Clinical Outcomes In Children Research Articles

A Review on the Role of Stem Cells against SARS-CoV-2 in Children and Pregnant Women.

Since the COVID-19 outbreak was acknowledged by the WHO on 30 January 2020, much research has been conducted to unveil various features of the responsible SARS-CoV-2 virus. Different rates of contagion in adults, children, and pregnant women may guide us to understand the underlying infection conditions of COVID-19. In this study, we first provide a review of recent reports of COVID-19 clinical outcomes in children and pregnant women. We then suggest a mechanism that explains the curious case of COVID-19 in children/pregnant women. The unique stem cell molecular signature, as well as the very low expression of angiotensin-converting enzyme 2 and the lower ACE/ACE2 ratio in stem cells of children/pregnant women compared to adults might be the cause of milder symptoms of COVID-19 in them. This study provides the main molecular keys on how stem cells can function properly and exert their immunomodulatory and regenerative effects in COVID-19-infected children/pregnant women, while failing to replicate their role in adults. This can lay the groundwork for both predicting the pattern of spread and severity of the symptoms in a population and designing novel stem cell-based treatment and prevention strategies for COVID-19.

The epidemiology and examination of clinical outcomes in children with COVID-19: A research overview

COVID- 19 pandemic has affected hundreds of thousands of people worldwide, and so far, accounted for 0.39-12.3% of affected disease population. Even though a large number of studies have reviewed symptoms and characteristics of adults with COVID-19, only some of them have included a smaller number of children.This study aimed a) To examine the epidemiological characteristics of SARS-CoV-2 infection reported in children from published studies b) To outline the signs and symptoms of SARS-CoV-2 infection reported in children from the research studies and c) To provide converging evidence of the clinical outcomes and prognosis of children affected with SARS-CoV-2 infection from reported studies. A literature review was conducted through online sources of data base available in the internet. Studies published from Jan 2020 up to September 2021 were included. The organism causing infection was the novel Corona virus (SARS-CoV-2). In children, almost 0.39-12.3% of the population was affected. A slight predominance of boys vs. girls was noted, but it was not statistically significant. The incubation period ranged from 2-14 days. Nearly 51% of children were presenting with mild disease and nearly 4% were asymptomatic. The children also presented with non-respiratory symptoms, but the exact figures were not available. Multisystem inflammatory response was the most common reported complication. Current findings indicate that children have a lower incidence of the disease, with milder predominance and better prognosis, but prolonged shedding of virus in the nasal and stools sample and being asymptomatic raises a concern of community transmission.

Severe Acute Respiratory Syndrome Coronavirus 2 RNAemia and Clinical Outcomes in Children With Coronavirus Disease 2019

The burden of coronavirus disease 2019 (COVID-19) in children represents a fraction of cases worldwide, yet a subset of those infected are at risk for severe disease. We measured plasma severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA in a cohort of 103 children hospitalized with COVID-19 with diverse clinical manifestations. SARS-CoV-2 RNAemia was detected in 27 (26%) of these children, lasted for a median of 6 (interquartile range, 2-9) days, and was associated with higher rates of oxygen administration, admission to the intensive care unit, and longer hospitalization.

A retrospective medical chart review of clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder treated with guanfacine extended-release in routine Canadian clinical practice

