Clinical Characteristics Of Children Research Articles

A prospective study of etiology and clinical characteristics of children with short stature and response to treatment

OBJECTIVE: To study the etiological and clinical profile of children presenting with short stature and to assess growth velocity in children after 6 months of treatment.METHODS: This prospective observational study was conducted between January 2017 to May 2018. One hundred consecutive children attending the outpatient department for short stature were thoroughly evaluated clinically and investigations were done as deemed necessary. The cases were followed up for 6 months to assess the growth velocity.RESULTS: Female to male ratio was 1.56. Nutritional short stature (NSS) and normal variant short stature were the most prevalent, with the equal frequency of 19% each, followed by endocrine and other causes. The significant number of children had Vitamin D deficiency/insufficiency (92%). mid-parental height (MPH) was below-1 standard deviation score (SDS) from the national standard in all the children studied.CONCLUSION: In the present study, normal variants of short stature and NSS were the most common causes of short stature, followed by endocrine disorders. Vitamin D status was low in the majority of the children (92%), with possible contribution to short stature in all groups irrespective of primary diagnosis and needs further exploration. Growth hormone (GH) therapy in select non GH deficiency short stature can be promising. We also noted that maternal, paternal heights, and consequently, MPH was below the national standard in 100% of children. This may implicate ethnic variations and maybe a call for local growth charts. It needs further studies to look for factors responsible for lower MPH in our cohort.

Congenital malformations of the urinary tract: progression to chronic renal disease.

Congenital nephrourological abnormalities (CAKUT) are a particularly relevant group of diseases due to their high prevalence and the fact they are the main cause of chronic renal disease (CRD) in the pediatric population. Our objective was to determine the characteristics and prevalence of CAKUT in our setting, while identifying the factors associated with the occurrence of renal damage. A retrospective, descriptive, analytical, cross-sectional study of patients seen in the Pediatric Nephrology Department of a third-level hospital from January 1 to December 31, 2018 was carried out. Epidemiological, clinical, and analytical variables were assessed, and potential risk factors associated with CRD were searched for. The study involved 685 patients with 827 kidney units affected by CAKUT with a mean age of 9.98 ± 5.12 years. 62.2% were male, and the mean follow-up period after diagnosis was 9.95 ± 5.09 years. 58.8% were non-obstructive dilations, followed by renal dysplasia, obstructive dilations, and number and position abnormalities. The most frequent malformation was vesicoureteral reflux (VUR). The most commonly affected side was the left (47.5%). 55% of the diagnoses were prenatal. 172 patients underwent surgery. The initially chosen treatment for VUR was endourological. Overall re-intervention rate was 20%. Of the total number of patients, glomerular filtration rate was analyzed in 383, 95 (24.8%) of whom had CRD (86% in stage 2). Male sex, bilaterality, and proteinuria were risk factors associated with CRD. Knowledge of the epidemiological and clinical characteristics of children with CAKUT and the factors associated with CRD helps to individualize the clinical follow-up of these patients, thus customizing diagnostic tests and healthcare resources.

Demographics and Clinical Features of Children with Functional Neurological Symptom Disorder/Conversion Disorder: A retrospective cross-sectional study

Amaç: Konversiyon bozukluğu, psikolojik stresin fiziksel yollarla kendini ortaya koymasıdır. Bu çalışmanın amacı, konversiyon bozukluğu tanılı hastaların kayıtlarının incelenmesiyle elde edilen demografik ve klinik veriler aracılığıyla çocuklarda konversiyon bozukluğunun özelliklerini araştırmaktır.
 
 Gereç ve Yöntemler: Yaşları 4-17 arasında değişen, Atatürk Üniversitesi Tıp Fakültesi Hastanesi Çocuk Nöroloji ve Çocuk Psikiyatri polikliniğinden konversiyon bozukluğu tanısı ile takipli olan 44 olgu çalışmaya alınmıştır. Olguların çocuk nöroloji ve çocuk psikiyatri kliniklerindeki dosya kayıtları geriye dönük incelenerek elde edilen sosyodemografik özellikleri, klinik durumları ve tedavi yanıtları gibi klinik veriler irdelenmiştir. 
 
