Pediatric Reference Hospital Research Articles

P-1131. Comparison of Vancomycin Use Before and After the Implementation of an Antimicrobial Stewardship Program in a Pediatric Reference Hospital in Mexico

Abstract Background The growing threat of antimicrobial resistance is associated with the overprescription of broad-spectrum antibiotics. Antimicrobial stewardship programs (ASP) promote the responsible use of antibiotics. Their successful implementation requires adequate infrastructure and interdisciplinary efforts. ASPs in Mexico (Mx) are still scarce, particularly in pediatric centers. Table 1. Diagnostics that justified use of Vancomycin Total of diagnostics founded on 71 Stewardship Interventions Methods Ambispective study to compare Vancomycin (VA) use before-after implementing a pilot 9-month handshake (HS) ASP at the pediatric reference hospital in NL, Mx. Stewardship interventions were applied from Jan to Oct 2022 among patients >1 mo and < 16 yr hospitalized with clinical suspicion/confirmation of Gram-positive infection, candidates to receive or currently receiving VA. PID specialists performed morning HS rounds. Prescription was labeled as correct/incorrect according to IDSA guidelines. Interventions were stratified as VA prevention and early discontinuation. VA use (DOT/1000 PD) from Jan to Oct 2021 was compared with t-Student test and ANOVA.Table 2.DOT/1000 PD Pre and Post the 9-month Pilot Hand-Shake Stewardship Program Analysis of the DOT/1000 PD Compared of the Same Population at the Pediatric Reference Hospital in NL, Mx on a 9-month Period. Results A total of 92 stewardship interventions were applied. Of these, the incorrect use of VA was prevented before its prescription in 21 cases. VA prescription was incorrect in 46% of the cases, in which early discontinuation was ordered. Correct use of VA (54%) occurred in patients with meningitis (31.5%), CLABSI (21%), septic shock (13%), among others (Table 1). SA was isolated in 14 patients. MRSA prevalence was 35.7% (5/14). Both prevention and early discontinuation of VA led to a decrease of 5.2 DOT/1000 PD (8.2 vs 3.6 DOT/1000 PD) (p=0.06) (Table 2). Conclusion Implementing a HS ASP for 9 months in a pediatric reference hospital in Mx decreased the use of VA by 5.2 DOT/1000 PD. Although this was a short pilot program, implementing ASP reduced the use of broad-spectrum antibiotics. Extending the ASP duration may achieve lower VA use and statistical significance. The number of PID specialists in Mx is limited, which highlights the importance of ASP. Multidisciplinary efforts are required to reduce antimicrobial overuse. Disclosures All Authors: No reported disclosures

P-1433. Characterization and Georeferencing of Tuberculosis Cases in Pediatric Patients at a Reference Hospital in México in 13 years

Abstract Background The 2022 "TB Global Report" documents a rise of Tuberculosis (TB) cases worldwide and emphasizes the importance of surveillance strategies. Geographic Information Systems (GIS) characterize geo-temporal trends of communicable diseases and assist in decision-making, including resource allocation. The use of GIS in pediatric TB is limited in Mexico, where the incidence of TB among children is high. Mexico’s public health system lacks outpatient clinics (OC) for diagnosis, treatment and prevention of TB. Identifying strategic areas to implement these facilities may reduce the burden of TB. Geographic distribution of pediatric patients with TB (n=145) diagnosed at the Pediatric Reference Hospital (HRMI) from 2010-2023. Interpretation of NNI and z-score revealed clusttering pattern for pulmonary, lymph node ad meningeal pedaitric TB Methods Subjects < 18 years with TB diagnosed at the Pediatric reference hospital (HRMI) in NL Mexico from 2010-2023 were included. Regional marginalization indices were obtained from official local authorities. Distance analysis techniques, nearest neighbor index (NNI) and hierarchical clustering were applied using QGis®. Kernel density estimation was calculated, and results were visualized with heat maps. Map 1. Distribution and Heat Map pf Pediatric TB Cases Diagnosed at the Pediatric Reference Hospital (HRMI) of NL, Mex. Heat Map was projected by Kernel Density Estimation of 31736.8 meters (SD ± 25279.2 meters), showing hot spots at the Metropolitan Area of Nuevo Leon. Results Clinical and geographic data of 145 subjects were included. Three areas showed the highest case concentration. NNI from the total sample showed a dispersion pattern; however, a clustering pattern was observed for pulmonary (p< 0.05), meningeal and lymph node TB (Table 1). Before diagnosis, most patients had at least one visit to a public OC where TB was not suspected. Average distance to the nearest public OC was 0.7 km and to HRMI 21.3 km. Case-to-hospital distance analysis showed that 65% of cases lived >10 km from HRMI. The majority of cases occurred in areas with high (23.5%) and medium (44%) marginalization indices. Map 2. Heat Maps of Pedaitric TB Subtypes with Clustter Distribution by Kernel Density Estimation (KDE) A. Pulmonary Pediatric TB: KDE 6434,8 mts B. Meningeal Pediatric TB: KDE 12,828 mts C. Lymph Node Pediatric TB: KDE 9,756 mts Conclusion We identify pediatric TB hotspots in NL, Mexico. The clustering patterns identified for pulmonary, lymph node, and meningeal TB indicate a non-random distribution, possibly influenced by marginalization, population density, and healthcare access. Long case-to-hospital distances and failure of general OCs to suspect pediatric TB highlight the importance of implementing specialized TB OCs in strategic high burden areas. Increasing the visibility of pediatric TB and implementing public health strategies according to community needs is crucial. Our full report will be shared with local health authorities in order to propose the creation of TB OCs. A. Map of distance Case-To-Hospital, category was determine by 4 gropus: Very Low (0 - 2.9 km), Low (3 - 9.9 km), High ( 10 - 29.9 km) and Very High ( > 30 km) B. Map of distance Case-To-Nearest OC, it demostrates that every case, was less tan 3km from an OC C. Map of relation of each case location and the Marginalization Index obtained by national authorities, showing vast majority in medium and high index areas Disclosures All Authors: No reported disclosures

