Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 1.570
Filter
1.
Preventive Medicine Reports ; 31:102109, 2023.
Article in English | ScienceDirect | ID: covidwho-2165768

ABSTRACT

The COVID-19 pandemic forced United States school closures in March 2020. Students moved to online learning, fostering a sedentary lifestyle. As the pandemic heightened population disparities, the impact on weight gain may also be unequally distributed. This study aimed to evaluate changes in body mass index (BMI) z-scores and weight percentiles of pediatric patients during the pandemic and associated demographics to identify those at risk for weight gain. Methods included a retrospective chart review of patients 5–18 years-oldwitha well-visit in the three years 2018, 2019 and 2020;first identified with a well-visit in August-September of 2020.BMI z-scores and weight percentiles were analyzed using a correlated errors regression model appropriate for longitudinal data. This longitudinal approach was used to model outcomes by patient demographics.Interaction terms with time were evaluated for each variable. Of 728 patients, mean age was 9.7 years (2018);47 % female, 70 % white, and 23 % publicly insured. BMI z-score did not increase significantly from 2018-2019 versus 2019–2020. Weight percentile demonstrated a slight trajectory increase over these same time points. Publicly insured patients demonstrated significantly greater increase in BMI z-score versus privately insured patients (p = 0.009). Mean differences between groups increased from 0.26 in 2018 (95 % CI [0.07, 0.45]) to 0.42 in 2020 (95 % CI [0.23, 0.61]). Results were similar for weight percentile. Publicly insured pediatric patients experienced significant increase in BMI-z score and weight percentile, but over time this trajectory remained constant. The results support targeting at risk subgroups in addressing long-term impacts of the pandemic.

2.
Journal of the Neurological Sciences ; : 120538, 2022.
Article in English | ScienceDirect | ID: covidwho-2165604

ABSTRACT

Objective The primary objective was to determine the effect of the COVID-19 pandemic on volume, demographics, and mechanisms of injury (MOI) for patients seen at an urban multidisciplinary concussion center. During the first phase of the pandemic in the United States, stay-at-home orders led to decreased group activities and required cancellation of outpatient appointments or initiation of telemedicine visits. Methods This study was a retrospective chart review of 3500 patient electronic medical records (EMR). Patients aged 1–99 years were eligible if they had been seen at New York University Langone Health Concussion Center during March 1–December 31, 2019 (control/pre-pandemic period) or during the same period in 2020 (pandemic period). Injury date, appointment date, age, sex, and MOI were captured;statistical analyses were performed using Stata17 (StataCorp, College Station, TX). Results There were 48% fewer visits during the COVID-19 pandemic period compared to the 2019 control period. There was a decreased proportion of pediatric patients (15% control, 6% pandemic;p = 0.007, chi-square test). Fewer concussions were related to team sports (21% control, 5% pandemic;p < 0.001), and a greater proportion were caused by bicycle accidents (4% control, 8% pandemic;p = 0.037) and assault/domestic violence (3% control, 9% pandemic;p < 0.001). Conclusion The relative proportions of concussion MOI, age distributions, and visit volumes were significantly associated with pre-pandemic vs. pandemic periods, suggesting that COVID-19 changed concussion epidemiology during the pandemic period. This study demonstrates how epidemiologic data may inform future resource allocation during public health emergencies.

4.
International Journal of Academic Medicine and Pharmacy ; 4(4):364-369, 2022.
Article in English | EMBASE | ID: covidwho-2164776

ABSTRACT

Background: Jalgaon district was one of worst hit hotspot in Covid- 19 outbreak in 2021. Pediatric patients were also affected and some of them were even hospitalized for the same. The present retrospective study was undertaken in pursuit of throwing light on clinical characteristics, laboratory findings and clinical outcomes in pediatric patients diagnosed with Covid- 19 infection. Material(s) and Method(s): All children up to 12 years of age admitted to this tertiary care hospital (DCH) between period of March 19, 2021 and August 7, 2021 enrolled for the study. Their medical records were reviewed retrospectively. SARS-CoV-2 positive children were confirmed using reverse transcriptase-polymerase chain reaction (RT-PCR) or rapid antigen test. Result(s): Of the 56 patients who were diagnosed as Covid 19 positive, 32 (57%) patients were males. On age analysis, majority of the patients belonged to the age group 1 month to 5 years are 30 (54%). Amongst clinical features, fever was most commonly encountered symptom. Twenty-one (37%) patients in the present study were classified as category D of disease severity. Abnormal chest X-ray was found in 41 (73%) patients. Twenty-four (43%) patients had oxygen saturation (SpO2) < 94% at room temperature, out of which 6 (25%) of the patients required only oxygen, 14 (58%) of the patients required non-invasive ventilation in the form of continuous positive airway pressure (CPAP) with oxygen and 4 (17%) patients required invasive ventilation. Abnormal high resolution computed tomography (HRCT) chest was found only in 1 patient. Total leucocyte count was elevated in 13 (23%) patients. C-reactive protein, serum ferritin, lactate dehydrogenase (LDH), D-dimer was abnormally elevated in 14 (32%) patients, 16 (38%) out of 42 tested and serum blood urea nitrogen (BUN)/ creatinine ratio was elevated in 14 (36%), 38 (97%) and 26 (60%) patients, respectively. Forty-eight (86%) patients had recovered from the disease and discharged, and 4 (7%) patients succumbed to the disease. Conclusion(s): The Covid- 19 epidemic has wreaked havoc on the world's health. The severity of sickness in babies and children with Covid- 19 was significantly less than that reported in adults. Copyright © 2022 International Journal of Academic Medicine and Pharmacy. All rights reserved.

