe COVID-19 and one critical case. Fifty-one cases were cured and discharged after general treatment, and one critical case with respiratory failure was intubated and transferred to another hospital. Conclusion The COVID-19 omicron variant infection in neonates is usually mild. The clinical manifestation and laboratory results are not specific, and the short-term prognosis is good.
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Affiliation(s)
- Yi-Kang Yang
- Institute of Medicine and Nursing, Hubei University of Medicine, Shiyan, China
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
| | - Fen Lin
- Precision Medical Lab Center, Chaozhou Central Hospital, Chaozhou, China
| | - Jian-Feng Lin
- Department of Neonatology, Pengpai Memorial Hospital, Shanwei, China
| | - Chun-Fan Lin
- Department of Neonatology, People's Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Li-Li Liu
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
| | - Yu-Bin Ma
- Department of Neonatology, Chaozhou Central Hospital, Chaozhou, China
| | - Xian-Yao Wang
- Department of Pediatrics, Shantou Central Hospital, Shantou, China
| | - Yu-Wei Liao
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
- Key Laboratory of Respiratory Disease of Yangjiang, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yu-Chan Huang
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
| | - Guang-Kuan Zeng
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
| | - Bei-Ru Xiao
- Department of Neonatology, People's Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Shan-Hua Huang
- Department of Neonatology, People's Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yu-Mei Xu
- Department of Neonatology, People's Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yue-E Chen
- Department of Neonatology, People's Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
| | - Yan-Bin Cao
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
| | - Li-Ye Yang
- Precision Medical Lab Center, People's Hospital of Yangjiang, Yangjiang, China
- Key Laboratory of Respiratory Disease of Yangjiang, People’s Hospital of Yangjiang Affiliated to Guangdong Medical University, Yangjiang, China
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14
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Abstract
Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection is common in children, and clinical manifestations can vary depending on age, underlying disease, and vaccination status. Most children will have asymptomatic or mild infection, but certain baseline characteristics can increase the risk of moderate to severe disease. The following article will provide an overview of the clinical manifestations of coronavirus disease 2019 in children, including the post-infectious phenomenon called multisystem inflammatory syndrome in children. Currently available treatment and prophylaxis strategies will be outlined, with the caveat that new therapeutics and clinical efficacy data are constantly on the horizon.
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Affiliation(s)
- Alpana Waghmare
- Department of Pediatrics, University of Washington, Fred Hutchinson Cancer Research Center Vaccine, 1100 Fairview Avenue North, Seattle, WA 98109, USA; Department of Infectious Diseases, Division Seattle Children's Hospital, Seattle, WA, USA
| | - Diego R Hijano
- St. Jude Children's Research Hospital, 262 Danny Thomas Place Mail Stop 230, Memphis, TN 38105, USA.
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15
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Farrar D, Hepburn CM, Drouin O, El Tal T, Morin MP, Berard R, King M, Thibodeau ML, Baerg K, Beaudoin-Bussières G, Beaufils C, Bennett TL, Benseler S, Chan K, Cyr C, Dahdah N, Donner E, Embree J, Farrell C, Finzi A, Forgie S, Giroux R, Kang K, Lang B, Laxer R, McCrindle B, Orkin J, Papenburg J, Pound C, Price V, Proulx-Gauthier JP, Purewal R, Sadarangani M, Salvadori M, Thibeault R, Top K, Viel-Thériault I, Haddad E, Scuccimarri R, Yeung R, Kakkar F, Morris S. Resource use and disease severity of children hospitalized for COVID-19 versus multisystem inflammatory syndrome in children (MIS-C) in Canada. CANADA COMMUNICABLE DISEASE REPORT = RELEVE DES MALADIES TRANSMISSIBLES AU CANADA 2023; 49:103-112. [PMID: 38356877 PMCID: PMC10866613 DOI: 10.14745/ccdr.v49i04a03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/16/2024]
Abstract
Background Direct comparisons of paediatric hospitalizations for acute coronavirus disease 2019 (COVID-19) and multisystem inflammatory syndrome in children (MIS-C) can inform health system planning. We describe the absolute and relative hospital burden of acute paediatric COVID-19 and MIS-C in Canada. Methods This national prospective study was conducted via the Canadian Paediatric Surveillance Program from March 2020-May 2021. Children younger than 18 years old and hospitalized for acute COVID-19 or MIS-C were included in the analysis. Outcomes included supplemental oxygen (low-flow oxygen or high-flow nasal cannula), ventilation (non-invasive or conventional mechanical), vasopressors, paediatric intensive care unit (PICU) admission, or death. Adjusted risk differences (aRD) and 95% confidence intervals (CI) were calculated to identify factors associated with each diagnosis. Results Overall, we identified 330 children hospitalized for acute COVID-19 (including five deaths) and 208 hospitalized for MIS-C (including zero deaths); PICU admission was required for 49.5% of MIS-C hospitalizations versus 18.2% of acute COVID-19 hospitalizations (aRD 20.3; 95% CI, 9.9-30.8). Resource use differed by age, with children younger than one year hospitalized more often for acute COVID-19 (aRD 43.4% versus MIS-C; 95% CI, 37.7-49.1) and more children 5-11 years hospitalized for MIS-C (aRD 38.9% vs. acute COVID-19; 95% CI, 31.0-46.9). Conclusion While there were more hospitalizations and deaths from acute paediatric COVID-19, MIS-C cases were more severe, requiring more intensive care and vasopressor support. Our findings suggest that both acute COVID-19 and MIS-C should be considered when assessing the overall burden of severe acute respiratory syndrome coronavirus 2 in hospitalized children.
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Affiliation(s)
- Daniel Farrar
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
| | - Charlotte Moore Hepburn
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON
| | - Olivier Drouin
- Division of General Paediatrics, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
- Department of Social and Preventive Medicine, School of Public Health, Université de Montréal, Montréal, QC
| | - Tala El Tal
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
| | - Marie-Paule Morin
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Roberta Berard
- Division of Rheumatology, Department of Paediatrics, Children’s Hospital at London Health Sciences Centre, London, ON
| | - Melanie King
- Canadian Paediatric Surveillance Program, Canadian Paediatric Society, Ottawa, ON
| | | | - Krista Baerg
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of General Paediatrics, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Guillaume Beaudoin-Bussières
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Camille Beaufils
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | | | - Susanne Benseler
- Alberta Children’s Hospital Research Institute, Cumming School of Medicine, University of Calgary, Calgary, AB
- Division of Rheumatology, Department of Paediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, AB
| | - Kevin Chan
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Department of Children’s and Women’s Health, Trillium Health Partners, Mississauga, ON
- Institute for Better Health, Trillium Health Partners, Mississauga, ON
| | - Claude Cyr
- Service de Soins Intensifs Pédiatriques, Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC
| | - Nagib Dahdah
- Division of Paediatric Cardiology, CHU Sainte-Justine, Department of Paediatrics, University of Montréal, Montréal, QC
| | - Elizabeth Donner
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Neurology, The Hospital for Sick Children, Toronto, ON
| | - Joanne Embree
- Department of Paediatrics and Child Health, University of Manitoba, Winnipeg, MB
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, MB
| | - Catherine Farrell
- Division of Paediatric Intensive Care, Department of Paediatrics, CHU Sainte-Justine, Montréal, QC
| | - Andrés Finzi
- Centre de Recherche du CHUM et Département de Microbiologie, Infectiologie et Immunologie, Université de Montréal, Montréal, QC
| | - Sarah Forgie
- Division of Infectious Diseases, Department of Paediatrics, University of Alberta, Edmonton, AB
- Stollery Children’s Hospital, Edmonton, AB
| | - Ryan Giroux
- Women’s and Children’s Health Program, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON
| | - Kristopher Kang
- Department of Paediatrics, University of British Columbia, Vancouver, BC
| | - Bianca Lang
- Division of Rheumatology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Ronald Laxer
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
| | - Brian McCrindle
- The Labatt Family Heart Centre, The Hospital for Sick Children, Department of Paediatrics, University of Toronto, Toronto, ON
| | - Julia Orkin
- Division of Paediatric Medicine, The Hospital for Sick Children, Toronto, ON
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON
| | - Jesse Papenburg
- Division of Paediatric Infectious Diseases, Department of Paediatrics, Montreal Children’s Hospital, Montréal, QC
- Division of Microbiology, Department of Clinical Laboratory Medicine, McGill University Health Centre, Montréal, QC
| | - Catherine Pound
- Division of Consulting Paediatrics, Department of Paediatrics, Children’s Hospital of Eastern Ontario, Ottawa, ON
| | - Victoria Price
- Division of Paediatric Hematology/Oncology, Department of Paediatrics, Dalhousie University, Halifax, NS
| | | | - Rupeena Purewal
- Department of Paediatrics, University of Saskatchewan, Saskatoon, SK
- Division of Paediatric Infectious Diseases, Jim Pattison Children’s Hospital, Saskatchewan Health Authority, Saskatoon, SK
| | - Manish Sadarangani
- Department of Paediatrics, University of British Columbia, Vancouver, BC
- Vaccine Evaluation Center, BC Children’s Hospital Research Institute, Vancouver, BC
| | | | - Roseline Thibeault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Karina Top
- Department of Paediatrics, Dalhousie University, Halifax, NS
| | - Isabelle Viel-Thériault
- Division of Infectious Diseases, Department of Paediatrics, CHU de Québec-Université Laval, Québec City, QC
| | - Elie Haddad
- Division of Paediatric Rheumatology-Immunology, CHU Sainte-Justine, Department of Paediatrics, University of Montreal, Montréal, QC
| | - Rosie Scuccimarri
- Division of Paediatric Rheumatology, Montreal Children’s Hospital and McGill University Health Centre, Montréal, QC
| | - Rae Yeung
- Division of Rheumatology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, ON
- Cell Biology Program, The Hospital for Sick Children, Toronto, ON
- Department of Immunology and Institute of Medical Science, University of Toronto, Toronto, ON
| | - Fatima Kakkar
- Division of Infectious Diseases, CHU Sainte-Justine, Montréal, QC
| | - Shaun Morris
- Centre for Global Child Health, The Hospital for Sick Children, Toronto, ON
- Department of Paediatrics, Temerty Faculty of Medicine, University of Toronto, Toronto, ON
- Division of Infectious Diseases, The Hospital for Sick Children, Toronto, ON
- Clinical Public Health, Dalla Lana School of Public Health, University of Toronto, Toronto, ON
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16
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Oliveira EA, Oliveira MCL, Silva ACSE, Colosimo EA, Mak RH, Vasconcelos MA, Silva LR, Martelli DB, Pinhati CC, Martelli-Júnior H. Clinical Outcomes of Omicron Variant (B.1.1.529) Infection in Children and Adolescents Hospitalized With COVID-19 in Brazil With Observational Data on the Efficacy of the Vaccines in Adolescents. Pediatr Infect Dis J 2023; 42:218-225. [PMID: 36730085 PMCID: PMC9935234 DOI: 10.1097/inf.0000000000003783] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/30/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Eduardo A. Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Maria Christina L. Oliveira
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ana Cristina Simões e Silva
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Enrico A. Colosimo
- Department of Statistics, Federal University of Minas Gerais, Belo Horizonte, Brazil
| | - Robert H. Mak
- Department of Pediatrics, Rady Children’s Hospital, University of California, San Diego, La Jolla, CA
| | - Mariana A. Vasconcelos
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Ludmila R. Silva
- Health Science/Postgraduate Program in Nursing. School of Nursing, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Daniella B. Martelli
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Brazil
| | - Clara C. Pinhati
- Department of Pediatrics, Health Sciences Postgraduate Program, School of Medicine, Federal University of Minas Gerais (UFMG), Belo Horizonte, Brazil
| | - Hercílio Martelli-Júnior
- Health Science/Primary Care Postgraduate Program, State University of Montes Claros (Unimontes), Montes Claros, Brazil
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17
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Assadi M, Kiani M, Shamsi Gooshki E, Aryanian Z, Afshar ZM, Hatami P. COVID-19 vaccination in children as a global dilemma through an ethical lens: A retrospective review. Health Sci Rep 2023; 6:e976. [PMID: 36479386 PMCID: PMC9719287 DOI: 10.1002/hsr2.976] [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: 05/04/2022] [Revised: 11/17/2022] [Accepted: 11/20/2022] [Indexed: 12/05/2022] Open
Abstract
Background and Aims COVID-19 pandemic led to a need to rapidly vaccinate as many people as possible. Children are an important part of the population with different characteristics which vaccinating them is a matter of great importance as it should be decided considering all aspects and ethics. Here, we present different aspects of COVID vaccination in children including the potential challenges. Methods We searched on PubMed, Google Scholar and Scopus in this regard, and all of the relevant papers published until June 28, 2021 were included if we could access their full-texts. Results We found various expert opinions in this regard and tried to summarized them. Saving lives has similar ethical value as preventing evitable adverse event. Accordingly, mandating the children to receive the SARS-CoV-2 vaccine, needs risk-benefit weighing with special consideration of ethical challenges. Conclusion Considering the vast range of benefits resulted from pediatric vaccination both for the children and the community, implementing the program in a scientific manner and also with the least financial expenses for the families seems to be reasonable and makes it both ethical and moral.