 Bulgular: Olguların %65,9’u (n=29) kız olmakla birlikte %61,8’i (n=21) kırsal alanda yaşamaktadır. %41,2’sinin konversiyonu tetikleyen faktörleri okul/öğrenme stresörleri iken, %23,5’inin ise kayıp/boşanma/ölümdür. İlk atakta doktora başvuru oranı %88,4’tür. Doktora başvuran olguların %61,4’ü (n=27) ilk atağında acile başvururken, olguların aynı oranda da pediyatri kliniğine yatışları yapılmıştır. Konversiyon alt tipleri açısından olguların %40,9’u ataklarla veya katılmalarla giden tiptir. Olguların %50’sinde komorbid psikiyatrik rahatsızlık saptanmıştır. Tanı alana kadar geçen süre ilk atakta doktora götürülen olgularda, doktora götürülmeyen olgulara kıyasla anlamlı olarak daha kısadır. 6 aydan uzun süren konversiyon vakalarının %85,7’si sebat ediyorken, 6 aydan kısa süren konversiyonların %90’ı düzelmiştir.
 
 Sonuç: Konversiyon bozukluğu daha çok nörolojik semptom ve bulgularla kendini göstermektedir. Bu hastaların erken tanı ve tedavisi ile kronikleşmenin önüne geçilebilir.

Clinical features of children with horseshoe kidney in Japan

Clinical features of children with horseshoe kidney in Japan

Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19

Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19

Clinical characteristics of attention-deficit/hyperactivity disorder in children and adolescents: association with quality of life and behavioral aspects.

Objective:To identify associations between clinical characteristics of children with attention-deficit/hyperactivity disorder (ADHD) and their sociodemographic aspects, quality of life, and results from the strengths and difficulties questionnaire.Methods:This is an observational analytical cross-sectional study with a non-probabilistic sample consisting of 72 children diagnosed with ADHD, aged 6 to 13 years, treated at 2 neuropediatric outpatient clinics. The instruments used were the Multimodal Treatment Study of Children with Attention-Deficit/Hyperactivity Disorder – Swanson, Nolan, and Pelham, version IV (MTA-SNAP-IV), the Strengths and Difficulties Questionnaire (SDQ), the Brazilian Economic Classification Criteria (CCEB), and the Quality of Life Assessment Scale for Children and Adolescents (AUQEI). We performed descriptive, bivariate, and multivariate analyses, considering a 5% significance level.Results:SDQ results were associated with abnormal MTA-SNAP-IV results (inattentive/hyperactive/combined). A 1-point increment in the SDQ score increased by 36.5% the likelihood of the child having an abnormal MTA-SNAP-IV classification. Regarding AUQEI, 30.6% of participants perceived their quality of life as poor and 69.4% as good.Conclusions:A higher SDQ score increased the child's chance of having an abnormal MTA-SNAP-IV result.

Clinical Features of Children with COVID-19 in Initial Time of Pandemic.

COVID-19 (Coronavirus Disease 2019) is now a global pandemic. Although children are said to have mild symptom, their clinical features are not known well. We conducted a retrospective study during initial term of pandemic to understand the difference of clinical features including clinical symptoms and patients' characteristics of COVID-19 children and those without COVID-19. To compare clinical features between children with and without COVID-19, we collected data on children who received a COVID-19 test between March 25th and October 31st, 2020. All data were collected from medical records. There were three groups of patients in the study sample; patients with COVID-19, patients with close COVID-19 contact and performed COVID-19 tests, and patients suspected COVID-19 but tested negative. We analyzed the clinical features of the groups. A total of 108 patients were included in this study, of whom 30 were patients with COVID-19, 25 were patients with close COVID-19 contact, 51 were suspected COVID-19 but tested negative, and two were excluded because they were infants born from COVID-19 mothers. The statistical analysis showed that children with COVID-19 had contact with COVID-19 patients had fewer clinical symptoms including cough and fever compared to children with a negative test of COVID-19. Sensitivity analysis showed that fever, cough, fever and/or cough could not distinguish children with COVID-19 from those without COVID-19. As conclusion, children with COVID-19 have less symptoms as fever or cough and the clinical symptoms cannot distinguish them from children with other diseases.

