Pediatric emergency revisits of children with COVID-19.

OBJECTIVE: This study was conducted to reveal the characteristics of pediatric emergency revisits of children with COVID-19 and the factors associated with clinical worsening and hospitalization at the revisit. MATERIALS AND METHODS: In pediatric emergency visits of children between July 2020 and March 2021 with COVID-19, the patients who had a revisit within 7 days were included in the study. Demographic and clinical characteristics, test results, and the relationship of these variables with clinical worsening and hospitalization at the revisit were investigated. RESULTS: In 6779 children with COVID-19, 284 (4.1%) patients included in the study. 51.8% of the patients were male, the median age was 11.1 years, and median time to revisit time was 2.0 days. The rates of clinical worsening and hospitalization were 9.1% and 14.7%, respectively. Children younger than 24 months and those with chronic diseases were more commonly hospitalized at the revisit. Though the frequency of laboratory and radiologic testing at the revisit was significantly increased compared to the first presentation, tests did not play an important role in the decision-making processes. More than 85% of patients were clinically mild at the first presentation and revisit. CONCLUSIONS: Children with a diagnosis of COVID-19 can revisit the emergency without evident clinical worsening. Since revisits cause increase in frequency of laboratory and radiological testing, preventing unnecessary revisits of children with COVID-19 can reduce the workload and cost of health care services. We may consider changing our perspective on revisit patients to make decisions based on clinical findings instead of obtaining for more laboratory tests.

Cat allergy in children and the effect of the COVID-19 pandemic.

Background: Cat allergen is among the most common household allergens and can cause respiratory allergies and anaphylaxis in children. Objective: The aim of this study was to evaluate the characteristics of cat allergies in children and the impact of the coronavirus disease 2019 (COVID-19) pandemic on these characteristics. Methods: The study included pediatric patients with cat allergen sensitization demonstrated by skin-prick test (SPT) over a period of 2 years: 1 year before and 1 year during the pandemic. Demographic data, clinical features, and laboratory findings were evaluated from the patients' records. Results: Of 7428 SPTs performed, 566 patients (7.6%) were sensitized to cat allergen (56% boys; median age, 11 years). Fifty-eight percent of the patients (n = 329) presented during the pandemic period, 44.5% (n = 252) had symptoms with cat exposure, and 9% (n = 51/566) had anaphylaxis. Allergic rhinitis and asthma were present in 76% (n = 431) and 46.6% (n = 264) of the patients, respectively. When compared to prepandemic period, patients who presented during the pandemic had higher rates of cat sensitization (15% in pandemic group versus 4.4% in prepandemic group of all SPTs performed; p < 0.05), cat ownership (29.1% versus 13.9%; p < 0.001), and symptoms on cat exposure (51% versus 34%; p < 0.001). Factors that predicted symptom development in the patients who were cat sensitized were induration > 5 mm on SPT (odds ratio [OR] 1.9 [95% confidence interval {95% CI}], 1.1-3.2), cat ownership (OR 9.2 [95% CI, 4.9-17.3]), close contact with a cat owner (OR 7.1 [95% CI, 4-12]), allergic rhinitis (OR 3.1 [95% CI, 1.6-5.8]), conjunctivitis (OR 4.7 [95% CI, 2-10]), and atopic dermatitis (OR 2.2 [95% CI, 1-4.7]). Conclusion: We observed an increase in the prevalence of cat allergy among children during the COVID-19 pandemic. Care must be taken in terms of anaphylaxis in patients who were cat sensitized.

Evaluation of Psychiatric Symptoms in 2-5 Years Old Children Who Are Followed and Treated with the Diagnosis of Wheezing during the COVID-19 Pandemic and Depression, Anxiety, and Stress Levels of Mothers