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Affiliation(s)
- Masoud Assadi
- Department of Medical EthicsShahid Beheshti University of Medical SciencesTehranIran
- Health Research InstituteBabol University of Medical SciencesBabolIran
| | - Mehrzad Kiani
- Department of Medical EthicsShahid Beheshti University of Medical SciencesTehranIran
| | - Ehsan Shamsi Gooshki
- Department of Medical Ethics, Faculty of Medicine/Medical Ethics and History of Medicine Research CenterTehran University of Medical SciencesTehranIran
| | - Zeinab Aryanian
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
- Department of DermatologyBabol University of Medical SciencesBabolIran
| | - Zeinab M. Afshar
- Clinical Research Development Center, Imam Reza, Hospital, KermanshahUniversity of Medical SciencesKermanshahIran
| | - Parvaneh Hatami
- Autoimmune Bullous Diseases Research CenterTehran University of Medical SciencesTehranIran
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18
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Chong SH, Burn LA, Cheng TKM, Warr IS, Kenyon JC. A review of COVID vaccines: success against a moving target. Br Med Bull 2022; 144:12-44. [PMID: 36335919 DOI: 10.1093/bmb/ldac025] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 08/11/2022] [Accepted: 08/27/2022] [Indexed: 11/09/2022]
Abstract
BACKGROUND Multiple vaccine platforms against COVID-19 have been developed and found safe and efficacious at a record speed. Although most are effective, they vary in their ease of production and distribution, their potential speed of modification against new variants, and their durability of protection and safety in certain target groups. SOURCES OF DATA Our discussion is based on published reports of clinical trials and analyses from national and global health agencies. AREAS OF AGREEMENT The production of neutralizing antibodies against the viral spike protein is protective, and all vaccines for which published data exist have been found to be effective against severe disease caused by the viral strain they target. AREAS OF CONTROVERSY The degree to which vaccines protect against emerging variants, moderate disease and asymptomatic infection remains somewhat unclear. GROWING POINTS Knowledge of the duration of protection and its decay is increasing, and discussions of booster frequency and target strains are ongoing. AREAS TIMELY FOR DEVELOPING RESEARCH The global effort to combat transmission and disease continues to rely upon intense epidemiological surveillance, whilst real-world data and clinical trials shape vaccination schedules and formulae.
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Affiliation(s)
- S H Chong
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - L A Burn
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - T K M Cheng
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK.,Department of Medicine, Level 5 Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK.,Cambridge Institute of Therapeutic Immunology & Infectious Disease (CITIID), University of Cambridge, Cambridge CB2 0AW, UK
| | - I S Warr
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK
| | - J C Kenyon
- Homerton College, University of Cambridge, Hills Rd, Cambridge CB2 8PH, UK.,Department of Medicine, Level 5 Addenbrookes Hospital, Hills Rd, Cambridge CB2 0QQ, UK.,Division of Virology, Department of Pathology, University of Cambridge, Tennis Court Road, Cambridge CB2 1QP, UK
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19
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Chen X, Hong J, Li Y, An C, Guo J, Yang J. Case report: Severe acute hepatitis in a 22-month-old Chinese boy with Omicron sub-variant BA.2.38. Front Public Health 2022; 10:1012638. [PMID: 36504992 PMCID: PMC9731137 DOI: 10.3389/fpubh.2022.1012638] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/08/2022] [Indexed: 11/27/2022] Open
Abstract
The etiology of severe acute hepatitis (SAH) in children is various. We describe the first Chinese case of severe acute hepatitis in a 22-month-old boy with the mild illness of Omicron sub-variant BA.2.38. With the application of Compound Glycyrrhizin Injection (CGI), the patient gradually recovered from acute liver injury (ALI). This case highlights the possibility of severe ALI in children with the non-critical illness of SARS-CoV-2. The management of SAH associated with the pandemic presents challenges for clinicians, and follow-up is in need. The method of differential diagnosis using limited laboratory results is of great value to the clinicians.
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Affiliation(s)
- Xinying Chen
- Department of Pediatrics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Xiaorong Luo's Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China
| | - Junbin Hong
- The Second Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Yuxia Li
- Department of Pediatrics, The Affiliated Hospital of Gansu University of Chinese Medicine, Lanzhou, China
| | - Caixia An
- Department of Pediatric Cardiology, Nephrology, Rheumatology and Immunology, Gansu Provincial Maternal and Child Health Hospital, Lanzhou, China
| | - Jianwen Guo
- State Key Laboratory of Dampness Syndrome of Chinese Medicine, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Department of Neurology, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,*Correspondence: Jianwen Guo
| | - Jinghua Yang
- Department of Pediatrics, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China,Xiaorong Luo's Renowned Expert Inheritance Studio, Guangdong Provincial Hospital of Chinese Medicine, Guangzhou, China,Jinghua Yang
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20
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Prijić A, Gazibara T, Prijić S, Mandić-Rajčević S, Maksimović N. Factors Associated with the Antibiotic Treatment of Children Hospitalized for COVID-19 during the Lockdown in Serbia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:15590. [PMID: 36497665 PMCID: PMC9737727 DOI: 10.3390/ijerph192315590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Revised: 11/19/2022] [Accepted: 11/21/2022] [Indexed: 06/17/2023]
Abstract
Unselective use of antibiotics to treat children with COVID-19 is one of the major issues during the pandemic in Serbia. Thus far, there has been no evidence about the predictors of multiple antibiotic use in the treatment of children with COVID-19. The purpose of this study was to assess the prevalence of antibiotic use, as well as to examine demographic and clinical factors associated with a greater number of antibiotics and with a longer antibiotic treatment administered to hospitalized children with COVID-19 during the lockdown in Serbia. This study included all children who were hospitalized from 6 March to 31 May 2020 at the only pediatric COVID-19 hospital, and who were confirmed to have SARS-CoV-2 infection. Demographic, clinical, and laboratory data were collected from medical records. The antibiotic treatment included the use of azithromycin, cephalosporin (ceftriaxone), ampicillin-amikacin, and hydroxychloroquine. The overall prevalence of antibiotics use in children hospitalized with COVID-19 regardless of age was 47.2% (43.3% in children aged 1-5 years and 44.4% in those aged 5-17 years). In children aged 1-5 years, not having a family member affected by COVID-19 (B = -1.38, 95% confidence interval [CI] -2.43, -0.34, p = 0.011), having pneumonia on chest X-ray (B = 0.81, 95%CI 0.34, 1.29, p = 0.002), being a boy (B = -0.65, 95%CI -1.17, -0.13, p = 0.018), and having higher C-reactive protein (CRP) values on admission (B = 0.12, 95%CI 0.07, 0.17, p = 0.001) were associated with the administration of a higher number of antibiotics. These factors, along with having fever (B = 3.20, 95%CI 1.03, 5.37, p = 0.006), were associated with a longer duration of antibiotic treatment in children aged 1-5 years. In children aged 5-17 years, having pharyngeal erythema (B = 1.37, 95%CI 0.61, 2.13, p = 0.001), fever (B = 0.43, 95%CI 0.07, 0.79, p = 0.018), and pneumonia on chest X-ray (B = 0.91, 95%CI 0.53, 1.29, p = 0.001), not having rhinorrhea (B = -1.27, 95%CI -2.47, -0.08, p = 0.037), being a girl (B = 0.52, 95%CI 0.08, 0.97, p = 0.021), and having higher CRP values on admission (B = 0.04, 95%CI 0.01, 0.06, p = 0.006) were associated with the administration of a higher number of antibiotics. These factors, not including the absence of rhinorrhea, were associated with a longer duration of antibiotics treatment in children aged 5-17 years. Demographic, epidemiological, clinical, and laboratory parameters were associated with the use of multiple antibiotics and a longer duration of antibiotic treatment both among children aged 1-5 years and those aged 5-17 years.
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Affiliation(s)
- Andreja Prijić
- Children’s Hospital for Lung Diseases and Tuberculosis, University Clinical Hospital Center “Dr Dragiša Mišović–Dedinje”, 11000 Belgrade, Serbia
| | - Tatjana Gazibara
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Sergej Prijić
- Mother and Child Health Institute of Serbia “Dr Vukan Čupić”, 11000 Belgrade, Serbia
| | - Stefan Mandić-Rajčević
- Institute of Social Medicine, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
| | - Nataša Maksimović
- Institute of Epidemiology, Faculty of Medicine, University of Belgrade, 11000 Belgrade, Serbia
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21
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Yeo JG, Chia WN, Teh KL, Book YX, Hoh SF, Gao X, Das L, Zhang J, Sutamam N, Lim AJM, Poh SL, Tay SH, Nay Yaung K, Ong XM, Hazirah SN, Chua CJH, Leong JY, Wang LF, Albani S, Arkachaisri T. Robust neutralizing antibody response to SARS-CoV-2 mRNA vaccination in adolescents and young adults with childhood-onset rheumatic diseases. Rheumatology (Oxford) 2022; 61:4472-4481. [PMID: 35199166 PMCID: PMC8903460 DOI: 10.1093/rheumatology/keac105] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 02/09/2022] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVES Immunogenicity to the SARS-CoV-2 mRNA vaccines in adolescents and young adults (AYA) with childhood-onset rheumatic diseases (cRD) is unknown. We aimed to evaluate the humoral immunogenicity and safety of the vaccines in our AYA with cRD. METHODS A monocentric observational study with 159 AYA (50.3% female and 70.4% Chinese). Humoral immunogenicity was assessed at 2-3 and 4-6 weeks following first and second vaccination by cPass™ SARS-CoV-2 Neutralization Antibody Assay. Inhibition signal of ≥30% defined the cut-off for positive detection of the SARS-CoV-2 neutralizing antibodies. Vaccine safety and disease activity were assessed within 6 weeks after second vaccination. RESULTS A total of 64.9% and 99.1% of 159 patients (median age: 16.9, IQR: 14.7-19.5) mounted positive SARS-CoV-2 neutralizing responses after first and second vaccination, respectively. Most patients (89.8%) had ≥90% inhibition signal after second vaccination. Methotrexate and mycophenolate mofetil increased the risk associated with negative cPass neutralization responses following the first vaccination. Holding both medications after each vaccination did not affect immunogenicity. There was no symptomatic COVID-19 infection. Local reaction remained the most common (23.3-25.2%) adverse event, without serious complication. Two and seven patients flared following the first and second vaccination, respectively. Subgroup analyses of the 12-18-year-old cohort did not show any differences in vaccine efficacy, predictors of poor response and general safety, but higher proportion of disease flares. CONCLUSIONS SARS-CoV-2 mRNA vaccines were efficacious after the two-dose regimen in almost all AYA with cRD without serious adverse event. The rate of disease flare observed is 4.4% after the second mRNA vaccine dose.