ObjectiveThis study evaluated clinical outcomes in children and adolescents with attention-deficit/hyperactivity disorder (ADHD) treated with the α2-adrenoceptor agonist guanfacine extended-release (GXR) in routine Canadian clinical practice.MethodsThis retrospective chart review focused on patients with ADHD aged 6–17 years initiating treatment with GXR as monotherapy or adjunctive therapy. Patients were followed for up to 12 months after GXR initiation and, if they had received prior ADHD pharmacotherapy, for 12 months before GXR initiation. The primary outcome was change in ADHD symptoms and functionality based on physician assessments, classified as improvement, no change, or worsening relative to the time of GXR initiation. Treatment-emergent adverse events (TEAEs) were evaluated. Clinical outcomes were also analyzed post hoc according to whether GXR treatment was received as monotherapy or adjunctive therapy, and by select psychiatric comorbidities. Exploratory analyses were conducted in patients who had received prior ADHD pharmacotherapy to evaluate clinical outcomes after initiating GXR.ResultsImprovements in ADHD symptoms were reported for 232/330 (70.3%) patients. Functional improvements in school performance and home life were reported for 213/330 (64.5%) and 209/330 (63.3%) patients, respectively. The most frequent TEAEs (≥ 5%) were somnolence, headache, insomnia, presyncope, and decreased appetite. Improvements in ADHD symptoms were observed when GXR was received as either monotherapy (35/60 [58.3%]) or adjunctive therapy (197/270 [73.0%]). Improvements in ADHD symptoms and functionality were observed in the majority of patients with select psychiatric comorbidities. Among patients who had experienced worsening of symptoms with prior ADHD pharmacotherapy, 44/54 (81.5%) experienced symptom improvement, 33/44 (75.0%) who had previously experienced worsening of school performance improved, and 34/48 (70.8%) who had previously experienced worsening of home life improved.ConclusionIn Canadian routine clinical practice, most children and adolescents with ADHD treated with GXR experienced improvements in ADHD symptoms and in functionality both at school and at home.

Measuring clinical outcomes in children with pediatric acute-onset neuropsychiatric syndrome: data from a 2\u20135\u2009year follow-up study

BackgroundIt is unclear how to best measure the complex symptom presentation of pediatric acute-onset neuropsychiatric syndrome (PANS).MethodsWell-characterized participants of a 2–5 year follow-up study (n = 34; 56% male) underwent clinical evaluations and completed scales assessing global symptom severity, functional impairment and specific psychiatric symptoms. We explored inter-correlations between the measures and used intraclass correlation coefficients to evaluate the agreement between clinician-, parent- and child ratings of the same constructs.ResultsRatings on symptom-specific measures varied largely between participants. Agreement between informants was excellent on functional scales, fair-to-moderate on global severity scales and mixed on symptom-specific scales. Clinician-rated global and functional measures had stronger inter-correlations with parent- and child-rated functional measures than with symptom-specific measures.ConclusionsGeneral instruments assessing global severity and functioning are well suited for the assessment and follow-up of PANS, but should be complemented by symptom-specific scales representative of core symptoms.

Dynamics of neutrophil-to-lymphocyte ratio can be associated with clinical outcomes of children with moderate to severe traumatic brain injury: A retrospective observational study

BackgroundThe neutrophil to lymphocyte ratio (NLR) has been reported to be associated with clinical outcomes of patients with severe traumatic brain injury (TBI). This study aimed to evaluate the correlation between the dynamics of NLR and clinical outcomes of pediatric patients with moderate to severe TBI. MethodsWe retrospectively evaluated the clinical data of a total of 374 pediatric patients with moder-ate to severe TBI who were treated in our department between May 2016 and May 2020.Clinical and laboratory data including the NLR upon admission and the NLR on hospital day four were collected. Poor clinical outcome was defined as Glasgow Outcome Scale (GOS) of 1–3. Multivariable logistic regression analyses were performed to investigate the correlation between the dynamics of NLR and clinical outcome. ResultsThree hundred seventy-four pediatric patients (mean age 7.37 ± 3.11, 52.7% male) were evaluated. Based on the ROC curves, a value of 5 was determined as the NLR cut-off value. The corresponding cutoff value for delta NLR was 1.The Glasgow Coma Scale (GCS) (OR, 3.42; 95% CI: 1.88–5.28; P <0.001), the light reflex (OR, 1.79; 95% CI: 1.34- 2.84; P = 0.027), the Rotterdam CT score (OR, 2.71; 95% CI: 1.72–4.13; P = 0.021), and delta NLR (OR, 1.71; 95% CI: 1.13- 2.52; P = 0.034) were identified as independent predictors for unfavorable outcomes in multivariable logistic regression analysis. ConclusionsThe result of the present study suggest that delta NLR could be a predictor of poor clinical outcome of pediatrics with moderate to severe TBI. This cost-effective and easily available biomarker could be used to predict clinical outcomes in these patients.

