Clinical Course Of Children Research Articles

Clinical Course of Children 1 to 24 Months Old With Positive Urine Cultures Without Pyuria

ObjectiveTo describe the clinical course of children with positive urine cultures without pyuria who were not given antibiotics initially, identify predictors of subsequent antibiotic treatment, and evaluate the association between subsequent treatment and urinary tract infection (UTI) within 30 days. MethodsWe conducted a multicenter retrospective cohort study of children 1 to 24 months old who had positive urine cultures without pyuria and who were not started on antibiotics upon presentation to 3 health care systems from 2010 to 2021. Outcomes included clinical status at the time urine cultures resulted, escalation of care (emergency department visit or hospitalization) and subsequent antibiotic treatment within 7 days, and subsequent UTI within 30 days of presentation. ResultsOf 202 included children, 61% were female and median age was 9 months. Of 151 patients with clinical status information when cultures resulted, 107 (70.8%, 95% confidence interval [CI] 62.9–77.9%) were improved. Two of 202 children (1.0%, 95% CI 0.2–4.0%) experienced care escalation. Antibiotics were started in 142 (82.2%) children, and treatment was associated with prior UTI (risk ratio [RR] 1.20, 95% CI 1.15–1.26) and lack of improvement (RR 1.22, 95% CI 1.13–1.33). Subsequent UTI was diagnosed in 2 of 164 (1.2%, 95% CI 0.1–4.3%) treated and 0 of 36 (0%, 95% CI 0–9.7%) untreated children. ConclusionsSeventy percent of children with positive urine cultures without pyuria improved before starting antibiotics; however, >80% were ultimately treated. Future research should study the impact of diagnostic stewardship interventions and various urine testing strategies to optimize the management of children evaluated for UTI.retain-->

Coronary artery dilation associated with bicuspid and unicuspid aortic valve disease in children: a series of 17 patients

Coronary artery dilation associated with bicuspid/unicuspid aortic valves is described in adults with limited data in children. We aimed to describe the clinical course of children with bicuspid/unicuspid aortic valves and coronary dilation including coronary Z-score changes over time, association of coronary changes with aortic valve anatomy/function, and complications. Institutional databases were searched for children ≤18 years with both bicuspid/unicuspid aortic valves and coronary dilation (1/2006-6/2021). Kawasaki disease and isolated supra-/subvalvar aortic stenosis were excluded. Statistics were descriptive with associations measured by Fisher's exact test and overlapping 83.7% confidence intervals. Of 17 children, bicuspid/unicuspid aortic valve was diagnosed at birth in 14 (82%). Median age at coronary dilation diagnosis was 6.4 years (range: 0-17.0). Aortic stenosis was present in 14 (82%) [2 (14%) moderate, 8 (57%) severe]; 10 (59%) had aortic regurgitation; 8 (47%) had aortic dilation. The right coronary was dilated in 15 (88%), left main in 6 (35%), and left anterior descending in 1 (6%) with no relationship between leaflet fusion pattern or severity of aortic regurgitation/stenosis on coronary Z-score. Follow-up evaluations were available for 11 (mean 9.3 years, range 1.1-14.8) with coronary Z-scores increasing in 9/11 (82%). Aspirin was used in 10 (59%). There were no deaths or coronary artery thrombosis. In children with bicuspid/unicuspid aortic valves and coronary dilation, the right coronary artery was most frequently involved. Coronary dilation was observed in early childhood and frequently progressed. Antiplatelet medication use was inconsistent, but no child died nor developed thrombosis.

