Mitigating the Burden of Severe Pediatric Respiratory Viruses in the Post-COVID-19 Era: ChatGPT Insights and Recommendations.

In the current post-pandemic era, the rapid spread of respiratory viruses among children and infants resulted in hospitals and pediatric intensive care units (PICUs) becoming overwhelmed. Healthcare providers around the world faced a significant challenge from the outbreak of respiratory viruses like respiratory syncytial virus (RSV), metapneumovirus, and influenza viruses. The chatbot generative pre-trained transformer, ChatGPT, which was launched by OpenAI in November 2022, had both positive and negative aspects in medical writing. Still, it has the potential to generate mitigation suggestions that could be rapidly implemented. We describe the generated suggestion from ChatGPT on 27 Feb 2023 in response to the question "What's your advice for the pediatric intensivists?" We as human authors and healthcare providers, do agree with and supplement with references these suggestions of ChatGPT. We also advocate that artificial intelligence (AI)-enabled chatbots could be utilized in seeking a vigilant and robust healthcare system to rapidly adapt to changing respiratory viruses circulating around the seasons, but AI-generated suggestions need experts to validate them, and further research is warranted.

Consequences of Social Distancing Measures During the COVID-19 Pandemic First Wave on the Epidemiology of Children Admitted to Pediatric Emergency Departments and Pediatric Intensive Care Units: A Systematic Review.

Objectives: To synthesize knowledge describing the impact of social distancing measures (SDM) during the first wave of the COVID-19 pandemic on acute illness in children by focusing on the admission to pediatric emergency departments (PED) and pediatric intensive care units (PICU). Methods: We searched Cochrane Database of Systematic Reviews, Cochrane Controlled Trials Register, EPOC Register, MEDLINE, Evidence-Based Medicine Reviews, EMBASE, WHO database on COVID-19, Cochrane Resources on COVID-19, Oxford COVID-19 Evidence Service, Google Scholar for literature on COVID-19 including pre-print engines such as medRxiv, bioRxiv, Litcovid and SSRN for unpublished studies on COVID-19 in December 2020. We did not apply study design filtering. The primary outcomes of interest were the global incidence of admission to PICU and PED, disease etiologies, and elective/emergency surgeries, compared to the historical cohort in each studied region, country, or hospital. Results: We identified 6,660 records and eighty-seven articles met our inclusion criteria. All the studies were with before and after study design compared with the historical data, with an overall high risk of bias. The median daily PED admissions decreased to 65% in 39 included studies and a 54% reduction in PICU admission in eight studies. A significant decline was reported in acute respiratory illness and LRTI in five studies with a median decrease of 63%. We did not find a consistent trend in the incidence of poisoning, but there was an increasing trend in burns, DKA, and a downward trend in trauma and unplanned surgeries. Conclusions: SDMs in the first wave of the COVID-19 pandemic reduced the global incidence of pediatric acute illnesses. However, some disease groups, such as burns and DKA, showed a tendency to increase and its severity of illness at hospital presentation. Continual effort and research into the subject should be essential for us to better understand the effects of this new phenomenon of SDMs to protect the well-being of children. Systematic Review Registration: Clinicaltrials.gov, identifier: CRD42020221215.

New-Onset Type 1 Diabetes in Children With SARS-CoV-2 Infection.

There has been a worldwide increase in cases of diabetic ketoacidosis in both adults and children with diabetes during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. This can be multifactorial: delayed care due to reduced medical services, fear of approaching hospitals, or SARS-CoV-2 infection itself. It is well-known that infection is an important trigger for diabetic ketoacidosis in children with type 1 or type 2 diabetes mellitus, but little is known whether SARS-CoV-2 infection can trigger diabetic ketoacidosis and new-onset diabetes mellitus in a child with no previous history of diabetes mellitus. The association of SARS-CoV-2 as a trigger for new-onset diabetes requires further investigation, as the incidence of diabetes is steadily rising in the pediatric population during the pandemic. This case report explores two cases where children present in diabetic ketoacidosis with concurrent SARS-CoV-2 infection and no known history of type 1 diabetes mellitus.

A Comparative Study of Children with MIS-C between Admitted to the Pediatric Intensive Care Unit and Pediatric Ward: A One-Year Retrospective Study.