A Study of the Prognostic Value of Initial EEG in Children with Acute Encephalitis

Abstract Objective to assess the short-term prognostic aid of the initial Electroencephalography (EEG) in patients with acute viral encephalitis. Methods An observational follow up study including 30 children with acute non-herpetic viral encephalitis. Cases were subjected to full history taking, examination and an EEG recording obtained during hospital admission. Functional outcome assessment was done using the Liverpool outcome score during admission and repeated again at 3 months post discharge. Results The mean age of patients was 2.8 ±3.5 years old, with ages ranging from 6 months to 15 years. 73% of the cases were male. Clinical seizures were observed in 96.7% of the cases and EEG was abnormal in 26.7%. The Liverpool outcome scores were significantly lower at discharge and even more so after 3 months in cases with epileptiform activity on EEG. Abnormalities of EEG background did not significantly impact the Liverpool outcome score of the patients. Conclusion The presence of EEG epileptiform discharges is associated with a worse clinical outcome in children with acute encephalitis. The same cannot be said for abnormalities of EEG background.

Clinical outcomes of children with ASD - Preliminary findings from a 18 month follow up study.

Parent-mediated intervention for children with Autism Spectrum Disorder (ASD) is a critical component to deliver evidence-based interventions in resource-limited settings. There is a need for methodologically rigorous longitudinal and follow-up studies of children with ASD to understand clinical outcome and developmental trajectories. We report the clinical outcome at 18-month follow-up of children diagnosed with ASD who received parent-mediated intervention for a 3-month period as part of a feasibility study. The study participants were followed up for 18 months as part of Treatment As Usual (TAU). Symptom severity and adaptive functioning were assessed on Childhood Autism Rating Scale (CARS) and Vineland Social Maturity Scale (VSMS) respectively. All the study participants(n = 42), continued to show improvement between baseline and the two follow-up evaluations at 3 months and 18 months respectively, with reduction in symptom severity, improvement in core features of ASD and adaptive functioning. The maximum gains were attained during the first three months. Three subgroups were identified based on the trajectory of improvement: 1) Children with best possible outcomes, 2) Child with maintenance of gains, and 3) Children with minimal improvement. Seven participants (16.7 %) had the 'best possible' outcome at 18-month follow-up with CARS scores in the non-autistic range and they no longer qualified for a DSM-5 diagnosis of ASD. The intensity of early intervention is pivotal to positively alter the developmental trajectories in children with ASD. Parent-mediated intervention is the best possible mode of intervention delivery to initiate early intervention and address the prevailing challenges in resource-limited settings.

65.1 PSYCHODYNAMIC PSYCHOPHARMACOLOGY CURRICULUM FOR CHILD AND ADOLESCENT PSYCHIATRY

The phenomenon of polypharmacy or inadequate treatment with psychotropic medication is not an uncommon issue in child and adolescent clinical practice. Using psychodynamic theory can guide psychopharmacology treatment, especially when dealing with treatment-resistant patients or when the formulations are very complex. This raised questions about the best way to integrate psychodynamic concepts into psychopharmacology. Through the AACAP Psychodynamic Faculty Training and Mentorship Initiative (PFTMI), the presenter collaborated with his mentor, Horacio Hojman, MD, MBA, Associate Professor at Alpert Medical School at Brown University, Faculty at Boston Psychoanalytic Society and Institute, to develop a psychodynamic psychopharmacology curriculum for children and adolescent psychiatry residency training programs. This curriculum emphasizes the importance of establishing a therapeutic alliance and recognizing the meanings, both conscious and symbolic, of medication to everyone in the system of prescribing medications. Applying psychodynamic understanding and techniques can help child and adolescent psychiatry residents become effective prescribers; the residents will maintain their self-esteem and may experience less burnout. In this way, they can become increasingly motivated to learn psychodynamics and to apply this psychodynamic knowledge in their daily practice in a variety of clinical settings, especially in psychopharmacology. A psychodynamic approach to psychopharmacology can enhance the comprehensive biopsychosocial formulation and may result in better clinical outcomes for children and families.