P-1434. Geostatistical Analysis of Rocky Mountain Spotted Fever Outbreak in Mexican Pediatric Patients: A Retrospective Observational Study

Abstract Background Rocky Mountain Spotted Fever (RMSF) is a bacterial vector-borne disease transmitted through infected ticks. Northern Mexico is currently experiencing an alarming rise of RMSF cases associated with high mortality, affecting the pediatric population. Geographic Information Systems (GIS) characterize geotemporal trends of infectious diseases and offer valuable information for public health strategies. Accurately pinpointing high burden areas of RMSF and tracking its geographical behavior throughout time was crucial to mitigate the outbreak. Heat map of pediatric RMSF cases from August 2022 and September 2023 at the Pediatric Reference of Hospital of Nuevo León, Mexico Heat map was projected with the minor ratio obtained by Kernel distribution Methods Geographical and clinical data of patients < 16 yr with confirmed RMSF diagnosed at the Pediatric reference hospital (HRMI) in NL, Mx from Aug 2022 to Sep 2023 were included. HRMI admitted the majority of affected children during the RMSF outbreak. QGIS® was used to map the geographical distribution of cases. The nearest neighbor index (NNI) was calculated, as well as the Kernel density estimation (KDE) to assess the influence ratio. Regional marginalization indices were obtained from official authorities. Results were visualized with heat maps. Map of Distance of pediatric RMSF cases from August 2022 and September 2023 to the Pediatric Reference of Hospital (HRMI), Nuevo León, Mexico Distance was projected in kilometers, the mean distance case-to-hospital was 24.1 km with a SD ± 10.1km, the lowest in 1.5 km and the highest in 42.6 km Results Total of 23 subjects were included. Mean age: 8 years (± 3.3). Most (82%) had a positive history of contact with ticks. Time from symptom onset 4.9 ± 1.8 days. High mortality (65.2%) despite in-hospital treatment. NNI: 0.54 (z-score -4.1), showing a statistically significant cluster distribution (p < 0.05). Mapping was performed with a KDE ratio of 8755 m, demonstrating two main geographical hotspots of Ped-RMSF. Case-to-hospital distance analysis shows a mean of 24.1 km (± 10.1km). Most cases located in areas with medium (65%) and high (30%) marginalization indices. Majority (95%) of cases lived >10 km from HRMI, where the diagnosis was made. Map of Correlation of RMSF cases from August 2022 and September 2023 at the Pediatric Reference of Hospital of Nuevo León, Mexico and de Margination Index Margination Index was obtain from CONAPO official data (2022). Most cases were located in areas with medium (65%) and high (30%) marginalization indices Conclusion The dynamism of vector-borne diseases requires advanced epidemiological surveillance. Through GIS-based analyses we were able to locate high burden areas of Ped-RMSF sharing them with local health authorities for the implementation of vector control strategies. The clustering pattern demonstrated a non-random distribution of cases, highlighting the importance of known factors involved in the transmission of diseases, like marginalization indices. Our study highlights the relevance of GIS use in outbreak response strategies. Clinical, managment, outcomes and mortality of Pediatric RMSF Outbreak cases from August 2022 and September 2023 at the Pediatric Reference of Hospital of Nuevo León, Mexico Disclosures All Authors: No reported disclosures