342 A case series of live attenuated vaccine administration in dupilumab-treated children with atopic dermatitis

Abstract In patients with atopic dermatitis (AD), it is unknown whether suppression of dysregulated type 2 immune cytokines, interleukin-4 and interleukin-13, with dupilumab impacts the risk of viral infections following live attenuated vaccination. Current medical consensus and regulatory labelling recommend completing age-appropriate non-live vaccinations according to immunization guidelines at least 4 weeks prior to starting dupilumab and to avoid the use of live vaccines in patients treated with dupilumab. Phase 3 dupilumab AD clinical trial protocols prohibited the administration of live attenuated vaccines within 4 weeks before the baseline visit and during treatment. For patients in the LIBERTY AD PED open-label extension (OLE; NCT02612454) who required a live attenuated vaccine, the protocol specified that the study drug be discontinued for 12 weeks prior to planned administration and could be re-initiated 4 weeks after vaccine administration. However, one patient in the 16-week LIBERTY AD PRESCHOOL (NCT03346434, part B) study received a live attenuated vaccine with a ≤ 12 weeks gap between dupilumab administration and vaccination and eight patients in the LIBERTY AD PED-OLE received a live attenuated vaccine, four patients were vaccinated with a ≤ 12 weeks gap and four patients > 12 weeks after discontinuing dupilumab. To describe the clinical course of children with moderate-to-severe AD administered a live attenuated vaccine during the LIBERTY AD PRESCHOOL or LIBERTY AD PED-OLE study. Paediatric patients with moderate-to-severe AD who had previously participated in the phase 2 open-label, multicentre, sequential study LIBERTY AD PRESCHOOL (part A; 3 or 6 mg/kg dupilumab single dose) or the randomized, double-blind placebo-controlled phase 3 study LIBERTY AD PRESCHOOL (part B; 200 mg dupilumab every 4 weeks [q4w] if baseline weight 5 to <15 kg, or 300 mg q4w if 15 to <30 kg) were subsequently enrolled into the LIBERTY AD PED-OLE study (200 mg dupilumab q4w if baseline weight 5 to <15 kg, 300 mg q4w if 15 to <30 kg, or 200 mg q2w if 30 to <60 kg). This case series includes nine patients with severe AD at the parent study baseline (Investigator’s Global Assessment score = 4) and Peak Pruritus Numerical Rating Scale (range: 0–10) scores of 5.2 (n = 1), 8 (n = 2), 9 (n = 4) or 10 (n = 2), who were administered a live attenuated vaccine, with or without pause, during dupilumab treatment in the LIBERTY AD PRESCHOOL (part B; n = 1) or LIBERTY AD PED-OLE study (n = 8). Of the nine patients in this case series, eight were male. All were first diagnosed with AD between 0 and 6 months of age and age at enrolment varied from 8 to 56 months old. Dupilumab treatment duration up to the date of vaccination with live attenuated measles, mumps, rubella (MMR) and varicella vaccines (n = 5) or MMR vaccine only (n = 4) ranged from 85 to 840 days. No adverse events (AEs), including serious AEs, treatment-emergent infections and infestations, or serious infections were observed in the 4-week window post-vaccination. In this limited prospective case series of children with moderate-to-severe AD who also received the live attenuated MMR vaccine, with or without live attenuated varicella vaccine, no serious adverse events were observed within 4 weeks or after 4 weeks post-vaccination. Additional research is needed to assess the safety of live attenuated vaccines in patients on dupilumab treatment and to investigate whether dupilumab treatment impacts vaccine efficacy.

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

Duration of Invasive Mechanical Ventilation Post-Liver Transplantation: Does One Size Fit All?

The Effects of Protein Intake on Clinical Outcome in Pediatric Intensive Care Units.

Factors such as increased metabolic needs and inadequate calorie and protein intake increase the risk of malnutrition in critically ill children admitted to the pediatric intensive care unit. This study aimed to determine the risk of malnutrition and associated clinical outcomes. Data from all patients aged 1 month to 18 years in 4 pediatric intensive care units in Adana, Turkey, were prospectively collected. Patient anthropometric data, the duration of mechanical ventilation, the length of stay in pediatric intensive care unit, 60-day mortality, nutritional status, and calorie and protein intake were recorded. A total of 111 patients were included in the study. There was a significant difference between survivor and non-survivor patients in terms of calorie and protein intake 48 hours after admission and protein intake on the seventh day after admission (P = .001, P = .000, and P = .003, respectively). No significant correlation was found between the length of pediatric intensive care unit stay, sepsis, and calorie intake in the first week. It was found that 1 g/kg/ day increase in protein intake on the seventh day of intensive care hospitalization decreased the risk of mechanical ventilation by 0.49 times (P = .035; sensitivity: 83.3%; specificity: 34.5%). Nutritional status should be evaluated fully in patients admitted to the pediatric intensive care unit and early detected malnutrition should be monitored closely to determine the need for early intervention. The risk of developing malnutrition is high in critically ill children. Providing the necessary energy and protein intake with nutritional therapy affects the clinical course in children with critical illness. Protein intake causes prolongation of mechanical ventilation time, delaying clinical recovery.

Clinical course in children with equivocal appendicitis on computed tomography: a retrospective cohort study.

Appendectomy is one of the most common surgeries in children. Although various radiological examinations are performed, they do not always reveal a definitive diagnosis of appendicitis. This study aimed to investigate the clinical course of equivocal appendicitis, identify the factors associated with appendectomy, and suggest appropriate management for these patients. Patients younger than 19 years who visited Seoul National University Bundang Hospital with a differential diagnosis of appendicitis from January 2013 to December 2017 were included. All participants conducted 'appendiceal CT' with a scoring scale of 1-5. The higher the score, the higher the likelihood of a radiologic diagnosis of appendicitis. We defined the appendicitis CT score of 2-4 as equivocal appendicitis (n = 143). Medical records were reviewed retrospectively for demographics, further examination as abdominal ultrasonography, and appendectomy status (yes or no). The mean follow-up period was 15.6 ± 71 days. Equivocal appendicitis accounted for 16.7%. Additional ultrasonography test was performed in 24.5% (35 of 143). In total, 34 patients (23.8%) underwent appendectomy. Among the patients with appendiceal CT scores 2, 3, and 4, 4.9%, 50.0%, and 87.5% underwent appendectomy, respectively. Higher WBC count, higher appendicitis CT score, and readmission were significantly associated with appendectomy in patients with equivocal appendicitis. Higher appendicitis CT score and WBC level were positively associated with appendectomy. Careful observation can be a treatment option in appendicitis CT score 2 or 3 groups. Appendectomy is the first-line treatment for patients with appendicitis score 4. Additional ultrasonography test is advisable to determine treatment modality for equivocal appendicitis.