OBJECTIVES: This descriptive study aimed to compare the clinical and laboratory features of the children with the multisystem inflammatory syndrome in children (MIS-C), requiring pediatric intensive care unit (PICU), admission with the MIS-C patients who did not require PICU admission. PATIENTS AND METHODS: This study was conducted between March 2020 and February 2021 at the University of Health Sciences Dr. Behçet Uz Children's Hospital, a referral center for pediatric infectious diseases in the Aegean Region of Turkey. All hospitalized patients aged 18 years old or less with MIS-C according to the definition of the universal guidelines were included in the study. Data of the patients with the diagnosis of MIS-C were recorded and collected from the electronic medical records of the hospital. The data included demographic characteristics, presenting signs and symptoms, laboratory findings and clinical data. RESULTS: A total of 58 patients with MIS-C were included in this study. Thirty-eight (65.5%) patients were male. The median age was 6 years (2 months-16 years). The patients admitted to PICU were 15 (25.9%). The rate of pulmonary involvement was 81.3% (n = 13) in the PICU group. The median procalcitonin, C-reactive protein, erythrocyte sedimentation rate, D-Dimer and ferritin values were significantly higher in the PICU group compared to non-PICU group (p < 0.001, p = 0.02, p < 0.001, p = 0.006 and p = 0.031). CONCLUSIONS: Besides the depressing cardiac functions reported before, the pulmonary involvement and signs of shock are important factors for PICU admission in children with MIS-C.

Management of COVID-19 in an adolescent demonstrates lasting effects of extreme prematurity on pulmonary function.

Extremely premature infants have demonstrated increased survival due to advancements in care. This population is at risk for decreased lung function that persists into adolescence. It is important for clinicians to consider this history when treating and assessing such patients who contract SARS-CoV-2 respiratory infection. A 17-year-old, former premature infant of 23 weeks gestation with BPD presented to the pediatric emergency department for evaluation of hypoxia and increased work of breathing in the setting of SARS-CoV-2 infection. He was managed aggressively with early noninvasive respiratory support, Remdesevir, systemic steroids, and convalescent plasma. Utilization of aggressive medical therapies early in the hospital course assisted in preventing intubation and mechanical ventilation for this patient. While there are studies examining the severity of SARS-CoV-2 infection in premature infants, there is a paucity of data on this vulnerable group as they age into adolescence. More studies are needed to assess the severity of illness and optimal management of this population.

Strategic management of pediatric intensive care unit in a tertiary children's hospital in southwest China during the COVID-19 pandemic.

Since early December 2019, patients with unknown pneumonia have been found in Wuhan City, Hubei Province, China. The pathogen in these cases was quickly identified as a new type of coronavirus. The World Health Organization named it 2019 novel coronavirus (2019-nCoV), and the disease caused by the pathogen was called 2019 Coronavirus Disease (COVID-19), which was characterized by higher pathogenicity, transmission of human to human. So it has rapidly spread to more than 190 countries all over the world. With the sudden outbreak of COVID-19, preventing the spread of COVID-19 is the primary problem. Despite fewer children than adults have been affected by the COVID-19, Pediatric Intensive Care Unit (PICU), as a ward for critically ill patients, is also confronted with high risk of 2019-nCoV infection. It is necessary for PICU managers to thoroughly carry out scientific and effective department management and carefully execute of infection control measures to prevent the transmission. According to recommendations for the COVID-19 prevention and control, the relevant guidelines and the authors' work experience, this paper proposes and optimizes the strategic plan for the management of COVID-19 outbreak in PICU, and emphasizes that department managers should conduct comprehensive risk assessments, manage the pediatric patients and healthcare workers meticulously, strengthen the implementation of infection control measures, and use risk management and process control to effectively manage the department as well as to protect the safety of both the patients and the staff.

Principles of approach to suspected or infected patients related Covid-19 in newborn intensive care unit and pediatric intensive care unit.

PURPOSE: In this study, it was aimed to evaluate physical and mental health (MH) effects of children and their parents in newborn intensive care unit and pediatric intensive care unit due to Covid-19. CONCLUSIONS: Children are less likely to develop severe illness than adults. It may benefit from medical and psychological/behavioral interventions. Prevent negative MH outcomes for babies/children/caregivers affected by Covid-19. PRACTICE IMPLICATIONS: It is useful to clarify the clinical course of children (treatment, care procedures, psychosocial effects, etc.). The establishment of mental health expert nursing teams, psychological counseling (synchronous telemedicine services for support purposes, telepsychiatry for parents, etc.) may have helped prevent negative mental health of Covid-19 outcomes. Continuous updating of medical staff's knowledge and skills for the prevention of Covid-19 is expected to slow the spread of the disease.