Clinical features of children with coronavirus disease2019 (COVID-19) at a single isolation centre in Ghana

Background: Children with coronavirus disease 2019 (COVID-19) who do not require hospitalisation must isolate to prevent the virus’s spread. Objective: This study describes the prevalence, characteristics, source of infection, and treatment outcome among children with asymptomatic or mild COVID-19 admitted to Ghana’s largest isolation centre. Methods: We conducted a retrospective descriptive study among children 0-18 years admitted to Pentecost Convention Isolation Centre in Ghana between April 24 and August 31, 2020. We extracted their clinical details and patient outcome information from their medical records. Results: The number of children enrolled was 57, with a median age of 16 years (interquartilerange:12–17years). The most common symptom was a headache. Most of the participants admitted from school attributed their source of infection to a school colleague. One patient required transfer to a hospital while the rest were discharged home after de-isolation. Conclusion: Children with asymptomatic and mild COVID-19 were managed successfully in a facility repurposed as an isolation centre. The use of repurposed isolation centres can reduce hospital care load during this pandemic. As schools re-open fully, school authorities must collaborate closely with public health institutions for rapid testing of all persons suspected to have COVID-19, to initiate early contact tracing and isolate those who are positive.

Pediatric severe factor XI deficiency: A multicenter study.

Factor XI (FXI) deficiency is a rare autosomal recessive bleeding disorder. Only scarce publications address its clinical features in children. The increased prevalence of FXI deficiency in Israel enabled data collection for this large multicenter cohort study. Some hemostatic challenges may be unique or more common in children, such as bleeding in the neonatal period or trauma-related injury. The current study was designed to explore the potential impact of these differences in children with severe FXI deficiency. Medical files of all children with FXI level under 15% followed at five tertiary centers were evaluated. The retrieved data comprised demographic and clinical characteristics, including bleeding episodes, surgical interventions, treatment strategies, as well as laboratory features. Sixty children, whose median age at diagnosis was 4.2years and their median FXI level was 4%, were included. Three children experienced triggered intracranial hemorrhage (ICH) and two children had major bleeds. No bleeding complications occurred in surgeries in which hemostatic treatment consisting mostly of tranexamic acid or fresh frozen plasma was applied (n=45). In contrast, excessive bleeding was noted in 25% of surgical procedures performed without hemostatic preparation (p=.002). This study's findings confirm the generally favorable outcome of this rare bleeding disorder, with no spontaneous bleeds or cases of perinatal ICH. Nonetheless, proper diagnosis and adequate hemostasis in the surgical setting are imperative. Unlike previous studies in adults, our pediatric study suggests an association between the severity of FXI deficiency and bleeding tendency.

Clinical features of children with coronavirus disease 2019 caused by Delta variant infection.

To study the epidemiological and clinical features of children with coronavirus disease 2019 (COVID-19) caused by Delta variant infection and their differences from children with ordinary COVID-19 (non-Delta variant infection). Eleven children aged <14 years, who were diagnosed with COVID-19 caused by Delta variant infection from August to September 2021 were enrolled (variant group). Five children aged <14 years who were diagnosed with ordinary COVID-19 from February to March 2020 served as the control group. The epidemiological data, clinical features, and laboratory examination results were compared between the two groups. There was no significant difference in the proportion of children with clinical symptoms between the two groups (P>0.05). There were no significant differences in white blood cell count, lymphocyte count, and platelet count between the two groups (P>0.05), while the variant group had a lower neutrophil count than the control group (P<0.05). Lymphocytopenia was not observed in either group. Compared with the control group, the variant group had a higher proportion of children with an increase in creatine kinase isoenzyme (P<0.05), while there were no significant differences in the proportion of children with an increase in lactate dehydrogenase, D-Dimer, C-reactive protein or interleukin-6 between the two groups (P>0.05). Among the 9 children in the variant group, 5 tested positive for IgM antibody at week 2 after admission, and all children tested positive for IgG antibody. At week 3 after admission, the level of IgM antibody tended to decrease in 9 children, and the level of IgG antibody tended to decrease in 8 children. Delta variant is more infectious. COVID-19 caused by Delta variant infection may cause more serious myocardial damage than ordinary COVID-19 in children. In children infected with Delta variant, IgG antibody appears at almost the same time as IgM antibody.

