Your browser doesn't support javascript.
Show: 20 | 50 | 100
Results 1 - 20 de 28
Filter
1.
Embase; 2021.
Preprint in English | EMBASE | ID: ppcovidwho-335786

ABSTRACT

Background: pediatric inflammatory multisystem syndrome (PIMS) is a complication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children that resembles Kawasaki syndrome and places them at high risk of cardiorespiratory instability and/or cardiac damage. This study aims to describe the clinical presentation and outcomes of patients with PIMS in Mexico City. Methods: This was an observational study of children hospitalized for PIMS based on the Centers for Disease Control and Prevention case definition criteria, in a single tertiary care pediatric center in Mexico City between May 1, 2020, and September 30, 2021. Demographic characteristics, epidemiological data, medical history, laboratory tests, cardiology evaluations, treatment, and clinical outcomes were analyzed. Results: Seventy-five cases fulfilled the case definition criteria for PIMS (median age: 10.9 years, Interquartile range [IQR]: 5.6-15.6). Fifteen (20%) patients had a severe underlying disease, 48 (64%) were admitted to the intensive care unit, 33 (44%) required invasive mechanical ventilation and 39 (52%) received vasopressor support. The patients were clustered through latent class analysis based on identified symptoms: Cluster 1 had rash or gastrointestinal symptoms (n = 60) and cluster 2 were those with predominantly respiratory manifestations (n = 15). Two patients (2.7%) died, and both had severe underlying conditions. Five patients (6.7%), all from cluster 1, developed coronary aneurysms. Conclusion: There were a high proportion of patients with severe respiratory involvement and positive RT-PCR SARS-CoV-2 and very few cases of coronary aneurysms in our study which suggests that a high proportion of the children had severe acute COVID-19. The clinical manifestations and outcomes are comparable to previously reported international studies.

2.
British Journal of Oral and Maxillofacial Surgery ; 60(1):e6, 2022.
Article in English | EMBASE | ID: covidwho-1767939

ABSTRACT

Introduction: Maxillofacial treatment is evolving with changing paediatric lifestyles and clinical limitations, including COVID-19. The aim of this study is to assess trends in the presentation of maxillofacial soft tissue injuries and subsequent management within a regional paediatric hospital. Methods: Retrospective study over a 3-year period (from 2019-2021 between January and April). Inclusion of all paediatric patients seen on the emergency department by OMFS team. Results: Between 2019 and 2021, the total number of patients dropped by over half. The average age dropped from 5.9 in 2019 to 3.8 in 2021. Males were more commonly seen. Extraoral injuries increased by 21%. Intraoral injuries reduced by 8%. Less complicated communicating injuries and associated dental trauma were seen in 2021. Lip lacerations accounted for most injuries. In 2020, there was 21% reduction in conservative management of injuries. Wound closure under LA increased by 12% in 2020. There has been an overall increase in wound closure under GA by 5% between 2019 and 2020. Falls accounted for most injuries, however, there has been an increase in dog bite injuries by 5% in 2021. Conclusions: The average age has dropped between 2019-2021 and hence treatment options remain limited. Age, cooperation, and severity of injury are important factors. The number of overall lacerations has decreased but a greater proportion required formal closure under general anaesthesia. It is vital OMFS surgeons are aware of the changes in presentation and current trends in management. This will help to better equip surgical teams for the changing landscape of paediatric maxillofacial trauma.

3.
Thoracic and Cardiovascular Surgeon ; 70(SUPPL 2), 2022.
Article in English | EMBASE | ID: covidwho-1747132

ABSTRACT

Background: In response to the pandemic, closure of daycare facilities has been implemented as part of infection control, jeopardizing children's education. Whether these measures proved effective, remains up for discussion. This study aimed at understanding how the behavior of families influenced the probability of acquiring the virus in children with chronic cardiovascular (CV) health conditions. Method: The “COVID-19 Child Health Investigation of Latent Disease” study screened 6,113 children of less than 18 years in pediatric hospitals and among healthy volunteers in Hamburg from May 9 to June 30, 2020. Participants were tested for SARS-CoV-2 infection by nasopharyngeal PCR. Of them, 4,657 participants were tested for antibodies against SARS-CoV-2. The family's social and psychological situation and medical history were assessed via questionnaire. Results: A total of 6,113 (age 7.7 ± 5.1 years) patients were included in the study of which 27.3% had at least one chronic health condition. Also, 219 children (16.2%) had a CV disease. While no active infection on PCR was detected, seropositivity rate amounted to 1.3%. The seropositivity rate did not differ between the population with chronic health conditions and the healthy population (1.0 vs.1.4%, p = 0.271). Parents of children with chronic health conditions more often reported worries regarding the health risk of the virus to their children (30.9 vs. 12.6%, OR = 3.1 [2.7-3.6], p < 0.001) and were less likely to have sent their children to an educational institution 14 days before the testing (48.3 vs. 67.2%, age-adjusted OR = 0.38 [0.33-0.43], p < 0.001). We did not observe increased odds of seropositivity when visiting educational institutions in the 14 days before testing (age-adjusted OR = 1.03 [0.61-1.76], p = 0.902). Increased physical burden of the caregiver and their assessment of their child's worse well-being correlated with increased seropositivity (OR = 2.7 [1.4-5.3], p = 0.004, and 3.3 [1.2-9.5], p = 0.021). Conclusion: The prevalence of SARS-CoV-2 in children with and without chronic health conditions is similar. Still, the anxiety in parents of sick children is higher, which leads to a reduced attendance of daycare facilities. Attendance at a daycare facility does not increase the risk of seropositivity in children with health conditions. Caregivers' assessment of the physical well-being in their child is a good predictor of seropositivity. In summary, the spread of SARS-CoV-2 seems to be limited in daycare facilities even in chronically sick children with CV disease.