5.
J Clin Med ; 11(23), 2022.
Article in English | PubMed | ID: covidwho-2163466

ABSTRACT

The impact of COVID-19 on pediatric patients with inflammatory bowel disease (PIBD) is still not clear and the knowledge acquired over the last 2 years is still evolving. This study aims to investigate the risk and clinical outcomes of COVID-19 in patients with PIBD. A systematic search of PubMed and Scopus databases was conducted to identify studies published up until September 2022. Out of the 475 articles screened, 14 studies were included in the review. Of the 4006 children with PIBD included, 390 (9.7%) tested positive for COVID-19. Among those with COVID-19, 5.9% (0-16.7%) needed hospitalization, 0.6% (0-1%) were admitted to the pediatric intensive care unit (PICU), and no deaths were reported. Among the included studies, only four presented details regarding patients' symptoms, with 21% (0-25%) presenting gastrointestinal (GI) symptoms. An association between PIBD activity or specific treatment and COVID-19 outcome could not be established. The prevalence of COVID-19 in patients with PIBD was low;therefore, the initial concerns regarding higher infection risk and worse prognosis in this population are not supported by the currently available data. Further research is needed to determine the natural history of the infection and the optimal treatment for these patients. Much is still unclear and additional studies should be performed in order to optimize prevention and care for this special group of patients.

6.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162666

ABSTRACT

PURPOSE OF THE STUDY: To evaluate if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could promote the initial development or relapse of Juvenile Dermatomyositis (JDM). The secondary aim was to identify if SARS-CoV-2 played a role in triggering of JDM through induction of interferon-α (IFNα). STUDY POPULATION: This study included 10 patients with new disease onset (n = 6) or relapse (n = 4) of JDM at a single center in France between April 2020 and March 2021. All patients met diagnostic criteria for JDM according to the European Neuro Muscular Centre 2018 dermatomyositis classification criteria. METHODS: This was a cross-sectional analysis of IgG and IgM levels directed against 5 different portions of the SARS-CoV-2 virus in the plasma of 10 patients with new onset or relapse of JDM at the time of diagnosis. The point prevalence of a positive SARS-CoV-2 infection concomitantly among new onset or relapse of JDM was determined using basic data analysis. Descriptive statistical analysis was also performed comparing the level of interferon-α2 (IFNα2) protein among 2 patients with concomitant SARS-CoV-2 infection against median IFNα2 protein levels of 33 JDM patients with active disease followed in the same clinical center. RESULTS: Out of the 10 patients, this study identified 2 (20%) patients with high titers of both IgG and IgM antibodies directed against SARS-CoV-2 proteins. One patient had new onset JDM (P1) and the second patient had relapsing JDM (P2). The clinical presentation at relapse (isolated to skin) in P2 was similar to the lesions observed at diagnosis. Both had an asymptomatic SARS-CoV-2 infection. Two weeks after diagnosis, there was a 150-fold increase in the IFNα2 level in P1 (73 476 fg/mL) and a 9-fold increase in the IFNα2 level in P2 (4612 fg/mL) compared with the median IFNα2 level (491 fg/mL) in 33 patients with active JDM at same clinical center. For P2, following treatment with IVIG and corticosteroids, there was a progressive decrease in IFNα2 level (1466 fg/mL) seen at 10 weeks after symptom onset. CONCLUSIONS: The point prevalence was 20% for a concomitant SARS-CoV-2 infection among the 10 patients with new onset or relapse of JDM at a single clinical center in France. SARS-CoV-2 infection may trigger the development of JDM through induction of IFNα.

7.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162665

ABSTRACT

PURPOSE OF THE STUDY: The aim of this study was to identify unique clinical features and immune markers in infants with Down Syndrome (DS) affected by multisystem inflammatory syndrome (MIS-C). STUDY POPULATION: Cases were 2 unrelated infant girls with DS ages 6 months (P1) and 8 months (P2) admitted to the hospital for MIS-C illness for over 4 months (n = 2). The first control group included infants without DS with MIS-C illness (n = 2) from an outpatient setting. The second control group included 10 children with DS unaffected by MIS-C illness from an outpatient setting. METHODS: This was a case-control study that compared the clinical characteristics including immune phenotyping between infants with Down Syndrome (DS) affected by MIS-C and age-matched controls with or without DS. Clinical characteristics were collected from P1 and P2 by chart review, and literature review was done for clinical characteristics of children with MIS-C without DS. Samples of blood were collected from the 2 cases and controls. Subsequently, both mass cytometry and multiplex cytokine analysis were performed. Unpaired t-tests were used to assess the significances of differences in quantitative variables between 2 groups. RESULTS: Both patients with DS and MIS-C had significant neutrophilia and profound B-cell lymphopenia when compared with children with DS without MIS-C (P = .008). Specifically, both patients had decreased memory and plasma B cell subsets, whereas naïve B cells were increased. Control patients with acute MIS-C without DS had normal B cell counts. Activated CD4 T cells were decreased in both patients. P1's neutrophils and monocytes had markedly increased intracellular interleukein-8 and interleukin-1β, but this was not seen in P2. Both patients had markedly elevated inflammatory and immune activation markers. CONCLUSIONS: Children with Down Syndrome affected by MIS-C can have an atypical and severe presentation compared with children affected by MIS-C without DS, hallmarked by significant B cell depletion, younger age of onset, prolonged hospital stay, and refractoriness to treatment.

