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Background: The benefits of facilitating breastmilk feeding and close contact between mother and neonate (family-centred care; FCC) in the perinatal period are well-established. The aim of this study was to determine how the delivery of FCC practices were impacted for neonates born to mothers with perinatal SARS-CoV-2 infection during the COVID-19 pandemic. Methods: Neonates born to mothers with confirmed SARS-CoV-2 infection during pregnancy were identified from the 'EsPnIC Covid paEdiatric NeonaTal REgistry' (EPICENTRE) multinational cohort between 10 March 2020 and 20 October 2021. The EPICENTRE cohort collected prospective data on FCC practices. Rooming-in and breastmilk feeding practice were the main outcomes, and factors influencing each were determined. Other outcomes included mother-baby physical contact prior to separation and the pattern of FCC components relative to time and local site guidelines. Findings: 692 mother-baby dyads (13 sites, 10 countries) were analysed. 27 (5%) neonates were positive for SARS-CoV-2 (14 (52%) asymptomatic). Most sites had policies that encouraged FCC during perinatal SARS-CoV-2 infection for most of the reporting period. 311 (46%) neonates roomed-in with their mother during the admission. Rooming-in increased over time from 23% in March-June 2020 to 74% in January-March 2021 (boreal season). 330 (93%) of the 369 separated neonates had no FCC physical contact with their mother prior, and 319 (86%) were asymptomatic. Maternal breastmilk was used for feeding in 354 (53%) neonates, increasing from 23% to 70% between March-June 2020 and January-March 2021. FCC was most impacted when mothers had symptomatic COVID-19 at birth. Interpretation: This is the largest report of global FCC practice during the COVID-19 pandemic to date. The COVID-19 pandemic may have impacted FCC despite low perinatal transmission rates. Fortunately, clinicians appear to have adapted to allow more FCC delivery as the COVID-19 pandemic progressed. Funding: The National Health and Medical Research Council (Australia): Grant ID 2008212 (DGT), Royal Children's Hospital Foundation: Grant ID 2019-1155 (EJP), Victorian Government Operational Infrastructure Support Program.
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Aim/Introduction: There is growing interest in the clinical management of children with persisting and debilitating symptoms after Sars-COV-2 infection (Long-COVID). Chronic effects could arise from residual clot burden and small vessel inflammation, both expressing endothelial damage that may lead to lung perfusion impairment. 99mTc-macroaggregated albumin (MAA) SPECT/ CT is a well-established tool to detect lung perfusion defects, even at the small-vessels level. This pilot study aimed at assessing lung perfusion in Long-COVID children with MAA SPECT/CT and at comparing functional patterns with clinical scenarios during acute infection and follow-up. Material(s) and Method(s): Clinical and biochemical data were collected during acute infection and follow-up in 10 children (6 males and 4 females, mean age: 13.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and post-exertional malaise after mild efforts. All patients underwent a cardiopulmonary test and MAA SPECT/CT scan. Dose activities were properly chosen according to the EANM guidelines for lung scintigraphy in children. Intravenous injections were administered to patients in the supine position immediately before the planar scan, which was followed by the lung SPECT/CT acquisition. Reconstructed studies were visually analyzed. Imaging results were compared with clinical scenarios during acute infection and follow-up. Result(s): The severity of acute disease was mild and moderate in 6/10 (60 %) and 2/10 (20 %) children, respectively;there were no significant symptoms in the remaining 2 cases. Persisting symptoms after the acute phase were observed in 7/10 (70%) patients. Five out of 10 (50.0%) children showed perfusion defects on MAA SPECT/CT scan, without morphological alterations on co-registered CT. In particular, 4/5 (80%) children with lung perfusion abnormalities were previously affected by a mild acute infection, whereas a single child (20%) was asymptomatic. However, during the follow-up, persisting symptoms (e.g., headache and dyspnea after the cardiopulmonary test) were detected in 5/5 (100%) patients. Conversely, among the five children without lung perfusion defects, only 2 (40%) showed persisting symptoms (in particular, headache), while 3 (60%) children had dyspnea after the cardiopulmonary test. Conclusion(s): This pilot study showed lung perfusion defects in Long-COVID children. Despite the small patient sample, perfusion abnormalities on MAA SPECT/CT seem to occur more frequently in children with persisting symptoms following the acute infection and dyspnea after the cardiopulmonary test. Larger cohort studies are needed to confirm these preliminary results, providing a better selection among children who can benefit the most from MAA SPECT/CT imaging.