4.
Open Forum Infectious Diseases ; 8(SUPPL 1):S346, 2021.
Article in English | EMBASE | ID: covidwho-1746506

ABSTRACT

Background. The temporal dynamics of SARS-CoV-2 infectivity in immunocompromised children (IC) are unknown but may have important infection control implications. We evaluated SARS-CoV-2 viral persistence and assessed factors associated with viral persistence and cycle threshold (CT) values as a surrogate of viral load for IC. Methods. We conducted a retrospective cohort study of SARS-CoV-2-positive IC at a large quaternary pediatric hospital from March 2020-2021. Immunocompromised status was defined as primary or secondary/acquired immunodeficiencies due to comorbidities or immunosuppressive treatment. The primary outcome was time to first-of-two consecutively negative SARS-CoV-2 PCR tests ≥ 24 hours apart. Polymerase chain reaction (PCR) testing of sequential patient samples was conducted using the Centers for Disease Control 2019-nCoV Real-Time RT-PCR Diagnostic Panel (CDC assay). Chi-square, Fisher exact, and Wilcoxon tests were used to compare demographic and clinical characteristics. Kaplan-Meier curve median event times and log-rank tests were used to compare outcomes. Subjects without 2 consecutive negative tests censored at the last test. Analyses were conducted using SAS v 9.4. Results. Ninety-one children met inclusion criteria, and 67 children had more than 1 test (Figure 1). Median age was 15.5 years (IQR 8-18 yrs), 64% were male, 58% of children were white, and 43% were Latinx. Most (67%) were tested in outpatient settings, and 58% of children were asymptomatic. The median time to two negative tests was 42 days (IQR 25.0,55.0), with no difference in duration of positivity with specific diagnoses, degree of lymphopenia, or symptomatic vs asymptomatic illness. Five of 7 (71%) children with samples available for repeat testing had initial CT values < 30, indicating a moderate to high viral load, and of these, 4 (57%) had repeat testing 21 to 30 days later with CT values < 30 (Figure 2), suggesting persistence of moderate to high viral loads. Figure 1. Plot of immunocompromised children in cohort with positive SARS CoV2 PCR and subsequent testing (n = 67). Timelines of immunocompromised children in cohort with positive SARS CoV2 PCR and subsequent testing, grouped by immunocompromising condition. Each line represents an individual patient. Positive results are shown in light grey, negative results are shown in black. Figure 2. Plot of CT values from SARS-CoV-2 PCR testing over time among children with sequential samples available for retesting (n = 7) Plot of CT values (y axis) from SARS-CoV-2 PCR testing on the CDC assay over time (x axis) in days from initial positive test. Repeated testing which yielded a negative result on the CDC assay or intermittent negative results on clinical testing represented as CT value of 40. Each line represents a unique patient. Conclusion. The median duration of viral persistence among IC with SARS-CoV-2 infection was 6 weeks, with no significant difference in immunocompromised diagnoses or clinical presentation, with over half of children with testing on the same platform having moderate to high viral loads after 3 weeks, suggesting potential transmission risk.

5.
Open Forum Infectious Diseases ; 8(SUPPL 1):S464-S465, 2021.
Article in English | EMBASE | ID: covidwho-1746388

ABSTRACT

Background. Although CRE are a global threat, data in low- and middle-income countries are scarce. Colonization data are vital for informing antibiotic resistance strategies. We characterized the colonization prevalence of CRE in various settings in Botswana. Methods. This study was conducted in 3 districts in Botswana (1 hospital and 2 clinics per district). Adult inpatients and clinic patients were randomly selected for enrollment. Community subjects were enrolled by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also asked to refer their children. All subjects had rectal swabs obtained and inoculated on selective chromogenic media for preliminary identification of CRE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. CRE underwent genotyping for carbapenemase genes. Results. Subjects were enrolled from 1/15/20-9/4/20 with a pause from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital - 469 (19%);clinic - 959 (39%);community adult - 477 (19%);and community child - 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 42 (1.7%) subjects were colonized with at least one CRE;10 subjects were colonized with multiple strains. E. coli (n=17), K. pneumoniae (n=20), and E. cloacae complex (n=11) were most common. CRE colonization prevalence was 6.8% for hospital subjects, 0.7% for clinic subjects, 0.2% for adult community subjects, and 0.5% for child community subjects (p< 0.001)). CRE prevalence varied across regions (Figure 1) and was significantly higher pre- vs post-lockdown (Figure 2). VIM and NDM were the most common carbapenemase genes (Figure 3). Conclusion. CRE colonization was significantly higher in hospital vs community settings in Botswana. CRE prevalence varied by region and decreased significantly following a countrywide lockdown. With CRE prevalence still modest, elucidating risk factors for CRE colonization holds promise in developing strategies to curb further emergence of CRE. Additional investigation of the CRE isolates without identified resistance genes is warranted.

