ABSTRACT
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.
ABSTRACT
BACKGROUND AND AIM: Bronchiolitis is the most common lower respiratory illness in young children, mostly caused by Respiratory Syncitial Virus (RSV);PICU admission for respiratory support is required in some cases. The recent Covid-19 pandemic has altered dynamics of viral transmission in the community. We aim to describe if there has been a modification in the number and characteristics of patients admitted to Italian PICUs between the pre-pandemic and post-pandemic period. METHOD(S): Multicenter retrospective observational study based on the national electronic web-based national registry of the Italian Network of PICU Study Group (TIPNet). PICU admissions due to bronchiolitis were compared from 2017 to 2022, considering the seasonal peak periods (October, 1st to April, 30th). RESULT(S): 918 patients have been admitted due to bronchiolitis to Italian PICUs in the above mentioned years. Cumulative yearly admissions are reported in Figure 1. The winter season of 2020-2021 reported a significantly lower number of admissions. RSV was consistently the reported cause in most cases throughout the years except in season 2020-2021, when it was never reported. In the 2020-2021 season, enterovirus was reported in 23% of cases. Covid-19 as cause of bronchiolitis was reported in one case in 2020- 21 and 2 cases in 2021-22. CONCLUSION(S): Covid-19 pandemic, due to possibly multiple factors, has changed the panorama of PICU admissions due to bronchiolitis in Italy. Although research is still ongoing, it seems that Covid itself is not a cause of severe bronchiolitis requiring respiratory support. (Figure Presented).
ABSTRACT
PURPOSE: COVID-19 disease may result in a severe multisystem inflammatory syndrome in children (MIS-C), which in turn may alter thyroid function (TF). We assessed TF in MIS-C, evaluating its impact on disease severity. METHODS: We retrospectively considered children admitted with MIS-C to a single pediatric hospital in Milan (November 2019-January 2021). Non-thyroidal illness syndrome (NTIS) was defined as any abnormality in TF tests (FT3, FT4, TSH) in the presence of critical illness and absence of a pre-existing hormonal abnormality. We devised a disease severity score by combining severity scores for each organ involved. Glucose and lipid profiles were also considered. A principal component analysis (PCA) was performed, to characterize the mutual association patterns between TF and disease severity. RESULTS: Of 26 (19 M/7F) patients, median age 10.7 (IQR 5.8-13.3) years, 23 (88.4%) presented with NTIS. A low FT3 level was noted in 15/23 (65.3%), while the other subjects had varying combinations of hormone abnormalities (8/23, 34.7%). Mutually correlated variables related to organ damage and inflammation were represented in the first dimension (PC1) of the PCA. FT3, FT4 and total cholesterol were positively correlated and characterized the second axis (PC2). The third axis (PC3) was characterized by the association of triglycerides, TyG index and HDL cholesterol. TF appeared to be related to lipemic and peripheral insulin resistance profiles. A possible association between catabolic components and severity score was also noted. CONCLUSIONS: A low FT3 level is common among MIS-C. TF may be useful to define the impact of MIS-C on children's health and help delineate long term follow-up management and prognosis.