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Introduction: Since COVID-19 spurred transitions from in-person to virtual telehealth visits, Press Ganey scores across adult specialties have shown improved patient satisfaction. The impact of telehealth on the pediatric surgery population, however, has not been characterized. This study aims to evaluate telehealth feasibility in pediatric surgery by examining Press Ganey surveys from the largest pediatric surgery telehealth group in the US. Method(s): Demographics were extracted from medical records of patients evaluated by general pediatric surgeons at a tertiary pediatric center from January to September of 2019 and 2021. Customized Press Ganey results were compared between in-person and telehealth patients. Ratings were categorized as satisfied (good, very good) or not satisfied (very poor, poor, fair). Analysis was performed using two-sample t-test or Fisher's Chi- Squared test. Result(s): In 2019, 7,965 (99.9%) patients were evaluated in-person and 3 by telehealth. In 2021, 8,454 (77%) were evaluated in-person and 2,514 (23%) by telehealth. Telehealth patients were more likely to no-show (11.2% vs 6.1%,p<0.01) and leave without being seen (1.4% vs 0.02%,p<0.01). Spanish speakers attended more in-person visits than telehealth (14% vs 8%,p<0.001). In 2021, telehealth patients reported greater satisfaction with providers and greater likelihood of recommending their provider. Conclusion(s): This study demonstrates improvement in patient satisfaction with telehealth implementation in a large pediatric surgery cohort. However, our data suggest that there may be access to care issues that can be optimized. Lessons from this study may be translated to other surgical disciplines and used to improve access to care and patient satisfaction.
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Objectives: A 14-year-old female patient presents with marked haemorrhagic, adherent crusting of the upper and lower lip and enoral vesicles and erosions. Two weeks before, she had suffered from a respiratory tract infection. She did not take antibiotics but ibuprofen. One week later, she described a swelling and crusting of the upper and lower lips. Urogenital mucosa was also erosive. There was no ocular involvement. Another week later, cocard-like single lesions with partly central blister formation developed. A flaccid blister of 15 mm in diameter was detected in the left ear helix. In total, there was a limited cutaneous involvement of <10% BSA. The girl was admitted to the paediatric clinic. Method(s): Due to mucocutaneous eruptions, bullous lesions and multimucosal involvement, we assumed a Steven-Johnson syndrome or reactive infectious mucocutaneous eruption (RIME). Intravenous rehydration and prophylactic administration of cefotaxime and aciclovir were given. She was balanced and given analgesia with novalgin. The recent increased intake of ibuprofen was discontinued. Local therapy included mometasone cream and serasept dressings. During the inpatient stay, the general condition stabilised and the skin efflorescence's showed a clear regression. Result(s): The microbiological smears for COVID-19, HSV, VZV, mycoplasma, and chlamydia were negative. Discussion(s): As adult classifications for blistering severe cutaneous adverse reactions are limited applicable in children, Ramien et al. proposed revised paediatric-focused clinical criteria 2021. They leave traditional definitions of EEM, SJS and TEN. But they distinguish erythema multiforme (EM) for classic targets with/without mucosal involvement, RIME for cases with mucosal predominance and a respiratory infection trigger, and drug-induced epidermal necrolysis (DEN) for cases caused by medications. (Ramien BJD 2021) There are no current guidelines for RIME therapy. A reasonable management approach includes symptomatic therapy, treatment of identifiable infectious triggers (if possible), consulting urologists, ophthalmologists and gynaecologists (if necessary), immunosuppression, and psychological support. (Ramien ClinExpDermatol 2021).
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Background: Coronavirus Disease 2019 (COVID-19) is a pandemic cause severe acute respiratory syndrome. It is a major public health crisis threatening humanity since world war two. Aim(s): This study aimed to assess challenges and adaptation strategies of pediatric nurses in charge of caring for children with COVID-19. Methodology: A descriptive research design was used to conduct this study. Setting(s): This study was carried out at pediatric hospital affiliated to Fayoum university hospitals. A purposive sample of 100 nurses who providing care for children with COVID-19 in the previous mentioned setting. A structured interview questionnaire sheet consisted of four parts were used for data collection: Part (1): Assess characteristics of studied sample;Part (2): Assess pediatric nurses' knowledge regarding caring for children with COVID-19;Part (3): Challenges that faced pediatric nurses in caring of children with COVID-19;Part (4): Adaptation strategies used by pediatric nurses to face of COVID-19 of children. Result(s): The results showed that 55% of the studied nurses had unsatisfactory knowledge level of caring for children with COVID-19. Regarding total challenges 75% of studied nurses had psychological challenges and 65% of the studied nurses had high working pressure. Also, regard adaptation strategy 60%, 55% and 51% of the studied nurses not used cognitive and educational adaptation, psychological and emotional adaptation and physical adaptation respectively. Conclusion(s): The present study concluded that, there was highly statistically significant between total challenges of COVID-19 and total adaptation strategies among pediatric nurses in charge of caring for children with COVID-19. Recommendations: Continuous training program for pediatric nurses to improve using of the adaptation strategies of caring for children during the COVID-19.Copyright © 2023 Scientific Publishers of India. All rights reserved.