Intramedullary Elastic Nailing Management for Fracture of Forearm Bones in Pediatric Patients

Background: Forearm fractures are the third most prevalent in children, accounting for 40% of all fractures in children. Using titanium elastic nailing techniques to fix both fractures of the forearm revealed a lot of benefits. Objective: This study aimed to determine if elastic nail fracture treatment improves the radiological and clinical outcomes in children. Patients and methods: 18 patients with fracture shafts of both bones forearm treated with intramedullary elastic nails were studied in Zagazig University Hospital and Sebha medical centre, Sebha, Libya for this prospective clinical trial. Patients returned for follow up visits nearly every 2 weeks following fixation for removal of suture. Then Serial radiographs were made after 2 weeks, 4 weeks, 6 weeks and 12 weeks after surgery. They were evaluated for callus formation and assessment of range of motion and any complications till complete bone healing. Results: Between 8 and 14 weeks, the average time for union was 10.38 ±1.72 weeks. According to the Price score majority were excellent 77.8%, then good 16.7% and finally fair 5.6%, Only 2 cases 11.1% had complication (Surgical site infection, superficial radial nerve injury, and re-displacement). Complicated cases were significantly associated with road traffic accident and Fair price score. Excellent cases were significantly associated with younger age and shorter union time. Conclusion: For the treatment of displaced forearm fractures, Elastic Stable Intramedullary Nailing (ESIN) is a safe and effective option for young patients. Effective and definitive therapy of these fractures is still achievable with this less invasive approach. A functional outcome was attained without the need for corrective treatments, angulations, or repeated reductions.

Expression and Prognostic Value of Metabolism-related Genes in Pediatric Acute Lymphoblastic Leukemia

To analyze the expression and prognostic value of metabolism-related genes in pediatric acute lymphoblastic leukemia (ALL), and explore the potential prognostic biomarkers or therapeutic targets. Transcriptome data from 84 children with B-cell ALL at the time of diagnosis and prior to any treatment were used to analyze the differential gene expression. A prognostic scoring system based on the expression of the metabolism-related genes was constructed using Cox and Lasso regression methods. The prognostic value of the scoring system was further assessed by multivariate Cox regression analysis. Gene set enrichment analysis was carried out by using GSEA software. Among the 933 metabolism-related genes, 14 up-regulated genes and 17 down-regulated genes were identified as differentially expressed genes. In addition, 8 up-regulated genes (ASS1, CKM, PTGES, ADCY5, HNMT, PHGDH, CYP4F3, AADAT) and 4 down-regulated genes (GDA, DHRS9, IDO2, UGT2B4) were selected to establish a novel prognostic scoring system. Patients in the high-risk group showed poorer survival significantly than patients in the low-risk group (P<0.05). The prognostic scoring system was still shown to be an independent prognostic factor for the survival of children with ALL after the clinical characteristics, such as gender, age, white blood cell count at initial diagnosis, cytogenetics and molecular genetics were included (HR=8.906, 95%CI: 3.114-25.470). GSEA results showed that 6 metabolism-related pathways (amino sugar and nucleotide sugar metabolism, arginine and proline metabolism, fructose and mannose metabolism, glyoxylate and dicarboxylate metabolism, pyrimidine metabolism, selenoamino acid metabolism) were enriched in the high-risk group. The abnormal metabolism-related gene expression is associated with the clinical outcome of children with ALL, and these results provide potential novel prognostic biomarkers and treatment targets for pediatric ALL.