8.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162664

ABSTRACT

PURPOSE OF THE STUDY: To evaluate the impact of genetic diagnosis and treatment on antibody response to coronavirus disease 2019 (COVID-19) vaccine and related adverse effects in patients with inborn errors of immunity (IEI). STUDY POPULATION: Eighty-one patients with IEI (ages 13–71), 2 adults with thymoma and a control group consisting of 22 health care workers (HCWs) without histories of COVID-19 infection. METHODS: This was a longitudinal study of SARS-CoV-2 specific antispike (anti-S) and antinucleocapsid (anti-N) antibody levels in study subjects as compared with the control group. All subjects received SARS-CoV-2 immunizations between December 2020 and May 2021. Preimmunization anti-S and anti-N IgG levels were obtained in all the HCWs and 32 of 83 patients. For the study group, information on diagnosis, demographic data, history of COVID infection, type of vaccine received, interval between vaccine schedule completion (2 doses of messenger RNA [mRNA] vaccine or 1 dose of adenovirus vector vaccine) and sample collection, immunoglobulin replacement therapy, and use of immunomodulatory or immunosuppressive drugs were collected. RESULTS: Serology was obtained after completion of the recommended vaccine schedules for all the HCWs and 74 of 83 patients with immunodeficiency. Nine with IEI received just 1 dose of an mRNA vaccine and has serology obtained. All HCWs developed anti-S IgG after the first dose of vaccine with a broad range of response and 21 of 22 (95%, 95% confidence interval = 81.5% to 100%) had high levels after the second dose. The 1 exception was a HCW who 6 months earlier had received steroids and rituximab (a B-cell depleting monoclonal antibody) for antineutrophil cytoplasmic antibodies–positive granulomatous vasculitis. Of the immune deficient patients, 27 of 46 (58.7%) had positive anti-S IgG after 1 dose and 63 of 74 (85.4%, 95% confidence interval = 74.5% to 92%) after 2 doses of mRNA vaccines, a rate comparable to the HCWs. After 1 dose, the levels of anti-S IgG between groups approached but did not quite reach statistical significance (P = .06). In contrast, after 2 doses patients with IEI had lower levels than the HCWs (geometric mean = 611 938 light units vs 2 403 642 LU;P = .004). Some subgroups of patients IEI were less likely to have robust anti-S IgG response to immunization. Patients on rituximab, those with CD3+ (T lymphocyte) counts <1000/mL, and CD19+ (B lymphocyte) counts <100/mL had lower responses than those who did not meet those criteria. Most patients on immunoglobulin replacement therapy developed protective anti-S IgG levels after immunization. Adverse events of injection site redness, pain, and swelling and systemic symptoms were reported more commonly in patients with IEI than HCWs and more often after the second dose (local reactions: 66.7% vs 27.3%;systemic reactions: 52.9 vs 36.4% after the second dose). None of the systemic reactions were severe. CONCLUSIONS: COVID-19 immunization is safe and effective in patients with IEI. Some subsets of patients with IEI may not develop anti-S IgG levels after immunization.

9.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162663

ABSTRACT

PURPOSE OF STUDY: To summarize the evidence on treatments for multisystem inflammatory syndrome (MIS-C) associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in children. STUDY POPULATION: Pediatric patients with suspected MIS-C or other inflammatory illness after SARS-CoV-2 infection between June 20th, 2020 and February 24th, 2021. METHODS: Pediatricians worldwide were invited to upload their data into a central database for any pediatric patient with suspected MIS-C or any inflammatory disease after SARS-CoV-2 infection. Deidentified data, including demographics, clinical features, laboratory results, treatments (including intravenous immunoglobulin [IVIG], glucocorticoid, and biologic medications), and hospital stay length were collected and analyzed. Three primary treatment groups were compared: IVIG alone, IVIG plus glucocorticoid, and glucocorticoid alone, with IVIG alone classified as primary treatment based upon prestudy acceptance of IVIG as a primary treatment. Day 0 was considered the first calendar day of treatment of each treatment modality. There were 2 primary outcomes: (1) inotropic or mechanical ventilation (invasive or noninvasive) by day 2 or later or death;(2) reduction in disease severity on a seven-point scale between day 0 and 2. A subgroup analysis of only those meeting World Health Organization (WHO) criteria for MIS-C were included. Secondary outcomes included trends in inflammatory markers, escalation of immunomodulators, time to decrease in disease severity by 1 point, left ventricular dysfunction on echocardiogram, coronary artery aneurysm after treatment and increase in cardiorespiratory support after day 0. RESULTS: A total of 614 patients, among 81 hospitals in 34 countries, had suspected MIS-C. Of these, 246 received primary treatment with IVIG, 208 with IVIG plus glucocorticoid, and 99 with glucocorticoid alone. An additional 22 patients received immunomodulators, and 39 patients received no immunomodulatory treatment. Troponin levels and percentage of patients on inotropic agents on day 0 were higher in the IVIG plus glucocorticoid group. The first primary outcome occurred in 56 patients with IVIG plus glucocorticoid (odds ratio [OR] 0.77 compared with IVIG alone;95% confidence interval [CI], 0.33 to 1.82) and in 17 patients on glucocorticoids alone (OR 0.54;95% CI, 0.22 to 1.33). In the subgroup analysis, 490 (80%) patients met WHO criteria for MIS-C and the first primary outcome occurred in 40 patients on IVIG and glucocorticoids (OR 0.95) and in 12 patients on glucocorticoids alone (OR 0.3). The second primary outcome occurred in 54 patients on IVIG plus glucocorticoids (OR 0.9) and in 20 patients on glucocorticoids alone (OR 0.93) among the entire group. In the subgroup that met MIS-C criteria, a second primary outcome event occurred in 52 patients on IVIG plus glucocorticoids (OR 1.09) and in 16 patients on glucocorticoids alone (OR 1.95). Regarding secondary outcomes, escalation of immunomodulatory treatment was less common in IVIG plus glucocorticoids (OR 0.18), though inconclusive in the glucocorticoid versus IVIG group (OR 1.31). There was no clear difference in inflammatory markers, inotropic support, or mechanical ventilation in groups who had escalation of care by day 2 versus those without escalation in care. CONCLUSIONS: There were no significant differences in the primary outcomes for patients receiving IVIG alone, IVIG plus glucocorticoids, or glucocorticoids alone. When restricted to only those who met WHO MIS-C criteria, there was modest evidence of benefit in use of glucocorticoids compared with IVIG alone. There were no major differences in secondary outcomes, with the exception of lower odds of immunomodulatory treatment escalation in patients in IVIG plus glucocorticoids.