Classification of pediatric soft and bone sarcomas using DNA methylation-based profiling

Pediatric sarcomas present heterogeneous morphology, genetics and clinical behavior posing a challenge for an accurate diagnosis. DNA methylation is an epigenetic modification that coordinates chromatin structure and regulates gene expression, determining cell type and function. DNA methylation-based tumor profiling classifier for sarcomas (known as sarcoma classifier) from the German Cancer Research Center (Deutsches Krebsforschungszentrum) was applied to 122 pediatric sarcomas referred to a reference pediatric oncology hospital. The classifiers reported 88.5% of agreement between histopathological and molecular classification confirming the initial diagnosis of all osteosarcomas and Ewing sarcomas. The Ewing-like sarcomas were reclassified into sarcomas with BCOR or CIC alterations, later confirmed by orthogonal diagnostic techniques. Regarding the CNAs profile, osteosarcomas had several chromosomal gains and losses as well as chromothripsis, whereas Ewing sarcomas had few large events, such as amplifications of chromosomes 8 and 12. The molecular classification together with clinical and histopathological assessment could improve the diagnosis of pediatric sarcomas although there are limitations to deal with more rare classes. This study provides an increase in the number of sarcomas evaluated for DNA methylation profiling in the pediatric population.

Lyme serology in non-endemic countries: Why do we request it and what do we find?

BackgroundThe primary objectives of our research were to analyze Lyme serology results from pediatric patients, identify the clinical reasons for ordering these tests, and assess the clinical relevance of the serology results in the context of Lyme disease.MethodsOur study, conducted at a reference pediatric hospital in a non-endemic region for Lyme disease, included all pediatric patients for whom Lyme serology was requested. ELISA and Western blot results were documented. Presenting complaints and findings at the time of admission were recorded. Diagnostic tests were categorized as first-step tests if conducted during the initial visit. Subsequent tests, sent due to the inability to establish a diagnosis based on the results of the first-line tests, were defined as second and third-step tests, respectively.Results219 patients, for whom Lyme serology had been requested for varying reasons, were included in our study. The most prevalent complaints and indications observed in the presentations of patients with serology requests were as follows: headache(24.7%), paresis/paresthesia(14.6%), and painful or blurred vision(13.2%). Serology was primarily requested in the presence of neurological(59.4%) and ocular symptoms(13.2%). 68% of the tests were requisitioned during the initial consultation. Nevertheless, it was discerned that no patient received a diagnosis of Lyme disease.ConclusionAccording to the guidelines, Lyme serology should only be performed when there is a realistic possibility of exposure to infected ticks, particularly in patients who have had untreated erythema migrans or those with a history of a tick bite presenting with unexplained joint or neurological symptoms. Our data, in line with these guidelines, suggests that unnecessary Lyme serology testing in non-endemic areas, where exposure is highly unlikely, may lead to false-positive results and unnecessary follow-up testing, as illustrated by the high rate of false-positive ELISAs in our cohort.

Detection of Vancomycin Resistance among Methicillin-Resistant Staphylococcus aureus Strains Recovered from Children with Invasive Diseases in a Reference Pediatric Hospital.

Vancomycin is the cornerstone in treating methicillin-resistant Staphylococcus aureus (MRSA) infections. However, therapeutic failures can occur when MRSA strains with decreased susceptibility to glycopeptides (DSG) are involved. The aim of this study was to detect and characterize DSG in MRSA recovered from children with invasive diseases at a reference pediatric hospital between 2009 and 2019. Fifty-two MRSA strains were screened using agar plates with vancomycin 3 and 4 mg/L (BHI-3 and BHI-4); the VITEK2 system; and standard and macro E-tests. Suspicious hVISA were studied by population analysis profiling-area under the curve (PAP-AUC), and wall thickness was analyzed by transmission electron microscopy. Neither VRSA nor VISA were detected in this set. As only three strains met the hVISA criteria, the PAP-AUC study included 12 additional MRSA strains that grew one colony on BHI-4 plates or showed minimum inhibitory concentrations of vancomycin and/or teicoplanin ≥ 1.5 mg/L. One strain was confirmed as hVISA by PAP-AUC. The wall thickness was greater than the vancomycin-susceptible control strain; it belonged to ST30 and carried SCCmec IV. As expected, a low frequency of hVISA was found (1.9%). The only hVISA confirmed by PAP-AUC was not detected by the screening methods, highlighting the challenge that its detection represents for microbiology laboratories.