Therapeutic and Reconstructive Management Options in Scleroderma (Morphea) en Coup de Sabre in Children and Adults. A Systematic Literature Review.

Scleroderma (morphea) en coup de sabre is a localized subtype restricted to the frontoparietal region of the head. Current treatment paradigms rely on low levels of evidence, primarily case reports and case series-supported by expert opinions. The aim of this article was to systematically analyze current data related to the treatment of localized scleroderma en coup de sabre. The databases Scopus, PubMed, and EBSCO were searched for all reports discussing the treatment of localized scleroderma en coup de sabre. The keywords en coup de sabre, “facial linear scleroderma”, and “morphea linearis”, combined with “treatment” or “therapy” were used as search terms. A total of 34 articles analyzed treatment outcomes for patients with localized scleroderma en coup de sabre including 4 retrospective cohort studies, 2 prospective cohort studies, 4 case series, and 24 case reports, representing a total of 69 patients (38 children and 31 adults). Methotrexate was the most commonly investigated treatment (26 patients) with a highest response rate (26/26, 100%). Other treatments included systemic glucocorticosteroids (nine patients), followed by UVA1 (four patients), mycophenolate mofetil (two patients), hydroxychloroquine (five patients), abatacept (two patients), tocilizumab (three patients), cyclosporine (one patient), interferon gamma (one patient), PUVA therapy (two patients), NB-UVB therapy (one patient), and pulsed dye laser (one patient). Reconstructive and surgery treatment was successfully used for lesions with settled disease activity to improve the cosmetic aspect of the lesions. Conclusion: methotrexate is the most often-studied treatment and reported good clinical outcomes in children and adults with localized scleroderma en coup de sabre.

Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences?

Individuals with Duchenne muscular dystrophy (DMD) frequently develop sleep-disordered breathing. Noninvasive ventilation is often prescribed for sleep-disordered breathing treatment based on the American Academy of Sleep Medicine (AASM) criteria. In 2018, DMD disease-specific criteria for sleep-disordered breathing were established. Our study aimed to examine the clinical interpretation differences using these different criteria. We performed a multicenter, retrospective chart review of children with DMD followed at The Hospital for Sick Children, Toronto, Canada, and Rady Children's Hospital, San Diego, California, who underwent polysomnography from August 1, 2012, to February 29, 2020. Baseline characteristics and polysomnography data were summarized using descriptive statistics. Agreement for the diagnosis of sleep-disordered breathing evaluated by kappa statistics and sensitivity/specificity analysis was assessed. One hundred five male children with DMD (mean ± SD age: 12.1 ± 3.8 years; body mass index z score: 0.2 ± 2.3) were included. The proportions of children with DMD that met at least 1 AASM criterion and at least 1 DMD criterion were 45.7% and 67.6%, respectively. We found that 32.4% of children met neither AASM nor DMD criteria. Overall agreement between AASM and DMD criteria was moderate (k = 0.57). There was almost perfect agreement in sleep apnea diagnosis (k = 0.90); however, there was only slight agreement in hypoventilation diagnosis (k = 0.12) between AASM and DMD criteria. There were more children with DMD diagnosed with nocturnal hypoventilation and prescribed noninvasive ventilation using DMD criteria compared with AASM criteria. Future studies should address whether the prescription of noninvasive ventilation for children with DMD based on both criteria is associated with different clinical outcomes. Hurvitz MS, Sunkonkit K, Massicotte C, Li R, Bhattacharjee R, Amin R. Characterization of sleep-disordered breathing in children with Duchenne muscular dystrophy by the American Academy of Sleep Medicine criteria vs disease-specific criteria: what are the differences? J Clin Sleep Med. 2022;18(2):609-615.