6.
Open Forum Infectious Diseases ; 8(SUPPL 1):S469, 2021.
Article in English | EMBASE | ID: covidwho-1746385

ABSTRACT

Background. Although ESCrE are a global challenge, data on ESCrE in low- and middle-income countries are limited. In particular, colonization data are critical for larger antibiotic resistance efforts. We characterized the colonization prevalence of ESCrE in various settings in Botswana. Methods. This study was conducted in 3 hospitals and 6 clinics located in 3 districts in Botswana. In each hospital, we conducted surveillance of adult patients. Adult clinic patients were also randomly selected for participation. Finally, we enrolled community subjects by inviting each enrolled clinic subject to refer up to 3 adults. Each adult clinic or community subject was also allowed to refer their children. All subjects had rectal swabs obtained which were inoculated onto chromogenic media for preliminary identification of ESCrE. Final identification and susceptibility testing were performed using MALDI-TOF MS and VITEK-2, respectively. Genotyping was done for identification of extended-spectrum beta-lactamase (ESBL) genes. Results. Enrollment occurred from 1/15/20-9/4/20 but paused from 4/2/20-5/21/20 due to a countrywide COVID lockdown. Of 5,088 subjects approached, 2,469 (49%) participated. Enrollment by subject type was: hospital - 469 (19%);clinic - 959 (39%);community adult - 477 (19%);and community child - 564 (23%). Of 2,469 subjects, the median (interquartile range) age was 32 years (19-44) and 1,783 (72%) were female. 759 (31%) subjects were colonized with at least one ESCrE;130 subjects were colonized with multiple strains. E. coli (n=663) and K. pneumoniae (n=121) were most common. ESCrE colonization prevalence was 43% for hospital subjects, 31% for clinic subjects, 24% for adult community subjects, and 26% for child community subjects (p< 0.001)). ESCrE prevalence varied significantly across regions (Figure 1) and was significantly higher pre-lockdown vs post-lockdown (Figure 2). CTX-M was the most common ESBL gene (Figure 3). Conclusion. ESCrE colonization was common in both healthcare and community settings in Botswana. Colonization prevalence varies by region and clinical setting and decreased following a countrywide lockdown. These findings provide important clues regarding potential drivers of ESCrE that might serve as targets for intervention.

7.
Journal of Cystic Fibrosis ; 20:S118, 2021.
Article in English | EMBASE | ID: covidwho-1735135

ABSTRACT

Objectives: In 2018 a new Adult Cystic Fibrosis Diabetes (CFD) servicewas established within the Blackpool Victoria Hospital Adult Cystic Fibrosis Service (BACFS). Over 3 years the number of patients in the BACFS has increased, reflecting an increase in patients with CFD requiring more diabetes specialist time (see table). Demands on the service were further impacted during the COVID-19 restrictions;however, this also inadvertently enhanced engagement between patients and the CFD service. Methods: 1. Designated CFD Clinics 2. Annual review 3. Policies and resources 4. Ongoing education of patients and clinicians (Table Presented) Results: 1. Designated clinics 2 Weekly CFD multidisciplinary team (MDT) review including Libre View discussions, new & transition patient clinics, follow-up clinic alternating with 2 weekly nurse-led clinics All patients with CFD have a Libre sensor fitted and share data 2. Annual review Due to COVID-19 restrictions, Libre view used for screening of CFD 2 weekly CFD MDT meeting to discuss Libre View data Discussion at CFD MDT re: diagnosis & treatment 3. Policies and resources Local and National protocols followed to screen for CFD and initiate early treatment Established resources for new patients starting insulin 4. Ongoing education of patients and clinicians Upskilled CF team regarding CFD annual review Contribute to journal club, local meetings and education for other specialities Joint working agreement with antenatal service at BVH Conclusion: There have been challenges to establish a CFD service around staffing hours, accommodation and cross cover. COVID-19 had further impacted this but the introduction of virtual working has increased patient contact without the need for face-to-face consultations. Further development is centred on working with local paediatric centres for the transition of patients and introduction of virtual, structured group education.

8.
Journal of Cystic Fibrosis ; 20:S107, 2021.
Article in English | EMBASE | ID: covidwho-1735125

ABSTRACT

Objectives: The COVID-19 pandemic has a substantial impact on the functioning of the entire society. Cystic fibrosis (CF) is an additional factorinfluencing mental health during this unpredictable time. In the Warsawpaediatric CF centre, increased level of stress, anxiety and more depressivesymptoms were observed in patients with CF and their parents. Over time,more children required psychiatric consultations and some of them wereprescribed pharmacological treatment. In many families, conflicts aroseand the financial situation deteriorated. There were no formal guidelineson psychological care during a pandemic. Active participation in Europeangroups of specialists working with patients with CF, such as the ECFSEuropean Psychosocial Special Interest Group and ECFS Mental HealthWorking Group, allowed us share experiences and practices with other CFcentres and implement new ideas in our centre.Results: Different actions and interventions were undertaken bypsychologists:1. Support and psychoeducation for children with CF and their families:• Communication by the special internal social media forum (onlyfor members), for example newsletters and posts. Mutual supportof parents and patients,• The additional possibility of consultation by phone, e-mail oronline,• An online support group for parents moderated by a psychologistorganised at the request of the parents,• Lecture on anxiety and coping with stress at a national onlineworkshop for parents and adults with CF 2. Individual help and support for the multidisciplinary team (MDT)members3. Lectures on the impact of epidemics on mental functioning andcoping at Polish conferences for CF specialists.Conclusion: The COVID-19 pandemic is still ongoing. All MDT members,including psychologists, have more knowledge and experience in caring forpatients with CF and their families. However, long-term psychologicaleffects are difficult to predict and require our attention

