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The article focuses on the challenges facing children's hospitals in the U.S. Topics discussed include the problem on shortage in medical professionals at these hospitals, events that have affected children's hospitals in the country, an increase in the number of child patients in the emergency room, and the conversion of hospital rooms to navigate capacity issues.
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Background Children under 5 years of age bear the highest burden of severe disease from respiratory illness. Surveillance of respiratory viral infections in hospitalized children informs local burden of disease and may assist in identifying potential sources of epidemics. In resource-limited countries, like Haiti, lack of infrastructure, resources, and oversight are barriers for such surveillance programs. Just before the onset of the pandemic in December 2019, we completed the preparation to implement a respiratory surveillance program at Hôpital Saint Damien (HSD). Furthermore, other major events such as a 7.2 magnitude earthquake and the assassination of the president of Haiti had an impact on the political and economic stability of the country, impacting the hospital and this study. Despite these challenges, we report the preliminary findings of a hospital-based surveillance program of severe acute respiratory illness (SARI) in children at a mother and child hospital in Tabarre, Haiti. Method Participants were included if they were < 18 years of age;met the World Health Organization definition for SARI, which includes presence of 1) cough, 2) history of fever or measured fever ≥ 38 C°, 3) onset within the last 10 days, and 4) requirement of hospitalization;and consented to participate. We collected demographic and clinical data for enrolled patients and obtained a nasopharyngeal swab sample. Samples were rapid tested for influenza A, influenza B, respiratory syncytial virus (RSV), and SARS-CoV-2 and stored and shipped for genomic sequencing. Results As of January 6th, 2022, we had enrolled and tested 143 patients who presented to the hospital with SARI. Of these cases, 31 were RSV-positive, 7 were positive for influenza B-positive, 1 was positive for influenza A-positive, and 1 was SARS-CoV-2-positive. 97 cases are currently available for descriptive analysis, with 10 RSV-positive cases, 2 influenza B-positive cases, and 1 SARS-CoV-2-positive case. 55% (n= 53) of participants are male, with an average age of 2 years (standard deviation = 2.8 years). Along with fever and cough, 18% (n=17) presented with wheezing, 60% (n=58) presented with shortness of breath, 37% (n=36) presented with tachypnea, 7% (n=7) presented with nasal congestion, 1% (n=1) had a sore throat, 2% (n=2) had nausea, 7% (n=7) were lethargic, and 9% (n=9) had diarrhea. Nearly all enrolled children, 99% (n=96) live in households where coal or biofuel is used for cooking indoors. In regard to type of respiratory tract infection (RTI), 18% (n=17) were upper RTI, 30% (n=29) were lower RTI, and 53% (n=51) were both upper and lower RTI. While sequencing of influenza A and B isolates remains to be conducted, sequencing for the SARS-CoV-2 sample revealed the isolate to be of P.1 lineage. Conclusion In children requiring hospital admission for SARI, our limited testing identified 40 children with respiratory viruses that were circulating during the SARS-CoV-2 pandemic. Identifying these viruses can support healthcare providers to provide better preventions measures, including compliance with vaccination, and administering appropriate therapeutics, such as antibiotics. Further testing with additional primers against other pathogens will be conducted to identify other potential causes of illness.
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Background At the beginning of the current COVID-19 pandemic, it became critical to isolate all infected patients, regardless of their age. In the case of hospitalized children, isolation imposes a significant, negative impact on the well-being of isolated infants and their parents, in addition to the deleterious effect that the clinical condition and hospitalization by itself inflicts on patients and their families;this negative effect must be weighed against the potential risk that visitation might have on COVID-19 dissemination, mostly among hospital workers. Method Parents were gradually allowed during supervised, restricted visit time, progressively increasing the visitation time, and carefully monitoring for the presence of COVID-19 symptoms among healthcare workers (HCW) in the COVID-19 area, who were also tested for the infection when clinically justified. Family members were interrogated about symptoms and signs suggestive of COVID-19 infection, or positive PCR testing within 14 days of hospital stay. Results We found that, when safely implemented, allowing parents to spend time with their hospitalized COVID-19 children does not increase the contagion risk for hospital workers. The percentage of COVID-19 cases among HCW decreased after parents were allowed to visit their children in the COVID-19 areas. The percentage dropped from 27.78% to 12.77% (p=0.022). The rate of workers with COVID-19 for every 1000 shifts per worker was reduced after the parents were allowed to visit, although no statistically significant differences were found. Only 6 out of 129 parents (4.65%), that visited their children, were infected and there is no guarantee that they got infected within the hospital. Conclusion With proper training, parents do not increase the risk of infection among healthcare workers or among themselves. To develop and implement policies to permit the children to be accompanied during their suffering should be a standard in the context of an epidemic and out of it.