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Objectives: As of March 5th, 2022, around 1.585 cases of MIS-C and 98 deaths (6,4%) were reported in Brazil. The state of Rio de Janeiro State (RJ) having 94 cases (5,9%) and 4 deaths (4,2%)1.Our aim was to evaluate clinical and laboratory features, and management of MIS-C in seven pediatric hospitals in RJ, Brazil. Method(s): Multicenter, observational, ambidirectional cohort study in seven tertiary hospitals in RJ(Brazil), assessing medical charts of pediatric inpatients (0-18 years) diagnosed with MIS-C according to WHO/CDC criteria, from August, 2020 to February, 2022. Descriptive statistics were used to analyze distributions of continuous variables, frequencies, and proportions. Result(s): A total of 112 cases of MIS-C were enrolled. The mean age was 4.2 years and thre was male predominance (59,8%). All cases had a SARS-CoV-2 contact (29.5% close contact;31.3%:positive PCR;serology:43.8%).Only 12.5% had comorbidities. Length of stay (LOS) was 7 days.Median duration of fever was 8 days. Most common symptoms were: rash(67%);gastrointestinal (67%);conjunctivitis (42%);neurological(39.6%);cardiovascular(37.5%);cervical lymphadenopathy (36.6%), and shock/hypotension(28.6%).Co-infection occurred in 3 patients. Forty-four patients fulfilled criteria for Kawasaki disease. Most patients were admitted to PICU(12;62,5%) for amedian of 2 days. Respiratory distress was seen in 18,7%;hypotension:28,6%, and shock in 23,2%. Main laboratory findings were: high C-reactive protein in 95%;D-dimer:77%, anemia:77%, thrombocytosis:63%;transaminitis:43.8%, lymphopenia:38%;hypoalbuminemia:34%;thrombocytopenia: 29%;hypertriglyceridemia:28%, and high pro-BNP in 27%. Echocardiogram was performed in 91/112 patients;abnormal in 70,3%;exhibiting myocardial dysfunction( 25%);pericardial effusion(21%);coronary dilation/aneurysms(11%) and, valvulitis (14.5%). IVIG+corticosteroids (CTC) were administered in 59.8%(67/ 112);18.6%(18/112) IVIG only;10.7%(12/112) CTC only;3.4%(4/112)biologics, and 15(13.3%) received no treatment. ASA low dose in 77.7% (87/112) and moderate/high dose in 34.8%. Oxygen support was needed in 27,7%;vasoactive amines:18,7%;dialysis:5,3%, and transfusion:18,7%.One patient died from a cytokine storm syndrome. Conclusion(s): Our study reports a higher number of MIS-C cases in RJ than the number reported to Brazilian authorities, highlighting underreporting. Our patients were younger, had fewer comorbidities, cardiovascular/gastrointestinal/renal involvement, shortest LOS in ICU, and a higher frequency of myopericarditis.
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Acute respiratory viral infections (ARVI) play an important role in morbidity formation among children. At the same time, studies about the ARVI etiological structure are not enough. The article presents the results of structure analyses of ARVI in children with severe and moderate degrees of disease hospitalized in the children's clinical hospital of Novosibirsk for the period 2015-2018. This research aimed to analyze the morbidity of acute respiratory viral infections with the estimation of a causal virus in children admitted to the hospital for the period 2015-2018. Material and methods. In this study, 1137 children aged between 0 and 15 years were examined. In order to determine the etiological factor in children with damage of the upper or lower respiratory tract, by using the method of RT-PCR (AmpliSensARVI-screen-FL test systems (InterLabService, Russia), mucus from the nose and throat was examined for the presence of genetic material of viruses that cause ARVI (influenza A and B viruses, parainfluenza viruses of types 1-4, respiratory syncytial virus, metapneumovirus, four types of human coronavirus, rhinovirus, adenovirus, and bocavirus). Results. The research found that the most frequently detected pathogens are respiratory syncytial virus (23.52%), influenza A and B viruses (19.73%) and rhinovirus (19.21%). Observe the dynamics some fluctuations in the detection of mentioned viral agents and increasing of mixed infections were detected. In addition, the importance of respiratory and gastrointestinal tract combined lesions, particularly for infants and preschool - age children has been noted. Conclusion. The distribution of respiratory viruses in children with severe ARVI who required hospitalization was assessed. It was shown the significance of the respiratory syncytial infection virus, influenza virus and rhinovirus in the etiological structure of hospitalized children of different ages that damage not only the respiratory tract, but also to the gastrointestinal tract. This is an important factor in optimizing the diagnosis, treatment and prevention of viral infections in children.Copyright © Infectious Diseases: News, Opinions, Training 2021.
