The effect of the COVID-19 pandemic on pediatric emergency admissions and tendency towards prescribing antibiotics

Aim: To determine the changes in the diagnoses of patients admitted to pediatric emergency department due to infection and the change in the tendency towards prescribing antibiotics during the COVID-19 pandemic.Methods: Age, gender and the diagnoses of and the antibiotics prescribed for patients under the age of 18 who admitted to the pediatric emergency department on two separate days before and during the pandemic period were compared retrospectively.Results: It was found that the admissions to the pediatric emergency department decreased by 83% during the pandemic period compared to the pre-pandemic period. Upper respiratory tract infection (URTI) was diagnosed in 61.6% of the patients during the pre-pandemic period compared to 32.6% of the patients during the pandemic periods, indicating a statistically significant difference between the groups (p<0.001). The percentage of patients diagnosed with paranasal infection in the pandemic period was also significantly lower than in the pre-pandemic period. On the other hand, the percentages of patients diagnosed with urinary infection and diagnoses other than infection in the pandemic period were significantly higher than in the pre-pandemic period. Additionally, the percentage of patients who were prescribed amoxicillin-clavulanic acid (CAM) was significantly higher, whereas the percentage of patients who were prescribed Clarithromycin was significantly lower in the pandemic period than in the pre-pandemic period. Furthermore, it was determined that Oseltamivir was not prescribed during the pandemic period.Conclusions: Quarantines imposed due to the COVID-19 pandemic and the use of masks have reduced the incidence of upper and lower respiratory tract infections. In parallel, it was determined that the percentage of patients presented to the pediatric emergency department with the diagnosis of non-infectious diagnoses has increased. This result has been attributed to the use of masks and the attention paid to the hygiene, which caused a decrease in the incidence of infectious diseases, influenza in particular.

Investigation of the Etiological Causes of Central Nervous System Infection in Children with Multiplex PCR

Objective The aim of this study is to investigate the causative agents of central nervous system (CNS) infection in hospitalized pediatric patients by multiplex polymerase chain reaction. Methods We retrospectively reviewed the medical records of children who underwent lumbar puncture with suspected CNS infection between September 2019 and September 2021. The cerebrospinal fluid (CSF) samples were evaluated by the BioFire FilmArray Meningitis/Encephalitis (ME) Panel. Results The etiology of the infection was established in 13,02% (n = 25) cases. Human herpesvirus (HHV) type 6 was the most commonly identified pathogen 60% (n = 15), followed by enterovirus 20% (n = 5), Streptococcus pneumoniae 8% (n = 2), Streptococcus agalactiae 4% (n = 1), HHV type 1 4% (n = 1), and Listeria monocytogenes 4% (n = 1). The statistical analysis showed that the age of the group with enterovirus was younger than the age of the group with other causative microorganisms and the group with HHV-6 (respectively p: 0.032;p: 0.011). The hospitalization periods of the group with enterovirus and HHV-6 were shorter than the hospitalization periods of the other causative microorganisms (respectively p: 0.016;p: 0.000) and the absolute neutrophil count values of the group with HHV-6 were lower than the group of other causative microorganisms (p: 0.015). Conclusion Our study identified HHV-6 as the main cause of CNS infection in Istanbul during coronavirus disease 2019 pandemic when isolation measures were taken. The duration of hospital stay was found to be shorter in CNS infection caused by viral agents. Revealing the causative agent in the CSF is a fast and effective method that prevents unnecessary antibiotic treatment and shortens the hospitalization period of patients.

Clinical Features and Laboratory Findings of COVID-19 in Children: A Tertiary Center Experience