IMPLEMENTATION OF INDICATORS IN AN URGENCY AND EMERGENCY PHYSICAL THERAPY SERVICE

As in other health professions, Physical Therapy needs indicators to guide its management and, consequently, ensure quality care. However, indicators in this area are still scarce. OBJECTIVE: implementing indicators as a care management tool in an Urgency and Emergency Physical Therapy service. METHODOLOGY: this is a cross-sectional study carried out in a reference pediatric hospital in the Federal District. The implementation of the 16 indicators was based on care records and service needs. RESULTS: the data revealed a higher incidence of professionals providing assistance in the months of February, July and August. Regarding the volume of care, the number of patients undergoing invasive and non-invasive mechanical ventilation, as well as the number of transfers to the hospital's own pediatric intensive care unit, there was a significant demand in the first few months of the year. As for the number of deaths and unscheduled extubations, there was a higher incidence in March and April, respectively. Regarding the absence of indicators recording, February and November were more prevalent. CONCLUSION: the seasonal period, characterized by a higher prevalence of bronchiolitis cases, occurs in the first half of the year, resulting in greater demand for pediatric beds. The implementation and effective monitoring of urgency and emergency indicators are challenging, given the operational dynamics marked by dynamism, unpredictability and high demand. Resistance to change and lack of organizational culture for management based on indicators are also significant obstacles.

Nutritional risk assessment by STAMP according to type of congenital heart disease in pediatric patients admitted to a reference hospital

patients with congenital heart disease are considered to be at high nutritional risk due to alterations in the metabolism of the underlying pathology and extracardiac factors. The STAMP (Screening Tool for the Assessment of Malnutrition in Paediatrics) is the only tool validated in our country in a pediatric population for nutritional screening. to evaluate nutritional risk by STAMP screening in pediatric patients according to type of congenital heart disease. an analytical cross-sectional study in 2023 in a pediatric reference hospital. Nutritional status was determined by Z scores based on WHO 2006/CDC 2000 child growth standards. The STAMP questionnaire was administered to establish nutritional risk. Inferential statistics with the Chi-squared and Mann-Whitney U-test were used. Spearman's correlation coefficient was used. Analyses were carried out using the SPSS V25 statistical package. 113 patients were included, male (n = 57, 50.4 %) and female (n = 56, 49.6 %). The most common age group was that of infants (n = 47, 45 %). Acute or chronic nutritional status impairment affected n = 50 (44.3 %) subjects. Cyanogenous congenital heart diseases had a greater impact on weight, height, average arm circumference and height/age, WBC/age indices. Two nutritional risk groups were established by STAMP: intermediate risk, n = 74 (65.5 %), and high risk, n = 39 (34.5 %). The greatest impact on anthropometric parameters was associated with elevated risk by STAMP, p = 0.000. The type of congenital heart disease was not associated with a greater increase in nutritional risk by STAMP (p = 0.76). There was no correlation of STAMP score with biochemical parameters. patients with congenital heart disease will have an intermediate risk per STAMP. The type of congenital heart disease is not related to a greater increase in nutritional risk due to STAMP.

Clinical aspects of co-infection by HIV and syphilis in pregnancy and exposure in newborn intended at Pediatric Hospital of Santa Catarina

Introduction: Sexually transmitted infections frequently affect pregnant women and, consequently, newborns. HIV and syphilis are vertically transmitted to children and co-infection requires special attention due to its clinical implications. Objective: To describe clinical aspects of HIV/syphilis coinfection during pregnancy and the exposure of newborns to infections treated at a pediatric reference hospital in Santa Catarina between 2015 and 2020. Methods: Observational, descriptive study, secondary to a line of research “Epidemiological description of children exposed to HIV” from January 2015 to December 2020 in a tertiary pediatric hospital in Santa Catarina. Results: 678 medical records were analyzed with ICD Z.206 (contact with and exposure to HIV), in which 71 (10.5%) newborns were exposed to HIV and Syphilis co-infection. Of these, 37 (52.1%) were male, 14 (19.7%) confirmed a diagnosis of HIV and 30 (42.2%) of congenital syphilis. Of the co-infected pregnant women, 38 (53.5%) were diagnosed with HIV prior to pregnancy, 53 (74.6%) used ART and 40 (52.1%) used harmful substances. Furthermore, 34 (46.4%) pregnant women had a minimum number of 6 prenatal consultations, 35 (49.3%) had vaginal births and 29 (40.8%) had undetectable HIV RNA quantification at the time of delivery. HIV prophylaxis for newborns occurred in 66 (92.9%) of cases. Conclusion: It is concluded that the studied population was mostly made up of pregnant women who were diagnosed with HIV infection prior to pregnancy. Of these, the majority were using ART, but the minority carried out the minimum number of consultations recommended by the Ministry of Health. Regarding newborns, the majority received HIV prophylaxis.