Natural course of acute COVID-19 among healthy children in a tertiary hospital.

Previous studies have reported the clinical and epidemiological characteristics of children with coronavirus disease 2019 (COVID-19) in a cross-sectional fashion; however, the natural course of each symptom based on a daily basis during the acute phase has not yet been clarified. This retrospective study aimed to describe the natural course of COVID-19 in children according to dominant variants. We conducted our study on symptomatic children with COVID-19 who were hospitalized at the National Center for Child Health and Development, in Japan. We excluded patients who were observed for less than 9 days and those with underlying disease, COVID-19 vaccination, coinfection, complications, or therapeutic intervention. We collected the data on each participant's age at admission, sex, medical history, observation period, hospitalization period, SARS-CoV-2 test results, and 10 daily symptoms in the first 9 days from the illness onset. Eventually, 115 children were included in this study. The prevalence of fever during the omicron era declined more rapidly over time than that during the pre-omicron era. The prevalence of cough and rhinorrhea did not decline during the observation period, and these clinical manifestations were more common during the pre-omicron era at any point. The prevalence of dysgeusia and/or dysosmia steadily increased over time in the pre-omicron era. This study demonstrated that the prevalence of some symptoms differed not only at the onset but also over time during the acute phase. Details of the natural clinical course of children with COVID-19 help primary care physicians to manage these patients.

Difference in the early clinical course between children with type 1 diabetes having a single antibody and those having multiple antibodies against pancreatic β-cells.

Islet-cell associated antibodies are predictive and diagnostic markers for type 1 diabetes. We studied the differences in the early clinical course of children with type 1 diabetes with a single antibody and those with multiple antibodies against pancreatic β-cells. Sixty-seven children with type 1 diabetes aged less than 15 years diagnosed between 2010 and 2021 were included in the study and subdivided into two subgroups: children who were single positive for either glutamic acid decarboxylase (GAD) antibodies (n = 16) or insulinoma-associated antigen-2 (IA-2) antibodies (n = 13) and those positive for both antibodies (n = 38) at diagnosis. We compared the patients' clinical characteristics, pancreatic β-cell function, and glycemic control during the 5 years after diagnosis. All clinical characteristics at diagnosis were similar between the two groups. One and two years after diagnosis, children who tested positive for both antibodies showed significantly lower postprandial serum C-peptide (CPR) levels than those who tested positive for either GAD or IA-2 antibodies (p < 0.05). In other periods, there was no significant difference in CPR levels between the two groups. There was a significant improvement in glycosylated hemoglobin (HbA1c) levels after starting insulin treatment in both groups (p < 0.05), but no significant difference in HbA1c levels between the groups. Residual endogenous insulin secretion may be predicted based on the number of positive islet-cell associated antibodies at diagnosis. Although there are differences in serum CPR levels, optimal glycemic control can be achieved by individualized appropriate insulin treatment, even in children with type 1 diabetes.

290. Quantitative Antibody Levels Against SARS-CoV-2 Spike Protein in Children with COVID-19 and MIS-C

Abstract Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has different clinical courses in children and adults. The majority of coronavirus diseases 2019 (COVID-19) caused by SARS-CoV-2 are either mild or asymptomatic in children. This report aimed to determine quantitative antibody levels against SARS-CoV-2 spike protein in children with COVID-19 and MIS-C. Methods A single-center retrospective study was conducted at a tertiary-level university hospital. Seventy-five pediatric patients diagnosed with COVID-19 and MIS-C were included between September 2021 and February 2022. The demographic, clinical and laboratory data of cases were extracted from medical records. The duration of hospitalization, management, and outcomes was reported. Quantitative antibody levels against SARS-CoV-2 spike protein in the third month after the initial diagnosis was measured, and patients were also evaluated for post-COVID-19 syndrome symptoms . Results The patients were categorized into three disease phenotypes; there were 36 (48%) patients with mild/asymptomatic (group1)( M/F 20/16, mean age, 11.4 years) 22 (29.3%) patients with moderate to severe SARS-CoV-2 infection (group 2)(M/F 13/9, mean age, 13 years) and 17 (22.6%) patients with MIS-C (group 3)( M/F 9/8, mean age, 10.1 years). The majority of the children in group 1 (80.6%), in group 2(90.9%), and in group 3(82.4%) had a detectable IgG antibodies to SARS-CoV-2 spike protein(p=0.567). The mean antibody values against SARS-CoV-2 spike protein was 321.9±411.6 in group 1, 274±261 in group 2, and 220±299 in group 3 (p &amp;gt;0.05). The antibody positivity rate was similar in patients with COVID-19(85.5%) and MIS-C (82.4%) (p=0.833). The mean antibody value against SARS-CoV-2 spike protein was 303.9±360.3 in the COVID-19 group and 220 ±299 in the MIS-C group(p &amp;gt;0.05). Conclusion The majority of the children had a detectable IgG antibody level to SARS-CoV-2 spike protein. There was no difference between asymptomatic/mild disease, moderate/severe disease, and MIS-C groups in mean antibody levels. Long-term studies are needed to examine antibody responses over time in children with COVID-19 and MIS-C for different vaccination schedules. Disclosures All Authors: No reported disclosures.

