Neonatal severe COVID-19 infection complicated by Staphilococcus aureus could be misinterpreted as MIS-C?: case report and review of literature

At 23 days of life a neonate presented to the emergency room with crying and decreased oral intake. His parents were positive to SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2), but he turned out negative. After one week he was admitted to NICU (neonatal intensive care unit) for respiratory failure, and nasopharyngeal swab (PCR test: polymerase chain reaction test) was positive for SARS-CoV-2. On examination the child had fever, tachy-dyspnea, reduced oxygen saturation, tachycardia, abdominal distension and tenderness, irritability and hypertonia. Blood exam showed respiratory acidosis, lymphocytopenia, hypoalbuminemia and coagulopathy; CRP (C reactive protein), procalcitonin, D-dimer, ferritin and NT-proBNP (N-terminal prohormone of brain natriuretic peptide) were elevated. Chest X-ray revealed bilateral interstitial infi ltration and abdomen ultrasound a thin fl uid effusion; echocardiography was normal. SARS-CoV-2 PCR tests on CSF (cerebrospinal fluid) and stool were also positive. He was started on non-invasive intermittent positive pressure respiratory ventilation, treated with antibiotic therapy, methylprednisolone, intravenous immunoglobulins, and antiplatelet therapy. Rapid clinical improvement was seen with remission of fever after eight days. The child complicated with bacterial super-infection presenting as pleural empyema. As presented in our case, it is not always easy to differentiate between severe forms of COVID-19 and MIS-C. Due to the rarity of these presentations in neonates, multicentric collaboration is needed to identify the specifi c characteristics of the two forms, better defi ne diagnostic criteria, and treatment options.

Disease Characteristics and Psychiatric Comorbidities in Adolescents with Anorexia Nervosa Hospitalized During COVID-19 Pandemic

BACKGROUND

Since the beginning of COVID-19 pandemic, an increase in new diagnoses and pediatric hospital admission for anorexia nervosa (AN) or atypical AN in adolescents have been reported, suggesting an adverse effect of COVID-19 on youth mental health. We hypothesized possible differences in prevalence of hospitalization and/or disease severity, related to socio-economic status and/or ethnicity.

METHODS

Retrospectively, patients were divided into two subgroups and compared according to the date of first hospital admission: "pre SARS-COV2 era" group (n. 45, 8th March 2016-8th March 2020) and "SARS-COV2 era" group (n. 43, 9th March 2020-8th March 2022).

RESULTS

During the two years of the SARS-COV2 era, we reported an increase in hospital admission incidence more than doubled respect to the "pre-SARS-COV2 era". The "SARS-COV2 era group" showed a more rapid weight loss (p = 0.005), a minor duration of weight loss from lifetime maximum to admission (p = 0.019) and needed most frequently treatments with intravenous fluids (p < 0.0001), oral dietetic supplements (p <0.001) and enteral nutrition by nasogastric tube (p = 0.002). The same group presented higher prevalence of psychiatric comorbidities (63% vs. 22%, p < 0.0001) and required most frequently treatments with psychotropic drugs (56% vs. 24%, p = 0.002). We found higher family socioeconomic status (SES) in our patients with AN in both the periods and we did not find a shift in social class distribution over time.

CONCLUSIONS

Our study confirms a significant increase in incidence of hospitalization and of psychiatric comorbidity in the pediatric population with AN during the second year of COVID-19 pandemic, regardless of SES or ethnic background. Further studies are needed to understand potential mechanisms that during COVID-19 pandemic trigger eating disorder symptoms.

Consenting practices in interventional cardiology: an analysis from the European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Background

Consenting practices in interventional cardiology vary across different procedures, operators, centres and nations.

Purpose

In order to define best practice for obtaining informed patient consent, it is first necessary to understand how consenting practice differs.

Methods

An online survey of 20 questions was sent to all members of the European Association of Percutaneous Cardiovascular Interventions, addressing consenting practices in elective and emergency scenarios.

Results

We received 483 responses from 74 countries. The majority of respondents (77%) were European operators. Responses were received from consultant cardiologists (n=370), fellows in training (n=55), allied health professionals (n=36) and others (n=21).

Across all respondents, in elective practice, 427 (88.4%) operators obtain written consent for every procedure, the remainder (9.5%) obtain verbal consent only. Consent is obtained by the consultant or fellow who directly performs the procedure in 56.9% cases. For coronary angiography, pre-emptive consent for possible additional procedures (pressure wire and PCI) is taken by operators in all cases (58.6%), some cases (30.6%) and never (11.0%). Prior to interventional therapies, written information detailing the risk of the procedure is provided in every case by 63.8% of operators, sometimes by 25.1% of operators, and is never provided by 11.0% of operators.

In emergency settings, where patients are conscious and have capacity to consent, 274 (56.7%) of respondents obtain written consent, 155 (33.1%) obtain verbal consent only and 52 (10.8%) stated that a consent process was not required. Where consciousness and capacity are impaired, 218 (45.1%) always, 118 (24.4%) sometimes and 145 (30%) never document a written capacity and best interests' assessment.

When asked to rate the overall quality of consenting practices in their own institution, 279 (57.8%) stated these were “excellent” or “above average”, 165 (34.2%) were “average” and 39 operators described consenting practices in their institution as “below average” or “poor”.

Conclusions

Diversity in consenting practice spans elective and emergency procedures. These results suggest that there is substantial variation in the understanding of the rationale, legal requirement, and perceived best practices for consent. Further work should consider the merits of standardisation of consent processes across Europe.

Funding Acknowledgement

Type of funding sources: None.

Pediatric emergency care in a low-income country: Characteristics and outcomes of presentations to a tertiary-care emergency department in Mozambique

Background

An effective pediatric emergency care (PEC) system is key to reduce pediatric mortality in low-income countries. While data on pediatric emergencies from these countries can drive the development and adjustment of such a system, they are very scant, especially from Africa. We aimed to describe the characteristics and outcomes of presentations to a tertiary-care Pediatric Emergency Department (PED) in Mozambique.

Methods

We retrospectively reviewed PED presentations to the "Hospital Central da Beira" between April 2017 and March 2018. Multivariable logistic regression was used to identify predictors of hospitalization and death.

Results

We retrieved 24,844 presentations. The median age was 3 years (IQR 1-7 years), and 92% lived in the urban area. Complaints were injury-related in 33% of cases and medical in 67%. Data on presenting complaints (retrieved from hospital paper-based registries) were available for 14,204 (57.2%) records. Of these, respiratory diseases (29.3%), fever (26.7%), and gastrointestinal disorders (14.2%) were the most common. Overall, 4,997 (20.1%) encounters resulted in hospitalization. Mortality in the PED was 1.6% (62% ≤4 hours from arrival) and was the highest in neonates (16%; 89% ≤4 hours from arrival). A younger age, especially younger than 28 days, living in the extra-urban area and being referred to the PED by a health care provider were all significantly associated with both hospitalization and death in the PED at the multivariable analysis.

Conclusions

Injuries were a common presentation to a referral PED in Mozambique. Hospitalization rate and mortality in the PED were high, with neonates being the most vulnerable. Optimization of data registration will be key to obtain more accurate data to learn from and guide the development of PEC in Mozambique. Our data can help build an effective PEC system tailored to the local needs.