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Our case is a 21 y/o pregnant female, 26weeks gestation who presented to OB triage with COVID-19. She was admitted to OB/GYN unit in acute hypoxic respiratory failure and started on steroids and remdesivir. On hospital day 6, she underwent an emergent c-section for fetal distress due to increasing hypoxia and severe ARDS. As her arterial blood gas being ph 7.17/81/40/29.6/-0.4, lactate 6.8nmol/L with escalating vasoactive medication and ventilator settings;ECMO was decided. However, all adult ECMO resources were limited, even within other adult facilities in Central Florida. Through multidisciplinary discussions amongst OB/GYN, adult ICU, and our pediatric ECMO activation team, it was decided to transfer the patient to our free-standing pediatric hospital. The patient was successfully transferred and cannulated for VV-ECMO. Total ECMO run was 413 hours. On ECMO day #12 patient underwent a tracheostomy. On ECMO day # 17, patient developed headaches and seizure activity in which CT revealed a subdural hemorrhage. She was taken off ECMO and underwent an emergent decompressive craniectomy with hematoma evacuation by our pediatric neurosurgical team. Once stable enough, she was discharged post ECMO day #15 (PICU day #32) to rehabilitation center. Two weeks later she had her bone flap replaced, trach removed, and she walked out of our unit home. This case exudes two key points for discussion. The first point of understanding ECMO physiology allows a team to treat many different patient populations. Although this patient was unusual to our pediatric bedside providers being post-partum, our team knew we could help. The second key point is excellent multidisciplinary teamwork and that communication is essential. At Orlando Health Arnold Palmer Hospital, our ECMO activation team consists of surgeons, pediatric intensivists, CT surgeons, perfusionists, nursing, and administration. We meet virtually to discuss how to execute initiation and daily ECMO treatment plans. There were some on the virtual call that were hesitant in accepting care of this adult due to variety of reasons, saying no would have been the easier answer, but not the right thing to do. What we learned from this case may seem so obvious and simple but very difficult to execute;multidisciplinary teamwork, humility, and open communication gave this patient the ability to walk out of the hospital with her baby. Other pediatric ECMO teams can learn from this case is they too can help in extraordinary times such as during a pandemic when adult recourses are limited.
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Introduction. Pediatric Inflammatory Multisystem Syndrome (MIS-C) is treated by the administration of intravenous polyvalent immunoglobulins and corticosteroids, as recommended by the French National Authority for Health (Haute Autorite de Sante) and the WHO (World Health Organization). However, no corticosteroids tapering schedule has been validated and patients returning home are not properly supervised by a pharmacist. Aims. Identify the occurrence of relapses according to the corticosteroid tapering schedules prescribed on return home. Analyze patients' reported compliance to these decreases. Identify possible links between poor compliance and relapse. Patients and method. This retrospective study analyzes the digital medical records on Orbis software of patients who have been hospitalized for a MIS-C between April 2020 and June 2021 in a French pediatric hospital. Results. 66 MIS-C patients were included. 54 were treated by intravenous corticotherapy 2 mg/kg/day, 2 with 1 mg/kg/day, 10 have not received any. Five different tapering schedules were prescribed, 3 patients relapsed. Recurrence of relapse is not significantly related to the tapering schedule followed (p = 0,759). 6/54 (11 %) patients wrongly followed their tapering schedules. Among them, 2 relapsed, versus 1/48 (2 %) among compliers (p = 0.029;OR = 0.04). Discussion - Conclusion. This study emphasizes the difficulty for a patient to comply with corticosteroids tapering schedule without supervision, as well as the subsequent rebound risks. Pharmaceutical counseling for patients returning home after hospitalization will be promoted to ensure better communication and patients' understanding and compliance.Copyright © 2023 John Libbey Eurotext. All rights reserved.