The impact of varicella vaccination: A 2005–2019 interrupted time series analysis

ABSTRACT Varicella is an acute, highly contagious disease in susceptible individuals and is preventable through vaccination. This study aimed to determine the impact of varicella vaccination on hospitalizations and complications at a pediatric reference hospital in Panama before and after the vaccine introduction. This descriptive ecological study analyzed clinical records of patients diagnosed with varicella through a retrospective and interrupted time series analysis. An autoregressive integrated moving average model was built to compare the incidence rates observed after vaccination with those expected rates derived from the model. A statistical model was fitted to the observed interrupted time series data by regression and used to predict future trends. The mean difference in varicella hospital discharges before and after the introduction of the varicella vaccine was 47%. The rate of hospitalizations for varicella decreased to 52.3%. A declining trend in varicella hospitalizations was observed from 2015 after vaccine introduction in 2014. Complications in vaccinated patients were secondary skin and soft tissue infection, possibly due to bacterial superinfection. The impact of varicella vaccination on reducing varicella hospital discharges reported at a pediatric reference hospital in Panama was confirmed.

Comparison of Easy-to-Use Bronchiolitis Scores in the Post-COVID-19 Era-An Observational Study.

In the post-restrictions COVID-19 period, the incidence of bronchiolitis in infants has increased considerably. Several scores determine the degree of severity of the bronchiolitis episode, but few are clinician-friendly. The main aim of this research was to find the easy-to-use score that most accurately estimated the severity of patients' infections according to their clinical situations and most accurately predicted the need for hospital admission. An observational cross-sectional study was performed in a reference pediatric hospital during the post-restrictions period of the COVID-19 pandemic (2021 and 2022). A comparison was made between the severity estimate provided by five international acute bronchiolitis scales and the clinical severity of the acute bronchiolitis episode. Three hundred and seventy-seven patients participated in the investigation, with a mean age of 5.68 months; 68.7% of the participants had a mild episode of bronchiolitis, 24.5% had a moderate episode, and 6.9% had a severe episode. The severity estimated by the Tal scale modified by McCallum showed a statistically significant correlation with the clinical severity established by clinical criteria (0.836; p < 0.001). It showed a high correlation with other international scores, such as the Wang score (0.820; p < 0.05) and the Wood-Downes-Ferrés score (0.936; p < 0.001). In the multivariate analysis, the constituent variables of the modified Tal score appeared in the final model that predicts the need for hospital admission. In the context of increased incidence after COVID-19, the Tal score modified by McCallum is an easy-to-use measuring instrument that presents an excellent concordance with the clinical severity estimated at first care contact. It also offers a more significant prediction of the need for hospital admission.

Epidemiological study of pediatric patients with signs and symptoms of intracranial hypertension with non-invasive cerebral compliance

Introduction: Intracranial hypertension (IH) is a clinical condition secondary to the loss of cerebral compensatory mechanisms. There are distinct methodologies used to diagnose IH and among them is the brain4care (b4c) sensor, which allows non-invasive monitoring of intracranial volume and pressure variations, intracranial compliance. Objective: To characterize the epidemiological profile of patients with suspected IH in the pediatric age range. Method: A cross-sectional study was carried out in a reference pediatric hospital in Brazil, with patients with signs and symptoms of IH monitored with the non-invasive B4C sensor. The patients underwent neurological evaluation and were submitted to exams - ophthalmological evaluation, lumbar puncture, magnetic resonance imaging (MRI) and computed tomography (CT). Result: 58 patients were evaluated, of whom 32 are female (55.2%) and 26 are male (44.8%); most patients presented symptoms such as drowsiness (81%), nausea (77.6%), headache (74.1%), vomiting (63.8%). The ophthalmoscopic examination 77.6% (n=58) of the patients did not show signs of papilledema. On CT and MRI, no changes were found in 84.5% (n=58) and 69.2% (n=26), respectively. Lumbar puncture showed changes in 57.1% (n=21). Considering the interpretation that would be made in adult patients, the b4c sensor monitoring (n=58) showed probable changes in the lying and sitting positions, respectively, in 46.3% and 38.9%. Conclusion: It was found that the b4c device can provide a possible complement of clinical information in the process of monitoring cerebral compliance.

