ABSTRACT
Abstract Objective To describe the clinical characteristics, laboratory parameters, treatment, and predictors of an unfavorable outcome of critically ill children with SARS-CoV-2 infection. Method This was a prospective observational study performed in a pediatric intensive care unit (PICU) of a tertiary care COVID referral hospital among critically ill children in the age group 1 month - 12 years admitted due to SARS-CoV-2 infection from June to December 2020. Demographic, clinical profile, pSOFA and PRISM III scores, laboratory parameters, treatment, and outcomes of the patients were recorded. Children who had a prolonged PICU stay (>14 days) or died were compared with those who were discharged from PICU within 14 days to assess predictors of unfavorable outcomes. Results PICU admission rate among hospitalized SARS-CoV-2 infected children was 22.1% (92/416). Infants comprised the majority of the ICU population. Invasive mechanical ventilation and inotropic support were required for 28.3% and 37% of patients, respectively. Remdesivir, IVIg, and steroids were administered to 15.2%, 26.1%, and 54.3% of the subjects, respectively. The mortality rate was 7.6 %. MIS-C patients were older, less comorbid, and required less ventilator support but more inotrope support than acute severe COVID-19 patients. Predictors of unfavorable outcomes were age < 1 year, fever duration > 5 days, respiratory distress, shock, comorbidity, elevated CRP (> 50 mg/L), procalcitonin (> 6 ng/L), D-dimer (> 6 µg/L) and arterial lactate (> 2 mmol/L). Conclusion Critically ill children with unfavorable outcomes were predominantly infants, comorbid, prolonged fever, respiratory distress, shock and elevated inflammatory markers, D-dimer and lactate. These factors may be useful for watchful monitoring and early intervention.
ABSTRACT
Objective: To determine the clinical presentation and outcome of children infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) during the third wave of the pandemic in India. Method: A review of hospital records was done at a tertiary care hospital, for children seen between 1 and 25 January, 2022. Result: Out of total 112 SARS-CoV-2 positive patients, 17 were hospitalized and 95 were treated in the outpatient department. Among non-hospitalized children, fever was the commonest feature (72, 75.7%), followed by sneezing, and loss of appetite. The median (IQR) duration of symptoms was 2.5 (1.5) days. Among hospitalized children, 10 had co-morbidities and one-third required intensive care unit admission. MIS-C was diagnosed in four patients. Out of 4 mechanically ventilated patients, two had coronavirus disease (COVID) pneumonia. The mean (SD) length of hospital stay was 7.5 (2.5) days. One child with leukemia died during management. Conclusion: During the third wave of the pandemic, most children had symptomatic illnesses, but recovery was fast among non-hospitalized children.
ABSTRACT
Poland syndrome (PS) is a rare congenital condition with predominant unilateral chest wall deformity due to hypoplasia of the pectoralis muscles. However, its clinical features are highly variable as all the features may not be present in one individual or it may present with some rare associations or complications as being reported here. A 6-year-old boy was diagnosed, for the first time, as a case of PS but, detailed examination and work up revealed two rare associations and/or incidental findings of this disorder, namely, Dandy-Walker variant and partial anomalous pulmonary venous return. Hence, a detailed clinical examination and a through workup are mandatory to quantify the disease spectrum of this rare disorder