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Background: Early diagnosis of COVID-19 is key to prevent severe cases and poor outcomes in vulnerable populations, including pregnant women and people living with HIV or infected with tuberculosis (TB). The feasibility of integration of SARS-CoV-2 antigen rapid diagnostic testing (Ag-RDT) into maternal neonatal, and child Health (MNCH);HIV;and TB clinics is unknown. Method(s): We analyzed data from a SARS-CoV-2 screen and test program implemented in 50 health facilities (25 in Kenya and 25 in Cameroon), integrating SARS-CoV-2 Ag-RDT in MNCH, HIV, and TB clinics between May and October 2022. Clients aged two and older attending MNCH, HIV, and TB clinics were offered SARS-CoV-2 screening, and those eligible were tested using SARS-CoV-2 Ag-RDT. Routine SARS-CoV-2 program data were captured through dedicated paper forms in Cameroon or an electronic medical record (EMR) interface in Kenya and transferred to a database for analysis. We estimated the proportion of clients screened and tested and the SARS-CoV-2 positivity rates. Result(s): Overall, 527,184 attendee visits were reported in Cameroon (282,404) and Kenya (244,780), with screening for COVID-19 symptoms and exposure performed in 256,033 (48.5%) with substantive variations between countries (62.6% in Cameroon and 32.4% in Kenya). Among the 256,033 screened, 19,058 (7.4%) were eligible for testing (9.0% in Cameroon and 3.9% in Kenya), of whom 12,925 (67.8%) were tested for SARS-CoV-2 with substantial variation in testing rates between countries (61.9% in Cameroon and 97.9% in Kenya) and clinics (59.9% in MNCH, 68.7% in HIV, and 92.8% in TB clinics). A total of 390 (3.0%) positive tests were identified (329 (3.3%) in Cameroon and 61 (2.0%) in Kenya). The estimated case detection rate was 1.26 (95% CI=0.76-1.75) per 1,000 attendee visits in Cameroon and 0.49 (95% CI=0.12-0.86) per 1,000 attendee visits in Kenya. Country integration strategy, facility level, setting, and clinic were independently associated with screening (Table 1) and testing. Conclusion(s): Integration of SARS-CoV-2 Ag-RDT in HIV, TB, and MNCH clinics was feasible in both countries despite challenges with low screening rates in Kenya and low testing rates in Cameroon. Decentralization of SARS-CoV-2 testing at different facility clinics allowed detection of SARS-CoV-2 cases among vulnerable populations. Integration strategies should consider facility settings (rural compared to urban) and additional human resources in high volume facilities to improve screening and testing rates.
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Background: Cystic fibrosis-related diabetes (CFRD) is the most common comorbidity in people with cystic fibrosis (CF), affecting approximately 20% of adolescents and 40% to 50% of adults [1]. CF care guidelines recommend screening for CFRD using the 75-gram 2-hour oral glucose tolerance test (OGTT) yearly beginning at 10 years old. Our CF center had a below-average percentage of eligible patients adequately screened for CFRD (65% total screened [only 36% with recommended OGTT] vs ~63% nationally) because of use of a non-preferred screening method and a wide clinic catchment area.We initiated a quality improvement project to increase the percentage of eligible people with CF appropriately screened according to recommended CF care guidelines. Method(s): We began in 2019 by reviewing current data and processes to understand our baseline, goals, and anticipated barriers. We then established the goals of our project with proposed interventions and obtained institutional reviewboard approval. The three goals of our project were to fully eliminate use of the non-preferred screening method by the end of 2020, streamline local OGTT location options for families that live far from our CF center, and increase the percentage of eligible patients screened via OGTT by 20% by the end of 2020.We accomplished these goals by educating families regarding the recommended CFRD screening by OGTT in our CF newsletter;surveying families on how, when, and where they would like to complete their OGTT;and creating an OGTT informational brochure including three selected locations across our clinic geographical coverage area where OGTT can be reliably obtained. An additional goal was added in January 2022 because our percentage of appropriately screened patients dropped in 2021.We aimed to increase our percentage of eligible patients screened by 10% for the year. We are doing this by changing the location of an outlying OGTT facility after receiving negative feedback from our patients. Result(s):We fully eliminated use of the non-preferred screening method by 2020;all patients screened in 2020 were done by OGTT. We increased our total screening percentage from 65% in 2019 to 86% percent in 2020, despite difficulties created by the COVID pandemic. Our screening percentage dropped to 78% in 2021, but we have worked to offer OGTT at one of our associated pediatric clinic locations to better serve families. Conclusion(s): Using traditional quality improvement methods and processes, we eliminated use of a non-preferred CFRD screening method in our pediatric CF clinic. We have increased our screening rates to above the national average and continue to work on improving the CFRD screening process for our patients and families.Copyright © 2022, European Cystic Fibrosis Society. All rights reserved
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Based on what is known at this time, pregnant women are at an increased risk for severe illness from COVID-19 compared to non-pregnant women. Additionally, pregnant women with COVID-19 might have an increased risk of adverse pregnancy outcomes, such as preterm birth. The study was conducted in the city of Kirkuk city during the period between February 1, 2020, and September 1, 2020, at Gynecology and children hospital. Through the study, 100 pregnant women were received, complaining of Covid-19 infections, which were diagnosed in Kirkuk, and now Real Time PCR was confirmed through nasopharyngeal swabs that were taken from the Hospital. The study also included measuring the level of blood pressure, sugar and IL-6 in those women during the fifth to eight week, where we were infected, and then in the 12th week of pregnancy took place, where communication was made, and a level was measured, and as a result, these women who completed the period with a pre-term labor, miscarriage before the 24th week of pregnancy or those completed the period with successful pregnancyThe study showed that were asymptomatic, 45% of cases of COVID-19 patients were with mild infection and 10% were with severe infection (P<0.001) In this study, 10 % of COVID-19 pregnant women suffer from hypertension, 13% were with Diabetes, 35% with UTI while 70% were suffered from fever. When reaching 24th week of pregnancy, and as shown in Table 3. The study showed that 40% COVID-19 pregnant women experienced completed the period with a preterm labor, 10% was with miscarriage before the 24th week of pregnancy, while 50% of them completed the period continued the pregnancy. In this study, 82.5 % of COVID-19 pregnant women with preterm labor were suffered previously from fever comparing with 55% of COVID-19 pregnant women without preterm labor.The study showed that the highest mean of serum IL-6 was found in women infected with COVID-19 comparing with healthy control (12.8+/-3.6 v.s. 29.3+/-3.1 ng/ml) (P: <0.001). Conclusion(s):The study showed a significant relation of COVID-19 infection with pregnant women who pre-term labor especially who have high body temperature.Copyright © 2020 Ubiquity Press. All rights reserved.