Clinical, Epidemiological and Laboratory Features of Invasive Candida parapsilosis Complex Infections in a Brazilian Pediatric Reference Hospital during the COVID-19 Pandemic.

The present study aimed to describe the clinical, epidemiological and laboratory characteristics of invasive candidiasis by C. parapsilosis complex (CPC) in a Brazilian tertiary pediatric hospital during the COVID-19 pandemic. Clinical samples were processed in the BACT/ALERT® 3D system or on agar plates. Definitive identification was achieved by MALDI-TOF MS. Antifungal susceptibility was initially analyzed by the VITEK 2 system (AST-YS08 card) and confirmed by the CLSI protocol. Patient data were collected from the medical records using a structured questionnaire. CPC was recovered from 124 patients over an 18-month period, as follows: C. parapsilosis (83.87%), C. orthopsilosis (13.71%) and C. metapsilosis (2.42%). Antifungal resistance was not detected. The age of the patients with invasive CPC infections ranged from <1 to 18 years, and most of them came from oncology-related sectors, as these patients were more affected by C. parapsilosis. C. orthopsilosis infections were significantly more prevalent in patients from critical care units. Invasive infections caused by different pathogens occurred in 75 patients up to 30 days after the recovery of CPC isolates. Overall, 23 (18.55%) patients died within 30 days of CPC diagnosis. Catheter removal and antifungal therapy were important measures to prevent mortality. COVID-19 coinfection was only detected in one patient.

Defibrillation test in paediatric patients: should be done?

Abstract Funding Acknowledgements Type of funding sources: None. The defibrillation test (DFT) of an implantable cardioverter-defibrillator (ICD) is performed to evaluate ventricular fibrillation detection and termination. In adults, routine defibrillation testing for transvenous ICD is less usually done as some studies found no advantages but some potentially risks associated with. On the other hand, implantation of ICDs in paediatric patients has different characteristics than in adults. The position of the defibrillation coil will change with the body’s growth and could reflect changes in the defibrillation vector. Also, the reasons of implantation of an ICD are different (ventricular arrhythmias frequently associated with adult’s myocardial infarction vs channelopathies, non-ischemic myocardiopathies and congenital heart defects in children and young). There is still lack of information about the utility of the DFT in paediatric patients. Objective To describe the characteristics of paediatric patients who underwent implantation of an ICD , results of DFT and follow-up. Methodology Retrospective cohort study of patients less than 21 years old who underwent implantation of an ICD in the lasts 10 years at a reference paediatric hospital. In DFT, VF was induced by T wave shock, fast burst pacing or continuous direct current. Response of ICD to VF was evaluated. Patients with failure to terminate VF by ICD were defibrillated with external defibrillator. Results 68 patients with 73 ICD implantations (five replacements). Median age was 13 years old. The youngest patient was 2 years old and the oldest 21 years old. 72.6% (53/73) of patients underwent DFT. In 90.6% (48/53) of them, a VF was induced. In two patients (4%, 2/48) the ICD did not terminate the VF. One of these patients had Danon syndrome and the VF did not terminate despite of maximum energy discharged and changes in the vector of defibrillation; the problem was fixed with replacement of the single coil lead by a dual coil system. The other patient had arrhythmogenic cardiomyopathy and the ICD did not detect the VF. During the follow up, there were 20 shocks in 13 patients. 13 shocks were appropriate (and successful). One patient died because of non-arrhythmic illness. Conclusions In paediatric patients, the defibrillation test is useful to ensure both adequate detection of malignant ventricular arrhythmias, as well as their ability to reverse them. Its lack of performance could affect 4% of the implants. Therefore, its performance in paediatric patients is recommended. There could be greater utility in patients with hypertrophic cardiomyopathy.