Objective: The impact of COVID-19 on the mental health of children and adults is a candidate to be one of the most current issues in healthcare in the near future. This study aimed to determine the clinical course of patients diagnosed with wheezing, to make emotional, behavioral, social, and psychiatric evaluations, and to investigate the possible effect of the pandemic on disease follow-up and treatment by evaluating the psychiatric conditions of their mothers. Material and Methods: The study included 58 patients diagnosed with a wheezy infant aged 2-5 years. Data regarding the sociodemographic characteristics and wheezing history of the patients were recorded. 'Test for Respiratory and Asthma Control in Kids (TRACK)' was applied to evaluate their current clinical condition. For psychiatric evaluation, the 'Strengths and Difficulties Questionnaires (SDQ)' was applied to the patients, and the 'Depression Anxiety Stress Scale 21 (DASS 21)' and 'The Brief Resilience Scale (BRS)' were administered to their mothers. Results: In our study, it was observed that our patients experienced emotional, behavioral, peer, and social problems at varying rates (17-43%) during the pandemic period. It was especially noteworthy that emotional problems were seen more frequently in girls. It has been shown that there is a positive relationship between depression scores in mothers and SDQ Total Scores of their children. On the other hand, it was observed that current disease control status, hospitalization history, and whether or not being symptomatic during the pandemic period did not contribute to mental impairment in mothers. Conclusion: The detection of high overall difficulty scores in children of mothers with high depression scores indicates that there is a need to evaluate maternal and child mental health together. Psychological influence is multifactorial and varies between societies. There is a need for studies on a larger scale that take familial and individual variables into account. (English) [ FROM AUTHOR] Amaç: COVÍD-19'un çocukların ve yetişkinlerin ruh sağlığı üzerindeki etkisi, yakın gelecekte sağlık hizmetlerinde en güncel sorunlardan biri olmaya adaydır. Bu çalışma ile hışıltılı çocuk tanılı hastaların pandemi dönemindeki klinik seyirlerini belirlemek, duygusal, davranışsal, sosyal ve psikiyatrik değerlendirmelerini yapmak, ayrıca annelerinin de psikiyatrik durumlarını değerlendirerek pandeminin hastalık takip ve tedavisi üzerine olan olası etkisinin araştırmak amaçlanmıştır. Gereç ve Yöntemler: Çalışmaya 2-5 yaş arası 58 hışıltılı çocuk tanılı hasta dahil edildi. Hastaların sosyodemografik özellikleri ve hışıltı geçmişlerine ait veriler kaydedildi. Güncel klinik durumlarını değerlendirmek üzere Çocuklar Íçin Solunum ve Astım Kontrol Testi uygulandı. Psikiyatrik değerlendirme amacıyla hastalara Güçler ve Güçlükler Anketi (SDQ), annelerine ise Depresyon Anksiyete Stres Ölçeği 21 (DASS 21) ve Kısa Psikolojik Sağlamlık Testi uygulandı. Bulgular: Çalışmamızda pandemi döneminde hastalarımızın değişen oranlarda (%17-43) duygusal, davranış, hiperaktivite, akran ve sosyal açılardan problem yaşadığı gözlemlenmiştir. Kız çocuklarda duygusal problemlerin daha sık görülmesi özellikle dikkat çekmiştir. Annelerdeki depresyon skorları ile çocuklarının SDQ toplam skorları arasında pozitif ilişki olduğu gösterilmiştir. Buna karşılık güncel hastalık kontrol durumunun, hospitalizasyon öyküsünün ve pandemi döneminde semptomatik olup olmamanın annelerde mental etkilenmeye katkıda bulunmadığı gözlenmiştir. Sonuç: Depresyon puanı yüksek olan annelerin çocuklarında genel güçlük puanlarının yüksek saptanması, anne ve çocuk ruh sağlığının birlikte değerlendirilmesine ihtiyaç olduğunu göstermektedir. Psikolojik etki çok faktörlüdür ve toplumlar arasında farklılık gösterir. Bu konuda ailesel ve bireysel değişkenlerin göz önüne alındığı daha büyük ölçekli gelecek çalışmalara ihtiyaç vardır. (Turkish) [ FROM AUTHOR] Copyright of Journal of Pediatric Disease / Cocuk Hastaliklari Dergisi is the property of Turkish Journal of Pediatric Disease 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.)

The Impact of Childhood and Parental Vaccination on SARS-CoV-2 Infection Rates in Children.