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Affiliation(s)
- Joo Guan Yeo
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
| | | | - Kai Liang Teh
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | - Yun Xin Book
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | - Sook Fun Hoh
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore
| | - Xiaocong Gao
- Division of Nursing, KK Women’s and Children’s Hospital, Singapore
| | - Lena Das
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
| | | | - Nursyuhadah Sutamam
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Amanda Jin Mei Lim
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Su Li Poh
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | - Shi Huan Tay
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Duke-NUS Medical School
| | - Katherine Nay Yaung
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Duke-NUS Medical School
| | | | | | | | - Jing Yao Leong
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
| | | | - Salvatore Albani
- Translational Immunology Institute, SingHealth Duke-NUS Academic Medical Centre
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
| | - Thaschawee Arkachaisri
- Rheumatology and Immunology Service, Department of Paediatric Subspecialities, KK Women’s and Children’s Hospital
- Duke-NUS Medical School
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22
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Bertran M, Amin-Chowdhury Z, Davies HG, Allen H, Clare T, Davison C, Sinnathamby M, Seghezzo G, Kall M, Williams H, Gent N, Ramsay ME, Ladhani SN, Oligbu G. COVID-19 deaths in children and young people in England, March 2020 to December 2021: An active prospective national surveillance study. PLoS Med 2022; 19:e1004118. [PMID: 36346784 PMCID: PMC9642873 DOI: 10.1371/journal.pmed.1004118] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 10/05/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Coronavirus Disease 2019 (COVID-19) deaths are rare in children and young people (CYP). The high rates of asymptomatic and mild infections complicate assessment of cause of death in CYP. We assessed the cause of death in all CYP with a positive Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) test since the start of the pandemic in England. METHODS AND FINDINGS CYP aged <20 years who died within 100 days of laboratory-confirmed SARS-CoV-2 infection between 01 March 2020 and 31 December 2021 in England were followed up in detail, using national databases, surveillance questionnaires, post-mortem reports, and clinician interviews. There were 185 deaths during the 22-month follow-up and 81 (43.8%) were due to COVID-19. Compared to non-COVID-19 deaths in CYP with a positive SARS-CoV-2 test, death due to COVID-19 was independently associated with older age (aOR 1.06 95% confidence interval (CI) 1.01 to 1.11, p = 0.02) and underlying comorbidities (aOR 2.52 95% CI 1.27 to 5.01, p = 0.008), after adjusting for age, sex, ethnicity group, and underlying conditions, with a shorter interval between SARS-CoV-2 testing and death. Half the COVID-19 deaths (41/81, 50.6%) occurred within 7 days of confirmation of SARS-CoV-2 infection and 91% (74/81) within 30 days. Of the COVID-19 deaths, 61 (75.3%) had an underlying condition, especially severe neurodisability (n = 27) and immunocompromising conditions (n = 12). Over the 22-month surveillance period, SARS-CoV-2 was responsible for 1.2% (81/6,790) of all deaths in CYP aged <20 years, with an infection fatality rate of 0.70/100,000 SARS-CoV-2 infections in this age group estimated through real-time, nowcasting modelling, and a mortality rate of 0.61/100,000. Limitations include possible under-ascertainment of deaths in CYP who were not tested for SARS-CoV-2 and lack of direct access to clinical data for hospitalised CYP. CONCLUSIONS COVID-19 deaths remain extremely rare in CYP, with most fatalities occurring within 30 days of infection and in children with specific underlying conditions.
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Affiliation(s)
- Marta Bertran
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Zahin Amin-Chowdhury
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Hannah G. Davies
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
| | - Hester Allen
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Tom Clare
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Chloe Davison
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Mary Sinnathamby
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Giulia Seghezzo
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Meaghan Kall
- COVID-19 National Epidemiology Cell, UK Health Security Agency, London, United Kingdom
| | - Hannah Williams
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Nick Gent
- Joint Modelling Team (JMT), UK Health Security Agency, London, United Kingdom
- Emergency Preparedness, Response and Resilience, UK Health Security Agency, Porton Down, United Kingdom
| | - Mary E. Ramsay
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
| | - Shamez N. Ladhani
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
- * E-mail:
| | - Godwin Oligbu
- Immunisation and Vaccine Preventable Diseases Division, UK Health Security Agency, London, United Kingdom
- Paediatric Infectious Diseases Research Group, St George’s University of London, London, United Kingdom
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23
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Lee JS, Cho KS, Choe YJ. A Suspected Case of Multisystem Inflammatory Disease in Children Following COVID-19 Vaccination: A Case Report and Systematic Literature Review. Pediatr Infect Dis J 2022; 41:e456-e460. [PMID: 36102702 PMCID: PMC9555605 DOI: 10.1097/inf.0000000000003674] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/08/2022] [Indexed: 11/07/2022]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is rare but can be a potentially serious complication following SARS-CoV-2 infection in children. 1 Introduction of coronavirus disease 2019 (COVID-19) vaccines are effective in lowering the burden due to SARS-CoV-2. However, there have been reports of MIS occurrence following COVID-19 vaccination in adults. 2 The potential public health implication of MIS-C following COVID-19 vaccination is not clear in children. Our objective is to describe the spectrum of clinical disease, therapy, and outcomes of MIS-C following COVID-19 vaccination in children.
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Affiliation(s)
- Jue Seong Lee
- From the Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kyu Sik Cho
- From the Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Young June Choe
- From the Department of Pediatrics, Korea University Anam Hospital, Seoul, Republic of Korea
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24
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Ramadori GP. SARS-CoV-2-Infection (COVID-19): Clinical Course, Viral Acute Respiratory Distress Syndrome (ARDS) and Cause(s) of Death. Med Sci (Basel) 2022; 10:58. [PMID: 36278528 PMCID: PMC9590085 DOI: 10.3390/medsci10040058] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/26/2022] [Accepted: 09/30/2022] [Indexed: 11/16/2022] Open
Abstract
SARS-CoV-2-infected symptomatic patients often suffer from high fever and loss of appetite which are responsible for the deficit of fluids and of protein intake. Many patients admitted to the emergency room are, therefore, hypovolemic and hypoproteinemic and often suffer from respiratory distress accompanied by ground glass opacities in the CT scan of the lungs. Ischemic damage in the lung capillaries is responsible for the microscopic hallmark, diffuse alveolar damage (DAD) characterized by hyaline membrane formation, fluid invasion of the alveoli, and progressive arrest of blood flow in the pulmonary vessels. The consequences are progressive congestion, increase in lung weight, and progressive hypoxia (progressive severity of ARDS). Sequestration of blood in the lungs worsens hypovolemia and ischemia in different organs. This is most probably responsible for the recruitment of inflammatory cells into the ischemic peripheral tissues, the release of acute-phase mediators, and for the persistence of elevated serum levels of positive acute-phase markers and of hypoalbuminemia. Autopsy studies have been performed mostly in patients who died in the ICU after SARS-CoV-2 infection because of progressive acute respiratory distress syndrome (ARDS). In the death certification charts, after respiratory insufficiency, hypovolemic heart failure should be mentioned as the main cause of death.
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25
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Beach CM, Faherty E, Pesce M. Coronavirus disease 2019 and the young heart: prevention, treatment, and return to play. Curr Opin Pediatr 2022; 34:471-475. [PMID: 36036422 PMCID: PMC9593324 DOI: 10.1097/mop.0000000000001167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW COVID-19-related guidance has changed dramatically since the onset of the pandemic. Awareness of data regarding prevention of disease, the cardiac manifestations and treatment of acute COVID-19 and multisystem inflammatory syndrome in children, and return to physical activity following an infection allows for appropriate adjustment of current care models and guides future study. RECENT FINDINGS Severe acute respiratory syndrome coronavirus 2 transmission can be reduced using various mitigation strategies, though their effectiveness differs based on viral prevalence. The risk of severe disease during acute COVID-19 infection is low in children and adolescents, though specific risk factors have been identified. COVID-19 vaccination significantly decreases the risk of severe disease and poor outcomes. Regular physical activity positively affects well being and has been a focus of recent guidance regarding well tolerated return to activities following an infection. SUMMARY The use of strategies to reduce viral transmission will depend on individuals' and communities' risk tolerance and on current viral prevalence. COVID-19 vaccination should be encouraged, particularly in patients with identified risk factors. Allowing children and adolescents to safely participate in physical and other activities should continue to be a focus of our clinical and research efforts given their myriad benefits in this population.
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Affiliation(s)
- Cheyenne M Beach
- Department of Pediatrics, Section of Pediatric Cardiology, Yale School of Medicine, New Haven, Connecticut, USA
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26
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Malone LA, Morrow A, Chen Y, Curtis D, de Ferranti SD, Desai M, Fleming TK, Giglia TM, Hall TA, Henning E, Jadhav S, Johnston AM, Kathirithamby DRC, Kokorelis C, Lachenauer C, Li L, Lin HC, Locke T, MacArthur C, Mann M, McGrath-Morrow SA, Ng R, Ohlms L, Risen S, Sadreameli SC, Sampsel S, Tejtel SKS, Silver JK, Simoneau T, Srouji R, Swami S, Torbey S, Gutierrez MV, Williams CN, Zimmerman LA, Vaz LE. Multi-disciplinary collaborative consensus guidance statement on the assessment and treatment of postacute sequelae of SARS-CoV-2 infection (PASC) in children and adolescents. PM R 2022; 14:1241-1269. [PMID: 36169159 PMCID: PMC9538628 DOI: 10.1002/pmrj.12890] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Laura A Malone
- Kennedy Krieger Institute, Department of Neurology, Johns Hopkins Medicine, Baltimore, Maryland, United States.,Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland, United States
| | - Amanda Morrow
- Kennedy Krieger Institute, Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Yuxi Chen
- Department of Rehabilitation Medicine, Montefiore Medical Center, Bronx, New York, United States
| | - Donna Curtis
- Department of Pediatric Infectious Diseases Children's Hospital Colorado and University of Colorado School of Medicine Aurora, Aurora, Colorado, United States
| | - Sarah D de Ferranti
- Department of Pediatrics, Harvard Medical School, Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Monika Desai
- Department of Rehabilitation Medicine, Montefiore Medical Center/Albert Einstein School of Medicine, Bronx, New York, United States
| | - Talya K Fleming
- Department of Physical Medicine and Rehabilitation, JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey, United States
| | - Therese M Giglia
- Director of the Center on Cardiac Anticoagulation and Thrombosis and Director of the Infant Single Ventricle Monitoring Program, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Trevor A Hall
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon
| | - Ellen Henning
- Department of Behavioral Psychology, Kennedy Krieger Institute, Baltimore, Maryland
| | - Sneha Jadhav
- Psychiatric Mental Health Program, Kennedy Krieger Institute, Baltimore, Maryland, United States
| | - Alicia M Johnston
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Dona Rani C Kathirithamby
- Department of Rehabilitation Medicine and Department of Pediatrics, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, United States
| | - Christina Kokorelis
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University and Kennedy Krieger Institute, Baltimore, Maryland, United States
| | - Catherine Lachenauer
- Division of Infectious Diseases, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Lilun Li
- Department of Otolaryngology, Head and Neck Surgery, Robert Wood Johnson Medical School, New Brunswick, New Jersey, United States
| | - Henry C Lin
- Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
| | - Tran Locke
- Department of Otolaryngology-Head and Neck Surgery Baylor College of Medicine Houston, Houston, Texas, United States
| | - Carol MacArthur
- Department of Otolaryngology, Head & Neck Surgery, Oregon Health & Science University, Oregon, Portland
| | - Michelle Mann
- Department of Pediatric Pulmonology, Baylor College of Medicine, Texas Children's Hospital, Houston, Texas, United States
| | - Sharon A McGrath-Morrow
- Department of Pediatrics, Division of Pediatric Pulmonary Children's Hospital of Philadelphia and the University of Pennsylvania
| | - Rowena Ng
- Neuropsychology Department, Kennedy Krieger Institute; Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Laurie Ohlms
- Department of Otolaryngology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Sarah Risen
- Department of Pediatric Neurology and Developmental Neuroscience, Texas Children's Hospital and Baylor College of Medicine, Houston, Texas, United States
| | - S Christy Sadreameli
- Eudowood Division of Pediatric Respiratory Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States
| | - Sarah Sampsel
- SLSampsel Consulting, Albuquerque, New Mexico, United States
| | - S Kristen Sexson Tejtel
- Pediatric Cardiology, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas, United States
| | - Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, Massachusetts, United States
| | - Tregony Simoneau
- Division of Pulmonary Medicine, Department of Pediatrics, Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts, United States
| | - Rasha Srouji
- Department of Neurology, Boston Children's Hospital, Boston, Massachusetts, United States
| | - Sanjeev Swami
- Department of Pediatrics, Division of Infectious Diseases, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, United States
| | - Souraya Torbey
- Kennedy Krieger Institute, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Monica Verduzco Gutierrez
- Department of Rehabilitation Medicine, Long School of Medicine at UT Health Science Center San Antonio, San Antonio, Texas, United States
| | - Cydni Nicole Williams
- Oregon Health & Science University, Department of Pediatrics, Division of Pediatric Critical Care, Pediatric Critical Care and Neurotrauma Recovery Program, Portland, Oregon, United States
| | | | - Louise Elaine Vaz
- Division of Pediatric Infectious Diseases, Department of Pediatrics, Oregon Health & Science University, Portland, Oregon, United States
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Campos-Castillo C, Laestadius LI. Mental Healthcare Utilization, Modalities, and Disruptions During Spring 2021 of the COVID-19 Pandemic Among U.S. Adolescents. J Adolesc Health 2022; 71:512-515. [PMID: 35934587 PMCID: PMC9236916 DOI: 10.1016/j.jadohealth.2022.06.012] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2021] [Revised: 05/12/2022] [Accepted: 06/15/2022] [Indexed: 12/05/2022]
Abstract
PURPOSE The COVID-19 pandemic fomented a mental health crisis among adolescents. The present study contributes a national snapshot of mental healthcare utilization, including disruptions, barriers, and modalities, among U.S. adolescents. METHODS Logistic regressions analyzing self-reports from a representative sample (N = 532) of 13-17-year-olds recruited from the AmeriSpeak Teen Panel during Spring 2021. RESULTS Few demographic characteristics were associated with disruptions. Text-based communication/chat was most prevalent among minoritized racial and ethnic groups. Parental support was positively associated with finding private space for telehealth visits. Black adolescents were less likely to report in-person visits. Among those unable to receive care, Black adolescents preferred in-person visits. DISCUSSION Policies enacted to facilitate access to text-based communication/chat should continue to limit disruptions and promote racial equity. Additional efforts should target improving access to in-person visits among Black adolescents. Clinicians should encourage parent/guardian collaboration to facilitate access to private space for telehealth visits.