Characterization of KPC-2-producing Klebsiella pneumoniae and affected patients of a pediatric hospital in Brazil

Carbapenemase-producing Klebsiella pneumoniae (CPKp) infections are important threats to pediatric populations. Thus, a retrospective study was conducted in a Brazilian reference pediatric hospital, and 26 CPKp isolates obtained from 23 patients were characterized. The affected population had important underlying diseases, reflecting previous hospitalization and antibiotic use. Most CPKp isolates were resistant to all antibiotic classes, and blaKPC-2 was the only carbapenemase-encoding gene. blaCTX-M-15 was common among the isolates, and modification or absence of the mgrB gene was the cause of polymyxin B resistance. Ten different sequence types were identified, and clonal complex 258 was prevalent. Alleles wzi50 and wzi64 were the most recurrent ones regarding K-locus type, with a remarkable contribution of the epidemic ST11/KL64 lineage as a colonizer. Our findings show that lineages associated with the pediatric population are similar to those found in adults, reinforcing the need for epidemiological surveillance to effectively implement prevention and control measures.

Características demográficas, clínicas y del uso de recursos hospitalarios de los pacientes pediátricos con trastorno de síntomas somáticos y trastornos relacionados, hospitalizados en un centro de referencia de Medellín

BackgroundSomatic symptom and related disorders (SSRD) constitute a clinical challenge in pediatric psychiatry due to the difficulties in their conceptualization, the complexity of their clinical presentation, which also depends on the cultural context, repeated consultations to health services and the predominance of studies in adults. ObjectiveTo describe the characteristics of the pediatric inpatients with SSRD in a reference hospital. Design and methodsDescriptive cross-sectional study of demographic, clinical variables, and the use of institutional resources, based on the review of medical records of hospitalized patients under 18 years of age with a diagnosis of SSRD evaluated by psychiatry or pediatric psychiatry between 2018 and 2021 at reference pediatric hospital in Medellín, Colombia. ResultsThe clinical records of 83 patients were included. Most patients were female (72%), with a median age of 12 years, anxiety and depression were the most frequent comorbidities (83% and 75%) and also the most frequent disorders in mothers (25% and 26%). The frequency of exposure to stressors in the family setting anytime in life, was high (83%) and required the involvement of multiple medical specialties and therapeutic supports, and the use of varied diagnostic aids. ConclusionsPediatric patients hospitalized with SSRD are generally female adolescents with depression or anxiety, surrounded by adverse family and social contexts that require interdisciplinary care from a comprehensive biopsychosocial model.

244.2: 18-Year Follow-up of Kidney Donation in the Living Donor Transplant Program at a Reference Pediatric Hospital

Introduction: The frequency of living donor transplant has recently increased for several reasons. On one hand, due to the increased prevalence of advanced chronic kidney disease and the decrease in the number of suitable brain-dead donors, and on the other hand, due to the improvement in the safety of the procedure for the donor. Since the primary objective of living-donor kidney transplantation is to guarantee the safety of the donor, the scientific community has recently become interested in the possible long-term complications of kidney donation, since follow-up information on the health of donors is essential for understanding the risks and consequences of donation, support donation selection and provide informed consent. The objective of this study is to evaluate the evolution after nephrectomy of the living donor population in a reference pediatric hospital. Methods: A cross-sectional study of the living donor’s outpatient database was carried out from October 2002 to December 2021. All donors who completed donation in this period of time were included. Surgical time, transoperative incidents, hospital stay, post-surgical complications and long-term behavior of creatinine clearance and proteinuria were analyzed. Results: A total of 1332 patients who entered the living donor kidney transplant program were analyzed, 796 completed donation (59.75%) and 43 lost follow-up (5.4%). Of the remaining 753 donors, 409 were women (54.31%) and 344 men (45.68%). A total of 702 patients underwent left nephrectomy (93.22%), 50 right nephrectomy (6.64%), and one patient was suspended before completing surgery (0.13%). The median age at nephrectomy was 37.068 years (r=18-56 yrs). The mean surgical time was 128.77 minutes (r=25-170 min). Among transoperative incidents, 125 pleural and/or peritoneum openings (16.60%), 10 kidney decapsulations (1.32%), 9 tearings of different vessels (1.19%), 1 adrenal vessel avulsion (0.13%), and 1 ureteral injury (0.13%) were described. There was one case of cardiorespiratory arrest in the recovery area. The mean days of hospital stay were 2.64 days (r=1-32 days). Creatinine clearance and proteinuria levels were analyzed during a follow-up period of up to 18 years. 96 patients (12.74%) had a sustained decrease in creatinine clearance and proteinuria (>150 mg/d) was found in 16 patients (2.12%). There were 2 donor deaths, none of theme related to renal failure. Conclusions: Although some increases in urinary protein levels and decreases in creatinine clearance were described, none of our living donors developed kidney failure. Of the 2 reported deaths, one was attributed to colon cancer and the other to alcoholic pancreatitis consequences, none of them related to donation. We can conclude that nephrectomy for donation purposes is a safe procedure since we found no decrease in long-term survival or progressive renal dysfunction.