10.
Pediatrics ; 150:23, 2022.
Article in English | ProQuest Central | ID: covidwho-2162662

ABSTRACT

PURPOSE OF THE STUDY: Given the similarities between multisystem inflammatory syndrome in children (MIS-C) and Kawasaki's disease, most patients with MIS-C have been treated with intravenous immune globulin (IVIG), the standard of care for Kawasaki's disease. However, other immunomodulatory therapies, including corticosteroids and biologics, have been used to counter the cytokine-related inflammatory changes in MIS-C. The purpose of this study was to describe the pattern of immunomodulatory therapies used in patients with MIS-C in the United States and to assess the relative effectiveness of IVIG plus corticosteroids (CSTs), compared with IVIG alone, in the initial treatment of MIS-C. STUDY POPULATION: The Overcoming COVID-19 surveillance registry identified 596 patients as having MIS-C at each of the 58 participating hospitals between March 15 and October 31, 2020. Of these, 518 (87%) were flagged as receiving at least 1 immunomodulatory treatment. The researchers then analyzed longitudinal data collected in this cohort, including demographic characteristics, underlying medical conditions, signs and symptoms at presentation, clinical course, laboratory test results, diagnostic studies, treatments, complications, and outcomes. METHODS: Statistical comparisons between IVIG+CSTs and IVIG treatment groups were done by population sampling using propensity score matching;among the patients treated with IVIG plus glucocorticoids or IVIG alone on day 0, a total of 206 could be matched at a 1:1 ratio and based on propensity scores. To compare the potential effectiveness of initial immunomodulatory treatment, the authors prespecified a primary composite outcome of cardiovascular dysfunction (left ventricular ejection fraction < 55% and/or shock needing vasopressor support) on day 2 or beyond, up until discharge. Secondary outcome measures included the primary outcome components, escalation of immunomodulation treatment after day 1, and recurrent or persistent fever on day 2 and beyond. The potential effectiveness of treatment in primary and secondary outcomes was also assessed using an inverse-probability weighted analysis. RESULTS: Of the patients treated, 241 (47%) received IVIG and CSTs;107 (21%) received IVIG, CSTs, and a biologic (anakinra, etanercept, infliximab, or tocilizumab);89 (17%) received IVIG only;and 81 (16%) received other treatments, including CSTs only, a biologic only, CSTs and a biologic, or IVIG and a biologic. Highest illness severity was seen in the 107 patients who received IVIG, CSTs, and a biologic combined. Treatment patterns changed over time, with an observed decrease in the fraction of cases treated with IVIG alone, offset primarily by an increase in the use of IVIG with CSTs together. In the propensity-score-matched analysis, initial treatment with IVIG + CSTs was associated with a lower risk of cardiovascular dysfunction and less escalation of immunomodulatory treatments later in hospitalization, but the risks of persistent or recurrent fever and length of stay in the ICU were not clearly lower. The inverse-probability-weighted analysis confirmed the findings of the propensity-score-matched analysis. CONCLUSIONS: The authors found that initial treatment with IVIG plus glucocorticoids for MIS-C was associated with a lower risk of cardiovascular dysfunction than initial treatment with IVIG alone.

11.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162661

ABSTRACT

PURPOSE OF STUDY: Multisystem inflammatory syndrome in children (MIS-C) is a serious complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The authors describe outcomes of MIS-C in a multicenter cohort and assessed incidence nationally during the α, Δ, and ο variant waves. STUDY POPULATION: Israeli children admitted for treatment with MIS-C during the COVID-19 pandemic. METHODS: To assess cardiac involvement and admission to the ICU in patients with MIS-C, a prospective study was conducted in 12 Israeli hospitals over a 16-week period of each pandemic wave. These participating institutions account for approximately 70% of the admissions to PICUs in Israel. Data of all patients with MIS-C younger than 18 years from the α (December 20, 2020, to April 10, 2021), Δ (July 18, 2021, to November 13, 2021), and ο (November 21, 2021, to March 12, 2022) waves were prospectively collected. Vaccination status was determined by reviewing the SARS-CoV-2 digital vaccination record. The MIS-C definition was based on Centers for Disease Control and Prevention criteria. RESULTS: In the 12 participating hospitals, 171 patients with a median (interquartile range) age of 8 (5–12) years were diagnosed with MIS-C;59 during the α wave, 79 during the Δ wave, and 33 during the ο wave. Ninety-four patients (55%) were males. All patients were treated with intravenous immunoglobulins and steroids. In 5 of 79 patients (6.3%) during the Δ wave and 5 of 33 (15.1%) during the ο wave, a second SARS-CoV-2 vaccine dose had been administered at least 2 weeks before hospital admission. None of the vaccinated patients were admitted to the ICU or required treatment with vasopressors. Cardiac outcomes were more favorable during the ο wave. Admission to the ICU occurred in 34 participants (57.6%) during the α wave, 39 (49.4%) during Δ, and 7 (21.2%) during ο, and median hospital length of stay was 2 days shorter during ο than the α and Δ waves. Vasopressors were used in 22% of patients during α, 17.7% during Δ, and 6.0% during ο, and mechanical ventilation was used in 8.5% of patients during α, 8.9% during Δ, and in no patients during ο. One patient died during the Δ wave. Nationwide, in persons younger than 18 years, there were 188 800 SARS-CoV-2 infections and 103 patients with MIS-C during α, 233 585 SARS-CoV-2 infections and 115 patients with MIS-C during Δ, and 946 779 SARS-CoV-2 infections and 36 patients with MIS-C during ο. MIS-C incidences per 100 000 persons younger than 18 years were 54.5 during α, 49.2 during Δ, and 3.8 during ο. There was a higher incidence of MIS-C among patients during the α wave (incidence rate ratio, 14.34 [95% confidence interval, 9.81–20.96]) and Δ wave (incidence rate ratio, 12.94 [95% confidence interval, 8.90–18.81]) compared with the ο wave. CONCLUSIONS: This study suggests that MIS-C during the ο wave was less severe than during the α or Δ waves of the coronavirus disease 2019 pandemic. Possible explanations include the ο variant itself, previous infection with SARS-CoV-2, vaccination against SARS-CoV-2, and improvement in treatment over time. In addition, the incidence rate of MIS-C during the ο wave was lower than during the Δ and α waves. Limitations of the study include the small number of patients in the prospective cohort and the single-country data. Because MIS-C is a late-onset phenomenon of SARS-CoV-2 infection, cases that appeared after the 16-week period of each wave were not included.