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Introduction: Extensive studies in adults raise concerns on severity and chronicity of lung impairment in COVID-19 survivors, yet data on the pediatric population remain scarce. Aim(s): To prospectively examine respiratory outcome in children with COVID-19 infection, in a six-month timeframe, regardless of disease severity. Method(s): Patients aged 4-16 years old, diagnosed with SARS-CoV-2 infection in a tertiary Pediatric Hospital were called for follow-up, 6 months post-diagnosis. Sex, age, days post-diagnosis and patient history, were obtained. Physical examination and spirometry were conducted in all subjects. Result(s): 103 patients were identified, of whom 77 were finally enrolled (Table 1). All patients recovered uneventfully, regardless of age, sex, weight status or disease severity, with no deterioration in spirometry, apart from two patients - with no compatible history or clinical image- with mildly restrictive spirometry pattern (Table 2). Conclusion(s): This study suggests that respiratory assessment post-COVID-19 may be unnecessary in asymptomatic patients with mild disease course and no underlying lung pathology. Further studies are needed to support this finding.
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In the age of 'influencers', social media is exerting an ever-increasing impact in dermatology. More than half the world's population use social media and its popularity continues to grow. However, studies have confirmed that content is not always evidence based. Owing to its accessibility, social media is frequently used as an information resource for patients on managing their own skin condition. The influence that it has on parents and guardians in paediatric dermatology is less well described. A 10-point questionnaire was designed to assess social media use in parents and guardians with regard to their child's skin condition. Data were collected on parent or guardian age, sex, online platforms used and changes in management as a direct result of social media-sourced information. Children's demographics, diagnosis and disease duration were also noted. Questionnaires were anonymously distributed in a general paediatric dermatology outpatient clinic waiting room over 3 months. A chi2-test of independence was used to examine the relationship between social media use and parent or guardian age, sex and child's disease duration. In total, 116 parents and guardians participated in the survey. Average child age was 9.9 years (range 0-18), male-to-female ratio 1 : 1. Diagnoses included eczema (n = 35;30%), naevi or other skin lesions (n = 27;23%), acne (n = 18;15%) and psoriasis (n = 4;3%). Ninety-three (80%) of the dermatoses had a duration of > 1 year. Over 40% (n = 48) of parents and guardians used social media on at least one occasion as an educational resource for their child's skin condition across eight online platforms, most commonly Facebook (n = 21;44%), Google (n = 15;31%) and YouTube (n = 8;16%). There was no significant relationship between social media use and parent or guardian age (P = 0.89), sex (P = 0.10) or disease duration (P = 0.77). Of the 48 social media users, 26 (54%) parents and guardians changed their use of over-the-counter products, and a further 14 (29%) altered use of physician-prescribed treatments as a result of social media-derived information. Our findings suggest that a significant number of parents and guardians use social media to understand their child's dermatosis and some change the management based on it. Following the COVID-19 pandemic, a shift to virtual platforms for human interactions has fuelled the use of social media. With its growing popularity, it is likely that dermatologicalrelated content will also increase and therefore this should be addressed in both adult and paediatric clinics.