The role of human bocavirus as an agent of community-acquired pneumonia in children under 5years of age in Fortaleza, Ceará (Northeast Brazil).

The human bocavirus (HBoV) is an agent of upper and lower respiratory infections, affecting mainly children under 5years of age. Community-acquired pneumonia (CAP) is an important public health problem in developing countries, representing one of the main causes of hospitalizations and deaths in children. The aim of this study was to describe the prevalence of HBoV and the clinical and epidemiological characteristics in children diagnosed with CAP. For this purpose, nasopharyngeal aspirates were collected from 545 children aged 0 to 60months diagnosed with CAP between January 2013 and December 2014 in a reference pediatric hospital in Fortaleza, Ceará, Brazil. The samples were subjected to PCR for detection of HBoV and parainfluenza 4 (PIV4) and indirect immunofluorescence for detection of respiratory syncytial virus (RSV), adenovirus (AdV), influenza A and B (FLU A and FLU B), and parainfluenza 1, 2, and 3 (PIV1, PIV2, PIV3). Clinically, most CAP were non-complicated (487/545; 89.3%); however, 10.7% (58/545) of children were treated in the ICU/resuscitation sector. Among the total samples analyzed, 359 (65.8%) were positive for at least one virus surveyed and 105 (19.2%) samples had two or more viruses. HBoV was detected in 87 samples (15.9%), being the second most prevalent virus. RSV, AdV, FLU A, FLU B, and PIV 1-3 were detected in 150 (27.5%), 45 (8.2%), 30 (5.5%), 3 (0.5%), and 131 (24%) samples, respectively. The age average was 12.1months in children infected with HBoV, and the most frequent symptoms were dyspnea and cough. In addition, 90.6% of HboV-positive children received antibiotics as empirical treatment. HBoV did not show any circulation pattern; however, it seemed to be more frequent in the first half of the year, totaling 68.9% of the cases. HBoV is a frequent agent of pneumonia in the child population studied.

Tracing COVID-19 Source of Infection Among Health Personnel in a Pediatric Hospital.

Health personnel (HP) have been universally recognized as especially susceptible to COVID-19. In Mexico, our home country, HP has one of the highest death rates from the disease. From the beginning of the SARS-CoV-2 pandemic, an office for initial attention for HP and a call center were established at a COVID-19 national reference pediatric hospital, aimed at early detection of COVID-19 cases and stopping local transmission. The detection and call center implementation and operation, and tracing methodology are described here. A total of 1,042 HP were evaluated, with 221 positive cases identified (7.7% of all HP currently working and 26% of the HP tested). Community contagion was most prevalent (46%), followed by other HP (27%), household (14%), and hospitalized patients (13%). Clusters and contact network analysis are discussed. This is one of the first reports that address the details of the implementation process of contact tracing in a pediatric hospital from the perspective of a hybrid hospital with COVID-19 and non-COVID-19 areas.

Indoor concentrations of particulate matter 2.5 in a pediatric emergency service.

Objective:To evaluate air quality in the waiting room of a pediatric emergency service considering the serial concentrations of particulate matter (PM2.5), and to determine if the number of people present in the room can have an influence on the pollutant concentrations.Methods:Cross-sectional study, carried out in the waiting room of a reference pediatric hospital in the city of Porto Alegre, conducted in a one-year period, in a continuous-time sample including all of the four seasons of the year. The monitoring of PM2.5 was performed using a real-time aerosol monitor (DustTrak II). The number of people in the room was determined every hour and the climatic characteristics per daily mean. The concentration of PM2.5 and the number of people were expressed by mean and standard deviation. The means were compared by Analysis of Variance and Pearson's correlation coefficient.Results:There was a significant increase in the concentration of PM2.5 in the autumn, when compared to other seasons (p<0.001). The pollutant increase, in this season, was accompanied by the higher number of people in the emergency room (p=0.026). The association between PM2.5 and the number of people is confirmed by the positive correlation between these two variables (r=0.738; p<0.001).Conclusions:The pediatric emergency waiting room showed elevated PM2.5 in all seasons. The number of people in the room had a positive correlation with the concentration of the pollutant in the environment.