12.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162660

ABSTRACT

PURPOSE OF THE STUDY: To evaluate the association between coronavirus disease 2019 (COVID-19) vaccination during pregnancy and peripartum outcomes. STUDY POPULATION: This study included all pregnancy records in the Canadian birth registry (Better Outcomes and Network Ontario) with a birth date or expected due date on or after December 14, 2020. The birth registry was linked with records within the provincial COVID-19 immunization database (COVaxON) up to September 30, 2021. The study included 97 590 persons who gave birth during this period with the majority of participants being vaccinated in the third trimester. Demographically, those vaccinated during pregnancy were more similar to those vaccinated after pregnancy than those never vaccinated. METHODS: This was a population-based retrospective cohort study using data provided in the birth registry and immunization database. COVID-19 vaccination was considered to have occurred during pregnancy if 1 or more doses were administered between the estimated date of conception (estimated by adding 14 days to the last menstrual period date) up to 1 day before birth with 23% of participants meeting this criteria. Individuals that were unvaccinated during pregnancy (77% of total participants) were divided into 2 comparison groups: (1) those vaccinated after pregnancy (46%) and (2) those with no record of any COVID-19 vaccination (31%) by September 30, 2021. Measured obstetric outcomes included postpartum hemorrhage, chorioamnionitis, cesarean delivery, and emergency cesarean delivery. Newborn outcomes included NICU admission and low newborn 5-minute Apgar score (<7). Poisson regression was used to calculate unadjusted risk differences and risk ratios and propensity score methods were used to account for potential confounding bias. RESULTS: Compared with those vaccinated after pregnancy, there was no significant association between COVID-19 vaccination during pregnancy and obstetric outcomes (postpartum hemorrhage, chorioamnionitis, cesarean delivery, or emergency cesarean delivery). However, rates of adverse newborn outcomes were lower among those born to individuals vaccinated during pregnancy with a lower risk of both NICU admission and low 5-minute Apgar scores. When compared with those that were not vaccinated at any time, participants vaccinated during pregnancy had no increased risks of any of the outcomes. In fact, there was a lower risk of emergency cesarean delivery and NICU admissions. Finally, when stratifying participants vaccinated during pregnancy by number of doses received, vaccine product, or trimester of vaccine dose 1, there was no statistically significant changes in study outcomes. CONCLUSIONS: Overall, vaccination was not associated with an increased risk of postpartum hemorrhage, chorioamnionitis, cesarean delivery, NICU admission, or low 5-minute Apgar score. In fact, vaccination during pregnancy may be protective to neonates with decreased risk of NICU admissions and low Apgar scores. These results are consistent with research regarding other vaccines such as influenza and pertussis that show no significant association with adverse maternal, fetal, or neonatal outcomes.

13.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162659

ABSTRACT

PURPOSE OF THE STUDY: To assess the likelihood of US parents to have their children receive a pediatric coronavirus disease 2019 (COVID-19) vaccine and to understand parental concerns about the vaccines. STUDY POPULATION: Study participants were selected from The Understanding America Study (UAS), a nationally-representative online panel who were surveyed between February 17, 2021 and March 30, 2021. METHODS: This was a survey-based study. Parents were asked about intent to have their child vaccinated against COVID-19, their perceptions about the vaccine, their own likelihood of getting a COVID-19 vaccine, whether their child previously received the flu vaccine, their trust in sources of information about a COVID-19 vaccine, and their trust in the vaccine development and approval process. Descriptive and multivariate analyses were used to assess likelihood of vaccination and to understand the association between likelihood of child vaccination and parent demographics, child age, and parental perceptions about COVID-19 vaccines. RESULTS: A total of 1745 parents responded to the survey (87% of eligible parents, 3759 children). Overall, likelihood of child COVID-19 vaccination was as follows: very likely (28%), somewhat likely (18%), somewhat unlikely (9%), very unlikely (33%), and unsure (12%). About 12% of parents reported that they did not plan to get their child vaccinated at this time but would "wait and see." Parental factors associated with a higher likelihood of child COVID-19 vaccination included: bachelor's degree or higher education (P < .001), Asian American or Hispanic ethnicity (P < .04), and Democratic party affiliation (P < .001). The strongest predictor independently associated with increased likelihood of child COVID-19 vaccination was whether a given child's parent had received or were likely to receive a COVID-19 vaccine themselves (P < .001;adjusted risk ratio = 3.42, 95% confidence interval: 2.32–5.04). Other factors associated with a higher likelihood of vaccination included: older child age (P < .001) and child influenza vaccination in the last 2 years (P < .001;adjusted risk ratio =1.44, 95% confidence interval: 1.24–1.67). Parents were most concerned about vaccine safety and possible side effects. Pediatricians were the most trusted source of information for pediatric COVID-19 vaccines, with 72% of parents reporting that they completely or mostly trust their child's doctor. CONCLUSIONS: This study found that there is a high level of parental vaccine hesitancy for pediatric COVID-19 vaccines, with less than half of parents reporting they are likely to have their child vaccinated against COVID-19. Pediatric health care providers were identified as parents' most trusted source of information about COVID-19 vaccines for children.