Clinical Course of Children with Chronic Suppurative Lung Disease or Bronchiectasis Infected with Pseudomonas aeruginosa.

Children with chronic wet cough and without cystic fibrosis (non-CF) may suffer from chronic suppurative lung disease (CSLD) or bronchiectasis. Pseudomonas aeruginosa (Pa) can be one of the offending microbes in these children. The present study aimed to describe the clinical course of children with the above two conditions who were infected with Pa. Data of 54 children with CSLD/bronchiectasis who were diagnosed and attended in our department were retrospectively analysed through a Cox proportional hazard model, with age, presence of bronchiectasis, use of inhaled colistin, azithromycin, inhaled hypertonic saline as the covariates. In 42 of the 54 patients, there was no identifiable cause or underlying chronic disorder. Microbiological clearance was defined as the absence of daily wet cough for four months along with four negative cultures taken during the last four consecutive follow-up visits. Multivariate analysis was performed with a Cox proportional hazard model with time to microbiological clearance as the outcome. Results are described as Hazard Ratios (HR) with 95% Confidence Intervals (95%CI). Nebulised antibiotics and the presence of bronchiectasis were statistically significant predictors of remission (HR: 3.99; 95%CI: 1.12-14.14; p = 0.032, and HR: 0.24; 95%CI: 0.08-0.71; p = 0.010). In conclusion, the rate of microbiological clearance increases with the use of inhaled colistin and decreases when there is established bronchiectasis.

Pediatric manifestations of Lynch Syndrome: A single center experience

Lynch syndrome is an autosomal dominant condition caused by a heterozygous variation in one of the DNA mismatch repair (MMR) genes that pre-disposes individuals to early onset colorectal cancers and other malignancies. Lynch syndrome is generally considered an adult-onset disorder, with malignancy rarely manifesting in childhood. Colorectal cancer is extremely rare in children, but hereditary syndromes including Lynch syndrome are an important cause. We aimed to assess the frequency and clinical course of children with Lynch syndrome associated pediatric colorectal cancers at our institution over the last 20 years. In this retrospective study, we describe four cases of children with Lynch syndrome-associated colorectal cancers age 14-17 years at diagnosis. All patients were diagnosed with Lynch syndrome after diagnosis, despite three of them having family histories consistent with Lynch syndrome. This series highlights a rare but important cause of pediatric malignancy and points to the need for early education on colorectal cancer warning symptoms and open discussion about this condition in affected families. It also illustrates the need for a thorough family history and a high level of suspicion for Lynch syndrome in children based on family background, as early detection may be key to improving cancer outcomes.

Temporal Dynamics of MOG Antibodies in Children With Acquired Demyelinating Syndrome.