Magnetic resonance spectroscopy features of the thalamus and the cerebellum and their association with clinical features in children with autism spectrum disorder: a prospective study.

To study the changes in biochemical metabolites in the thalamus and the cerebellum and their association with clinical features in children with autism spectrum disorder (ASD). In this prospective study, magnetic resonance spectroscopy (MRS) with point-resolved spatial selection was used to analyze the thalamus and the cerebellum at both sides in 50 children with ASD aged 2-6 years. Creatine (Cr) was as the internal standard to measure the relative values of N-acetylaspartate (NAA)/Cr, choline (Cho)/Cr, myoinositol (MI)/Cr, and glutamine and glutamate complex (Glx)/Cr, and the differences in metabolites and their association with clinical symptoms were compared. In the children with ASD, NAA/Cr in the left thalamus was positively correlated with the scores of hearing-language and hand-eye coordination in the Griffiths Development Scales-Chinese (P<0.05). Cho/Cr in the right cerebellum was positively correlated with the scores of personal-social competence, hearing-language, and hand-eye coordination (P<0.05). NAA/Cr and Glx/Cr in the left thalamus were positively correlated with those in the left cerebellum (P<0.05). There was no significant difference in metabolites between the left and right sides of the thalamus and the cerebellum in the children with ASD (P>0.05). There are metabolic disorders in the cerebellum and the thalamus in children with ASD, and there is a correlation between the changes of metabolites in the left cerebellum and the left thalamus. Some metabolic indexes are related to the clinical symptoms of ASD. MRS may reveal the pathological basis of ASD and provide a basis for diagnosis and prognosis assessment of ASD as a noninvasive and quantitative detection method.

347. SARS-CoV-2 and Acute Otitis Media in Children: A Case Series

BackgroundReports in adults with COVID-19 and acute otitis media (AOM) show that severe symptoms and hearing loss may be more common than with the clinical presentation of typical AOM. However, the association of SARS-CoV-2 with AOM in children is poorly understood. MethodsCases were identified as a subpopulation enrolled in the NOTEARS prospective AOM study in Denver, CO from March-December 2020. Children enrolled were 6-35 months of age with uncomplicated AOM and prescribed amoxicillin. Children diagnosed with AOM and SARS-CoV-2, detected by polymerase chain reaction assay, were included in the case series. Data was obtained from electronic medical records and research case report forms. Patients completed surveys at enrollment and 5, 14 and 30 days after enrollment that included the Acute Otitis Media Severity of Symptoms (AOM-SOS©) scale. All patients had nasopharyngeal otopathogen testing completed.ResultsA total of 108 patients had been enrolled through December 2020 (all of whom were subsequently tested for SARS CoV-2). During the study period for this case series, 16 patients were enrolled, and 7 (43.6%) were identified with AOM/SARS-CoV-2 co-infection. Among these 7 patients, fever was present in 3 children (29%). Four children (57%) attended daycare. Only 2 children (29%) had testing for SARS CoV-2 as part of their clinical workup. Mean AOM-SOS© scores were similar among the SARS CoV-2 positive and negative patients with no statistical significance noted with two-sided t-tests: 13.6 (± 4.5) vs 14.2 (± 4.9) at enrollment, 1.4 (± 1.8) vs 4.2 (±4.9) on Day 5, and 0.6 (± 0.9) vs. 2.5 (±6.1) on Day 14 (Table 1). Among the 7 patients, no child had an AOM treatment failure or recurrence. Of the 6 patients in whom bacterial and viral testing have been completed, a bacterial otopathogen was identified in 6 (100%), and a viral pathogen in 3 (50%) children (Table 2).Table 1. Clinical features of children with concurrent SARS-CoV-2 and AOM Table 2. Laboratory findings of children with concurrent SARS-CoV-2 and AOM. ConclusionSARS-CoV-2 can occur in children with AOM. It is important that providers maintain a high index of suspicion for COVID-19 even in patients with clinical evidence of AOM, particularly to ensure families are appropriately advised on isolation and quarantine requirements. AOM with SARS-CoV-2 does not appear to be more severe than AOM without SARS-CoV-2. Disclosures Samuel R. Dominguez, MD, PhD, BioFire Diagnostics (Consultant, Research Grant or Support)DiaSorin Molecular (Consultant)Pfizer (Grant/Research Support) Samuel R. Dominguez, MD, PhD, BioFire (Individual(s) Involved: Self): Consultant, Research Grant or Support; DiaSorin Molecular (Individual(s) Involved: Self): Consultant; Pfizer (Individual(s) Involved: Self): Grant/Research Support