14.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162658

ABSTRACT

PURPOSE OF THE STUDY: T cell lymphopenia is prevalent in severe coronavirus disease 2019 (COVID-19). This study evaluated associations with homeostatic and functional T cell responses in COVID-19 with the goal of identifying immunologic features of severe disease. STUDY POPULATION: Patients aged 18 years and older with symptomatic, real time-quantitative polymerase chain reaction confirmed SARS-CoV-2 (mild, n = 54;severe, n = 49) were recruited at 4 hospitals in the Canton of Zurich, Switzerland from April 2 to August 19, 2020, and a group of healthy controls recruited for comparison (n = 27). A subset (mild, n = 28;severe, n = 38, healthy, n = 22) had comprehensive T cell characterization. METHODS: In this prospective, observational, cross-sectional study, symptomatic participants with mild and severe COVID-19 and healthy controls were sampled at a single time point. Phenotypic and functional characteristics of T cells were evaluated using 40-parameter mass cytometry, flow cytometry, targeted proteomics, and functional assays. RESULTS: Compared with mild disease, severe COVID-19 was associated with T cell lymphopenia and redistribution of T cell populations, including loss of naïve and memory CD4+ and CD8+ T cells, skewing toward CD4+ T follicular helper cells and cytotoxic CD4+ T cells, and expansion of activated and exhausted T cells. Individuals with severe disease and T cell lymphopenia had signs of tissue migration, extensive T cell apoptosis, and impaired T cell responses to common viral antigens. Patients with severe disease also showed elevated interleukin-7 and increased T cell proliferation. Those sampled longest after symptom onset had higher T cell counts and improved antiviral T cell responses. CONCLUSIONS: Severe COVID-19 is characterized by extensive T cell dysfunction. Reduced naïve T cells and virus-specific memory T cell numbers are associated with severe disease and impaired T cell responses to viral antigens, particularly early in the disease. Increased T follicular helper cells may contribute to a robust antibody response often observed in COVID-19. T cell apoptosis is associated with lymphopenia and homeostatic T cell proliferation and T cell recovery in the later stages of disease.

15.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162657

ABSTRACT

PURPOSE OF THE STUDY: To investigate the role of the mucosal immune system of the upper respiratory tract in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection by exploration of the presence of pre-existing mucosal SARS-CoV-2-reactive B cells in tonsillar tissue specimens. STUDY POPULATION: Tonsillar tissue from pediatric patients who underwent tonsillectomy at The Hospital for Sick Children in Toronto, Canada in 2015 to 2016, before the COVID-19 pandemic. METHODS: Using flow cytometry and fluorescently labeled tetramers to the SARS-CoV-2 Spike protein (S-protein), SARS-CoV-2-reactive B cells were isolated from tonsillar tissue. Monoclonal antibodies (mAbs) recognizing the SARS-CoV-2 S-protein were generated from these B-cells using single-cell real time-polymerase chain reaction and RNA sequencing. Human embryonic kidney derived cell lines expressing SARS-CoV-2 S protein were used for in vitro assays assessing the mAbs' SARS-CoV-2 recognition and Ag binding. RESULTS: Pre-existing SARS-CoV-2-reactive B cells were identified and isolated from prepandemic human tonsillar tissue. The mAbs generated from these B cells recognized the S-protein of the wild-type SARS-CoV-2 virus. Additionally, the mAbs originated from naïve B cells as well as Ag-experienced memory B cells, germinal center B cells, and plasma cells. These mAbs were able to partially block binding in vitro by consistently showing >20% inhibition of S-protein binding. The antibodies did not react to the S-proteins of endemic coronaviruses, human coronavirus-OC43 and human coronavirus-229E. The antibodies also demonstrated significantly reduced recognition of the SARS-CoV-2 B.1.1.7 and B1.315 variants. CONCLUSIONS: B cells contained in the lymphoid tissues of the upper respiratory tract can contain pre-existing SARS-CoV-2 reactive antibodies. Monoclonal antibodies generated by these B-cells demonstrated in vitro SARS-CoV-2 recognition and neutralizing potential. However, these mAbs had reduced binding to the Spike proteins of SARS-CoV-2 variants and did not recognize endemic coronaviruses. The existence of these antibodies may explain the variation in COVID-19 symptom severity since these pre-existing Abs may lead to rapid engagement of the SARS-CoV-2 pathogen as the mucosal surface of the respiratory tract is a main point of contact.