Background and ObjectiveThe spectrum of myelin oligodendrocyte glycoprotein (MOG) antibody–associated disorder (MOGAD) comprises monophasic diseases such as acute disseminated encephalomyelitis (ADEM), optic neuritis (ON), and transverse myelitis and relapsing courses of these presentations. Persistently high MOG antibodies (MOG immunoglobulin G [IgG]) are found in patients with a relapsing disease course. Prognostic factors to determine the clinical course of children with a first MOGAD are still lacking. The objective of the study is to assess the clinical and laboratory prognostic parameters for a risk of relapse and the temporal dynamics of MOG‐IgG titers in children with MOGAD in correlation with clinical presentation and disease course.MethodsIn this prospective multicenter hospital-based study, children with a first demyelinating attack and complete data set comprising clinical and radiologic findings, MOG-IgG titer at onset, and clinical and serologic follow-up data were included. Serum samples were analyzed by live cell-based assay, and a titer level of ≥1:160 was classified as MOG-IgG–positive.ResultsOne hundred sixteen children (f:m = 57:59) with MOGAD were included and initially diagnosed with ADEM (n = 59), unilateral ON (n = 12), bilateral ON (n = 16), myelitis (n = 6), neuromyelitis optica spectrum disorder (n = 8) or encephalitis (n = 6). The median follow-up time was 3 years in monophasic and 5 years in relapsing patients. There was no significant association between disease course and MOG-IgG titers at onset, sex, age at presentation, or clinical phenotype. Seroconversion to MOG-IgG–negative within 2 years of the initial event showed a significant risk reduction for a relapsing disease course. Forty-two/one hundred sixteen patients (monophasic n = 26, relapsing n = 16) had serial MOG-IgG testing in years 1 and 2 after the initial event. In contrast to relapsing patients, monophasic patients showed a significant decrease of MOG-IgG titers during the first and second years, often with seroconversion to negative titers. During the follow-up, MOG-IgG titers were persistently higher in relapsing than in monophasic patients. Decrease in MOG-IgG of ≥3 dilution steps after the first and second years was shown to be associated with a decreased risk of relapses. In our cohort, no patient experienced a relapse after seroconversion to MOG-IgG–negative.DiscussionIn this study, patients with declining MOG-IgG titers, particularly those with seroconversion to MOG-IgG–negative, are shown to have a significantly reduced relapse risk.

KAWASAKI DISEASE, MULTISYSTEM INFLAMMATORY SYNDROME IN CHILDREN AND COVID-19 IN A TERTIARY PEDIATRIC HOSPITAL IN MONTRÉAL, CANADA

BackgroundDuring the SARS-CoV-2 (COVID-19) pandemic speculation arose on possible association between Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19. This retrospective study describes the demographics and clinical course of children diagnosed with KD or MIS-C during COVID-19 pandemic.Methods and ResultsMethods: Retrospective chart reviews on children hospitalized at CHU Sainte Justine in Montréal, Canada, for KD (n=46) or MIS-C (n=73) between 01/2020 and 02/2022. Results: Only 13.4% KD patients tested rt-PCR positive for COVID-19 or were exposed to a positive contact before symptom onset vs. 82.19% MIS-C patients. KD patients were 3.61±3.56 years old vs. MIS-C 8.38±4.17 years (p < 0.0001); 52.17% vs. 63.01% male. No KD case required pediatric intensive care unit (PICU) admission vs. 52% MIS-C (p < 0.0001) with an average PICU duration of 3.18±2.08 days. Ethnic origins in KD vs. MIS-C respectively included African (6.52% vs.15.07%), Arab (13.04% vs. 27.40%), Asian (2.17% vs. 2.74%), Caribbean (2.17% vs. 5.48%), Hispanic (2.17% vs. 4.11%), Caucasian (56.52% vs. 35.62%), and mixed-ethnicity (17.39% vs. 4.11%); with a 2.2±0.5 average odds ratio for non-Caucasians to develop MIS-C/KD (p < 0.01). Most common KD clinical criteria observed with MIS-C were (table) conjunctivitis and skin rash with a Median of 4[1-5] criteria in KD vs. 2[0-5] criteria in MIS-C. Fever duration was 8.20±3.50 days for KD vs. 8.15±3.65 for MIS-C (p=0.94) and hospital duration 5.09±2.32 days in KD vs. 7.66±3.52 in MIS-C (p < 0.0001). Coronary dilatations with a Z-score of greater than or equal to 3.0 occurred in 21.74% of KD patients vs. 9.59% of MIS-C patients (p=0.10).Conclusion BackgroundDuring the SARS-CoV-2 (COVID-19) pandemic speculation arose on possible association between Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19. This retrospective study describes the demographics and clinical course of children diagnosed with KD or MIS-C during COVID-19 pandemic. During the SARS-CoV-2 (COVID-19) pandemic speculation arose on possible association between Kawasaki Disease (KD), Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19. This retrospective study describes the demographics and clinical course of children diagnosed with KD or MIS-C during COVID-19 pandemic. Methods and ResultsMethods: Retrospective chart reviews on children hospitalized at CHU Sainte Justine in Montréal, Canada, for KD (n=46) or MIS-C (n=73) between 01/2020 and 02/2022. Results: Only 13.4% KD patients tested rt-PCR positive for COVID-19 or were exposed to a positive contact before symptom onset vs. 82.19% MIS-C patients. KD patients were 3.61±3.56 years old vs. MIS-C 8.38±4.17 years (p < 0.0001); 52.17% vs. 63.01% male. No KD case required pediatric intensive care unit (PICU) admission vs. 52% MIS-C (p < 0.0001) with an average PICU duration of 3.18±2.08 days. Ethnic origins in KD vs. MIS-C respectively included African (6.52% vs.15.07%), Arab (13.04% vs. 27.40%), Asian (2.17% vs. 2.74%), Caribbean (2.17% vs. 5.48%), Hispanic (2.17% vs. 4.11%), Caucasian (56.52% vs. 35.62%), and mixed-ethnicity (17.39% vs. 4.11%); with a 2.2±0.5 average odds ratio for non-Caucasians to develop MIS-C/KD (p < 0.01). Most common KD clinical criteria observed with MIS-C were (table) conjunctivitis and skin rash with a Median of 4[1-5] criteria in KD vs. 2[0-5] criteria in MIS-C. Fever duration was 8.20±3.50 days for KD vs. 8.15±3.65 for MIS-C (p=0.94) and hospital duration 5.09±2.32 days in KD vs. 7.66±3.52 in MIS-C (p < 0.0001). Coronary dilatations with a Z-score of greater than or equal to 3.0 occurred in 21.74% of KD patients vs. 9.59% of MIS-C patients (p=0.10). Methods: Retrospective chart reviews on children hospitalized at CHU Sainte Justine in Montréal, Canada, for KD (n=46) or MIS-C (n=73) between 01/2020 and 02/2022. Results: Only 13.4% KD patients tested rt-PCR positive for COVID-19 or were exposed to a positive contact before symptom onset vs. 82.19% MIS-C patients. KD patients were 3.61±3.56 years old vs. MIS-C 8.38±4.17 years (p < 0.0001); 52.17% vs. 63.01% male. No KD case required pediatric intensive care unit (PICU) admission vs. 52% MIS-C (p < 0.0001) with an average PICU duration of 3.18±2.08 days. Ethnic origins in KD vs. MIS-C respectively included African (6.52% vs.15.07%), Arab (13.04% vs. 27.40%), Asian (2.17% vs. 2.74%), Caribbean (2.17% vs. 5.48%), Hispanic (2.17% vs. 4.11%), Caucasian (56.52% vs. 35.62%), and mixed-ethnicity (17.39% vs. 4.11%); with a 2.2±0.5 average odds ratio for non-Caucasians to develop MIS-C/KD (p < 0.01). Most common KD clinical criteria observed with MIS-C were (table) conjunctivitis and skin rash with a Median of 4[1-5] criteria in KD vs. 2[0-5] criteria in MIS-C. Fever duration was 8.20±3.50 days for KD vs. 8.15±3.65 for MIS-C (p=0.94) and hospital duration 5.09±2.32 days in KD vs. 7.66±3.52 in MIS-C (p < 0.0001). Coronary dilatations with a Z-score of greater than or equal to 3.0 occurred in 21.74% of KD patients vs. 9.59% of MIS-C patients (p=0.10). Conclusion