1151. Clinical Characteristics of Persistent Staph Aureus Bacteremia in Children

BackgroundPersistent Staphylococcus aureus bacteremia (pSAB) is a poorly defined entity, but associated with significant morbidity and mortality in children. We aim to better describe the epidemiological features of this clinical entity.MethodsWe performed a retrospective case series analysis of pediatric patients with pSAB at a single center children’s hospital using electronic medical data from 2016 – 2020. Bacterial persistence was defined as culture growth > 72 hours after first blood culture. ResultsTwenty-two patients with pSAB were included in the analysis. Sources of persistent infection were endovascular infection (n=11, 50%), osteoarticular infection (n=6, 27%,), isolated central line associated blood stream (n=4, 18%), isolated skin and soft tissue infection (n=2, 9%), and no known primary infectious site (n=1). Methicillin resistance occurred in 41% (n=9) of cases of pSAB. Total duration of therapy varied, with a median of 4 weeks from negative cultures (range of 2 – 8 weeks). Total days of positive cultures in pSAB were not significantly associated with methicillin susceptibility of the bacterial isolate, use of double gram-positive coverage, nor presence of a central venous catheter. Use of double gram-positive coverage occurred in 50% of cases with a mean duration of therapy of 11 days, most frequently in cases of septic thrombophlebitis (Table 1). Rifampin and gentamicin were the most commonly used agents. Table 1. Clinical Characteristics of Children Treated with Double Gram-Positive Coverage ConclusionChildren presenting with persistent S. aureus bacteremia present with a heterogenous group of underlying conditions and epidemiological features. While pediatric recommendations for double gram-positive coverage for synergy have not been established, their use for pSAB is common, especially in endovascular infections where culture persistence is often an expected outcome. Further research should examine risk factors for pSAB and define optimal treatment modalities and duration. Disclosures All Authors: No reported disclosures

Effects of the extensively hydrolyzed protein and amino acid-based formulas on growth parameters in children with chronic diseases

Rationale: Malnutrition is common in children with chronic diseases. Extensively hydrolyzed protein-based formula (EHF) and amino acid-based formula (AAF) are formulated to meet the all needs of infants with food allergy and different types of GI disorders. In our study, the clinical features of children were treated with EHF and/or AAF the effects of this intervention on their nutritional status were analyzed.