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Affiliation(s)
| | - Linnea I Laestadius
- Joseph J. Zilber School of Public Health, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin
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Gawlik AM, Berdej-Szczot E, Chmiel I, Lorek M, Antosz A, Firek-Pędras M, Szydłowski L, Ludwikowska KM, Okarska-Napierała M, Dudek N, Piwoński K, Afelt A, Suski-Grabowski C, Kursa MB, Kuchar E, Szenborn L, Jackowska T, Peregud-Pogorzelski J, Mazur A. A tendency to worse course of multisystem inflammatory syndrome in children with obesity: MultiOrgan Inflammatory Syndromes COVID-19 related study. Front Endocrinol (Lausanne) 2022; 13:934373. [PMID: 36225207 PMCID: PMC9549035 DOI: 10.3389/fendo.2022.934373] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 08/03/2022] [Indexed: 12/05/2022] Open
Abstract
Background A new disease entity called multisystem inflammatory syndrome in children (MIS-C) is a rare consequence of COVID-19 infection. The pathophysiology and risk factors of MIS-C are still unclear, and the clinical manifestation ranges from milder forms to cases needing intensive care unit treatment. Based on available data, obesity is linked to pro-inflammatory stimulation. Moreover, several studies showed that obesity could play a role in COVID-19 severity and its comorbidities among the adult and children's populations. This study aimed to investigate the influence of overweightedness/obesity in childhood for the course of MIS-C in Poland. Methods This study presented data from the national MultiOrgan Inflammatory Syndromes COVID-19 Related Study (MOIS-CoR) collected between 4 March 2020 and 20 February 2021. Of the 371 patients that met the Polish MIS-C criteria, 306 were included for further analysis. Results Children who are obese (OB with body mass index (BMI) ≥95th percentile) and overweight (OV with BMI ≥85th percentile but <95th percentile) (28 and 49 patients, respectively) represented 25.1% (n=77) of all recruited patients. Complete recovery at the time of discharge presented in 93% of normal body weight (NW) participants and 90% of OV children (p>0.05). Among OB children, 76% recovered fully, which differed from the NW group (p=0.01). Calculated odds ratio (OR) of incomplete recovery for OB children was 4.2. Irrespective of body weight, there were no differences (p>0.05) in the length of hospitalization and the duration of symptoms (for OB, 13 and 16.5 days; for OV and NW, 10 and 14 days, respectively), as well as in the frequency of cardiovascular abnormalities, necessity of oxygen therapy (OB, 26.9%; OV, 23.9%; and NW, 20.7%), and intravenous immunoglobulin and glucocorticosteroid (GCS) treatment. Conclusion The higher risk of incomplete recovery and observed tendency toward a worsening course of MIS-C in patients with obesity suggest the need for further studies to confirm and understand our findings.
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Affiliation(s)
- Aneta Monika Gawlik
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Elżbieta Berdej-Szczot
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Iga Chmiel
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Miłosz Lorek
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Aleksandra Antosz
- Department of Pediatrics and Pediatric Endocrinology, Faculty of Medical Sciences, Medical University of Silesia, Katowice, Poland
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Małgorzata Firek-Pędras
- Department of Pediatrics and Pediatric Endocrinology, John Paul II Upper Silesian Child Health Centre, Katowice, Poland
| | - Lesław Szydłowski
- Department of Pediatric Cardiology, Medical University of Silesia, Katowice, Poland
| | | | | | - Natalia Dudek
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Krzysztof Piwoński
- Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland
| | - Aneta Afelt
- Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland
- Espace-DEV, IRD - Institut de Recherche pour le Développement, Montpellier, France
| | - Catherine Suski-Grabowski
- Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland
| | - Miron Bartosz Kursa
- Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Warsaw, Poland
| | - Ernest Kuchar
- Department of Pediatrics with Clinical Assessment Unit, Medical University of Warsaw, Warsaw, Poland
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wrocław Medical University, Wrocław, Poland
| | - Teresa Jackowska
- Department of Pediatrics, Medical Center of Postgraduate Education, Warsaw, Poland
| | | | - Artur Mazur
- Department of Pediatrics, Pediatric Endocrinology and Diabetes, Medical College University of Rzeszów, Rzeszów, Poland
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Choudhary R, Webber BJ, Womack LS, Dupont HK, Chiu SK, Wanga V, Gerdes ME, Hsu S, Shi DS, Dulski TM, Idubor OI, Wendel AM, Agathis NT, Anderson K, Boyles T, Click ES, Da Silva J, Evans ME, Gold JA, Haston JC, Loga P, Maloney SA, Martinez M, Natarajan P, Spicer KB, Swancutt M, Stevens VA, Rogers-Brown J, Chandra G, Light M, Barr FE, Snowden J, Kociolek LK, McHugh M, Wessel DL, Simpson JN, Gorman KC, Breslin KA, DeBiasi RL, Thompson A, Kline MW, Boom JA, Singh IR, Dowlin M, Wietecha M, Schweitzer B, Morris SB, Koumans EH, Ko JY, Siegel DA, Kimball AA. Factors Associated With Severe Illness in Patients Aged <21 Years Hospitalized for COVID-19. Hosp Pediatr 2022; 12:760-783. [PMID: 35670605 PMCID: PMC9773098 DOI: 10.1542/hpeds.2022-006613] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVES To describe coronavirus disease 2019 (COVID-19)-related pediatric hospitalizations during a period of B.1.617.2 (Δ) variant predominance and to determine age-specific factors associated with severe illness. METHODS We abstracted data from medical charts to conduct a cross-sectional study of patients aged <21 years hospitalized at 6 United States children's hospitals from July to August 2021 for COVID-19 or with an incidental positive severe acute respiratory syndrome coronavirus 2 test. Among patients with COVID-19, we assessed factors associated with severe illness by calculating age-stratified prevalence ratios (PR). We defined severe illness as receiving high-flow nasal cannula, positive airway pressure, or invasive mechanical ventilation. RESULTS Of 947 hospitalized patients, 759 (80.1%) had COVID-19, of whom 287 (37.8%) had severe illness. Factors associated with severe illness included coinfection with respiratory syncytial virus (RSV) (PR 3.64) and bacteria (PR 1.88) in infants; RSV coinfection in patients aged 1 to 4 years (PR 1.96); and obesity in patients aged 5 to 11 (PR 2.20) and 12 to 17 years (PR 2.48). Having ≥2 underlying medical conditions was associated with severe illness in patients aged <1 (PR 1.82), 5 to 11 (PR 3.72), and 12 to 17 years (PR 3.19). CONCLUSIONS Among patients hospitalized for COVID-19, factors associated with severe illness included RSV coinfection in those aged <5 years, obesity in those aged 5 to 17 years, and other underlying conditions for all age groups <18 years. These findings can inform pediatric practice, risk communication, and prevention strategies, including vaccination against COVID-19.
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Affiliation(s)
- Rewa Choudhary
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Bryant J. Webber
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
- Air Force Institute of Technology, Wright-Patterson AFB, Ohio
| | - Lindsay S. Womack
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Hannah K. Dupont
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Sophia K. Chiu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valentine Wanga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan E. Gerdes
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sophia Hsu
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Dallas S. Shi
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Theresa M. Dulski
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Osatohamwen I. Idubor
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Arthur M. Wendel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Nickolas T. Agathis
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kristi Anderson
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Tricia Boyles
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Eleanor S. Click
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Juliana Da Silva
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mary E. Evans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jeremy A.W. Gold
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Julia C. Haston
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- Epidemic Intelligence Service, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pamela Loga
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Susan A. Maloney
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Marisol Martinez
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Pavithra Natarajan
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kevin B. Spicer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Mark Swancutt
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Valerie A. Stevens
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jessica Rogers-Brown
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Gyan Chandra
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Megan Light
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Larry K. Kociolek
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Matthew McHugh
- Ann & Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | | | | | | | - Aaron Thompson
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Mark W. Kline
- Children’s Hospital New Orleans, New Orleans, Louisiana
- Tulane University School of Medicine and LSU Health, New Orleans, Louisiana
| | - Julie A. Boom
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Ila R. Singh
- Texas Children’s Hospital, Houston, Texas
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | - Michael Dowlin
- Department of Pathology and Immunology, Baylor College of Medicine, Houston, Texas
| | | | - Beth Schweitzer
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Sapna Bamrah Morris
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Emilia H. Koumans
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jean Y. Ko
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - David A. Siegel
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
- United States Public Health Service, Commissioned Corps, Rockville, Maryland
| | - Anne A. Kimball
- COVID-19 Emergency Response Team, Centers for Disease Control and Prevention, Atlanta, Georgia
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Lee M, Hwang JY, Park SE, Jung S, Jo KJ. A Case Report of Postinfectious Bronchiolitis Obliterans After Coronavirus Disease 2019 in a 10-Year-Old Child. J Korean Med Sci 2022; 37:e246. [PMID: 35942559 PMCID: PMC9359921 DOI: 10.3346/jkms.2022.37.e246] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 07/19/2022] [Indexed: 11/20/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) is usually less severe in children and adolescents than in adults. However, it can cause severe respiratory illness in a small proportion of children with risk factors. Here, we report a rare case of a 10-year-old boy with postinfectious bronchiolitis obliterans that developed after pneumonia caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). This patient was previously healthy apart from a high body mass index (BMI, 30.13; 99.6th percentile for the age bracket), history of preterm birth (35 weeks), and low birth weight (1,850 g). He had persistent exertional dyspnea after recovering from SARS-CoV-2-related pneumonia. Spirometry revealed obstructive lung disease with the following results: predicted forced vital capacity (FVC%pred), 71%; forced expiratory volume in 1 second (FEV1%pred), 63%; FEV1/FVC, 0.81; and forced expiratory flow25-75%pred, 55%. Chest computed tomography showed multifocal areas of parenchymal hyperlucency and mosaic attenuation in both lungs. This case suggests that careful observation of children with obesity and low birth weight is necessary after recovery from SARS-CoV-2-related pneumonia.
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Affiliation(s)
- Miran Lee
- Department of Pediatrics, Division of Pediatric Allergy and Respiratory Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
| | - Jae-Yeon Hwang
- Department of Radiology, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
| | - Su Eun Park
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea
| | - Sungsu Jung
- Department of Pediatrics, Division of Pediatric Allergy and Respiratory Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea.
| | - Kyo Jin Jo
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, College of Medicine, Pusan National University, Yangsan, Korea.
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31
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Boast A, Curtis N, Holschier J, Purcell R, Bannister S, Plover C, Chinnapan M, Burgner D, Boyce SL, McNab S, Gwee A. An Approach to the Treatment of Children With COVID-19. Pediatr Infect Dis J 2022; 41:654-662. [PMID: 35622429 PMCID: PMC9281416 DOI: 10.1097/inf.0000000000003576] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/20/2022] [Indexed: 12/15/2022]
Abstract
There are limited data to guide treatment recommendations for children with acute, symptomatic coronavirus disease 2019 (COVID-19). This review outlines a proposed management approach for children based on the published evidence to date and the approval of medications through drug regulatory agencies, as well as the known safety profile of the recommended drugs in this age group.