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Introduction: Being a recent disease, there are still unknown facts about coronavirus disease 2019, especially in children. Therefore, reports from centers worldwide are important to better understand this condition. This study aimed to describe all severe acute respiratory syndrome coronavirus 2 positive cases admitted to a Portuguese tertiary pediatric hospital. Methods: All patients with severe acute respiratory syndrome coronavirus 2 infection confirmed by polymerase chain reaction test until January 31st, 2021, were included in this study. A descriptive analysis was conducted on demographic, epidemiological, clinical, and laboratorial characteristics, as well as patient management. Results: In total, 331 (3.8% of the total tested) patients were included in this study, 51.1% of whom were male, and the median age was 6 years (range 7 days-17 years), being the 1-5 years age group the more prevalent. Family / cohabitant contact was the main form of exposure to disease. Symptoms included fever (50.2%), cough (45%) and gastrointestinal symptoms (38.7%) (diarrhea in 13%). There were 10 patients with anosmia and eight with ageusia (all older than 5 years) and 14.8% of the children were asymptomatic. Excluding asymptomatic patients, hospitalization occurred in 17 (6.0%) cases, four of whom were adolescents (three obese, one with progressive cancer) and needed oxygen supplementation, and one patient was admitted to the intensive care unit. Discussion: In our center, pediatric infection rate was low, frequently with a mild clinical presentation and after a contact with an infected cohabitant / family member. Asymptomatic patients corresponded to 14.8% of the cases. Of the four patients with more severe disease, all were adolescents and three were obese. The outcome was overall good. © Author(s) (or their employer(s)) and Portuguese Journal of Pediatrics 2022. R.
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BACKGROUND: The COVID-19 pandemic has necessitated rapid changes in healthcare delivery in the United States, including changes in the care of hospitalized children. The objectives of this study were to identify major changes in healthcare delivery for hospitalized children during the COVID-19 pandemic, identify lessons learned from these changes, and compare and contrast the experiences of children's and community hospitals. METHODS: We purposefully sampled participants from both community and children's hospitals serving pediatric patients in the six U.S. states with the highest COVID-19 hospitalization rates at the onset of the pandemic. We recruited 2-3 participants from each hospital (mix of administrators, front-line physicians, nurses, and parents/caregivers) for semi-structured interviews. We analyzed interview data using constant comparative methods to identify major themes. RESULTS: We interviewed 30 participants from 12 hospitals. Participants described how leaders rapidly developed new hospital policies (e.g., directing use of personal protective equipment) and how this was facilitated by reviewing internal and external data frequently and engaging all relevant stakeholders. Hospital leaders optimized communication through regular, transparent, multi-modal, and bi-directional communication. Clinicians increased use of videoconference and telehealth to facilitate physical distancing, but these technologies may have disadvantaged non-English speakers. Due to declining volumes of hospitalized children and surges of adult patients, clinicians newly provided care for hospitalized adults. This was facilitated by developing care teams supported by adult hospitalists, multidisciplinary support via videoconference, and educational resources. Participants described how the pandemic negatively impacted clinicians' mental health, and they stressed the importance of mental health resources and wellness activities/spaces. CONCLUSIONS: We identified several major changes in inpatient pediatric care delivery during the COVID-19 pandemic, including the adoption of new hospital policies, video communication, staffing models, education strategies, and staff mental health supports. We outline important lessons learned, including strategies for successfully developing new policies, effectively communicating with staff, and supporting clinicians' expanding scope of practice. Potentially important focus areas in pandemic recovery include assessing and supporting clinicians' mental health and well-being, re-evaluating trainees' skills/competencies, and adapting educational strategies as needed. These findings can help guide hospital leaders in supporting pandemic recovery and addressing future crises.