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The impact of COVID-19 pandemic on paediatric asthma, the most common chronic condition of childhood, in Australia remains unknown. In a multicentre study, we examined the impact of COVID-19 on paediatric asthma in New South Wales Australia. Method(s): Time series analysis was performed to determine trends in asthma hospital presentations in children aged 2-17 years in pre-pandemic (Jan 2015-Dec 2019) and COVID-19 pandemic years (Jan 2020-August 2021) using emergency department and hospital admission datasets from two large tertiary paediatric hospitals. Result(s): In the pre-pandemic years there were in total 492,863 hospital presentations in children aged 2-17 years, of these 13,160 (2.67%) were due to asthma and in pandemic years there were 163,521 hospital presentations of which 3,364 (2.05%) were due to asthma. We observed a significant decrease in asthma hospital presentations during lockdown periods of COVID-19 pandemic including April (68.85%), May (69.46%) and December (49.00%) of 2020 and August 2021 (66.59%) compared to pre-pandemic predictions. The reduction in asthma hospital presentation in April-May of 2020 and August 2021 was observed across all the age-groups excluding children aged 2-5 years. Conclusion(s): While this decline may be associated with reduced exposure to outdoor environmental factors from restricted movement due to lockdowns, such an approach is not feasible or sustainable in the absence of an infectious disease outbreak. Therefore further research to determine the positive factors associated with this observed pattern will help develop strategies to build a resilient health system.
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Rationale: Childhood food insecurity was exacerbated during the COVID-19 pandemic, with burdens falling disproportionately on minority children. This study aims to describe the prevalence of food insecurity in food-allergic children of an urban minority community and examine the association between food insecurity and food allergy. Methods: We conducted a retrospective review of electronic medical records of all patients aged 6 months to 18 years seen in a primary care pediatric clinic at NYC Health + Hospitals/Kings County, from 10/2020 to 06/2022. Pediatricians at this clinic in Central Brooklyn routinely screen for food insecurity using the Hunger Vital Sign™, a validated tool recommended by the American Academy of Pediatrics. Data was collected based on ICD-10 diagnosis codes for food insecurity (Z59.41) and food allergy (Z91.01). Logistic regression was used for analysis. Results: Among 7,856 children included in the study, 84.9% were Black or African American, 6.0% Hispanic/Latinx, 1.2% white, and 1.1% were Asian/Pacific Islander. Of 275 children diagnosed with a food allergy by a primary care pediatrician, 4.7% screened positive for food insecurity. Of 7,581 children without a diagnosed food allergy, 2.6% screened positive for food insecurity (p=0.029). Children with food allergy (adjusted odds ratio: 2.14, 95% confidence interval: 1.19-3.85) were significantly more likely to be food insecure than those without a food allergy, adjusted for age, gender, and race/ethnicity. Conclusions: Childhood food allergy is associated with increased odds of food insecurity. This study highlights the importance of assessing and addressing food insecurity in children with food allergies.
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Purpose of Study: Acute bacterial upper respiratory infections, such as acute otitis media, pharyngitis, and sinusitis, are common indications for antibiotics in pediatrics, and it is estimated one-third of these prescriptions may be inappropriate. Cefdinir is an oral cephalosporin commonly used in pediatrics due to taste and ease of once-a-day dosing. However, there are no evidencebased guidelines recommending it as a first-line agent. Outpatient clinician education has demonstrated some improvement in antibiotic prescribing habits but is often not sustainable long term. Clinical decision support systems in the form of pathways and order sets are more feasible in the outpatient setting and have demonstrated sustained improvements in provider prescribing habits. Best practice advisory alerts are commonly used in the inpatient setting and have shown promising results, but there are little data on their use in the outpatient setting. Methods Used: We developed an intervention in our electronic health record consisting of an order-set based on our local acute upper respiratory infection guidelines and a best practice advisory alert targeting Cefdinir use in non-penicillin allergic patients. The pre-intervention period was defined as April 2018 to December 2021. The post-intervention periodwas defined as January 2022 to December 2022. Data shown here are through September 2022. Oral antibiotic prescriptions from all general pediatric clinics within our institution with diagnosis codes pertaining to acute otitis media, pharyngitis, and sinusitis were included. Thesewere then grouped into first-line and non-first-line categories. Patient data were collected for each prescription, including diagnosis, date, sex, and race/ethnicity. The primary endpoint was the percentage of first-line prescribing. Summary of Results: A total of 45 038 prescriptions were included in our analyses with 36 578 in the pre-intervention period and 8460 in the post-intervention period. There was no difference noted between the pre- and postgroups in patient sex, however, there were notable differences in patient race/ethnicity and diagnosis. Firstline prescribing accounted for 73.5% of the pre-intervention group, and 81.9% of the post-intervention group (P = <0.001). Conclusion(s): Implementation of an outpatient order-set coupled with a best practice advisory alertwas associated with an 8.4% increase in first-line antibiotic prescribing for acute upper respiratory infections in outpatient pediatric clinics affiliated with our institution. Differences in diagnoses noted between pre- and post-intervention periods may be attributable to the COVID-19 pandemic. Copyright © 2023 Southern Society for Clinical Investigation.