BACKGROUND: The data on the indirect protection of children via the coronavirus disease 2019 (COVID-19) vaccination of household members are insufficient, and analyses to evaluate the efficacy of COVID-19 vaccines are limited. METHODS: We gathered data on 12,442 patients under the age of 18 regarding the vaccination status of their household members, their vaccine preferences and doses, and their previous history of COVID-19 infection immediately before the patients were administered a real-time reverse transcriptase-polymerase chain reaction (RT-PCR) test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) between September 1, 2021 and December 5, 2021. RESULTS: A total of 18.4% (2289) were vaccinated, 91.4% with BNT162b2mRNA vaccine, 8.6% with inactivated COVID-19 vaccine; 48.7% received a single dose, and 51.3% had 2 doses. Real-time RT-PCR positivity proportions were much higher in older children ( P < 0.001) and were higher in children 12 years of age and older [odds ratio (OR), 1.34; 95% confidence interval (CI): 1.21-1.47] compared with others. SARS-CoV-2 infection was significantly lower in the vaccinated group (fully and incompletely) ( P < 0.001). Unvaccinated (OR, 4.88; 95% CI: 3.77-6.13) and incompletely vaccinated children (OR, 1.83; 95% CI: 1.52-2.12) had a higher risk of COVID-19 infection compared with fully vaccinated patients No significant association was found between the COVID-19 real-time RT-PCR positivity rates of patients and the vaccination status or vaccine preferences of household members ( P > 0.05 each). CONCLUSIONS: SARS-CoV-2 infection rates were significantly lower in vaccinated children, especially with mRNA vaccines. The indirect protection of unvaccinated children via the vaccination of household members against COVID-19 seems inadequate. The individual vaccination of children remains crucial.

Evaluation of Suspected COVID-19 Patients in a Pediatric Emergency Department.

Coronavirus disease 2019 (COVID-19) is now a global pandemic. The aim of this study was to investigate the prevalence of COVID-19 in pediatric patients and to compare the characteristics of positive and negative patients. This study conducted from March to May 2020 in a tertiary children's hospital. Patients were included if they were under 18 years old and a SARS-CoV-2 polymerase chain reaction test had been performed. Of the 1,812 patients included in the study, 365 (20.1%) were positive for COVID-19. The median age was 102 months in the positive group, 70 months in the negative group ( p < 0.001). The sex distribution was almost equal. Nearly all positive patients had been in close contact with a COVID-19 infected family household member ( p < 0.001). The most common symptoms were fever (54.4%) and cough (38.6%). The asymptomatic patient rate was higher in the positive group ( p < 0.001). Lymphopenia (<1500/mm 3 ) was found in 29.9% of the positive children ( p = 0.005). When the groups were compared, white blood cell, neutrophil, lymphocyte, and platelet counts; neutrophil-to-lymphocyte ratio; and C-reactive protein level were lower in the positive group. Chest radiography was performed in 95.3% of the positive patients, and the results of 29.7% of them were interpreted as pathological ( p < 0.001). Most of the pediatric patients had a history of contact with COVID-19 positive individuals, and therefore, the diagnosis is generally suspected from a history of household exposure to COVID-19. Lymphopenia can help predict positivity. Awareness, reinforcing infection control measures, and performing health management within families are important steps to manage these patients.

Algorithm for the diagnosis and management of the multisystem inflammatory syndrome in children associated with COVID-19.

OBJECTIVE: Although the initial reports of COVID-19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called "multisystem inflammatory syndrome in children" (MIS-C) shares common clinical features with other well-defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow-up of patients with MIS-C. METHODS: The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. CONCLUSION: Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS-C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS-C should be tailored depending on the patients' phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS-C with severe symptoms. Long-term follow-up of patients with cardiac involvement is required to identify any sequelae of MIS-C.

Evaluation of the Clinical and Laboratory Findings of Asthmatic Children with SARS-CoV-2 Infection.

INTRODUCTION: There are a limited number of studies about the clinical findings of coronavirus infection in pediatric patients with asthma. We aimed to evaluate the clinical and laboratory characteristics of pediatric patients with asthma and healthy children without chronic disease who infected with SARS-CoV-2. METHODS: This is a retrospective, case-control study comparing the asthma diagnosed and healthy children who were diagnosed as COVID-19 in our hospital between March 11 and November 10, 2020. RESULTS: During the study period, 6,205 children were diagnosed with CO-VID-19 in our hospital. Only 54 (0.87%) patients had a diagnosis of asthma. The mean of the age was 10.5 years and 53.7% (n:29) of the patients with asthma were male. Cough, shortness of breath, emesis, and diarrhea were found to be significantly higher in asthma group than in the control group (respectively p = 0.002, 0.000, 0.002, 0.019, 0.015). Patients who were given SABA was significantly higher in asthma diagnosed patients (p = 0.000). Hospitalization was significantly higher in asthma group (p = 0.025), and the duration of hospitalization was significantly higher in control group (p = 0.034). There was no significant difference between the 2 groups in terms of requiring oxygen treatment and in laboratory findings between groups. CONCLUSION: This study revealed that pediatric patients diagnosed with asthma were in a mild clinic. According to these findings, asthma may not affect the course of the COVID-19 in children.