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Affiliation(s)
- Alison Boast
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Nigel Curtis
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Johanna Holschier
- Pharmacy and Medicines Information Centre, The Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Rachael Purcell
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
| | - Samantha Bannister
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Christine Plover
- Pharmacy and Medicines Information Centre, The Royal Children’s Hospital Melbourne, Parkville, Australia
| | - Maidhili Chinnapan
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
| | - David Burgner
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Suzanne L. Boyce
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Sarah McNab
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
| | - Amanda Gwee
- Infectious Diseases and General Medicine, The Royal Children’s Hospital Melbourne
- Department of Paediatrics, The University of Melbourne
- Infectious Diseases, Inflammatory Origins and Clinical Paediatrics Research Groups, Murdoch Children’s Research Institute
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Narasimhan H, Wu Y, Goplen NP, Sun J. Immune determinants of chronic sequelae after respiratory viral infection. Sci Immunol 2022; 7:eabm7996. [DOI: 10.1126/sciimmunol.abm7996] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
The acute effects of various respiratory viral infections have been well studied, with extensive characterization of the clinical presentation as well as viral pathogenesis and host responses. However, over the course of the recent COVID-19 pandemic, the incidence and prevalence of chronic sequelae after acute viral infections have become increasingly appreciated as a serious health concern. Post-acute sequelae of COVID-19, alternatively described as “long COVID-19,” are characterized by symptoms that persist for longer than 28 days after recovery from acute illness. Although there exists substantial heterogeneity in the nature of the observed sequelae, this phenomenon has also been observed in the context of other respiratory viral infections including influenza virus, respiratory syncytial virus, rhinovirus, severe acute respiratory syndrome coronavirus, and Middle Eastern respiratory syndrome coronavirus. In this Review, we discuss the various sequelae observed following important human respiratory viral pathogens and our current understanding of the immunological mechanisms underlying the failure of restoration of homeostasis in the lung.
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Affiliation(s)
- Harish Narasimhan
- Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA 22908, USA
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Yue Wu
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA 22908, USA
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
| | - Nick P. Goplen
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
- Department of Physiology and Biomedical Engineering, Mayo Clinic, MN 55905, USA
| | - Jie Sun
- Carter Immunology Center, University of Virginia, Charlottesville, VA 22908, USA
- Division of Infectious Diseases and International Health, Department of Medicine, University of Virginia, Charlottesville, VA 22908, USA
- Department of Microbiology, Immunology, and Cancer Biology, University of Virginia, Charlottesville, VA 22908, USA
- Department of Immunology, Mayo Clinic, Rochester, MN 55905, USA
- Division of Pulmonary and Critical Medicine, Department of Medicine, Mayo Clinic, Rochester, MN 55905, USA
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Gavriilaki E, Tsiftsoglou SA, Touloumenidou T, Farmaki E, Panagopoulou P, Michailidou E, Koravou EE, Mavrikou I, Iosifidis E, Tsiatsiou O, Papadimitriou E, Papadopoulou-Alataki E, Papayanni PG, Varelas C, Kokkoris S, Papalexandri A, Fotoulaki M, Galli-Tsinopoulou A, Zafeiriou D, Roilides E, Sakellari I, Anagnostopoulos A, Tragiannidis A. Targeted Genotyping of MIS-C Patients Reveals a Potential Alternative Pathway Mediated Complement Dysregulation during COVID-19 Infection. Curr Issues Mol Biol 2022; 44:2811-2824. [PMID: 35877417 PMCID: PMC9325260 DOI: 10.3390/cimb44070193] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/21/2022] [Accepted: 06/24/2022] [Indexed: 11/24/2022] Open
Abstract
Complement dysregulation has been documented in adults with COVID-19 and implicated in relevant pediatric inflammatory responses against SARS-CoV-2. We propose that signatures of complement missense coding SNPs associated with dysregulation could also be identified in children with multisystem inflammatory syndrome (MIS-C). We investigated 71 pediatric patients with RT-PCR validated SARS-CoV-2 hospitalized in pediatric COVID-19 care units (November 2020-March 2021) in three major groups. Seven (7) patients suffered from MIS-C (MIS-C group), 32 suffered from COVID-19 and were hospitalized (admitted group), whereas 32 suffered from COVID-19, but were sent home. All patients survived and were genotyped for variations in the C3, C5, CFB, CFD, CFH, CFHR1, CFI, CD46, CD55, MASP1, MASP2, MBL2, COLEC11, FCN1, and FCN3 genes. Upon evaluation of the missense coding SNP distribution patterns along the three study groups, we noticed similarities, but also considerably increased frequencies of the alternative pathway (AP) associated with SNPs rs12614 CFB, rs1061170, and rs1065489 CFH in the MIS-C patients. Our analysis suggests that the corresponding substitutions potentially reduce the C3b-inactivation efficiency and promote slower and weaker AP C3bBb pre-convertase assembly on virions. Under these circumstances, the complement AP opsonization capacity may be impaired, leading to compromised immune clearance and systemic inflammation in the MIS-C syndrome.
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Affiliation(s)
- Eleni Gavriilaki
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Stefanos A. Tsiftsoglou
- Laboratory of Pharmacology, Department of Pharmacy, Aristotle University of Thessaloniki, 54124 Thessaloniki, Greece
| | - Tasoula Touloumenidou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Evangelia Farmaki
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Paraskevi Panagopoulou
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Elissavet Michailidou
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Evaggelia-Evdoxia Koravou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Ioulia Mavrikou
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Elias Iosifidis
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Olga Tsiatsiou
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Eleni Papadimitriou
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Efimia Papadopoulou-Alataki
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Penelope Georgia Papayanni
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Christos Varelas
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Styliani Kokkoris
- Laboratory of Hematology and Hospital—Blood Transfusion Unit, Medical School, University General Hospital “Attikon”, NKUA, 12462 Athens, Greece;
| | - Apostolia Papalexandri
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Maria Fotoulaki
- 4th Pediatric Department, Aristotle University of Thessaloniki, Papageorgiou Hospital, 56429 Thessaloniki, Greece; (P.P.); (E.P.-A.); (M.F.)
| | - Assimina Galli-Tsinopoulou
- 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54621 Thessaloniki, Greece; (A.G.-T.); (A.T.)
| | - Dimitrios Zafeiriou
- 1st Pediatric Department, Aristotle University of Thessaloniki, Hipporkation Hospital, 54642 Thessaloniki, Greece; (E.F.); (E.P.); (D.Z.)
| | - Emmanuel Roilides
- 3rd Pediatric Department, Aristotle University of Thessaloniki, Hippokration Hospital, 54642 Thessaloniki, Greece; (E.M.); (E.I.); (O.T.); (E.R.)
| | - Ioanna Sakellari
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Achilles Anagnostopoulos
- Hematology Department & BMT Unit, G Papanicolaou Hospital, 57010 Thessaloniki, Greece; (T.T.); (E.-E.K.); (I.M.); (P.G.P.); (C.V.); (A.P.); (I.S.); (A.A.)
| | - Athanasios Tragiannidis
- 2nd Pediatric Department, Aristotle University of Thessaloniki, AHEPA Hospital, 54621 Thessaloniki, Greece; (A.G.-T.); (A.T.)
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Campbell JI, Dubois MM, Savage TJ, Hood-Pishchany MI, Sharma TS, Petty CR, Lamb GS, Nakamura MM. Comorbidities Associated with Hospitalization and Progression Among Adolescents with Symptomatic Coronavirus Disease 2019. J Pediatr 2022; 245:102-110.e2. [PMID: 35240138 PMCID: PMC8883759 DOI: 10.1016/j.jpeds.2022.02.048] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/16/2022] [Accepted: 02/23/2022] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To identify subgroups likely to benefit from monoclonal antibody and antiviral therapy by evaluating the relationship between comorbidities and hospitalization among US adolescents with symptomatic coronavirus disease 2019 (COVID-19). STUDY DESIGN We analyzed the relationship between presence of comorbidities and need for hospitalization within 28 days of COVID-19 diagnosis for adolescents aged 12-17 years listed in the Pediatric COVID-19 US registry, a multicenter retrospective cohort of US pediatric patients with COVID-19. Comorbidities assessed included obesity, chronic kidney disease (CKD), diabetes, immunosuppressive disease or treatment, sickle cell disease (SCD), heart disease, neurologic disease/neurodevelopmental disorders, and pulmonary disease (excluding patients with mild asthma). We used multivariable logistic regression to determine race/ethnicity-adjusted associations between comorbidities and hospitalization. RESULTS A total of 1877 patients met our inclusion criteria, of whom 284 (15%) were hospitalized within 28 days of their COVID-19 diagnosis. In a race/ethnicity-adjusted model, the following comorbidities were independently associated with increased odds of hospitalization: SCD (aOR, 6.9; 95% CI, 3.0-15.9), immunocompromising condition (aOR, 6.4; 95% CI, 3.8-10.8), obesity (aOR, 3.2; 95% CI, 2.1-4.9), diabetes (aOR, 3.0; 95% CI, 1.4-6.2), neurologic disease (aOR, 2.8; 95% CI, 1.8-4.3), and pulmonary disease (excluding mild asthma) (aOR, 1.9; 95% CI, 1.2-3.1). Heart disease and CKD were not independently associated with hospitalization. CONCLUSIONS SCD, immunocompromising conditions, obesity, diabetes, neurologic disease, and pulmonary disease (excluding mild asthma) were associated with hospitalization for symptomatic COVID-19. Adolescents with acute COVID-19 and these comorbidities should be prioritized for consideration of therapy to avert hospitalization.
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Affiliation(s)
- Jeffrey I. Campbell
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Melanie M. Dubois
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Timothy J. Savage
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA,Division of Pharmacoepidemiology and Pharmacoeconomics, Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - M. Indriati Hood-Pishchany
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Tanvi S. Sharma
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Carter R. Petty
- Institutional Centers for Clinical and Translational Research, Boston Children's Hospital, Boston, MA; and
| | - Gabriella S. Lamb
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA
| | - Mari M. Nakamura
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Harvard Medical School, Boston, MA,Antimicrobial Stewardship Program, Boston Children's Hospital, Boston, MA,Reprint requests: Mari M. Nakamura, MD, MPH, Antimicrobial Stewardship Program, Boston Children's Hospital, 300 Longwood Ave, Mailstop BCH 3052, Boston, MA 02115
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King MA, Matos RI, Hamele MT, Borgman MA, Zabrocki LA, Gadepalli SK, Maves RC. PICU in the MICU: How Adult ICUs Can Support Pediatric Care in Public Health Emergencies. Chest 2022; 161:1297-1305. [PMID: 35007553 PMCID: PMC8739819 DOI: 10.1016/j.chest.2021.12.648] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 11/24/2021] [Accepted: 12/23/2021] [Indexed: 11/29/2022] Open
Abstract
Initial waves of the COVID-19 pandemic have largely spared children. With the advent of vaccination in many older age groups and the spread of the highly contagious Delta variant, however, children now represent a growing percentage of COVID-19 cases. PICU capacity is far less than that of adult ICUs. Adult ICUs may need to support pediatric care, much as PICUs provided adult care earlier in the pandemic. Critically ill children selected for care in adult settings should be at least 12 years of age and ideally have conditions common in children and adults alike (eg, community-acquired sepsis, trauma). Children with complex, pediatric-specific disorders are best served in PICUs and are not recommended for transfer. The goal of such transfers is to maintain critical capacity for those children in greatest need of the PICU's unique abilities, therefore preserving systems of care for all children.
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Affiliation(s)
| | - Renee I Matos
- Brooke Army Medical Center, Fort Sam Houston, TX; Uniformed Services University, Bethesda, MD
| | - Mitchell T Hamele
- Uniformed Services University, Bethesda, MD; Tripler Army Medical Center, Honolulu, HI
| | - Matthew A Borgman
- Brooke Army Medical Center, Fort Sam Houston, TX; Uniformed Services University, Bethesda, MD
| | - Luke A Zabrocki
- Uniformed Services University, Bethesda, MD; Naval Medical Center, San Diego, CA
| | | | - Ryan C Maves
- Uniformed Services University, Bethesda, MD; Wake Forest School of Medicine, Winston-Salem, NC.