9.
Irish Medical Journal ; 114(9), 2021.
Article in English | EMBASE | ID: covidwho-1733356
10.
Journal of Crohn's and Colitis ; 16:i621-i622, 2022.
Article in English | EMBASE | ID: covidwho-1722370

ABSTRACT

Background: In Ireland, the transition process is ad hoc with no formal guidelines on how to conduct transition clinics. This nurse-led project, aimed to develop a specific young person clinic for adolescents and provide information to adolescents and their families on the service they were joining, before their first clinic visit, subsequently reducing anxiety and improving outcomes. Providing the right care for young people with IBD, in the right place, at the right time, where the patient is a priority, is the end goal. Methods: The successful implementation of this project is due to the collaborative work of a multidisciplinary team using the Health Service Executive (HSE), Peoples Needs Defining Change Guide (2018). This change model provides clear definitive steps to Define, Design and Deliver innovative projects. The model was applied as follows: Define Raise awareness of the need for adolescent clinic Activate a core change team Develop a vision in line with the organisational culture Design Propose a care pathway for adolescents including transition. Design an informative 'Welcome Booklet' Arrange Virtual Meet and Greet (due to Covid restrictions) Deliver Open communication with all relevant stakeholders Determine a time suitable for recurring adolescent clinic Seek input from patients, colleagues and communication team to develop an informative 'Welcome Booklet' Results: The CIPP evaluation model, Context, Input, Process and Product, complimented this change model as formative evaluation throughout. This ensured the change process was streamlined with the values and vision of all stakeholders involved. Context -SWOT analyses was undertaken, and Goals defined Input - Strategy was defined and stakeholder analyses Process -Monthly MDT meetings, design model of care, welcome booklet. Plan virtual introductory meetings due to Covid unable to meet face to face in the paediatric hospital Product - Dedicated recurring clinic time for 16-24-year-olds with IBD to include transition clinics. 100% of parents and 80% of adolescents found the welcome booklet informative and useful. 100% both adolescents and parents found the introductory WebEx meeting beneficial. Commenced RCT to look at best format for transition clinics going forward Conclusion: (HSE), Peoples Needs Defining Change Guide (2018) provided the essential toolkit to ensure leadership, teamwork, the importance of stakeholders while keeping the patient central to all decisions made in developing young person's clinics for 16-24-year-olds with IBD.

11.
Journal of Investigative Medicine ; 70(2):651-652, 2022.
Article in English | EMBASE | ID: covidwho-1709232

ABSTRACT

Purpose of Study As COVID-19 cases rose in spring of 2020, schools faced the unprecedented challenge of providing safe and effective education during a global pandemic. With most institutions transitioning to remote instruction, teachers, students, and parents had to cope with changes that came with online distance learning (ODL). Children with learning or behavioral disabilities, such as ADHD, may have faced setbacks. The aim of the study was to examine parents' observations of their children with ADHD transitioning from in-person classroom instruction to ODL in regards to their academic performance and ADHD symptoms during the COVID-19 pandemic. Methods Used The study utilized a cross-sectional design and recruited patients from a pediatric clinic in Houston, TX. Participants included parents of school-age children with an ADHD diagnosis. Parents were emailed a novel survey that utilized questions from the Vanderbilt Assessment Scale via Qualtrics in February 2021, and again in May 2021. Responses were anonymously collected until August 2021. Children using ODL during some or all of fall 2020 were included in the study. Parents reported semester grades for fall 2019 and fall 2020, and Vanderbilt Survey responses from the same time frame. Grades were measured on a 0-100 sliding scale, and behavioral responses were weighted (1-symptom decreased, 2-symptom did not change, 3-symptom increased). The study was IRB-approved. Summary of Results Eighty-one parents of children in grades 1-12 with ADHD were identified and contacted to take part in the survey via email. Sixty of these parents received followup phone calls. Twenty-four started surveys. Twenty-one parent-child dyads met the study criteria, completed surveys, and were enrolled in the study. Semester averages in math, science, language arts/reading, and social studies appeared to all decrease from fall 2019 to fall 2020 (-3.5,-5.3,-2.8,-1.6), with the most prominent decrease in science (p=0.08). Overall, ADHD symptoms varied from fall 2019 to fall 2020. Parents reported increases in the following: lack of follow through with directions and failure to finish activities(62%), forgetfulness in daily activities(57%), and lack of attention to detail and making careless mistakes(57%). Most parents reported no change in relationships. Two-thirds of parents reported that their child did not benefit at all from ODL;however, 10% of parents said their child benefitted from less distraction, and 10% said their child preferred computer-based learning. Parents reported the following challenges with ODL: staying focused/organized and boredom(43%), lack of 1-on-1 instruction and ability to ask questions(33%), and social isolation( 14%). Conclusions During the COVID-19 pandemic, pediatric patients with ADHD seemed to perform worse academically in a virtual school setting compared to an in-person classroom. In this same population and time frame, ADHD behavioral symptoms appeared to either increase, especially those that were task-oriented, or remain unchanged.