Gastrointestinal Manifestations, Clinical Characteristics and Outcomes of COVID-19 in Adult and Pediatric Patients

Background: Italy was the first country in Europe to report a SARS-CoV-2 case. Since then, the country has suffered a large number of COVID-19 infections both in adults and children. This disease has been shown to lead to different outcomes in these two groups, which oftenpresent varying symptoms and comorbidities. Aim: Therefore, we aimed to evaluate the symptoms, comorbidities and laboratory values in adults and children. Methods: We present the characteristics of 1,324 adults and 563 pediatric COVID-19 Italian patients. The data was retrieved from studies published in Italy and found via PubMed and Google Scholar. Results: The virus appeared to affect adults more than children and men more than women, and to result in more severe outcomes in patients with abnormal laboratory values and a higher number of comorbidities. Adults are at higher risk for complications and death, and they usually present with fever, respiratory symptoms, cough, fatigue, diarrhea, myalgia, and/or loss of taste, smell, or appetite. Children usually have a milder disease progression and usually present with fever, cough, rhinorrhea, pharyngitis, sore throat, pneumonia, GI symptoms (diarrhea, vomiting, abdominal pain), fatigue, and dyspnea. Conclusion: Our findings support early reports that showed that SARS-CoV-2 is associated with more common asymptomatic cases and milder clinical outcome in children than in adults. Acute respiratory distress syndrome and Multisystem inflammatory syndrome in children (systemic vasculitis) are the most severe disease progressions for adults and children, respectively. Keywords: Coronavirus Disease-19; Pandemic; Gastrointestinal Manifestation; Italy; Adults; Pediatrics Abbreviations: COVID-19: Coronavirus Disease-19; GI: Gastrointestinal; RT-PCR: Real-time Polymerase Chain Reaction; SARS-CoV-2: Severe Acute Respiratory Syndrome Coronavirus-2

Early Plasma Osmolality Levels and Clinical Outcomes in Children Admitted to the Pediatric Intensive Care Unit: A Single-Center Cohort Study.

Objective: Identifying high-risk children with a poor prognosis in pediatric intensive care units (PICUs) is critical. The aim of this study was to assess the predictive value of early plasma osmolality levels in determining the clinical outcomes of children in PICUs.Methods: We retrospectively assessed critically ill children in a pediatric intensive care database. The locally weighted-regression scatter-plot smoothing (LOWESS) method was used to explore the approximate relationship between plasma osmolality and in-hospital mortality. Linear spline functions and stepwise expansion models were applied in conjunction with a multivariate logistic regression to further analyze this relationship. A subgroup analysis by age and complications was performed.Results: In total, 5,620 pediatric patients were included in this study. An approximately “U”-shaped relationship between plasma osmolality and mortality was detected using LOWESS. In the logistic regression model using a linear spline function, plasma osmolality ≥ 290 mmol/L was significantly associated with in-hospital mortality [odds ratio (OR) 1.020, 95% confidence interval (CI) 1.010–1.031], while plasma osmolality <290 mmol/L was not significantly associated with in-hospital mortality (OR 0.990, 95% CI 0.966–1.014). In the logistic regression model with plasma osmolality as a tri-categorical variable, only high osmolality was significantly associated with in-hospital mortality (OR 1.90, 95% CI 1.38–2.64), whereas low osmolality was not associated with in-hospital mortality (OR 1.28, 95% CI 0.84–1.94). The interactions between plasma osmolality and age or complications were not significant.Conclusion: High osmolality, rather than low osmolality, can predict a poor prognosis in children in PICUs.