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Jone PN, John A, Oster ME, Allen K, Tremoulet AH, Saarel EV, Lambert LM, Miyamoto SD, de Ferranti SD. SARS-CoV-2 Infection and Associated Cardiovascular Manifestations and Complications in Children and Young Adults: A Scientific Statement From the American Heart Association. Circulation 2022; 145:e1037-e1052. [PMID: 35400169 DOI: 10.1161/cir.0000000000001064] [Citation(s) in RCA: 25] [Impact Index Per Article: 12.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Coronavirus disease 2019 (COVID-19) resulted in a global pandemic and has overwhelmed health care systems worldwide. In this scientific statement, we describe the epidemiology, pathophysiology, clinical presentations, treatment, and outcomes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and multisystem inflammatory syndrome in children and young adults with a focus on cardiovascular manifestations and complications. We review current knowledge about the health consequences of this illness in children and young adults with congenital and acquired heart disease, the public health burden and health disparities of this infection in these populations, and vaccine-associated myocarditis.
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Adolescent COVID-19 Vaccine Decision-Making among Parents in Southern California. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074212. [PMID: 35409893 PMCID: PMC8998887 DOI: 10.3390/ijerph19074212] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/21/2022] [Accepted: 03/30/2022] [Indexed: 01/12/2023]
Abstract
Adolescent COVID-19 vaccination has stalled at 53% in the United States. Vaccinating adolescents remains critical to preventing the continued transmission of COVID-19, the emergence of variants, and rare but serious disease in children, and it is the best preventive measure available to return to in-person schooling. We investigated parent–adolescent COVID-19 vaccine decision-making. Between 24 February and 15 March 2021, we conducted surveys and 12 focus groups with 46 parent–adolescent dyads in Southern California. Parents and adolescents completed a survey prior to participation in a focus group discussion, which focused on exploring COVID-19 vaccine acceptance or uncertainty and was guided by the 5C vaccine hesitancy model. Parents uncertain about vaccinating adolescents expressed low vaccine confidence and high COVID-19 disease risk complacency. Parents who accepted COVID-19 vaccination for adolescents expressed high confidence in health authority vaccine recommendations, high perceived COVID-19 risk, and collective responsibility to vaccinate children. Additionally, unique pandemic-related factors of vaccine acceptance included vaccinating for emotional health, resuming social activities, and vaccine mandates. Among parents, 46% were willing to vaccinate their adolescent, 11% were not, and 43% were unsure. Among adolescents, 63% were willing to vaccinate. Despite vaccine availability, 47% of adolescents remain unvaccinated against COVID-19. Factors associated with vaccine uncertainty and acceptability inform health care practitioner, school, community, and public health messaging to reach parents and adolescents.
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COVID-19 Mortality in Children: A Referral Center Experience from Iran (Mofid Children’s Hospital, Tehran, Iran). CANADIAN JOURNAL OF INFECTIOUS DISEASES AND MEDICAL MICROBIOLOGY 2022; 2022:2737719. [PMID: 35340920 PMCID: PMC8942697 DOI: 10.1155/2022/2737719] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2021] [Revised: 01/27/2022] [Accepted: 02/09/2022] [Indexed: 01/08/2023]
Abstract
Background. The novel coronavirus disease 2019 (COVID-19) started in Wuhan, China, in December 2019. It spread widely around the world and was described as a pandemic by the World Health Organization (WHO). The knowledge regarding the mortality rate and risk factors of COVID-19 among the pediatric population is lacking. In this regard, we aimed to report the clinical and laboratory characteristics of deceased pediatric patients with SARS-CoV-2 infection. Method. This cross-sectional study was conducted in Mofid Children’s Hospital, Tehran, Iran, from February 2020 to April 2021. Recorded documents of 59 pediatric patients (under 18 years old) assumed to have COVID-19 who had died in the COVID-19 ward and COVID-19 intensive care unit (ICU) were retrospectively evaluated. All statistical analyses were performed using SPSS software (v. 26.0, Chicago, IL). A
value of less than 0.05 was considered statistically significant. Results. From 711 COVID-19 definite and suspected patients, 59 children died. Of these deceased pediatric patients, 34 were boys (57.62%) and 25 were girls (42.37%), with a total mean age of 5.6 years. The median length of stay in the hospital was 10 days (range 1–215). 91.52% had underlying comorbidities of which neurological diseases accounted for the largest share. 54 patients were admitted to the ICU and 83.05% of them had intubation during their hospitalization. In addition, the most common reasons for death in our study were related to respiratory and multiorgan failure. Conclusion. According to our knowledge, we are the first team to report such a thorough study in the field of COVID-19 pediatric mortality in Iran. Mortality was observed in all age groups of children, especially in those with previous comorbidities, specifically neurological disease. Abnormally elevated tests of ESR, CRP, LDH, AST, and ALT as well as the presence of proteinuria and hematuria were found in more than 50% of patients in our investigations, and ICU admission between both definite and suspected groups had significant differences, so monitoring and considering these factors may help to control and reduce the progression of the disease to death.
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Abstract
With the recent licensure of mRNA vaccines against COVID-19 in the 5- to 11-year-old age group, the public health impact of a childhood immunization campaign is of interest. Using a mathematical epidemiological model, we project that childhood vaccination carries minimal risk and yields modest public health benefits. These include large relative reductions in child morbidity and mortality, although the absolute reduction is small because these events are rare. Furthermore, the model predicts "altruistic" absolute reductions in adult cases, hospitalizations, and mortality. However, vaccinating children to benefit adults should be considered from an ethical as well as a public health perspective. From a global health perspective, an additional ethical consideration is the justice of giving priority to children in high-income settings at low risk of severe disease while vaccines have not been made available to vulnerable adults in low-income settings. IMPORTANCE Countries have recently begun implementation of childhood vaccination against SARS-CoV-2 with the Pfizer/BioNTech mRNA vaccine in children 5 to 11 years of age. Because SARS-CoV-2 disease severity is remarkably age dependent, vaccinating children may have modest public health benefits, relative to the unequivocal benefit of vaccinating vulnerable older adults. Furthermore, vaccinating children to "altruistically" increase herd immunity should be considered from an ethical as well as a public health perspective. An additional question is related to global social justice: should priority be given to vaccinating children in high-income settings while older adult populations in low-resource settings have limited access to vaccine? To address the risks and benefits of childhood vaccination, we provide a balanced commentary, supported by a mathematical epidemiological model, using Australia and Alberta, Canada, as case studies. We give highlights of the modeling findings in the commentary and include details in the supplemental materials for interested readers.
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Recent research on the application of biologics in the treatment of multisystem inflammatory syndrome in children after SARS-CoV-2 infection. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2022; 24:216-222. [PMID: 35209989 PMCID: PMC8884044 DOI: 10.7499/j.issn.1008-8830.2111005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a type of hyperinflammatory symptoms similar to Kawasaki disease after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and is commonly observed in children aged 8-10 years. Primary therapeutic medications for MIS-C are intravenous immunoglobulins and glucocorticoids. It has been reported that biologics, such as IL-1 receptor antagonist anakinra, IL-6 receptor antagonist tocilizumab, and TNF-α receptor antagonist infliximab, can be used as an option for critically ill patients. This article elaborates on the mechanism of action of the above biologics and discusses the efficacy and safety biologics in the treatment of MIS-C after SARS-CoV-2 infection, in order to provide methods for the treatment of MIS-C with severe symptoms.
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Lanziotti VS, Bulut Y, Buonsenso D, Gonzalez‐Dambrauskas S. Vaccine apartheid: This is not the way to end the pandemic. J Paediatr Child Health 2022; 58:228-231. [PMID: 34674333 PMCID: PMC8662126 DOI: 10.1111/jpc.15805] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/03/2022]
Abstract
There are many reasons why the international community as a whole should advocate for COVID-19 vaccine equity: global economic recession, uncontrolled outbreaks with higher risk of virus variants and persistent unsafe travelling in an era of now vaccine-preventable cause of death. This inequity is an avoidable threat to global health. Funding agencies, policy makers, drug companies and NGOs among others have the moral duty to end this vaccine apartheid and to make vaccine equity a reality. In this viewpoint, we discuss how inequalities in vaccination access affect a proper control of the pandemic, highlighting specific consequences on child health.
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Affiliation(s)
- Vanessa S Lanziotti
- Pediatric Intensive Care Unit, Research and Education Division/Maternal and Child Health Postgraduate ProgramFederal University of Rio de Janeiro (UFRJ)Rio de JaneiroBrazil
| | - Yonca Bulut
- Division of Critical Care Medicine, Department of PediatricsDavid Geffen School of Medicine, University of California, Los AngelesLos AngelesCaliforniaUnited States
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public HealthFondazione Policlinico Universitario A. Gemelli IRCCSRomeItaly,Department of Biotechnological SciencesCatholic University of RomeRomeItaly,Center for Global Health Research and StudiesUniversità Cattolica del Sacro CuoreRomeItaly
| | - Sebastian Gonzalez‐Dambrauskas
- Cuidados Intensivos Pediátricos Especializados (CIPe)Casa de GaliciaMontevideoUruguay,Red Colaborativa Pediátrica de Latinoamérica (LARed Network)MontevideoUruguay
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Funk AL, Florin TA, Kuppermann N, Tancredi DJ, Xie J, Kim K, Neuman MI, Ambroggio L, Plint AC, Mintegi S, Klassen TP, Salvadori MI, Malley R, Payne DC, Simon NJ, Yock-Corrales A, Nebhrajani JR, Chaudhari PP, Breslin KA, Finkelstein Y, Campos C, Bergmann KR, Bhatt M, Ahmad FA, Gardiner MA, Avva UR, Shah NP, Sartori LF, Sabhaney VJ, Caperell K, Navanandan N, Borland ML, Morris CR, Gangoiti I, Pavlicich V, Kannikeswaran N, Lunoe MM, Rino PB, Kam AJ, Cherry JC, Rogers AJ, Chong SL, Palumbo L, Angelats CM, Morrison AK, Kwok MY, Becker SM, Dixon AC, Poonai N, Eckerle M, Wassem M, Dalziel SR, Freedman SB. Outcomes of SARS-CoV-2-Positive Youths Tested in Emergency Departments: The Global PERN-COVID-19 Study. JAMA Netw Open 2022; 5:e2142322. [PMID: 35015063 PMCID: PMC8753506 DOI: 10.1001/jamanetworkopen.2021.42322] [Citation(s) in RCA: 35] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
IMPORTANCE Severe outcomes among youths with SARS-CoV-2 infections are poorly characterized. OBJECTIVE To estimate the proportion of children with severe outcomes within 14 days of testing positive for SARS-CoV-2 in an emergency department (ED). DESIGN, SETTING, AND PARTICIPANTS This prospective cohort study with 14-day follow-up enrolled participants between March 2020 and June 2021. Participants were youths aged younger than 18 years who were tested for SARS-CoV-2 infection at one of 41 EDs across 10 countries including Argentina, Australia, Canada, Costa Rica, Italy, New Zealand, Paraguay, Singapore, Spain, and the United States. Statistical analysis was performed from September to October 2021. EXPOSURES Acute SARS-CoV-2 infection was determined by nucleic acid (eg, polymerase chain reaction) testing. MAIN OUTCOMES AND MEASURES Severe outcomes, a composite measure defined as intensive interventions during hospitalization (eg, inotropic support, positive pressure ventilation), diagnoses indicating severe organ impairment, or death. RESULTS Among 3222 enrolled youths who tested positive for SARS-CoV-2 infection, 3221 (>99.9%) had index visit outcome data available, 2007 (62.3%) were from the United States, 1694 (52.6%) were male, and 484 (15.0%) had a self-reported chronic illness; the median (IQR) age was 3 (0-10) years. After 14 days of follow-up, 735 children (22.8% [95% CI, 21.4%-24.3%]) were hospitalized, 107 (3.3% [95% CI, 2.7%-4.0%]) had severe outcomes, and 4 children (0.12% [95% CI, 0.03%-0.32%]) died. Characteristics associated with severe outcomes included being aged 5 to 18 years (age 5 to <10 years vs <1 year: odds ratio [OR], 1.60 [95% CI, 1.09-2.34]; age 10 to <18 years vs <1 year: OR, 2.39 [95% CI 1.38-4.14]), having a self-reported chronic illness (OR, 2.34 [95% CI, 1.59-3.44]), prior episode of pneumonia (OR, 3.15 [95% CI, 1.83-5.42]), symptoms starting 4 to 7 days prior to seeking ED care (vs starting 0-3 days before seeking care: OR, 2.22 [95% CI, 1.29-3.82]), and country (eg, Canada vs US: OR, 0.11 [95% CI, 0.05-0.23]; Costa Rica vs US: OR, 1.76 [95% CI, 1.05-2.96]; Spain vs US: OR, 0.51 [95% CI, 0.27-0.98]). Among a subgroup of 2510 participants discharged home from the ED after initial testing and who had complete follow-up, 50 (2.0%; 95% CI, 1.5%-2.6%) were eventually hospitalized and 12 (0.5%; 95% CI, 0.3%-0.8%) had severe outcomes. Compared with hospitalized SARS-CoV-2-negative youths, the risk of severe outcomes was higher among hospitalized SARS-CoV-2-positive youths (risk difference, 3.9%; 95% CI, 1.1%-6.9%). CONCLUSIONS AND RELEVANCE In this study, approximately 3% of SARS-CoV-2-positive youths tested in EDs experienced severe outcomes within 2 weeks of their ED visit. Among children discharged home from the ED, the risk was much lower. Risk factors such as age, underlying chronic illness, and symptom duration may be useful to consider when making clinical care decisions.