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Purpose of Study: All-terrain vehicles (ATVs) are a significant cause of morbidity and mortality in children. Annually, over 100 pediatric ATV-related fatalities and >30 000 emergency department (ED) visits occur in the US. The Consumer Product Safety Commission (CPSC) cited a significant decrease (38%) in ATV-related ED visits from 2009-2018. Our study objectives were to: evaluate changes in the number of ATV injury visits in a pre-covid vs covid time frame, provide a descriptive epidemiology of our ATV injury visits, understand the impact of median household income and population type on amount ATV injuries, and realize preventative strategies for education intervention. Methods Used: A retrospective review of children <= 16 years old (yo) presenting to our pediatric hospital ED who were coded for ATV injury during 2019-2020 was conducted. An ATV patient database was developed and managed using Excel. This study was approved by our institutional IRB. Student t test and z test for proportions were utilized for statistical comparisons. National Center for Health Statistics was used to compare county population types. Summary of Results: There were 405 pediatric ED visits for ATV injuries January 2019 - December 2020. Overall, 77% were white. Ages ranged from 1 to 16 yo with an average age 10 yo (S.D. = 3.9). In 1-4 yos, 66% were passengers, 30% drivers. After 5 yo, >50% were drivers. Most common insurances were Alabama Blue Cross (45%), Medicaid (40%). A significant increase in ATV injuries occurred between 2019 and 2020. By comparing seasons, we found increase in spring (30%), fall (72%), and winter (52%) 2020 compared to 2019. Orthopedic injuries were the most common (60%) while 12% of injuries were brain and/or spinal cord injuries. We found 40% and 60% female vs male with no significant difference in gender distribution by disposition, and no significant difference in ages for admitted vs discharged (t = 0.93, p = 0.3). The range of length of stay for the discharged was 1-9 hours (average 3.5 hours) and admitted was 0-70 days (average 5.2 days). We found a bimodal distribution among the counties. With median household income, the peaks were $30 000-39 000 with 5.7 ATV injuries per 10 000 children and $70 000-79 999 with 6.3 injuries per 10 000 children. With population types, the peaks were "large fringe metropolitan" with 9.4 injuries per 10 000 children and "noncore" with 4.2 injuries per 10 000 children. [Figure presented] Conclusion(s): Most ATV injuries occurred in whites with 62% male, 39% female. Orthopedic injuries were most common. There was a bimodal distribution of injuries among the patients' counties when evaluated by median income and population. Year 2020 had 2.2 times the rate of ED visits compared to 2019 (5.2 ATV injury visits per 1000 ED visits in 2020 and 2.4 ATV injury visit per 1000 ED visits (z = 8.1, p < 0.0001)). When comparing seasons, we found the greatest difference was fall 2020 (72% increase) vs 2019. The steady increase is the inverse of the national trend found by the CSPS. Copyright © 2023 Southern Society for Clinical Investigation.
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Objective: To describe a case of SARS-CoV-19-associated encephalitis in a neonate. Method(s): Case report. Report: A 9-day-old term neonate presented with two focal motor seizures (right upper limb jerking and facial twitching). He had a 1-day history of coryzal illness with reduced feeding, but was afebrile. Antenatal course was uneventful. He was born at term via vaginal delivery. He did not require resuscitation or admission to SCBU. Maternal history was notable for symptomatic SARS-CoV-19 infection at time of delivery. Two siblings subsequently tested positive for SARS-CoV-19. He had further seizures in the emergency department and was loaded with phenobarbitone. The infant was stabilised locally and transferred to a tertiary paediatric hospital for the management of neonatal sepsis. He never required respiratory support. However, he was diffusely hypotonic with poor suck, necessitating nasogastric feeding. Nasopharyngeal PCR was positive for SARS-CoV-19. Lumbar puncture microscopy was negative (WCC 6). All CSF bacterial and viral investigations were negative. CSF testing of SARS-CoV-19 was not available. Brain MRI revealed bilateral asymmetric areas of reduced diffusivity involving the subcortical white matter, medulla and the corpus callosum with frontal lobe predominance. He made a full neurologic recovery with supportive therapies and was discharged following a 9-day admission. He had no further clinical seizures and phenobarbitone was successfully weaned pre-discharge. Conclusion(s): In the absence of another aetiology or antenatal risk factor, SARS-CoV-19 infection was presumed causative in this case of focal seizures and white matter changes in this term neonate. White matter abnormalities on MRI imaging are reported in neonates with seizures in the context of other viral infections. Single case reports have been published of SARS-CoV-19 infection with associated abnormal MRI brain findings, particularly diffusion abnormalities of the corpus callosum, as seen in our case.