X-Linked Retinoschisis: Deep Phenotyping and Genetic Characterization

To examine the genetic and clinical features in children and adults with X-linked retinoschisis (XLRS). Single-center consecutive, retrospective, observational study. Adults and children with molecularly confirmed XLRS followed up between 1999 and2020. Analysis of genetic, clinical, and retinal imaging findings, including OCT and fundus autofluorescence (FAF), cross-sectionally and longitudinally, was performed. RS1, variants, type of variants and phenotype correlations, ageof onset, complications rates and types, fundoscopy findings,OCT metrics, FAF patterns,correlations including between best corrected visual acuity (BCVA) and age, and OCT characteristics. One hundred thirty-two male patients were identified harboring 66 retinoschisin 1 variants, with 7 being novel. The mean age at onset was 16.5 years (range, 0-58 years). Seventy-one patients (71/75 [94.7%]) were symptomatic at presentation; all had decreased best-corrected visual acuity (BCVA). Funduscopy findings were symmetric in 104 patients (104/108 [96.3%]), with the most common finding being macular schisis (82.4%), whereas peripheral retinoschisis was present in 38.9% and macular atrophy was present in 11.1%. Twenty patients (18.5%) demonstrated complications (vitreous hemorrhage, retinal detachment, or both). Mean BCVA was 0.65 logarithm of the minimum angle of resolution (logMAR; Snellen equivalent, 20/89) in the right eye and 0.64 logMAR (Snellen equivalent, 20/87) in the left eye. Mean BCVA change over a mean interval of 6.7 years was 0.04 and 0.01 logMAR for right and left eyes, respectively. A normal FAF pattern was identified in 16 of 106 eyes (15.1%); 45 eyes (42.5%) showed a spoke-wheel pattern, 13 eyes (12.3%) showed foveal hyperautofluorescence, and 18 eyes (17.0%) showed a central reduction in signal. In total, 14 patients demonstrated evidence of progression on FAF over time. On OCT, foveoschisis was observed in 172 eyes (172/215 [80%]), parafoveal schisis was observed in 171 eyes (171/215 [79.5%]), and foveal atrophy was observed in 44 eyes (44/215 [20.5%]). Cystoid changes were localized to the inner nuclear layer (172/181 eyes [95%]), the outer nuclear layer (97/181 [53.6%]), and the ganglion cell layer (92/181 [50.8%]). Null variants were associated with worse final BCVA and aforementioned complications. X-linked retinoschisis is highly phenotypically variable, but with relative foveal and BCVA preservation until late adulthood, allowing more accurate prognostication. The slowly (often minimally) progressive disease course may pose a challenge in identification of early end points for therapeutic trials aimed at altering the kinetics of degeneration.

Case Report of Multisystem Inflammatory Syndrome in a Child Related to COVID-19

Background : Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition that appears to be linked to Coronavirus Disease 2019 (COVID-19). Most children who become infected with the COVID-19 virus have only a mild illness. Aim of this study to evaluate the children who go on to develop MIS-C, some organs and tissues-such as the heart, lungs, blood vessels, kidneys, digestive system, brain, joints, skin or eyes -become severely inflamed.&#x0D; Case Report : 11 years old girl admitted in Paediatric Ward of in Imperial Hospital Chattogram on 12 July 2020 with the complains of fever, loose motion, rash in hands, body and legs, swelling of the wrist and ankle joints which were associated with anorexia, nausea , vomiting and bodyache. For this reason the child was evaluated.&#x0D; Conclusion : Clinical features in children have varied but predominantly include cardiac dysfunction, abdominal pain, and elevated inflammatory markers, including C-Reactive Protein (CRP) Ferritin, D-dimer and Interleukin-6. MIS-C can lead to shock and multiple organ failure requiring intensive care.&#x0D; Chatt Maa Shi Hosp Med Coll J; Vol.20 (2); July 2021; Page 89-92

Anxiety and depression in parents of children with autism spectrum disorder during the first COVID-19 lockdown: Report from the ELENA cohort