12.
Journal of Investigative Medicine ; 70(2):726-727, 2022.
Article in English | EMBASE | ID: covidwho-1708849

ABSTRACT

Case Report Multisystem inflammatory syndrome in children (MIS-C) typically presents with fever and multisystem dysfunction following infection with SARS-CoV-2. Per CDC guidelines, MIS-C can be diagnosed when an individual less than 21 years of age presents with fever, laboratory evidence of inflammation, and multisystem organ involvement requiring hospitalization with no alternative diagnosis and evidence of current or prior COVID-19 infection. Systems are categorized as either cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic, or neurological. Otolaryngologic is not a designated system. However, atypical presentations of MIS-C involving the deep neck have been reported. Specifically, cases of children with retropharyngeal pathology, including edema and phlegmon, have been described. Our report highlights a case of deep neck infection as the initial presentation of MIS-C. A 12-year-old male was admitted to the pediatric hospital medicine service for medical management of a moderately large retropharyngeal phlegmon/ abscess confirmed by computed tomography (CT) scan. Otolaryngology team was consulted, and surgical intervention was not recommended. The patient was started on empiric intravenous (IV) antibiotic treatment with ceftriaxone and vancomycin. After two days of antibiotics, he showed minimal improvement. On physical exam, he continued to have neck pain, tenderness to palpation on the left neck inferior/posterior to the left ear, mild edema, and limited lateral range of motion due to pain. Repeat CT scan of his neck also showed minimal improvement of phlegmon. During admission, he developed bilateral non-exudative conjunctivitis, erythematous lips, mild erythema over his palms, abdominal pain, and cough, with a worsening fever curve while on broad spectrum antibiotics. At this time, differential diagnosis was broadened to include viral syndrome, MIS-C, and atypical Kawasaki Disease. Respiratory viral panel (including COVID-19) was negative. Inflammatory markers were elevated, including CRP of 26.6 mg/dL, ESR of 64 mm/hr, and Pro-BNP of 1,908 pg/mL. Ultimately, the patient met criteria for MIS-C: less than 21 years old, presence of fever, elevated inflammatory markers, multisystem involvement, and positive COVID-19 antibody. Treatment was initiated for moderate-severe MIS-C with IV immunoglobulin (IVIG) infusion, aspirin, IV methylprednisolone, and omeprazole prophylaxis. The patient clinically improved after IVIG infusion, and antibiotics were de-escalated to oral Augmentin for a total duration of 14 days of antibiotic therapy. He was discharged on aspirin, a prednisone wean, and omeprazole with Cardiology outpatient follow-up established. MIS-C is a novel syndrome that can have unique presentations. Clinicians should consider MIS-C when a febrile patient being treated for infection does not improve with standard therapies and have a low threshold to initiate MIS-C evaluation if new symptoms involving other organ systems develop.

13.
Circulation ; 144(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1634577

ABSTRACT

Background: The SARS-Cov-2 virus and the associated Multi-System Inflammatory Syndrome in Children (MIS-C) can cause myocardial injury, cardiac dysfunction, and coronary dilation. This makes echocardiography a key component during clinical evaluation. To improve technician safety, we implemented a protocol utilizing a tablet-based echocardiography (TBE) system to evaluate patients who had active COVID-19 or whose testing was pending. We hypothesized that appropriate clinical evaluations could be completed with TBE while having a shorter exposure time for personnel. Methods: We retrospectively evaluated 35 patients at a tertiary, pediatric hospital between March 2020 and May 2021 who underwent TBE. We compared the TBE findings and duration to comprehensive echocardiograms done on average two weeks later with a traditional machine. A complete study included evaluation of ventricular function, coronary artery diameter, and pericardial fluid assessment. Pro-brain natriuretic peptide (pro-BNP) and troponin-T levels were reviewed. Subjects were divided into two groups based on an elevation in troponin-T as a surrogate for myocardial injury (Trop and Trop ).Results: Eight subjects had cardiac dysfunction with 6/12 being from the Trop group and 2/23 in the Trop group. The mean troponin-T elevation was 0.32 ng/mL. Pro-BNP levels were elevated in all but 1 of the 35 subjects but were ten times higher in the trop group (mean 18,055 vs 1,888 pg/mL;p = 0.001). Three subjects with MIS-C had coronary dilation noted by TBE (2 in Trop and 1 in Trop ) with one persistently dilated at follow up. TBE findings such as coronary dilation or cardiac dysfunction guided medical therapies and no clinically relevant findings were missed when compared to studies at follow up. TBE was on average 29 minutes shorter (41 ± 18 vs 12 ± 5 min;p < 0.001). One patent ductus arteriosus was found by TBE and this was confirmed on repeat imaging. Conclusions: TBE allows for experienced sonographers to limit exposure time to potentially contagious patients and easier decontamination while not compromising essential clinical information. This study shows TBE is a useful tool to effectively evaluate patients during highly contagious viral respiratory outbreaks.