Surgical management, staging, and outcomes of Wilms tumours with intravascular extension: Results of the IMPORT study

PurposeTo review surgical management, tumour stage and clinical outcomes in children with intravascular extension of Wilms tumour (WT) registered in a national clinical study (2012–19). MethodsWTs with presence/suspicion of tumour thrombus in the renal vein (RV) or beyond on radiology, surgery or pathology case report forms were identified. Only cases where thrombus was confirmed by surgeon and/or reference pathologist were included. Surgical management, disease stage, overall (OS) and event free survival (EFS) were investigated. Results69/583 (11.8%) patients met the inclusion criteria. Forty-six (67%) had abdominal stage III due to thrombus-related reasons: 11 had macroscopically incomplete resection, including 8 cases where cavotomy was not performed; 20 had piecemeal complete resection of thrombus; 15 had microscopically positive resection margins at the RV. 66% of tumour thrombi contained viable tumour. There were eight relapses and five deaths. EFS, but not OS, was significantly associated with completeness of surgical resection (P<0.05). OS and EFS were also significantly associated with histological risk group (P<0.05) but not with viability of tumour thrombus (P=0.19; P=0.59). ConclusionsWTs with intravascular extension have a high risk of local stage III due to thrombus-related reasons. Controlled complete removal of the thrombus should be the aim of surgery. Level of EvidenceLevel II

Trends in COVID-19 Cases, Emergency Department Visits, and Hospital Admissions Among Children and Adolescents Aged 0-17 Years - United States, August 2020-August 2021.

Although COVID-19 generally results in milder disease in children and adolescents than in adults, severe illness from COVID-19 can occur in children and adolescents and might require hospitalization and intensive care unit (ICU) support (1-3). It is not known whether the B.1.617.2 (Delta) variant,* which has been the predominant variant of SARS-CoV-2 (the virus that causes COVID-19) in the United States since late June 2021,† causes different clinical outcomes in children and adolescents compared with variants that circulated earlier. To assess trends among children and adolescents, CDC analyzed new COVID-19 cases, emergency department (ED) visits with a COVID-19 diagnosis code, and hospital admissions of patients with confirmed COVID-19 among persons aged 0-17 years during August 1, 2020-August 27, 2021. Since July 2021, after Delta had become the predominant circulating variant, the rate of new COVID-19 cases and COVID-19-related ED visits increased for persons aged 0-4, 5-11, and 12-17 years, and hospital admissions of patients with confirmed COVID-19 increased for persons aged 0-17 years. Among persons aged 0-17 years during the most recent 2-week period (August 14-27, 2021), COVID-19-related ED visits and hospital admissions in the states with the lowest vaccination coverage were 3.4 and 3.7 times that in the states with the highest vaccination coverage, respectively. At selected hospitals, the proportion of COVID-19 patients aged 0-17 years who were admitted to an ICU ranged from 10% to 25% during August 2020-June 2021 and was 20% and 18% during July and August 2021, respectively. Broad, community-wide vaccination of all eligible persons is a critical component of mitigation strategies to protect pediatric populations from SARS-CoV-2 infection and severe COVID-19 illness.

Clinical and neurodevelopmental outcomes based on brain imaging studies in a Colombian cohort of children with probable antenatal Zika virus exposure.

Our aim was to describe the neuroimaging and clinical evaluations of children with antenatal Zika-virus (ZIKV) exposure. The Colombian National Institute of Health performed serial clinical evaluations of children with probable antenatal ZIKV exposure (i.e., born to ZIKV symptomatic mothers or born with birth defects compatible with ZIKV infection, regardless of laboratory results) over 2 years that included head circumference (HC), eye examination, and neurodevelopmental assessments. Clinical neuroimaging studies (head computed tomography and/or brain magnetic resonance imaging) were analyzed for abnormalities, two-dimensional measurements were made of the right and left frontal and occipital cortical thickness. Two abnormal patterns were defined: Pattern 1 (sum of four areas of cortex <6cm) and Pattern 2 (sum of four areas of cortex ≥6cm and < 10cm). Thirty-one children had a neuroimaging study; in 24, cortical thickness was measured. The median age at the first visit was 8 (range: 6-9) months and 22 (range: 19-42) months at the last evaluation. In the 24 cases with cortical measurements, three were normal, 12 were in Pattern 1, and nine were in Pattern 2. Children within Pattern 1 had lower mean HC at birth and in follow-up (both p < .05) and a higher frequency of structural eye abnormalities (p < .01). A trend towards poorer neuromotor development was seen in Pattern 1, although not statistically significant (p=.06). Brain imaging classification based on cortical measurements correlate with ophthalmologic abnormalities and HC. Cortical thickness may be a marker for clinical outcomes in children with congenital ZIKV infection.

