Childhood Pneumococcal Diseases and Serotypes: Can Vaccines Protect.

Objectives To describe pneumococcal diseases in pediatric intensive care unit (PICU) and non-PICU patients. Methods The clinical, serotypes, and antibacterial sensitivity patterns of all children admitted to the pediatric wards (including PICU) of a university-affiliated teaching hospital from 2007 through 2009 with pneumococcal isolates were reviewed. Results Twelve cases of pneumococcal disease in children from 2007 through 2009 were reported. Five patients were admitted to PICU and 7 were general pediatric admissions. Four patients (2 PICU and 2 general pediatric) had received full or partial 7-valent pneumococcal vaccinations. All four patients recovered following systemic antibiotic treatment without sequelae. The serotypes of all PICU and some general pediatric cases were available and included 3, 6B, 19A and 19F. All isolates were sensitive to vancomycin. 50% were intermediate resistant/resistant to penicillin and 17% resistant to cefotaxime. PICU cases required longer total hospital stay (23 days vs 5 days, p=0.013). Three patients were ventilated and one received inotropic support. There was no death in this series. Conclusions Pneumococcal disease may develop despite prior vaccination. The expanded coverage of newer polyvalent pneumococcal vaccines might have prevented some, but not all, of these admissions.

Influenza and Parainfluenza Associated Pediatric ICU Morbidity.

Objectives To investigate if morbidity in young children admitted to a pediatric intensive care unit (PICU with a laboratory proven diagnosis of influenza and parainfluenza infection) had increased. Methods Retrospective study from January 2003 through December 2009 was carried out. Every child in the PICU with a laboratory-confirmed influenza or parainfluenza infection was included. Results 18 influenza (influenza A=13 and influenza B=5) and 17 parainfluenza admissions were identified over the 7-year period. Parainfluenza type 3 (n=9) was the commonest subtype of parainfluenza infection. The median age of children admitted with influenza was higher than parainfluenza (4.5 vs 1.7 years, p=0.044). Admissions associated with proven influenza and parainfluenza infections accounted for 2% of PICU annual admissions. There was only one death in 2003. 51% of these patients required ventilatory support, 45% received systemic corticosteroids, and 91% received initial broad spectrum antibiotic coverage. Bacterial co-infections were identified in 25% of these patients. The incidence of influenza admissions had not increased significantly in 2009 (H1N1 pandemic) when compared with 2003 (SARS epidemic) (p=0.3). There were only two PICU cases of pandemic H1N1 in 2009 and both survived. The annual incidence of severe PICU cases of influenza and parainfluenza were 0.94 and 0.88 per 100,000 children per annum, respectively. Conclusions Pandemic H1N1, influenza and parainfluenza viruses may be associated with significant childhood morbidity and PICU admissions.

Atopy in children with eczema.

Objective. To explore the prevalence of common food and aeroallergens sensitization in early childhood skin diseases and to compare the pattern of common food and aeroallergens sensitization before and after 6 months among infants with atopic dermatitis (AD). Methods. All skin prick tests (SPTs) performed on children =< 18 months of age managed at the pediatric dermatology clinic of an university-affiliated teaching hospital over a 16-month period were examined. Results. There was generally no difference in the pattern of sensitization to common food and aeroallergens between AD patients and non-AD young children with miscellaneous dermatological or gastrointestinal conditions. Dust mites were the only common aeroallergens in these patients; whereas egg and peanuts were the common sensitizing food allergens. Cat and dog fur as aeroallergens, soy bean, orange and beef as food allergens were relatively uncommon among the studied subjects. In AD, infants =< 6 months were generally naive to aeroallergens but became sensitized to the D. Pteronyssinus in the next 12 months of age. 80% of these infants were not sensitized to cow’s milk and none sensitized to soybean. Conclusions. Atopic sensitization to common allergens was common in early childhood with or without AD. Majority of young infants were not sensitized to milk, and develop eczema before they show atopy to the milk or soy allergens.

Ingestion--associated adverse events necessitating pediatric ICU admissions.

OBJECTIVE: To review the pattern of food-associated pediatric intensive care unit (PICU) admissions. METHODS: A retrospective chart review was conducted to analyse the pattern of food-associated PICU admissions at a teaching hospital between January 2004 and May 2007. RESULTS: Ten cases (7 boys and 3 girls, aged 9 month to 11.7 year) were identified. One girl developed progressive generalized urticarial rash and anaphylactic shock following consumption of bird nest drink. A boy presented with the classic triads of acute onset altered mental state, respiratory depression and small pupils following consumption of a bottle of presumed "green tea", which was subsequently found to contain methadone. In the remaining 8 cases, dried mango, peanut, peanut-shell, fishmeat ball, pork chop, bread and bone were the culprits, impacting in the airway or oesophagus. All but one patient had short ICU stay (<or=3 days). Ingestion-associated adverse events can be protean and may necessitate PICU admissions. All age groups can be affected. Solids are usually associated with symptoms from local obstruction or suffocation, while fluids may be associated with systemic manifestations. CONCLUSION: Presentations were generally acute, dramatic and unmistaken. The majority of patients made prompt and uneventful recovery and had short PICU stay.