Objective: Despite increasing data on Coronavirus Disease 2019 (COVID-19) in adults, the data in pediatric patients are still limited. The aim of our study is to evaluate the clinical features and laboratory findings of our confirmed pediatric COVID-19 cases. Methods: This retrospective descriptive study was conducted in one of the largest COVID-19 treatment centers in Ístanbul, Turkey. Four hundred and fifty-six cases confirmed using reverse transcriptase-polymerase chain reaction (RT-PCR) were included in the study. One hundred inpatients and 356 outpatients were treated. Patients were classified according to the disease severity as asymptomatic, mild, moderate and severe. Results: The number of asymptomatic, mild, moderate or severe cases were 199 (43.6%), 194 (42.5%), 33 (7.2%) and 30 (6.6%) respectively. Most of the hospitalized patients younger than 5 years old had the mild disease (67.7%), whereas most of the patients over 15 years of age had severe disease (54.2%). Lymphopenia and high ferritin levels at admission were more common in severe cases (p<0.05). Also, multiple regression analysis revealed that high ferritin and D-dimer levels were found to prolong hospital stay (p=0.000;R2=0.404). Conclusion: Age, lymphocyte count, ferritin and D-dimer levels can be used to estimate the disease severity for COVID-19 infection in children. (English) [ FROM AUTHOR] Amaç: Erişkinlerde Coronavirus Hastalığı 2019 (COVID-19) hakkında artan verilere rağmen, pediatrik hastalardaki veriler hala sınırlıdır. Çalışmamızın amacı, doğrulanmış pediatrik COVID-19 olgularımızın klinik özelliklerini ve laboratuvar bulgularını değerlendirmektir. Gereç ve Yöntem: Bu geriye dönük çalışma, Türkiye'deki en büyük COVID-19 tedavi merkezlerinden birinde yapıldı. Çalışmaya ters transkriptaz polimeraz zincir reaksiyonu (RT-PCR) kullanılarak doğrulanan 456 olgu dahil edildi.Yüz hasta yatarak, 356 hasta ayakta tedavi edildi. Hastalar hastalık şiddetine göre asemptomatik, hafif, orta ve şiddetli olarak sınıflandırıldı. Bulgular: Asemptomatik, hafif, orta ve ağır vaka sayısı sırasıyla 199 (%43.6), 194 (%42.5), 33 (%7.2) ve 30 (%6.6) idi. Hastanede yatan beş yaş altı hastaların çoğu hafif (%67.7) iken, 15 yaş üstü hastaların çoğu ağır hastalığa (%54.2) sahipti. Başvuru anında lenfopeni ve yüksek ferritin düzeyleri ağır olgularda daha yaygındı (p<0.05). Ayrıca çoklu regresyon analizi, yüksek ferritin ve D-dimer düzeylerinin hastanede yatış süresini artırdığını ortaya koydu (p=0.000;R2=0.404). Sonuç: Çocuklarda COVID-19 enfeksiyonu için hastalık şiddetini tahmin etmek için yaş, lenfosit sayısı, ferritin ve D-dimer seviyeleri kullanılabilir. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Management of Children with Severe COVID-19 in a Pediatrics Unit in Istanbul: A Retrospective Study

Objective: SARS-CoV-2 is a probable causative agent of severe disease both in children and adults. In this study, we aimed to evaluate the management of hospitalized severe pediatric COVID-19 patients. Methods: Data on the management of 21 children under the age of 18 who were hospitalized with severe COVID-19 between March 2020 and May 2020 were included in this study. Results: A total of 1109 patients, including 888 outpatients and 221 inpatients, were included in this study. 91 (41.1%) of the 221 hospitalized children were PCR positive for SARS-CoV-2. 21 (23%) of 91 COVID-19 patients were considered severe COVID-19. 10 (47.6%) were females and 11 (52.4%) were males, with a mean±standard deviation (SD) age of 14.4±2.7 years (range;9 years-17.6 years). The most prevalent symptoms at admission were fever (80.9%), cough (76.1%), shortness of breath (23.8%) and myalgia (23.8%). 4 (19%) of 21 patients had underlying diseases. 19 (90.4%) patients were in close contact with confirmed cases in the family. All patients had typical findings on lung computed tomography (CT) and the major CT abnormalities observed were ground-glass opacities. Two patients who needed respiratory support received favipiravir treatment. The mean hospital stay was 7.34±2.65 (5-16) days. Clinical improvement was achieved in all patients. Conclusion: The clinical course of COVID-19 in children is milder and has a better prognosis than adults, but it should be kept in mind that severe cases are defined in the pediatric patient group and these patients should be followed closely. (English) [ FROM AUTHOR] Amaç: SARS-CoV-2, hem çocuklarda hem de yetişkinlerde ciddi hastalığın olası bir etkenidir. Bu çalışmada, hastanede yatan ağır çocuk COVID-19 hastalarının yönetimini değerlendirmeyi amaçladık. Gereç ve Yöntem: Mart 2020 ile Mayıs 2020 tarihleri arasında 18 yaş altı ağır COVID-19'lu hastanede yatan 21 çocuğun yönetimine ilişkin veriler bu çalışmaya dahil edildi. Bulgular: Bu çalışmada 888 ayaktan ve 221 yatan hasta olmak üzere toplam 1109 hasta toplandı. Hastanede yatan 221 çocuğun 91'i (%41.1) SARS-CoV-2 için PCR pozitifti. Doksan bir COVID-19 hastasının 21'i (%23) şiddetli COVID-19 olarak kabul edildi. Onu (%47.6) kız, 11'i (%52.4) erkek olup, yaşları ortalama±standart sapma (SS) 14.4±2.7 yıl (aralık;9 yıl-17.6 yıl) olarak saptandı. En sık başvuru semptomları ateş (%80.9), öksürük (%76.1), nefes darlığı (%23.8) ve miyalji (%23.8) idi. Yirmi bir hastanın dördünde (%19) altta yatan hastalık vardı. On dokuz (%90.4) hasta ailede doğrulanmış olgularla yakın temas halindeydi. Tüm hastalarda tipik olarak akciğer bilgisayarlı tomografi (BT) bulguları vardı ve başlıca gözlenen BT anormallikleri buzlu cam opasiteleriydi. Solunum desteğine ihtiyaç duyan iki hasta favipiravir tedavisi aldı. Ortalama hastanede kalış süresi 7.34±2.65 (5-16) gündü. Tüm hastalarda klinik iyileşme sağlandı. Sonuç: Çocuklarda COVID-19'un yetişkinlere göre klinik seyri daha hafiftir ve daha iyi prognozu vardır ancak çocuk hasta grubunda ciddi olgular tanımlandığı ve bu hastaların yakından takip edilmesi gerektiği akılda tutulmalıdır. (Turkish) [ FROM AUTHOR] Copyright of Southern Clinics of Istanbul Eurasia is the property of KARE Publishing and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Relationship of chest computed tomography score with disease severity and laboratory values in children with COVID-19.