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Affiliation(s)
- Anna L. Funk
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Todd A. Florin
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois
- Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | - Nathan Kuppermann
- Departments of Emergency Medicine and Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Daniel J. Tancredi
- Department of Pediatrics, University of California, Davis School of Medicine, Sacramento
| | - Jianling Xie
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Kelly Kim
- Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Mark I. Neuman
- Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
- Division of Emergency Medicine, Boston Children’s Hospital, Boston, Massachusetts
| | - Lilliam Ambroggio
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Amy C. Plint
- Children’s Hospital of Eastern Ontario, Division of Emergency Medicine, Departments of Pediatrics and Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Santiago Mintegi
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Terry P. Klassen
- Children’s Hospital Research Institute of Manitoba, Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Manitoba, Canada
| | | | - Richard Malley
- Division of Infectious Diseases, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
| | - Daniel C. Payne
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Norma-Jean Simon
- Data Analytics and Reporting, Division of Emergency Medicine, Ann and Robert H. Lurie Children’s Hospital of Chicago, Chicago, Illinois
| | | | | | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Los Angeles, California
- Keck School of Medicine of the University of Southern California, Los Angeles, California
| | | | - Yaron Finkelstein
- Divisions of Emergency Medicine and Clinical Pharmacology and Toxicology, Department of Pediatrics Hospital for Sick Children, Toronto, Ontario, Canada
| | - Carmen Campos
- Hospital Universitario Miguel Servet, Pediatric Emergency Department, Zaragoza, Spain
| | - Kelly R. Bergmann
- Department of Emergency Medicine, Children’s Minnesota, Minneapolis, Minnesota
| | - Maala Bhatt
- Department of Pediatrics, Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Fahd A. Ahmad
- Department of Pediatrics, Washington University School of Medicine in St Louis, St Louis, Missouri
| | - Michael A. Gardiner
- Rady Children’s Hospital, Department of Pediatrics, University of California, San Diego, San Diego, California
| | - Usha R. Avva
- School of Medicine Hackensack Meridian Health, Hackensack, New Jersey
| | - Nipam P. Shah
- Division of Pediatric Emergency Medicine, Department of Pediatrics, University of Alabama at Birmingham, Birmingham
| | - Laura F. Sartori
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Children’s Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Vikram J. Sabhaney
- Department of Paediatrics, The University of British Columbia, Vancouver, British Columbia, Canada
| | - Kerry Caperell
- Norton Children’s Hospital, University of Louisville, Louisville, Kentucky
| | - Nidhya Navanandan
- Section of Emergency Medicine, Children’s Hospital Colorado, Department of Pediatrics, University of Colorado, Aurora
| | - Meredith L. Borland
- Perth Children’s Hospital, Divisions of Emergency Medicine and Paediatrics, School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Claudia R. Morris
- Department of Pediatrics, Division of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Iker Gangoiti
- Pediatric Emergency Department, Biocruces Bizkaia Health Research Institute, Hospital Universitario Cruces, University of the Basque Country, UPV/EHU, Bilbao, Basque Country, Spain
| | - Viviana Pavlicich
- Departamento de Emergencia Pediátrica, Hospital General Pediátrico Niños de Acosta Ñu, Facultad de Medicina, Universidad Privada del Pacífico, San Lorenzo, Paraguay
| | | | - Maren M. Lunoe
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Pedro B. Rino
- Hospital de Pediatría “Prof Dr Juan P. Garrahan”, RIDEPLA, Buenos Aires, Argentina
| | - April J. Kam
- Department of Pediatrics, Division of Emergency Medicine, McMaster Children’s Hospital, Hamilton, Ontario, Canada
| | - Jonathan C. Cherry
- Department of Pediatric Emergency Medicine, IWK Health Centre, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Alexander J. Rogers
- Departments of Emergency Medicine and Pediatrics, University of Michigan School of Medicine, Ann Arbor
| | - Shu-Ling Chong
- Department of Emergency Medicine, KK Women’s and Children’s Hospital, Duke-NUS Medical School, SingHealth Duke-NUS Global Health Institute, Singapore
| | - Laura Palumbo
- ASST Spedali Civili di Brescia - Pronto soccorso pediatrico, Brescia, Italy
| | | | - Andrea K. Morrison
- Division of Emergency Medicine, Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Maria Y. Kwok
- Department of Emergency Medicine, New York Presbyterian Morgan Stanley Children’s Hospital, Columbia University Irving Medical Center, New York
| | - Sarah M. Becker
- University of Utah School of Medicine and Primary Children’s Hospital, Salt Lake City, Utah
| | - Andrew C. Dixon
- University of Alberta, Stollery Children’s Hospital, Women’s and Children’s Health Research Institute, Edmonton, Alberta, Canada
| | - Naveen Poonai
- Child Health Research Institute, Division of Paediatric Emergency Medicine, Departments of Pediatrics, Internal Medicine, Epidemiology and Biostatistics, Schulich School of Medicine & Dentistry, London, Ontario, Canada
| | - Michelle Eckerle
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio
- Division of Pediatric Emergency Medicine, Cincinnati Children’s Hospital, Cincinnati, Ohio
| | | | - Stuart R. Dalziel
- Children’s Emergency Department, Starship Children’s Hospital, Auckland, New Zealand
- Departments of Surgery and Paediatrics: Child and Youth Health, University of Auckland, Auckland, New Zealand
| | - Stephen B. Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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Lee H, Choi S, Park JY, Jo DS, Choi UY, Lee H, Jung YT, Chung IH, Choe YJ, Kim JY, Park YJ, Choi EH. Analysis of Critical COVID-19 Cases Among Children in Korea. J Korean Med Sci 2022; 37:e13. [PMID: 34981683 PMCID: PMC8723896 DOI: 10.3346/jkms.2022.37.e13] [Citation(s) in RCA: 17] [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: 10/19/2021] [Accepted: 12/13/2021] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Coronavirus disease 2019 (COVID-19) is generally asymptomatic or mild in otherwise healthy children, however, severe cases may occur. In this study, we report the clinical characteristics of children classified as critical COVID-19 in Korea to provide further insights into risk factors and management in children. METHODS This study was a retrospective case series of children < 18 years of age classified as critical COVID-19. Cases were identified by the Korea Disease Control and Prevention Agency surveillance system and medical records were reviewed. Critical COVID-19 was defined as cases with severe illness requiring noninvasive (high flow nasal cannula, continuous positive airway pressure, or bilevel positive airway pressure) or invasive mechanical ventilation, extracorporeal membrane oxygenation (ECMO) or continuous renal replacement therapy (CRRT), between January 20, 2020 and October 7, 2021. RESULTS Among 39,146 cases diagnosed with COVID-19 in subjects < 18 years of age, eight cases (0.02%) were identified as critical COVID-19. The median age was 13 years (range 10 month-17 years) and male-to-female ratio was 1:1. Three children had underlying diseases; one child has asthma and major depressive disorder, one child had Lennox-Gastaut syndrome and one child had mental retardation and was newly diagnosed with type 2 diabetes mellitus with the diagnosis of COVID-19. Among the eight children, seven were obese (body mass index range [BMI] median 29.3, range 25.9-38.2, weight-for-length > 97% for infant) and one was overweight (BMI 21.3). All patients had fever, six patients had dyspnea or cough and other accompanied symptoms included sore throat, headache, lethargy and myalgia. Radiologic findings showed pneumonia within 1-8 days after symptom onset. Pneumonia progressed in these children for 2-6 days and was improved within 5-32 days after diagnosis. Among the eight critical cases, remdesivir was administered in six cases. Steroids were provided for all cases. Inotropics were administered in one case. Six cases were treated with noninvasive mechanical ventilator and three required mechanical ventilator. One case required ECMO due to acute respiratory distress syndrome. All cases were admitted to the intensive care unit and admission period ranged from 9-39 days. Among all critical COVID-19 cases < 18 years of age, there were no fatal cases. CONCLUSION To develop appropriate policies for children in the COVID-19 pandemic, it is important to monitor and assess the clinical burden in this population.
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Affiliation(s)
- Hyunju Lee
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Sujin Choi
- Department of Pediatrics, Seoul National University Bundang Hospital, Seongnam, Korea
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
| | - Ji Young Park
- Department of Pediatrics, Chung-Ang University Hospital, Seoul, Korea
| | - Dae Sun Jo
- Department of Pediatrics, Jeonbuk National University Medical School, Jeonju, Korea
| | - Ui Yoon Choi
- Department of Pediatrics, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Heayon Lee
- Division of Pulmonary, Critical Care and Sleep Medicine, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Yun Tae Jung
- Department of Surgery, Gangneung Asan Hospital, University of Ulsan College of Medicine, Gangneung, Korea
| | - In Hyuk Chung
- Department of Pediatrics, National Health Insurance Corporation Ilsan Hospital, Goyang, Korea
| | - Young June Choe
- Department of Pediatrics, Korea University Anam Hospital, Seoul, Korea
| | - Jin Yong Kim
- Division of Infectious Diseases, Department of Internal Medicine, Incheon Medical Center, Incheon, Korea
| | - Young-Joon Park
- Korea Disease Control and Prevention Agency, Cheongju, Korea
| | - Eun Hwa Choi
- Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea.
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Fremed MA, Farooqi KM. Longitudinal Outcomes and Monitoring of Patients With Multisystem Inflammatory Syndrome in Children. Front Pediatr 2022; 10:820229. [PMID: 35433557 PMCID: PMC9010503 DOI: 10.3389/fped.2022.820229] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 02/28/2022] [Indexed: 12/15/2022] Open
Abstract
The acute manifestations and short-term outcomes of multisystem inflammatory syndrome (MIS-C) have been extensively described; however, our understanding of the longitudinal outcomes associated with this condition continue to evolve. Here we review the existing literature on outcomes of MIS-C up to 1 year following diagnosis and summarize current published expert recommendations for management and follow up of these patients.
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Affiliation(s)
- Michael A Fremed
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
| | - Kanwal M Farooqi
- Division of Pediatric Cardiology, Department of Pediatrics, Columbia University Vagelos College of Physicians and Surgeons, NewYork-Presbyterian-Morgan Stanley Children's Hospital, New York, NY, United States
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Pérez López P, Carvajal Duque D, Salgado García DM, Vega Vega MR, Ramos-Castaneda JA, Ardila Gómez IJ, Romero AF. Multisystemic Inflammatory Syndrome in Children From the South of Colombia: One Year of Experience. Front Pediatr 2022; 10:838922. [PMID: 35450106 PMCID: PMC9016331 DOI: 10.3389/fped.2022.838922] [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: 12/18/2021] [Accepted: 02/10/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Multisystemic inflammatory syndrome in children (MIS-C) is one of the most severe presentations of COVID-19 infection in pediatrics. Currently, we have few studies that describe the characteristics of this condition in Colombian children. OBJECTIVE To describe the clinical and epidemiological characteristics of children hospitalized with MIS-C in Neiva, Colombia. METHODS Observational follow-up study of a cohort of children with MIS-C for 12 months (May 15, 2020, to May 30, 2021) in two hospitals in the city of Neiva. Epidemiological data, clinical characteristics, laboratory characteristics, cardiological evaluation, treatment, and clinical outcomes were analyzed. RESULTS We included 34 patients who met the diagnosis of MIS-C. The median age was 68 months. Some type of nutritional issue was observed by 43.75% of those under 5 years of age and by 27.78% of those over 5 years of age. Gastrointestinal symptoms were the most frequent, with vomiting, diarrhea, and abdominal pain being the most frequent by 79, 70, and 67%, respectively. By 77% of the patients, a history of SARS-COV-2 infection was documented through IgG. In the echocardiogram, 35.4% of the patients had systolic dysfunction, followed by coronary involvement by 35%. CONCLUSION This study describes a series of cases of children with MIS-C in Colombia. Gastrointestinal manifestations were predominant. Mortality was high in comparison to other countries but similar to that reported in Colombia. This fact was associated with relevant pathological background. More training is required for physicians in order to have a better understanding of the disease so as to have an early diagnosis and timely treatment.