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Introduction The UK has been severely affected by the COVID-19 pandemic. The impact on the adult population has been disproportionately higher when compared to children with consequent challenges to organ donation and liver transplantation (LT). Across the three UK paediatric liver centres there has only been a very small number of patients who tested positive for COVID-19 and all made a speedy and full recovery. We report here the response during the pandemic across the 3 paediatric LT centres. Methods A series of nationally agreed policy changes affecting the liver procurement, listing and transplant process were agreed during regular meetings with LT centre directors and NHSE. Actions at a local and national level were agreed to protect and maintain the paediatric LT programmes. Data were collected from 27/03/20 until 26/11/20 and compared with same time period for the years 2016-19. Results During the study period, there was a significant reduction in the adult population in the mean number of weekly liver offers, donors and LTs compared to before the pandemic with signs of recovery between the 1st and 2nd UK lockdown periods (figure 1). More specifically the number of livers offered nationally was reduced from an average 30-40/week to only <10/week during the 1st wave in the March-April period. The number of children on the LT list during the study period across all 3 centres was 74 in total with 17 (23%) super-urgent and 57(77%) electives, which was comparable to previous years. Overall, 65-80 paediatric LTs are performed annually across the UK's 3 paediatric centres. From March-November 2020 there were 58(82%) elective and 13(18%) super urgent (acute liver failure & hepatoblastoma) paediatric LTs performed. Donor Brain Dead (DBD) and Donor Cardiac Dead (DCDC) LTs were 54(76%) and 3(4%), respectively. Living related LT (LRLT) programme was sustained comprising 20% of LTs performed. The number of paediatric LTs performed during the pandemic was comparable to those performed yearly since 2016. The number of LT per paediatric centre for King's College Hospital (KCH), Birmingham Children's Hospital (BCH) and Leeds Liver Unit were 40 (56%), 15(21%) and 16(23%), respectively with excellent outcome. A 15-year-old girl from KCH diagnosed with Wilson disease presented with liver failure and became COVID-19 positive whilst listed. She underwent LT soon after becoming COVID-19 negative. No perioperative mortality was reported with excellent outcome so far in all. Conclusion The current COVID-19 pandemic had a significant impact on the UK adult LT programme. The paediatric programme LT was preserved despite a decrease in organ offering and retrieval nationally plus limitations on adult intensive care resources at a regional level. Overall, paediatric LT outcome remained very good.
ABSTRACT
Objective: The COVID-19 pandemic has led to major changes in healthcare around the world, including postponing elective surgery. The aim of this study is to examine the COVID-19 test results in pediatric patients who are asymptomatic and have no history of contact with a COVID-19 case prior to their scheduled elective surgery. Material(s) and Method(s): This prospective study has evaluated pediatric patients who were asymptomatic and had no contact history with a COVID-19 case and who were scheduled for elective surgery between 01.05.2020-31.10.2020 in one of the world's largest pediatric hospitals. Nasopharyngeal swab (PCR) samples were obtained from all patients one day before the scheduled elective surgery. Result(s): Eight hundred twelve patients in this study had a mean age of 6.98 +/- 4.37 years. The PCR test was positive in 4 patients (0.49%), and one patient had diarrhea during the quarantine period of 15 days. Conclusion(s): The low PCR positivity rate in patients scheduled for elective surgery after a detailed history and physical examination raises the question whether elective surgery can be planned without testing. Pediatric surgeons can continue elective surgical procedures by taking precautions, but without requesting PCR, in patients who are asymptomatic and have no suspicious contact history. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
ABSTRACT
BACKGROUND AND AIM: Tell me and I will forget, show me and I may remember;involve me and I will understand Confucius Simulation training is well established in improving patient care by learning from mistakes in a safe environment. During COVID pandemic, lot of junior doctor workforce were redeployed and having not worked in paediatrics was a cause of concern and need of the hour. METHOD(S): We formulated a team of enthusiastic, passionate and dedicated registrars and identified the barriers to setting up simulation for the first time in Leicester children hospital targeting specifically junior doctors. 1. Social distancing whilst working in a team. 2. Accessibility for time out from busy workload on the wards. 3. Being put on spot fear when already stressed with workload. RESULT(S): We took the support of college tutors, Senior Consultant and Nursing team to developed robust structured pathway for simulation scenarios and how to conduct them so that learning needs are achieved. This enabled registrars let the junior doctors to attend and adapt into existing teaching rota as a simulation session. We rotated to different wards and different day of the week to cover wide range of junior doctors and kept the scenarios specific for their workplace which in turn made them more relaxed and interested. CONCLUSION(S): Simulation is a great learning tool and be able to share experience and knowledge in difficult time of pandemic was a challenging but achievable. We learned and adapted changes from each simulation as coordinators which helped in running the subsequent sessions better.