14.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617064

ABSTRACT

Introduction: Respiratory tract diseases are a major cause of morbidity and mortality in children. This study aimed to compare respiratory illness rates and aetiology requiring hospitalization in 2019 (pre-COVID lockdown in Ireland) and 2020 (during COVID lockdown in Ireland). Methodology: Data from medical admissions were retrospectively collected from the emergency department admissions record of a Tertiary Paediatric Hospital in Dublin, Ireland. This study focused on September, October and November in 2019 and 2020. The documented reason for admission in each case was noted;these were transcribed and grouped into categories. Reasons for admission under the category of respiratory included: bronchiolitis, lower respiratory tract infection, upper respiratory tract infection, wheeze, stridor and exacerbation of asthma. Rates of admission in this category were compared from 2019 versus 2020. Rates of investigative nasopharyngeal swabs for these admissions were documented, as well as the resultant viruses isolated. The results were compared across 2019 and 2020. Results: 1040 admission were included in the study. Of these, 620 were in 2019 and 420 in 2020. This alone shows a decrease of 32% in the admissions rate to Temple Street Children's hospital during COVID-19 restrictions. Of the 620 admissions across September, October and November 2019, 265 were attributed to respiratory illnesses (42.77%). In the same time period of 2020, only 67 admissions were attributed to respiratory causes (15.95%). This shows a dramatic decrease in the number of paediatric respiratory illnesses requiring hospital admission. There was a decrease in the number of respiratory panel nasopharyngeal swabs taken in 2020 compared to 2019, although 89% of respiratory admissions were swabbed for Sars-CoV-2 in 2020. Respiratory syncytial virus accounted for 54.60% of respiratory admissions swabbed in 2019 versus a 0% isolation rate in 2020. The table below further outlines virology differences between 2019 and 2020. (table) Conclusion: SARS-CoV-2 pandemic related social restrictions dramatically interfered with the seasonality of childhood respiratory illnesses. This was reflected in the unexpected reduction in the number of hospitalizations in the paediatric population during this period. There is also an obvious stark contrast in the viruses isolated in children presenting with respiratory illnesses in 2019 and 2020. This study raises serious questions and concerns regarding paediatric immunity to respiratory illnesses and begs the question: will we experience a more severe respiratory season in 2021?

15.
Cogent Medicine ; 8, 2021.
Article in English | EMBASE | ID: covidwho-1617063

ABSTRACT

Background: Whilst the Irish Health Service Executive (HSE) currently recommends COVID-19 screening for all adult hospital admissions, current guidelines state that the screening of asymptomatic paediatric admissions is not necessarily required. However, clinically determining who requires testing can be difficult and subject to inter-carer variability. We sought to audit our acute admissions and swab results to determine rates of testing, characteristics of those being tested, and rates of positivity in a busy Irish tertiary paediatric unit. Methods: We reviewed the charts of 122 patients admitted acutely to our unit over the course of July 2021 to determine whether or not they had undergone COVID-19 screening using a nasopharyngeal PCR test and the clinical indication for testing. The clinical presentation of these admissions was analysed to try to determine positive predictive factors for COVID-19 screening and better streamline surveillance criteria. Results: A total of 122 admissions were analysed, with 74 (60.7%) having had a COVID-19 PCR test performed at the point of admission. Of these, 1 patient was found to be COVID-19 positive, giving an overall positivity rate of 0.8% amongst admissions analysed and 1.4% for admissions screened. The patient who returned a positive result was febrile at presentation but did not have any respiratory symptoms. Respiratory symptoms were documented for 45 of the 122 admissions (36.9%), and 42 of these underwent COVID-19 screening (93.3%). All swabs were negative. A total of 59 out of 122 were febrile at presentation, 55 (93.2%) of whom underwent screening. As above, 1 case tested positive. Of the afebrile patients, 19 out of 64 underwent COVID-19 screening. COVID-19 screening was performed in 12 patients who did not have a fever or respiratory symptoms at the time of presentation. In terms of non-respiratory presentations, screening was performed in 12 out of 14 (85.7%) presenting with gastritis/gastroenteritis, and 9 out of 12 (75%) presenting with a history and examination consistent with a UTI/pyelonephritis. Of 18 patients who were admitted with primarily psychiatric presentations, none had either a fever or respiratory symptoms at presentation, and none underwent COVID-19 screening. Conclusion: Our results reflect the existing data that COVID-19 appears to be less pathogenic in paediatric populations than in adult ones. Our low positivity rate compared to a high swab rate has repercussions in terms of bed allocation and isolation status. There is variation in terms of clinical criteria being viewed as sufficient to justify screening. Further study is required to determine consensus guidelines for COVID-19 surveillance in acute paediatric hospital admissions.

16.
Research and Practice in Thrombosis and Haemostasis ; 5(SUPPL 1), 2021.
Article in English | EMBASE | ID: covidwho-1611353

ABSTRACT

Background: On May 15, 2020 the World Health Organization published the preliminary case definition of multisystem inflammatory syndrome (MIS-C) in children and adolescents, a new clinical entity in the evolving COVID-19 pandemic. COVID-19 associated coagulopathy, with prominent elevations in d-dimers was widely reported in adults;in contrast to the sepsis-related disseminated intravascular coagulation (DIC), adult patients demonstrated hypercoagulability, not bleeding, with approximately 25% having overt venous thromboembolism (VTE)., There are limited data regarding coagulopathy and hypercoagulability in pediatric patients with acute COVID-19 or MIS-C to guide treating physicians in optimal management including VTE prevention strategies. We report the hematologic findings, VTE prophylaxis strategy, and thrombotic outcomes in a cohort of patients at a single pediatric center. Objectives: NA. Methods: At Children's Wisconsin we rapidly convened a multi-disciplinary MIS-C working group to create guidelines for evaluation and treatment of suspected/confirmed MIS-C patients. A MIS-C panel, including CBC, CMP, DIC panel, ESR, CRP , ferritin, troponin I, pro BNP, and COVID PCR was obtained for all patients presenting to the ER with fever for ≥4 days plus any of the following: GI symptoms, rash, bilateral non-purulent conjunctivitis, cough, headache , and/or irritability. Specialty-specific treatment guidelines, including modifications of an existing VTE prophylaxis guideline, were established (Table 1). As a quality improvement measure, we performed electronic query of the use of the MIS-C panel including evaluating laboratory trends, and outcomes of cases receiving specific therapeutics, including anticoagulation. We present data regarding hematologic findings and outcomes of VTE prophylaxis in this cohort. Results: As of October 20, 2020, a total of 56 patients had an MIS-C panel obtained in the ER, of whom 12 (21.4%) met full criteria for MIS-C (Table 2). Of these, mild CBC abnormalities predominated as did mild coagulopathy, elevated fibrinogen levels, and d-dimers (on average 5.5 × upper limit of normal) (Table 2). Three (25%) patients met criteria for VTE prophylaxis with enoxaparin which was continued during hospitalization in 1 patient, and for 2 weeks following hospital discharge in the remaining 2. There were no reported thromboses in any patients, including those who did not meet criteria for thromboprophylaxis. Enoxaparin was well tolerated, and no patients had bleeding events despite having mild coagulopathy. Conclusions: We report an approach to evaluation of MIS-C, the hematologic abnormalities, and successful use of a VTE prophylaxis strategy in children. Given the drastic increase in COVID-19 cases in Wisconsin and the US as of October 2020, and limited large-scale pediatric studies to guide patient care, we recognize the importance of our own institutional surveillance and the need for collaboration amongst pediatric providers to gather data on outcomes of such patients. (Table Presented).