16.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162656

ABSTRACT

PURPOSE OF THE STUDY: To examine the production and persistence of neutralizing antibodies against SARS-CoV-2 in a cohort of family clusters with history of coronavirus disease 2019 (COVID-19). STUDY POPULATION: The study enrolled 57 Italian families over a 6-month period (March 1–September 4, 2020) who met the inclusion criteria, which required that the families had a child or children of pediatric age (<15 years old) and had at least 1 immediate family member with a history of COVID-19. METHODS: Families were enrolled 4 to 8 weeks after the end of isolation or hospitalization. They underwent clinical evaluation, and blood samples were collected from confirmed COVID-19 cases. Confirmed cases were defined as having a history of positive polymerase chain reaction (PCR) testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV2) or having a positive serologic test (chemiluminescence immunoassay or plaque reduction neutralizing test). Data regarding the date of infection, severity of illness, and age at the time of illness were retrospectively collected. RESULTS: During this study, 57 family clusters were evaluated. Of these, 209 recruited subjects underwent serological assessment. In total, 152 confirmed COVID-19 cases were identified, with 70 children or older siblings and 82 parents making up these confirmed cases. The median age for the group of children and older siblings was 8 years old, and the median age for the parent cohort was 42 years old. Neutralizing antibodies persisted up to 7 to 8 months from infection with only a modest decline over time. Neutralizing antibodies inversely correlated with age with children <6 years old (particularly toddlers <3 years old) showing the highest levels. Mildly affected children (<6 years old) showed increasing levels of neutralizing antibodies over the study time (236 days from time of infection). CONCLUSIONS: This study provides a longitudinal evaluation of neutralizing antibody production and duration in asymptomatic and mildly symptomatic patients from familial clusters. Of the participants in this study, younger children developed higher levels of neutralizing antibody compared with older siblings or adults.

17.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162655

ABSTRACT

PURPOSE OF THE STUDY: To characterize demographic, clinical, and laboratory characteristics of children with suspected severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to evaluate coinfections with common respiratory tract pathogens. STUDY POPULATION: Included 422 participants ages 0 to 18 years with household exposure or contact with someone with SARS-CoV-2 or with respiratory symptoms who presented to a pediatric emergency department in an academic center in Turkey between March 23rd and July 23rd, 2020. METHODS: This cross-sectional study assessed SARS-CoV-2 suspected cases per guidelines set by the Turkish Ministry of Health during this time period. Demographic information, SARS-CoV-2 exposure, preexisting comorbidities, and disposition information was collected. Quantitative real time reverse transcriptase polymerase chain reaction test and panel testing for other common respiratory pathogens in nasopharyngeal secretions were performed in asymptomatic cases with SARS-CoV-2 exposure in the prior 14 days. Complete blood count, C-reactive protein, serum electrolytes, procalcitonin, liver function tests, creatine phosphokinase levels, creatinine, and coagulation parameters were assessed in subjects requiring hospitalization. Chest x-ray (CXR), as well as chest computed tomography (CT) in the event of a negative CXR, was performed in the symptomatic suspected cases. COVID-19 disease severity was classified according to the published literature in 2020. RESULTS: There were 57.6% (n = 243) boys and 42.4% (n = 179) girls. Of the 18.4% who were SARS-CoV-2 positive, 78.2% had a positive adult household contact and 29.5% were asymptomatic. All but 3 did not have an underlying comorbidity. The SARS-CoV-2 positive group (median 132.6 months) was older than the SARS-CoV-2 negative group (median 51.9 months). Fever was the most common sign in 51.2% of SARS-CoV-2 positive subjects followed by cough, myalgia or weakness, headache, sore throat, nausea or vomiting, and diarrhea. Rhinorrhea was seen only in the SARS-CoV-2 negative group. Most (89.4%) of the positive cases were asymptomatic or mild, and 29.5% were admitted. No critical cases and no mortality was reported. In the SARS-CoV-2 positive cases, 8 had an abnormal CXR and 11 had an abnormal chest CT. More SARS-CoV-2 negative cases had a CT-positive pneumonia than positive cases (18% vs 14%). SARS-CoV-2 positive cases had significantly lower white blood cell and platelet counts and significantly higher acute phase reactants, lactate dehydrogenase (LDH), and creatine phosphokinase. The rate of viral coinfection with SARS-CoV-2 was 16.4% (n = 21) with the most common copathogen being rhinovirus, followed by human metapneumovirus, adenovirus, bocavirus, respiratory syncytial virus, and both respiratory syncytial virus and rhinovirus. CONCLUSIONS: SARS-CoV-2 infection generally caused mild symptoms in children with a favorable clinical course in those admitted to the hospital. One third of the positive cases were asymptomatic. Fever and cough were common, but rhinorrhea was typically absent. Most of the SARS-CoV-2 positive patients had a normal CXR and chest CT.

18.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162654

ABSTRACT

PURPOSE OF THE STUDY: To assess the association between maternal and neonatal severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific antibody concentrations. STUDY POPULATION: Mother and newborn dyads (n = 1471) from 1714 parturient women at a single, urban, hospital center in Pennsylvania from April 9, 2020 to August 8, 2020. METHODS: Pregnant women who delivered at Pennsylvania Hospital were screened for SARS-CoV-2 by nasopharyngeal polymerase chain reaction (PCR) upon admission, SARS-CoV-2 exposure, and development of coronavirus disease 2019 (COVID-19) symptoms. Residual maternal and cord blood sera routinely collected at delivery were used for SARS-CoV-2 spike protein antibody measurement using a validated enzyme-linked immunosorbent assay. Antibody (IgG, IgM) concentrations and transplacental transfer ratios were analyzed along with demographic and clinical data obtained from electronic medical record review. RESULTS: The study cohort of 1714 women who delivered included White non-Hispanic (51.3%), Black non-Hispanic (26.3%), Hispanic (11.8%), Asian (7.3%), and other (3.3%) participants with a median age of 32 years. SARS-CoV-2 IgG and/or IgM antibodies were detected in 83 of 1471 (6%) mothers with matched mother and newborn sera available at delivery. Among newborns born to seropositive women, IgG was detected in 72 of 83 (87%) newborns. Infants born to seronegative mothers did not have any detectable antibodies, and IgM antibodies were not detected in any cord blood sample. Most seropositive women (60%) were asymptomatic for COVID-19. None of the infants born to seropositive mothers tested positive to SARS-CoV-2 by PCR between 24 and 48 hours after birth. Neonatal cord blood IgG concentrations were positively correlated to maternal IgG concentrations (r = 0.886, P < .001). Placental transfer ratios were associated with time elapsed from maternal infection, defined as time of symptom-prompted PCR testing, to delivery (r = 0.620, P < .001). Transfer ratios were not associated with infection severity. Ratios more than 1.0 were observed among all disease severities, including those asymptomatic. Antibody transfer ratios increased as time increased between onset of maternal infection and delivery. CONCLUSIONS: Maternal IgG antibodies to SARS-CoV-2 were transferred across the placenta in symptomatic and asymptomatic infection in pregnancy. Neonatal cord blood antibody concentrations correlated with maternal antibody concentrations and with the length of time between onset of infection and delivery.