AIM: Although chest computed tomography (CT) score has been well evaluated in adult coronavirus disease (COVID-19), its use in paediatric cases is insufficiently studied. Our aim is to evaluate the relationship of chest CT score with disease severity and laboratory parameters. METHODS: Seventy-six paediatric patients with confirmed COVID-19 and chest CT evaluation on admission have been included in this study. Chest CT score was calculated for each of the five lobes considering the extent of anatomical involvement, as follows: 0: 0%; 1: <5%; 2: 5%-25%; 3: 26%-50%; 4: 51%-75% and 5: >75%. The resulting total CT score was the sum of each individual lobar score; the range was between 0 and 25. RESULTS: Total chest CT score was found to be positively correlated with alanine aminotransferase and d-dimer, and negatively correlated with lymphocyte count. In receiver operating characteristic analysis, total chest CT score had area under the curve 0.99 (95% confidence interval, 0.98-1.00) at cut-off 2 with 95% sensitivity and 96% specificity for the severe disease. Furthermore, in-depth analysis of lobar CT scores showed a correlation between left upper lobe with lymphocyte count, left lower lobe with d-dimer, right middle and lower lobes with alanine aminotransferase and right upper lobe with leukocyte count. CONCLUSIONS: There is a significant relationship between chest CT score and COVID-19 severity and laboratory findings in children. This suggests that chest CT scores can be used to assess the severity of the disease and can play an important role in paediatric clinical practice.

Coinfection in SARS-CoV-2 Infected Children Patients.

INTRODUCTION: The aim of this study is to determine the coinfections with other respiratory pathogens in SARS-CoV-2 infected children patients in a pediatric unit in Istanbul. METHODOLOGY: This retrospective descriptive study was conducted in a 1000-bedded tertiary education and research hospital in Istanbul. All children hospitalized with the diagnosis of SARS-CoV-2 infection had been investigated for respiratory agents in nasopharyngeal secretions. Laboratory confirmation of SARS-CoV-2 and the other respiratory pathogens were performed using reverse transcriptase-polymerase chain reaction (RT-PCR). RESULTS: A total of 209 hospitalized children with suspected SARS-CoV-2 infection between March 2020-May 2020 were enrolled in this study. Among 209 children, 93 (44.5%) were RT-PCR positive for SARS-CoV-2 infection, and 116 (55.5%) were RT-PCR negative. The most common clinical symptoms in all children with SARS-CoV-2 infection were fever (68.8%) and cough (57.0%). The other clinical symptoms in decreasing rates were headache (10.8%), myalgia (5.4%), sore throat (3.2%), shortness of breath (3.2%), diarrhea (2.2%) and abdominal pain in one child. In 7 (7.5%) patients with SARS-CoV-2 infection, coinfection was detected. Two were with rhinovirus/enterovirus, two were with Coronavirus NL63, one was with adenovirus, and one was with Mycoplasma pneumoniae. In one patient, two additional respiratory agents (rhinovirus/enterovirus and adenovirus) were detected. There was a significantly longer hospital stay in patients with coinfection (p = 0.028). CONCLUSIONS: Although the coinfection rate was low in SARS-CoV-2 infected patients in our study, we found coinfection as a risk factor for length of hospital stay in the coinfected patient group.