SARS-CoV-2: The Impact of Co-Infections with Particular Reference to Mycoplasma pneumonia—A Clinical Review

Background: After its 2019 outbreak in Wuhan, scientists worldwide have been studying the epidemiology and clinical characteristics of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in children. Evidence indicates that children with SARS-CoV-2 infection are more likely to develop upper and lower respiratory tract infections in association with other infectious agents, such as Mycoplasma pneumoniae. Here, we conducted a systematic review of SARS-CoV-2 and Mycoplasma pneumoniae co-infection and their clinical course in children. Methods: We evaluated the published literature on SARS-CoV-2 by using the medical databases PubMed, Embase, Cochrane Library, Scopus, and Web of Science. In the searches, the Medical Subject Heading (MeSH) terms “SARS-CoV-2 and Mycoplasma pneumoniae” AND “co-infection SARS-CoV-2” were used. Studies describing co-infection with SARS-CoV-2 and Mycoplasma pneumoniae in children were included in the review. The study was conducted and reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Results: According to the PRISMA guidelines, of the 38 identified studies, 14 were conducted in children (children/adolescents 0–18 years), 6 of which were included in this review. In total, 5867 children under the age of 17 years were diagnosed with SARS-CoV-2 infection through real-time polymerase chain reaction analysis of nasopharyngeal swabs to detect viral RNA. Elevated serum IgM levels specific to Mycoplasma pneumoniae were observed in 534 children and were associated with a Kawasaki-like illness in one child. To date, all of the children are alive. Conclusion: This study underlines the importance of considering, depending on the clinical context, a possible co-infection between SARS-CoV-2 and atypical bacteria, such as Mycoplasma pneumoniae. Co-infections with other respiratory pathogens during the pandemic and hospital stay can cause mistakes in clinical diagnostic and drug treatment. Physicians should perform early differential diagnosis of SARS-CoV-2 in association with other infectious agents. Further studies are needed to have a real incidence of these co-infections and their impact on symptoms, course, and outcome of patients with SARS-CoV-2.

Idiopathic left fascicular ventricular tachycardia in children and adolescents.