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Aim/Introduction: There is growing interest in the clinical management of children with persisting and debilitating symptoms after Sars-COV-2 infection (Long-COVID). Chronic effects could arise from residual clot burden and small vessel inflammation, both expressing endothelial damage that may lead to lung perfusion impairment. 99mTc-macroaggregated albumin (MAA) SPECT/ CT is a well-established tool to detect lung perfusion defects, even at the small-vessels level. This pilot study aimed at assessing lung perfusion in Long-COVID children with MAA SPECT/CT and at comparing functional patterns with clinical scenarios during acute infection and follow-up. Material(s) and Method(s): Clinical and biochemical data were collected during acute infection and follow-up in 10 children (6 males and 4 females, mean age: 13.6 years) fulfilling Long-COVID diagnostic criteria and complaining of chronic fatigue and post-exertional malaise after mild efforts. All patients underwent a cardiopulmonary test and MAA SPECT/CT scan. Dose activities were properly chosen according to the EANM guidelines for lung scintigraphy in children. Intravenous injections were administered to patients in the supine position immediately before the planar scan, which was followed by the lung SPECT/CT acquisition. Reconstructed studies were visually analyzed. Imaging results were compared with clinical scenarios during acute infection and follow-up. Result(s): The severity of acute disease was mild and moderate in 6/10 (60 %) and 2/10 (20 %) children, respectively;there were no significant symptoms in the remaining 2 cases. Persisting symptoms after the acute phase were observed in 7/10 (70%) patients. Five out of 10 (50.0%) children showed perfusion defects on MAA SPECT/CT scan, without morphological alterations on co-registered CT. In particular, 4/5 (80%) children with lung perfusion abnormalities were previously affected by a mild acute infection, whereas a single child (20%) was asymptomatic. However, during the follow-up, persisting symptoms (e.g., headache and dyspnea after the cardiopulmonary test) were detected in 5/5 (100%) patients. Conversely, among the five children without lung perfusion defects, only 2 (40%) showed persisting symptoms (in particular, headache), while 3 (60%) children had dyspnea after the cardiopulmonary test. Conclusion(s): This pilot study showed lung perfusion defects in Long-COVID children. Despite the small patient sample, perfusion abnormalities on MAA SPECT/CT seem to occur more frequently in children with persisting symptoms following the acute infection and dyspnea after the cardiopulmonary test. Larger cohort studies are needed to confirm these preliminary results, providing a better selection among children who can benefit the most from MAA SPECT/CT imaging.
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BACKGROUND AND AIM: Following Covid-19 infection, children can develop an hyperinflammatory state termed Multisystem Inflammatory Syndrome in Children (MIS-C). Lung Ultrasound (LUS) features of COVID-19 in children have been described but data describing the LUS findings of MIS-C are limited. Aim of this retrospective observational study conducted between March, 1st, and December 31st, 2020, at a tertiary pediatric hospital in Milano, is to describe LUS patterns in patients with MIS-C and to verify correlation with illness severity. Secondary objective is to evaluate concordance of LUS with Chest X-Ray (CXR). METHOD(S): Clinical and laboratory data were collected for all patients (age 0-18 years) admitted with MIS-C, as well as LUS and CXR patterns at admission. PICU admission, need for respiratory support and inotrope administration, hospital and PICU length of stay were considered as outcomes and evaluated in the different LUS patterns. Agreement between LUS and CXR evaluation was assessed with Cohen' k. RESULT(S): 38 children were enrolled;24 had a LUS examination upon admission. LUS pattern of subpleural consolidations < or > 1 cm with or without pleural effusion were associated with worse Left Ventricular Ejection Fraction at admission and need for inotropes. Subpleural consolidations < 1 cm were also associated with PICU length of stay. Agreement of CXR with LUS for consolidations and effusion was slight. CONCLUSION(S): LUS pattern of subpleural consolidations and consolidations with or without pleural effusion are predictors of disease severity;under this aspect, LUS can be used at admission to stratify risk of severe disease.