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Affiliation(s)
- Pilar Pérez López
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | - Darling Carvajal Duque
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | | | - Martha Rocío Vega Vega
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | | | - Iván José Ardila Gómez
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
| | - Andrés Felipe Romero
- Department of Pediatrics, Hospital Universitario Hernando Moncaleano Perdomo, Neiva, Colombia.,Department of Pediatrics, Clínica Uros, Neiva, Colombia.,Department of Pediatrics, Universidad Surcolombiana, Neiva, Colombia
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O’Neill L, Chumbler NR. Risk Factors for COVID-19 Hospitalization in School-Age Children. Health Serv Res Manag Epidemiol 2022; 9:23333928221104677. [PMID: 35706910 PMCID: PMC9189522 DOI: 10.1177/23333928221104677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Introduction With the recent emergence of the Omicron variant, there has been a rapid and alarming increase in the number of COVID-19 cases among pediatric populations. Yet few US pediatric cohort studies have characterized the clinical features of children with severe COVID-19. The objective of this study was to identify those chronic comorbidities that increase the risk of hospitalization for pediatric populations with severe COVID-19. Methods A retrospective cohort study that utilized the Texas Inpatient Public Use Data file was conducted. The study included 1187 patients (ages 5 to 19) from 164 acute-care Texas hospitals with the primary or secondary ICD-10CM diagnosis code U07.1 (COVID-19, virus identified). The baseline comparison group included 38 838 pediatric patients who were hospitalized in 2020. Multivariable binary logistic regression, controlling for patient characteristics, sociodemographic factors, and health insurance, was used to estimate the adjusted risk of hospitalization for COVID-19. Results Obesity and type 1 diabetes increased the risk of hospitalization with COVID-19 among both children (5-12 years) and adolescents (13-19 years). Adolescents with morbid obesity were 10 times more likely to have severe COVID-19 (p < 0.001). Regardless of age, single-parent households (%) for the patient's zip code was associated with an increased risk of hospitalization with COVID-19 (AOR = 1.02, CI: 1.01-1.03, p < 0.01). Other risk factors included chronic kidney disease (p < 0.05), male gender (p < 0.001), Medicaid (p < 0.001), and charity care (p < 0.001). Conclusion Pediatric providers and public health officials should consider the need to tailor clinical management and mitigation efforts for pediatric populations with identifiable risk factors for severe COVID-19. These findings can be used to improve risk communication with families of children with underlying medical conditions and to prioritize prevention measures, including vaccinations.
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Affiliation(s)
- Liam O’Neill
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Neale R. Chumbler
- Department of Diagnostic and Health Sciences, College of Health Professions, University of Tennessee Health Science Center, Memphis, TN, USA
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Sumner MW, Kanngiesser A, Lotfali-Khani K, Lodha N, Lorenzetti D, Funk AL, Freedman SB. Severe Outcomes Associated With SARS-CoV-2 Infection in Children: A Systematic Review and Meta-Analysis. Front Pediatr 2022; 10:916655. [PMID: 35757137 PMCID: PMC9218576 DOI: 10.3389/fped.2022.916655] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2022] [Accepted: 05/18/2022] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVE To estimate the proportion of SARS-CoV-2 infected children experiencing hospitalization, intensive care unit (ICU) admission, severe outcomes, and death. DATA SOURCES PubMed, Embase, and MedRxiv were searched for studies published between December 1, 2019 and May 28, 2021. References of relevant systematic reviews were also screened. STUDY SELECTION We included cohort or cross-sectional studies reporting on at least one outcome measure (i.e., hospitalization, ICU admission, severe outcomes, death) for ≥100 children ≤21 years old within 28 days of SARS-CoV-2 positivity; no language restrictions were applied. DATA EXTRACTION AND SYNTHESIS Two independent reviewers performed data extraction and risk of bias assessment. Estimates were pooled using random effects models. We adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. MAIN OUTCOMES AND MEASURES Percentage of SARS-CoV-2 positive children experiencing hospitalization, ICU admission, severe outcome, and death. RESULTS 118 studies representing 3,324,851 SARS-CoV-2 infected children from 68 countries were included. Community-based studies (N = 48) reported that 3.3% (95%CI: 2.7-4.0%) of children were hospitalized, 0.3% (95%CI: 0.2-0.6%) were admitted to the ICU, 0.1% (95%CI: 0.0-2.2%) experienced a "severe" outcome and 0.02% (95%CI: 0.001-0.05%) died. Hospital-based screening studies (N = 39) reported that 23.9% (95%CI: 19.0-29.2%) of children were hospitalized, 2.9% (95%CI: 2.1-3.8%) were admitted to the ICU, 1.3% (95%CI: 0.5-2.3%) experienced a severe outcome, and 0.2% (95%CI: 0.02-0.5%) died. Studies of hospitalized children (N = 31) reported that 10.1% (95%CI: 6.1-14.9%) of children required ICU admission, 4.2% (95%CI: 0.0-13.8%) had a severe outcome and 1.1% (95%CI: 0.2-2.3%) died. Low risk of bias studies, those from high-income countries, and those reporting outcomes later in the pandemic presented lower estimates. However, studies reporting outcomes after May 31, 2020, compared to earlier publications, had higher proportions of hospitalized patients requiring ICU admission and experiencing severe outcomes. CONCLUSION AND RELEVANCE Among children tested positive for SARS-CoV-2, 3.3% were hospitalized, with rates being higher early in the pandemic. Severe outcomes, ICU admission and death were uncommon, however estimates vary by study population, pandemic timing, study risk of bias, and economic status of the country. SYSTEMATIC REVIEW REGISTRATION PROSPERO, identifier [CRD42021260164].
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Affiliation(s)
- Madeleine W Sumner
- Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Alicia Kanngiesser
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Kosar Lotfali-Khani
- Department of Biological Sciences, University of Calgary, Calgary, AB, Canada
| | - Nidhi Lodha
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Diane Lorenzetti
- Health Sciences Library and Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Anna L Funk
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Stephen B Freedman
- Sections of Pediatric Emergency Medicine and Gastroenterology, Departments of Pediatrics and Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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Lima EJDF, Faria SMD, Kfouri RDÁ. Reflections on the use of COVID-19 vaccines in children and adolescents. EPIDEMIOLOGIA E SERVIÇOS DE SAÚDE 2021; 30:e2021957. [PMID: 34932771 DOI: 10.1590/s1679-49742021000400028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
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49
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Hashemian H, Mansouri SS, Badeli HR, Esmaili E, Asgharzadeh M, Shahraki T, Ghasemabadi NA, Falahatkar R, Mashouf P, Jafari A. Pediatrics Infected with COVID-19: A Case Series Study on Pediatrics Hospitalized in a Referral Pediatric Hospital. Int J Pediatr 2021; 2021:1135503. [PMID: 34917154 PMCID: PMC8670982 DOI: 10.1155/2021/1135503] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 11/23/2021] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION COVID-19 infection which is a novel pneumonia associated with coronavirus suddenly broke out in the world. The aim of this study is to analyze and summarize the clinical characteristics of pediatric patients who were hospitalized in a referral pediatric hospital because of COVID-19 infection. MATERIALS AND METHODS Twenty-one COVID-19 infection cases confirmed by clinical and laboratory findings who were hospitalized in our center from 20 February to 19 April 2020 were included. Demography information, clinical, laboratory, and radiological findings, and treatment strategies of patients were evaluated. RESULTS The mean age was 91.5 ± 68.38 months (1-225), and there were 12 (57.1%) boys and 9 (42.9%) girls. Fever ≥ 38°C was detected in 11 (52.4%) patients. Eleven (52.3%) patients had tachypnea, and 4 (19%) of them developed tachycardia. Nine CT scans (42.85%) demonstrated a halo sign, and patchy infiltration was seen in CT scan of 7 patients (33.33%). Furthermore, bilateral crazy-paving pattern was seen in CT scan of nine (42.85%) patients. We prescribed chloroquine in 8 (38.1%), oseltamivir in 8 (38.1%), Kaletra in 6 (28.6%), and Ribavirin in 1 (4.8%) of patients. Finally, four (19.04%) patients expired which one of them suffered from ARDS. CONCLUSIONS We found out that boys might develop more severe cases of COVID-19, and this could be more common in school age. Manifestations might be milder than adults, and the most severe cases might be associated with underlying diseases. Also, the effectiveness of drugs in the treatment of this disease needs further study.
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Affiliation(s)
- Houman Hashemian
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Saeid Sadat Mansouri
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Hamid Reza Badeli
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Ebrahim Esmaili
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Majid Asgharzadeh
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Tamkin Shahraki
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Neda Aligoli Ghasemabadi
- Pediatric Diseases Research Center, 17 Shahrivar Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Reza Falahatkar
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Parham Mashouf
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
| | - Alireza Jafari
- Urology Research Center, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
- Inflammatory Lung Disease Research Center, Department of Internal Medicine, Razi Hospital, School of Medicine, Guilan University of Medical Sciences, Rasht, Iran
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Hendler JV, Miranda do Lago P, Müller GC, Santana JC, Piva JP, Daudt LE. Risk factors for severe COVID-19 infection in Brazilian children. Braz J Infect Dis 2021; 25:101650. [PMID: 34774486 PMCID: PMC8578000 DOI: 10.1016/j.bjid.2021.101650] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 09/29/2021] [Accepted: 10/17/2021] [Indexed: 02/06/2023] Open
Abstract
The aim of this study was to describe the epidemiological characteristics and clinical outcome of children hospitalized with COVID-19 and identify the risk factors for severe disease. All hospital admissions of pediatric patients between March and December 2020 in the southern region of Brazil were reviewed and the patients positive for RT-PCR for SARS-CoV-2 were identified. This region encompasses a population of over 2.8 million children and adolescents. Data were extracted from a national database that includes all cases of severe acute respiratory syndrome requiring hospitalization in Brazil. A total of 288 hospitalizations (51.3% female) with a median age of 3 years (interquartile range 0-12 years) were identified. Of these, 38.9% had chronic medical conditions, 55.6% required some form of supplementary oxygen, and 30.2% were admitted to an intensive care unit. There were 17 deaths (5.9%) related to COVID-19. Age less than 30 days was significantly associated with increased odds of critical illness (OR 9.52, 95% CI 3.01-30.08), as well as the presence of one chronic condition (OR 5.08 95%CI 2.78-9.33) or two or more chronic conditions (OR 6.60, 95% CI 3.17-13.74). Conclusion: Age under 30 days old and presence of chronic conditions were strongly associated with unfavorable outcomes in Brazilian children with SARS-CoV-2 infection. These findings could help local public health authorities to develop specific policies to protect this more vulnerable group of children.
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Affiliation(s)
- Jordana Vaz Hendler
- Universidade Federal do Rio Grande do Sul (UFRGS), Child and Adolescent Health, Porto Alegre, RS, Brazil.
| | - Patricia Miranda do Lago
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Gabriel Cardozo Müller
- Universidade Federal do Rio Grande do Sul(UFRGS), Biological Science: Biochemistry, Department of ICBS, Porto Alegre, RS, Brazil
| | - João Carlos Santana
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Jefferson Pedro Piva
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Servico de Medicina Intensiva e Emergência Pediatricas (SEMIP), Porto Alegre, RS, Brazil
| | - Liane Esteves Daudt
- Universidade Federal do Rio Grande do Sul (UFRGS), Hospital de Clínicas de Porto Alegre (HCPA), Porto Alegre, RS, Brazil
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