17.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e5, 2021.
Article in English | EMBASE | ID: covidwho-1584153

ABSTRACT

BACKGROUND: There are concerns of increased food insecurity rates during the COVID-19 pandemic, but there is no evidence to date about families with children with an acute or chronic illness. Parents with a child admitted to the hospital may also experience hospital-based food insecurity, defined as the inability of caregivers to afford adequate food during their child's hospitalization. OBJECTIVES: We aimed to measure the prevalence of household and hospital-based food insecurity in an academic pediatric hospital setting during the COVD-19 pandemic. We also explored the effects of food insecurity on parental distress and overall caregivers' experiences obtaining food during their hospital stay. DESIGN/METHODS: This was a cross-sectional study from April to October 2020. Household food insecurity was measured using the 18-item U.S. Household Food Security Survey Module. Three adapted questions about hospital-based food insecurity were added. Parental distress was measured with the validated Distress Thermometer for Parents: "0" indicates "no distress" and "10" indicates "extreme distress". Descriptive statistics were used to assess the proportions of food insecurity. Linear regression models were used to explore the relationship between food insecurity and parental distress adjusted for potential confounders. To explore caregivers' experiences we included one open-ended question in our survey, asking: "Do you have any other feedback regarding your food situation during your child's hospital admission?". Recurrent themes were identified using qualitative analysis. RESULTS: 851 families were reached by telephone and 775 (91.0%) provided consent to participate. 435 (56.1%) completed at least one questionnaire [Figure 1 Study Flow Diagram]. Caregivers described a high prevalence of household (34.2%) and hospital-based (38.0%) food insecurity. Both adult (B= 0.21 [95% CI 0.07-0.36]), child (B= 0.38 [95% CI 0.10-0.66]) and hospital-based (B= 0.56 [95% CI 0.30-0.83]) food insecurity were significantly associated with parental distress independent of covariates [Table]. In the qualitative analysis, the financial burden and emotional and practical barriers obtaining food in the hospital were identified as important themes. Parents also commented that they "need to eat to be able to take part in the care of their child during hospitalization". CONCLUSION: Both household and hospital-based food insecurity were highly prevalent in caregivers and significantly associated with parental distress, independent of covariates. High parental distress is known to be associated with a child's maladjustment to illness and adherence with medical treatment. Hospitals need to strongly consider reducing barriers for parents to obtain food for themselves during their child's admission in order to reduce parental distress.

18.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e64, 2021.
Article in English | EMBASE | ID: covidwho-1584143

ABSTRACT

BACKGROUND: Child and family-centered care, a partnership approach to health care decision-making, is central to paediatric practice. To reduce transmission of SARS-CoV-2, healthcare institutions implemented policies to protect staff, patients and families. Family presence at the bedside was reduced to one caregiver, except in special circumstances requiring pre-approval by hospital leadership. OBJECTIVES: We explored the impact of the COVID-19 pandemic on paediatric healthcare delivery, focusing on family presence. We describe the clinician's experience of restricted family presence during the COVID-19 pandemic in a paediatric hospital. DESIGN/METHODS: Physicians, trainees, and nurses at The Hospital for Sick Children completed surveys between March-August 2020 to identify patients they perceived to have experienced a suboptimal quality of care or health-outcome related to changes that had occurred as a result of the pandemic and describe the impact. Data were analyzed via case report and thematic analysis. As part of a larger study, here we report on cases related to family presence in the hospital. RESULTS: A total of 212 clinicians reported 116 cases;eighteen cases specified an impact on child and family-centered care. Nine cases related to patient experiences and nine to family experiences of the restricted family presence policy. Clinicians reported a perceived distress in patients due to family members not being present. 6267 family restriction exemption requests were received. Cases described families who opted for a different location for end-of-life care so that extended family could be present. Further cases highlighted how important conversations such as disclosure of diagnosis involved one parent present and the other joining remotely. Siblings were also reported to be impacted by visitor restrictions and closure of the sibling play area. Exclusions were also reported to be challenging for children with complex medical needs and technology dependency whereby two-caregivers were often required. Clinicians reported experiencing stress and moral distress as part of being required to support family restriction policies, impairing their ability to provide care. CONCLUSION: Family presence policies are a critical component of child and family-centered care and have been impacted by the pandemic as described both by family and clinician stress. Recommendations based on these findings would include: facilitating two-caregiver presence to support shared decision making, regular remote meetings to communicate information with families in cases where they cannot be physically present;using remote technology or implementing allotted visitation time for siblings, reviewing exceptions to caregiver restrictions, and mental health supports for clinicians such as peer-support groups, or wellness workshops.