BackgroundThe Covid-19 pandemic had a strong impact on mental health in the general population. This study conducted during the first lockdown in France considered parents of children with Autism Spectrum Disorder (ASD) prospectively followed in the ELENA Cohort. ObjectivesWe aimed to (1) compare the Anxiety and Depression (AaD) levels during the lockdown between mothers and fathers, (2) compare the parent's AaD between the lockdown and the last ELENA follow-up visit, and (3) identify risk factors for parental AaD during lockdown among socio-demographic and children's clinical characteristics. MethodsThe Hospital Anxiety and Depression Scale (HADS) was used to assess AaD in 134 parent's pairs. Parents also completed the Questionnaire about their living conditions during COVID-19, their child's interventions and perceived changes about their child's behaviors and sleep. Child's ASD severity, intellectual and socio-adaptive skills and parent's socio-demographic characteristics were collected from ELENA follow-up. ResultsThe parents' AaD levels were lower during the lockdown compared to the last ELENA visit that coincided in 96% with the child's ASD diagnosis. The AaD levels were more pronounced in mothers and significantly associated with the child's challenging behaviors, parents' teleworking and perceived knowledge about COVID-19. The perception of an insufficient knowledge was the only risk factor for mothers' AaD. ConclusionOur findings highlighted the pertinence for an assessment of the mental health of main caregivers of children with ASD, consideration of their gender characteristics, and the importance of providing relevant information during pandemic. Future studies examining the pandemic long-term effects are needed. Trial registration numberNCT02625116.

Clinical Characteristics of Children With COVID-19 in the United Arab Emirates: Cross-sectional Multicenter Study.

BackgroundCOVID-19 has infected over 123 million people globally. The first confirmed case in the United Arab Emirates (UAE) was reported on January 29, 2020. According to studies conducted in the early epicenters of the pandemic, COVID-19 has fared mildly in the pediatric population. To date, there is a lack of published data about COVID-19 infection among children in the Arabian region.ObjectiveThis study aims to investigate the clinical characteristics, laboratory findings, treatment, and outcomes of children with COVID-19.MethodsThis cross-sectional, multicenter study included children with confirmed COVID-19 infection admitted to 3 large hospitals in Dubai, UAE, between March 1 and June 15, 2020. Serial COVID-19 polymerase chain reaction (PCR) testing data were collected, and patients’ demographics, premorbid clinical characteristics, and inpatient hospital courses were examined.ResultsIn all, 111 children were included in our study and represented 22 nationalities. Of these, 59 (53.2%) were boys. The mean age of the participants was 7 (SD 5.3) years. About 15.3% of children were younger than 1 year. Only 4 (3.6%) of them had pre-existing asthma, all of whom had uneventful courses. At presentation, of the 111 children, 43 (38.7%) were asymptomatic, 68 (61.2%) had mild or moderate symptoms, and none (0%) had severe illness requiring intensive care. Fever (23/111, 20.7%), cough (22/111, 19.8%), and rhinorrhea (17/111, 15.3%) were the most common presenting symptoms, and most reported symptoms resolved by day 5 of hospitalization. Most patients had no abnormality on chest x-ray. The most common laboratory abnormalities on admission included variations in neutrophil count (22/111, 24.7%), aspartate transaminase (18/111, 22.5%), alkaline phosphatase (29/111, 36.7%), and lactate dehydrogenase (31/111, 42.5%). Children were infrequently prescribed targeted medications, with only 4 (3.6%) receiving antibiotics. None of the 52 patients tested for viral coinfections were positive. COVID-19 PCR testing turned negative at a median of 10 days (IQR: 6-14) after the first positive test. Overall, there was no significant difference of time to negative PCR results between symptomatic and asymptomatic children.ConclusionsThis study of COVID-19 presentations and characteristics presents a first look into the burden of COVID-19 infection in the pediatric population in the UAE. We conclude that a large percentage of children experienced no symptoms and that severe COVID-19 disease is uncommon in the UAE. Various laboratory abnormalities were observed despite clinical stability. Ongoing surveillance, contact tracing, and public health measures will be important to contain future outbreaks.