Assessment of Clinical Outcome in Children with Severe Thinness on Medical Nutrition Therapy at 8 Weeks and 6 Months

The term malnutrition involves both over nutrition, accompanying with overweight, obesity, and under-nutrition including acute and chronic malnutrition as well as micronutrient deficiencies. The present study was undertaken to assess clinical outcome at 8 weeks and 6 months in children with Severe Thinness on Medical Nutrition Therapy (MNT). A total of 52 severe thinness (ST) children were enrolled and given MNT. The anthropometry was recorded at every visit and analyzed at two time points viz.8 weeks and 6 months. The body mass index has been measured using formula: weight (kg)/height(metre)2. Mean weight on enrolment was 15.85±4.08 kg. At 8 weeks, mean weight was 17.35±4.55 kg and at 6 months it was 19.33±5.12 kg. Mean height on enrolment was 114.33±14.06 cm while at 8 weeks was 115.27±14.06 cm and at 6 months was 120.21±15.29 cm. Mean BMI on enrolment was 11.92±0.44kg/m2 while at 8 weeks it improved to 12.89±0.67kg/m2; at 6 months, it continued improved to 13.26±0.96kg/m2. Rate of weight gain from enrolment to 8 weeks was 1.67 grams/kg/day and from 8 weeks to 6 months was 0.36 gm/kg/day (P&lt;0.001). At end of 8 weeks, in 73.33% subjects BMI improved to thin and 17.8% became normal while 8.9 % continued to remain ST. At 6 months, 22.22% remained ST, 33.33% subjects remained thin and 44.44% became normal. Improvement in mean weight and mean BMI as well as rate of weight gain was significant indicating the role of indigenously prepared MNT in improving acute malnutrition.

Pediatric Acute Alcohol Intoxication Admitted to the ICU: A Review of 102 Cases in France

To describe the profile and clinical outcomes of children (<18 yr) admitted to intensive care for acute alcohol intoxication, with special attention to complications and to the subgroup that required intubation. Retrospective observational study. Seven pediatric and three adult ICUs in France. Children 1-17 yr admitted to intensive care for acute alcohol intoxication between January 1, 2010, and December 30, 2017. The study was observational and patients received standard care. We included 102 patients, with 71 males (69.6%) and 31 females (30.4%). Mean age was not different between males and females (14.0 ± 3.0 yr [range, 2-17 yr] and 14.2 ± 1.3 yr [range, 11-17 yr]; p = 0.67); six children were younger than 10 years. Mean blood alcohol concentration was not significantly different in males and females (2.42 ± 0.86 and 2.20 ± 0.54 g/L, respectively; p = 0.51). Of the 102 patients, 58 (57%) required intubation. Factors significantly associated with requiring intubation were lower Glasgow Coma Scale score (p = 0.002), lower body temperature (p = 0.045), and higher blood alcohol concentration (p = 0.012); vascular filling, and electrolyte disturbances were not associated with needing intubation. Mean intubation time was 9.7 ± 5.2 hours. Among the 59 patients with Glasgow Coma Scale score less than 8, 12 did not require intubation. The most common metabolic disturbance was a high lactate level (48%), followed by hypokalemia (27.4%); 59 (58.2%) patients had hyperglycemia and three had hypoglycemia. Male adolescents make up the majority of pediatric patients admitted to intensive care for acute alcohol intoxication. A need for intubation was associated with a worse Glasgow Coma Scale, lower body temperature, and higher blood alcohol concentration. Intubation was usually required for less than 12 hours. Other acute medical complications reported in adults with acute alcohol intoxication, such as electrolyte disturbances and aspiration pneumonia, were rare in our pediatric patients.