19.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e69-e71, 2021.
Article in English | EMBASE | ID: covidwho-1584141

ABSTRACT

Background Fever is a common presentation among children coming to the Emergency Department (ED) and a urinary tract infection (UTI) often needs to be excluded. Sterile techniques, like catheterization, are invasive, can be traumatizing to children, and are time consuming to complete. A two-step approach has been shown to reduce the catheterization rate in febrile, young children without unintended consequences. Objectives Our aim was to implement a two-step approach for UTI screening in febrile children 6-24 months in order to decrease unnecessary urine catheterizations by 50% without impacting ED length of stay (LOS) or return visits (RVs). Design/Methods After engaging key stakeholders and a nursing champion, we created a process map to understand the current urine collection process in our ED, and areas for targeted improvement. Using the model for improvement, we adopted a 2-step pathway for a suspected UTI in children 6-24 months as our change idea. The pathway involved identifying children who met inclusion criteria for UTI screening, followed by urine bag application and urinalysis (UA) if clinically indicated. Only if the UA was positive, a second urine sample was collected via catheterization, for repeat UA and culture. Through multiple PDSA cycles, our pathway was implemented in the ED along with concurrent staff education. The outcome measure was the rate of ED urine catheterizations. Process measures included the total number of urine cultures sent to microbiology and percent positivity. The balancing measures included ED LOS and RVs. Results Since project initiation in July 2019, the ED catheterization rate decreased from 73% to 53% (Figure 1) and the number of urine cultures sent to Microbiology decreased by 23%. The number of urine cultures sent to Microbiology decreased by 23% with a mild improvement in the positivity rate by 2% (Figure 2). There was no significant change in RVs. There was a slight 10-min increase in ED LOS, most likely confounded by the COVID pandemic. Conclusion Using improvement methodology, we successfully decreased the number of unnecessary catheterizations in children and the number of urine cultures sent to microbiology. Further refinements to our intervention are ongoing and include optimizing urine screening equipment in patient rooms, poster reminders, re-education for providers, and introducing a parent resource explaining the 2-step pathway. This improvement work is also being spread to the paediatric wards and can easily be adopted by other paediatric centres. It has also been adapted by the Choosing Wisely hospital campaign.

20.
Paediatrics and Child Health (Canada) ; 26(SUPPL 1):e74, 2021.
Article in English | EMBASE | ID: covidwho-1584138

ABSTRACT

BACKGROUND: The coronavirus (COVID-19) pandemic has had profound effects on adolescent mental health. Beginning in mid-March 2020, public health measures were implemented throughout the province of Quebec, including full school closure and confinement. Previous studies have demonstrated the association between stressful events and the exacerbation of anorexia nervosa (AN), however the association of the COVID-19 pandemic on new AN diagnoses remains unknown. OBJECTIVES: To assess the incidence and severity of newly diagnosed AN or atypical AN (AAN) cases among adolescents during the COVID-19 pandemic compared to the five preceding years. DESIGN/METHODS: We performed a retrospective analysis from Jan 1 2015 to Nov 15 2020 of new eating disorder assessments at an urban tertiary pediatric hospital. Baseline demographic information and clinical assessment variables were collected. The primary outcomes were the incidence of de novo AN or AAN diagnoses and hospitalization within 7 days of diagnosis. Event rate time trends were compared during the period of pandemic public health measures (March 2020 to November 2020) to the proceeding 5-years (January 2015 to February 2020) using an interrupted time series and logistic mixed modeling. RESULTS: Overall, 353 patients met inclusion criteria during the study period. Median patient age was 15.9 (IQR 13.8-16.9) years, 93% were female, and 65% of patients were diagnosed with atypical AN. For the full cohort at diagnosis, %mBMI was 92% (SD ±15%) and mean weight loss was 11 Kg (SD ±7Kg). In the 5 years preceding the pandemic, there were 4.5 new AN/AAN cases per month with a modest downward trend (ßcoeff=-0.016). During confinement, new diagnoses rose to 8.0/month with a steep upward trend (ßcoeff=1.417, p < 0.001). Similarly, hospitalizations for new cases increased from 0.8 to 2.6/month with a significant increase in linear tend (ßcoeff-0.012 vs. 0.500, p < 0.001). Moreover, patients diagnosed during COVID-19 confinement had a shorter duration of symptoms (6 months vs. 10 months, p=0.001), with a higher percentage of body weight loss (19% vs. 16%, p=0.03) at a faster rate (2.3kg/mo vs. 1.5Kg/mo, p=0.001). Bradycardia was more pronounced at diagnosis during the pandemic (55 bpm vs. 62 bpm, p=0.001) with a greater proportion meeting threshold for admission (38% vs. 19%, p=0.001). CONCLUSION: During the COVID-19 confinement, new diagnoses of AN and AAN nearly doubled and hospitalizations for these patients more than tripled. Markers for disease severity were more pronounced and evolved more rapidly. Findings highlight the urgent need for increased community resources during the pandemic, as well as prospective research to understand drivers and prognosis for these patients more effectively.

SELECTION OF CITATIONS
SEARCH DETAIL