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Background Religious and cultural beliefs strongly influence people's attitudes and behaviors that, in turn, may positively or negatively affect both individual and public health. In this regard, we aimed to collect and analyze evidence on the impact of religion in the current COVID-19 pandemic. Methods We performed a scoping review investigating both scientific and grey literature available on the topic from the onset of the pandemic to September 2021. Pubmed, Web of Science and Google Scholar were investigated and a hand-search on Google was also performed. Studies dealing with religion and COVID-19 were included and narratively summarized according to topics. Results 46 articles were included in the review. Predominant topics emerged were 1) religious pilgrimages and rituals worldwide being relevant to COVID-19 outbreaks, especially in the first pandemic wave 2) difficulties to engage the Closed Religious Communities (e.g. Haredi, Amish, etc.) in which community way of life, restrictions in using media and resistance to comply to preventive measures were identified as significant COVID-19 risk 3) COVID-19 unofficial treatments and vaccine hesitancy also supported by concerns on the religious acceptability of vaccine composition or firm interpretation of the Ramadan fasting 4) a fuel of religious discrimination 5) religious communities and leaders strongly trusted in conveying COVID-19 information. Conclusions Our findings highlighted how religion has represented both a risk for the spreading of the virus and a precious opportunity to convey evidence-based and culturally-sensitive COVID-19 information engaging people in fighting the pandemic. To be prepared for similar future challenges, scientists, politicians and health professionals need to acknowledge the role that culture and religion have in influencing people's lives to design specific health policies and strategies to ensure that all people are effectively engaged in health production and protection. Key messages Religion has represented both a risk factor for COVID-19 outbreaks and a resource to convey evidence-based information and overcome resistance to implementing COVID-19 preventive measures. Health policy should become more sensitive to religious and cultural issues acknowledging the role played by religion in facing complex global health challenges.
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RATIONALE4,4-44,4% of children suffer from post-COVID syndrome, commonly known as long- COVID, after an acute SARS-CoV-2 infection. However, an uniform clinical definition, and guidelines to diagnose or treat children suspected of long-COVID are lacking. Multiple careprograms have been initiated worldwide. In this study, we aimed to assess the currently available pediatric international long-COVID care programs and explore the characteristics of their patient cohorts.METHODSWe established an international network (IP4C) and performed a crosssectional analysis from aggregated data collected by its members using a survey. Topics included: the used definition for long-covid in children, the organization of pediatric long-COVID clinics and long-COVID patients characteristics. Descriptive analysis of the aggregated data was used to summarize and compare each of these categories across countries. RESULTSWe included data concerning organization of care from 17 cohorts based in 13 different countries. A wide range of definitions for long COVID was used, which differed mostly in duration of symptoms and the necessity of microbiologically proven SARS-COV-2 infection. 66,6-100% of patients in the long- COVID cohorts suffered from complaints for more than twelve weeks, and 49,5-97,3% of patients had a positive RT-PCR or serology for SARS-CoV-2. Most long-COVID care programs consisted of real-life visits with multidisciplinary teams, consisting of general pediatricians, pediatric lung specialists, cardiologists and infectiologist, a physiotherapist and psychologist. The type of investigations performed at the long-COVID clinics ranged from assessment of medical history (100%) and standardized questionnaires (91%) to in depth evaluation of organ functioning (e.g. spirometry performed in 0-100% of patients). Aggregated data of 431 long-COVID patients from 11 dedicated long-COVID care programs were analyzed. Mean age of patients ranged from 6,5-16,4 years old. Girls were overrepresented in most cohorts (20-65%). 28-81,8% of patient had a positive medical history, most commonly atopic syndrome, asthma and prematurity. Most patients (90- 100%) suffered from asymptomatic or mild acute COVID-19. Frequent long-COVID symptoms were fatigue, headaches, concentration difficulties, dyspnea and sleep disturbances. 5-37% of patients had severe limitations in daily life. CONCLUSIONSThis is the first study to describe the organization of pediatric long-COVID care. It demonstrates that pediatric long-COVID is recognized worldwide as a multisystemic disease, but its definition and care programs for pediatric long- COVID patients differ between cohorts. A clear definition of pediatric long-COVID is needed to improve international scientific collaboration and patient care. Our international network will facilitate further collaboration in investigation pathophysiology and therapeutic interventions in order to provide evidence based medical care for these patients.