Idiopathic ventricular tachycardia (VT) in children with structurally normal hearts is generally unrelated to the risk of sudden arrhythmic death. Still, it may be associated with deterioration in the quality of life. VT involving the fascicular conduction system is the most typical form of idiopathic left VT. In this retrospective study, we describe the experience of the clinical presentation, catheter ablation, and long-term follow-up of left fascicular VT in children. An electrophysiological study was performed on consecutive children at a single tertiary center. Clinical fascicular left VT was induced by programmed stimulation, and catheter ablation was guided searching for Purkinje potentials. We included 18 patients (0.8 patients/year): 14 (77.8%) males and four females. The mean age of the first VT episode was 8.5 ± 5 years. Intravenous verapamil administration was effective for paroxysmal fascicular VT but not for prevention of recurrences. The mean age at the time of catheter ablation was 11.1 ± 3.8 years (8 months-16 years). The mean weight was 36.8 ± 16.4 kg (8.7-58 kg). A 100% success rate was observed with catheter ablation after repeated procedures without major complications. Mean follow-up was 2.0 ± 1.2 years (1.0-4.0 years, median 1.5), with permanent success in all patients and no antiarrhythmic drug administration. Fascicular VT has an adverse clinical course in children. In most cases, this condition is drug refractory. Catheter ablation is successful and safe treatment and should represent the first-line approach in symptomatic children.

The associations between the clinical course of children with tracheostomy and their mothers' depression, burnout, burden, and self-esteem.

The aim of this study was to evaluate the clinical features of children with tracheostomy and the predictors of psychological status of their primary caregivers in order to determine the associations between the children's clinical course with their caregivers' psychological status. The caregivers of children with tracheostomy are responsible for providing basic tracheostomy care at home. All these responsibilities may be associated with significant changes in family members' lifestyles, daily routines and family dynamics. This study is a cross sectional study. Data of the family's socioeconomic status and clinical status of children with tracheostomy were noted in four paediatric pulmonology centers. The Beck Depression Inventory, Maslach Burnout Inventory, Zarit Caregiver Burden Scale, and Rosenberg Self-esteem Scale were used for psychological measurements of the caregivers. The STROBE checklist was used for this study. Eighty-five children and their primary caregivers were enrolled in the study. The children's median age was 4.1 years. Thirty-eight of them were dependent on home ventilators. Twenty-one had bacterial colonisation. All children's primary caregivers were their mothers. Beck Depression Inventory scores of mothers of children with colonisation were higher. Number of hospitalizations in previous 6 months was related to mothers' emotional exhaustion and depersonalization scores. Duration of children's hospitalizations in previous 6 months was positively correlated to mothers' emotional exhaustion, depersonalization, and Beck Depression Inventory scores. Mothers of children with tracheostomy may experience psychological conditions, such as high levels of depression, burnout, burden and low levels of self-esteem. Frequent and long-term hospitalizations of children correlated with mother's depression and burnout. Therefore, primary caregivers should be evaluated and supported psychologically. Preventing mothers of children with tracheostomy from experiencing psychological conditions such as depression, burnout, burden and low self-esteem can also increase the quality of care for children.

Evaluation of paediatric immune thrombocytopenia patients with clinical and laboratory findings: emphasizing the role of monocytosis.

We aimed to investigate the relationship between demographics, clinical features, laboratory findings including monocytosis and clinical course in children with immune thrombocytopenia (ITP). Data of 100 ITP patients were analysed. Complete blood count findings of the patients at certain time points were evaluated to classify the disease as acute, persistent and chronic. An effect of sex on chronicity was not observed ( P = 0.166). Of the patients enrolled in the study, 38% ( n = 38) had chronic course. The mean age of patients with the chronic course was 7 ± 4.1 years, which was significantly higher than the other groups ( P = 0.007). Sixty-five percent ( n = 13) of the patients presenting with mucosal bleeding and 27.4% ( n = 20) of the patients presenting with skin bleeding became chronic ( P = 0.008). MPV was found to be significantly high in chronic ITP patients ( P = 0.049). Monocytosis was noted in 80% of the patients at diagnosis. Intravenous immunoglobulin was used in 84% of the patients with acute ITP; 33% of them developed chronic ITP. The age at diagnosis, presence of mucosal bleeding and increased MPV on admission were high-risk factors for the development of the chronic course. Monocytosis was detected in 80% of the patients on admission, and it may play a role in the pathogenesis of ITP.

Clinical characteristics of Kawasaki disease in Polish children: A retrospective study.