19.
Pediatrics ; 150, 2022.
Article in English | ProQuest Central | ID: covidwho-2162653

ABSTRACT

PURPOSE OF THE STUDY: Respiratory viruses, air pollutants, and aeroallergens are all implicated as triggers for pediatric asthma symptoms. The current study sought to determine whether changes in respiratory viruses, air pollutants, or aeroallergens during the coronavirus disease 2019 (COVID-19) pandemic were associated with decreased asthma exacerbations. In a prior study, the authors found that during the first months following public health interventions to limit the spread of COVID-19, asthma visits and steroid prescriptions decreased by more than 80%, with a corresponding decrease in rhinovirus infections, without noted changes in air pollution. STUDY POPULATION: The authors reviewed asthma patient encounter data from January 1 to December 31 for the years 2015 through 2020 from the Children's Hospital of Philadelphia Care Network, including 48 outpatient primary care and specialty care sites, 4 urgent care sites, 15 community hospitals, and a 557-bed quaternary care center. Demographic data for outpatient, inpatient, and video visits were characterized by patient sex, race, ethnicity, birth year cohort, and payer type. 2020 data for 28 157 patients were compared with 2015 to 2019 data for 88 039 patients. METHODS: Health care utilization and respiratory viral testing data for the period between January 1, 2015 and December 31, 2020 were extracted from the Children's Hospital of Philadelphia Care Network electronic health record. Air pollution data, including particulate pollution, ozone, and nitrogen dioxide, were obtained from US Environmental Protection Agency databases. Tree, grass, weed, and mold aeroallergen data were obtained from a National Allergy Bureau-certified monitoring station. Summary statistics for rates of encounters and asthma-related prescriptions from 2020 were compared with those from 2015 to 2019. Comparisons were made between prelockdown, lockdown, and phased reopening periods for public health measures in Philadelphia and surrounding counties. RESULTS: During the COVID-19 pandemic, weekly positive tests for influenza A, influenza B, RSV, and rhinovirus were lower than 2015 to 2019 historical averages. Air pollution and aeroallergen trends did not substantially change during the COVID-19 pandemic compared with historic and seasonal average data. CONCLUSIONS: Viral respiratory infections are a primary driver of pediatric asthma exacerbations.

20.
Ital J Pediatr ; 48(1):198, 2022.
Article in English | PubMed | ID: covidwho-2162406

ABSTRACT

BACKGROUND: It is reported that the adverse impact of nonpharmaceutical interventions (NPIs) on the mental health of children and adolescents may lead to psychologically related disorders during the coronavirus disease 2019 (COVID-19) period. Subject symptoms such as chest pain, chest tightness, and palpitation may be related to increased stress and anxiety in children and adolescents. The present research aimed to determine the number of pediatric consults and etiology of subject symptoms during the COVID-19 pandemic period and compared it with the same timelines in 2019 and 2021 to discuss the impact of different periods on the organic disease onset of children with subject symptoms, especially in cardiac involvement. METHODS: Children who visited Qingdao Women and Children's Hospital, Qingdao University between January 23 to April 30, 2019 (pre-COVID-19 period), January 23 to April 30, 2020 (COVID-19 period), and January 23 to April 30, 2021 (post-COVID-19 period) presenting chest pain, chest tightness, and palpitation were recruited. Information to determine gender, age, medical history, department for the initial visit, clinical manifestations, time from the latest onset to the visit, and diagnosis were recorded. RESULT: A total of 891 patients were enrolled in the present study (514 males;median age: 7.72). One hundred twenty-three patients presented during the pre-COVID-19 period while 130 during the COVID-19 period, nevertheless, the number substantially increased during the post-COVID-19 period (n = 638). Cardiac etiology accounted for 1.68% (n = 15) of the patient population, including arrhythmias (n = 10, 1.12%), myocarditis (n = 4, 0.44%), and atrial septal defect (n = 1, 0.11%). There was no significant difference among groups in the distribution of organic etiology. The median time from the latest onset to the visit during the pre-COVID-19 period was 7 days compared to 10 days during the COVID-19 period and 3 days during the post-COVID period. CONCLUSION: During the post-COVID-19 period, the median time from the latest onset to the visit was significantly shorter than that in the pre-COVID-19 period or COVID-19 period. The pediatric consult of children with subject symptoms presented increased substantially during the post-COVID-19 period, while there was no significant difference in the number of patients involving the cardiac disease. Clinicians ought to be more careful to screen heart diseases to prevent missed diagnosis and misdiagnosis during special periods.

SELECTION OF CITATIONS
SEARCH DETAIL