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Data from adult studies show that COVID-19 is more severe in men than women. However, no data are available for the pediatric population. For this reason, we performed this study aiming to understand if sex influenced disease severity and outcomes in a large cohort of Latin-American children with COVID-19 and multisystem inflammatory syndrome (MIS-C). We found that a higher percentage of male children developed MIS-C (8.9% vs 5% in females) and died (1.2% and 0.4% in females), although on multivariate adjusted analyses the only statistically significant difference was found in need of hospitalization, with females less frequently admitted compared with boys (25.6% vs 35.4%). This data are preliminary and need further independent studies to better assess the role of sex. © 2021, Il Pensiero Scientifico Editore s.r.l.. All rights reserved.
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We report a case of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, occurring in an adolescent resulting positive to SARS-CoV-2 nasopharyngeal swab. At the admission in Emergency Department, the child presented with left cervical and sternal pain, without respiratory symptoms. Radiological studies showed sizeable pneumomediastinum, bilateral apical pneumothorax, massive emphysema subcutaneous and pneumorrhachis. Patients' clinical conditions stood stable during the monitoring and he only needed conservative management. To our knowledge, this is the first description of spontaneous pneumomediastinum, pneumothorax, emphysema subcutaneous and pneumorrhachis, in a COVID-19 adolescent without concomitant pneumonia.
Subject(s)
COVID-19/diagnostic imaging , Mediastinal Emphysema/diagnostic imaging , Pneumorrhachis/diagnostic imaging , Pneumothorax/diagnostic imaging , Adolescent , COVID-19/complications , Humans , Male , Mediastinal Emphysema/etiology , Pneumorrhachis/etiology , Pneumothorax/etiologyABSTRACT
COVID-19 is an infectious illness caused by a virus named SARS-CoV-2. Recent studies underlined the need for chest computed tomography (CT) in COVID-19 patients to assess lung involvement. However, CT has a series of disadvantages, such as the need to move the patient from an isolation room to a Radiology Department, the difficulty in protecting and disinfecting the machine, the high cost of the equipment. These disadvantages apply especially to pregnant women, in particular because of the exposure to a significant amount of radiation to the fetus. In order to avoid these disadvantages, a series of manuscript were published on the alternative use of Lung Ultrasound (LUS) during COVID-19 outbreak. Therefore, we carried out a review of the published studies and case reports, in order to underline the advantages, the correct technique, the typical LUS manifestations of COVID-19 and to help researchers in the diagnosis and monitoring of the disease, especially for obstetricians and gynecologists who already use ultrasound in their clinical practice.
Subject(s)
Betacoronavirus/pathogenicity , Coronavirus Infections/transmission , Infectious Disease Transmission, Vertical , Milk, Human/virology , Pneumonia, Viral/transmission , Adult , Amniotic Fluid/virology , Betacoronavirus/genetics , COVID-19 , COVID-19 Testing , Clinical Laboratory Techniques/methods , Coronavirus Infections/diagnosis , Coronavirus Infections/virology , Female , Fetal Blood/virology , Humans , Pandemics , Placenta/virology , Pneumonia, Viral/diagnosis , Pneumonia, Viral/virology , Pregnancy , Reverse Transcriptase Polymerase Chain Reaction , SARS-CoV-2ABSTRACT
Under certain circumstances, such as during the current COVID-19 outbreak, pregnant women can be a target for respiratory infection, and lung examination may be required as part of their clinical evaluation, ideally while avoiding exposure to radiation. We propose a practical approach for obstetricians/gynecologists to perform lung ultrasound examination, discussing potential applications, semiology and practical aspects, which could be of particular importance in emergency situations, such as the current pandemic infection of COVID-19. Copyright © 2020 ISUOG. Published by John Wiley & Sons Ltd.