Kawasaki disease (KD), an acute, generalized vasculitis, is associated with an increased risk of coronary heart disease and is the most common cause of acquired heart disease in childhood. The incidence of KD is increasing worldwide. Our study aims to analyze KD's clinical course in children and to evaluate risk factors for persistent changes in coronary vessels after 6-8 weeks of treatment. The retrospective analysis included patients with KD hospitalized in a single tertiary carehospital. The diagnosis, as well as treatment, were based on the current worldwide treatment standards. The clinical course, selected laboratory parameters, the treatment effect, and following cardiac complications were analyzed in different age groups. In the years 2006-2019, 140 patients aged from two months to 16 years: 52 girls and 88 boys, were diagnosed with KD. Coronary artery aneurysms (CAA) at weeks 6-8 of disease were found in 16% of patients. Boys and infants were more likely to develop aneurysms at weeks 6-8 of the disease (P = 0.045; P = 0.03; respectively). The CAA frequency was related to the atypical course (P = 0.02), late diagnosis (P = 0.04), presence of changes in the coronary arteries at the time of diag nosis (P<0.001), immunoglobulin resistance (P = 0.002), a lower hemoglobin concentraction (P<0.001), and a higher platelet count (P = 0.02). There were 28% of patients resistant to first-line time treatment. In this group, we found CAA in 31% of children. We found that late diagnosis, low hemoglobin level, high platelet count, CAA presence at diagnosis, atypical course of KD, and resistance to intravenous immunoglobulins are predictors of CAA after 6-8 weeks in KD patients.

Clinical Course of Children with Campylobacter Gastroenteritis With and Without Co-Infection in Lima, Peru.

This study describes the clinical course of gastroenteritis caused by Campylobacter spp. as a single-infection versus coinfection and the corresponding changes that occur according to the treatment received, in children between 12 and 24 months of age. This descriptive study is based on the data of a pediatric cohort conducted between 2008 and 2011 of 555 children in Lima, Peru. Ninety-six diarrheal episodes with positive cultures for Campylobacter spp. were evaluated. In 52 episodes, empirical antibiotic treatment was started before pathogen isolation. Of these 96 episodes, 64.6% were coinfections with other pathogens. Coinfections were led by Escherichia coli, norovirus, and Giardia. Compared with single-infection episodes, coinfections had a mean symptom duration of 6.6 versus 5.7 days, a mean frequency of bowel movements per episode of 18.9 versus 14.8, and occurrence of vomiting and fever in 24.2% versus 14.7% of patients. Most of the patients with more severe clinical features at diagnosis were prescribed macrolides as empiric treatment. In the single-infection group, symptom duration was 7.2 ± 3.3 days in the macrolide-treated group and 7.9 ± 2.7 days in the nonmacrolide group. Diarrhea caused by coinfection appeared to be generally more severe than a single-pathogen. Patients with more severe clinical courses who received macrolides treatment might have had a faster recovery than patients who received nonmacrolides.

Docosahexaenoic and Eicosapentaenoic Intervention Modifies Plasma and Erythrocyte Omega-3 Fatty Acid Profiles But Not the Clinical Course of Children With Autism Spectrum Disorder: A Randomized Control Trial.

BackgroundThe pathogenesis of autism spectrum disorder (ASD) is under investigation and one of the main alterations relates to the metabolic and inflammatory system dysfunctions. Indeed, based on a possible deficit of omega-3 fatty acids (FAs) of patients with ASD and looking for an anti-inflammatory effect, dietary supplements with omega-3 fatty acids have been proposed. We aimed to evaluate differences in plasma and erythrocyte FA profiles and plasma cytokines in patients with infantile ASD after supplementation with docosahexaenoic (DHA) and eicosapentaenoic (EPA) acids or placebo and both compared at baseline with a reference healthy group.MethodsA double-blind, randomized placebo-controlled intervention with DHA/EPA for 6 months was carried out in 54 children between 2 and 6 years diagnosed with ASD. They were selected and randomly assigned into two groups: 19 children received 800 mg/day of DHA and 25 mg/day of EPA, or placebo. In addition, another reference group of 59 healthy children of the same age was included. Plasma lipids and cytokines, and FA profiles in plasma and erythrocytes were measured at baseline and after 6 months of treatment in ASD children, and at baseline in the reference group.ResultsThere were no differences in demographic, anthropometric characteristics, and omega-3 intake between the healthy reference group and the ASD children at baseline. Children with ASD showed the higher plasma percentages of palmitic acid and total saturated FA and lower total omega-6 polyunsaturated FA (PUFA) compared with healthy children. An increased level of DHA and reduced EPA level in erythrocytes were detected in the ASD group vs. the reference group. After 6 months of treatment, the ASD group that received DHA enriched product significantly increased the plasma and erythrocyte percentages of DHA, but no differences were observed in the clinical test scores and other parameters as plasma cytokines between the two groups of ASD related to the intervention.ConclusionSpanish children with ASD exhibit an appropriate omega-3 FA status in plasma and erythrocytes. Neither a clinical improvement of ASD children nor a better anti-inflammatory or fatty acid state has been found after an intervention with DHA/EPA for 6 months. So, the prescription of n-3 LC-PUFA and other dietary supplements in ASD should be only indicated after a confirmed alteration of FA metabolism or omega-3 LC-PUFA deficiency evaluated by specific erythrocyte FA.Clinical Trial Registration[www.ClinicalTrials.gov], identifier [NCT03620097].