Analysis of bacterial pathogens and clinical characteristics of children with respiratory tract infections in Tianjin

Objective: To analyze the pathogenic bacteria and epidemiological characteristics in children with respiratory tract infection in Tianjin area. Methods: Retrospective case analysis was performed on 2 392 hospitalized children in the wards of respiratory diseases, intensive care unit and special care ward of Tianjin Children's Hospital from June 2018 to May 2019. Thirteen pathogenic bacteria in deep sputum and bronchoalveolar lavage fluid samples were detected by loop-mediated isothermal amplification. The laboratory data and clinical characteristics of the infected children were analyzed, and the comparison between groups was performed by t test or χ2 test. Results: Among 2 392 cases, 1 407 were males and 985 females. There was no significant difference in the detection rate between males and females (72.5% (1 020/1 407) vs.74.2% (731/985), χ2=0.87, P=0.35). A total of 1 751 strains and 12 kinds of positive respiratory pathogens were detected, with a detection rate of 73.2%. Among them, 913 (38.2%) strains were Mycoplasma pneumoniae (MP), 514 (21.5%) were Streptococcus pneumoniae (Sp), 381 (15.9%) were Methicillin-resistant Staphylococcus aureus (MRSA) and 279 (11.7%) were Hemophilus influenzae (Hi). There was significant difference in the detection rate of pathogens among different age groups (χ²=83.67, P<0.01). The positive rate of alveolar lavage fluid group was higher than that of deep sputum fluid group [81.6% (614/752) vs. 69.3% (1 137/1 640), χ2=39.89, P<0.01]. The length of hospital stay of children infected with different pathogens was significantly different (all P<0.01). There was significant difference in duration of fever among children infected with different pathogens (χ²=228.69,103.56, 3.96, 27.38,24.50,41.66, all P<0.05). There were 63 (7.7%) cases of atelectasis, 260 (31.9%) cases of pleurisy and 120 (14.7%) cases of pleural effusion in MP children. Children with Sma were most likely to involve the heart system (2/9), and children with Eco infection had a higher incidence of complications such as those of blood (3/19), urinary (2/19), digestive systems(4/19), systemic inflammatory response syndrome and sepsis (1/19). Conclusions: The main bacterial pathogens of respiratory tract infection in children in Tianjin were MP, Sp, MRSA and Hi. It is suggested that clinicians should not only pay attention to the respiratory symptoms of children, but also pay attention to the complications caused by bacterial pathogen infection, so as to prevent the deterioration of the disease and improve the prognosis.

Giant R waves on electrocardiogram in children with asphyxia after cardiopulmonary resuscitation

Abstract Introduction: Giant R waves on electrocardiogram (ECG) in pediatric patients is extremely rare. The present case report explores the giant R wave ECG characteristics and clinical features of children with asphyxia after cardiopulmonary resuscitation. Patient concerns: Two children presented with suffocation due to drowning and foreign body inhalation. Cardiopulmonary resuscitation was performed, and the children were admitted to the hospital. Diagnosis: On the day of admission, the two children were in a deep coma, with decreased blood pressure, elevated myocardial enzymes and glucose, and metabolic acidosis. However, ECG examination showed no obvious abnormalities. On the day after admission, the children experienced frequent convulsions. The ECG showed the features of giant R waves from three consecutive ECG readings. Interventions: Treatment measures during hospitalization included tracheal intubation assisted ventilation, ice cap to protect the brain to reduce basal brain metabolism, anti-infection, dehydration, lower intracranial pressure, correction of acidosis, adjustment of glucose levels, sedation, analgesia, normal saline to supplement blood volume and protect liver function. Outcomes: The giant R waves on ECG persisted until the children passed away three days after admission. Conclusion: Giant R waves on ECG in children with asphyxia after cardiopulmonary resuscitation may be related to the large release of catecholamines, which results in myocardial injury. Giant R waves on ECG indicates a serious illness and poor prognosis of the patient. In addition, giant R waves on ECG may be misdiagnosed as other arrhythmias and needs to be carefully differentiated.